EFAS Certification Examination

European Foot and Ankle Society (EFAS)

EUROPEAN CERTIFICATION IN TRAUMA AND ORTHOPAEDIC FOOT AND ANKLE SURGERY

Following Examination on 12th October 2016 in Malmö, Sweden
Dr. Med Helka Koivu
Was awarded Certification by the EFAS Certification Board

Congratulations to Dr. Koivu

Apply for the 2017 Certification Examination

2017 EFAS Certification Examination will be scheduled on 27th September 2017 in Lisbon, Portugal, prior to the 6th EFAS Advanced Symposium and 6th IFFAS Triennial Meeting.

 

The primary aim of the development of a European Certification process in Trauma and Orthopaedic Foot and Ankle Surgery is to promote the highest standard of practice in our field of expertise to benefit patients.

There are many secondary benefits. Surgeons who complete this process will have a general understanding of the knowledge and surgical skills required but the standard shall be placed at specialist level providing complete confidence in our art and science for the patients that we treat.

In addition, this shall promote educational and scientific research in basic science, paediatric, adult and traumatic foot and ankle surgery. By reinvestment the training of young surgeons interested in pursuing a career in trauma and orthopaedic foot and ankle surgery shall be facilitated.

Certification requires a basic postgraduate trauma and orthopaedic qualification, evidence of at least 5 years practice in the speciality with an associated ratified logbook and a knowledge base and practical skills based on the developed curriculum. EFAS has developed specific further criteria based on meeting attendance, publications and fellowships. When the Certification Board is happy that the entry criteria are fulfilled the candidate shall proceed to the examination involving a Multiple Choice Questionnaire (MCQ) and Viva. After a pass is awarded a recommendation will be submitted to the Union of European Medical Societies (UEMS) for their ratification. However, this certificate will remain as an additional qualification to the examinations in individual European Countries and will be complimentary to the more general trauma and orthopaedic awards, for example, EBOT.

It is the wish of the European Foot and Ankle Society to remain at the forefront of these exciting developments and take our speciality proactively in to the future setting the standards for many years to come.


Don McBride

Chairman, EFAS Certification Committee




Table of content

Introduction

THE PROCESS FOR CERTIFICATION IN EUROPEAN TRAUMA AND ORTHOPAEDIC FOOT AND ANKLE SURGERY

A DOCUMENT PREPARED BY THE CERTIFICATION COMMITTEE AND COUNCIL OF THE EUROPEAN FOOT AND ANKLE SOCIETY MARCH 2014

Introduction

The primary aim of the development of a European Certification process in Trauma and Orthopaedic Foot and Ankle Surgery is to promote the highest standard of practice in our field of expertise to benefit patients.
There are many secondary benefits. Surgeons who complete this process will have a general understanding of the knowledge and surgical skills required but the standard shall be placed at specialist level providing complete confidence in our art and science for the patients that we treat. The process shall promote educational and scientific research in basic science, paediatric, adult and traumatic foot and ankle surgery. By reinvestment the training of young surgeons interested in pursuing a career in trauma and orthopaedic foot and ankle surgery shall be facilitated. It is the wish of the European Foot and Ankle Society to remain at the forefront of these exciting developments and take our speciality proactively in to the future setting the standards for many years to come. This document outlines the requirements for Certification and the examination process by which its award shall be achieved and sanctioned.

Certification committee

Introduction

The committee overseeing the process of Certification shall be subject to standard EFAS Committee regulations with the relevant periods of tenure.
The present Committee (2012-14) comprises the following -

Chairman
Mr DJ McBride Honorary Treasurer EFAS

Committee Members
Dr H Kofoed Past President EFAS
Mr I Winson Past President EFAS

Ex officio
Dr A Viladot President EFAS
Prof M Richter President Elect EFAS
Dr J Louwerens Immediate Past President EFAS
Dr Y Tourne Honorary Secretary EFAS

Examination Board
The Examination Board shall include the Certification Committee and all members of EFAS Council when each examination is taking place and shall include co-opted examiners as required. This board shall confirm the eligibility of candidates based on the entry criteria, shall prepare and conduct the examinations and shall be responsible for the award of a pass or fail based on a standard scoring system for the Multiple Choice Question (MCQ) paper and the Oral Examination (Viva). For the candidates who pass the Board shall be responsible for the recommendation to the Union of European Medical Societies (UEMS) for endorsement prior to the award of the Certificate.

Entry criteria

General criteria

Post Basic Trauma and Orthopaedic Examination and Training All candidates shall provide evidence of completion of the relevant Basic Trauma and Orthopaedic Examination and Training Certificate for their country of origin and shall have been in a Consultant Orthopaedic Foot and Ankle post or equivalent for at least 5 years. Logbook A complete logbook of surgical cases shall be required preferably electronically for ratification by the examination board before proceeding to the examination. Knowledge Base and Practical Skills This is discussed and clarified in detail in the section on Curriculum. However, candidates will be expected to maintain a high standard of knowledge and practical skills in the field of Trauma and Orthopaedic Foot and Ankle Surgery.

EFAS criteria

It has been agreed that the following additional EFAS criteria are required:

  • Meetings

    Evidence of attendance at 3 EFAS meetings shall be required. EFAS currently has Basic Instructional Courses, Cadaver Courses, and an Annual Meeting or Advanced Instructional Course each year. Ideally the candidate shall have attended each of these courses but variations may be acceptable and the final decision about proceeding to sit the examination shall be determined by the Examination Board.

  • Publications

    Evidence of at least two international publications in appropriate Journals on Foot and Ankle Surgical topics shall be required. Preference shall be given to those publishing in the Journal of the European Foot and Ankle Society.

  • Fellowships

    Evidence of appropriate Fellowship training in a Foot and Ankle Surgery Centre of Excellence is desirable but not mandatory at present. The Certification Board recognises that this is very variable depending on the country of origin of candidates and would not wish to disadvantage some EFAS members. The final decision shall rest with the Examination Board. However, in the future as the Certificate develops this will become a likely significant component of the proposed Advanced Specialist Certificate. A list of Centres throughout Europe has been collected but consideration may be given to other International Fellowships. The minimum time period is three months but this may include training for shorter periods in several centres.

  • Disclaimer

    Candidates will be asked to sign a disclaimer before proceeding to the examination that they agree that the Examination Board has the final say regarding pass or fail. There shall be no Appeals process. However, there shall be no limit to the number of times that a Candidate may present for examination.

Examination

Once a candidate has been accepted for examination the following process will occur, preceding the biennial meeting or advanced instructional course.

Written MCQ

The format will be a 1 hour multiple choice questionnaire comprising 50 questions with five options. A bank of questions has been developed by the examination board and shall be reviewed and updated regularly.

Oral examination

These will be aligned to the Curriculum and shall involve 20 minute sessions with two examiners, 10 minutes each. They shall include the following topics:

  • Basic science
  • Paediatric
  • Adult
  • Trauma
  • Foot and Ankle surgery

This format should allow the whole examination to take place in one day.

 

Certification process

Examination Pass

Once the candidate has satisfied the examiners and examination board, a pass and Certificate shall be awarded by EFAS. As previously agreed with UEMS this shall be ratified and sanctioned by UEMS. However,

Individual Countries

The Certificate shall be an EFAS award ratified and sanctioned by UEMS. Medico- legally, or through revalidation and recertification/licence conditions it may not be recognised initially in individual countries. However, it is expected that once established it will be seen as a benchmark in our particular area of expertise.

Honorary Certification

EFAS Council and the Certification Board have agreed that it would be appropriate to consider awarding an Honorary Certificate to European Foot and Ankle Surgeons of merit. This shall be drawn from the previous list of Executive and Council Members who were democratically elected and who have been active in EFAS and its committees.

Fees / Costs

Fees

These shall be determined by the examination board in conjunction with the Honorary Treasurer. An initial fee of €850 has been recommended.

Examination Entry Criteria

Entry criteria

  • Post Basic Trauma and Orthopaedic Examination and Training

    All candidates shall provide evidence of completion of the relevant Basic Trauma and Orthopaedic Examination and Training Certificate for their country of origin and shall have been in a Consultant Orthopaedic Foot and Ankle post or equivalent for at least 5 years.

  • Logbook

    A complete logbook of surgical cases shall be required preferably electronically for ratification by the examination board before proceeding to the examination.

  • Knowledge Base and Practical Skills

    This is discussed and clarified in detail in the section on CURRICULUM. However, candidates will be expected to maintain a high standard of knowledge and practical skills in the field of Trauma and Orthopaedic Foot and Ankle Surgery.

EFAS criteria

It has been agreed that the following additional EFAS criteria are required.

  • Meetings

    Evidence of attendance at 3 EFAS meetings shall be required. EFAS currently has Basic Instructional Courses, Cadaver Courses, and an Annual Meeting or Advanced Instructional Course each year. Ideally the candidate shall have attended each of these courses but variations may be acceptable and the final decision about proceeding to sit the examination shall be determined by the Examination Board.

  • Publications

    Evidence of at least two international publications in appropriate Journals on Foot and Ankle Surgical topics shall be required. Preference shall be given to those publishing in the Journal of the European Foot and Ankle Society.

  • Fellowships

    Evidence of appropriate Fellowship training in a Foot and Ankle Surgery Centre of Excellence is desirable but not mandatory at present. The Certification Board recognises that this is very variable depending on the country of origin of candidates and would not wish to disadvantage some EFAS members. The final decision shall rest with the Examination Board. However, in the future as the Certificate develops this will become a likely significant component of the proposed Advanced Specialist Certificate. A list of Centres throughout Europe has been collected but consideration may be given to other International Fellowships. The minimum time period is three months but this may include training for shorter periods in several centres.

  • Disclaimer

    Candidates will be asked to sign a disclaimer before proceeding to the examination that they agree that the Examination Board has the final say regarding pass or fail. There shall be no Appeals process. However, there shall be no limit to the number of times that a Candidate may present for examination.

Curriculum

Curriculum for Certification in Trauma and Orthopaedic Foot and Ankle Surgery in Europe

Introduction

The purpose of this curriculum is to provide a basis for the certification of young trainee trauma and orthopaedic surgeons specialising in foot and ankle management and surgery. It is clear that there may be a case for separating trauma and elective foot and ankle surgery but they are quite significantly intertwined and although the emphasis may be different in different countries it has been deemed appropriate to provide this certification across the speciality. A similar case may be made about separating paediatric conditions eg. CTEV from adult conditions but, again, there is a continuum in to adult life and a basic understanding is invaluable to the adult foot and ankle surgeon treating their subsequent effects.

General Principles

The satisfactory practice of Trauma and Orthopaedic Foot and Ankle Surgery involves taking an adequate history, performing a thorough examination (evaluation), requesting appropriate confirmatory diagnostic tests and thereafter providing a comprehensive explanation of the conservative and surgical options available to the patient.
General knowledge may be obtained from relevant Books, Journals and Publications but it is accepted that some will be country dependent, and some generally available.
In addition, it has been suggested that further specific training in a Centre of Excellence or Fellowship Centre with a clinical supervisor would be complimentary to this curriculum with a minimum of 50 CME points over two years in foot and ankle surgery and a minimum of 2 peer reviewed foot and ankle papers in international journals. This is discussed elsewhere.
Evidence that the applicant has fulfilled these criteria shall be required and confirmation that they may proceed shall be determined by the examination board on an individual basis as previously outlined.
The following is a guide to the topics, which are likely to be encountered but is not intended to be exhaustive and is subject to change. It covers Basic Science applied to the Ankle and Foot, Paediatric, Adult Orthopaedic and Traumatic Foot and Ankle Surgery.

Basic Science

  • Anatomy

    Clinical and functional anatomy with pathological and operative relevance to the foot and ankle, anatomy of the nervous and vascular systems in the foot and ankle including surface markings, surgical approaches to the foot and ankle, bones and articulations, ligamentous structures (ankle, hindfoot, midfoot, forefoot, plantar fascial and MTP anatomy, tendon anatomy and muscle compartments in the foot.

  • Biomechanics/Bioengineering/Prosthetics and Orthotics

    Function of the lower limb and foot in gait including kinematics and gait analysis, ankle and subtalar joint biomechanics, plantar fascial mechanisms, tendon function, biomaterials, implant design and implant failure, tribology of natural and artificial joints, principles of design of prosthetics/orthotics, prescription and fitting of standard prostheses, principles of orthotic bracing for control of disease, deformity and instability, orthoses and footwear.

  • Research and Audit

    Design and performance of clinical trials, data analysis and statistics (principles and applications), principles of epidemiology and statistics and audit.

  • Medical Ethics

    Duties of care, informed consent and medical negligence.

Pathology

  • General

    Osteoarthritis (primary and secondary), osteoporosis/osteopaenia, metabolic bone disease, rheumatoid arthritis and other poly-arthropathy, inherited musculoskeletal disorders, neuromuscular disorders (inherited and acquired) and osteochondral lesions.

  • Neuropathy/Neurological disorders

    Diabetic foot, Charcot neuro-arthropathy, Morton’s neuroma, Nerve entrapment eg tarsal tunnel syndrome. neurological foot deformity, neuropathic joint and skin changes.

  • Tumours

    Knowledge of the presentation, radiological and pathological features, treatment and outcome for common benign and malignant tumours in the foot and ankle. Knowledge of the presenting features, management and outcome of soft tissue lesions including sarcomas.

  • Specific

    • Ankle and Hindfoot

      Hindfoot pain, ankle instability, heel pain, degenerative disease of the ankle, rheumatoid arthritis, osteochondral lesions of the talus.

    • Forefoot Disorders

      Hallux valgus, hallux rigidus, lesser toe deformities, metatarsalgia, inflammatory arthropathy.

    • Complex Foot and Ankle Deformity

      Flatfoot deformity (mobile and rigid, childhood and adult acquired), cavus and cavo- varus deformity, residual congenital foot deformity.

Investigation

Relevant blood tests, musculoskeletal imaging: x-ray, contrast studies (arthrography), CT, MRI, ultrasound, radioisotope studies, effects of radiation, bone densitometry, electrophysiological investigation.

  • Radiographs

    Standard foot and ankle radiographs, additional foot and ankle radiographs.

  • CT, MRI, Ultrasound and Nuclear Medicine

    Knowledge of the role of these ancillary investigations in certain specific conditions eg. Infection, tumour, tibialis posterior dysfunction, osteonecrosis.

  • Electrophysiology

    Relevance to foot and ankle disorders.

Management

Non-operative

Prosthetics and orthotics, footwear, physiotherapy, medical podiatry.

Operative

  • General

    A detailed knowledge of closed and operative methods for the management of fractures and dislocations of the ankle, hindfoot, midfoot and forefoot.
    A detailed knowledge of common reconstructive surgical procedures for foot deformity for example hallux valgus, lesser toe deformity, acquired adult flat foot include arthroplasty, arthrodesis, osteotomy and soft tissue reconstruction
    Knowledge of common amputations in the foot and ankle
    Knowledge of common reconstructive surgical procedures for degenerative and inflammatory disorders of the ankle and foot including arthrodesis, arthroplasty and excision arthroplasty and interventions in the first ray both proximal and distal for the management of hallux valgus and rigidus

  • Operative Topics

    Tourniquets (thigh and calf), design of theatres, skin preparation, anaesthesia (principles and practice of local and regional anaesthesia and principles of general anaesthesia).

  • Infection, VTE and Pain

    Infections of bone, joint, soft tissue, including TB, and their prophylaxis, sterilisation, VTE (prophylaxis and bleeding risk), behavioural dysfunction and somatisation, AIDS and surgery in high-risk cases, pain and pain relief, complex regional pain syndromes eg RSD, compartment syndrome in the foot and ankle.

Trauma

  • Wound Management

    It is considered that a detailed knowledge of plastic surgical techniques is not required but it is appropriate to have a basic understanding of the following:
    Free flap, full thickness skin graft, muscle flap, nerve repair, pedicle flap, transpositional flap, split skin graft, wound closure (delayed primary or secondary), wound debridement, removal of foreign body from skin or subcutaneous tissue.

  • Tibia and Fibula

    It is considered that a detailed knowledge of the following surgical techniques is not required by some practising orthopaedic foot and ankle surgeons but it is appropriate to have a basic understanding of the following:
    Diaphyseal tibial fractures external fixation (including frame), diaphyseal tibial fractures intramedullary nailing, diaphyseal tibial fractures MUA and POP, tibial shaft plating, tibial non-union, tibial non-union circular frame management, tibial non-union intramedullary nailing +/- bone graft.

  • Ankle

    Ankle fracture/dislocation classification (Lauge-Hansen, Weber, AO), ankle fracture/dislocation MUA and POP, ankle fracture/dislocation ORIF, Pilon fracture, Pilon fracture ORIF, Pilon fracture with circular frame, Tendo Achilles (Percutaneous, open).

  • Foot

    Amputation toe/ ray for trauma, calcaneal fracture (ORIF, external fixation, arthroscopically assisted, minimally invasive), talar fracture (ORIF), metatarsal fracture ORIF eg Jones fracture, phalangeal fracture MUA +/- K wire +/- ORIF, talar, subtalar or midtarsal fracture/dislocation, talar, subtalar or midtarsal fracture/dislocation MUA +/- POP +/- K wires, talar, subtalar or midtarsal fracture/dislocation ORIF

Elective

  • Elective – Nonspecific

    Aspiration/injection joint, benign tumour excision, biopsy bone (needle, open), bursa excision, ganglion excision, bone cyst curettage +/- bone graft, malignant tumour excision.

  • Ankle

    Supramalleolar osteotomy, arthrodesis ankle (open or arthroscopic), arthroplasty ankle, arthroscopy ankle diagnostic (anterior and posterior approaches), arthroscopy ankle therapeutic eg talar osteochondral lesions, arthrotomy ankle, ankle instability including medial and lateral ligament reconstruction and repair, subtalar arthrodesis (open or arthroscopic), triple arthrodesis (open or arthroscopic), Choparts arthrodesis, decompression or reconstruction of tendons at the ankle eg. Tibialis posterior dysfunction (FDL transfer, Cobb reconstruction and allied procedures), tendon transfers, dislocation of the peroneal tendons – relocation, Tendo Achilles surgery including late repair, decompression and lengthening.

  • Foot

    Amputation toe /ray, Calcaneal osteotomy, CTEV correction, Ponseti management, spring ligament reconstruction, plantar fascial reconstruction, repair or release, midfoot arthrodesis including medial column shortening and lateral column lengthening, wedge tarsectomy, first metatarsal osteotomy – proximal (including Lapidus), distal, Scarf, proximal phalangeal osteotomy (Akin), first MTPJ cheilectomy, first MTPJ arthrodesis, first MTPJ excision arthroplasty, first MTPJ soft tissue correction, lesser metatarsal osteotomy, elongation or shortening of metatarsals, lesser toe arthrodesis eg hammer toe, curly toe, clawed toe, lesser toe excision part/all phalanx, lesser toe tenotomy, fifth toe soft tissue correction, bunionette surgery, surgical management Morton’s neuroma, surgical management Freiberg’s disease, forefoot reconstruction and arthroplasty, tendon decompression or repair, tendon transfers, minimally invasive surgery in the foot and ankle.
    Ingrowing toenail surgery. It is accepted that this condition may not be treated by Orthopaedic Foot and Ankle Surgeons throughout Europe.

Past certifications

Following Examination on 15th October 2014

Dr. med Jurgen Goetz
Dr. med Joris Hermus

Were awarded Certification by the EFAS Certification Board. Congratulations!


Dr. med Juergen Goetz, Germany


Dr. med Joris Hermus, The Netherlands