Search for a command to run...
In an era of increasingly specialized and globally connected healthcare, ensuring consistent excellence in medical practice is paramount. For the field of allergy and clinical immunology, the EAACI-UEMS Knowledge Examination (EUKE) stands as a cornerstone of this commitment, offering a high-level certification designed to assess specialist-level knowledge across Europe. Jointly organized by the European Academy of Allergy and Clinical Immunology (EAACI) and the Union of European Medical Specialists (UEMS), the EUKE consists of a single-session, high-stakes 120-question test assessing candidates’ essential factual knowledge and clinical critical judgment. A successful candidate is a “safe pair of hands,” demonstrating competence and readiness for unsupervised specialist practice. First established in 2008, the EUKE remains the first and only European exam in the field of allergy and clinical immunology, and follows the legacy of other medical European specialist assessments [1]. Since 2021, EUKE has embraced a fully online format. This transition has significantly enhanced accessibility and reach to a diverse international candidate pool (Figure 1A,B). This includes trainees completing their specialist education in allergy and/or clinical immunology, experienced allergists and professionals from related clinical and basic research backgrounds, particularly those involved in allergy/immunology laboratory diagnostics. Multiple-choice questions (MCQs) are included in 88.1% of written exams listed on the UEMS site [1]. They may be used alone or in combination with other theoretical and practical assessment formats. In its current format, the EUKE single-part, MCQ written examination aligns with 28.6% of UEMS-listed specialty exams, predominantly medical specialties (additional information on other European Specialty Examinations provided in Table 1). The EUKE also aligns in scope and quality to the American Board of Allergy and Immunology exam [2], which offers a nationally recognized, two-part, computer-based examination, comprised of 225 MCQs covering basic immunology and clinical allergology. Of the 120 EUKE questions, between 60% and 70% address allergic diseases, 20% cover basic and clinical immunology, and 10% to 20% focus on additional knowledge such as allergy diagnosis. Looking ahead, adding a practical component (e.g., viva, practical exam) to the existing MCQ format could support wider adoption of the EUKE as official examination at the national level. MCQ + Viva Other While the EUKE is currently officially recognized only in Switzerland, its influence and recognition are expanding. This progress aligns with broader efforts by EAACI and the National Allergy Immunology Society Committee to secure full, formal recognition of Allergology as an independent medical specialty. As 19 of the 28 EU member states now formally recognize Allergology as an independent medical specialty (Figure 1C) [1, 3], the exam holds potential for wider recognition and influence in shaping the future of the specialty. The EUKE is strongly aligned with European Training Requirements [1, 4] and is continuously updated to reflect contemporary clinical practice. These efforts will support the long-term integration of the EUKE into the European training framework. By embracing EAACI standards, the exam aims to address knowledge gaps that arise from different national curricula. Despite ongoing harmonization efforts, significant variations still exist across European countries in terms of training programs, diagnostic availability (e.g., component diagnostics), and access to medication (e.g., biologics). Preparing for the exam gives candidates exposure to a broad, standardized body of knowledge not always covered by national training. This enhances their expertise, accelerating the adoption of new techniques and enabling the application of cutting-edge treatments in clinical practice. The EUKE Committee manages all aspects of the yearly exam, including preparation, organization, and analysis. The Committee is led by an elected Chair and Secretary (serving 2-year terms), along with the UEMS Allergology Section Board Chair, the EAACI Vice President of Education and Specialty, the Knowledge Hub Editor, and the Continuing Medical Education and Specialty Committee Co-Chairs. Former EUKE Chairs provide advisory support. Additionally, 29 expert representatives from EAACI Interest Groups, Sections, and Working Groups recommend current literature and author exam questions after receiving targeted training (Table S1). All exam questions are carefully reviewed, updated, and aligned with the EUKE blueprints, ensuring the exam is structured and fair. The blueprints and practice questions are freely available online to support candidate preparation [5]. Additionally, the reference literature list, currently under revision, ensures the exam content is valid and transparent. Since first organized online, the exam has been held annually in autumn and is administered through a fully online platform with remote proctoring [6]. While online delivery increases accessibility, it can present technical challenges and raise security concerns compared to in-person exams [7, 8]. The EUKE Committee carefully considers these factors to balance accessibility, security, and candidate experience. The University of Bern conducts thorough psychometric analyses to ensure the exam's quality and fairness. These analyses have the purpose of assessing question difficulty, discrimination, and overall exam performance. The pass mark is determined using the Rasch method [9], ensuring a standardized and defensible threshold. Candidates receive individual feedback on their performance across blueprints topics and a certificate upon successful completion. While the EUKE does not serve as a direct license to practice medicine, it holds significant prestige throughout Europe. Candidate feedback from the 2025 exam showed strong satisfaction and perceived career benefits, highlighting its value as a significant addition to a doctor's curriculum vitae. Earning such certification signals demonstrable competence. Furthermore, for those seeking cross-border career opportunities, the exam acts as a powerful credential. However, formal recognition by national health authorities will always be subject to local regulations. To boost its European and international credibility further, the exam is slated for formal evaluation by the Council for European Specialist Medical Assessments (CESMA) in 2026–2027. In conclusion, the EUKE exemplifies the pan-European commitment to excellence in specialist medical assessment. Through its expert-driven development, quality assurance, and transparent structure, it provides a respected credential for allergology professionals. By fostering consistent training standards and supporting professional mobility, the exam plays a key role in improving patient care and advancing the careers of allergy and clinical immunology specialists across Europe. The authors acknowledge the support by Gabrielle Pauli and Ulrike Raap in creating and performing the EAACI Knowledge Exam. The activities of the EAACI Exam Committee are funded by the European Academy of Allergy and Clinical Immunology and by the European Union of Medical Specialists (UEMS). The authors declare no conflicts of interest. The data that supports the findings of this study are available in the supporting information of this article. Table S1: Structure of the 2024–26 Exam Committee. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.