Specialist Training (EBID)

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 http://www.jrcptb.org.uk/trainingandcert/ST3-SpR/Pages/Infectious-Diseases.aspx\ 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 ‚Äúdiets‚Äù each of 100 multiple choice questions in ‚Äúbest of 5 format‚Äù, 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. </span></p>\r\n<p class=\”MsoNormal\” style=\”margin-bottom: .0001pt; line-height: normal;\”><span lang=\”EN-GB\”>¬†</span></p>\r\n<p class=\”MsoNormal\” style=\”margin-bottom: .0001pt; line-height: normal;\”><span lang=\”EN-GB\”>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.¬† </span></p>\r\n<p class=\”MsoNormal\” style=\”margin-bottom: .0001pt; line-height: normal;\”><span lang=\”EN-GB\”>¬†</span></p>\r\n<p class=\”MsoNormal\” style=\”margin-bottom: .0001pt; line-height: normal;\”><span lang=\”EN-GB\”>Questions regarding a standard European examination, to complement an agreed core competency assessment process, include:</span></p>\r\n<p class=\”MsoListParagraphCxSpFirst\” style=\”margin-bottom: .0001pt; mso-add-space: auto; text-indent: -18.0pt; line-height: normal; mso-list: l0 level1 lfo1;\”><!–[if !supportLists]–><span lang=\”EN-GB\”>1.<span style=\”font-size: 7pt; font-family: \’Times New Roman\’;\”>¬†¬†¬†¬† </span></span><!–[endif]–><span lang=\”EN-GB\”>Do we need one?</span></p>\r\n<p class=\”MsoListParagraphCxSpMiddle\” style=\”margin-bottom: .0001pt; mso-add-space: auto; text-indent: -18.0pt; line-height: normal; mso-list: l0 level1 lfo1;\”><!–[if !supportLists]–><span lang=\”EN-GB\”>2.<span style=\”font-size: 7pt; font-family: \’Times New Roman\’;\”>¬†¬†¬†¬† </span></span><!–[endif]–><span lang=\”EN-GB\”>If so, should it be voluntary or compulsory for each country to use?</span></p>\r\n<p class=\”MsoListParagraphCxSpMiddle\” style=\”margin-bottom: .0001pt; mso-add-space: auto; text-indent: -18.0pt; line-height: normal; mso-list: l0 level1 lfo1;\”><!–[if !supportLists]–><span lang=\”EN-GB\”>3.<span style=\”font-size: 7pt; font-family: \’Times New Roman\’;\”>¬†¬†¬†¬† </span></span><!–[endif]–><span lang=\”EN-GB\”>How do we address the wide regional variations in epidemiology of infection, drug resistance and differing clinical guidelines?</span></p>\r\n<p class=\”MsoListParagraphCxSpLast\” style=\”margin-bottom: .0001pt; mso-add-space: auto; text-indent: -18.0pt; line-height: normal; mso-list: l0 level1 lfo1;\”><!–[if !supportLists]–><span lang=\”EN-GB\”>4.<span style=\”font-size: 7pt; font-family: \’Times New Roman\’;\”>¬†¬†¬†¬† </span></span><!–[endif]–><span lang=\”EN-GB\”>What language(s) should be used?</span></p>\r\n<p class=\”MsoNormal\” style=\”margin-bottom: .0001pt; line-height: normal;\”><span lang=\”EN-GB\”>¬†</span></p>\r\n<p class=\”MsoNormal\” style=\”margin-bottom: .0001pt; line-height: normal;\”><span lang=\”EN-GB\”>If we want an exam, the subcommittee needs guidance on which options to follow:</span></p>\r\n<p class=\”MsoListParagraphCxSpFirst\” style=\”margin-bottom: .0001pt; mso-add-space: auto; text-indent: -18.0pt; line-height: normal; mso-list: l1 level1 lfo2;\”><!–[if !supportLists]–><span lang=\”EN-GB\”>1.<span style=\”font-size: 7pt; font-family: \’Times New Roman\’;\”>¬†¬†¬†¬† </span></span><!–[endif]–><span lang=\”EN-GB\”>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.</span></p>\r\n<p class=\”MsoListParagraphCxSpLast\” style=\”margin-bottom: .0001pt; mso-add-space: auto; text-indent: -18.0pt; line-height: normal; mso-list: l1 level1 lfo2;\”><!–[if !supportLists]–><span lang=\”EN-GB\”>2.<span style=\”font-size: 7pt; font-family: \’Times New Roman\’;\”>¬†¬†¬†¬† </span></span><!–[endif]–><span lang=\”EN-GB\”>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.</span></p>\r\n<p class=\”MsoNormal\” style=\”margin-bottom: .0001pt; line-height: normal;\”><span lang=\”EN-GB\”>¬†</span></p>\r\n<p class=\”MsoNormal\” style=\”margin-bottom: .0001pt; line-height: normal;\”><span lang=\”EN-GB\”>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.</span></p>\r\n<p class=\”MsoNormal\” style=\”margin-bottom: .0001pt; line-height: normal;\”><span lang=\”EN-GB\”>¬†</span></p>\r\n<p class=\”MsoNormal\” style=\”margin-bottom: .0001pt; line-height: normal;\”><span lang=\”EN-GB\”>Any comments or questions will be very welcome.</span></p>\r\n<p class=\”MsoNormal\” style=\”margin-bottom: .0001pt; line-height: normal;\”><span lang=\”EN-GB\”>¬†</span></p>\r\n<p class=\”MsoNormal\” style=\”margin-bottom: .0001pt; line-height: normal;\”><span lang=\”EN-GB\”>¬†</span></p>\r\n<p class=\”MsoNormal\” style=\”margin-bottom: .0001pt; line-height: normal;\”><span lang=\”EN-GB\”>Nick Beeching</span></p>\r\n<p class=\”MsoNormal\” style=\”margin-bottom: .0001pt; line-height: normal;\”><span lang=\”EN-GB\”>Liverpool </span></p>\r\n<p class=\”MsoNormal\” style=\”margin-bottom: .0001pt; line-height: normal;\”><span lang=\”EN-GB\”><a href=\”mailto:nbeeching@blueyonder.co.uk\”>nbeeching@blueyonder.co.uk</a></span></p>\r\n<p class=\”MsoNormal\” style=\”margin-bottom: .0001pt; line-height: normal;\”><span lang=\”EN-GB\”>¬†</span></