EBQ Upper GI SURGERY – EXAMINATION
The EBSQ (European Board of Surgery) or EBTSQ (European Board of Thoracic Surgery) - Upper GI Surg Examination (in the following Board Exam) is subject of comprehensive revision and continuous development. The examination covers the whole field of Upper GI Surgery as defined in the relevant UEMS documents (www.uemssurg.org www.uemsthorax.eu)
This is conducted in cooperation with the section of Surgery and of thoracic Surgery and the relevant European authorities and fulfilling EU legislation and directives.
The evolving process of the Board Examinations is paralleled by the European ambition towards harmonization and standardization of medical education, specialist training and qualification.
Frequency of Board Examination, location and language are subject of continuous development. In any case of language diversification the EBS/EBTS makes certain, that the content of all questions and items will be identical.
The structure of the Board Qualification is clearly defined and consists of a 2-stage process involving the Eligibility and the Examination, the Examination comprising a MCQ test with at least 100 items and an OSCE circuit with at least 6 stations.
Date, Location & Language
The Board Exam takes place at least annually mainly in cooperation with surgical meetings. Dates will be announced on the Board website www.uemssurg.org, www.uemsthorax.eu
Date, location and languages(s) of the Board Exam are to the discretion of the committee. This and further details about the next Board Exam(s) are published on the Board website.
The Board Exam is held in English. Upon special additional announcement the exam may also be offered in the national language of the country, where it is held. In that case, the content and the procedure of the Board Exam is identical in the provided languages.
In other cases the executive may offer the Board exam in English with interpretation support. Interpretation in the MCQ-test (see later) is on candidates’ request and given to the whole audience to ensure equality.
Interpretation in the OSCE-circuit (see later) is only to reduce and overcome specific language difficulties for the candidates.
Examiners
The EB UGIS Board of Examiners is supported by selected local representatives from the scientific societies and/or the national boards and authorities.
The Examination can be observed and monitored by non-medical experts to enhance quality control.
The EB UGIS makes every effort to ensure that there are no conflicts of interest between examiners and candidates. The EB UGIS verifies that candidates and examiners have never been at the same institution at the same time or have worked together in any venue.
The Board Examination consists of a MCQ test and an OSCE circuit.
The MCQ examination session is surveilled by the EB UGIS examination executive and the scoring is done by the executive immediately after completion of the session.
In the OSCE circuit at least two examiners are used in each of the stations to assure the validity of the examination. At least one examiner will be an EB UGIS examination executive and another will be an experienced EBS/EBTS expert from the local regional medical community.
All examiners are surgeons in active practice and hold valid certificates. The examiners are carefully instructed to evaluate each candidate objectively. Examiners have no knowledge of a candidate other than an anonymized ID sticker carrying a number produced for the examination and distributed randomly.
MCQ-Test
The MCQ test includes up to 150 questions, not less than 100 questions. The time frame for the MCQ test is 3-5 hours. This time frame includes transfer of the individual answer codes to the evaluation form.
In the MCQ session the candidates have to demonstrated sufficient knowledge of Upper GI Surgery.
The MCQ-answers are selected by the committee from a catalogue respecting a numeric distribution following the "Blueprint Upper GI Surg" categories.
The question items may include relevant pictures (e.g. graphs, photographs, radiological pictures).
4 types of questions are used for the MCQ-test :
- Apos type (1-2 answers out of 5 items, true)
- Aneg type (single answer out of 5 items, false)
- Kprim type (4 items, give true/false for each item)
- E type (select between: 5 items: "+ because+", "+/+", "+/-", "-/+", "-/-")
The type of the question is clear from the structure, the wording and the number and expression of items. For each correct answer in A and E questions 2 points are given. Three correct answers in a Kprim question are given 1 point.
Sample questions are published on the website www.uemssurg.org, www.uemsthorax.eu
OSCE Circuit
The purpose of the OSCE circuit is on process thinking and judgment and the focus is on decision making. The candidates are faced with cases and/or clinical pathways representing the breadth of OG surgery. The circuit may include the evaluation of relevant manual skills (e.g. simulation).
The clinical pathways presented are structured beforehand and constitute common problems seen in Upper GI surgery practice. The cases follow real clinical situations; patients are anonymized.
In the OSCE circuit candidates should be able to answer not only what they would do and how, but why.
The circuit consists of 6-7 stations (15 min each; total duration of circuit: 90 min) where candidates will be confronted with clinical situations.
Each candidate will visit each station where he/she will be assessed by 1 examiner and 1 censorer and may be asked to give an oral or written answer respectively.
The circuit will include all types of laboratory investigations, x-rays, CT, MRI, endoscopical and ultrasonography scans and pictures from typical clinical situations to interpret.
The candidates may also be asked to demonstrate practical abilities.
The individual time schedule for the OSCE circuit is established after the MSQ-test (6 candidates per 1½ hour maximum). Candidates appear prior to their randomly assigned starting time. After finishing the OSCE circuit candidates have to collect and wait separated from pre-OSCE candidates until the last round of the circuit has commenced.
Sample stations are published on the website www.uemssurg.org. , www.uemsthorax.eu
In the OSCE listen carefully to each case presented, read all information thoroughly and respond with your own plan or actions to resolve it. The examiners want to find out what you would do in your own practice. Tell them what you would do, not what you think they may want you to say. Be prepared to defend your plans and actions with acceptable logic. If you honestly do not know anything about a problem, it is recommended that you say so. This will allow the examiners to proceed to other problems with which you may be more conversant.
In particular, the examiner will assess:
- Can the candidate recognize a basic problem?
- Can the candidate gather and analyze data relative to that problem in an efficient way?
- Can the candidate use that data in an organized and logical fashion to arrive expeditiously at a diagnosis?
- Can the candidate choose realistic, effective, and safe solutions (including nonoperative ones) to the problem?
- If multiple options are available for treatment of a given problem, can the candidate evaluate these logically and efficiently, and choose the one that is optimal and least hazardous to the patient?
- Can the candidate recognize the Iong-term risks/benefits of the solutions chosen?
- Does the candidate react in a prompt but flexible manner to alterations in the patient's course, e.g., disease or treatment complications?
- Does the candidate know the technical aspects of the procedures he or she will employ?
At the end of each OSCE circuit station, each examiner independently records a grade based on his or her evaluation of the candidate's performance.
S.O.P.
The candidates have to prove their identity (valid passport) at the Board exam venue. Mobile telephones, computers, tablets and other communication aids as well as all types of cheating are strictly forbidden as well as any type of written and/or printed material throughout the Board Exam. Cheating is subject to subsequent termination of the exam.
Prior to the exam the candidates are briefed and anonymized by the chairman or a representative of the executive. They draw numbers and receive stickers for the evaluation forms. The numbers reflect also the starting time for the OSCE circuit. A "Starting Grid" is provided locally.
The candidates stay anonymized during the whole examination process and also during evaluation. Personal data are synchronized after the evaluation process is concluded.
All documents for the exam are prepared and printed out previously. The evaluation forms with the candidates' stickers and the actual scoring are collected online after being signed by the 2 examiners from each station. The scoring is entered online by the chairman and the result calculated.
The result of the Board Exam is announced within 1 hour after the end of the last circuit.
Evaluation & Threshold
A member of the jury will act as the Chair of the Jury .
The Chairman of the Board UGIS shall not be an examiner in order to stay strictly neutral.
The EBS/EBTS' decision regarding certification is not based upon any preset pass/fail rate, but solely upon the aggregate evaluation of the examiners.
A total of up to 600 points can be achieved in the Board Exam, up to 300 points in the MC test (2 or 1 points per question) and 200-350 points in the OSCE circuit (50 points per station). At both the OSCE and the MCQ the percentage of correct answers are calculated.
When the MCQ test includes less than 150 questions or when questions may be excluded at the discretion of the Executive during the evaluation process for certain reasons, the number of individually achieved points is calculated to 300 points equal 100%, by that ensuring, that the MCQ test and the OSCE circuit are weighted equally.
The threshold for passing the exam is 75%, and at least 6 out of 7 (5 out of 6) of OSCE stations has to be completed and passed.
After the examination the candidates are asked to fill out a feedback form. The evaluation of the feedback questionnaires will be published.
Appeals against the decision of the Board of Examiners are possible and should be submitted to the Chairman of the Board UGIS .
An unsuccessful candidate is entitled to another chance to take the exam that he/she failed.
The successful candidates (successful Eligbility and Examination) are awarded the title "Fellow of the European Board of Surgery – UGI Surg" or "F.E.B.S. / UGI Surg" or the title of “Fellow of the European Board of Thoracic Surgery – UGI Surg” or “F.E.B.T.S. / UGI Surg” and are provided with the relevant Diploma normally the same day in a formal celebration.
The title F.E.B.S. or F.E.B.T.S. / UGI Surg determines, that the person successfully proved to have validated knowledge and skills, that in most cases exceed the requirements for the national CCSTs and allow him/her to successfully cover the broad field of Upper GI Surgery in respective to the actual demanding according to the judging of the commission.
In the moment the qualification F.E.B.S. or F.E.B.T.S. / UGI Surg has no automatic legal recognition in the E.U. or in any other country. Individual recognition of qualifications by the national authorities is supported by the EBSQ/EBTSQ committee.
Individual recognition of qualifications by the national authorities is supported by the EBS/EBTS committee and the number of countries officially adopting the Board exam is continuously rising.
The acceptance status of a Board Exam is published on the website www.uemssurg.org., www.uemsthorax.eu
How to prepare?
The EBS/EBTS believes that the best preparation for the examination is to "practice" taking MCQ tests and oral examinations. You should ask a colleague, preferably a board-certified surgeon, to question you in several sessions over a longer period. Practice not only the content of your answers, but focus on presenting your decision making process in a clear, logical manner. Your trainer should probe deeply enough into your answers to make certain that you provide adequate information, and should critique your answers with regard to promptness, clarity, logic, and evidence of problem-solving ability.
Once you have passed the Eligibility and are registered for the Examination, you will be assigned an exact day, time and place for you to be present for a candidates' briefing. You may base your travel plans on this information. Your actual examination will take place in the afternoon of day 1 and morning of day 2 based on your briefing assignment. Assignment of candidates is done randomly, candidates may not request a specific date or time.
No books, papers, briefcases or electronic devices may be brought into the examination sessions. You will not need to take extra notes during the sessions.
The fellowship does not implicate automatic allowance to work at own responsibility and does not automatically enhance participation in national social security systems of the E.U.
The future perspective of this European diploma is to be seen in unanimous legalization within the ongoing project of the European standardization process of medical education.
Lars Bo Svendsen, DMSci
Chairman, MJC Upper GI Surgery
Toni Lerut, MD, PhD
Co-chairman, MJC Upper GI Surgery (thorax)
Philippe Nafteux,MD,PhD
Chairman oft he UEMS Board of Upper GI Surgery