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Training in proctologic surgery: How and for whom?
+Model JVS-418; No. of Pages 2
ARTICLE IN PRESS
Journal of Visceral Surgery (2014) xxx, xxx—xxx
Available online at
ScienceDirect www.sciencedirect.com
EDITORIAL
Training in proctologic surgery: How and for whom?
KEYWORDS Proctology; Teaching; Hepato-gastroenterology; Digestive tract surgery
Proctology is a medicosurgical discipline that encompasses the diagnosis and treatment of rectal and anal disorders. Proctology does not figure among the 30 specialty certifications or qualifications in France (DES [Diplôme d’études spécialisées] or DESC [Diplôme d’études spécialisées en chirurgie]). Various types of practitioners participate in the management of proctologic disorders in France: gastroenterologists, general surgeons, colorectal surgeons, but also practitioners such as gynecologists who manage pelvic floor disorders or even, more anecdotally, dermatologists, and venous vascular specialists. Often, these practitioners deal with only a single facet of the overall discipline, medical therapy, diagnosis and instrumental management for the gastroenterologist, and surgery for the surgeons. In Europe, general or colorectal surgeons most often perform proctologic surgery. One particularity in France is that there are many nonsurgeons who perform anal surgery but are also equally competent in the medical aspects of proctology. For many years, proctology in France was essentially a medical field, practiced by gastroenterologists or dermatologists; treatment was either medical or instrumental (sclerosing injection for hemorrhoids, incision of thrombosed external hemorrhoids, subfissular injections introduced in France by Raoul Bensaude during the first quarter of the 20th century. . .). Surgery of the anus was in its infancy and was quite traumatic (Whitehead hemorrhoidectomy, anal dilatation for fissure. . .); it was often disdained by surgeons who took little interest in this type of surgery and relegated it to the end of their operative schedule. With progress in anesthesia, anal surgery developed under the impulsion of the Saint Mark’s Hospital in London and several surgeons, both from France and elsewhere, were trained. Thus, was born the French school of Proctology [1], including pioneers such as Adrien-Albert Poirier, Alfred Bensaude, Jean Arnous, Jacques Soullard, Jean Duhamel, and Ernest Parnaud. In 1998, the Inter-University Diploma of Colo-Proctology was created, replacing the regional University Diplomas. The courses were set up to run over two years with the goal of training gastroenterologists and visceral surgeons as well as other specialists who took part in the management of pelvic floor disorders. The goal of the course was to inform the participants about the current status of basic and clinical research, to teach the basics in anatomy, pathophysiology and therapeutics of proctology disorders, in order to acquire understanding and skills to manage these patients. Since 2007, teaching of theory is offered exclusively on an e-learning platform, based on the existing polyvalent level 1 general surgery and hepato-gastroenterology programs. This program also was geared to enable practitioners to acquire the necessary competency to practice proctology at a subspecialty level (Level 2). A student at level 2 should be able to perform only medical and instrumental procedures. The validation of level 2 surgical competency implies at least one year of training in an expert center with a strong focus on colorectal or proctology. At the end of level 2 training, the participants receive an Inter-University Diploma (DIU), delivered by one of the participating medical universities.
http://dx.doi.org/10.1016/j.jviscsurg.2014.07.010 1878-7886/© 2014 Elsevier Masson SAS. All rights reserved.
Please cite this article in press as: Senéjoux A. Training in proctologic surgery: How and for whom? Journal of Visceral Surgery (2014), http://dx.doi.org/10.1016/j.jviscsurg.2014.07.010
+Model JVS-418; No. of Pages 2
ARTICLE IN PRESS
2
Editorial
Some physicians registered under the title of continuing postgraduate training already have a DIU in proctology or a university certification that is no longer current (Paris VII, Montpellier, Toulouse. . .). These candidates can qualify for the current diploma by documenting their past experience in medical and surgical proctology, and can then take advantage of a simplified e-learning program. At present, 150 persons are enrolled within this framework. Modifications in the structure and content of the administrative text (pertaining to acquisition of professional competencies, integration of the surgical valence) have been validated by the medical schools of Rennes and Toulouse. Proctology ‘‘à la Franc ¸aise’’ is most certainly a national particularity, but this is also one of its richnesses. Attested by its dynamism, the French Society of Colo-Proctology (Société franc ¸aise de Colo-Proctologie), includes both gastroenterologists and surgeons and is an illustration of the value of medical and surgical collaboration, wherein each actor can play a role. Let us continue to cultivate this particularity, in the name of a fascinating but all too often neglected discipline. . .
Disclosure of interest The author declares that she has no conflicts of interest concerning this article.
Reference [1] de Parades V, Attienza P. Les médecins qui ont fait la proctologie médicochirurgicale « à la franc ¸aise ». Presse Med 2011;40:644—50.
A. Senéjoux ∗ Centre Hospitalier Privé Rennes de Saint-Grégoire, 6, boulevard de la Boutière, 35760 Saint-Grégoire, France ∗ Tel.:
+02 99 23 33 85. E-mail address: [email protected]
Please cite this article in press as: Senéjoux A. Training in proctologic surgery: How and for whom? Journal of Visceral Surgery (2014), http://dx.doi.org/10.1016/j.jviscsurg.2014.07.010
ARTICLE IN PRESS
Journal of Visceral Surgery (2014) xxx, xxx—xxx
Available online at
ScienceDirect www.sciencedirect.com
EDITORIAL
Training in proctologic surgery: How and for whom?
KEYWORDS Proctology; Teaching; Hepato-gastroenterology; Digestive tract surgery
Proctology is a medicosurgical discipline that encompasses the diagnosis and treatment of rectal and anal disorders. Proctology does not figure among the 30 specialty certifications or qualifications in France (DES [Diplôme d’études spécialisées] or DESC [Diplôme d’études spécialisées en chirurgie]). Various types of practitioners participate in the management of proctologic disorders in France: gastroenterologists, general surgeons, colorectal surgeons, but also practitioners such as gynecologists who manage pelvic floor disorders or even, more anecdotally, dermatologists, and venous vascular specialists. Often, these practitioners deal with only a single facet of the overall discipline, medical therapy, diagnosis and instrumental management for the gastroenterologist, and surgery for the surgeons. In Europe, general or colorectal surgeons most often perform proctologic surgery. One particularity in France is that there are many nonsurgeons who perform anal surgery but are also equally competent in the medical aspects of proctology. For many years, proctology in France was essentially a medical field, practiced by gastroenterologists or dermatologists; treatment was either medical or instrumental (sclerosing injection for hemorrhoids, incision of thrombosed external hemorrhoids, subfissular injections introduced in France by Raoul Bensaude during the first quarter of the 20th century. . .). Surgery of the anus was in its infancy and was quite traumatic (Whitehead hemorrhoidectomy, anal dilatation for fissure. . .); it was often disdained by surgeons who took little interest in this type of surgery and relegated it to the end of their operative schedule. With progress in anesthesia, anal surgery developed under the impulsion of the Saint Mark’s Hospital in London and several surgeons, both from France and elsewhere, were trained. Thus, was born the French school of Proctology [1], including pioneers such as Adrien-Albert Poirier, Alfred Bensaude, Jean Arnous, Jacques Soullard, Jean Duhamel, and Ernest Parnaud. In 1998, the Inter-University Diploma of Colo-Proctology was created, replacing the regional University Diplomas. The courses were set up to run over two years with the goal of training gastroenterologists and visceral surgeons as well as other specialists who took part in the management of pelvic floor disorders. The goal of the course was to inform the participants about the current status of basic and clinical research, to teach the basics in anatomy, pathophysiology and therapeutics of proctology disorders, in order to acquire understanding and skills to manage these patients. Since 2007, teaching of theory is offered exclusively on an e-learning platform, based on the existing polyvalent level 1 general surgery and hepato-gastroenterology programs. This program also was geared to enable practitioners to acquire the necessary competency to practice proctology at a subspecialty level (Level 2). A student at level 2 should be able to perform only medical and instrumental procedures. The validation of level 2 surgical competency implies at least one year of training in an expert center with a strong focus on colorectal or proctology. At the end of level 2 training, the participants receive an Inter-University Diploma (DIU), delivered by one of the participating medical universities.
http://dx.doi.org/10.1016/j.jviscsurg.2014.07.010 1878-7886/© 2014 Elsevier Masson SAS. All rights reserved.
Please cite this article in press as: Senéjoux A. Training in proctologic surgery: How and for whom? Journal of Visceral Surgery (2014), http://dx.doi.org/10.1016/j.jviscsurg.2014.07.010
+Model JVS-418; No. of Pages 2
ARTICLE IN PRESS
2
Editorial
Some physicians registered under the title of continuing postgraduate training already have a DIU in proctology or a university certification that is no longer current (Paris VII, Montpellier, Toulouse. . .). These candidates can qualify for the current diploma by documenting their past experience in medical and surgical proctology, and can then take advantage of a simplified e-learning program. At present, 150 persons are enrolled within this framework. Modifications in the structure and content of the administrative text (pertaining to acquisition of professional competencies, integration of the surgical valence) have been validated by the medical schools of Rennes and Toulouse. Proctology ‘‘à la Franc ¸aise’’ is most certainly a national particularity, but this is also one of its richnesses. Attested by its dynamism, the French Society of Colo-Proctology (Société franc ¸aise de Colo-Proctologie), includes both gastroenterologists and surgeons and is an illustration of the value of medical and surgical collaboration, wherein each actor can play a role. Let us continue to cultivate this particularity, in the name of a fascinating but all too often neglected discipline. . .
Disclosure of interest The author declares that she has no conflicts of interest concerning this article.
Reference [1] de Parades V, Attienza P. Les médecins qui ont fait la proctologie médicochirurgicale « à la franc ¸aise ». Presse Med 2011;40:644—50.
A. Senéjoux ∗ Centre Hospitalier Privé Rennes de Saint-Grégoire, 6, boulevard de la Boutière, 35760 Saint-Grégoire, France ∗ Tel.:
+02 99 23 33 85. E-mail address: [email protected]
Please cite this article in press as: Senéjoux A. Training in proctologic surgery: How and for whom? Journal of Visceral Surgery (2014), http://dx.doi.org/10.1016/j.jviscsurg.2014.07.010