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will be computer-based for all participating countries.
The aim is to comply with the international standards
set by the Council for European Specialists Medical
Assessment (CESMA) (8) for the delivery of medical
examinations, including enhanced security, faster
processing of results, advanced statistics and the pro-
vision of detailed feedback to examinees. The Jury
of the European PRM Board, which is responsible
for the examination procedure, constantly monitors
the quality of the examination procedure, from the
registration of candidates to the delivery of results.
Both national managers and candidates participate in
the quality assessment of the examination, through
specially designed surveys.
define the cut-off score. To ensure that the procedure
is free of any potential bias, the results are presented
to the Jury in absolute anonymity. The status of Eu-
ropean/UEMS PRM Board Fellow is offered to those
candidates who have passed the examination, after
achieving the status of PRM specialist at the national
level. Since 1993, a total of 1,232 PRM doctors have
passed the European PRM Board examination. The rate
of pass/fail varied throughout the years; in particular,
the enrolment of an increasing number of applicants,
coming from countries where the specialty is not yet
fully developed, has corresponded to a slight increase
in the failure rate, as indicated in Fig. 2.
FUTURE DEVELOPMENTS
PREPARATION OF THE EXAMINATION
Adherence to the guidelines of the UEMS-CESMA is
a priority for the UEMS PRM Board. The procedures
related to the creation of MCQs, the delivery of the exa-
mination, processing and statistical analysis of results
are constantly updated so as to comply with interna-
tional standards in medical qualification assessment.
The traditional paper-based examination is currently
being replaced by a computer-based examination.
The methodology adopted to appraise the results of
the examination will be based on the modified Angoff
score (9), which uses a systematic and documented
approach to establish defensible pass/fail scores, i.e.
to ensure both the validity (the test measures what the
students are expected to know) and the reliability (the
test produces consistent results time after time) of the
examination.
Moreover, in order to increase the validity, a stronger
link has been established between the educational
opportunities for trainees and the examination con-
tent. Initiatives to support education and training in
PRM, also via an electronic education platform, have
The examination comprises 100 multiple-choice
questions (MCQs), extracted from a data-bank, that
currently includes approximately 1,500 questions. Se-
lected experts, who are members of the Question Bank
Committee, regularly update and expand the data-bank.
Their duties include assessment of the MCQs sub-
mitted to the Board by National Managers and other
colleagues and preparation of new questions based on
the previously mentioned curriculum of knowledge
established by the Board. The objective is to accumu-
late a large choice of MCQs on all the different topics
of the curriculum, so as to offer to the candidates a
balanced assessment of knowledge relevant to the
practice of PRM. In the past, the questionnaire was
typically composed of 80 single MCQs and 4 clinical
cases, each with 5 MCQs. In recent years, the number
of clinical cases has increased gradually in an attempt
to provide an assessment focused on clinical reasoning.
ORGANIZATION OF THE
EUROPEAN EXAMINATION IN
PRM
According to the internal rules of pro-
cedures, the President of the Board,
who is the Examination Director, with
the secretarial support provided by the
Certification Secretary General, super-
vises the entire examination process.
The Jury of the Board is responsible for
processing the results. A critical task of
this committee is to assess the quality
of the examination, evaluate the level of
difficulty, statistically analyse the results
and address eventual problems related to
the examination procedure, in order to
www.medicaljournals.se/jrm
Success rate (%)
100
90
80
91
93
96
87
88
95
90
89
86
88
81
86
87
87
78
70
60
50
40
30
20
10
0
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018
Fig. 2. Pass rates of the European PRM Board examination, during 2004–2018.