Europe Unveils a Pan-Continent Exam to Standardise Geriatric Medicine Training

After more than two decades of negotiation, committee work and quiet diplomatic persistence, Europe finally has a common benchmark examination for the medical specialty devoted to older people. The European Geriatric Medicine Specialty Exam, known by its acronym EGeMSE, was piloted for the first time in April 2025 and has now been formally recommended as a benchmark assessment of specialist knowledge in the 2025 European Training Requirements for the Specialty of Geriatric Medicine. A detailed historical account of how the exam came into being, published in the journal European Geriatric Medicine, traces the initiative from its tentative origins in 2003 to the delivery of a two-paper, multiple-choice, English-language postgraduate examination that any specialist trainee in Europe can now sit on a voluntary basis.

The stakes behind this bureaucratic-sounding achievement are far from trivial. Europe is ageing faster than almost any other world region, and the clinical science of caring for frail, multimorbid older adults remains unevenly recognised across the continent. In some countries geriatric medicine is a fully established specialty with its own training pathway, royal college examinations and hospital departments; in others it barely exists as a distinct discipline, and the care of older people is dispersed across general internal medicine, neurology, rehabilitation and primary care. Surveys of geriatric services across dozens of European countries have documented this patchwork, and educational researchers working within the European Cooperation in Science and Technology framework have highlighted substantial gaps in what health professionals know about the basic principles of geriatric care. A shared examination, its developers argue, is one of the most concrete instruments available to narrow those differences.

The story begins in the institutional machinery of the European Union of Medical Specialists, the body that represents medical specialists across the continent and whose Geriatric Medicine Section, abbreviated UEMS-GMS, acts as the specialty’s European voice. Discussions about some form of European examination in geriatric medicine first surfaced in 2003, in the wake of earlier efforts to define minimum training standards for the specialty within the European Union. Those early debates were shaped by a paradox that has defined European geriatrics ever since: the specialty is unified by the clinical problems it addresses, yet dramatically diverse in how national health systems organise, fund and credential its practitioners. Any pan-European assessment would have to respect that diversity while still setting a common bar.

Over the following decade the idea evolved through successive working groups that tackled the problem from several angles at once. One strand of work focused on postgraduate training itself, producing consensus documents on what a trainee geriatrician in any European country should know and be able to do. Another strand built collaborative educational structures that connected the UEMS-GMS with kindred organisations, most notably the European Geriatric Medicine Society, or EuGMS, the European Academy for Medicine of Ageing, and the European region of the International Association of Gerontology and Geriatrics. The authors of the new historical review reconstructed this evolution chronologically from meeting minutes, educational documents, reports, presentations and policy papers, some of which had never previously been assembled in one place. Their account shows that the exam was never a standalone project; it was deliberately tethered to the broader ambition of a common European postgraduate curriculum.

That curriculum arrived in a rigorous form in 2019, when a European postgraduate curriculum in geriatric medicine was published after being developed with an international modified Delphi technique, a structured consensus method in which expert panels iteratively rate and re-rate competing competencies until agreement converges. The Delphi process drew on representatives from across the continent and distilled the sprawling content of geriatric practice, from falls and frailty to polypharmacy, delirium, cognitive disorders and the ethics of end-of-life care, into a coherent framework of competencies. A European training requirements document followed, and a systematic international survey of postgraduate training had already revealed just how variable existing national programmes were in duration, content and assessment. The curriculum gave the future exam its blueprint; what it still lacked was a delivery mechanism.

The turning point came from an unexpected direction: the United Kingdom. From 2018 onwards, the UEMS-GMS pursued a formal partnership with the British Geriatrics Society and the Federation of the Royal Colleges of Physicians of the United Kingdom, the federation that administers the UK’s Specialty Certificate Examinations across many internal medicine specialties. Rather than inventing an assessment infrastructure from scratch, the European initiative adapted an established, psychometrically mature examination model. The result was a two-paper, multiple-choice examination delivered in English, modelled on the UK Specialty Certificate Examination but with content mapped to the European curriculum rather than to any single national syllabus. The strategy echoes precedents elsewhere in European medicine, where specialties such as cardiology, ophthalmology, colorectal surgery and emergency medicine have developed European board examinations, some over decades, providing both templates and cautionary lessons about candidate uptake and sustainability.

The first pilot examination took place in April 2025, marking the moment when twenty-plus years of committee minutes crystallised into an assessment that real candidates could sit. Its endorsement quickly followed: the 2025 revision of the European Training Requirements for the Specialty of Geriatric Medicine, which drive competency-based education and harmonisation across Europe, recommended the EGeMSE as a benchmark assessment of specialist knowledge. In the language of medical education, the exam now occupies a specific and carefully bounded role. It is voluntary, it does not replace national licensing or certification, and it confers no legal right to practise. Instead, it functions as a portable, externally validated signal that a specialist has mastered the knowledge base of the European curriculum, in the same way that other European diploma examinations function as quality markers layered on top of national qualifications.

The initiative has also gathered momentum from a broader network-building effort. The PROGRAMMING COST Action, a European-funded network whose full name promises the promotion of geriatric medicine in countries where the specialty is still emerging, has explicitly endorsed the exam as part of its mission to bridge gaps in geriatric education, particularly in eastern and south-eastern Europe where the specialty’s institutional footprint is thinnest. Focus group research within that network has assessed what educational needs European health professionals actually experience, providing an evidence base for exam content and for the wider training ecosystem around it. Complementary scholarship has argued that geriatrics should be treated as a core competency for all physicians in an ageing Europe, a framing that positions the EGeMSE not as an inward-looking credential but as an anchor point for a continent-wide educational project.

The historical review also documents the less glamorous determinants of success. Delivering a pan-European exam required governance arrangements, candidate regulations, funding commitments and administrative support across multiple organisations with different constitutions and priorities, all tested against the disruption of the COVID-19 pandemic and the ordinary turnover of volunteer leadership in professional societies. The authors note that the work received no specific funding and was carried out by a large, geographically dispersed group of geriatricians from Dublin to Palermo, Reykjavik to Prague. Intriguingly, the article’s transparency statement reveals that the authors used an artificial intelligence tool to help organise and summarise anonymised archival materials, with all outputs critically reviewed by the authors, a small but telling sign of how even the history of medical education is now being written with computational assistance.

What the EGeMSE ultimately represents, its developers contend, is the culmination of more than two decades of European collaboration and a practical tool for harmonisation in a field where harmonisation matters acutely. Older patients move across borders less often than younger ones, but medical knowledge, training standards and workforce expectations do not respect national boundaries, and the specialist workforce caring for Europe’s rapidly growing older population remains inadequate in many countries. A voluntary exam will not, by itself, create geriatricians where none are trained, and the authors are candid that it is a benchmark rather than a solution. Yet in a specialty whose history is one of hard-won institutional recognition, the existence of a common European examination gives trainees, trainers and health ministries alike a shared reference point for what excellent geriatric medicine means, and a measurable standard toward which emerging programmes can aspire.

Subject of Research: Development of a pan-European benchmark examination for postgraduate geriatric medicine training

Article Title: The development of the European Geriatric Medicine Specialty Exam

Article References: Romero-Ortuño, R., Barbagallo, M., Bonin-Guillaume, S., Clarfield, A. M., Dhesi, J., Duque, S., Farré Mercadé, M. V., Ferro, A., Graf, C., Guerin, O., Ihle-Hansen, H. B., Jónsdóttir, A. B., Macijauskienė, J., Michel, J.-P., Münzer, T., Nuotio, M. S., Piotrowicz, K., Polidori, M. C., Roller-Wirnsberger, R., … Masud, T. (2026). The development of the European Geriatric Medicine Specialty Exam. European Geriatric Medicine. https://doi.org/10.1007/s41999-026-01600-0

Image Credits: AI Generated

DOI: 10.1007/s41999-026-01600-0

Keywords: geriatric medicine, EGeMSE, medical education, UEMS, EuGMS, postgraduate training, European curriculum, specialty examination, physician certification, ageing, harmonisation, Europe