Why the European qualification in Vascular Surgery (FEBVS) will be even more important in the future!

Transcription

1 Union Européenne des Médecins Specialistes European Union of Medical Specialists Since 1958: 38 sections among which Vascular Surgery Why the European qualification in Vascular Surgery (FEBVS) will be even more important in the future! Armando Mansilha MD, PhD, FEBVS Julian Scott MD, FRCS, FEBVS

2 European Law currently a European specialist qualification in any speciality, including vascular surgery, does not replace the accreditation by the national authorities, which is the primary specialist accreditation recognized by law by all member countries thus, the European Qualification, entitling those who pass the examination as FEBVS, must be seen as a respected qualification and an European quality mark

3 **************

4 Why the European Examination? to harmonize knowledge and skills to indicate that the candidate has passed a structured training program to guarantee a minimal level of competence promote exchange between countries by establishing a standard: FEBVS (Fellow European Board of Vascular Surgery)

5 The Structure of the Examination Part I (Eligibility) Certificate: CCST (*) Logbook (endo)vascular procedures; signature / validation by supervisor Letter from the National Vascular Society Part II (Oral) Viva voce and technical skills assessment (*) Certificate of Completion of Specialist Training

6 EBVS Examination (Part II) Five Sections: 1. Clinical case analyses ( 4 cases) 2. Academic Viva; one paper 3. Overall assessment 4. Open Technical skills assessment 5. Endovascular skills assessment

7 Viva Voce examiners

8 Clinical Examination 4 vivas of 15 minutes each AAA Lower limb Endovascular Miscellaneous Two examiners; mark INDEPENDANTLY Fixed marking scheme 4-8 Pass mark 6

9

10 Failure Mark Overall Knowledge and Judgement 4 Demonstrated incompetence in diagnosis and management Serious Concerns 5 Failed to demonstrate competence in diagnosis and management Did not progress beyond basic questions Very poor basic knowledge Poor deductive skills Failed to apply knowledge Significant errors Poor higher order thinking Lack of understanding Quality of Response Disorganised Confused Lack of insight Prompts did not work Disorganised answers Required frequent prompts but hesistant and indecisive

11 Report The candidate was taken through the AAA case. He was extremely slow and unable to get beyond the simple questions. He required multiple prompts and was unable to recall the findings of the EVAR 1 and DREAM studies and despite the elderly patient ( 85years) having significant co morbidities and an AAA of 5.4 cms he wished to procede with EVAR. We felt that he lack insight and was unable to produce a logical management plan

12 Report The candidate was awful We both felt he was useless and he would never work in my country. Is he a doctor??

13 Academic viva 20 minutes Paper JVS / EJVES Two examiners Score system 4-8 The pass mark is 6 for each element.

14 Overall Assessment 30 minutes Two examiners Questions about indications, guidelines, evidence, trials, radiaction protection Score System 4-8 for each element

15 Technical Skills Examination (Part II) Three-station bench assessment Carotid endarterectomy Distal anastomosis Aortic anastomosis All models used are bought from Vascular International

16 Open Technical Skills

17

18 Carotid Model

19 Leg Model

20 Aortic Model

21 Rating scales OSATS Objective Structured Assessment of Technical Skill Generic (All procedures) 8 Components Five point scale

22 Rating scales ICEPS Imperial College Evaluation of Procedure-specific Skill Unique to procedure Five point scale High inter-observer reliability and validity

23 Endovascular Skills Examination STRESS machine (*) Simulator for Testing Radiological and Endovascular SkillS Not a TRAINING but a TESTING machine Simple objectives (catheter/guidewires) Contrast, Balloons, Stents not necessary

24 Endovascular Skills Examination STRESS-machine: schematic drawing Camera Plain Abdominal Film Container with glass model Light-box

25 Endovascular Glass Model RA osteal Stenosis Easy Stenosis Straight Side Angulated Side Difficult Stenosis

26 Rating scales generic technical skill respect for tissue time and motion instrument handling flow of operation careful handling of tissue and/or lesion, but occasional potential for inadvertent tissue damage frequently used unnecesary force on tissue and/or lesion, potential tissue damage many unnecessary moves and/or excessive time repeated tentatve, awkward, and/or inappropriate moves with instruments frequently stopped operating and seemend unsure of next move: demonstrated imprecise and/or wrong operative technique efficient in time and moves, but some unneccesary moves and/or excessive time competent use of instruments, but occasionally appeared stiff or awkward demonstrated forward planning with reasonable progression of procedure: careful operative technique with occasional errors consistently handled tissue and/or lesion appropriately with minimal damage to tissue clear economy of moves and time with maximum efficiency fluid movements with instruments and no stiffness or awkwardness planned course of operation with effortless flow throughout. Fluent, secure and correct operative technique in all stages of procedure overall performance very poor /inacceptable quality competent / average clearly superior Do you feel confident this candidate is SAFE to perform a diagnostic angiography, with the ability to make SAFE decisions when unexpected difficulty is encountered, with a supervisor in the neighborhood Y / N comments:

27 Procedural Rules Exam conducted in English Never have two English first language examiners Roving assessors to help but not translate Pairs of examiners Quality Assurance observers They mark the examiners, not the candidates Observers Examiners in training

28 New FEBVS Examiner Eligibility Criteria - FEBVS title - 5 years as Consultant Application Form at our website

29 New FEBVS Examiner 1. Being accepted as Observer by the Examination Committee 2. If accepted, being Observer for 2 consecutive Examinations 3. The Examination Committee will decide if I m approved as Examiner 4. If approved, on the first Examination after, I ll will act as Examiner in the presence of a most experienced Examiner 5. If appointed, I am prepared to serve on the Board of Examiners for a period of five years from the date of my first Examination

30 Results Max possible score = 192 Pass criteria score at least 144 and pass at least 4 sections of the exam and pass at least 2 open technical stations

31 EBVS Examinations since 1996 Year and place candidates pass rate 1996 Venice (86%) 1997 Lisbon (80%) 1998 Paris (81%) 1999 Copenhagen (100%) 2000 London (71%) 2001 Lucerne (65%) 2002 Istanbul (71%) 2003 Dublin (86%) 2004 Innsbruck (85%) 2005 Helsinki (83%) 2006 Prague (88%) 2007 Madrid (82%) 2008 Nice (84%) 2009 Oslo (75%) 2010 Amsterdam (68%) 2011 Athens (56%) 2012 Maastricht/Bologna (84%) 2013 Maastricht/Budapest (84%) 2014 Maastricht/Stockhom (82%) 2015 Maastricht/Porto (75%) 2016 Maastricht/Copenhagen (61%) (73%)

32 Number of Candidates per Year UEMS Section and Board Vascular Surgery - All rights reserved

33 Pass Rate per Examination UEMS Section and Board Vascular Surgery - All rights reserved

34 UEMS vs Non-UEMS Candidates UEMS Section and Board Vascular Surgery - All rights reserved

35 Open Technical Open Carotid Open AAA Open Distal Average = 82% Average = 74% Average = 83% UEMS Section and Board Vascular Surgery - All rights reserved

36 Endovascular Average = 86% UEMS Section and Board Vascular Surgery - All rights reserved

37 Comments 1. Huge increase in the number of candidates in last years 2. Candidates from non-uems countries with higher failure rate 3. Open technical higher failure rate for AAA model 4. Endo technical higher pass rate comparing with previous years

38 What s Needed 1. Promote the FEBVS as the speciality examination in countries where such an examination is not required yet 2. Increase the participation of examiners from countries which adopt the FEBVS as their exit examination 3. Improve examiner training, include equality and diversity etc 4. Development of the European Vascular Curriculum

39 Union Européenne des Médecins Specialistes European Union of Medical Specialists Since 1958: 38 sections among which Vascular Surgery

40 Union Européenne des Médecins Specialistes European Union of Medical Specialists Since 1958: 38 sections among which Vascular Surgery Why the European qualification in Vascular Surgery (FEBVS) will be even more important in the future! Armando Mansilha MD, PhD, FEBVS UEMS SBVS Secretary General