Z. Rahimtoola. The Anglo Dutch Way to the European Boards. Nederlands Tijdschrift voor Plastische Chirurgie, 2016, 1
The Anglo Dutch Way to the European Boards
WHITE BOOK ONHAND SURGERY IN EUROPEEUROPEAN BOARD OF HAND SURGERY
Does succeeding the European Board of Hand Surgery (EHBS) examination make one a hand surgeon? In my humble opinion it does not. It does, however, bring a dedicated hand surgeon a sense of academic completion and personal confidence with direct relevance to his or her daily practice in hand surgery. Since the Federation of European Societies for Surgery of the Hand (FESSH) was founded in 1996 the FESSH exam was intended to be "a mark of excellence and of recognition for fulfilling the high standards required by the EBHS".  Indeed the emphasis should be on "a mark of excellence" but taken into the context of an individual surgeon who has been fellowship trained clinically and has chosen a dedicated career in hand surgery. Multiple accredited clinical fellowships, ongoing years of practice of hand surgery with demonstrable outcome data, research and publication all form additional markers of excellence. The EBHS examination simply tests your knowledge and dedication but by no means reflects your competency and skill as a hand surgeon. Having said that it has become a tool in advising the representative surgical societies in Europe of who has reached an appropriate standard of hand surgical care. It has also become (albeit somewhat politically and economically driven) an instrument for both the British and the Dutch Hand societies, respectfully, to informally advise on who should be recognised as a "practicing hand surgeon". Nevertheless, the EBHS examination is, today, the only international exam available to all hand surgeons who have met certain standards and stringent entry criteria. These criteria are well published in the "White Book on Hand Surgery in Europe"  and the purpose of this article was not to repeat or comment on them. The purpose of this invited short letter was to provide a guide onto how to approach and hopefully pass the EBHS examination using some of the "Anglo Dutch" resources available.
As European advisor and faculty member of the British Instructional Courses committee (British Society of Surgery of the Hand, BSSH) [3,41 and dedicated member of the Netherlands Society for Surgery of the Hand (NVVH) , I am in a unique position to offer advice to both camps of the channel on what is worthwhile preparation for the EBHS examination. It is most definitely not a "one size fits all" strategy and any exam preparation requires personalised tailoring. After submission of your EBHS examination application (deadlines usually in November) and pending your acceptance (usually in January) I encourage you to start your revision for the theoretical part of the examination as soon as possible. This part is usually held in March of the subsequent year at one of the designated EBHS recognised centres. I have not provided any key books in the reference other than Green's Operative Hand Surgery  which is considered the EBHS official examination textbook. I would, however, suggest choosing one or two other textbooks that suit your reading style and learning affinity best. Six weeks prior to the theoretical part consider the various multiple choice tutorials offered on line to test your competency (American Academy for Surgery ofthe Hand, AS SH and Orthobullets). [7,8] Sixty to 75% hit rate at this revision point and you are on the right track.
During this theory learning phase previous attendance to some of the British Instructional Courses can be useful but they do not compensate for the more important home type study. Furthermore, the courses are held twice a year in a three year cycle which makes them more suitable for any national orthopaedic or plastic surgery training exit exams, hence making them less attractive for the EBHS examination but are compulsory for the British Hand Diploma.
During my service on the committee and what proved to be extremely valuable, was a mock viva voce session ("proef tentamen") of the EBHS examination held during the instructional courses. This consisted of an introductory lecture on the details of the examination, sample multiple choice questions and a dedicated group of senior hand surgeons examining at various stations on all topics covered in the EBHS examination. It gave the pre exam candidates a wonderful opportunity to test their previously acquired knowledge in a practical setting according to the format conducted in part two of the EBHS oral examination. In the time between the theory and oral parts of the exam (usually held in June) the accent of your revision should change from textbook learning to discussion type learning. The American Journal of Hand Surgery offers excellent sections on evidence-based practice and current concepts which will provide you with a good overview on various topics and further discussion material.  With all this in mind, the board members of the NVVH and I are talking about organising similar mock examinations during the spring meetings of the Dutch society. This should provide some valuable pre exam experience for the orals of the EBHS examination and prepare you for the exam style expected. The proposed faculty members of this simulated EBHS exam are all members of the society and possess different orthopaedic and plastic surgery backgrounds having already succeeded the EBHS examination in the past.
I hope these breakout sessions during the meetings will be as useful and beneficial to the all Dutch/Benelux members as it was in Manchester and I still have to meet a candidate yet who did not enjoy the sessions. What started for us at the BSSH as a free mock exam has recently become a payable tutorial with a maximised number of delegates from all over Europe to accommodate for the overwhelming enthusiasm.
On a final note, completing the EBHS examination is a socio-professional challenge for all those who consider it but it may well be the most enjoyable reading, academically fulfilling and hopefully last exam you will ever take again.
- M. Calcagni. The European Board of Hand Surgery Examination. Journal of Hand Surgery (European Edition). 2013;692-5.
- FESSH. White Book on Hand Surgery in Europe EBHS. FESSH, 20131-17.
- BSSH. British Societyfor Surgery ofthe Hand, www.bssh.øc.uk
- www.jhs.sagepub.com 5. NVvH. Netherlands Society for Surgery of the Hand, www.handchirurgie.nl
- Green's Operative Hand Surgery 6th Edition.
Z.O. Rahimtoola MD, FRCS, PhD, EHBS Diploma
Orthopaedic Hand Surgeon, Royal Berkshire Hospital, UK