Certification will be based on the following:
The candidates will be expected to demonstrate they have attained knowledge in breast cancer management and more in-depth expertise in surgical management, as set out in the knowledge curriculum.
This will be attested to by:
The candidate will have to complete a twelve to 18 months' fellowship in a breast unit practicing intermediate level care, exposing trainees to wide local excision (WLE), sentinel lymph node biopsy (SLNB), axillary clearance and mastectomy, with good MDT working (tier 1 training centres, basic training). This will enable trainees to develop basic skills and a broad understanding of the subject. This may either be during or after residency (certification) or a mixture of the 2. The candidate will have to demonstrate their practical skills by means of a certified log book with evidence of a prescribed number of index cases being performed and certified evidence of ability to undertake key procedures to a good standard (axillary clearance (ANC), level 1 and 2 oncoplastic surgery (OCBS), wide local excision (WLE), mastectomy (Mx) and skin and nipple sparing mastectomy (SSM/NSM) for example). This will be by means of a reference from a supervisor.
In addition, a period of high quality training in a specialist breast centre is required where higher level skills will be attained such as oncoplastics, reconstruction (although not necessarily practical expertise in all countries), research literacy, oncology and genetics. These latter centres (tier 2 training centres, advanced level skills) will need to be quality assured (for example EUSOMA certified). This training may be post residency (certification) in most countries to allow full immersion in breast surgery without the distraction of emergency surgery and other specialist subject areas, unless such a specific post can be arranged during standard residency training (as in the UK where Oncoplastic training is a routine part of training for breast specialists). As a result, surgeons will be expected to have acquired a minimum number of procedures to the level required for post residency practice, certified by a recognised trainer.
Following completion of training and certification (as above) all breast surgeons should engage with on-going continuous professional development (CPD) and apply for re-certification at intervals of 5 years by submission of proof of approved course attendance. Such courses should be evidence based, free from commercial bias and of high quality.
Acquisition of relevant practical skills and knowledge is estimated to take 2 years of full time training (for someone with basic general, gynaecological or plastic surgery competencies) with 1 year in a tier 1 training centre and 1 year in a tier 2 centre either during or following completion of standard general, gynaecological or plastic surgery training. Tier 1 and 2 training centres should be BRESO certified.