Purpose: To describe the development of the European Geriatric Medicine Specialty Exam (EGeMSE), from its early conception within the European Union of Medical Specialists-Geriatric Medicine Section (UEMS-GMS) to implementation of the first pilot examinations.

Methods: This narrative article was based on a review of UEMS-GMS meeting minutes, European Geriatric Medicine Society (EuGMS) educational documents, appendices, reports, presentations, policy documents, and other relevant archival and publicly available sources. The evolution of the EGeMSE was reconstructed chronologically.

Results: Discussions regarding a European Geriatric Medicine examination began in 2003 and evolved through successive working groups addressing postgraduate training, curricula, and assessment. During the following decade, the initiative became closely linked to development of a common European postgraduate curriculum and collaborative educational structures involving the UEMS-GMS, EuGMS, European Academy for Medicine of Ageing, International Association of Gerontology and Geriatrics-European Region, and other organisations. From 2018 onwards, the UEMS-GMS proposed a formal partnership with the British Geriatrics Society and the Federation of the Royal Colleges of Physicians of the United Kingdom, enabling adaptation of an established examination model to create a two-paper, multiple-choice, English-language European postgraduate examination. Following the first pilot examination in April 2025, the EGeMSE was recommended as a benchmark assessment of specialist knowledge within the 2025 European Training Requirements for the Specialty of Geriatric Medicine.

Conclusion: The EGeMSE represents the culmination of more than 2 decades of European collaboration and provides a voluntary benchmark for specialist knowledge that supports the harmonisation of postgraduate Geriatric Medicine education across Europe.