Young GI angle: European Specialty Examination in Gastroenterology and Hepatology exam: Tips and tricks
The European Specialty Examination in Gastroenterology and Hepatology (ESEGH) is a significant milestone for aspiring specialists in the field, offering a rigorous assessment of knowledge. The ESEGH was created through a collaborative effort by the Federation of Royal Colleges, the British Society of Gastroenterology (BSG), and the Union of European Medical Specialties (UEMS) European Section and Board of Gastroenterology and Hepatology (ESBGH). This examination evolved from the original United Kingdom Specialty Certificate Examination. Starting in 2018, the Specialty Certificate Examination and the ESEGH were merged into a single exam. It is important to mention that the exam is not mandatory in most of Europe, but there are countries which have made it part of their mandatory curriculum, such as the Netherlands and Switzerland. Designed to evaluate the expertise and factual knowledge of candidates seeking specialization in gastroenterology and hepatology, the ESEGH plays a crucial role in shaping the careers of healthcare professionals across Europe. The ESEGH assesses the ability of candidates to diagnose and manage a wide range of gastrointestinal and liver diseases. In 2022, the ESEGH was taken by 480 candidates and amongst them were 146 UK trainees. There is a network of accredited training centers which encourage the candidates to apply for the exam but provides the opportunity to potentially work in these centers. Preparing for the ESEGH requires a comprehensive and focused approach, encompassing a solid knowledge base, practical experience, and effective examination strategies. In the following sections, we will delve into the key aspects of preparing for the ESEGH, providing guidance, tips, and resources to help candidates navigate this crucial milestone in their careers. 

Selecting the right literature is the cornerstone of successful preparation for the ESEGH. It is about choosing the right resources that align with the examination's curriculum and requirements. First and foremost, candidates should familiarize themselves with the ESBGH curriculum well known as The Blue Book. The Blue Book is approved by the UEMS and is the result of work from specialists from ESBGH to reflect and aim for a harmonized approach and can be found on the following link: https://www.eubogh.org/blue‐book/ . , In addition, textbooks such as Sleisenger and Fordtran's Gastrointestinal and Liver Disease, Textbook of Gastroenterology (Ed T Yamada), The Textbook of Hepatology (Ed J Rodes), and Oxford Handbook of Gastroenterology and Hepatology (S Bloom, G Webster) may offer help. Review articles and clinical guidelines provide current insights and evidence‐based practices that may not be covered in standard textbooks. It is important to mention that the questions are based mostly on European guidelines published by specialist societies such as the European Association for the Study of the Liver, European Crohn's and Colitis Association, BSG, United European Gastroenterology (UEG), European Society of Gastrointestinal Endoscopy, European Society for Clinical Nutrition and Metabolism (ESPEN), etc. Also, concise and updated information on particular topics can be found in reputable journals such as UEG Journal, Alimentary Pharmacology and Therapeutics, European Journal of Gastroenterology and Hepatology, Frontline Gastroenterology, Gastroenterology, Gut, Journal of Hepatology, Lancet, New England Journal of Medicine, Clinical Nutrition, Clinical Nutrition ESPEN, etc. , Online platforms and resources, such as e‐learning modules provided by specialty societies, can complement traditional reading materials. These platforms often offer interactive learning experiences and up‐to‐date content that aligns with current best practices, such as UEG Education. , In addition, there is also a very useful “Best of Five MCQS for the ESEGH (Oxford Higher Specialty Training) 2021”, and other available online resources by the Membership of the Royal Colleges of Physicians of the United Kingdom (MRCPUK). The Postgraduate Teaching Program at UEG Week follows a 3‐year curriculum, which is based on recommendations of the Blue Book. 

The exam structure can be broken down into various components, each of which requires different strategies. The ESEGH is structured as a written examination which typically comprises multiple‐choice questions (MCQs). Familiarizing oneself with the format and type of questions that may appear in the written examination is essential for success. Sample questions and practice exams are available for revising and preparing the exam and are available at the official website; also, there are several online resources with MCQs that are of great value , Regarding the exam structure, one should bear in mind the proportion of different areas that are covered in the exam, which is shown in Table according to the ESEHG Blueprint. Understanding the timing of the exam is vital. A total of six hours is available to solve 200 exam questions, and this is divided into two parts (first part 100 questions in three hours, one hour break and second part another 100 questions in three hours). The regimen within the exam centers is strict, and neither food nor drinks are allowed. The exam is video documented and any inproper behaveviour leads to disqualification. It is crucial to get acquainted with the technical aspects of the examination, such as the software interface. 

The plan should align with the ESEGH curriculum, distributing time across different topics based on their weight in the examination and personal areas of weakness. Utilizing tools like study planners and seeking guidance from experienced colleagues, mentors, or at dedicated UEG Week sessions can aid in developing an optimal study schedule. Being aware of the time allocated for different sections of the ESEGH exam helps candidates practice under similar conditions. Mock tests can mimic the pressure of the exam environment, assisting in developing strategies for answering questions efficiently. There is a free MRCPUK mock test available, which could serve as a good starting point to get familiar with the structure of the exam. Furthermore, incorporating periodic reviews and self‐assessments into the study plan helps to gauge progress and identify areas that require more focus. This continuous evaluation helps in reallocating time and resources effectively. For many candidates, preparation for the ESEGH must be balanced with ongoing clinical responsibilities. A clear understanding of work schedules, commitments, and maximizing available study time (such as during breaks or commuting) is vital to maintaining progress without burnout. Using technological aids such as digital calendars, alarms, or specialized study apps can automate reminders and track study progress. Many educational platforms also offer tailored study schedules and time management tools specific to the ESEGH. While adherence to a plan is essential, flexibility is equally vital. Unforeseen circumstances may arise and being able to adapt the study plan to accommodate changes prevents loss of progress and maintains morale. In short, the overall time for preparing for the exam is individual and depends on various factors, but we would recommend having a minimum of 3 months fully dedicated to the studying for the exam, ideally 6 months or even more during regular work, depending on the current knowledge of the participant. Therefore, crafting a well‐thought‐out study plan, understanding the timing of the exam, regularly reviewing progress, balancing other responsibilities, utilizing technology, and maintaining flexibility are keys to efficient preparation. 

The manner in which candidates approach and conduct themselves during the ESEGH can significantly influence their performance. A positive and optimistic attitude, combined with effective examination strategies, helps ensure optimal concentration, time management, and success. At the beginning of the exam, candidates must pay close attention to the instructions provided. This includes understanding the format of the questions, any specific directions, and the overall structure of the examination. Candidates should keep track of the time allocated for each section, utilizing any provided clocks or timers. For example, there are two sessions of 100 questions that last 3 h each. This is a substantial number of complex questions and therefore one must be aware of the approximate time that has to be dedicated to each question. Therefore, having a mental plan for how much time to spend on each question helps prevent getting stuck on complex problems and ensures that all questions are addressed. This can be practiced with mock tests. In addition, some of the questions can be “flagged” and left for later. Here it is also important to keep in mind that questions will have to be read again and this will again consume additional time, especially if they are long and complex questions. There is no generic advice on how to answer questions; it is individual and needs to be practiced; however, the general approach could be to answer as many questions you can during the first round of answering and leaving as little questions for a second round of answering, if possible. Furthermore, it's common to feel nervous during a high‐stake exam like the ESEGH. Implementing relaxation techniques, such as deep breathing or brief mental pauses, can assist in maintaining focus and reducing anxiety. Developing a strategy for tackling questions is not crucial but can be beneficial. Some candidates may choose to answer easier questions first to build confidence, while others may prefer to follow the sequence of the examination. Whichever path you have chosen, it is important to stick with it and not to panic if everything does not go as planned during the exam, but to move forward and finish answering all the questions. The ESEGH exam has specific rules regarding behavior, such as restrictions on speaking with other candidates or using unauthorized materials. Understanding and adhering to these rules is vital to avoid potential disqualification or penalties. If time allows, reviewing answers can help catch mistakes or reconsider responses. Care must be taken not to second‐guess oneself unnecessarily, but a thoughtful review can be valuable. Behavior during the ESEGH encompasses a strategic approach to answer questions, manage time, and maintain focus. By carefully reading instructions, staying calm, employing an intelligent question strategy, adhering to examination rules, utilizing available tools, and reviewing answers, candidates position themselves for a successful examination experience. Participants should keep in mind that the final score for the paper was then derived by calculating the mean of these individual average scores. This method typically results in a pass mark of around 60% (+/− 2%) for each exam. 

The ESEGH is a comprehensive and challenging examination, requiring thorough preparation, strategic planning, and composure during the exam itself. The journey to success in the ESEGH involves multiple facets, including choosing the right literature, understanding the exam structure, mastering time management, knowing how to behave during the examination, and reflecting on personal experiences. Here are some key pieces of advice for those who aspire to take the ESEGH: Start Early: Begin your preparation well in advance of the examination date. Early planning allows you to understand the curriculum, identify weaknesses, and create a tailored study plan. Utilize Official Resources: Leverage the official guidelines, sample questions, and recommended literature provided by relevant governing bodies to align your study with the actual exam requirements. Practice Under Exam Conditions: Simulating the exam environment through timed practice tests helps you develop essential skills in managing time and handling pressure. Seek Support: Connecting with mentors, tutors, or peers who have experience with the ESEGH can provide valuable insights, encouragement, and guidance. Emphasize Well‐being: Maintain a balanced lifestyle, incorporating breaks, exercise, and healthy eating. Mental and physical well‐being is crucial for sustained focus and stamina during preparation. Adapt and Reflect: Be ready to adapt your study plan based on ongoing assessments of your progress. Reflect on what works best for you and adjust accordingly. Familiarize Yourself with Exam Day Protocols: Know what to expect on the day of the exam, including location, timing, necessary identification, and any specific rules or regulations. Maintain Integrity: Adhere to all ethical guidelines and rules during the examination. Success in the ESEGH is attainable through diligent preparation, strategic planning, and maintaining a positive, focused attitude. The journey is undoubtedly demanding, but with the right approach and dedication, it leads to valuable certification and recognition in the field of gastroenterology and hepatology. Good luck and stay positive! 

The authors have no conflicts of interest to declare. 

