Art therapy for depression: a systematic review and meta-analysis.

Training programmes, assessments and examinations for physicians vary globally and are continually evolving in response to modern educational principles and healthcare needs. These changes aim to improve the validity, reliability and alignment of examinations with real-world clinical practice. Validity and reliability of assessments are fundamental to producing defensible judgements about professional competence that are credible, reproducible and appropriate to the intended purpose. In high-stakes examinations, these are particularly important to support decisions about readiness for independent clinical practice while maintaining consistency across candidates, contexts and examiners. Common to all examinations is the need to confirm clinical competency and applied theoretical knowledge. Significant changes have been introduced internationally. In the United Kingdom (UK), the long-standing five-station clinical carousel was remodelled with altered station composition and timing to enhance reliability and reduce station-specific bias. These changes, originally scheduled for 2020 but delayed because of the coronavirus disease 2019 (COVID-19) pandemic, were implemented in 2023. In Canada, the written component was moved earlier in training, with emphasis on aligning the examinations with unsupervised practice in a competence by design (CBD) model in a multi-year phased implementation from 2015 to 2022. Competency-based medical education (CBME) frameworks, such as Canada’s CBD model, emphasise the longitudinal development of competence through staged training outcomes supported by continuous formative and workplace-based assessment (WBA). These shifts reflect a move away from time-based progression towards earlier verification of foundational knowledge, allowing subsequent training to emphasise applied competence, WBA and individualised learning trajectories. In South Africa (SA), the Colleges of Medicine of South Africa (CMSA) is the unitary examination body for all specialist examinations. Prior to the COVID-19 pandemic, the Fellowship of the College of Physicians (FCP) Part II examinations were held biannually with a written theory component, and a bedside clinical assessment (one long case and two short cases) held at a single venue. The CMSA had started a process of moving towards CBME, and the process of engagement with trainers had been initiated.