Union Europeenne Des Medecins Specialistes Research Articles

Fahrplan für das Fachgebiet Allergologie und die Versorgung allergischer Patienten in Europa und den angrenzenden Ländern

textabstractThe high prevalence of allergic diseases warrants for sufcient health care provisions available to patients with allergic diseases. Allergy care should be delivered by well-trained specialists. However, the current status of allergy care is not well documented. For this reason a survey among European and a few non-European countries was launched by the National Allergy Society Committee from the European Academy of Allergy and Clinical Immunology and the Union Europeenne des Medecins Specialistes section and board of Allergology. The survey shows that in the vast majority of countries allergy care services are available. However, a substantial heterogeneity is reported regarding recognition of the full specialty, the number of practicing specialists or subspecialists, and training aspects. Growth but also decline of specialty and subspecialties is reported. In addition, the survey gives insight in strengths, weaknesses, opportunities and threats in this feld. It appears that the recognition of the full specialty determines strength as well as weakness. Aging of specialists combined with a decline in the number of trainees form a major threat. Opportunities are seen in creating awareness for allergy, focus on attracting young physicians. The conclusion is that harmonization of allergy services across Europe is needed. Investment in young doctors, creating new opportunities and lobbying for the full specialty is required

How Can We Improve Education of Breast Surgeons Across Europe?

European Board of Surgery Qualification in Breast Surgery (EBSQ in BS): phase 1-eligibility assessment (CV, logbook, references); phase 2- test; phase 3- oral examination with 2 clinical cases and 1 critical review of academic paper. The applicant must hold a current license to practice as a surgeon (general or plastic or gynaecologist), demonstrate work for one year in a breast surgery unit with at least 150 new primary breast cancer cases per year, attended at least one national/ international training course in breast surgery and has attended at least one well recognized international congress. The applicant should present a signed log book for breast surgery with application; published either one paper or book chapter on breast disease Conclusions 1. The need for certified breast units: Standardised techniques by specialist breast surgeons across Europe should be the aim. 2. No man'™s land. Across Europe oncoplastic reconstruction is performed by specialist breast, general or plastic surgeons, sometimes in collaboration with each other. There may be dispute as who should or should not be involved. This needs to be addressed. 3. Oncoplastic reconstruction technique expansion. Significant expansion in number, variety and complexity of available techniques is a fact. A good example would be a 6-fold increase together with a low rate of complications in some Eastern European countries over the last decade 4. CME. European breast surgeons want to improve their skills, as evidenced by fully or overbooked ESSO-endorsed breast surgery courses and other high quality workshops. Applications for the European Examination in Breast Surgery (EBSQBS) continue to increase.

The recognition of plastic surgery as a medical speciality in the European economic community: a 40th anniversary

With the signing of the Treaty of Rome in 1957, the European Economic Community (EEC) was established. Its principal aim was to allow free mutual movement of goods, capital, services and persons. Medical doctors from the EEC countries were to obtain the right of establishment and practice in all six countries, as of January 1, 1968. In 1959, the national professional associations of doctors formed an interest group (Standing Committee) to act as discussion partner for the legislative bodies of the EEC on medical issues. The professional organisations of the medical specialists in the EEC countries formed the Union Europeenne des Medecins Specialistes (UEMS) to give advice to the Standing Committee in matters concerning specialised medicine. The UEMS established various monospecialistic sections, one for each recognised speciality, thus expressing the fact that the speciality is practised by specialists who occupy themselves solely with this one particular speciality. Because no monospecialistic section for plastic surgery was initially established, the Dutch plastic surgeons initiated efforts to have their speciality recognised, in 1964. This initiative resulted in recognition and the establishment of a ‘Section Monospecialisee de Chirurgie Plastique’ by the UEMS, in 1969. The impact of the formation of this separate section on the national status of plastic surgery in various countries has been considerable. Still, it took another 6 years before the European Council of Ministers formally recognised this speciality on June 16, 1975. The years of step-by-step efforts to obtain this recognition are memorised to commemorate its 40th anniversary.

The Perspective of Trainees On the Psychiatry Training

The European Federation of Psychiatric Trainees (EFPT) represents the consensus of psychiatric trainees across more than 30 European countries, advocating for the improvement of the psychiatry training regardless of the country. The current challenges in the psychiatry training that trainees face at the European level will be presented; discussing the attitudes and opinions of the psychiatric trainees in the light of EFPT studies. Recently, the EFPT has developed a cross-sectional multicentre study, collecting data from trainees across 33 European countries, inquiring them on the conditions to be improved in their country regarding Psychiatry, such as: academic (training or educational opportunities), professional network (team work, cooperation), work (employment, conditions, workload) and financial (salaries); having been reported their attitudes and experiences of mobility and migration. Indeed the EFPT supports trainees going across borders through the EFPT Exchange Program. Moreover, being highly skilled brain migration a current trend, the EFPT has as well investigated deeply this topic. Likewise, the EFPT aims to research the aspects of postgraduate training in European countries in collaboration with Union Europeenne des Medecins Specialistes (UEMS) in an effort to find solutions to the lack of training standards. This future approach is expected to facilitate the harmonization of psychiatric training in Europe, so important nowadays, especially given the increase of mobility opportunities and marked migration trends of professionals across countries. Enhancing and harmonizing the training can afterwards take an effect towards improving the similarities of the mental healthcare internationally.

Training of Future Interventional Neuroradiologists

The development of interventional neuroradiology (INR) has increased rapidly during the past few years. A majority of cerebral aneurysms today are treated using more and more sophisticated endovascular techniques dedicated to the different types of aneurysms (fusiform/saccular, large and giant/small, wide neck/small neck, ruptured/unruptured). Also, endovascular techniques for the treatment of acute ischemic stroke are increasingly being used with highly effective results, particularly in the management of large-vessel occlusions, whereas angioplasty and stenting have a significant place in the prevention of stroke by treating cervical and intracranial stenoses. INR is the principal technique for the treatment of intracranial and spinal dural arteriovenous fistulas and also plays a significant role in the management of brain and spinal arteriovenous malformations, as well as in the presurgical embolization of cranial and spinal hypervascular tumors and in the devascularization of patients with, for example, epistaxis. Although the creation and development of INR were initiated by neuroradiologists, other medical specialists have become progressively more involved with the techniques, particularly neurosurgeons and, to a lesser extent, neurologists. Because it was a new medical practice, no specific medical training was initially available but, over time, several scientific societies began to propose guidelines for the training and practice of INR.1,2 Until now, training in INR has been a matter between trainee and teacher and, thus, the result has often been less-than-optimal training with a long learning curve, with patients paying a high price. The Union Europeenne des Medecins Specialistes (UEMS)/European Union of Medical Specialists) is the officially recognized and permanent consulting nongovernmental organization for European medical institutions; today it represents 35 national organizations and ≈1.6 million medical specialists. The UEMS is involved in professional issues important to European specialists and has a significant influence on how these issues are formulated in the directives and laws …

Editorial Comment: Time to end the disparity of training in Europe

Free movement of people (and so workers) is one of the four economic freedoms guaranteed under the internal market of the European Union (the others being goods, capital and services). It is a fundamental principle of European Law that each of the 27 member states must recognize professional qualifications granted in another country. The details relating to this mutual recognition are set out in the Directive 93/16/EEC of 5 April 1993. This only makes sense if we have a common training programme which produces surgeons with equivalent knowledge and skills. Yet, we all know that there are marked variations, not only in the content and delivery of training but also in the selection, assessment and accreditation of trainees. The current situation is nonsensical. The paper, published in this issue, by Loubani et al. [1] is a valuable contribution to the debate which we must have if we are to make any progress towards harmonization of training. The authors rightly compare the organization of training in other countries with the wide variation in Europe. The practice of cardiothoracic surgery is evolving rapidly with a significant move towards subspecialization (to the benefit of patients who must remain our key focus), and so, the way we train the next generation must change. They make a good argument for a modularbased system with an initial broad-based ‘basic’ programme with later specialization. As things stand at present, the UEMS (Union Europeenne des Medecins Specialistes) is the representative organization of all medical specialists in the EC [2]. As it is the legal entity, we must work through UEMS. A ‘European Board’ is a body set up by the relevant UEMS/Specialized Section with the purpose of guaranteeing the highest standards of care in the speciality concerned in the EC member states by ensuring that the training of specialists is raised to an adequate level. This might seem to be a rather unwieldy and bureaucratic system, but it is the only mechanism we have to work with. I believe it is something the National Societies can use to work together towards a common European training system. The Canadians, the Americans and the Royal Australasian College have all managed to agree their own common training programmes. So, surely it is time that we in Europe took up the challenge. Continuing with the current nonsensical situation is unacceptable and does our speciality (and our future trainees) a disservice—it makes a mockery of the law. If patients understood the reality, they would expect better from us.

Cardiologists in training: be prepared for exams!

On Thursday 14 October, 50 cardiology fellows-in-training took a national examination in the Jaarsbeurs (Utrecht). The exam was organised by our National Institute for Continuing Cardiovascular Education (Cardiovasculair Onderwijs Instituut, CVOI). This national examination was held for the first time in history and on this occasion only fellows-in-training in their fourth cardiology year participated. The initiative for this exam was taken by the Concilium of the Netherlands Society of Cardiology (NVVC). The national exam consisted of 120 multiple choice questions of which 11 questions were based on video images (5 choices for each question). The entire exam lasted three hours. The material was provided by the EBSC (European Board for the Specialty of Cardiology) of the European Society of Cardiology (ESC). The EBSC/ ESC lends its support in setting up national exams. The main interest of the EBSC/ESC is to promote national exams within Europe and to offer the exams to the national societies of the ESC. The uniformity of the exams is directly linked to the Union Europeenne des Medecins Specialistes (UEMS). The EBSC produces the multiple choice questions which are anchored in the European knowledge base and can be used for knowledge-based assessment (KBA). The questions are made available to those national societies that intend to organise a national exam. The EBSC/ESC also offers assistence in organising a national exam and to be present on the day. At the beginning of this year, the British Cardiac Society (BCS) was the first ESC national society to hold a (pilot) exam for their first 100 residents. This initiative of the NVVC/CVOI should be embraced and further encouraged. The pilot exam will be only the start of a more direct evaluation of knowledge, thereby confronting young cardiologists in spe with their knowledge levels and also with their shortcomings. However, it should be realised that exams are primarily meant to improve the knowledge level rather than to point to knowledge gaps. It is hoped that these national cardiology exams will be extended to each of the four years of dedicated cardiology training and that they will become mandatory. Finally, also the mature cardiologist should be subjected to national exams at regular intervals. The mere thought of doing exams at an older age may provoke ventricular premature beats but this is far less serious than experiencing a sudden death caused by an individual who has not renewed his/her drivers license. ■

UEMS charter on the training of rheumatologists in Europe

The Treaty of Rome provides for the free exchange of persons, services, goods and capital within the European Community. Free exchange of persons and services within the medical sector has...

EBCOG Newsletter September 2006

These are important times for EBCOG. We have had an outstandingly successful start to 2006 and are now in the process of planning actively for an exciting future. That we are in a strong position to do so is in large part due to the great success of the European Congress of Obstetrics and Gynaecology held in Torino in April. I must pay tribute to the enormous efforts made on behalf of EBCOG by the Presidents of the Congress, Professor Chiara Benedetto and Professor Andre Van Assche, as well as the Chair of the Scientific Committee, Professor Ziva Novak Antolic, and the Chair of the Italian Committee, Professor Marco Massobrio. The meeting was a huge success on every level, scientifically, socially and financially. It was attended by almost 1,500 European obstetricians and gynaecologists, more than ever before, and covered a vast range of topics. Particularly successful were the sessions involving colleagues in our affiliated European subspecialty societies, the European Society of Gynaecological Oncology, the European Society for Human Reproduction and Embryology, the European Association of Perinatal Medicine and the European Urogynaecology Association. Links with these societies are of great value in keeping EBCOG up to date with developments in the subspecialties that they represent. Amongst the most popular sessions were the hands-on training sessions, several of which were organised by other European societies, such as the European Society for Gynaecological Endoscopy, European Federation for Colposcopy and International Society of Ultrasound in Obstetrics and Gynaecology. Other organisations involved in the special symposia included International Society of Psychosomatic Obstetrics and Gynaecology, European Menopause and Andropause Society and European Society of Contraception. Ours is rapidly becoming the most important European meeting for general obstetricians and gynaecologists, and we intend to build on the outstanding success, which has been achieved. The next European Congress will take place in Lisboa, the capital of Portugal, slated on 5–8 March 2008. Plans are already well under way to arrange a joint meeting with the Portuguese Federation of Obstetrics and Gynaecology. Further information about the Congress can be found currently at http://www.mundiconvenius.pt/2008/ ebcog2008/ and will soon be available also on the EBCOG web site. Please put these dates in your diary now. It is already time to start planning the 2010 Congress. National Societies are invited to submit bids now, so that they can be considered at the EBCOG Council meeting on 2–3 December 2006. I know that there will be great competition to hold this prestigious event and I look forward with enthusiasm to receiving the applications. The EBCOG Council met immediately after the Congress in Torino. This was the last meeting as SecretaryGeneral for Professor Juriy Wladimiroff and as President of the Union Europeenne des Medecins Specialistes (UEMS) Section of Obstetrics and Gynaecology for Professor Antolic Van Assche. Professor Eeva Marja Rutanen had also come to the end of her term on the Executive group. We thanked them all for their outstanding contributions to the development of European obstetrics and gynaecology in Europe. Professor Wolfgang Holzgreve from Basel was elected Secretary-General and Professor Jacques Lansac from Tours was elected to the Executive group. Professor Lansac is currently President of the College National des Gynecologues et Obstetriciens Francais and has already Eur Clinics Obstet Gynaecol (2007) 2:223–224 DOI 10.1007/s11296-006-0049-2

Training in Vascular Surgery in Europe – the Impact of Endovascular Therapy

Vascular Surgery has been defined by the Division in endovascular procedures not part of the curriculum, while in U.K. it is not mandatory. Training in endoand Board of Vascular Surgery of the Union Europeenne des Medecins Specialistes (UEMS), as the clinvascular surgery is mandatory in the other 12 countries, and in 9 of these, vascular surgery is an ical and scientific discipline concerned with the diagnosis, treatment and prevention of diseases afindependent specialty. These variations can be looked upon as weakness by some but as a strength by others. fecting arteries, veins and lymphatics. Modern vascular surgery took off as a dynamic and It seems that the vascular surgical community in Europe has to come to terms with some facts of life: rapidly evolving branch of general surgery in the 1950s largely due to technological developments in (1) Conventional percutaneous balloon angioplasty prosthetic grafts by the textile and polymer industries. (PTA) is now an established therapeutic modality. The recent introduction of endovascular techniques (2) The volume in absolute and relative terms of endoand devices has raised the question of whether vasvascular prostheses for aneurysmal and arterial cular surgeons should become involved with this new occlusive diseases is small despite its prominence technology. The answer comes from the past and the in the literature. origins of our specialty. Vascular surgeons were the (3) Endovascular procedures are currently performed first to adapt to new ideas and technological inin too many centres and in too small numbers per novations and it seems absurd to back away from centre. endovascular techniques just because they were not (4) Endovascular AAA repair is still an experimental taught to us during training. There are parallels here procedure with unknown long-term clinical with laparoscopic surgery: most surgeons undertaking results. laparoscopic procedures learned the technique after their initial training. Specialties should be based on For open vascular surgical procedures it is well body systems and diseases, not on treatment modestablished that surgeon and hospital volume are asalities. sociated with better outcomes for patients who unThe current status of training across the EU and dergo carotid endarterectomy and AAA repair both the involvement of vascular surgeons in endovascular in U.S.A. and Canada. In the same studies, cerprocedures are shown in Table 1. This shows the tification in vascular surgery was associated with statresults of a survey conducted in April 2001 among the istically better outcomes following AAA repair national representatives of the European Board of compared to non-certification in vascular surgery. Of Vascular Surgery (EBVS). We can see that in only three course, certification does not guarantee that a surgeon countries (Denmark, Ireland and Norway) is training will perform a better operation compared to a noncertified colleague. However, it does indicate that the individual has gone through a period of dedicated ∗ Please address all correspondence to: C. Liapis, 131, Vas. Sofias Str., 11521, Athens, Greece. training in a structured training programme. Why then

Vascular and Endovascular Surgical Activity in Denmark, Finland, Norway, Sweden and Northern Ireland

At the meeting of the European Board of Vascular The European Board of Vascular Surgery discussed various drafts and eventually agreed on the index Surgery, Union Europeenne des Medecins Specialistes (UEMS), on April 13th, 1996, in London it was decided procedures listed in Table 1. We are well aware that this preliminary effort could be criticised on certain to explore the possibilities for creating a registry of vascular and endovascular surgical activity in terms points, especially with regard to the coupling of indications and procedures. On the other hand, although of procedures performed within the European Union and associated states. national database structures and entry points vary, it should be possible to obtain realistic and reasonably In the United States of America, the volume of selected index procedures has been published with comparable data. Table 1 provides the background for collecting a minimal common data set, and it can be information from The National Center for Health Statistics through its National Hospital Discharge Survey and from individual practitioners. Table 1. Detailed definitions of the index procedures. In some European countries, detailed information Code Definition on activity is available, notably from the registries created and maintained by the national scientific soA Open vascular surgical procedures on the carotid artery B Open vascular surgical procedures for non-specific cieties, viz. The Danish Vascular Registry, Karbase infrarenal aortic aneurysm (Denmark), Swedvasc (Sweden), Norkar (Norway), C Open vascular surgical procedures for occlusive Finnvasc (Finland) and independently, viz. Nivasc atherosclerotic arterial disease of the aorto-iliac-femoral segments (the most distal anastomosis, (Northern Ireland). thrombendarterectomy etc. may be in the groin) A working party consisting of David Bergqvist (SweD Open vascular surgical procedures for occlusive den), Ola B. Saether (Norway), Mauri Lepantalo (Finatherosclerotic arterial disease in the leg (including procedures in the groin without simultaneous procedures land) and William Paaske (Denmark) was formed to proximal to the inguinal ligament) above knee suggest a format for the proposed EUROVASC registry. E Open vascular surgical procedures for occlusive The aim was to identify certain index procedures atherosclerotic arterial disease in the leg (including procedures in the groin without simultaneous procedures that could be used as a template for extraction of proximal to the inguinal ligament) below knee meaningful information on activity from the national F Percutaneous transluminal angioplasty +/− stenting above registries already in existence. The EUROVASC rethe inguinal ligament G Percutaneous transluminal angioplasty +/− stenting below gistry should also be relatively simple, enabling the the inguinal ligament inclusion of data from future national registries withH Endoprostheses for abdominal aortic and/or iliac out too many problems. Further, the format of the aneurysm I Endoprostheses for occlusive atherosclerotic arterial disease European registry, at least in part, ought to correspond above the inguinal ligament to its American counterpart. J Endoprostheses for occlusive atherosclerotic arterial disease below the inguinal ligament ∗ Please address all correspondence to: W. Paaske, Department of K Procedures for arterial trauma Cardiothoracic and Vascular Surgery T, Aarhus University Hospital, L Permanent angioaccess procedures for haemodialysis Skejby Sygehus, DK-8200 Aarhus N, Denmark.

Report from the president of U.E.M.S. division of vascular surgery

This is the first annual report from the Division of Vascular Surgery in the Union Europeenne des Medecins Specialistes (UEMS). Its purpose is to inform vascular surgeons of progress made during the year by this committee which officially represents their interests within the medico-political structure of the European Union. Having agreed a Constitution and the Statutes in the opening sessions, the Division went on to make the important decision to establish a European Board of Vascular Surgery. This Board will be concerned exclusively with matters related to training, but its creation could significantly alter the status of European vascular surgery relative to other surgical specialities and may eventually impact upon the organisation of clinical services. A brief summary of the structure and function of the UEMS and the European Speciality boards may assist fuller appreciation of the implications of this decision.