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Initiative will improve training for the next generation of orthopaedic surgeons
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Across Europe there is debate about whether younger orthopaedic colleagues have attained sufficient expertise by the time they have completed training to begin practicing the specialty independently. This is an issue for many reasons. At larger hospitals a new orthopaedic and traumatology specialist often remains surrounded and supported by experienced colleagues who regularly provide guidance and feedback while the trainee practices. On the other hand, many new orthopaedists complete training program and quickly assume duties in clinics with limited access to experienced specialists. For this second group, reaching a certain level of education and training is practically mandatory. It will not only help improve the overall quality of the orthopaedic service, but also can reduce morbidity and negative outcomes.
In more European nations, however, the orthopaedic curriculum does not state specifically how much training and education a new orthopaedic surgeon should have, particularly with regard to the procedures the surgeon plans to perform most often.
Usually a country’s national health service creates training guidelines and a curriculum, frequently in conjunction with the national orthopaedic society. The result can be as many different guidelines for orthopaedic training as there are nations in Europe and highly dissimilar training criteria across the continent. Although not necessarily a national problem, it can become so when an orthopaedic colleague crosses the border to practice in another country.
The European Federation of National Associations of Orthopaedics and Traumatology (EFORT) have started an initiative to ensure that all orthopaedic and traumatology specialists in Europe receive the same level of training. As a first step, EFORT analyzed the existing curricula to identify differences among them and developed recommendations for a curriculum to be used in future training programs. Eventually, all European national orthopaedic societies are expected to review the curriculum.
It also needs the involvement of politicians and health authorities for this initiative to be successful. In most countries, politicians ultimately make the final decision about the structure and delivery of the training programs.
What remains to be addressed is how to best assess the skill level of new orthopaedic colleagues. Is an examination — written, oral or both — sufficient? With many different languages used in Europe, can such a test be administered equitably? The European Board of Orthopaedics and Traumatology and the European Union of Medical Specialists are now involved in developing this aspect of the initiative.
Another issue that needs to be addressed is that several nations already have qualifying examinations for practicing orthopaedic specialists, while other countries either do not have an exam or do not have a penalty for inferior exam results. This complicates the issue more.
I hope all the national orthopaedic societies will participate in the European training initiative. Extensive participation will help ensure that the initiative is successful and is implemented across Europe. If orthopaedic surgeons are to be recognized worldwide as the physicians who provide patients with quality treatment of musculoskeletal diseases and injuries, then a consensus is essential.
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- Per Kjaersgaard-Andersen, MD, is Chief Medical Editor of Orthopaedics Today Europe. He can be reached at Orthopaedics Today Europe, 6900 Grove Road, Thorofare, NJ 08086, USA; email: orthopaedics@healio.com.
Disclosure: Kjaersgaard-Andersen has no relevant financial disclosures.