Credentialing for international fellowships.

The common market may provide a unique opportunity to develop certification models between countries as some of the economic, social, and language barriers begin to soften. International fellowships must be encouraged, especially those from the third world, but with the understanding that the purpose of such international education is for the fellow to return to the country of origin and improve the health care delivery there, not to improve the personal finances of the fellow in an adopted country. The autocratic dogmatic certification by the decreed blessing of the department chair must give way to objective examination by impartial boards. There are too many differences now to establish an international certifying process, but everyone must encourage and work toward common professional, educational, political, national, and economic goals so that eventually such certifying might be possible. Dialogue between boards in the United States and analogous bodies in other countries (such as colleges of surgeons) to nurture the definition of necessary core knowledge, standardize examination design and technique, and eventually develop reciprocity for requirements to take examinations should also be encouraged.