Since its inception, the Federation of Orthopaedic Trainees in Europe has aimed to promote and improve the standards of orthopaedic and trauma training in Europe. In 2015, at the first FORTE summit, which was held at EFORT headquarters in Geneva, national representatives from several European countries met and shared current requirements for residency in their respective countries. Although there were similarities in the residency programs, there were also significant differences and several issues that were considered problematic or needing improvement.

As a follow-up to this meeting, the Federation of Orthopaedic Trainees in Europe (FORTE) conducted an initial survey to compare orthopaedic and trauma residency programs and demographics of residents in various European countries. For this initial study, data from 18 countries (Croatia, Denmark, Finland, France, Germany, Greece, Ireland, Kosovo, Malta, Norway, Portugal, Slovakia, Slovenia, Spain, Sweden, Switzerland, Turkey and the United Kingdom) were compared for the year 2014. The initial findings were presented at the FORTE session held at the 17th EFORT Annual Congress in Geneva in June.

Trainees per specialist

The study found the ratio of number of trainees per specialist orthopaedic surgeon varied from 1:2 to 1:7, which reflected possible inherent differences in the need for orthopaedic specialists across Europe. The data also showed in nearly all the countries surveyed, the proportion of female trainees was higher than the proportion of female orthopaedic specialists, which would therefore likely shift the gender parity in the specialty in the near future.

The selection process for entering a residency program varied somewhat, based on the results. In more than half the participating countries, selection was based on an interview or a combination of merit and an interview. In the remainder of the programs, selection was based on results of a national exam or a basic application. The duration of the residency program was generally 5 years to 6 years in all the countries. Nearly every country used a logbook system throughout the residency, and only a few used a web-based log book. However, there were still a few countries that did not require a logbook for keeping track of residents’ achievements.

Final exam

About 80% of the countries surveyed gave a final exam at completion of the residency. The remainder used some form of interim exams and did not have a mandatory final examination. When the main components of training were assessed, the results showed one country had mandatory minimum requirements for courses, surgical procedures, research and leadership. Surprisingly, nearly 40% of the countries studied had one or none of these four training components as a mandatory component of their orthopaedic and traumatology residency requirements. Among the countries with minimum requirements for course training and surgical procedures, the requirements consisted of 50 hours to 360 hours of training and 300 to 1,800 procedures.

These initial findings showed there are many similarities among European orthopaedic and trauma residency programs, but also some important differences in overall requirements and final qualifications by country. FORTE will continue to serve as a forum for sharing best practices with the ultimate goal of improving and harmonizing the level of orthopaedic training throughout Europe. The FORTE summer school held in August is an example of ongoing endeavors by FORTE to promote these goals.

Reference:
www.forte-orthopaedics.com

For more information:
Gazi Huri, MD, can be reached at Hacettepe University School of Medicine, Orthopaedics and Traumatology Department 06320, Ankara, Turkey; email: gazihuri@yahoo.com.
Rami Madanat, MD, PhD, FEBOT, can be reached at Helsinki University Hospital, Arthroplasty Unit, Sairaalakatu 1, Vantaa, PO Box 900, FIN-00029 HUS, Helsinki, Finland; email: rami.madanat@hus.fi.
Tatu J. Mäkinen, MD, PhD, FEBOT, can be reached at Helsinki University Hospital, Arthroplasty Unit, Sairaalakatu 1, Vantaa, PO Box 900, FIN-00029 HUS, Helsinki, Finland; email: tatu.makinen@hus.fi.
Nikolaos K. Paschos, MD, PhD, can be reached at Department of Orthopaedics & Sports Medicine, Pennsylvania Hospital of the University of Pennsylvania, 800 Spruce St., Philadelphia, PA 19107 USA; email: nikolaos.paschos@uphs.upenn.edu.
Danny Ryan, MA, MB BChir (Cantab), PGCME, FRSA, MRCSEng, MFSTEd, MacadMEd, can be reached at 6 The Hendre, Overton Park Road, Cheltenham, Gloucestershire, United Kingdom GL50 3BW; email: danny.ryan@cantab.net.
João Vide, MD, can be reached at c/o Secretariado de Ortopedia - Hospital Beatriz Angelo, Av. Carlos Teixeira, 3, 2674 - 514 Loures, Lisbon, Portugal: email: joaovide@gmail.com.
The FORTE writing committee consists of Stjepan Dokuzovic, Croatia; Bjarke Viberg, Denmark; Charles Riviere, France; Matthias Klotz, Germany; Fiachra Rowan, Ireland; Bujar Shabani, Kosovo; Kurstein Sant, Malta; Kjartan Koi, Norway; Yousef Naser, Slovakia; Ane Miheli, Slovenia; Eduardo Gardella, Spain; Yosef Tyson and Marie Leksell, Sweden; Jasmin Diallo, Switzerland.

Disclosures: Huri, Madanat, Mäkinen, Paschos, Ryan and Vide report no relevant financial disclosures.