# Fellowship of the European Board of Surgery in the specialty of Minimally Invasive Surgery (F.E.B.S./MIS): a continuous evaluation

## TL;DR

This paper evaluates a new certification exam for minimally invasive surgery, showing it is effective but needs improvements.

## Contribution

The paper introduces and evaluates a new multi-modality board exam for minimally invasive surgery certification.

## Key findings

- The exam had pass rates of 61–88% among experienced surgeons from 28 countries.
- Participants provided positive feedback, especially for case-based oral stations.
- Higher credit scores were linked to passing, but experience alone did not guarantee success.

## Abstract

Minimally Invasive Surgery (MIS) has become the standard approach for many procedures, driving rapid changes in training pathways and challenging traditional assessment and accreditation methods. To address this, the European Union of Medical Specialists (UEMS), in collaboration with the European Association for Endoscopic Surgery (EAES), established a working group in 2015 to develop a MIS-specific board fellowship exam (Fellow of European Board of Surgery in Minimally Invasive Surgery (F.E.B.S./MIS)). This rigorous, multi-modality examination assesses surgeons’ knowledge and skills to ensure high-quality independent practice. This study provides an overview of the exam’s development, structure, and quality assurance, with a focus on participant evaluation.

Eligibility followed UEMS criteria, including certified MIS training, case logbook documentation, and English proficiency. The exam comprised a 100-item multiple-choice test (MCQ) and an objective structured clinical examination (OSCE) with clinical scenarios and validated technical skill tasks. Participants completed evaluation questionnaires on exam experience. Data were analyzed using descriptive statistics, linear regression, and independent-samples t-tests to examine associations between experience, performance, and total scores.

Between 2018 and 2024, 119 participants from 28 countries undertook the exam in seven European countries. Most were experienced attending surgeons, with pass rates of 61–88%. Higher credit scores were linked to passing, though not directly correlated, indicating experience alone did not ensure success. Fellowships were considered as the optimal exam time, with motivations including certification and knowledge updates. Feedback was highly positive, especially for oral case-based stations, and nearly all recommended the exam. Suggested improvements included streamlining the application process, enhancing practical training opportunities, offering flexible dates, and enabling exams in candidates’ home countries or languages.

The UEMS/EAES MIS Board exam is firmly established as a specialized certification for MIS and has been well received by participants. Nevertheless, its broader influence and professional recognition still require systematic assessment.

The online version contains supplementary material available at 10.1007/s00464-025-12204-3.