President's Report of the European Board of Paediatric Surgery (EBPS)

Introduction

I would like to pay tribute to all the members of the Executive Committee, past and present, who have been supportive in my role as President of the EBPS. As often happens, the seeds of success have been sown by other people in the past. Ian Molenaar who kept the UEMS Specialist section in Paediatric Surgery alive for so long; Hugo Heij who became the Secretary/Treasurer during the period when the European Boards were established, who was responsible for the statutes of the EBPS, and my predecessor, Juan Tovar, who became the first President of the EBPS. One must also pay tribute to our Secretary/Treasurer Gianbattista Parigi, without whose untiring efforts many of our ideas would not have come to fruition. As Webmaster, our webpage is vibrant and alive detailing all the activities of the Board. www.uems.be/paedsurg.htm. Our purpose was to unite European Paediatric Surgeons, look at their training and ensure harmonisation of the standards of training in Europe. I have listed below the aims and achievements of the EBPS.

Aims and Achievements

Handbook publication of EBPS

The political structure of the UEMS and of the European Boards was difficult to comprehend and so it was decided to prepare a handbook. This was one of the first handbooks of all the European Boards which contained all the documentation relating to Brussels, UEMS and Boards and contained the statutes for procedure. A sum of money, over ¥ 1000, was raised to produce these handbooks which were then distributed to all the delegates and most of the national associations in Europe as well as the Presidents of the Royal College in Britain. This allowed the Executive Committee, by following these rules and regulations, to structure our meetings and allow better communication through agenda and minutes for all Executive Members as well as Member delegates from all the European countries.

Certification secretary

A Secretary was appointed on a part-time basis in Glasgow, Mrs. Rosemary Mackenzie, who was employed on a session per week to process the certification of European Paediatric Surgeons and eventually produce a database of the manpower of European Surgeons in Europe. This was pivotal to the success of the certification process which took place during my period of office.

Funding

Funding of the UEMS Specialist Section in Paediatric Surgery was in the past supported entirely by a levy from each member country in Europe which was barely enough to support the meagre activities of the section let alone the more intensive ones of the Board. It was decided to charge a fee for the certification process which was established and amounted to ¥ 25 per certificate processed.

Certification process

The certification process was established for all Paediatric Surgeons within the European Union initially and subsequently for the associated countries. This process was time limited to allow applications from those Paediatric Surgeons who had trained in their own country and were accepted through their own national association as bona fide Paediatric Surgeons. A special application form had to be filled in and their curriculum vitae sent together, in many instances, with logbooks and publications from their institution. These were processed by their national association and had to be stamped and signed by the Secretary of the Association before they were then passed on to the Executive Committee of the EBPS. The Executive Board processed successfully 1,121 of these applications over three years. There were others that were submitted but were not accepted on a variety of grounds. Mrs. Rosemary Mackenzie informed the individuals at their homes that they had been accepted as trained Paediatric Surgeons within their own country, a fee was then sent by the individual or collectively through their national association, to the European Board Certification Secretary in Glasgow, and once received their names were put on a database and their certificate was sent to them directly. A breakdown of this number is shown in Table [1] and this database in effect forms the cohort of European Paediatric Surgeons who have registered with the EBPS in accordance with the rules and statutes produced by the UEMS in Brussels. There is still indecision from Brussels about whether people who own these certificates have legal status calling themselves Fellows of the European Board of Paediatric Surgery (FEBPS).

Table 1 EBPS - Registered Paediatric Surgeons Country Number of Registered Paediatric Surgeons Austria 18 Belgium 28 Denmark 7 Finland 45 France 143 Germany 15 Greece 54 Italy 147 Netherlands 27 Norway 8 Portugal 43 Spain 217 Sweden 57 Switzerland 28 UK 41 878 Croatia 23 Hungary 26 Poland 115 Turkey 77 Syria 1 Tunisia 1 243 Total Registered 1121

Hospital site visits

Hospital visitations were carried out by the EBPS over a three year period and a list of these are included in Figure [1].

Fig. 1 Hospital Visitations. Carried out by the European Board of Paediatric Surgery.

Certificates for the hospitals that have passed the visitation process were be presented at the Budapest Annual Congress this year. Site visits were carried out by two members of the Executive Board of the EBPS and one local Paediatric Surgeon from another hospital. The site visit lasted from one to two days and was hosted by the hospital. The master plan was to perform one site visit per country and then that hospital would become a model for other centres to receive site visits mainly from locally organised trained site visitors who would include one Executive member of the EBPS to ensure standards were maintained. The report was then submitted to the European Board for discussion and strengths and weaknesses were outlined of the individual institution and these were then reported back to the hospital concerned. Full certification was given to hospitals who had all the facilities which could allow a Paediatric Surgeon to train fully over a period of time. Some institutions did not have the ability to do this and were granted limited certification, for a limited period of time, for a limited number of individuals. Re-certification takes place every five years and in some institutions at a three year time interval with an intermediate report by them to ensure that the recommendations of the EBPS were carried out. In some instances, these visitations were very helpful to the local surgeons to help them raise their standards, establish a variety of services that might have been lacking and to give a higher profile to paediatric surgery in their country where it is not recognised as a specialist service.

The European examination

A European examination was designed for all trainees who wished to be certified as Paediatric Surgeons after the time was expired for the initial certification process for established Paediatric Surgeons. The plan was to set a high standard which included clinical examinations and oral examinations in paediatric surgery, neonatal surgery, paediatric urology and spot tests. Individuals who were successful in this examination would be awarded the EBPS certificate as a sign of completion of their training. Countries with established examination systems were used as a model to develop the European examination. So far, two examinations have been held, the first in Paris where four candidates sat for the examination and three passed, and the second examination was held in Madrid where nine candidates sat for the examination and all passed. The first examination was run at a significant financial loss but this was expected and the money obtained from the certification process was used to run this examination. In the second examination, a small marginal gain was made and it is intended to keep the examination at this level in future. The future examination will be held in Cologne on November 16th and 17th 2001. It has to be stressed that the only way trainees in Europe can get the certificate of completion of training is through this examination process. It is envisaged that this examination will become more popular as time goes by. The initial cost of ¥ 300 has been reduced to ¥ 250 per individual. The examination rules and regulations were published in the handbook but can now be found in the EBPS Website.

Links with other boards

Another aim was to develop important links with other European Boards which include paediatrics, urology, trauma and child care in Europe. Members of the Executive of the European Board regularly sit at these Board Meetings as guests and report back to the Executive and where our interests have common ground, then documents are signed by the two Boards concerned and sent to Brussels for information or ratification.

Relationship with EUPSA

The relationship with EUPSA developed which was one of an educational role and included the establishment of the European Congress of Paediatric Surgery which has become highly successful as years go by. UEMS has supported EUPSA in a number of roles both in promoting educational interests as well as financial help. It was decided to donate 500 Euros to the recent Budapest meeting to help support individuals who may not be able to pay the registration fee in order to attend that meeting.

The European Journal of Pediatric Surgery

The European Journal of Pediatric Surgery adopted the UEMS and the Board of Paediatric Surgery as the official organ of paediatric surgeons in Europe. The Journal had been very supportive under the leadership of Professor Alexander Holschneider who is also an Executive Committee member. The European Journal of Pediatric Surgery has been helpful in the publicity of the Board and all its activities as well as in publishing key documents ([1], [2], [3], [4], [5]). It has helped publicise the examination of the Board as well as its site visits and we hope it will continue to do so in the future.

What about the future?

The introduction of continuing medical education, revalidation processes and accreditation portfolios are all items which need to be developed for the European Paediatric Surgeons to participate in. Increased movement of trainees and established Paediatric Surgeons from one country to another in Europe is still in its infancy and needs to be encouraged. It is important that European centres extend beyond Europe and link with the World Federation of Paediatric Surgeons and other such bodies.

References

• 1 Carachi R. The UEMS specialist section in paediatric surgery.  Eur J Pediatr Surg. 1999;  9 132-137
• 2 Carachi R. The UEMS specialist section in paediatric surgery. UEMS Compendium of Medical Specialists. 2000 1: 183-188
• 3 Carachi R. The European Board in Paediatric Surgery, Examination Handbook. 
• 4 Carachi R. Union Europeenne des Medicins Specialistes Handbook. 1994
• 5 Parigi G B, Carachi R, Zachariou Z. European Websurfer Bulletin.  Eur J Pediatr Surg. 2001;  11 211-215