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OSN Europe: SOE contributes toward harmonization of educational practices with fellowship training initiatives
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The European Society of Ophthalmology is contributing to the development of strategies to implement fellowships across continental Europe and gradually harmonize subspecialty training.
The results of the European Board of Ophthalmology (EBO) Surgical Skills questionnaire, reported at the European Society of Ophthalmology (SOE) meeting in Vienna by Marko Hawlina, MD, PhD, chairperson of the SOE Education Committee, highlighted a situation of large disparity among the surgical part of ophthalmic training for ophthalmology across continental Europe. On the other hand, possibilities for post-specialist training, or fellowships, that are common in the U.K. or U.S. are few and seldom publicized in continental European countries.
“The European Union of Medical Specialists (UEMS) and EBO have issued guidelines and recommendations, including that for post-specialist training, but then it is up to individual countries in Europe to implement them as they please. Specialty-training curricula are still substantially different in today’s Europe,” Hawlina said. “The length varies between the two extremes of 7 years in the U.K. and 3 years in some countries. The recommendation of UEMS and EBO is that the minimum requirement should be 4 years but there is no uniform agreement on what surgical procedures should be learned in the core curriculum.”
Within the European Union, medical professionals are granted unrestricted mobility and patients have the right to equal services. In this respect, the harmonization of study curricula, to ensure equal educational standards and service quality standards across Europe, is a crucial goal to pursue.
“The problem is that in Europe we have no external regulatory body to demand harmonization. The instruments in place by UEMS and EBO are not obligatory for the member states, and assessment is still mostly national,” Hawlina said.
The EBO exam is optional, but the steadily growing number of participants shows that young ophthalmologists are aiming toward common European standards and certifications. This year, there were more than 550 candidates from more than 28 countries, almost 15% more than in the previous year.
Other instruments toward harmonization have been the adoption of the International Council of Ophthalmology (ICO) curriculum by the EBO; the definition of sources, such as the American Academy of Ophthalmology Basic and Clinical Science Course, since 2013 co-edited by the EBO; and the EBO accreditation of training centers. They are now more than 100 across Europe, including Eastern Europe. Also important is the newly developed EBO subspecialist exam, this year introduced for glaucoma and aimed for other subspecialties in the coming years. It is, however, important to have subspecialty training in place to be able to take the final subspecialist EBO exam.
“There are also 80 short-term grants for young ophthalmologists from Eastern Europe, and 10 grants for teachers issued by the SOE. In addition, EBO issues 40 grants for residents from the countries in the European Union, and ICO and ESCRS have their grant program as well. The ICO ‘Training the Trainers’ workshops are aimed at creating a common platform in teaching practices and professionalism for teachers internationally, and meetings such as the SOE and other international societies play an important role in the way of harmonizing practices,” Hawlina said.
Surgical training
Surgical training appears to be the weakest point of curricula across continental Europe. On average, European ophthalmology trainees perform 10 to 50 cataract surgeries during residency, while the minimum requirement is 89 for U.S. colleagues.
“Again, the U.K. is at the top of the list, with a high number and a wide range of surgical operations mandatorily required during residency. On the opposite side, there are countries where intraocular surgery is not a part of the core curriculum and is only learned during additional years of post-specialist training,” Hawlina said.
“Not surprisingly, the survey launched by the SOE YO, and published in OSN Europe last year, unveiled a dramatic 22% of responders who never had the opportunity to do intraocular surgery during their residency.”
“The truth is that the better we are, the harder it is to teach and learn surgery. There is no margin for less than up-to-best standard. Patients know more, demand more, and their rights are well protected. Excellence is expected. Hospital administrations require full lists, and there is no time for training. Surgery is also less and less invasive, and no assistant surgeon is needed,” he said.
Most EU states agree that basic surgery techniques should be learned during residency, that a realistic minimum number should be defined and accomplished, and that there is a need for surgical fellowships for additional subspecialist training.
In the U.K., most subspecialties have fellowships in place, similar to the U.S. In continental Europe, few centers offer fellowships and almost none are advertised. There are a few fellowships offered by societies such as the European Glaucoma Society or the EVER Foundation. Why there are almost no fellowship positions advertised in continental Europe is a question that seems to be related to the tradition of in-house training of preassigned residents, according to Hawlina. Others have no possibilities to get the training that is required to apply for fellowships.
“The few surgical fellowships available are often conditioned upon a certain amount of surgical experience of applicants, which is what they couldn’t get during their residency. Therefore, residents often go to train in India, where a number of commercially oriented training centers offer quick and ethically questionable training, which is not a good solution,” Hawlina said.
Action plan
The SOE action plan involves inviting training centers that are interested and capable of providing formal fellowships in Europe, to advertise these on a Web platform of the SOE Young Ophthalmologists program which is already in place to provide information and publicize job and training opportunities.
“There is some interest across Europe to offer fellowships. According to our survey, a number of centers responded they would be willing to take on young ophthalmologists from any country in Europe. Most would be happy to provide training in English or another major EU language and do not necessarily require proficiency of local language,” Hawlina said.
Lack of funds seems to be the main obstacle. Most centers would not accept financial obligations for fellowships, and some of them would require payment from fellows. Only a couple of centers would offer a salary.
The SOE, Hawlina said, will back up the EBO and UEMS in their standardization efforts if and when fellowships become more frequent in continental Europe. It is however important to start somewhere and creating a website link between the well-organized SOE Young Ophthalmologists and those university centers that would wish to have fellows is the first such initiative.
“Improving education and opportunities for young ophthalmologists across Europe, also beyond European Union countries, is one of the priorities of the European Society of Ophthalmology,” he said. – by Michela Cimberle
For more information:
Marko Hawlina, MD, PhD, can be reached at Eye Hospital, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia; email: marko.hawlina@gmail.com.
Disclosure: Hawlina reports no relevant financial disclosures.