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Status of vascular surgery in Greece
International Congress Series 1272 (2004) 304 – 307
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Status of vascular surgery in Greece C.D. Liapis a,*, M.K. Lazaridesb a
Department of Vascular Surgery, UEMS Division and Board of Vascular Surgery, Athens University Medical School, Athens, Greece b Department of Vascular Surgery, Democritus University of Alexandroupolis of Thrace, Greece
1. Introduction Vascular surgery became an independent specialty in Greece in 1989. As is the case with all medical specialties, residency training is under governmental control. Accreditation of training centers is held on an annual basis through the Greek Ministry of Health and Social Welfare following documentation of caseload, teaching records and research activity. Junior doctors, following graduation from medical school, have to serve for 1 year in a rural area as general practitioners incorporated into the National Health System. Training in vascular surgery requires a 3-year fellowship in general surgery. After completion of the common trunk training, trainees are eligible for higher surgical training in 1 of 14 centers accredited for training in vascular surgery. The duration of training in vascular surgery is 4 years. The fourth year of training consists of a rotation in cardiac surgery and thoracic surgery, as well. While the whole training period is 7 years, with the inclusion of time lost in waiting lists, the average duration is nearly 10 years. Trainees who have completed the 7-year fellowship are assessed by logbook evaluation and examined viva voce by a three-member committee authorized by the Central Council of Health. 2. An update of current status in vascular surgery training Researchers from vascular units in two university hospitals have conducted a nationwide survey on the current status of training in vascular surgery. Since there is no vascular registry in Greece, data were obtained by direct contact with all 14 vascular units accredited for training during a 1-year period. The survey was performed in the form of a questionnaire addressed to all vascular departments querying the number of trainers, trainees, operations performed in total and per trainee. Data from vascular units dedicated to private practice or those within army hospitals, or units with no accreditation in training, were not included in the query.
* Corresponding author. Tel.: +30-210-7456128; fax: +30-210-6847949. E-mail address: [email protected] (C.D. Liapis). 0531-5131/ D 2004 Elsevier B.V. All rights reserved. doi:10.1016/j.ics.2004.04.086
C.D. Liapis, M.K. Lazarides / International Congress Series 1272 (2004) 304–307
305
Fig. 1. The geographical distribution of trainers/trainees.
Between January 1st and December 31st 2001, 5315 operations were performed in the aforementioned training centers. Most of these centers are in Athens (nine) and Thessalonica (three). The majority of the units are in academic hospitals as well. A number of 52 trainers and 38 trainees were recorded as serving in the participating vascular centers during the study period. Trainers were either professors, members of the faculty of medical schools in university hospitals, or consultants and non-consultant specialists dedicated to the Greek National Health System. The mean age of trainees was 34.5 years (range 32 –39). The ratio of trainers per trainee was 1.4:1. Fig. 1 depicts the geographical distribution of trainers/trainees. As Greece has a population of approximately 10.5 million, the ratio of vascular trainees/million population was 3.6. An average of 380 vascular operations (elective and emergency procedures) was performed per center/year. Fig. 2 illustrates the geographical distribution of operations held per city/year. A total of 140 operations were held per trainee/year. Fig. 3 denotes the average number of surgical exposures per trainee/year, while Fig. 4 depicts the relevant caseload performed per trainee/year according to type of vascular unit (academic vs. district). 3. Areas of concern A number of hot topics have been raised following this survey. Since training and certification in vascular surgery are under governmental control, the number of trainees
Fig. 2. The geographical distribution of vascular procedures performed in the year 2001.
306
C.D. Liapis, M.K. Lazarides / International Congress Series 1272 (2004) 304–307
Fig. 3. Surgical exposure per trainee/year.
seems to be greater than the demand for vascular surgeons nationwide. This is in contrast to the need for high-quality training. An adequate number of vascular procedures are performed in vascular centers each year. However, not all hospital programmes have successfully added an endovascular surgery component to their training protocols, while percutaneous interventional techniques have not been adopted in the majority of training units’ disciplines. Moreover, no system of peer-review has been set in order to provide quality standards for higher surgical training. Trainees, according to law restrictions, are not allowed to act as principal surgeons if not assisted by a scrubbed trainer. This limitation seems inappropriate for a training programme focusing on self-confident surgeons. In addition, young Greek vascular surgeons may have difficulties meeting the eligibility criteria for the European Board of Surgery Qualifications in Vascular Surgery Assessments. The weaknesses of the training programme in vascular surgery are well recognized by the Greek Society for Vascular Surgery, and currently all professional bodies are pressing for harmonization in vascular training among European countries. We do hope that the
Fig. 4. Vascular procedures performed per trainee/year depending on type of vascular unit.
C.D. Liapis, M.K. Lazarides / International Congress Series 1272 (2004) 304–307
307
European Division and Board of Vascular Surgery will undertake a more active role towards high-quality training on our continent. Acknowledgements We thank Dr. E.A. Tzortzis, Research Associate, Athens, Greece, who kindly contributed to the preparation of the manuscript. Data included in this paper were presented at the 2002 ESVS meeting held in Istanbul, Turkey.
www.ics-elsevier.com
Status of vascular surgery in Greece C.D. Liapis a,*, M.K. Lazaridesb a
Department of Vascular Surgery, UEMS Division and Board of Vascular Surgery, Athens University Medical School, Athens, Greece b Department of Vascular Surgery, Democritus University of Alexandroupolis of Thrace, Greece
1. Introduction Vascular surgery became an independent specialty in Greece in 1989. As is the case with all medical specialties, residency training is under governmental control. Accreditation of training centers is held on an annual basis through the Greek Ministry of Health and Social Welfare following documentation of caseload, teaching records and research activity. Junior doctors, following graduation from medical school, have to serve for 1 year in a rural area as general practitioners incorporated into the National Health System. Training in vascular surgery requires a 3-year fellowship in general surgery. After completion of the common trunk training, trainees are eligible for higher surgical training in 1 of 14 centers accredited for training in vascular surgery. The duration of training in vascular surgery is 4 years. The fourth year of training consists of a rotation in cardiac surgery and thoracic surgery, as well. While the whole training period is 7 years, with the inclusion of time lost in waiting lists, the average duration is nearly 10 years. Trainees who have completed the 7-year fellowship are assessed by logbook evaluation and examined viva voce by a three-member committee authorized by the Central Council of Health. 2. An update of current status in vascular surgery training Researchers from vascular units in two university hospitals have conducted a nationwide survey on the current status of training in vascular surgery. Since there is no vascular registry in Greece, data were obtained by direct contact with all 14 vascular units accredited for training during a 1-year period. The survey was performed in the form of a questionnaire addressed to all vascular departments querying the number of trainers, trainees, operations performed in total and per trainee. Data from vascular units dedicated to private practice or those within army hospitals, or units with no accreditation in training, were not included in the query.
* Corresponding author. Tel.: +30-210-7456128; fax: +30-210-6847949. E-mail address: [email protected] (C.D. Liapis). 0531-5131/ D 2004 Elsevier B.V. All rights reserved. doi:10.1016/j.ics.2004.04.086
C.D. Liapis, M.K. Lazarides / International Congress Series 1272 (2004) 304–307
305
Fig. 1. The geographical distribution of trainers/trainees.
Between January 1st and December 31st 2001, 5315 operations were performed in the aforementioned training centers. Most of these centers are in Athens (nine) and Thessalonica (three). The majority of the units are in academic hospitals as well. A number of 52 trainers and 38 trainees were recorded as serving in the participating vascular centers during the study period. Trainers were either professors, members of the faculty of medical schools in university hospitals, or consultants and non-consultant specialists dedicated to the Greek National Health System. The mean age of trainees was 34.5 years (range 32 –39). The ratio of trainers per trainee was 1.4:1. Fig. 1 depicts the geographical distribution of trainers/trainees. As Greece has a population of approximately 10.5 million, the ratio of vascular trainees/million population was 3.6. An average of 380 vascular operations (elective and emergency procedures) was performed per center/year. Fig. 2 illustrates the geographical distribution of operations held per city/year. A total of 140 operations were held per trainee/year. Fig. 3 denotes the average number of surgical exposures per trainee/year, while Fig. 4 depicts the relevant caseload performed per trainee/year according to type of vascular unit (academic vs. district). 3. Areas of concern A number of hot topics have been raised following this survey. Since training and certification in vascular surgery are under governmental control, the number of trainees
Fig. 2. The geographical distribution of vascular procedures performed in the year 2001.
306
C.D. Liapis, M.K. Lazarides / International Congress Series 1272 (2004) 304–307
Fig. 3. Surgical exposure per trainee/year.
seems to be greater than the demand for vascular surgeons nationwide. This is in contrast to the need for high-quality training. An adequate number of vascular procedures are performed in vascular centers each year. However, not all hospital programmes have successfully added an endovascular surgery component to their training protocols, while percutaneous interventional techniques have not been adopted in the majority of training units’ disciplines. Moreover, no system of peer-review has been set in order to provide quality standards for higher surgical training. Trainees, according to law restrictions, are not allowed to act as principal surgeons if not assisted by a scrubbed trainer. This limitation seems inappropriate for a training programme focusing on self-confident surgeons. In addition, young Greek vascular surgeons may have difficulties meeting the eligibility criteria for the European Board of Surgery Qualifications in Vascular Surgery Assessments. The weaknesses of the training programme in vascular surgery are well recognized by the Greek Society for Vascular Surgery, and currently all professional bodies are pressing for harmonization in vascular training among European countries. We do hope that the
Fig. 4. Vascular procedures performed per trainee/year depending on type of vascular unit.
C.D. Liapis, M.K. Lazarides / International Congress Series 1272 (2004) 304–307
307
European Division and Board of Vascular Surgery will undertake a more active role towards high-quality training on our continent. Acknowledgements We thank Dr. E.A. Tzortzis, Research Associate, Athens, Greece, who kindly contributed to the preparation of the manuscript. Data included in this paper were presented at the 2002 ESVS meeting held in Istanbul, Turkey.