European Diploma in Pain Medicine

The examination is taken in two parts. Part 1 is a multiple-choice (MCQ) examination. Part 2 is a series of objective structured clinical examinations (OSCEs) and viva examinations. The Examination Committee may hold the two parts separately or together in one sitting.

Until further notice, Part 1 can only be sat virtually and Part 2 can only be sat in person.

Candidates who complete Part 1 must complete Part 2 within four years. For example, a candidate who completes Part 1 in February 2024 has until 31 December 2028 inclusive to complete Part 2. EFIC aims to offer one full examination sitting per year, giving candidates three to four opportunities to take Part 2 within the validity period. If EFIC is unable to offer a Part 2 sitting in a calendar year, that year does not count towards the four years available.

The MCQ examination tests knowledge of pain assessment and treatment. It features 50 questions. Each question consists of a stem followed by five answer statements, each of which is either true or false. There is no negative marking. The time allowed is 90 minutes.

The MCQ examination can take one of two forms. In paper form, answers are marked with a pen or pencil, with one choice of true or false per answer statement. In virtual form, the examination is organised through a virtual examination environment, with candidates answering remotely from their workspace.

The OSCEs test clinical experience, judgement, interpretation of evidence, attitude, and communication skills. They take place within an examination facility, typically a wing of a teaching hospital or university with an appropriate layout and equipment.

There are usually six stations, each representing a simple clinical situation. Candidates have a few minutes per station, typically eight, with a short break between stations. Each station is marked using an examination paper, completed by the candidate or, in some cases, by an examiner attending the station. Information provided at each station is as objective as possible, and any communication from examiners or actors follows guidance given in advance at the examiner briefing.

The vivas test clinical experience, judgement, attitude, and communication skills. They are oral examinations in which the candidate engages in a dialogue with an examiner.

There are two sets of two vivas, each set lasting 20 minutes, with the viva examination totalling 40 minutes. Vivas are based on vignettes (hypothetical cases) designated by the Examination Committee. Candidates are expected to demonstrate familiarity with a wide variety of clinical pain syndromes and the ability to propose a multimodal, multiprofessional pain management plan.

Each component of the examination must be passed individually.

• MCQ: 50 questions, pass mark 75%.
• OSCE: each station has its own marking scheme, with a percentage score from each station forming the final mark. A candidate must achieve a mean score of 50% across all stations and must not score below 25% in more than one station.
• Viva: examiners use a descriptive scoring table. The two examiners' scores in each station are pooled, then pooled across the second station. Examiners reach agreement, and any significant disagreement is mediated by the Exam Director. The standard pass mark is 50%. For vignettes, the Exam Director may set specific pass or fail criteria for elements considered critical, for example an automatic fail where a candidate misses something essential to the diagnosis or management plan.

Final decision of the Board of Examiners. At the end of each Part 2 sitting, the Board of Examiners meets to determine marks. Where the Examination Committee identifies anomalies or concerns about a candidate's performance, it may deviate from the standard marking rules and provide justification to the candidate.

Maintaining marks from previous attempts. Provided all components are passed within the four-year period, a candidate may count marks achieved in previous valid attempts towards their total. For example, a candidate who passes the viva but fails the OSCE may retake the OSCE and count the earlier viva result alongside the new OSCE attempt.

Candidates are provided with pens and pencils. No additional materials may be taken into the examination venue, and electronic devices such as phones, tablets, computers, and smart watches are strictly prohibited. Communication between candidates during the examination is strictly prohibited. Any candidate found breaching these rules, or otherwise jeopardising the fair conduct of the examination, will be excluded. Any candidate found to have passed any part through fraudulent means will have their qualification rescinded.

For virtual examinations, additional measures apply, such as randomising the order of questions and answers. The following conduct policy applies:

• Each candidate must take the examination alone. Conferring orally or by text or messaging is a violation.
• The examination must be taken in a quiet room without disturbance. Other people visible or audible via webcam or microphone may be considered a violation, even if they are not assisting.
• Candidates must remain at their desk throughout. Please use the bathroom before the examination starts. In a genuine emergency, it is at the examiner's discretion whether leaving briefly is a violation.
• The examination must be taken without learning materials, such as textbooks, a web browser, or visual aids.
• Following the proctoring requirements is part of the conduct policy. The webcam and microphone must be on and working throughout. Where a webcam is unavailable for reasons beyond the candidate's control, it is at the examiner's discretion to allow the candidate to continue.
• Candidates may not seek clarification on examination content. If you believe you have spotted an error, raise it with the examination organiser directly, and any necessary clarification is communicated to all candidates.
• Any candidate found violating these policies may be excluded and will receive a mark of 0 for the MCQ. It is at the discretion of the examiner and organiser to take steps to ensure the smooth conduct of the examination.

All examination content, written and oral, is in English, and a high level of spoken and written English is required. Translation and interpretation services are not available. The Examination Committee allows a reasonable degree of flexibility for medical and technical terminology, but candidates should be familiar with such terminology in English.

Where Part 1 is offered virtually, candidates are expected to follow all EFIC guidance, tutorials, and preparatory sessions so that they are comfortable with the platform on the day. EFIC uses a proctoring tool to ensure conduct rules are followed, which requires recordings, including of the candidate's webcam and desktop. Candidates are expected to have a reasonable level of IT literacy, including adjusting hardware settings such as the webcam and microphone.

Any candidate wishing to appeal should write to the Examination Committee via the Federation Secretariat within four weeks of receiving their results. The Examination Committee responds within six weeks of the initial communication of results.