General Surgery

General Surgery (GenSurg) provides the prevailing majority of surgical service for the population in all European countries.

GenSurg as a specialty was initially regulated by the EU-directive 93/16 and following documents up to actual EU-directive 2006/100 EC implicating automatic mutual recognition in the European Community.

Despite automatic mutual recognition in the EU the spectrum of competences and education within GenSurg in Europe varies significantly and depends mainly on national regulations and local demands.

Whereas any metropolis offers the most fertile ground for subspecialty in the e.g. University Clinics, the General Surgeon is necessary to provide a more comprehensive continuity in patient management.

In large district hospitals and peripheral hospitals the logistics and volume of work clearly favour the employment of a General Surgeon, not only especially in the treatment of all emergencies and most elective interventions, but also in the adequate handling and referral of elective cases suitable for surgical treatment by a subspecialist.

Special geographical conditions (e.g. large or small islands, variable density of population) yield a hospital structure favouring the necessity for a broadly competent General Surgeon.

Beyond the basic skills GenSurg includes a variety of diagnostic and therapeutic measures depending on national and local requirements. By that the general surgeon covers the majority of local surgical services.

These services include not only all on-call and emergency surgical interventions like e.g. appendicectomies, cholecystectomies, Hartmann-procedures in sigmoid perforation or treatment of intestinal bleedings and ileus, but also elective procedures like e.g. strumectomies, varices, hernia repair or hemicolectomies.

The General Surgeon should be able to treat trauma and emergency patients in respect to the local resources and decide on referral to a specialised institution depending on personal abilities, geographical situation and other regional modalities.

In the last decade a numerous of subspecialties have been evolving out of GenSurg, by that compromising substance and integrity of GenSurg.

Indeed, there are strong arguments that certain operations (e.g. anorectal J-pouch reconstruction, aortal grafting) should be performed by specialists, who have additional training and experience. On the other hand, GenSurg cannot not be reduced to a simple common trunk without jeopardizing the existence of GenSurg at all.

The arguments clearly make lucent, that GenSurg continues to pragmatically exist as a defined specialty with knowledge, skills and competencies that are beyond common trunk surgery and beyond most actual national CCST requirements.

By that any European examination giving a European qualification must not be based on the lowest common denominator of all national regulations (which is falsely generally called "harmonization").

The UEMS has a clear mandate by the European Commission to set the basis for a harmonization process focussing on competencies and on the content of medical training. This standardization process will be a multi-level step-by-step project and undergo continuous development.

There are 2 main goals to achieve, a long-term and a short term:

The long-term goal is standardization of surgical training not only in respect of duration of training, but training on the basis of a consensual European syllabus defining the criteria for the perfect "European Surgeon".
The short-term goal is the relaunch of the GenSurg examination based on the today situation.
The relaunched EBSQ GenSurg examination is based on actual criteria reflecting the requirements for the national CCSTs, but tries to avoid the devaluation by a lowest common denominator.

The syllabus for GenSurg contains "Knowledges" and "Knowledges and Skills", the latter giving the basis for an individual "log-book" including a procedure catalogue that was consensually worked out by the members of the Division and Board of GenSurg and will be updated regularly. The final achievement of this continuously developing project will be the synchronisation and unification of the actual EBSQ criteria and the results of the surgical training standardization process.

Successful EBSQ GenSurg examination candidates are awarded the title "Fellow of the European Board of Surgery /GenSurg – F.E.B.S./GenSurg".

The title F.E.B.S./GenSurg determines, that the person successfully proved to have validated knowledges and skills, that in most cases exceed the requirements for the national CCSTs and allow him/her to successfully cover the broad field of GenSurg in respective to the actual demandings according to the judging of the commission.

In the moment the qualification F.E.B.S./GenSurg has no automatic legal recognition in the E.U. or in any other country. Individual recognition of qualifications by the national authorities is supported by the EBSQ committee. The number of countries officially accepting the Board examination as their national exam rises continuously.

The fellowship does not implicate automatic allowance to work at own responsibility and does not automatically enhance participation in national social security systems of the E.U.

The UEMS fellowship (F.E.B.S.) represents a high-level validated quality control process and reflects certain knowledges and skills of a candidate.

The future perspective of this European diploma is to been seen in unanimous legalization within the ongoing project of the European standardization process of medical education.

Wolfgang Feil
President of the European Board of Surgery
Honorary & Foundation President of the Division of General Surgery

Definition of General Surgery

General Surgery is a large specialty which requires the acquisition of knowledge in basic sciences required in the development of clinical and operative skills as well as specialised knowledge and skills in managing congenital and acquired diseases and injuries of most organ systems which are treated by operations and other interventions.  It provides for operative and non-operative management, i.e. prevention, diagnosis, evaluation, decision making, treatment, intensive care and rehabilitation of patients with pathological processes that affect these organs, including the management of pain.  It also involves the necessary knowledge and expertise leading to referral to specialised centres when this is indicated and possible, and where this is not possible because of time and geographical considerations, to possess the multi-specialty skills to carry out these interventions safely.

General Surgery co-operates with other surgical specialties: anaesthesia, intensive care, emergency medicine, radiology, neurology, paediatrics, internal medicine, geriatrics, rehabilitation medicine, obstetrics and gynaecology and also pharmacy in the management of patients.

More on the national recognition of F.E.B.S. (General Surgery)

The UEMS EBSQ - General Surgery leading to FEBS is a quality mark for training in General Surgery. Passing this exam does not give the right to practice in any EU member state or UEMS area country  (Glasgow Declaration: Appendix 1; point 3). Such a right is only granted by the relevant National Authority. It may lead to eligibility for independent practice subject to authorisation by relevant bodies. In some European countries the European Examinations have been adopted officially and as such, these now have legal status. In some countries agreements of mutual reciprocity have been established between the European Examinations and the National Authorities’ equivalent. In these countries the UEMS EBSQ in General Surgery provides supporting evidence for Specialist Registration. It may lead to eligibility for CCST (CCT) (but no automatic conferment), where this qualification is one of the requisites for its attainment, the candidate having completed the training programme and satisfied all the requirements of the relevant Curriculum.

For General Surgery there is official recognition in Malta, Turkey,  Austria. There are many other states where the UEMS EBSQ General Surgery has not been officially adopted for purposes of CCST (CCT) or Specialist Registration, but where this Qualification is taken into consideration when allocating surgical appointments e.g. Republic of Ireland, UK, Belgium and several other countries. 

The EBSQ is recognised as a certificate in Iraq, Syria, Yemen, Lebanon, Qatar and Saudi Arabia. In these countries the candidate may officially add the title of FEBS  after his/her name after passing the EBSQ exam. In UAE the EBSQ certificate is currently not officially recognised yet, but one may add  the FEBS title after successful completion of the EBSQ assessment. It should be noted that in none of the aforementioned countries can the EBSQ exam replace the candidate's national exit exam which is a must to be recognised as specialist. It can, however, help in upgrading the candidate's licence later.