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Paediatric Respiratory Medicine – The European Perspective
Paediatric Respiratory Reviews 11 (2010) 64–65
Contents lists available at ScienceDirect
Paediatric Respiratory Reviews
Editorial
Paediatric Respiratory Medicine – The European Perspective
The European Union (EU) is an economic and political union of 27 member states with approximately 500 million citizens. The EU has developed a single market, including free access for European medical specialists to the European job market via two relevant directives (issued in 1995 and 2005) with an automatic recognition of the diplomas and certificates of qualification in medicine in all member countries. However, within Europe, countries are in different stages of development of medical training and some countries even do not formally recognise Paediatric Respiratory Medicine (PRM) as a subspecialty. This has at least two important implications: 1) a strategy has to be developed to further strengthen PRM in Europe and 2) harmonised training standards across the entire European Union have to be ensured to make an open job market within the EU acceptable. Therefore, and as a result of the first relevant EU directive from 1995, the Long Range Planning Committee of the Paediatric Assembly of the European Respiratory Society (ERS), led by Maximilian Zach, more than 10 years ago developed the first European syllabus for Training in Paediatric Respiratory Medicine as a tertiary care subspecialty.1 This 2002 syllabus harmonised training content and concepts and has introduced the training modules. However, despite this initiative, Paediatric Respiratory Medicine is still developing as a subspecialty in Europe. There are widely differing approaches to training. Formal training in a recognised training centre is the norm in countries such as the UK, the Netherlands, Germany, Austria and Switzerland; whilst in other countries there is no formal recognition of PRM and junior doctors have to train abroad or in adult respiratory departments. In addition, changes in practice and political changes now required an update which has been undertaken by the ERS Task Force ‘‘Paediatric HERMES’’ (Harmonized Education in Respiratory Medicine for European Specialists). The Paediatric HERMES project has been running since 2007 with the aim of developing an up-to-date curriculum which is both realistic (i.e. defining minimum standards) and aspirational (i.e. reflecting best practice). To increase acceptability of this new curriculum across the different European countries, and following the example of our adult colleagues,2 a three-round Delphi consensus process was followed in close collaboration with a cohort of 28 experts and 29 trainees in PRM involving representatives from 20 countries within the EU which were nominated by their national societies. As the first step of this ambitious project, the syllabus describing the content of training has recently been published.3,4 The new syllabus describes
1526-0542/$ – see front matter ß 2009 Elsevier Ltd. All rights reserved. doi:10.1016/j.prrv.2009.11.003
twenty-one mandatory modules (respiratory symptoms and signs, pulmonary function testing, airway endoscopy, imaging, acute and chronic lung infection, tuberculosis, cystic fibrosis, bronchial asthma, allergic disorders, congenital malformations, bronchopulmonary dysplasia, rare diseases, sleep medicine, rehabilitation, inhalation therapy, technology dependent children, epidemiology and environmental health, management and leadership, teaching, communication and research) and 3 optional modules (rigid and interventional endoscopy, post lung transplant management, additional diagnostic tests) with the level of competence to be achieved. This is currently followed by developing the corresponding curriculum, which describes knowledge, skills and attitude & behaviour expected for each of the items in the predefined modules, as well as suggested minimum requirements for the training to be recognized, recommended methods for training and assessment of training. The basis for entering such specialist training in PRM is defined as at least a 3-year period of training in General Paediatrics as recommended by the European Academy of Paediatrics (EAP). An example of an obligatory module is given in Figure 1. The next steps towards harmonisation of PRM across Europe will be the development of a centre visitation program for accreditation of training centres and the development of training networks throughout Europe. In parallel, comprehensive educational materials such as E-learning resources, and courses and seminars to facilitate training are being developed by the ERS School. For 2011, the first voluntary knowledge-based European Examination in Paediatric Respiratory Medicine has been envisaged. It remains yet to be seen how the new syllabus and particularly the curriculum recommendations will be accepted and implemented. Information about available facilities to offer training or parts of training in PRM are voluntary and there is no experience yet with the implementation of training centre visitation programs. In addition, the EU principle of subsidiarity applies, meaning that the content of the syllabus and the curriculum will only remain a recommendation as there is no legal basis for this initiative; there may even be resistance against further development of PRM as a separate subspecialty e.g. in countries, where traditionally paediatric respiratory medicine is covered by allergologists or adult respiratory physicians. However, the aim is that all PRM training centres and trainees should study and know the current syllabus to ensure that the recommended curriculum is followed and all mandatory modules are being achieved during the training period.
Editorial / Paediatric Respiratory Reviews 11 (2010) 64–65
65
Figure 1. Example of mandatory module Airway Endoscopy; dots indicate level of competence to be achieved, with level 3 representing advanced knowledge sufficient for independent clinical practice, and level 1 Basic knowledge. From3 with permission.
References 1. Zach MS. Long Range Planning Committee, Paediatric Assembly of the European Respiratory Society, Committee on Paediatric Respiratory Training in Europe, European Board of Paediatrics. Paediatric respiratory training in Europe: syllabus and centres. Eur Respir J 2002;20:1587–93. 2. Loddenkemper R, Se´verin T, Eisele´ JL, et al. HERMES : a European core syllabus in respiratory medicine. Breathe 2006;3:59–70. 3. Gappa M, Noel J-L, Severin T, the Paediatric HERMES Task Force. Paediatric HERMES: a European Syllabus in Paediatric Respiratory Medicine. Breathe 2009;5:236–47. 4. Gappa M, Paton J, Baraldi E, Bush A, Carlsen KH, de Jongste JC, Eber E, Fauroux B, McKenzie S, Noel JL, Palange P, Pohunek P, Priftis K, Severin T, Wildhaber JH, Zivkovic Z, Zach M. Paediatric HERMES: update of the European
Training Syllabus for Paediatric Respiratory Medicine. Eur Respir J 2009;33:464– 5 (editorial).
M. Gappa, on behalf of the Paediatric HERMES ERS1 Task Force (J. Paton, E. Baraldi, A. Bush, K-H. Carlsen, J. de Jongste, E. Eber, B. Fauroux, S. McKenzie, J-L. Noe¨l, P. Pohunek, K. Priftis, T. Se´verin, J. Wildhaber, Z. Zivkovic and M. Zach) 1
http://dev.ersnet.org/437-projetc-structure.htm.
Contents lists available at ScienceDirect
Paediatric Respiratory Reviews
Editorial
Paediatric Respiratory Medicine – The European Perspective
The European Union (EU) is an economic and political union of 27 member states with approximately 500 million citizens. The EU has developed a single market, including free access for European medical specialists to the European job market via two relevant directives (issued in 1995 and 2005) with an automatic recognition of the diplomas and certificates of qualification in medicine in all member countries. However, within Europe, countries are in different stages of development of medical training and some countries even do not formally recognise Paediatric Respiratory Medicine (PRM) as a subspecialty. This has at least two important implications: 1) a strategy has to be developed to further strengthen PRM in Europe and 2) harmonised training standards across the entire European Union have to be ensured to make an open job market within the EU acceptable. Therefore, and as a result of the first relevant EU directive from 1995, the Long Range Planning Committee of the Paediatric Assembly of the European Respiratory Society (ERS), led by Maximilian Zach, more than 10 years ago developed the first European syllabus for Training in Paediatric Respiratory Medicine as a tertiary care subspecialty.1 This 2002 syllabus harmonised training content and concepts and has introduced the training modules. However, despite this initiative, Paediatric Respiratory Medicine is still developing as a subspecialty in Europe. There are widely differing approaches to training. Formal training in a recognised training centre is the norm in countries such as the UK, the Netherlands, Germany, Austria and Switzerland; whilst in other countries there is no formal recognition of PRM and junior doctors have to train abroad or in adult respiratory departments. In addition, changes in practice and political changes now required an update which has been undertaken by the ERS Task Force ‘‘Paediatric HERMES’’ (Harmonized Education in Respiratory Medicine for European Specialists). The Paediatric HERMES project has been running since 2007 with the aim of developing an up-to-date curriculum which is both realistic (i.e. defining minimum standards) and aspirational (i.e. reflecting best practice). To increase acceptability of this new curriculum across the different European countries, and following the example of our adult colleagues,2 a three-round Delphi consensus process was followed in close collaboration with a cohort of 28 experts and 29 trainees in PRM involving representatives from 20 countries within the EU which were nominated by their national societies. As the first step of this ambitious project, the syllabus describing the content of training has recently been published.3,4 The new syllabus describes
1526-0542/$ – see front matter ß 2009 Elsevier Ltd. All rights reserved. doi:10.1016/j.prrv.2009.11.003
twenty-one mandatory modules (respiratory symptoms and signs, pulmonary function testing, airway endoscopy, imaging, acute and chronic lung infection, tuberculosis, cystic fibrosis, bronchial asthma, allergic disorders, congenital malformations, bronchopulmonary dysplasia, rare diseases, sleep medicine, rehabilitation, inhalation therapy, technology dependent children, epidemiology and environmental health, management and leadership, teaching, communication and research) and 3 optional modules (rigid and interventional endoscopy, post lung transplant management, additional diagnostic tests) with the level of competence to be achieved. This is currently followed by developing the corresponding curriculum, which describes knowledge, skills and attitude & behaviour expected for each of the items in the predefined modules, as well as suggested minimum requirements for the training to be recognized, recommended methods for training and assessment of training. The basis for entering such specialist training in PRM is defined as at least a 3-year period of training in General Paediatrics as recommended by the European Academy of Paediatrics (EAP). An example of an obligatory module is given in Figure 1. The next steps towards harmonisation of PRM across Europe will be the development of a centre visitation program for accreditation of training centres and the development of training networks throughout Europe. In parallel, comprehensive educational materials such as E-learning resources, and courses and seminars to facilitate training are being developed by the ERS School. For 2011, the first voluntary knowledge-based European Examination in Paediatric Respiratory Medicine has been envisaged. It remains yet to be seen how the new syllabus and particularly the curriculum recommendations will be accepted and implemented. Information about available facilities to offer training or parts of training in PRM are voluntary and there is no experience yet with the implementation of training centre visitation programs. In addition, the EU principle of subsidiarity applies, meaning that the content of the syllabus and the curriculum will only remain a recommendation as there is no legal basis for this initiative; there may even be resistance against further development of PRM as a separate subspecialty e.g. in countries, where traditionally paediatric respiratory medicine is covered by allergologists or adult respiratory physicians. However, the aim is that all PRM training centres and trainees should study and know the current syllabus to ensure that the recommended curriculum is followed and all mandatory modules are being achieved during the training period.
Editorial / Paediatric Respiratory Reviews 11 (2010) 64–65
65
Figure 1. Example of mandatory module Airway Endoscopy; dots indicate level of competence to be achieved, with level 3 representing advanced knowledge sufficient for independent clinical practice, and level 1 Basic knowledge. From3 with permission.
References 1. Zach MS. Long Range Planning Committee, Paediatric Assembly of the European Respiratory Society, Committee on Paediatric Respiratory Training in Europe, European Board of Paediatrics. Paediatric respiratory training in Europe: syllabus and centres. Eur Respir J 2002;20:1587–93. 2. Loddenkemper R, Se´verin T, Eisele´ JL, et al. HERMES : a European core syllabus in respiratory medicine. Breathe 2006;3:59–70. 3. Gappa M, Noel J-L, Severin T, the Paediatric HERMES Task Force. Paediatric HERMES: a European Syllabus in Paediatric Respiratory Medicine. Breathe 2009;5:236–47. 4. Gappa M, Paton J, Baraldi E, Bush A, Carlsen KH, de Jongste JC, Eber E, Fauroux B, McKenzie S, Noel JL, Palange P, Pohunek P, Priftis K, Severin T, Wildhaber JH, Zivkovic Z, Zach M. Paediatric HERMES: update of the European
Training Syllabus for Paediatric Respiratory Medicine. Eur Respir J 2009;33:464– 5 (editorial).
M. Gappa, on behalf of the Paediatric HERMES ERS1 Task Force (J. Paton, E. Baraldi, A. Bush, K-H. Carlsen, J. de Jongste, E. Eber, B. Fauroux, S. McKenzie, J-L. Noe¨l, P. Pohunek, K. Priftis, T. Se´verin, J. Wildhaber, Z. Zivkovic and M. Zach) 1
http://dev.ersnet.org/437-projetc-structure.htm.