Training inspection visits--pushing up quality of training in Europe.

Abstract

It is essential that in Europe we train the next generation of dermatologists to a very high standard. Probably we can all agree on that statement. The present situation, however, where some countries have rigorously externally inspected training programmes while others answer to no one, is unsustainable and indefensible. It is evident that in a community of over 250 million, where 10 000 dermatologists have the right to practice across the growing number of EU member states, not only must we believe that our training programmes are effective, we must also prove that they are. If we do not create systems to monitor and regulate the quality of training programmes, the dermatologists from low-quality programmes will drag down the reputation of our specialty and our patients will not be protected from inadequately trained specialists. We must organize ourselves to ensure that minimum standards are met, and that standards across Europe are constantly being raised. We must be able eventually to assure our patients across the continent that all dermatologists have not only completed a training programme, but that all training programmes are quality assured. In the majority of countries across Europe there is no system of regular external inspection of dermatology training programmes. This does not necessarily imply that the programmes in these countries are not of a high standard – that is obviously absurd. However, they do not have the benefit of being inspected. And what is the benefit? The experience of departments in those countries, such as Sweden and the UK, where a programme of external inspection is well established, is that the process of inspection is of great political benefit as well as a spur to improve locally. Resources can be argued for with much greater force if there is a threat of an adverse inspection report. Inspection visits are generally welcomed by departments as an opportunity for critical review of the training. How does the system work in those countries where it is established? In 1991 the Swedish Medical Association started review visits of training programmes focusing on the structure and the process of the training. A review report is written to answer a series of questions concerning the organization, volume and range of the clinical work, the size and expertise of the clinical staff, the quality of the premises, library and equipment, research opportunities, inclusion of theoretical education and the overall educational environment. The specialist sections within the Swedish Medical Association had a key role in designing and encouraging the introduction of this system, and in recruiting reviewers. In Sweden visitation is recommended every third year, but is not compulsory. The gradings of the training in each centre, based on the visits, are published every year. The publishing of the results has been a very important tool for the training centre to improve its quality and achieve an increase in resources. In the UK a similar system has been organized for over 20 years at a national level jointly by the Royal Colleges of Physicians. Every centre is inspected once every 5 years, or more often if problems are found. In the UK the results of the inspections are not published, but are made available to the centres. Ultimately the Royal Colleges’ joint committee can recommend that training status be removed from a department if problems identified at visits are not corrected. It is of course this final sting that provides a very effective stimulus to improve. It is not realistic to expect every country in Europe to rapidly introduce a national system of training programme inspection. But it is a valid aim. The UEMS seeks to persuade member countries of the benefits of creating such systems. It is much better to organize oneself rather than to wait until external systems are imposed. This issue of the JEADV contains the Charter for Visitation: this document is offered as a basis for the documentation for inspections visits, each country would probably wish to adjust the methods to suit local circumstances. Once a system of inspection is in place across the majority of countries, then the organization of international inspection will become feasible. Organisers of high quality training programmes have nothing to fear and much to gain from the introduction of external review.