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European Journal of Internal Medicine 21 (2010) 1

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European Journal of Internal Medicine

j o u r n a l h o m e p a g e : w w w. e l s ev i e r. c o m / l o c a t e / e j i m

Commentary

European examinations in internal medicine

Colin G. Semple a,, Stefan Lindgren b

a b

Section of Internal medicine, Southern General Hospital, Glasgow, Scotland, UK Gastroenterology­Hepatology Division, Department of Medicine, Lund university, University hospital MAS, SE-205 02 Malmö, Sweden

The European Board of Internal Medicine (EBIM) is a joint venture between the UEMS Section of Internal Medicine and EFIM. In 2005, a decision was made to promote a Diploma in Internal Medicine in order to provide an assessment of the core knowledge required of trainees in this specialty. The Diploma is built on documented knowledge in Internal Medicine together with a support for the candidate from his/her National Society regarding completion or near completion of specialist training in Internal medicine and confirming that the candidate currently holds a post covered by UEMS/EFIM [1]. The development of modern quality assured examinations is expensive and time consuming and it was considered appropriate to use the expertise developed by others rather than start an examination de novo. After an investigation of the examinations available it was decided to work in collaboration with the MRCP organisation which runs English language examinations for internists [1]. The examination was a multiple choice question (best of five alternatives) two-part paper and was available in five major capitals in Europe. There was an appreciation that some European countries already have their own assessment methodology but it was also clear that quite a few countries do not. Assessment of trainees does not relate purely to core knowledge but also to skills and professional attitudes. There was always a clear understanding that the Diploma provided only one part of the overall assessment of a trainee's competence. It was hoped that national organisations might incorporate a European diploma into a wider assessment of their trainees. Unfortunately, the uptake of the examination has been poor and does not merit its continuation at the present time [1]. EBIM is unclear as to what form of knowledge based assessments are carried out in European countries and this is perhaps a body of work that could usefully be undertaken. Increasingly our patients expect us to show

that our specialists are competent to practice and EBIM still believes that there is a place for knowledge based assessment. Whilst it may be that each country can design its own assessment system it seems that there would be merit in having a uniform basic assessment, which national authorities might use and add to as they feel appropriate to the practise of Internal Medicine in their own country. Harmonising training across Europe is considered desirable by most commentators. This poses considerable difficulties which are more pronounced in the case of Internal Medicine than for other specialties. There are a number of reasons for this. The role of the Internist varies considerably across Europe. In some countries they are largely office based and provide care directly to presenting patients. In other countries they are more inpatient based and their main role is to care for the acutely ill patient with a general medical problem. The diseases that are cared for by Internists vary from one country to another and the curriculum of training is likely to differ accordingly. Nevertheless, it seems to EBIM that there may still be value in having a core knowledge based assessment which national authorities might supplement with additional questions or assessments which are particularly relevant to their own training structure. At this stage a European Diploma is not viable, but if there was enthusiasm from national authorities to have a European wide assessment EBIM would be prepared to revisit this.

Reference

[1] Duckit R, Durusu Tanriover M, Bosanka L, Dagna L, Vardi M. The European Diploma of Internal Medicine -- perspectives on the exam from across Europe. Eur J Intern Med 2010;21:46­7.

Corresponding author. E-mail address: [email protected] (C.G. Semple). 0953-6205/$ ­ see front matter © 2009 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved. doi:10.1016/j.ejim.2009.10.006

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