Forum: UEMS – European Union of Medical Specialists

by Alexandre Bisdorff

The European Union of Medical Specialists (UEMS: Union Européenne des Médecins Spécialistes) is a professional European organization of doctors (except general practitioners).
The UEMS was founded in 1958 and is constituted by the national medical associations of EU member states and European Economic Area countries (as full members). Additional 4 countries have an associate member status and 2 are observers.
The UEMS represents approximately 1.4 million medical specialists working in Europe. The management Council that governs the UEMS is composed of delegates of national medical associations from full member states.
Each medical specialty recognized in the European Directive 2005/36/EC has a section and board dealing with the matters specific to this specialty. For neurology, this is the UEMS Section and European Board of Neurology (EBN).

The objects of the UEMS are the study, promotion and harmonization of the highest level of training of the medical specialists, medical practice and health care within the European Union. The UEMS represents the medical specialist profession to EU authorities.

The best-known activity of the UEMS is probably the accreditation of CME through the European Accreditation of CME (EACCME®).

The EBN implements UEMS policy for neurology. The UEMS worked out a Charter for Specialist Medical Training in Europe, divided in 6 chapters, chapter 6 is specific to each specialty, the EBN has just updated chapter 6 for neurology in 2011.

A further activity is the European Board examinations.
The EBN will hold its 4th board examination for neurology this year during the EFNS Congress in September in Stockholm.

Alexandre Bisdorff is working at the Deparment of Neurology, Centre Hospitalier Emile Mayrisch, Esch sur Alzette, Luxembourg and is President of the European Board of Neurology

Report of the visitation of the European Board of Neurology, to the neurological department of the Istanbul Faculty of Medicine of the Istanbul University March 23, 2012 

“One of the important endeavours of EBN for quality control of education in neurology is the visitation program. The report of the first visitation has been kindly provided to Neuropenews by Professors Serefnur Ozturk and Wolfgang Grisold.”

Section and Board of Neurology

UEMS EBN is offering educational department visits to assess the educational programmes of teaching centres. The procedure and contents of the visitation areaccording to the UEMS suggestions. The purpose is the assessment of the teaching unit, to be accredited as a UEMS teaching centre. (see also UEMS EBN website).

The department of Neurology of the Istanbul Faculty of Medicine of the Istanbul University has requested such a visit. As visitors Professor Wolfgang Grisold was nominated by UEMS EBN and Professor Serefnur Ozturk by the Turkish Medical Association and Turkish Neurological Society. A joint interview with the hospital management and the vice dean clarified the position of the department in the university. Also the official figures of in-and outpatients and the general statistics of the neurological department were discussed. The application was made by the Istanbul University, Faculty of Medicine, Department of Neurology and submitted by Professor Betul Baykan, Head of Education, via the electronic application form on www.uems-neuroboard.org.

The visiting committee consisted of Professor Wolfgang Grisold (chair), who was appointed by UEMS EBN and Professor Serefnur Ozturk (co-chair) on behalf of The Turkish Medical Association and Turkish Neurological Society. The secretarial assistance was provided by the Vienna medical Academy (VMA) office in Vienna.

Organisation of the visit

The department was provided with the questionnaires for the teaching staff, the head of department, the administration, and was asked to provide documentation of their scientific work. All staff members provided a CV. On March 23rd 2012 Dr Ozturk and Dr Grisold met at the department and commenced the visit, which lasted from 9.30 am until 5.30 pm. During the visit the individual departments, Stroke Unit, laboratories, outpatient facilities and residents’ quarters as well as the library and administrative part could be visited. Research facilities as electrophysiology, EEG, neurosonology, laboratories for genetics, movement and behavioural disorders were visited.

Methodology

The visit was prepared according to the guidelines available on the UEMS EBN website. Individual questionnaires were prepared for residents, teaching staff, the head of department and the hospital management. The questionnaires were given to the residents onsite and they had 30 minutes time to complete them. Out of the 13 present residents 6 were randomly selected for a 15 minutes oral interview. These interviews were structured and each resident was asked the same questions. They were performed only in the presence of Dr Ozturk and Dr Grisold to keep confidentiality.

The staff filled out standardised questionnaires prior to the visit. The printouts were collected from all staff members. 6 staff members were asked for an oral interview of 15 minutes each. Also these interviews also took place in privacy and were performed by Dr Ozturk and Dr Grisold. All staff members were asked the same questions.

In addition interviews were conducted with the head of the department the administration officer and the vice dean. According to the vice dean the neurologic department was considered to be among the best units in education and research.

Residents and Staff interviews
Residents

The residents confirmed that a training schedule was available and regular systematic training took place. The general impression was rated between good and excellent, the majority being very good. The impression was that the program was suitable to deal with the needs of neurologists. The supervision of the residents was considered as very good. Working hours were between 60-80 hours a week. Some residents wished for an improvement in outpatient supervision. The general impression was that the physical conditions of the building and department needed improvement. All confirmed access and support to scientific work.

Staff

Staff members received an electronic questionnaire prior to the visit. These questionnaires contained the basic item and the results. In addition 6 persons from the staff were asked for an oral interview which was based on the following questions. In addition CVs with their scientific publications were received. The questions evaluated the duration of their specialist function, their role in education, and the weekly hours devoted to education. They confirmed the classical structured teaching approach, and also explained that the “substructures” and subspecialised departments had their own training goals. According to their specific specialisation they have specific roles in the training process. The impression was that the staff is dedicated and thoroughly involved in the teaching activities. One staff member questioned whether the department should have more general neurology instead of the focus into the subspecialties.

Structure of resident teaching

The department has a resident commission which’s members see the residents through their entire training. This guarantees a smooth transition between the different units. They are exposed to the emergency room (ER) from the beginning of training in general neurology as well as emergency service and outpatient clinic. A care fully developed ”on call system“ guarantees a double supervision for the residents day and night as well as weekends. There are several structured teaching activities as the daily emergency course, structured reading of textbooks and the AAN continuum, and specific topics, journal clubs monthly, seminars. The program seems to be dense. As a rule residents are encouraged to participate in meetings, make presentations and early participate in scientific projects. The equipment (library, internet access, university library and the qualified teaching staff are a good structure.

Department visit

The visit of the department was carried out according to the checklist. The stroke unit, the inpatient departments could be visited and also a visit to patient rooms was granted. Several laboratories as ultrasound, electrophysiology, immunology and genetics, neuropsychology, neurosonology, neuropathology could be seen and inspected. The number of beds is 12 SU beds and 46 general beds. The condition of the building is an old building with modern equipment but needing building renewal. The residents’ room, which also serves for the person on duty was seen, and also has some working space. For a future department these quarters needs to be enlarged. The secretariat staff of the neurological ward was very helpful and assisted in all ways needed.

Summary

The impression is that this department is a highly structured teaching department, satisfying European and also worldwide standards. It has both a qualified and well trained staff and a highly sophisticated and structured teaching program. In addition the department is part of a highly qualified university, cooperates with other departments and has a high patient load, giving the trainees a wide exposition of different diseases.

The interview with the residents, both written and oral, confirmed this view and from the answers and interviews most questions were positively answered. Negative and critical points were few. In frequency they are the minority of answers and should not be amplified: The most mentioned inadequacy by residents was the “physical” appearance of the department, housing and also residents’ quarters; a few residents mentioned the high number of hours, lack of free time and heavy patient load. Also the busy organisation did not allow residents to attend several educational meetings. The staff is experienced and dedicated. There may be a slight lack of general neurology which is partially compensated by the ER room. The interviews with the head of department, administration and the vice dean confirmed the overall positive impression and the high standing of the department in the campus.

Interdisciplinary work with specialties, as cardiology, neurosurgery, physical medicine and rehabilitation is effectively taking place but is lacking in some as cancer (neuro-oncology). The stroke unit in particular seems highly competent and well equipped. The low number of yearly admissions of stroke patients is probably due to a lack of an efficient emergency stroke system in Istanbul and also to a lack of general neurologic wards and direct access to rehabilitation to guarantee a swift and high rotation of beds. This would be a recommendation to change this in regard to modern stroke training.

In summary

The department of neurology of the Istanbul Faculty of Medicine of the Istanbul University has successfully participated in the European Board of Neurology visitation and will be allowed to be a teaching centre accredited by UEMS EBN. Trainees of this department are eligible for a 30% reduction on the European Board Examination in Neurology examination fees.

European Board of Neurology accredited Department

Serefnur Ozturk
Turkish Neurological Society, Turkish Medical Association
Professor of Neurology, Selçuk University in Konya, Turkey

Wolfgang Grisold
UEMS EBN Visitation Committee Chair
Professor of Neurology, Kaiser-Franz-Josef Spital in Vienna, Austria

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