Medical Specialities: Surgery, Vascular Surgery, Hematology, Radiology, Allergiology, Anesthesiology, Internal Medicine, Gastroenterology, genetics, General Medicine, Maxillofacial surgery, Dermatology, Endocrinology, Social medicine, Public Health, Cardiology, Cytology, Gynecology – Obstetrics, Neurosurgery, Nephrology, Orthopaedics & Traumatiology, Urology, Ophthalmology, Pathology, Psychiatry , Paediatrics, Paediatric Psychiatry, Plastic surgery, Pneumonology, Nuclear Medicine, Reumatology, Rehabilitation medicine, Thoracic surgery, Paediatric surgery, ENT, Forensic medicine.

1. TRAINING IN SURGERY IN
GREECE
George N Zografos
Consultant Surgeon, Athens General Hospital
General Secretary Hellenic Surgical Association
National Delegate, UEMS Division of General
Surgery

2. STATISTICAL DATA
• Panhellenic Medical Association
• Panhellenic Association NHS Nursing staff
• Greek Statistics Authority ( statistics.gr)

3. • 64.003 Doctors ( 38.508 male, 25.495 female)
• 2.208 Surgeons
• 1125 Surgeons in Athens - Peireus
• 1.143 Members of the Hellenic Surgical
Society

4. NATIONAL HEALTH SYSTEM
• 15.407 Doctors
• 3.161 Consultants
• 845 Chairman
• 2.183 Staff Grade A
• 1846 Staff Grade B
• 31.567 Nursing staff

5. • 141 National Hospitals, Infirmary( 30.400 beds)
• 169 Private Clinics, Infirmary (15.587 beds)
• 314 Total National + Private Clinics, Infirmary
• 483 beds / 100.000 habitants
• 251 Hospital Doctors/ 100.000 habitants
• 440 Nursing Staff / 100.000 habitants
Greek Statistics Authority

6. CENTRAL STATE CONTROL OF
SURGICAL TRAINING
• Ministry of Health
• Central Committee of Health ( KESY)

7. 36 Basic Medical Specialties
Surgery, Vascular Surgery, Hematology, Radiology,
Allergiology, Anesthesiology, Internal Medicine,
Gastroenterology, genetics, General Medicine,
Maxillofacial surgery, Dermatology, Endocrinology,
Social medicine, Public Health, Cardiology, Cytology,
Gynecology – Obstetrics, Neurosurgery, Nephrology,
Orthopaedics & Traumatiology, Urology, Ophthalmology,
Pathology, Psychiatry , Paediatrics, Paediatric
Psychiatry, Plastic surgery, Pneumonology, Nuclear
Medicine, Reumatology, Rehabilitation medicine,
Thoracic surgery, Paediatric surgery, ENT, Forensic
medicine.

9. DURATION OF TRAINING IN SURGEY
• 6 Years
• 5 Years General Surgery
• Two 6-month period in other surgical specialties:
Gynecology, Vascular surgery, Urology, Neurosurgery,
Orthopaedics, Plastic surgery, ENT, Pediatric surgery

10. SURGICAL TRAINING IN GREECE
• Application at a “ District State office”
and transmission to the Hospital and Ministry of Health
Waiting list in chronological order ( 1-2 years in General
Surgery)
Only National Health System Hospitals ( + University
Hospitals) can offer surgical training
Large Hospitals usually cover the whole 6-year training
period
District and Military Hospitals cover 1-3 years

11. • Choice of the Hospital from the trainee
• Usually the training is completed for all the 6
years in the same Hospital
• The trainee can select to start with low volume
Hospitals and cover the initial 1-3 years
( District Hospitals, Military Hospitals)
• There is a fixed number of trainees per hospital
( 1/3-4 beds)

12. SPECIAL SUPERNUMERARY
CATEGORIES
• Military doctors
• Doctors with severe chronic diseases
• Overseas doctors sponsored by their own
countries

13. DURING THE TRAINING
• A Number of surgical procedures ( perform/assist)
• Spectrum of procedures
• Surgical research, Medical thesis
• Visiting clinician overseas
• Postgraduate courses
• Chairman/ Staff surgeons of the Department of Surgery
• Chairman sign a testimonial in order to apply for the
exam

14. DURING THE TRAINING
Hands on courses , Congresses, Meetings, Medical
knowledge courses
Hellenic Surgical Society,
Other smaller societies (Endocrine, breast, colon, HPB etc)
International societies
University Departments
National Health System Departments
Private Clinics Departments
Support from Pharmaceutic/ medical supplies companies

15. FINAL CENTRAL EXAM
• Three Examiners ( 1 from the University, 2 from the
NHS - determined by Ministry of Health)
• MCQs & Oral exam the following day
• Success rate 70-80 %
• Possibility up to 3 attempts
• Further failure repeat 6 months training in another
hospital and new final exam

16. SPECIAL ISSUES IN SURGICAL TRAINING
IN GREECE
• Full Training Hospitals are not of equal volume and
spectrum
• Departments within Hospitals or same Hospital are not
equal and the level of training varies
• Absence of national principles/guidelines for training
• Rotation of trainees is not legislated
• Medical research is not encouraged in all Hospitals
• Log book kept on volunteer basis
• Failed trainees can not be removed

17. SPECIAL ISSUES IN SURGICAL TRAINING
IN GREECE
• There is no Hospital/ Department evaluation (quality control)
• There is no surgical trainee evaluation
• There are no criteria for selection of trainees at the stage of
program entrance
• Endoscopy is not included in the surgical training
• A number of high quality trainees do not wait at the list of the
Ministry of Health and enter residency programs abroad ( U.K, USA,
Germany, Sweden, France, Switzerland)

18. SPECIAL ISSUES IN SURGICAL TRAINING
IN GREECE
• Several attempts to establish panhellenic entrance
exams to commence specialty training
• Severe reaction from Athens Medical Association and
student unions - syndicalism
• Repeat hesitation from the Governements to establish
criteria for training commencement and transfer
competence/responsibilities to the Hellenic Surgical
Society

19. THE ROLE OF EUROPEAN AND US HOSPITALS
• Significant number of young surgeons/trainees go
overseas after the final exam or during the training ( UK,
USA, Germany, France)
• To enrich surgical training of Greek doctors
• During – After basic training

20. • There is no official involvement of the Hellenic
Surgical Society in the surgical training and
exams in Greece

21. PROPOSALS OF THE HELLENIC
SURGICAL SOCIETY

22. SUBJECT OF TRAINING
• Theoretical backround and practical training of
the resident on basic rules of surgical science
and diagnosis & treatment of several diseases,
malformations, trauma of human organs as well
as the technique of various surgical procedures

23. CONTENT OF GENERAL SURGERY
• Oesophagus
• Stomach
• Small bowel, Large bowel, Anus
• Head & Neck, Endocrine surgery
• Thorax, Vascular
• Liver, Biliary tract, Pancreas, Spleen
• Breast
• Uterus, ovaries, kidney
• Abdominal wall
• Skin, soft tissue

24. TRAINING INCLUDES PROCEDURES ON:
• Retroperitoneum, pelvis
• Various diseases of other organs
• Trauma
• Laparoscopic/Robotic surgery

25. • Selection criteria for entering the residency
program in Surgery
• Panhellenic exams / chronological list

26. • Training program in Surgery only in eligible Hospitals
• Responsible for trainees tutor in cooperation with the
chairman of the Department
• Training classified as basic and advanced, 3 years each
• Number of procedures: 400-750 ( minor, moderate,
major) as a surgeon
• Double the number for 1st
/2nd
assistance

27. BASIC
• Medical knowledge
• Minor, moderate
procedures
• Basic laparoscopic
procedures
ADVANCED
• Medical knowledge
• Major procedures
• Advanced laparoscopic
procedures

28. • Responsible for trainees at least at the level of staff
grade A, or associate professor
• In cooperation with the team evaluation of the trainee
every year
a) medical knowledge- multiple choice questions
b) skill evaluation
c) attitude
d) communication with the medical – nursing staff

29. LOG BOOK
• Subject of training per year
• Number, spectrum, category of surgical
procedures ( dates, initials, Hospital number,
exact operation)

30. REPORT AT THE END OF THE BASIC
3 YEARS
• Conducted by chairman/tutor
• Training centres
• Scoring at the annual evaluation
• Number, spectrum of procedures
• Obligatory participation at the postgraduate
courses of the Hellenic Surgical Society
• Total score Entrance to the exam

31. REPORT –EXAM AT THE END OF THE
ADVANCED 3 YEARS
• Conducted by chairman/tutor
• Training centre
• Scoring at the annual evaluation
• Number, spectrum of procedures
• Obligatory participation at the postgraduate
courses of the Hellenic Surgical Society
• Total score Entrance to the exam

32. FINAL EXAM
• Multiple choice questions ( 150-200)
• Short written elucidation on current knowledge,
topics, clinical scenario, innovation
• Oral exam

33. Committee of examiners
• 3 Surgeons
• Professor/Chairman NHS, Assoc. Professor/ Consultant
Surgeon
• The list of examiners is proposed exclusively by the
Hellenic Surgical Society vs The society decides for 1
of the 3 examiners
• The Board changes synthesis every 2 years
• Exam centre are large hospitals with significant number
of trainees

34. TRAINING CENTRES - ELIGIBILITY
• General, or University or Prefecture* Hospitals
• Fully equiped laboratories
• Departmnent of Orthopaedics, Urology, Gynecology,
ENT, Ophthalmology, Endoscopy Unit
• Intensive care Unit
• Admit emergencies
• 100-150 surgical procedures under G.A. per trainee
( including surgical oncology)
• Systematic training program
*administrative area/county

36. CONTRIBUTION OF THE HELLENIC
SURGICAL SOCIETY
• To improve standards of surgical training in
Greece
• Achieve homogeneity of training in General
Surgery in Europe