EUROPEAN BOARD OF SURGERY EXAMINATION IN SURGICAL ONCOLOGY

2014

European Society of Surgical OncologyEducation and Training Committee – President: Dr. Lynda WyldReport presented by Ibrahim Edhemovic

THE EBSQ SURGICAL ONCOLOGY EXAMINATION

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2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

Applicant number

SURGICAL ONCOLOGY EXAM GEOGRAPHYCountry Spain Germany

Swiss UK

Hungary Czech Rep

Austria Cyprus

Belgium Greece

Arab Portugal

Turkey India

Ireland France

Croatia slovenia

italy

2014 CANDIDATE NUMBERS

• 23 applicants: all applicants eligible based on criteria

• 3 apologies: withdrawals for personal reasons

• 2 no shows

• 18 candidates examined

EXAM COMMITTEE: THE ETC OF ESSO

Name Gender Nationality Specialty

Lynda Wyld f UKBreast, sarcoma

Beate Rau f German HIPEC, pelvic, sarcoma and lung

Michel Rivoire m French Upper GI/HPB

Geerard Beets m NetherlandsColorectal

Marjut Leidenius f FinnishBreast

Odysseas Zoras m GreekMelanoma, sarcoma

Joost van der Vorst m DutchTrainee Representative

Ibrahim Edhemovic m SlovenianGI

Sergio Sandrucci m ItalianSarcoma, upper GI

Daniel Perez m Swiss Upper GI/HPB

Isabel Rubio f Spanish Breast

Dawid Murawa m PolishUpper GI and Breast

Plus additional examiners: Zen Rayter, Sebastian Aspinall and Marjolein Schmidt to cover breast and endocrine

2014 CANDIDATE SPECIALIST INTERESTS

Breast Endocrine Sarcoma Visceral (colorectal) Visceral (upper GI) Visceral (HPB) Melanoma

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MCQ 1: GENERAL SURGICAL ONCOLOGYCandidate Name %

1: Failed written 38

2 76

3 91

4 82

5 88

6: Borderline 58

7 82

8: Borderline 58

9: Borderline 52

10 64

11 61

12 64

13 70

14 82

15 88

16 73

17 73

18 70

Pass mark set using Anghoffreferencing. Borderline score +/-10% of pass mark.

EXCLUDED QUESTIONS

• 6 of the 40 MCQs were answered correctly by less than 20% (chance only)

• Review of questions: Poorly or confusingly phrased or overly specialist

• Excluded from analysis10

Which of the following statements regarding lung cancer is

incorrect

a Screening with computed tomography (CT) can reduce the

mortality in high risk patient populations

b Screening with CT produces an excessive number of false

positive findings

c Chest radiography is effective in screening for lung cancer

d Lung function tests are effective in the early detection of lung

cancer

e Serum antibody markers may be effective in screening for lung

cancer

Correct c

22 Which one of the following statements about types of medically utilised

radiation is incorrect

a Hypofractionation refers to the use of larger radiation doses per fraction

b Brachytherapy has a maximal radiation penetration depth of 2cm

c Accelerated fractionation is administration of normal fractions over a

shorter time span

d In most cases standard fractions are 1.8 to 2 Gy

e Protons deliver a minimal exit dose permitting normal tissue sparing

Correct b

MCQ 2: APPLIED CLINICALCandidate Number %

1 Failed 38

2: Borderline 56

3 88

4: Borderline 56

5 75

6 62

7 75

8 69

9 75

10 75

11: Borderline 50

12 69

13 94

14 56

15 81

16 68

17 63

18: Borderline 50

Pass mark set using Anghoff referencing. Borderline score +/- 10% of pass mark.

EXCLUDED QUESTIONS

• 4 questions had very poor scores of less than 20%

• Review indicated confusing, poorly written or overly specialist

• Excluded from analysis

3 Which one of the following statements about the use of acellular dermal

matrices (ADM) in breast reconstruction is incorrect?

a ADM are associated with a lower rate of capsule formation than fully

submuscular implant placement

b ADM reconstructions are associated with a higher short term failure rate

than non ADM procedures

c ADM reconstructions are associated with a higher rate of seroma

formation than non ADM reconstructions

d ADMs facilitate single stage or direct to implant reconstruction

e ADMs facilitate delayed reconstruction because of their high

elasticity

Correct e

20 A 64-year-old patient presents acutely with peritonitis. Past medical

history reveals type 2 diabetes, ischaemic heart disease, atherosclerosis,

weight loss of 8% within two months. Emergency abdominal CT shows air

under the diaphragm and cancer in the gastric body with infiltration

limited to the gastric wall and no dissemination. At laparotomy

perforation of the gastric tumour is confirmed. Which is the optimal

procedure?

a Two-stage surgery should be performed, dressing the

perforation/partial resection/gastrectomy during the emergency

laparotomy and completing the therapy, including total

gastrectomy and D2 lymphadenectomy, at a second stage

b If the patient’s general state is stable perform total gastrectomy

with D2 lymphadenectomy.

c Option a or b depending on clinical status

d Perform partial gastrectomy during the emergency laparotomy and

when the patient has recovered commence adjuvant ECF

chemotherapy in recognition of the fact that the disease was perforated

at presentation

e Dress the perforation during the emergency laparotomy. Instigate

palliative treatments as appropriate thereafter as perforation

means cure is not possible.

Correct c

ORAL EXAMINATION

• 2 viva examinations each of 30 minutes with 4 examiners

• 1 on academic papers and general theory

• 1 on specialist applied clinical cases

ACADEMIC VIVA

• Candidate have 1 hour to read 2 academic papers selected to reflect their nominated area of specialist interest

• 15 minutes examination on each with 2 examiners to discuss scientific critique and clinical relevance.

• Standard scoring criteria

CLINICAL VIVA

• 9 pre-submitted clinical cases with photos and radiology images

• Standard setting examiners meeting beforehand

• Standard numeric scores and subjective score (pass, fail, borderline)

• All borderline and fails discussed at examiners meeting to assess safety and competence to practice at consultant level in Europe.

ORAL EXAM RESULTName Academic Clinical

1: failed written. Did not sit oral exam NA NA

2 36 38

3 39 32

4 32 32

5 30 32

6 31 27

7 25 32

8: Failed oral exam, borderline on 1 written, fail

overall 12 24

9 22 28

10 36 33

11 27 28

12 28 22

13 40 32

14 36 34

15 39 36

16 34 30

17 34 30

18 32 24

Overall pass rate 16/18=89%

CESMA: EXTERNAL REVIEW

• Professor Zeev Goldik and Professor Daniel Mathysen from CESMA attended the exam as external observers

• Reviewed all documents and papers before the exam

• Reviewed protocols and quality assurance

• Observed examinations and interviewed candidates and examiners

• Attended examiners meeting and standard setting meeting

CESMA OUTCOME

• Anonymisation of candidates needed

• Independent scoring of vivas rather than by conferring between examiner pairs

• Generally to an acceptable standard

• Formal report awaited

PRIZE WINNERS

• Jean De Menezes (India): first prize

• 2 runners up:

• Hannes Neef and Andraz Perhavic

THANK YOU

• Special thanks to our external examiners: Professor Zeev Goldik and Professor Daniel Mathysen

• Special thanks to our administrative coordinators: Carine Lecoq and Ana Galan

• Thanks to the team of examiners!