Chris Plummer^1,2
Danny Mathysen³, Stephanie Thibault¹ and Clive Lawson⁴
1 European Society of Cardiology
2 Union of European Medical Specialists Cardiology Section 3 University of Antwerp
4 Maidstone and Tunbridge Wells NHS Trust

Background
The EECC[1] is a summative test of core cardiology knowledge[2], comprising 120 best-of- five multiple choice questions, with a Hofstee derived pass mark[3]. From 2012 to 2019, the EECC was delivered in test centres. The pandemic made this impossible in 2020, so exam preparation meetings were on-line, and delivery was on-line with remote proctoring. 

We analysed data from the delivery and proctoring suppliers, candidate satisfaction questionnaires, costs and meeting records for 3 years before, and 4 years after transition. 

A total of 5267 cardiology trainees have sat the EECC – 2489 in-person, and 2778 on-line since 2020. Comparing in-person (2019) and on-line delivery (2023), the number of participating national societies has more than doubled (16 to 44), and candidates have increased by 51% (575 to 868). Costs have fallen by over €100 per candidate for preparation, a total of >€86,800 in 2023, because of reduced travel and accommodation costs, and delivery is €21 lower per candidate, €18,228 in 2023, with further savings for candidates in reduced travel. The proportion of candidates not attending the exam has fallen from 7.3% to 2.2% and the proportion with technical difficulties has fallen from 12% to 2.2%. There has been no significant change in mean pass mark (66.7 vs 66.8) or pass rate (80.0% vs 82.8%). There was no change in the candidates’ satisfaction with the examination software, and rigorous monitoring has not identified any attempts at misconduct. 

The transition to on-line preparation and delivery of the EECC was necessitated by the COVID- 19 pandemic, but we are pleased to find that this has allowed widened participation, improved quality and reduced costs. 

High-stakes exams can safely be prepared and delivered on-line. However, face-to-face meetings at least once each year, are highly desirable to build and maintain long-term teams. 

References (maximum three) 

[1] European Exam in Core Cardiology (EECC)
 Available at: https://www.escardio.org/Education/Career-Development/European-Exam-in- Core-Cardiology-(EECC)
 Accessed: 28 June 2023. 

[2] Felix Tanner, Nicolas Brooks, Kevin Fox, Lino Gonçalves, Peter Kearney, Lampros Michalis, Agnès Pasquet, Susanna Price, Eric Bonnefoy, Mark Westwood, Chris Plummer, Paulus Kirchhof.
 ESC Core Curriculum for the Cardiologist 

European Heart Journal 2020;41:3605-3692. https://doi.org/10.1093/eurheartj/ehaa641 

[3] Chris Plummer, Sarah Bowater, Jim Hall, Clive Lawson, Georgina Ooues, Susanna Price, Russell Smith, Ian Wilson, Rob Wright.
 Behind the scenes of the European Examination in General Cardiology
Heart 2019;105:889-890. 

http://dx.doi.org/10.1136/heartjnl-2018-314495