Advancing paediatric surgery through education and research
European Union of Medical Specialists (UEMS)
Europe is always on our minds. Currently, the argument in Brussels is over control of fishing rights in UK waters. Today, we are outside of Europe but still very much on the inside when it comes to medical training and its harmonisation. Once you can get your head around this paradox it all becomes clear….
To quote from its own preamble: “The UEMS is a non-governmental organization representing national associations of medical specialists at the European Level. With a current membership of 37 national associations and operating through 43 Specialist Sections and European Boards, the UEMS is committed to promote the free movement of medical specialists across Europe while ensuring the highest level of training which will pave the way to the improvement of quality of care for the benefit of all European citizens. The UEMS areas of expertise notably encompass Continuing Medical Education, Post Graduate Training and Quality Assurance.”
The current document sets a framework [European Training Requirements (ETR)] for the training necessary to produce a “pediatric surgeon” (their spelling not mine) within the members’ area. So, what’s that got to do with me…..I voted Brexit…I hear from an admittedly small proportion of BAPS members. Well you might have done but this legally operates not only within the 27 countries within the EU but also EFTA (which now includes the UK, Iceland, Norway, Switzerland etc) and “associated member states” such as Armenia, Israel, Turkey and Serbia…so that’s almost half the world then.
So, I have set out to strip out the unnecessary verbiage and obfuscation inherent in any educational/legal document. Out goes “holistic vision”, (let’s restrict that to Gwyneth Paltrow’s website please); “..he should endeavour to work in accord with her/his colleagues in a spirit of progressive cooperation..” (have you ever worked in Kings!); “…always keeping in mind nature’s laws…”, (the Law of Gravity is pretty fundamental to a paediatric surgeon certainly); and ”…. by act cast imputations upon them or their rightful practices..”, (something to do with witchcraft in the 17th century, I think).
Here they are fairly specific – your practice should extend up to 18 year olds.
In a nutshell this could be described as everything…..and a bit more. Certainly “must have competent and up to date theoretical knowledge of the core and pediatric surgical subspecialties. This knowledge includes all phases of treatment: diagnosis, management, follow-up care and prevention.” It also goes on to include “…theoretical aspects of paediatric anesthesia, intensive care, pain management, fetal and neonatal medicine.”
There is not much credence given to sub-specialisation (at least in training) so one has to have knowledge on surgical pathologies of: digestive tract, including hepatobiliary system; head and neck; respiratory system; genitourinary system; endocrine system; vascular anomalies; musculoskeletal system and skin and central and peripheral nervous system. So, you could have been a brain surgeon after all!
It sets out the levels of competence as Level I (assist any procedure); Level 2 “perform the procedure under supervision”;Level 3 “able to perform the procedure independently).
Numbers – always a bone of contention.
Minimal numbers over 5-6 years of training.
General or CORE Procedures
The actual levels of competence are set out using a 1- 5 scale
Cannot be expected to preform
Performs under full supervision
No need for direct supervision
May perform independently
Full knowledge and skills
Level 5 is only expected for things like hernias, UDT, foreskin surgery etc; most the interesting bits of surgery are Level 3 (pyeloplasty, esophageal atresia, fundoplication etc). But then again “neurosurgery” is also given as a Level 3 – so best of luck with the next craniotomy.
The remainder of the document is more to do with how this is all achieved – setting up of programmes; – who should be the Training Program Director etc. None of it is contentious and all pretty well established in the UK.
One thing which I have advocated for many years however is mentioned – yearly examinations. I always thought one could cruise though the annual ARCP without actually reading too many textbooks and then the final FRCS examination came as a rude awakening.