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The financial turmoil that has engulfed the world over the past 12 months has meant that financial regulation will rightly be tightened up and accountability will increasingly become transparent. Doctors will not be immune. Indeed, it is likely that processes being put in place will be accelerated so that the certification and regulation of the medical profession will become the responsibility of government, accountable to the people. Even countries where such a concept has been considered impossible will have to re-think their policies as government has to take on responsibility for the health services it provides. The process of revalidation, started in the US, will soon be introduced in the UK and other countries, such as Sweden and The Netherlands. Therefore, it is not a question of if, but more a question of when and how, regulation will be introduced in developed countries. As doctors we ignore this at our cost. We must embrace this change and boldly take our place at the table in order to ensure that the revalidation process is fair and effective and will stand up to public scrutiny. It is evident that there will be many competing forces and we can be certain that there will be many authorities that would wish to assume leadership in such a process, not only because of the importance and prestige but particularly because of the large financial returns that may be expected.

For cardiologists or cardiac surgeons, medical education after certification has traditionally been rather loose and usually based on self-reporting and continuing medical education (CME) credits. It is clear that this is not sufficient and not the way forward. A more rigorous approach is being demanded by government authorities. The revalidation process will require an assessment of knowledge, skills and performance. Knowledge will be tested either by a summative process (an examination) or by a formative process (CME and testing in modular form). Skills will probably be tested by log books and audit; audit may well be in the public domain, for example individual, surgeon-specific results for certain operations, such as first-time coronary grafts, aortic stenoses and coronary angioplasties. Performance is likely to be tested through a thorough appraisal process.

Ultimately, it will be necessary for cardiologists to maintain the knowledge that they learned at medical school. Cardiologists will be obliged to work to standards set by guidelines and should be prepared to be judged against those standards; needless to say, cardiologists will need to be up-to-date with the latest guidelines produced locally, nationally and internationally.

The need for modern, informative, well-written medical education will be all the greater. The important role that journals such as European Cardiology can contribute to this learning process cannot be underestimated. In this issue, for example, a number of important topics have been addressed that will help keep European cardiologists abreast of modern cardiology. This issue of European Cardiology does not attempt to try and cover all of cardiology, but does succeed in identifying some important areas of which every cardiologist should have a working knowledge. The complete knowledge base necessary for cardiologists will be drawn from many areas, and those who succeed will be those for whom education becomes a pleasure, not a chore. I am sure this issue of European Cardiology will be a pleasurable addition to our learning development in this exciting speciality.