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Research PeerRev DOI: 10.1308/rcsbull.2015.


The European Board of

Surgery Qualification
in general surgery
Can it standardise surgical training throughout Europe?
V Laloë Liaison Officer
W Feil President of the Division of General Surgery
European Union of Medical Specialists

he rules regulating mutual recognition As a consequence, the European Com- readers to the EBSQ in general surgery
of qualifications in the EU (Directive mission has reinforced the primacy of the (EBSQ/GenSurg).
2005/36/EC) are based on the length of European Union of Medical Specialists
training and the title of qualification required (UEMS), whose goal is to complement EBSQ/GENSURG
by individual countries. For example, any rather than supersede the authority of The EBSQ/GenSurg is a validated, quali-
citizen of a member state holding a specialist any one nation. European standards for ty-controlled assessment of surgical knowl-
qualification that is listed in the 2005 direc- postgraduate medical specialist training in edge and competence at an equivalent level to
tive can apply for direct entry onto the Gener- general surgery have been agreed and the that of the CCT. It is based on the recognition
al Medical Council (GMC) specialist register; European Parliament has passed a new law that ‘general surgery’ is still relevant today in
conversely, all EU countries accept a holder of facilitating the movement of health profes- peripheral hospitals across Europe and that
a Certificate of Completion of Training (CCT) sionals within Europe.1 The various Europe- general surgery goes well beyond ‘common
from the UK as being adequate for specialist an Board of Surgery Qualification (EBSQ) trunk’ surgery. In the UK, it is estimated that
registration. However, there is significant examinations offered by the UEMS are part about 80% of elective procedures are carried
disparity in the degree of competence that of an evolving effort to unify standards and out by general surgeons, outside subspecialty
these national qualifications represent and promote movement of surgeons within the services.2 Far from being the lowest common
they are not entirely comparable. EU. The aim of this paper is to introduce denominator of all national qualifications, the

PeerRev Research

EBSQ/GenSurg standards in fact exceed those Table 1 Eligibility requirements

of most national CCTs in general surgery. Training requirements EU country, associated country or country of
Candidates may now take the two nec- equivalent standard
essary steps, eligibility and examination, in Eligibility points 25 points for CPD activities and publications
either order. The eligibility requirements are General procedures logbook 250 credit points
described in Table 1. The financial cost for Endoscopy logbook 250 credit points
the candidate is €350 for each step or €700 Operations logbook 1,000 credit points
(£585) in total. Recommendation 2 surgeons from different countries

Eligibility criteria
The syllabus for the qualification covers the Examination The goal of this ongoing project is the
whole spectrum of general surgery. In order The examination takes place at least once a standardisation of surgical training and
to be eligible, candidates must demonstrate year in a member state. The EBSQ Board of qualifications across European countries. It
broad skills and submit logbooks as evidence Examiners is supported by local represent- is hard to tell whether the EBSQ/GenSurg
of those skills. A system of ‘credit points’ is atives from the national surgical societies will ever become popular in the UK. At the
used to quantify experience. The logbooks of the host country. The examination is moment, it is probably of most value to those
must be submitted in the UEMS format conducted anonymously. UK surgeons planning to practise overseas.
and validated. Procedures performed by the It comprises two parts: a paper with However, one should consider that although
candidate as main operator confer two credit multiple-choice questions and an objective the GMC does not accept the EBSQ for di-
points and procedures performed as an structured clinical examination (OSCE). rect entry to the specialist register at present,
assistant confer one credit point. Candidates can gain a maximum of 300 it is obliged to accept a diploma recognised
A minimum total of 1,500 credit points re- points in the paper, which tests a wide in another EU country.
lating to operations, endoscopies and general spectrum of knowledge in general surgery. As more countries embrace the EBSQ/
procedures is required for eligibility. General During the OSCE circuit, candidates rotate GenSurg, it follows that it is only a matter of
procedures include radiology and ultrasonog- through six stations, meeting international time before it allows entry to the UK special-
raphy as well as a number of other technical examiners; real patients are not used ist register, with equivalence to a UK CCT.
procedures. Of the 1,500 credit points, 1,000 but the clinical knowledge being tested This will, of course, open the way for those
points must be generated from operative pro- is, again, very broad. A maximum of 300 surgeons, be they British or non-British, who
cedures alone, 250 points from endoscopies points can be gained in the OSCE. This wish to apply for substantive consultant posts
and 250 points from more general procedures. gives a potential total score of 600 points in the UK. This does not sit well with the fact
At least 50% of credit points must represent and the pass mark is 450 points. Results are that in many surgical specialties, too many
the candidate as the principal operator. If for announced shortly after the end of the last surgeons are being trained in the UK for the
any reason a logbook cannot be produced by a circuit on the second day and successful number of potential consultant posts.3
candidate, two independent experts must try candidates are awarded the title Fellow of
to assess the candidate’s surgical experience in the European Board of Surgery – GenSurg ACKNOWLEDGEMENT
each of the categories mentioned above. (FEBS/GenSurg). The authors would like to thank Mr Arthur
A wide range of surgery (surgery of the Allen for his kind help with reviewing
head and neck, thoracic and abdominal RECOGNITION OF THE EBSQ/GENSURG the manuscript.
surgery, surgery on the musculoskeletal The UEMS is keen to see the EBSQ/Gen-
system [including trauma and infection], Surg recognised by all national regulatory References
vascular surgery, and surgery on soft tissues authorities in the same way that they accept 1. NHS European Office. New EU Law on Mobility of
Health Professionals Across Europe. London: NHS
and nerves) contributes to the total credit the qualifications of individual European
Confederation; 2013.
point score. The scoring system is somewhat countries; the qualification is accepted in
2. The Surgical Specialties: 1 – General Surgery. Royal
skewed in favour of abdominal surgery, as some member states already. British surgical College of Surgeons of England. http://www.rcseng.
80% of the credit points and 45% of the exam trainees may have difficulty gathering suffi- ac.uk/media/media-background-briefings-and-
questions assess abdominal surgery experi- cient eligibility points and are likely to need statistics/the-surgical-specialties-1-general-surgery
ence and knowledge. However, some degree to read widely before sitting the paper but (cited August 2014).
3. MacFie F. Challenges for the Future of Surgical Training.
of flexibility is allowed between each of the they are unlikely to face major difficulties in
Surgical Forum of Great Britain and Ireland; 2013.
surgical disciplines. the OSCE.