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"To live
in the 21st century means to be informed":
European and National Institutions relevant for
education, training and CME in Thoracic, Cardiac and
Vascular Surgery (links):
Educational material (Power Pint Slide Show):
Serbia,
Europe, World - Creating a Common Standard in TCVS
Education, Training and CME
The ultimate goal for
the future is to create a common high standard for
the quality of Thoracic and Cardiac and Vascular
Surgery in all countries. To accomplish this task,
different National and Continental Associations and
Boards are investing significant efforts to set up
and establish feasible education, training and CME
for Thoracic, Cardiac and Vascular Surgery, that can
be internationally and globally recognized and that
can provide surgeons, who attain a level of
knowledge and competence, to be recognized as
appropriate for independent practice throughout the
World.
Although noble in its intention, this mission has
proved to be very difficult to accomplish. Different
traditions, cultures, economies (and many other
minor differences) are commonly said to be the mayor
reasons for the lack of substantial progress in this
field.
Regardless of
previous statement, as the result of personal,
independent survey (since 1997), there is still one
crucial unanswered question: "What kind of surgeon
we really need?" Is it: Thoracic, Cardiac, Vascular,
Cardio-Thoracic or Cardio-Vascular? While "single"
specialties are practical and logical (but not so
"bio-logical"), the existence of "combined"
specialties are commonly supported with "anatomical"
or "physiological" reasons. In a reality, both
modalities (i.e. "single and combined") do not
ensure desirable level of surgical competence.
At very first glance,
one could recognize that 3 "single" specialties, in
different combination, could produce 5 (above
mentioned) surgical profiles. The logic of
competence (i.e. "bio-logic") implies that, no
matter which of these 5 profiles is selected, one
must attain a certain level of knowledge from each
of 3 "single" specialties. Therefore, any
comprehensive education, training and CME should
seriously take into account this fact.
However, in spite of
many points of departure, it seems that certain
consensus was reached so far. It is about duration
and common trunk of training. Thus,
from the time of qualification as an M.D. to
establishing independent practice a minimum training
of six years is required. At least two years
training is required in the generality of surgery,
including experience in the management of acute
surgical emergencies, trauma, and some general
operative experience.
Accordingly, a minimum of four years training is
required in Thoracic, Cardiac and Vascular Surgery,
before establishing independent practice.
While these efforts
are continuing in Europe and the rest of the world,
Serbia is trying to make its efficient first step.
Current situation in Education, Training and CME in
Thoracic, Cardiac and Vascular Surgery is far from
any recognizable international standard.
Thoracic Surgery
exists as "single" specialty in Serbia. There is 5
years training program, with 6 months rounds at
Cardiac and Esophageal Surgery. After completing
this training and final exam, one gets certificate
in Thoracic Surgery.
Cardiac Surgery is in
the worst position in Serbia. There is no particular
training program, neither as specialty nor as
sub-specialty. The future "cardiac surgeons" are
recruited by Cardiac Surgical Clinics among M.D.s
with the highest grade point average at school of
medicine. Afterwards, they enter 5 years training in
General Surgery and upon completing this training
and final exam, they receive certificate in General
Surgery. But, in a reality, our residents do not go
on all rounds prescribed in General Surgery program.
Instead, they stay at Cardiac Surgical Clinics,
trying to learn from the practice as much as it is
possible. In such setting, theoretical knowledge,
necessary for their future job, depends on their
individual initiative. To overcome this problem,
when they pass the final exam, they are usually (but
not obligatory) sent aboard for some time (up to 1
year) in order to improve their skills.
Vascular Surgery
exists as sub-specialty in Serbia. After completing
5 years training in General Surgery, those who want
to become Vascular Surgery sub-specialists, have to
complete additional 2 years program.
In conclusion,
current situation in Education, Training and CME in
Thoracic, Cardiac and Vascular Surgery is diverse,
non-coordinated and hardly acceptable.
"Belgrade
Project 1-3-5"
All, above mentioned,
facts have inspired me to create the unique
educational tree, which would overcome difficulties
encountered at National, European and global levels.
With 1 common trunk,
3 ramifications and 5 licenses, "Belgrade Project
1-3-5" (Diagram 1)
provides optimal framework for efficient and
reliable education, training, research and CME in
either: Thoracic, Cardiac, Vascular, Cardio-Thoracic
or Cardio-Vascular Surgery. By connecting 3 closely
related specialties into single educational tree,
this Project reduces the net costs of the education,
provides a rational personnel engagement and ensures
desirable level of knowledge and competence for all
participants.
Diagram 1
- "Belgrade project 1-3-5" educational algorithm.
Depending on National
needs (if program is financed by government) and/or
individual preferences (self-financing), a certain
number of participants would enter the common
educational trunk each year.
Minimum duration of
common trunk is 2 years. During this time,
participants should gain knowledge and experience in
general surgery, urgent surgery and intensive care.
This initial time allows participants to make some
definitive decisions about their future career
(according to National policy and/or their personal
preference).
Upon completing the
common trunk program, participants would be referred
to one of three special educational programs,
managed by appropriate Cathedra. Special educational
program lasts minimum 4 years, with predefined
rounds, according to desirable license. Thus:
-
Future Thoracic
Surgeons - will spend minimum 3 years at Thoracic
Surgery, with 6 months rounds at Cardiac and
Vascular Surgeries.
-
Future Cardiac
Surgeons - will spend minimum 3 years at Cardiac
Surgery, with 6 months rounds at Thoracic and
Vascular Surgeries.
-
Future Vascular
Surgeons - will spend minimum 3 years at Vascular
Surgery, with 6 months rounds at Thoracic and
Vascular Surgeries.
-
Future
Cardio-Thoracic Surgeons - will spend minimum 2
years at Thoracic and Cardiac Surgery, with 6 months
round at Vascular Surgery.
-
Future
Cardio-Vascular Surgeons - will spend minimum 2
years at Cardiac and Vascular Surgery, with 6 months
round at Thoracic Surgery.
Cathedrae for
Thoracic, Cardiac and Vascular Surgery will be
obliged to ensure Research activities and PhD
studies for all residents and specialists. Cathedrae
will be also responsible to create appropriate
policy and to conduct and control CME activities of
residents and specialists.
Validity of the
acquired licenses will be limited on 2 to 5 years.
After this period of time, the validity of the
licenses could be extended either by the collection
of appropriate quantity of CME credits, or, by
undertaking a formal licensing
examination.
"Belgrade
Project 1-3-5" promotion
"Belgrade Project
1-3-5" was announced at "2nd Global Forum on
Humanitarian Medicine in Cardiology and Cardiac
Surgery" (May 26 - 28, 2005 Geneva, Switzerland) and formally presented at "4th Annual Meeting
of the SSCVS" (Belgrade, November 2005), which was
organized under thematic title: "European and Global
Standards of Education and Training in Thoracic,
Cardiac and Vascular Surgery - Towards Integrated
National Program".
This meeting was
meant to gather all relevant participants (National,
Regional, European and American). Unfortunately,
even after several announcements and letters of
invitation, many (most) of them were not able to
come.
Dr.
Robert Replogle's
help was of the great importance, during the final
formulation of the "Belgrade Project 1-3-5" and our
efforts to ensure presence of international guests.
It was his idea to propose this Project as a
template, or a trial program, in the region of the
Balkans and Eastern Europe. Overcoming the problems
within the regional program, it would be possible to
move ahead to the rest of the world
(For the details of Dr.
Replogle's ideas, please see the letter, at the end
of this page).
SSCVS was honored
with attendance and active participation of
Dr. Leonard P. Harvey
- UK, (UEMS Liasion Officer; Past President – EC
Advisory Committee On Medical Training; Past
President – European Union of Medical Specialists;
Past Vice-president – Standing Committee Of European
Doctors) and Mrs.
Maud Zingmark - SWE (EACTS Administrative
Director).
Although
"4th Annual Meeting
of the SSCVS"
did not achieved its initial goals, newly elected
SSCVS Council has
decided not to give-up
the idea of "Belgrade
Project 1-3-5". SSCVS Cardiac Surgical Committee, on
the last meeting (25. Novemeber 2006) has decided to
promote this Project and to provide a support for
its commencement from National, Regional, European
and global institutions and individuals. This
initiative should bring together all relevant
representatives (Diagram 2) in order to start fully
supported Regional Pilot Project.
We do expect
understanding and support from
National Ministries of Health and Education,
International Credentialing Commitee, World Bank,
WHF, UEMS, EBTCS, EBTS, EBVS, EACTS, EATS, ESCVS,
ESVS, National and Regional Societies, American and
other Associations and distinguished professionals.
We also sincerely hope that CTSNet will help in
"Belgrade Project 1-3-5" promotion.
Diagram 2
- Organization of "Belgrade Project 1-3-5" promotion
Letter
from Dr. Bob Replogle:
"Dear
Dr. Kocica,
I was excited to
receive your e-mail. Plans for developing an
International Certification process are moving
along nicely following a long period of
planning. The World Heart Foundation, founded by
Dr James Cox, has taken this project on as one
of its main efforts. Many influential surgeons
around the world have expressed a strong
interest in pursuing its goals, The president of
the European Board of Cardiac Surgery, Dr. Toni
Lerut, is strongly in favor of moving ahead. I
spent last Friday with with Dr Bill Gay,
Executive Director of the American Board of
Thoracic Surgery, and he is enthusiastic about
the prospects, and has agreed to help in any way
he can. Nearly every leader in our specialty
around the world is on board and ready to go,
they are waiting to have a plan in effect that
appears to be worthy and a goal established that
seems possible to achieve. The major obstacle is
finding the money to get started and identifying
the resources to sustain the program over the
long term.
The American Board of Thoracic Surgery and the
Residency Review Committee for Thoracic Surgery
(which examines the adequacy of the training
programs) are self supporting based on either
assessments on all thoracic surgeons, or by fees
paid by training programs or by the candidates
for certification.The annual budget of the
American Board of Thoracic Surgery (ABTS) is
about $1 million, this to examine and certify
about 160 candidates. The examination fee is
currently $1600 for each candidate. Usually the
training program pays this, although often the
candidate will have to pay it themselves. Then
the candidate has to go to the examination
center, where ever it is set up, and this will
cost them another $1000 in travel expense. These
charges are not tolerable in many places in the
world, and we have to come up with a plan to
lower the cost without reducing the merit of the
examination. The ABTS has been forward looking
with regard to reducing the costs of
certification, and this year for the first time,
the written examination was given entirely on
the Internet, in 300 locations around the US,
saving the ABTS and the candidates a great deal
of time and money. It was for this purpose that
CTSNet was originally designed, and the tools
are in place to accomplish examination world
wide on the Internet. using CTSNet. It is not a
simple thing, largely because of security
concerns but it can be done.
The next obstacle was to find a way to get
started. Initiating a Certification process
throughout the world, in one huge burst, seemed
overwhelming.
While I was trying to think of a way to get
started, along came your e-mail and the solution
jumped out at me. The way to get started is to
set up a template, or a trial program, in the
region of the Balkans and Eastern Europe, taking
care to set up this trail in the exact same
manner as we would move ahead with a full
International Certification program. We could
work out the details, overcome the problems
within the regional program and then move ahead
to the rest of the world. Perhaps the best
approach would be to use several regional
templates, but using a process which would be
applicable to all the regions worldwide. It is
essential that we have a certification process
that is recognized in all areas of the world as
being genuine.
One of the biggest problems is going
to be the need to overcome any untoward
political influence. Unless this certification
if recognized as being of the highest integrity,
it will eventually be doomed. The pioneers that
will be involved in the process must be of the
highest personal integrity. I know you are of
that opinion also, and it gives great hope that
this will work out in you area.
The World Heart Foundation is meeting in San
Francisco at the AATS on Sunday April 10th at 3
PM. I am certain that Dr Cox would like to have
you attend if you are going to be at the AATS.
At that meeting I am going to present a
preliminary framework for the organization of
the International Certification process for
discussion. After the revisions that will come
following the discussion, I am going to present
the latest iteration of the organizational
structure at the 2nd Global Forum on
Humanitarian Medicine in Cardiology and Cardiac
Surgery in Geneva May 26th, organized by Dr. Jan
Christenson at the University of Geneva. Dr
Christenson has arranged for me to have a
meeting with the Deputy Director of the World
Health Organization in Geneva, and it is my hope
that I can convince him to arrange some funding
for this by the WHO. Dr Don Watson , President
of the World Heart Foundation, will be there as
well, and he will also be seeking funding with
the WHO.. In the meantime, Dr Cox has arranged
for us, and other organizations concerned with
Heart Disease in the Developing Nation of the
world, to meet with a representative of the
World Bank, in Washington D.C. to seek financial
assistance from the World Bank. We may not need
a lot of money, but we will need some to get
started.
Of course I will be available on Nov 4-6th. No
matter what, I will make myself available to
help in any way I can. I would be pleased to
suggest some other people you might find
helpful. I admire your persistence of your
thoughtfulness in arranging this initial
meeting, and I truly hope it will be successful.
Please let me know what I can do to be of
assistance.
Best
wishes, Bob Replogle".
Belgrade, 04. December
2006
Dr Mladen J. Kočica
SSCVS Secretary
General
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