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Helpful experience with the European Board of Orthopaedics and Traumatology exam
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Having successfully passed the European Board of Orthopaedics and Traumatology fellowship exam, I decided to write about my experience. During pre-exam preparation, it was difficult to find reliable information about the exam and how to prepare for it. The official EBOT website gives clear guidance for the application process, but the information about the examination day and previous exams experience might not be enough to give candidates the adequate understanding needed to successfully pass the exam. It was unfortunate that none of my colleagues appeared for this exam before me, which made the preparation process difficult and without insight into what was expected of me as a candidate.
During the exam days I met other candidates, some of whom were re-sitting for the exam. Apart from advice received from their colleagues, these candidates agreed there is a shortage of guidance on exam preparation and what is expected during the exam day. This article is intended to help candidates prepare for the exam and have a better understanding of the examination process.
EBOT exam
The EBOT exam is a specialist exam in trauma and orthopaedics. It is aimed to assess basic knowledge and management skills across orthopaedic specialists in Europe who have completed the orthopaedic training in their respective countries or who are about to finish their training. EBOT exam stands at the same level as the American Board of Orthopaedic Surgery and the British FRCS (Tr & Orth) exams. It requires the full extent of knowledge of trauma and orthopaedics. Candidates are expected to be able to diagnose and manage common trauma and orthopaedics conditions and to deal with complications related to these conditions. They should have a sound knowledge of the uncommon trauma and orthopaedic presentations and safely initiate the investigation and management of such conditions.
The EBOT examination is carried out once a year and it consists of two parts; Part 1 involves computer-based multiple-choice questions. Candidates are expected to answer 100 multiple-choice questions (MCQs) within a set period of time, which cover a broad aspect of the orthopaedic curriculum. Candidates can sit for the exam in their respective European countries on the same day across Europe at various dedicated centers. Once the candidate successfully passes Part 1, he or she is invited to attend the second part of the examination, which is the oral examination. It takes place in a different European city each year during 1 weekend, usually in October.
Candidates for the EBOT Examination
Candidates sit the EBOT exam to mark the end of their specialist training in preparation for the next step in their career as a specialist (consultant). Some candidates elect to sit the EBOT exam for its prestigious well-known international value to boost their curriculum vitae (CV) to practice in a different country. Surgeons also elect to go for the EBOT exam to enhance their CV at local and international levels.
Regulations and guidelines
The exam eligibility has evolved during the last 15 years. Candidates from European Union (EU) countries, as well as candidates from non-EU countries who practice in the EU who have completed or neared completion of their final orthopaedic training can sit the exam if they can provide reference from their program director or clinical supervisors regarding their clinical orthopaedic knowledge and their level of training. Initially, there were no restrictions on non-European orthopaedic doctors who do not practice in the EU to sit the exam. However, in the last few years, it became required from non-EU candidates to have European working experience before being eligible to sit the exam. The application process is simple. Instructions on the required documents are available on the EBOT website.
The exam day: Part 1
Part 1 is MCQs, which is usually held in June every year. It is a computer-based exam, available to be taken at several centers across Europe. Once an application is accepted, the candidate is given instruction on how to book the exam online. The exam is currently hosted by Pearson Vue test centers and candidates are given a choice of the available centers in Europe.
Candidates are expected to arrive at least 30 minutes early at the test center to have an identification (ID) check. There will be other center visitors for different exams and activities on the day. The admission process is simple and does not typically disrupt other users of the center.
Those who sit for the exam should wear comfortable clothing. Once the candidate’s ID is checked and the admission process is finished, he or she is guided into the exam room and to a computer cubicle/partition to start the exam. Candidates are not allowed to enter the exam room with any belongings except an ID document. There are lockers to store any belongings. Clear instructions and guidance are given on the screen before starting the actual exam. The computer system provides the option to flag a question for later review or to review all the questions before submission. Once the exam begins, 2 hours are allowed to finish it. There is an inspector and security cameras that overview the exam room. After the exam, candidates sign out and should leave the building immediately. Results will be emailed to all candidates in 2 to 4 weeks. I received my results in 2 weeks. Candidates must pass Part 1 before being eligible for Part 2.
The exam day: Part 2
Part 2 of the exam is usually held in October. Unlike Part 1, it is held at one center in a different European country each year. My exam was held in a hotel meeting room in Barcelona, during which four batches of candidates were examined for 2 days. Although it is not an official requirement, I recommend dressing formally for this part of the exam because it will reflect on your professionalism and help boost your confidence.
At the start of the day, the exam committee welcomed the candidates and briefed us about the regulations. The exam was well organized; we were guided by the organizers throughout the exam process. The official language is English; examiners were from several European countries and most of them spoke fluent English.
We rotated through five stations focused on upper limb, lower limb, basic science, pediatric and spine. The order of the rotation was given at the beginning of the exam. Two examiners were present at each table and they each took turns questioning each candidate for 15 minutes. Candidates were then asked to leave the exam hall while the examiners recorded the scores, which was about 5 to 10 minutes, and they were called into the exam hall again for the next viva. A 30-minute break occurred between each of the five viva tables, and refreshments were available throughout the day. All candidates were invited to a reception buffet at the end of the last exam day. Candidates were given the choice either to wait for the results, which were handed out at the end of the last exam day, or have their result mailed to their home address.
Viva questions
The examiners used different exam modalities. Some of which had clinical images and radiographs on their laptop, some questions were in-depth discussion of one topic and others skimmed through different topics. Most of the questions were aimed at the core knowledge of the speciality. The examiners were professional and allowed candidates sufficient time to think about their answers and would prompt a candidate if needed. At my upper limb table, I was asked about shoulder arthritis, rotator cuff injury and distal radius fracture. While at the lower limb table, I was asked about hip arthritis, neck of femur fracture and knee sports injury. At the pediatric table, one examiner skipped through many clinical images asking a couple of questions per case. The other examiner focused on septic arthritis, Perthes disease and slipped capital femoral epiphysis. Examiners at the basic science table questioned me on rheumatoid arthritis, osteoporosis, statistics and bone healing. My last table was spine. The examiners presented me with radiographs and MRIs of discitis, scoliosis, disc prolapse and spinal fractures and questioned me about investigations and management for each case.
How to prepare for EBOT: Part 1
Preparation for this exam is like any other exit exam. It starts at first day of the orthopaedic residency. This exam requires, in my opinion, at least 5 years of orthopaedic training to achieve the expected level of clinical knowledge. During these years, you should read textbooks, journal articles, as well as general orthopaedic knowledge updates. In the 6 to 12 months before the exam, a candidate should focus on revision books and question books; at this stage, textbooks should be used for reference only. The most widely used revision books for similar exams are the AAOS Comprehensive Review series, Miller’s Review of Orthopaedics and the Postgraduate Orthopaedics book series.
The European Federation of National Associations of Orthopaedics and Traumatology (EFORT)[9] has invested considerably in developing European orthopaedic curriculum and the European Orthopaedics & Traumatology Education Platform (EOTEP)[10]. The Federation of Orthopaedic Trainees in Europe (FORTE)[11] and European School for Training in Orthopaedics (ESTRO)[12] can also provide valuable additional orthopaedic training. Along with other materials to enhance the orthopaedic training in Europe, candidates should make use of these resources early in their training years in conjunction with the local training program.
Recently, EFORT introduced the interim exam, in which European trainees are allowed to sit a yearly exam during their training years to encourage them to read and prepare for the final exam early in their training. EFORT has encouraged European centers to take part in this exercise, which I think is a good opportunity for EBOT candidates to have a mock exam before their actual EBOT exam. Unfortunately, you cannot register for the interim exam as an individual. The orthopaedic trainee’s hospital must be registered before the trainee can be registered. Therefore, I advise you to contact your department administration and encourage them to register for your benefit, as well as that of your colleagues.
Part 1 was one of the most difficult exams I have encountered. With many questions that were new and needed deep thinking, I was pressed for time and hardly had any time left to review the questions I flagged for later review. Many questions were anatomy-based. I knew those well, but many others were about diseases and syndromes for which I want to well-prepared. Therefore, I advise starting early, at least 6 months before the exam, and going over as many MCQs as possible. The main online MCQ bank is Orthobullets. In addition to that website, there are several MCQ books and other online sources. MCQ books that target FRCS (Tr & Orth) candidates in the United Kingdom can be used to prepare for this exam. During the early months of the revision, use the questions as a study guide to direct you to the areas where your knowledge is deficient. Once it is closer to the Part 1 exam, try to master the technique and time yourself to avoid running out of time during the actual exam. Before the Part 1 exam, do not need to worry much about Part 2 except as it applies to gaining knowledge. There will be 3 months after the Part 1 results and before the Part 2 exam, which is sufficient preparation time.
How to prepare for EBOT: Part 2
Overall, preparation for the part 2 exam is different. In addition to the difference in the knowledge needed, a candidate must demonstrate understanding and logical thinking. This part of the exam tests clinical skills and judgement. To be prepare for it, a candidate must practice viva questions, and there are viva question books available for revision. My advice is to form a revision group for this purpose that ideally consists of two to three people. Keep in mind that candidates are not only asked about the knowledge, but they are assessed on how they present their knowledge and thought process. Therefore, practicing viva is important. It is also valuable to schedule a mock viva session with senior colleagues, which will help candidates develop a polished performance, have realistic expectations about the questions asked and provide them with feedback on their performance.
In the U.K., there are several viva revision courses for candidates who are preparing for FRCS (Tr & Orth), which are helpful for EBOT exam preparation, as well. Similar courses are held in United States for board exams. One of the important revision courses is the EFORT Comprehensive Review Course (CRC), which is usually held during the annual EFORT Congress at the same venue as the congress. It is usually held 2 to 3 weeks before the Part 1 exam to serve as a final revision course and the CRC can be registered for separately without registering for the full EFORT Congress. It is a 1-day intensive review course with multiple lectures that cover important topics of the syllabus and recent knowledge updates. The lectures are printed in a CRC book, which is given to the candidates during the course.
Previous CRC books are accessible online on the EFORT website under the Education and Courses tab [14]. The FORTE (Federation of Orthopaedic and Trauma Residents in Europe) Summer School, now in its third year, also offers an opportunity to prepare for the exam in advance, either through the comprehensive review course or, for those whose exam date is sooner, through the exam preparation course. The Summer School, which is supported by all the European specialist societies, provides lectures and workshops from internationally renowned speakers and has a scientific program that is sponsored by EFORT, which takes place during 1 week in an immersive environment. Each year, it is attended by more than 100 trainees from more than 20 European countries.
This is not an easy exam and should not be taken lightly. Prepare well, aim to pass from the first attempt and give yourself plenty of time. Good luck.
- References:
- Andersen PK. Passing specialty medical examinations enhances patient safety. Orthopaedics Today Europe; Issue 5; 2012.
- Banaszkiewicz PA. Postgraduate Orthopaedics: The Candidate’s Guide to the FRCS (Tr & Orth) Examination. 3rd ed. Cambridge, United Kingdom. Cambridge University Press; 2018.
- Boyer MI. AAOS Comprehensive Orthopaedic Review 2. 2nd ed. Illinois; American Academy of Orthopaedic Surgeons; 2014.
- EFORT Comprehensive Review Course. www.efort.org/education/advanced-training-programme/crc/
- www.forteortho.org
- Mäkinen TJ, et al. Eur Orthop Traumatol. 2014;doi:10.1007/s12570-013-0232-0.
- Mineiro J. The first decade of the Fellowship Examination of the European Board of Orthopaedics and Traumatology (EBOT Exam): A prestigious orthopaedic-traumatology qualification in Europe. EFORT newsletters; 2010.
- Thompson SR, Miller MD. Review of Orthopaedics. 7th ed. Philadelphia, PA; Elsevier; 2016.
- www.ebotexam.org
- www.efort.org
- www.efort.org/education/eotep-framework/
- www.estroproject.eu
- www.orthobullets.com
- www.pearsonvue.com
- For more information:
- Sherif Elnikety, FRCS (Orth), MD (Res), can be reached at Trauma and Orthopaedics Department, Royal United Hospital, Bath, United Kingdom BA1 3NG; email: selnikety@nhs.net.
- Daniel Ryan, MRCS, MFSTEd, is national medical director’s clinical fellow at Royal United Hospital, Bath, United Kingdom BA1 3NG. He can be reached at: email: danny.ryan@cantab.net.
Disclosures: Elnikety and Ryan report no relevant financial disclosures.