All aspects of health care are under intense scrutiny, none more so than the competence of health care professionals to diagnose and manage disease. Correctly, patients expect those who minister to them to be competent and properly trained. Concepts of what constitutes a good and a bad doctor vary widely. Good may equate with sympathy, yet sympathy is no substitute for ability. The question of competence has received relatively scant attention but is now an important issue. Establishing competence requires setting standards and usually setting conditions for maintaining clinical acumen and ability. Such is laudable, particularly as it can bring about constructive retraining and can divert specific clinical problems to those best able to deal with them.

Specific circumscribed procedures have been an obvious first target for criteria of competence. Such procedures are amenable to audit and are performed in sufficient numbers to establish average rates for success, failure, and efficiency. Standards of competence have been suggested for areas such as angioplasty and stenting.1 Cardiac electrophysiological procedures have also been examined and are similarly amenable to suggestions for levels of competence.2 3 Competence involves exposure to and performance of procedures but more importantly it should include an audit of complications and success. It is to be expected that those with the greatest exposure are likely to be those most competent although this relation is not necessarily so simple. Experience in dealing with complications or anticipating their occurrence plays a large part in the successful performance of many clinical procedures, cardiac electrophysiological ones included.

Establishing and maintaining levels of competence in those performing procedures is very desirable. It identifies those who can be expected to offer safe modern care, and it helps to identify manpower needs for given disease situations.

There are, however, problems with establishing strict guidelines for …