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EUROPEAN BOARD OF SURGERY

EXAMINATION IN
SURGICAL ONCOLOGY

2014

European Society of Surgical Oncology


Education and Training Committee – President: Dr. Lynda Wyld
Report presented by Ibrahim Edhemovic
THE EBSQ SURGICAL ONCOLOGY
Applicant number
EXAMINATION
25

20

15

10

0
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
SURGICAL ONCOLOGY EXAM GEOGRAPHY
Country 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


Breast, sarcoma
Lynda Wyld f UK
Beate Rau f German HIPEC, pelvic, sarcoma and lung
Michel Rivoire m French Upper GI/HPB

Geerard Beets m Netherlands


Colorectal Plus additional
Breast examiners: Zen
Marjut Leidenius f Finnish Rayter, Sebastian
Melanoma, sarcoma
Odysseas Zoras m Greek Aspinall and
Joost van der Vorst m Dutch
Trainee Representative Marjolein Schmidt
GI to cover breast and
Ibrahim Edhemovic m Slovenian
endocrine
Sarcoma, upper GI
Sergio Sandrucci m Italian
Daniel Perez m Swiss Upper GI/HPB
Isabel Rubio f Spanish Breast
Upper GI and Breast
Dawid Murawa m Polish
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
Candidate Name % ONCOLOGY
1: Failed written 38
2 76
3 91
4 82
5 88
Pass mark set using Anghoff
6: Borderline 58 referencing. Borderline score +/-
7 82 10% of pass mark.
8: Borderline 58
9: Borderline 52
10 64
11 61
12 64
13 70
14 82
15 88
16 73
17 73
18 70
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


Which of the following statements regarding lung cancer is
10 incorrect
• Excluded from analysis
22 Which one of the following statements about types of medically utilised a Screening with computed tomography (CT) can reduce the
radiation is incorrect mortality in high risk patient populations
b Screening with CT produces an excessive number of false
a Hypofractionation refers to the use of larger radiation doses per fraction positive findings
b Brachytherapy has a maximal radiation penetration depth of 2cm c Chest radiography is effective in screening for lung cancer
c Accelerated fractionation is administration of normal fractions over a d Lung function tests are effective in the early detection of lung
shorter time span cancer
d In most cases standard fractions are 1.8 to 2 Gy e Serum antibody markers may be effective in screening for lung
e Protons deliver a minimal exit dose permitting normal tissue sparing cancer

Correct b Correct c
MCQ 2: APPLIED CLINICAL
Candidate Number %
1 Failed 38
2: Borderline 56
3 88
4: Borderline 56
5 75 Pass mark set using
6 62 Anghoff referencing.
7 75 Borderline score +/- 10%
8 69
of pass mark.
9 75
10 75
11: Borderline 50
12 69
13 94
14 56
15 81
16 68
17 63
18: Borderline 50
EXCLUDED QUESTIONS
20 A 64-year-old patient presents acutely with peritonitis. Past medical
history reveals type 2 diabetes, ischaemic heart disease, atherosclerosis,

• 4 questions had very poor scores weight loss of 8% within two months. Emergency abdominal CT shows air
under the diaphragm and cancer in the gastric body with infiltration
of less than 20% limited to the gastric wall and no dissemination. At laparotomy
perforation of the gastric tumour is confirmed. Which is the optimal
procedure?

• Review indicated confusing, a Two-stage surgery should be performed, dressing the


perforation/partial
3 Which one of the followingresection/gastrectomy
statements about the use during the emergency
of acellular dermal
poorly written or overly specialist laparotomy
matrices and completing
(ADM) in breast reconstruction the therapy, including total
is incorrect?
gastrectomy and D2 lymphadenectomy, at a second stage
b
a ADM areIf the patient’swith
associated general state
a lower is stable
rate perform
of capsule total gastrectomy
formation than fully
with D2
submuscular lymphadenectomy.
implant placement
• Excluded from analysis c
b
d Perform
Option a or b depending
ADM reconstructions
partial
are associated
gastrectomy
than non ADM procedures
on clinical
during the
status short term failure rate
with a higher
emergency laparotomy and
c when the
ADM patient has recovered
reconstructions commence
are associated with adjuvant
a higherECF rate of seroma
chemotherapy in recognition of
formation than non ADM reconstructionsthe fact that the disease was perforated
d at presentation
ADMs facilitate single stage or direct to implant reconstruction
e
e Dress the
ADMs perforation
facilitate delayedduring the emergency
reconstruction laparotomy.
because Instigate
of their high
palliative
elasticity treatments as appropriate thereafter as perforation
means cure is not possible.
Correct e
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 RESULT
Name Academic Clinical
1: failed written. Did not sit oral exam NA NA
2 36 38
3 39 32
4 32 32 Overall pass rate
5 30 32
6 31 27
16/18=89%
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
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!