Starting in the mid twentieth century, pediatric surgery as a specialty became gradually recognized in many countries around the world. Ever since, pediatric surgeons have differentiated themselves from adult general surgeons and organ specialists, maintaining a relatively large spectrum of indications, including neonatal surgery, general pediatric surgery, pediatric urology, pediatric trauma and burn care, as well as many other fields. Consequently, pediatric surgeons around the world had to establish comprehensive training systems that ensured competency. Systems developed differently from country to country, but with increasing globalism and the creation of the European Union, there was an impetus to create a certification system that would ensure a set benchmark for pediatric surgical knowledge and competency. This was the driving force behind the implementation of an international European pediatric surgical examination.
The EBPS was therefore established in the latter part of the 1990s with the aim of ensuring harmonization of standards of training in Europe within the framework of the UEMS [2]. The exam can be taken by candidates who have already passed the EBPS part one examination and have completed an approved Pediatric Surgical Training scheme. For countries which have no official structured training program, the candidate must show evidence of at least 5 year of pediatric surgery experience in a recognized training insitution and show evidence of operative experience (personal log book or operative summary signed by their training supervisor).
To standardize the quality of pediatric surgeon board in Europe, the UEMS Section of Pediatric Surgery designed and published a European syllabus for pediatric surgical training in 2009 [5]. This syllabus was revised and new European training requirements were adopted in 2014 with the goal of “harmonizing the training programs in pediatric surgery among different European countries". However, there remains a lack of data on the real, actual training conditions within the European national associations of pediatric surgery. In 2016 a questionnaire survey of Executive Committee of UEMS Section of Pediatric Surgery presented data from 29 of 37 national associations, revealing that a uniform training schedule in pediatric surgery has not been formulated or achieved within Europe so far [6]. Only general pediatric surgery and newborn surgery are included in the core pediatric surgical training uniformly across all countries and training is provided according to historical developments on the local and national regulations. They concluded that this situation mandated an urgent attempt to harmonize both training curricula and final examinations at a European level. Although there are so many problems to resolve for harmonizing pediatric surgical training, the EBPS is one of the sentinel agencies key to this endeavor. However, although it has been more than 20 years since the first EBPS exam was held, only slightly more than 50% (15/28) of the European countries have some kind of recognition [6], and it is legally currently only in Turkey as an exit examination to practice pediatric surgery. Interestingly, Turkey is not part of the European Union at this time.
From the start, the EBPS examination contrasted itself from other board examinations, such as the Pediatric Surgery Qualifying Exam by the American Board of Surgery, in that it accepted applicants from all over the world, providing that they had met certain predetermined requirements set forth by the UEMS. Actually, in our previous study, we have already shown that Part 2 EBPS graduates trained in 33 different countries, including 12 countries of the European Union [3]. This implies that the EBPS is gradually being recognized internationally as the only universal benchmark exam in pediatric surgery currently being offered. With increasing standardization in the future using validated text-based questions for Part 1 and standardized OSCE scenarios for Part 2, we anticipate that this trend will continue and that it will eventually serve as an alternative for or even replace national exit examinations across Europe and beyond. This may foster the international exchange of pediatric surgeons among countries in the future.
In our study, most candidates that had passed Part 2 were under the impression that it helped them with career advancement. Those individuals also had higher Career Success Scale scores. Overall, the cohort was academically highly productive, despite the fact that a minority actually practiced in university hospitals. Also, the mean CSS score of all participants, regardless of whether they perceived the EBPS to be helpful or not, was substantially (threefold) higher than the resulting score of 1.76 +/- STD 2.33 from the cohort of 406 physicians used to validate the CSS the original publication by Buddeberg-Fischer et al. [4].
The CSS is tool that was validated in a prospective Swiss cohort study in a sample of 406 young physicians in their sixth year of residency. It is considered to be a short and reliable instrument to measure career progress by objective criteria [4]. The CSS is based on the premise that research productivity is the most relevant factor for pursuing a relevant medical career. Since the evaluation of career performance in the CSS mainly focuses on research activities, grants, publications, it does not incorporate clinical productivity or reputation. Despite its drawbacks, for lack of an alternative, we considered the CSS the only way to assess career advancement in our cohort.
Interestingly, the mean score the CSS for all candidates in our cohort was much higher than the CSS scores reported previously on young physicians, or boarded women surgeons [7, 8]. This finding goes hand in hand with the surprisingly high academic publication and presentation activities found in our subjects. Perhaps those pediatric surgeons interested in taking the EBPS are also the ones who are motivated to do research and have higher career aspirations than those who do not wish to sit for the exam. Strangely, however, with regard to the third party funding, we found no differences between those who perceived the EBPS examination to be helpful or not, despite the importance to acquire funding for general career progression [9].
Another important factor positively influencing career advancement is mentorship. It has been described as crucial for personal development, career guidance, career choice and career success in the literature, and a core component to pursue an academic career [10, 11]. Since EBPS has been around for two decades, older, established EBPS certified surgeons may be inclined to mentor younger EBPS graduates and thus help with building their careers.
Our study has several limitations. Our response rate of 53% to the on line questionnaire is in line with other similar studies. However, only 58% of the respondents completed all items of the questionnaire. We believe that this study serves as the basis of future prospective investigations on the impact of passing the EBPS examination. Also, we were unable to include a comparison group. It would be interesting to compare the CSS of those who passed the examination to those who failed it. Motivating those who failed the examination to participate in an online survey may be a challenge, however.