Competence
“The degree to which the individual can use the knowledge, skills and judgment associated with the profession to perform effectively in the domain of possible encounters defining the scope of professional practice.”
Kane MT. The assessment of professional competence. Eval Health Prof 1992;15:163-82.
Clinical Quality
If someone asks why a medical professional deserve to work in a public emergency medical system, despite a degree (as many others in different fields), experience (subjective) and a fist of courses (mostly individually chosen and not institutionally validated) there is nothing objective that demonstrates that this professional was, and still is, eligible for this kind of job in terms of competence.
Certification of clinical quality is something missed in action in the jungle of Health Systems in general and in Emergency Medical Services in particular.
We have generic admission criteria but no instruments to monitor on a regular basis the adequacy of clinical competence for medical professionals who work in emergency field.
Education
We spread education, giving competences equally distributed to all medical professionals, despite any specific need.
Cultural needing are not a question of democracy.
They are specific for each person who works in a certain field and are conditioned by different personal attitudes and everyday clinical practice.
We waste time, money and human resources giving, in large part of cases, unuseful informations to the wrong persons at the wrong time of their working careers.
Competence
The fact is that we do not have a clear idea of who and which competences are needed to be a good medical emergency professional.
None stated which skills and which clinical practices, in quality and quantity, are needed to achieve a minimum level of competence.
The future?
- Personal record of clinical competences for every emergency medicine professional.
- Self-constructed (self-certified) on the base of daily clinical practice and individually acquired education. Externally and institutionally validated.
- Specific targeted education based on personal needing.
- Targeted to complete the personal competence record when both, clinical practice and self-acquired education, are not sufficient or when new clinical instances come into the system
- Quality assessment.
- All the professionals who work in the emergency medical system respond to minimum required clinical competency standard.
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MEDEST 
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