The European Society of Pediatric Nephrology Board Examination—a certified benchmark of knowledge and clinical practice with global recognition

BACKGROUND: Subspecialty recognition and certification in Pediatric Nephrology remain heterogeneous across Europe and globally, resulting in variations in training standards and professional mobility. To address this gap, the European Society for Paediatric Nephrology (ESPN) launched the European Board Certification in 2020 as a pan-European and curriculum-based assessment of knowledge and clinical reasoning in Pediatric Nephrology. METHODS: We performed a descriptive and analytical evaluation of candidates who applied for the ESPN Board Certification in Pediatric Nephrology between 2020 and 2025. Candidate characteristics, examination performance, and factors associated with success were analyzed. The exam consisted of 100 case-based multiple-choice questions developed according to a predefined blueprint. Multivariable logistic regression was used to identify factors independently associated with passing. Additionally, a cross-sectional survey assessed candidates' perceptions of the examination and its professional impact. RESULTS: A total of 349 pediatric nephrologists from 52 countries and four continents completed the examination. Median age was 38.2 years (IQR 34.7-43.5), and 59.9% were female. The overall pass rate was 54.7%, with significant variation by continent (p = 0.014). Attendance at the International Pediatric Nephrology Association (IPNA)-ESPN Junior Master Class was associated with higher odds of success (OR 3.76, 95% CI 1.65-5.87, p < 0.001), whereas increasing age was associated with lower odds of success (OR 0.66 per additional year, 95% CI 0.55-0.78, p = 0.002). Among 74 survey respondents, perceptions regarding the examination were highly positive: 93.2% considered the content clinically relevant, 89.2% reported increased self-confidence, and 75.6% perceived a positive professional impact. CONCLUSIONS: Since its launch, the ESPN Board Examination has emerged as an internationally acknowledged benchmark of key knowledge and clinical reasoning in Pediatric Nephrology. Structured preparatory education enhances examination success, and certification is widely perceived as professionally meaningful. The examination plays a vital role in standardizing subspecialty criteria and reinforcing the professional identity within Pediatric Nephrology.