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Status of vascular surgery in The Netherlands
International Congress Series 1272 (2004) 319 – 321
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Status of vascular surgery in The Netherlands J. Hajo van Bockel a,*, J.D. Blankensteijn b a
Department of Vascular Surgery, Leiden University Medical Centre, P.O. Box 9600, 2300 RC Leiden, The Netherlands b Division of Vascular Surgery, University Medical Centre Nijmegen, Nijmegen, The Netherlands
Abstract. In the Netherlands, vascular surgery is not a monospecialty. Vascular interventions are performed by general surgeons with an interest and additional training in vascular surgery. The Dutch Society for Vascular Surgery was founded in 1981, is stimulating and coordinating patient care and research and is also involved in postgraduate training of vascular surgery. An official 2-year training programme has been established in 1986. Currently, there are 12 vascular training programmes certified to certify surgeons as vascular surgeons. The quality of the training programmes is thoroughly evaluated every 5 years. Renewed certification is based on a written report from the director of the programme, supplemented with an ’on-site’ visit and established by the Dutch Association of Surgeons of the Netherlands. Currently, (vascular) surgical training is being restructured due to working hour requirements (EC Directive), shortening of the years of training (currently 6+2) and further improvement of the quality of training. D 2004 Elsevier B.V. All rights reserved. Keywords: Vascular surgery
1. Preamble The Netherlands has a population of 16 million inhabitants. There are approximately 100 hospitals including eight University Medical Centres. There are approximately 900 members of the Dutch association of Surgeons of The Netherlands and, in addition, there are 300 residents in training for general surgery (6-year programme). The number of residents entering the surgical training programme each year is restricted by the Dutch Association of Surgeons of The Netherlands and is determined each year according to a manpower planning schedule (for 2003 there are 72 training positions for starters throughout the country). Most surgeons work together in groups (between 4 and 15 associates). The vascular expertise varies from 0 in very small hospitals to four or five colleagues in large teaching hospitals. The total number of vascular operations in the arterial system is approximately 10,000 – 15,000 per year in The Netherlands.
* Corresponding author. Tel.: +31-71-52-63-610; fax: +31-71-52-66-750. E-mail address: [email protected] (J.H. van Bockel). 0531-5131/ D 2004 Elsevier B.V. All rights reserved. doi:10.1016/j.ics.2004.05.080
320
J.H. van Bockel, J.D. Blankensteijn / International Congress Series 1272 (2004) 319–321
2. Historical situation In the past, vascular surgery was not organized or structured. It was not incorporated in the general surgical programme. Since the end of the 1970s, individuals who chose to get more experience in vascular surgery contacted a centre and worked there after qualification for surgery for 1 or 2 years. From the beginning of the 1980s, some vascular surgery was incorporated in the general surgical programme. However, only a minority of the residents obtained full exposure to vascular surgery. 3. The Dutch Society for Vascular Surgery The Dutch Society for Vascular Surgery was founded in 1981. The society has around 350 members. Most of these members combine a vascular surgical practice with a general surgical practice. A minority, mostly associated with university medical centres or large teaching hospitals, practice exclusively vascular surgery. 4. Establishment of vascular training programmes The Dutch Society for Vascular Surgery initiated a pilot study for a vascular surgery training programme in 1986. Two centres were involved and after the pilot study the requirements were put together. To enter the programme, the candidate had to successfully complete his general surgical training programme of 6 years. Two years of vascular surgical training included: pre- and postoperative care, operation theatre experience, noninvasive diagnostics in the vascular laboratory and research. Recently, endovascular surgery has been added to the training module. The Dutch Association of Surgeons of The Netherlands, in cooperation with the Dutch Society for Vascular Surgery, set up these guidelines. After successful completion, the candidate receives a certificate from the Dutch Association of Surgeons of The Netherlands. This structure implies that vascular surgery is not a monospecialty in The Netherlands like the general surgery, rather it is closely linked to general surgery. The quality of vascular training programmes is guaranteed by the system of visitations. For new training programs, there is a visitation at the start and after 2 years thereafter every 5 years. This system is the same for general surgery, as well as for the other postgraduate training programmes in oncology, trauma and gastrointestinal surgical training. A team of three surgeons performs the visitation, one general surgeon and two surgeons appointed by the Dutch Society for Vascular Surgery, after an extensive report by the director of the training programme has been submitted. A decision about qualification of the training programme is made during the monthly meetings of the Concilium Chirurgicum (the training and education committee of the Dutch Association of Surgeons of The Netherlands). This committee may ask for adjustments or additional requirements and checks that these have been implemented within the defined period of time. Currently, there are 12 vascular training programmes (7 in University Medical Centres and 5 in large teaching hospitals) and there are more to be established in the near future.
J.H. van Bockel, J.D. Blankensteijn / International Congress Series 1272 (2004) 319–321
321
5. Changes during the years In the early 1990s, it was felt that the field of general surgery had grown too large to fully train each resident sufficiently in all aspects. It was decided that the last year of the 6year general surgery training programme should be devoted either to vascular, trauma, oncology or gastrointestinal surgery. Thereafter, the 2-year postgraduate training was additional training. This change in the general surgery programme was not popular and has never been successfully implemented for several reasons. The 48-h week has been implemented since 1993 (European Directive). This law has had a major impact on training and methods of training. At the same time, it was decided by the government that the duration of training of specialists (6 years of medical school, 1 or 2 years of work, 6 years of general surgery and 2 years postgraduate training) was too long and had to be reduced substantially. Since then, major efforts have been made to design a shorter, still effective (vascular) surgical training programme. Currently, two models are being discussed: either the 2 + 2 + 2 system (2 years of basic training, 2 years of general surgery and 2 years of vascular training) or 2 + 3 + 2 (2 years of basic training, 3 years of general surgery and 2 years of vascular training). In each scenario, vascular training will remain the full 2 years.
www.ics-elsevier.com
Status of vascular surgery in The Netherlands J. Hajo van Bockel a,*, J.D. Blankensteijn b a
Department of Vascular Surgery, Leiden University Medical Centre, P.O. Box 9600, 2300 RC Leiden, The Netherlands b Division of Vascular Surgery, University Medical Centre Nijmegen, Nijmegen, The Netherlands
Abstract. In the Netherlands, vascular surgery is not a monospecialty. Vascular interventions are performed by general surgeons with an interest and additional training in vascular surgery. The Dutch Society for Vascular Surgery was founded in 1981, is stimulating and coordinating patient care and research and is also involved in postgraduate training of vascular surgery. An official 2-year training programme has been established in 1986. Currently, there are 12 vascular training programmes certified to certify surgeons as vascular surgeons. The quality of the training programmes is thoroughly evaluated every 5 years. Renewed certification is based on a written report from the director of the programme, supplemented with an ’on-site’ visit and established by the Dutch Association of Surgeons of the Netherlands. Currently, (vascular) surgical training is being restructured due to working hour requirements (EC Directive), shortening of the years of training (currently 6+2) and further improvement of the quality of training. D 2004 Elsevier B.V. All rights reserved. Keywords: Vascular surgery
1. Preamble The Netherlands has a population of 16 million inhabitants. There are approximately 100 hospitals including eight University Medical Centres. There are approximately 900 members of the Dutch association of Surgeons of The Netherlands and, in addition, there are 300 residents in training for general surgery (6-year programme). The number of residents entering the surgical training programme each year is restricted by the Dutch Association of Surgeons of The Netherlands and is determined each year according to a manpower planning schedule (for 2003 there are 72 training positions for starters throughout the country). Most surgeons work together in groups (between 4 and 15 associates). The vascular expertise varies from 0 in very small hospitals to four or five colleagues in large teaching hospitals. The total number of vascular operations in the arterial system is approximately 10,000 – 15,000 per year in The Netherlands.
* Corresponding author. Tel.: +31-71-52-63-610; fax: +31-71-52-66-750. E-mail address: [email protected] (J.H. van Bockel). 0531-5131/ D 2004 Elsevier B.V. All rights reserved. doi:10.1016/j.ics.2004.05.080
320
J.H. van Bockel, J.D. Blankensteijn / International Congress Series 1272 (2004) 319–321
2. Historical situation In the past, vascular surgery was not organized or structured. It was not incorporated in the general surgical programme. Since the end of the 1970s, individuals who chose to get more experience in vascular surgery contacted a centre and worked there after qualification for surgery for 1 or 2 years. From the beginning of the 1980s, some vascular surgery was incorporated in the general surgical programme. However, only a minority of the residents obtained full exposure to vascular surgery. 3. The Dutch Society for Vascular Surgery The Dutch Society for Vascular Surgery was founded in 1981. The society has around 350 members. Most of these members combine a vascular surgical practice with a general surgical practice. A minority, mostly associated with university medical centres or large teaching hospitals, practice exclusively vascular surgery. 4. Establishment of vascular training programmes The Dutch Society for Vascular Surgery initiated a pilot study for a vascular surgery training programme in 1986. Two centres were involved and after the pilot study the requirements were put together. To enter the programme, the candidate had to successfully complete his general surgical training programme of 6 years. Two years of vascular surgical training included: pre- and postoperative care, operation theatre experience, noninvasive diagnostics in the vascular laboratory and research. Recently, endovascular surgery has been added to the training module. The Dutch Association of Surgeons of The Netherlands, in cooperation with the Dutch Society for Vascular Surgery, set up these guidelines. After successful completion, the candidate receives a certificate from the Dutch Association of Surgeons of The Netherlands. This structure implies that vascular surgery is not a monospecialty in The Netherlands like the general surgery, rather it is closely linked to general surgery. The quality of vascular training programmes is guaranteed by the system of visitations. For new training programs, there is a visitation at the start and after 2 years thereafter every 5 years. This system is the same for general surgery, as well as for the other postgraduate training programmes in oncology, trauma and gastrointestinal surgical training. A team of three surgeons performs the visitation, one general surgeon and two surgeons appointed by the Dutch Society for Vascular Surgery, after an extensive report by the director of the training programme has been submitted. A decision about qualification of the training programme is made during the monthly meetings of the Concilium Chirurgicum (the training and education committee of the Dutch Association of Surgeons of The Netherlands). This committee may ask for adjustments or additional requirements and checks that these have been implemented within the defined period of time. Currently, there are 12 vascular training programmes (7 in University Medical Centres and 5 in large teaching hospitals) and there are more to be established in the near future.
J.H. van Bockel, J.D. Blankensteijn / International Congress Series 1272 (2004) 319–321
321
5. Changes during the years In the early 1990s, it was felt that the field of general surgery had grown too large to fully train each resident sufficiently in all aspects. It was decided that the last year of the 6year general surgery training programme should be devoted either to vascular, trauma, oncology or gastrointestinal surgery. Thereafter, the 2-year postgraduate training was additional training. This change in the general surgery programme was not popular and has never been successfully implemented for several reasons. The 48-h week has been implemented since 1993 (European Directive). This law has had a major impact on training and methods of training. At the same time, it was decided by the government that the duration of training of specialists (6 years of medical school, 1 or 2 years of work, 6 years of general surgery and 2 years postgraduate training) was too long and had to be reduced substantially. Since then, major efforts have been made to design a shorter, still effective (vascular) surgical training programme. Currently, two models are being discussed: either the 2 + 2 + 2 system (2 years of basic training, 2 years of general surgery and 2 years of vascular training) or 2 + 3 + 2 (2 years of basic training, 3 years of general surgery and 2 years of vascular training). In each scenario, vascular training will remain the full 2 years.