| Certification Programme |
EUROPEAN CERTIFICATION IN TRAUMA AND ORTHOPAEDIC FOOT AND ANKLE SURGERY
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.
Table of contents
INTRODUCTIONThe 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. 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 This format should allow the whole examination to take place in one day. 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. 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 CRITERIAEntry 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
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. 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 o Ankle and Hindfoot 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. • 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: • 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: • 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.
PAST CERTIFICATIONSDr. Helka Koivu, MD, PhD, EFAS Certification Awarded Certification by the EFAS Certification Board on 12th October 2016 in Malmö, Sweden
Dr. Nikos Gougoulias, MD, PhD, EFAS Certification |
09/11/2020 » 10/11/2020
EFAS patronage | The Foot and Ankle Warsaw Cadaver Lab Course
12/11/2020 » 13/11/2020
EFAS Hindfoot Specimen Lab Course - postponed 2021 2 & 3 December 2021