The questions in the basic exam are based on the list of learning objectives and the blueprint, which have been agreed with the individual specialist societies. The questions are prepared by the examination board, evaluated and accepted after a consensus decision. The question content must tally with the blueprint and with currently accepted teaching and practice in Switzerland. The board checks that the questions meet the criteria for science-based assessment for high-stakes exams.* 

Key validation takes place following the exam, based on statistical analysis of the entire exam and of each individual question. This assesses: the p value (e.g., critical if <0.3), selectivity (critical if <0.1), deflector differences and group differences. 

Reliability is a further criterion: this is achieved because the standard Cronbach’s alpha factor usually reaches >0.8 (= target level for a «high-stake» exam).

Another criterion is validity (does the exam measure what it should?). The content must correspond to the list of learning objectives accepted by all specialist societies. The questions are distributed according to the blueprint/ weighted content grid. 

The aim  is a largely normally distributed difficulty of all questions of all subsections. All questions are based on a consensus of the examination board in which all surgical specialist societies are represented.

*Norcini J, Anderson B, Bollela V, Burch V, Costa MJ, Duvivier R, Galbraith R, Hays R, Kent A, Perrott V, Roberts T. Criteria for good assessment: consensus statement and recommendations from the Ottawa 2010 Conference. Medical Teacher. 2011 Mar 1 ;33(3):206-14.