european board of surgery examination in surgical oncology

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  • 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

    0

    5

    10

    15

    20

    25

    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

    X X X

    X X X

    X X X

    X X X

    X X X

    X X X

    X X X

    X X X

    X X X

    X X X

    X X X

    X X X

    X X X

    X X X

    X X X

    X X X

    X X X

    X X X

    X X X

    X X X

    X X X

    X X X

  • 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 patients 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!