Current issues in medically assisted reproduction and genetics in Europe: research, clinical practice, ethics, legal issues and policy. European Society of Human Genetics and European Society of Human Reproduction and Embryology.

In March 2005, a group of experts from the European Society of Human Genetics and European Society of Human Reproduction and Embryology met to discuss the interface between genetics and assisted reproductive technology (ART), and published an extended background paper, recommendations and two Editorials. Seven years later, in March 2012, a follow-up interdisciplinary workshop was held, involving representatives of both professional societies, including experts from the European Union Eurogentest2 Coordination Action Project. The main goal of this meeting was to discuss developments at the interface between clinical genetics and ARTs. As more genetic causes of reproductive failure are now recognised and an increasing number of patients undergo testing of their genome before conception, either in regular health care or in the context of direct-to-consumer testing, the need for genetic counselling and preimplantation genetic diagnosis (PGD) may increase. Preimplantation genetic screening (PGS) thus far does not have evidence from randomised clinical trials to substantiate that the technique is both effective and efficient. Whole-genome sequencing may create greater challenges both in the technological and interpretational domains, and requires further reflection about the ethics of genetic testing in ART and PGD/PGS. Diagnostic laboratories should be reporting their results according to internationally accepted accreditation standards (International Standards Organisation - ISO 15189). Further studies are needed in order to address issues related to the impact of ART on epigenetic reprogramming of the early embryo. The legal landscape regarding assisted reproduction is evolving but still remains very heterogeneous and often contradictory. The lack of legal harmonisation and uneven access to infertility treatment and PGD/PGS fosters considerable cross-border reproductive care in Europe and beyond. The aim of this paper is to complement previous publications and provide an update of selected topics that have evolved since 2005

Competency Assessment

Assessment is an essential feature of the competency-based educational model because only by means of evaluation can we verify achievement of specified learning outcomes. This is especially important in the context of health professions education, where the competencies of interest impact the well-being of patients. Therefore, just as with planning the instructional component of a curriculum, development of an assessment system must start with the specification of desired learning outcomes in the form of knowledge, skills, and attitudes expected of trainees or practitioners in order to provide safe and effective patient care. Issues to consider when judging the quality of evaluation methods include the reliability of data generated by the assessment, validity of decisions based on test results, educational impact on individuals undergoing evaluation and other stakeholders, and the feasibility of implementing the assessment system. In addition to these criteria and the particular competencies to be evaluated, the choice of testing methods from among numerous available techniques should consider multiple dimensions, such as appropriate level of assessment, stage of learner development, and, very importantly, overall purpose and context of the assessment. Ultimately, no one method can assess all aspects of professional competence, but familiarity with strengths and limitations of various modalities can guide the development of appropriate assessment systems. Strengths of simulation-based methods for evaluative purposes include the ability to assess actual performance of psychomotor skills and demonstration of nontechnical professional competencies in environments that safely and authentically mirror real practice settings. In addition, the programmability of simulations permits on-demand testing of rare but important clinical situations and consistent presentation of evaluation problems to multiple examinees; this reproducibility becomes especially important when high-stakes decisions are contingent upon such assessments