THE FEBOS-CR EXAM: A STEPPING STONE TO GREATER ACCOMPLISHMENT?

Given the already high bar to becoming an ophthalmologist, taking exams for subspecialties might seem excessive. But those who have sat for and passed the FEBOS-CR exam—an assessment of the knowledge and skills needed by cataract and refractive (CR) surgeons to perform difficult cases—say the test is worth the time and effort.

“Although it was challenging to take the exam when nobody had done it before, I think it was a great experience,” says Julio Ortega-Usobiaga MD, PhD, who sat for—and passed—the exam, which was developed by the ESCRS in conjunction with the European Board of Ophthalmology (EBO). “This exam proves you have a vast knowledge of this subspecialty. In addition, you must show, in English, that you can explain complex surgical cases and scientific literature before a board of eminent colleagues.”

Dr Ortega-Usobiaga is one of just 25 ophthalmologists who have earned the FEBOS-CR honorific. Nearly 150 ophthalmologists have applied to take the exam since its inception in 2017, and of those, only 57 were invited to sit for it.

The FEBOS-CR exam is one of a handful of European ophthalmic subspecialty exams, along with glaucoma, paediatric, and strabismus; others are in development. The goal of these exams is to harmonize ophthalmic education in Europe and define the expected level of knowledge and skills a subspecialist should acquire to solve complex, difficult cases.

“The level should be advanced, since the final goal is getting a structured fellowship programme in different fields of ophthalmic subspecialists in Europe,” says Marie-José Tassignon MD, PhD, who led the development of the exam and chairs the FEBOS-CR exam committee. “Successful candidates have shown high skills in education and surgical skills within their subspecialty and should be able to run clinical trials. This explains why the application process is a bit more daunting for the primarily surgically oriented subspecialisations like FEBOS-CR.”

Dr Ortega-Usobiaga concurs, saying the exam serves as proof of excellence in a specialised field that historically has lacked credentials to signify accomplishment.

“There is a clear pathway to be a physician in most countries,” he says. “There is also another pathway to be an ophthalmologist and even another to achieve a PhD. But there is not a clear path to be a subspecialist in most countries.”

To provide a “clear path,” EBO began to approach subspecialty scientific societies in Europe and request their assistance in creating exams. EBO reached out to the ESCRS in 2016 and asked for assistance in organising the FEBOS-CR exam.

“The ESCRS membership is composed of high-volume cataract surgeons in academic and private settings,” says Dr Tassignon. “This is the perfect mix out of which a committee can be created of colleagues who will define the curriculum considered to best fit what is expected of a candidate who potentially will finish a fellowship education and who can, in turn, eventually further evolve to become a trainer of fellowship programmes.”

Rudy Nuijts MD, PhD, who chairs the ESCRS Education Committee (which is responsible for the FEBOS-CR exam), confirms the ESCRS is committed to continuing this project, with a final goal of harmonizing criteria for defining fellowship standards across Europe.

“Currently, there are no formulated criteria, or consensus on a definition of criteria is lacking,” he says. “The ultimate goal of the ESCRS is to add value to the personal skills of its members that are recognized throughout Europe.”

The 2023 exam will be administered in September at the ESCRS Annual Congress in Vienna. The application deadline is March 10; as part of the application process, candidates must submit a recommendation letter, a video of a complex case they operated on, and a completed CV/application that lists their surgical, teaching, and publication experience.

This year will mark the fourth round of FEBOSCR exams; the exam was not given in 2020–2022 because of the COVID-19 pandemic. Dr Tassignon hopes the exam serves not just as a barometer of surgical achievement but as a stepping stone to greater accomplishment.

“There is much more to learn than surgical skills and knowledge to become an excellent ophthalmologist,” she says. “There is also leadership, planning, team building, research, etc. Much awaits those who have the ambition to grow in their profession and who would like to find the solution to currently unanswered pathological conditions.”

The ESCRS membership is composed of highvolume cataract surgeons in academic and private settings.