Joint sub Committee structure

UEMS (ID Section/Board) and ESCMID have agreed to work in a joint subcommittee to address specific issues around the training curriculum and assessment. The suggested composition is:

 

Nick Beeching (Liverpool, UK) Chair  Member, UEMS Section and Board (EBID) & ESCMID PAS

Haakon Sjursen (Bergen, NO) President EBID

Andrzej Horban (Warsaw, PL) EBID

Evelina Tacconelli (Rome, IT)  Co-chair (ID) ESCMID PAS

Murat Akova (Ankara, TR) ESCMID Education Officer

Kate Adams (Hull, UK) President Elect, ESCMID TAE

 

Aims/Plan

To produce recommendations and discussion papers on feasibility, structure & content of a common curriculum and possible specialist level examination for trainees nearing the end of their training. These will be discussed at the annual UEMS ID Section/Board meeting in September, and then amended for discussion by PAS ESCMID and ratification by both bodies.

 

Common training curriculum in ID for Europe

The outline curriculum for European training (Article 6) is currently available from the ESCMID website. It allows for flexibility in interpretation according to the needs of each country, as tabled in Read et al, Lancet ID 2011, and a similar table is updated each September at the UEMS Section/Board. Areas of most inter-country variation are the amounts of internal medicine, clinical microbiology/virology and tropical/travel/immigrant medicine that are included. The core curriculum does not include a framework for competency assessment.

 

Each country addresses this differently, with a trend in many towards developing a portfolio of evidence of formal assessment of increasing levels of competency throughout training. This is often supported by a summative assessment process towards the end of training, to enable specialist certification.

 

We anticipate the future development of a common standard for specialist certification in Europe: this means that a core European curriculum and assessment process should be clearly defined.

The subcommittee will address this over the summer, aiming to present a full draft at the UEMS Section/Board meeting in September, following which the amended document could be placed on UEMS/ESCMID websites for consultation prior to further discussion at PAS and next ECCMID.

 

Throughout this process we need to be aware of the need to be able to adapt the curriculum for possible integrated ID/microbiology training, already occurring in some countries.

 

Common specialist examination

 

Different forms of summative assessment occur throughout Europe, in some places none. These include viva voce exams, written exams (essays, short notes, multiple choice etc) and clinical case station or bedside discussions around patients. In the UK, a Specialist Certificate Examination (SCE) has recently been introduced with an intentional expected pass rate of about 90% for UK-based trainees.  This attempts to assess interpretative clinical knowledge appropriate for a newly qualified specialist. The exam is taken about 1-1.5 years before the end of specialist training, and complements a highly structured progression through an e-portfolio of regular competency assessments (see www.jrcptb.org.uk/trainingandcert/ST3-SpR/Pages/Infectious-Diseases.aspx). The exam can be taken in any centre equipped with appropriate computer testing screens throughout the world (in the UK we use driving test centres). It is based on accepted best international practice but specifically reflects clinical guidelines currently in force in the UK. It consists of two “diets” each of 100 multiple choice questions in “best of 5 format”, which is the most reproducible and consistent way of assessment and is subject to extensive quality control monitoring via the MRCP(UK) offices of the Royal Colleges of Physicians, who provide the managerial and educationalist expertise. This is done in partnership with the British Infection Association, which provides examiners to write questions and assess all the questions. I chair the Examination Board.

 

Because of the large number of people and stages involved in preparing the exam, the process is very expensive and examination fees are approx £800 for UK based trainees and £1000 for those from overseas. Even so, the numbers taking the exam in the UK (about 20 per year) mean that it is run at a considerable loss, underwritten by the MRCP(UK) office via profits from the SCEs for larger specialties such as gastroenterology. As a registered charity, the BIA has declined to contribute to costs (or share any profit) but has joint intellectual ownership of the growing question bank. 

 

Questions regarding a standard European examination, to complement an agreed core competency assessment process, include:

1.     Do we need one?

2.     If so, should it be voluntary or compulsory for each country to use?

3.     How do we address the wide regional variations in epidemiology of infection, drug resistance and differing clinical guidelines?

4.     What language(s) should be used?

 

If we want an exam, the subcommittee needs guidance on which options to follow:

1.     Opening the UK examination to all European trainees (or others) on a voluntary basis initially, to assess its generalisability. This has been discussed with the TAE at ECCMID Vienna 2010 and again today.

2.     Developing a similar exam with European ownership of questions, with ESCMID as the specialist society providing expertise in question setting and assessment. A partner with expertise in exam process and administration would need to be identified. Although there is potential conflict of interest for ESCMID as both provider of education and part of specialist assessment, this has not been an issue in the UK because specialist training is not the responsibility of the BIA, and both training and assessment processes in UK are ultimately overseen by Government, with certification by the General Medical Council.

 

Pragmatically, I recommend starting with option one and then trying to include ESCMID question writers on the UK exam setting boards to contribute to the process and to broaden the scope of the UK exam for Europe. ESCMID should not underestimate the cost of embarking on a separate exam. If the UK exam was shared in some way, there will be issues of IP rights to address and probably some (lesser) cost implications.

 

Any comments or questions will be very welcome.

 

 

Nick Beeching

Liverpool

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