{"paper_id":"841af5d9-991e-40c4-bd5f-b2912bd4c03a","body_text":"INVITED EDITORIAL\nA compulsory examination in pathology: redundant\nor necessary?\nJan G. van den Tweel & Claude Cuvelier &\nAnthony J. Freemont\nReceived: 24 June 2012 / Accepted: 25 June 2012 / Published online: 8 July 2012\n# The Author(s) 2012. This article is published with open access at Springerlink.com\nIn this issue Lehr et al. describe the compulsory exami-\nnation used by the Swiss Society of Pathology to assess\nsenior residents, and thereby assure the professional com-\npetence of its future qualified members [ 1]. With this\nexamination, Switzerland is, with Britain, one of the\nfew European countries with a comprehensive examina-\ntion (lasting several days) that tests the full range of\ntheoretical and practical competencies required of a med-\nical specialist-pathologist.\nThere is considerable variation across Europe in the\nway that the final competencies of pathology trainees\nare assessed [ 2]. The reason for this variation is the fact\nthat European countries are all entirely autonomous with\nregard to training, licensing and the issuing of specialty\ndiplomas in postgraduate medical education. For exam-\nple, in pathology six countries do not require any form\nof testing at all at the end of specialty training. In the\nremaining 26 there is considerable heterogeneity of test-\ning [ 2], with autopsy competency tested in 11, gross\ns p e c i m e ne x a m i n a t i o na n ds a m p l i n gi n9a n dc y t o l o g y\nin 18. No exact data about the duration of these exami-\nnations are known.\nHarmonization of training and the assessment of its ef-\nfectiveness in producing competent specialists has proven to\nbe very difficult because very few countries are willing to\ngive up their autonomy to decide on the competencies of\ntheir medical specialists, to be acquired during residency\ntraining. This is in stark contrast to many countries where\nobligatory specialty examinations, sometimes with consid-\nerable failure rates, are the norm. Examples include the\nNorth American specialty boards and the examinations of\nthe British Royal Colleges [ 3, 4]. For the Royal College of\nPathologists, examinations are one of the principal bench-\nmarks by which trainees are judged to have reached profes-\nsional competence. The British examinations are still copied\nin one form or another by their old colonies (e.g. Australia,\nCanada, many African countries). When one of us (JGvdT)\nwas an external examiner in Zimbabwe in the 90 ’s it was\nmuch more difficult to become a pathologist there (or indeed\na specialist in any medical discipline) than in the Nether-\nlands and many other European countries. The same applies\ne.g. to Tanzania where, to progress further in the specialty,\nresidents have to pass a general pathology examination\nalready after 6 months of training.\nTo tackle this diversity in training and testing in 1997 the\nEuropean Board of Pathology (EBP) of the European Union\nof Medical Specialists (UEMS), introduced an annual vol-\nuntary examination for senior pathology residents, based\nupon a similar examination successfully introduced by the\nEuropean Board of Urology. Although introduction of the\nexamination was supported by a large majority of the mem-\nbers of EBP , due to the lack of any consequence of failing,\nand poor support by senior pathologists, the test never really\ngot off the ground and is currently taken by only a handful\nof people, mainly those from outside the EU hoping to\nJ. G. van den Tweel (*)\nDepartment of Pathology, University Medical Center,\nHeidelberglaan 100,\n3508 GA Utrecht, The Netherlands\ne-mail: j.vandentweel@umcutrecht.nl\nC. Cuvelier\nDepartment of Pathology, Ghent University,\n9000, Ghent, Belgium\ne-mail: Claude.Cuvelier@ugent.be\nA. J. Freemont\nManchester Medical School, The University of Manchester,\nManchester, UK\ne-mail: tony.freemont@manchester.ac.uk\nVirchows Arch (2012) 461:1 –2\nDOI 10.1007/s00428-012-1278-z\n\nincrease their prospect of finding work as pathologist in\nEurope. The only exception is Malta where since 2011 the\nUEMS examinations are officially recognized for all medi-\ncal specialisms.\nWith support of a grant from the EU, the European Asso-\nciation of Pathology Chairs and Program Directors (EAPCP)\ndeveloped a voluntary progress test (EUROP ALS) [5], com-\nparable to the American RISE (Resident In Service Examina-\ntion). The latter test is given for all medical specialties in the\nUSA and is for pathology a good outcome predictor for the\nAmerican Board Examination [6]. This EUROP ALS test had\na high participation rate and is now, thanks to the support of\nthe European Society of Pathology being developed as an\nofficial progress test, not only for residents but also for\nspecialised pathologists and subspecialists.\nThe relevant question here of course is why trainee\nmedical specialists, inclu ding in pathology, in so many\ncountries in Europe are not thoroughly tested at the end of\ntheir training. This is relevant in view of the results of the\nAmerican and British examinations, showing that a propor-\ntion of advanced residents do not have the core competen-\ncies, as defined by senior members of the profession,\nconsidered necessary for practicing safely. As there is no\nsuggestion that the training in the UK or USA is substan-\ndard, the question is relevant whether introduction of similar\nassessments across Europe would demonstrate lacunar com-\npetencies in some of the examined residents. That is not to\nsuggest that trainees across Europe might be less competent\nthan their North American or UK homologues, merely that\nas the experience in the e.g. USA and UK indicates, assess-\nment stimulates learning. Creating a knowledgeable,\nthoughtful and competent pool of specialists is surely the\nfundamental goal of any postgraduate medical training\nprogramme.\nOpen Access This article is distributed under the terms of the Crea-\ntive Commons Attribution License which permits any use, distribution,\nand reproduction in any medium, provided the original author(s) and\nthe source are credited.\nReferences\n1. Lehr H-A, Moch H, Christen B, Safret A, Gugger M, Rössle M, von\nGunten M, Lemoine R, Kurt AM, Caduff R, Arnold W, Singer G,\nLuscieti P , Bannwart F, Genton CY (2012) Board examination for\nanatomical pathology in Switzerland: two intense days to verify\nprofessional competence. doi: 10.1007/s00428-012-1262-7\n2. Bosman FT, van den Tweel JG (2009) Unison or cacophony: post-\ngraduate training in pathology in Europe. Virchows Arch 454:497 –\n503\n3. Picarsic J, Raval JS, Macpherson T (2010) United States Medical\nLicensing Examination step 1 two-digit score: a correlation with the\nAmerican Board of Pathology first-time test taker pass/fail rate at\nthe University of Pittsburgh Medical Center. Arch Pathol Lab Med\n135:1349–1352\n4. Gray TA (2009) The Royal College of Pathologists Annual Report of\nExaminations and Assessments undertaken in 2009 Dr. T.A. Gray.\nDirector of Examinations and Assessment. http://www.rcpath.org/\nResources/RCPath/Migrated%2 0Resources/Documents/A/\nannual_report_2009.pdf\n5. European Pathology Training Curriculum (2009)http://www.eapcp.org/\nEuropals/training.htm\n6. Rinder HM, Grimes MM, Wagner J, Bennett BD, RISE Committee,\nAmerican Society for Clinical Pathology and the American Board of\nPathology (2011) Senior pathology resident in-service examination\nscores correlate with outcomes of the American Board of Pathology\ncertifying examinations. Am J Clin Pathol 136:499 –506\n2 Virchows Arch (2012) 461:1 –2","source_license":"CC-BY-4.0","license_restricted":false}