Mr Bache and his colleagues (December 2002, JRSM¹) describe a broadened assessment for specialist registrars, built onto the mandatory record of in-training assessment (RITA). This account seems to me to typify the confusion between appraisal and assessment that lies at the root of our profession's consistent inability to self-regulate.

The RITA process was designed to be critical and judgmental, so that trainees could be assessed dispassionately, without their trainers present, irrespective of their career plans, the quality of their training or other mitigating factors—i.e. a pure judgment of their competence and hence of their competency to proceed to the next stage of training. (It was this which vindicated the removal of the registrar/senior registrar hurdle, so greatly lamented by seniors, when ‘Calmanization’ was introduced.) To confuse RITA with career guidance and evaluation of the training programme is to cloud its role in assessing competence, and thereby to encourage connivance between trainers, trainees and assessors if deficiencies are demonstrated—everyone explaining these away for their own purposes.

Some day we must wake up to the fact that, when doctors emerge poorly trained and inadequate, they are the product of just such a muddled method of assessment as the Liverpool authors propose.