European Panorama on Vascular Surgery: Results from Five Years of FEBVS Examinations

Abstract

(Angiol Cir Vasc vol. 15 no. 3 set. 2019) Objective: The Fellow of the European Board of Vascular Surgery (FEBVS) examination is a comprehensive exam for Certified Vascular Surgeons or General Surgeons with Vascular Certification. It includes a thorough assessment of vascular pathology knowledge, and includes critical analysis of diverse clinical cases and vascular subjects (clinical viva), critical review of an academic paper, and direct open and endovascular skills examination in independently validated simulators. It is, therefore, increasingly seen as a quality standard for International Vascular Specialists, so that it currently represents the final exam for Vascular Surgery Certification in countries including the Netherlands and Switzerland. Through this work, a critical review of the results of 10 FEBVS examinations was performed. Methods: Data on the results of open technical skills assessment (aortic anastomosis, distal anastomosis, and carotid endarterectomy), endovascular technical skills assessment, clinical viva, and academic paper analysis were collected from 10 consecutive FEBVS examinations. Candidates’ demographic characteristics were also reviewed. A review of both global and specific failure rates, as well as their behaviour throughout the years was performed. Results: Three hundred consecutive candidates, who performed their vascular training in 26 countries, were assessed in 10 different examinations performed over a period of five years (2014 – 2018). Most candidates were male (77.7%), with a mean age of 36 years. The majority of candidates were from the Netherlands (24.1%), although Germany (13.4%), Spain (12.4%), and the United Kingdom (11.4%) had significant representation as well. The global failure rate was 28.3%, and 5.3% of the candidates were granted “honours” for outstanding performance (global score > 90%). Of the failed candidates, 21.2% repeated the exam, with a global pass rate of 56.1%. In terms of the individual assessments that constitute the exam, failure rate was significantly higher in the academic paper review (24.7%), compared with technical open (16%), technical endo (14%), and clinical viva assessments (15.5%). Regarding each of the individual skills evaluated in the open technical section, the failure rate was significantly higher in the aortic anastomosis (29.3%), compared with distal anastomosis (16%) and carotid endarterectomy (17.6%). More importantly, a progressive increase in the failure rate in aortic anastomosis assessment was observed through the years (Fig. 1), in accordance with the known perception of progressive loss of open aortic skills among young physicians. Portugal represents only 4.2% of all FEBVS candidates, with a pass rate of 100%. Conclusion: The FEBVS examination is a comprehensive exam that independently assesses both theoretical and technical knowledge. The failure rate is high, although the existence of “honours” confirms a balanced difficulty level. An alarming loss of open aortic skills is noticeable and reinforces the need for simulation training in such territory. Keywords: FEBVS, Training, Vascular surgery