N E W S L E T T E R 2 0 0 7
Sections representation to the UEMS Central Executive Committee
Our President prof. Holschneider has been highly active as Representative of the Surgical Sections within the UEMS Central Executive Committee, together with prof. Greenhalgh of the Section of Surgery. In this capacity he strongly supported the position of the Sections in the general framework of the UEMS organisation and their initiatives such as European Examination and Site Visits, intended as main available ways to raise and to keep the standards of medical training in Europe.
The need of a standardisation of training is becoming more and more evident due to the increased exchanges of medical specialists throughout European Countries. This phenomenon raised a lot of problems because of evident inequalities of training and quality assessing among the different Countries: this leads to consider more in depth the issue of international recognition of the validity of the European Examinations, once thwarted and now just barely recognised by the UEMS headquarters.
Our Section will go on strongly supporting the request of voting right for the delegates representing the Sections and Boards in the UEMS Management Committee, to express at the highest level of our Organisation proposals and views coming out from the people directly involved in the patients care, European medical specialists.
Council for European Specialist Medical Examinations (CESME)
The 9-10/2/2007 our Section organised a Meeting in Glasgow, attended by representatives of 9 Sections already running European Examination as well as by the General Secretary of UEMS Bernard Maillet, to discuss different issues on the topic of European Medical Examination. A common Declaration was agreed upon, where it was also proposed to establish a Council for European Specialist Medical Examinations (CESME) as an advisory body to the UEMS and its Sections. The so-called Glasgow Declaration was then presented and discussed at the Presidents and Secretaries meeting in Brussels the 26th May; amended version was again discussed in the UEMS Executive Meeting in Bratislava the 11-12/10/2007, while two other meetings of the CESME were held in Brussels (16/6/2007 and 17/11/2007). Up to now 22 out of 38 Sections took part to these meetings.
The Glasgow Declaration is still waiting its final approval, but the issues raised by problem of European Examination and dealt within the Declaration are on top of the Agenda of our Section.
Last Centers visited and approved are the Training Centers in Paediatric Surgery of Warsaw, Poland and Bern, Switzerland, raising the total number of approved Centres to 20 (1 Austria, 1 Czech Republic, 1 Denmark, 4 France, 3 Germany, 1 Hungary, 2 Netherlands, 1 Poland, 1 Portugal, 2 Spain, 1 Switzerland, 2 Turkey).
National Delegates have been invited to appreciate in full the importance for a Training Center to be recognised at European level, as a mark of excellence, and to foster the application from Centers in their Country not yet approved by the European Board. Actually, site visiting is the only way to assess the quality of Centres and to increase quality standards, also because National Authorities in many countries do not deal with this issue.
About the problem of setting the standards required by a Training Centre in Paediatric Surgery, discussion within the Section underlined how needed are them particularly now with our discipline so rapidly evolving with new technologies. This issue prompted some Countries such as UK to consider dividing Centres in two different branches, the first with few centres of excellence - devoted to advanced Paediatric Surgery and the second the average Centre dealing with ordinary Paediatric Surgery. While considering the basic requisites for a training centre it comes out the problem of the number of index cases to be dealt with by the trainees, not always available in different periods of the year: this also implies the need of fixing the maximum number of trainees each Centre can train at a time.
This problem presents different aspects in the different Countries. If the training is meant to prepare the trainee to enter private practice he will need to master only standard procedures for routine surgery; moreover, approbation of a Centre needs to take into account multiple factors, such as regional boundaries, catchments area, number of treated patients, facilities available, number of surgeons and their subspecialties, which are the results of the Centre (is there an audit system or not ?). Definition of the minimum standard for a Centre to be recognised is yet to be defined, as well as the number of trainees it can train at a time.
European Registry of Paediatric Surgery
After the extension to Romania and Bulgaria of the EU boundaries, it was decided to offer also to our Bulgarian and Romanian Colleagues the opportunity to apply for European Registration for established Paediatric Surgeons, with the same procedure and limitation applied for the last Countries admitted to EU, i.e. allowing them one year to register according to the rules set up for the first Registration. This was reserved for bona fide Paediatric Surgeons already established from at least three years in 1996, in other words for pediatric surgeons specialised before 31st December 1993. About the issue of amount of fee to be paid for registration, it was decided to reduce it to 25 euro instead of 35 pounds as formerly established, clearly specifying that this sum has to be intended as a fee and not as a coverage of the expenses for registration.
In 2007 European Examinations part one (100 MCQ, preliminary screening) were held in Glasgow, Turin and Budapest; European Examination part two (clinical examination and vivas) were held in Istanbul, were 25 candidates were examined, 22 approved and 3 failed, and in Budapest with 24 candidates examined, all approved but one.
Two major problems were encountered: 1) difficulties in english fluency by some candidates, declaring a workable knowledge of english but on the contrary needing on the spot translation; 2) high number of candidates, involving a complex organisation.
Turkish Association of Paediatric Surgeons agreed to adopt the European Examination as National Examination, automatically approving at national level the Turkish successful candidates; locally organised national examination were performed with the same set of MCQ and general setting of European Examination.
The issue of admitting to the European Examination also candidates not EU citizens or not trained in EU was discussed: considering that it seems advisable to separate political issues from cultural ones, that keeping the European Examination as a high level standard improves the position of the UEMS towards foreign Countries, that in the Glasgow Declaration it was expressed a common position on this issue, it has been agreed that the Examination will be open also to non-EU citizens, recording the successful candidates in two different Registers for EU and non-EU citizens.
Syllabus in Paediatric Surgery
The long way to final approbation of the European Syllabus in Paediatric Surgery saw in 2007 the presentation of the third draft, the discussion of the fourth one and the collection of suggestions and amendments from the National Scientific Societies, summarised in the final draft that will be hopefully approved and published in 2008.
Topics emphasised in the last versions are the need to keep Urology within the umbrella of Paediatric Surgery; the opportunity not to compare and to copy the UK system for the whole Europe; not to impose guidelines so strict to make them impossible to follow; not to be too much specific in detailing procedures; to be very careful with minimum numbers of procedures to be performed.
In 2007 two events (Sevilla Hypospadias Course on Current Surgical Treatment and Live Surgery and European Congress in Torino) were approved and accredited by the EACCME.
The agreement signed with the UEMS headquarters is working smoothly and the accreditation of events approved by the Sections Committee is registered promptly, assuring a recognition also by the American AMA accreditation system.
European Working Time Directive
This issue raised a lot of discussions and practical proposals aimed to harmonise the formal requests of the Directive with the needs of a proper training of postgraduate students. The 48 + 12 working hours model was judged essential to allow enough time for good patient care as well as for research. Unfortunately, the huge amount of variables involved in this issue as well as the total impermeability of European Commission to the modifications suggested by the UEMS made any further discussion on this topic practically useless.
Section participation to Multidisciplinary Joint Committees
Our Section is involved in four Multidisciplinary Joint Committees, i.e. Paediatric Urology (MJCPU), Sport, Emergency Medicine and Hand surgery.
About MJCPU and particularly about the resolution of the Committee to register as Paediatric Urologist only Colleagues dealing with this subspecialty for more than 80% of their activity, it was raised the problem that many Paediatric Surgical Centres perform a lot of Paediatric Urology, but cannot by approved by the MJCPU because of the 80% rule. According to our representatives in the Committee also with this rule the work of MJCPU is running smoothly: the committee organised the European Exam in Paediatric Urology with now some 120 Fellows of the European Academy of Paediatric Urology. Seventeen candidates were rejected because devoting to Paediatric Urology less than 80% of their activity. Site visits were performed in three Centres while 3 are still in the waiting list; a system of recertification as a Fellow of the Academy through CME achievements was set in place.
No specific activities have to be reported for the other three MJCs.
UEMS / EUPSA relationship
Relationship between the Section and the EUPSA (European Paediatric Surgeons Association) continues to be very strict, both having the same goal to increase the quality of Paediatric Surgery in Europe. The main instrument of EUPSA is since many years the European Pediatric Surgical Scientific Congress. In addition, in the last year many further activities concerning the exchange of clinical experience and research activities were realised.
The Executive agreed to keep EUPSA and UEMS meetings in parallel in order to go on working together, but with a clear definition of whos who, the EUPSA a private scientific association and the UEMS a political one dealing with the European Commission.
The Syllabus is the example of a very important issue to be dealt with jointly; about the istitutionalisation of relationship between the two bodies, it was agreed that both Presidents will be reciprocally invited in the Executive Boards without voting rights.
Elections of the President and the Secretary
2007 has been the last year of term for the President Holschneider, for the Secretary Parigi and for two Executives, Aigrain and Lindahl. The General Council of the Section held in Turin elected Gian Battista Parigi (Italy) as new President for the term 2008-2011, Tomas Wester (Sweden) as Secretary for the same term, and re-elected Yves Aigrain (France) and Harry Lindahl (Finland) for another term as Executives.