The European Breast Examination Lynda Wyld Secretary of the European Breast Exam Board Reader in Surgical Oncology, University of Sheffield and Consultant Oncoplastic Surgeon at Doncaster and Bassetlaw Teaching Hospitals

Union of European Medical Specialists The UEMS was established in 1958 to promote the free movement of medical specialists within Europe and to ensure the highest standards of medical care. It is a non-governmental organisation representing national associations of medical specialists in the European Union and in associated countries. 37 specialist sections, representing 35 countries and includes the European Board of Surgery (EBS) of which Breast Surgery is a division.

European Standards in Medical Training UEMS has developed a European Curriculum and training standards for each medical specialism. Runs EACCME which is a pan European training course accreditation body for CME points The breast curriculum is available on the UEMS web site along with the syllabus for the exam

Founded in 1981, the European Society of Surgical Oncology (ESSO) supports its members in advancing the science and practice of surgical oncology for the benefit of cancer patients through a range of activities including education, research and leadership in multidisciplinary care. Annual congress (Liverpool in 2014, Vienna 2015, Krakow 2016) with over 1000 delegates 20 Regular courses and masterclasses including 3 for breast surgery (masterclass, oncoplastic and advanced) European Surgical Oncology and Breast Exams Research and quality control Fellowships (minor, major, clinical and joint with US-SSO and ESMO)

Quality assess breast units Produce Guidelines Quality assess breast units Co-Organise the biennial European Breast Cancer Conference (EBCC)

EBSQ Exams European Board of Surgery of the UEMS runs Specialist Examinations each year. Award of the exams entitles use of the post-nomial: FEBS, Fellow of the European Board of Surgery Coloproctology, Trauma Surgery, General Surgery, Surgical Oncology, Thoracic Surgery, Transplant Surgery, Transplant Medicine, Transplant Coordination, Endocrine Surgery, HPB Surgery and Hand Surgery Breast Surgery

Board of the Breast Exam Past-President Marjut Leidenius, Finland President Christos Markopoulos, Greece Vice President Fiona MacNeill Secretary Lynda Wyld, UK Treasurer Janez Zgajnar, Slovenia Webmaster Bahadir M. Gulluoglu, Turkey Officers Kerstin Sandelin, Sweden Isabel Rubio, Spain Michael Gnant, Austria

Examiners/National Representative for the EBSQ Breast Surgery exam Ireland James Geraghty Niall O´Higgins Maurice Stokes Hungary Zoltan Matrai Italy Roberto Agresti Luigi Cataliotti The Netherlands Liesbeth Jensen Jakob de Vries Norway Ellen Schlichting Austria Florian Fitzal Michael Gnant Belgium Marie-Rose Christiaens Denmark Peer Christiansen Niels Kroman Egypt Omar Sherif Omar Finland Tiina Jahkola Karl von Smitten Marjut Leidenius Greece Christos Markopoulos Poland Agniezka Kolacinska Russia Vladimir Semiglazov Slovenia Ibrahim Edhemovic Marco Hocevar Janez Zgajnar Spain Isabel Rubio Sweden Leif Bergqvist Stig Holmberg Kerstin Sandelin Turkey Bahadir Gulluoglu UK Riccardo Audisio Michael Douek Kieran Horgan Chris Holcombe Tibor Kovacs Masoom Muttalib Gabor Peley Jerome Pereira Hodigeree Ramesh Jois Zenon Rayter Lynda Wyld Charlie Chan Fiona MacNeill Andrew Baildam

The HONORARY DIPLOMA in Breast Surgery It is possible to obtain an HONORARY DIPLOMA of Breast Surgery. With this diploma the Division of Breast Surgery recognizes experienced and practicing Consultant Breast Surgeons, who actively contribute to the development of the field of Breast surgery. The conditions for application are: - At least 10 years' experience at the level of Consultant/Attending Surgeon - At least 10 PubMed listed publications on breast of which at least 3 in the last 5 years - University based work in a leading position (confirmed by the dean or by the hospital director) non- university based leading position with practice specialized in Breast Surgery - 2 letters of support (one by a national and one by an international colleague)

The EBSQ Examination numbers

The Exam: Format Phase 1: Eligibility assessment Phase 2: MCQ examination (now on line at multiple exam centres across Europe, 3-4 months before the oral exam) Phase 3: Oral examination with clinical scenarios and academic stations

Eligibility CV Log book References

1. The applicant must hold a current license to practice as a surgeon (general or plastic or gynaecologist.) 2. Demonstrate worked for one year in a breast surgery unit with at least 150 new primary breast cancer cases a year. 3. Attended at least one national/international training course in breast surgery and has attended at least one well recognized international congress on breast disease during the last 3 years. 4. The applicant should present a signed log book for breast surgery with the application. 5. Published either one paper or book chapter on breast disease or presented one paper (oral or poster)

Or performed during the past 2 years - at least 10 operations on benign or borderline lesions - at least 20 axillary lymph node surgeries, including both full axillary dissections and sentinel lymph node biopsies - at least 20 breast conserving cancer operations including at least 5 observed or assisted oncoplastic level I - II breast remodelling procedures - at least 20 mastectomies, including at least 10 NAC- or skin-sparing mastectomies - observed or assisted at 10 immediate and delayed total breast reconstructions using both implants and autologous tissue.

Assisted at (during one’s entire career) - at least 40 operations on benign or borderline lesions - at least 100 full axillary lymph node dissections or sentinel node biopsies, including 1. at least 30 full ALND 2. at least 30 SNB - at least 100 breast cancer operations during the two last recent years, including: 1. at least 40 breast conserving surgeries, including at least 5 oncoplastic level I - II breast remodeling procedures 2. at least 40 mastectomies, including at least 10 NAC- or skin-sparing mastectomies

MCQ and orals 50 questions Cover cancer and benign. High standard (UK CCT level). Academic and evidence based focus. Knowledge of research/trials is important. Only if MCQ is passed can you progress to the oral. Pass rate variable. Lowest rate was 2014 at 50%, usually about 70% 2 stations of 2 examiners. 1 to discuss clinical scenarios, 1 an academic paper critique (Z0011 for example in 2011). Usually highly current or controversial paper

What do you get? Able to use title ‘Fellow of the European Board of Surgery’ FEBS Recognised officially in Sweden Not elsewhere at present but has been appearing on the list of desirable qualities on consultant job descriptions in the UK

How much does it cost? €500 for the whole exam. Half of fee is eligibility assessment so this does not need to be paid twice If you fail one or other part you can retake for €250 the following year. If you fail twice you have to wait 2 years to try again. Pass rate is variable but was as low as 50% 2014. The standard is that of junior consultant breast surgeon but requires knowledge of reconstruction and oncoplastics and the latest breast research

The next sitting? Oral exam in Naples in October following MCQ in June: this exam is closed to new applications. The next oral is likely to be at the EBCC in Barcelona in March 2018 with the MCQ in December 2017 (date to be announced shortly) There may be a waiting list of candidates so please don’t apply at the last minute Curriculum is on the website and the exam board execs and examiners are writing a textbook to support the exam, due out October 2017. Profits from the book will go to support the exam.