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UEMS and European Diploma

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  • 1. Meeting of UEMS Radiology Section in Vienna on the 8th of March 2008Report by Dr. Miraude Adriaensen, MD, MSc, PWG representativeIntroductionThe UEMS (Union Européenne des Médecins Spécialistes) is the Europeanrepresentative organisation of the various National Associations of medicalspecialists in the EU Member Countries. The objectives of the UEMS include thepromotion of quality patient care through the harmonisation and improvement ofquality of specialists’ medical care in the countries of the European Union andthe encouragement and facilitation of CME (Continuing Medical Education) forEuropean specialists. The UEMS represents over one million specialists in alldifferent specialties and is working through 37 Specialist Sections each with itsown European Board. Each Specialist Section has the possibility to install anEducational Board within its Specialist Section.The PWG (Permanent Working Group of European Junior Doctors) is theumbrella organisation of Junior Doctors’ Associations from all over Europe (EUand EEA). At present the PWG represents the residents of 23 Europeancountries. PWG’s initial objectives include improving relations between itsmember organisations and narrowing the gap (in among other things quality oftraining and working conditions) between the residents in different countries aswell as safeguarding the interests of residents in Europe.The UEMS is the most important body dealing with Medical Specialist Trainingon a European level. It sets standards of PGT (Post Graduate Training), CME(Continuing Medical Education) and decides how many European Credit Pointsyou can get for having attended a certain PGT/CME event. The SpecialistSections deal with specialty-specific topics. The Specialist Sections set up theEuropean Training Syllabuses, i.e. the training standards for its specialty, andorganize visitations of training centers.In accordance with the statutes of the UEMS European Sections and Boards,each UEMS Specialist Section welcomes one PWG delegate to represent theresidents of the specialty in question. The PWG delegate is a full member of theSpecialist Section and the Educational Board if the Specialist Section hasinstalled an Educational Board, and the PWG delegate has voting rights.UEMS radiology section websiteSince the last meeting in October 2007, the UEMS radiology section website waslaunched. www.uemsradiology.euRadiology training in EuropeThe UEMS stands for quality and harmonisation of post graduate training acrossEurope. Therefore a European Training Charter for Clinical Radiology wasdeveloped and revised. Currently the European Training Charter for Clinical
  • 2. Radiology is being revised again to include communication skills, evidence basedmedicine and molecular imaging into the curriculum.Hybrid imaging: towards closer collaboration between nuclear medicine andclinical radiologyA white paper on multimodality imaging has been written by the EuropeanSociety of Radiology (ESR) and the European Association of Nuclear Medicine(EANM). Diagnostic PET-CT, SPECT-CT, and PET-MR bring togetheranatomical and molecular information and require the competency andaccreditation of individuals from both specialties. Currently, ways to bring hybridimaging into the educational programs are discussed.Subsections within the UEMS Radiology SectionAccording to UEMS rules of procedure, a section may create one or moresubsections, under the responsibility of the main section, devoted to the study,promotion and defence of a branch of the specialty or competence, which formsan integral part of its practice, and involves a recognised higher training program.However, a field of practice which crosses the boundaries of more than onespecialty cannot compose a subsection. During this meeting the majority ofUEMS delegates voted for the creation of a subsection of Neuroradiology and asubsection of interventional radiology within the UEMS Radiology section.The creation of subsections is seen as a way to protect specific skills andcompetencies and let them stay exclusively within the field of radiolgy. TheUEMS and the ESR want to keep radiology as one unified specialty and want toprevent fragmentation. The field of radiology has to remain flexible as it is a fastchanging field. You should not lock yourself into subspecialties too much. Dangerof official subspecialists is that health insurance companies might only want toreimburse the work of officially recognised subspecialists like already happenedin Czech Republic. This consequently can lead to more than one or tworadiologists having to take the same duty as not all radiologists are allowed toperform and report on certain exams.European Training Assessment Visiting Program (ETAP)Since the beginning of the ETAP, over 20 radiology training centers throughoutEurope have been assessed by assigned UEMS assessors. Now it is time totake the program to the next level i.e. trying to set up assessment schemes in allindividual member countries on a national level. Currently, assessment andaccreditation of radiology training centers on a national level only exist in theNetherlands and the UK. In Belgium they are planning to set up such a program.The plan is to start with three to four other member countries and help themorganise their own national assessments.EU affairsDirective on electromagnetic fieldsThe EU Directive on the minimum health and safety requirements with regard tothe exposure of workers to the risks arising from physical agents
  • 3. (electromagnetic fields) was passed in 2004 (Directive 2004/40/EC). ThisDirective will put limits on the exposure of operating staff to magnetic fields from0 to 300 GHz. These European limits are 1000 times lower than the US safetylimits. Incorporation of these limits into national law would make many MRIprocedures illegal, close off development and could lead to a brain drain to theUS. Research into interventional MRI would become illegal. MRI performed onpatients under mild sedation will have to be done under general anaesthesia.The number of X-ray examinations with proven unwanted side effects willincrease.Because of the concern over the unintended negative effects of the directive onthe use of MRI in health care, the ‘Alliance for MRI’ was launched during theECR 2007. The ‘Alliance for MRI’ is a coalition of European Parliamentarians,patient groups, leading European scientists and the medical community, whotogether are seeking to avert the serious threat posed by EU health and safetylegislation to the clinical and research use of MRI.A successful lobby lead to the following result. On the 26th of October 2008 theEuropean Commission proposed to postpone the deadline for introducinglegislation on workers´ exposure to electromagnetic fields to the 30th of April2012. This will allow time to amend the directive in order to take account ofrecent research findings of the possible impact of the exposure limits on MRI.However the battle has not been won yet. Lobbying needs to continue. Newmeasurements, study results and their consequences need to be explained tothe relevant European bodies.Competence Assurance of European Healthcare Professionals: the PortugalAgreement (www.hpcb.eu)Key principle of the Portugal agreement is that competent authorities shoulddevelop appropriate information exchange tools to provide assurance to othercompetent authorities of current practitioner performance competence whenpracticioners seek to practice in other Member States.AcknowledgementI thank Dr. A van Gils, MD, PhD, radiologist and Dutch delegate to the UEMSRadiology Section for his cooperation on this report.RequestsComments and requests for documents can be send to miraude@gmail.comAddendum: European ExamsHistorically the UEMS and the UEMS radiology section are not in favour of aEuropean Diploma. As a European Exam has no legal meaning nationally or at aEuropean level and it should not grant any privileges. Exams are only onemethod of quality assurance of specialist training. Other methods such asevaluation of training centers and evaluation of doctors in training throughout thewhole training period are also justified.
  • 4. The PWG believes that the focus should primarily be on the process ofpostgraduate training rather than on final examination. The focus of the UEMStherefore, should be on the introduction of a harmonised curriculum andappropriate training resources across all member states for each medicalspecialty. Residents should fulfill criteria for successful progress. These criteriashould include the full range of abilities required for medical specialist practiceand should be monitored by continuous assessment. The PWG does not supportthe idea that all skills and knowledge required by a medical specialist can betested to the full extent solely by any form of final exam. Therefore, the PWGopposes any attempts to make European Speciality Board Examinations directlyor indirectly compulsory in addition to national speciality qualification. The PWGsees the following potential problems with European Exams. Trainees andtrainers could focus on what can be tested by such examinations rather than onthe range of skills required for competent specialist practice. This may ultimatelybias their future clinical practice. Next problem: different health care systemshave different needs. Furthermore, different hospital settings offer differentlearning opportunities for residents. Potential hazards of European Exams asseen by the PWG. European Exams have no legal meaning yet. We do not knowhow the national laws and EU directives will change in the future. Quality controlshould stay within the field of the professional autonomy of the medical specialist.Finally, as European Exams would be considered a good idea to test andsafeguard the quality among medical specialists, this might lead to the impositionof these examinations as part of a recertification process.From the official minutes of the UEMS Radiology Section meeting dd 27/10/07: