By any measure, it is easier to judge who is at the top of the class than it is to objectively determine and enforce minimal standards of competence. This challenge has been made even more difficult by the rapidly expanding knowledge base and technical skill required of today's cardiologists. Board certification is now time limited. Our CME credits, utilization of services, and markers of our clinical outcomes all are monitored. Some cardiologists understandably feel oppressed by what can appear to be a perpetual winnowing process, with Big Brother always looking over the shoulder, constantly demanding that individuals pay for and pass yet another test, fill out yet another form, or go to yet another continuing medical education course so that they can continue to practice their profession.
Quality is an elusive concept, as medicine remains an art as well as a science.
But to improve quality and to assure society that minimum acceptable standards are met requires that quality be objectively measured. The quality of a cardiologist's training can be measured by testing his or her knowledge base at the end of a controlled curriculum. Clinical reasoning, image interpretation, and even manual skills can be tested. But, just as we don't judge racehorses only by their bloodlines, cardiologists should be judged by the results of their trained efforts, not just their pedigrees. Assessing outcomes in cardiology is considerably more difficult than judging the winner of a horserace, but our peers have now created excellent, comprehensive databases in several important areas of cardiology, including the cath lab, the echo lab, and nuclear cardiology.