Background Free circulation of medical specialists within the European Union was approved under the Treaty of Rome in 1993. To maintain standard of care and support easy flow of medical specialists across the European Union, harmonization of training is essential. Although differences in training across countries are subjectively perceived, attempts at assessing their scope have been few.
Objectives The aim of this study was to analyse similarities and discrepancies in the rheumatology training across Europe.
Methods Three European countries – United Kingdom (UK), Portugal (POR) and Spain (ESP) - were invited to participate in this pilot study. A pre-designed data extraction questionnaire was devised to analyse the following domains: General structure of training (duration, internal medicine training, training in other specialties, research opportunities) Clinical syllabus and Assessments of competences. Results were subsequently analysed using a Microsoft EXCEL spreadsheet with ranking.
Results Each country had an approved written curriculum: UK 2010, ESP 2009 and POR 1992. The Portuguese curriculum was under review. The minimum period of time from graduation until the beginning of specialist training differed in all three countries (UK >4 years, POR 1-2 years, ESP <1 year). Length of specialist rheumatology training was between 4-5 years for all three countries. Training in internal medicine for UK trainees was a minimum of 2 years, whilst POR and ESP were between 1-2 years. Opportunities for research in ESP and POR were not defined within the curricula; the UK curriculum stated opportunities for research but no specific time period was defined. Mandatory training in orthopedics and rehabilitation medicine was present in the POR curriculum, whereas optional training was noted in ESP. UK trainees had no training opportunities in these specialties. The clinical syllabus for rheumatology was similar across all three countries with the UK curriculum being the most descriptive. A major difference between curricula were generic competences, such as leadership, team working and time management, which were present within the UK curriculum, but had only a limited value, if any, in the curricula from POR and ESP. To complete specialist training, a mandatory written theoretical examination was required in UK and an oral theoretical and practical exam in POR. All three countries undertook an evaluation of the general and clinical curriculum achieved by the trainee in addition to complete specialist training. Teaching observation and assessment by a patient were noted for certification of rheumatology in the UK curriculum but were not present in the other curricula.
Conclusions This study highlights the wide variations in training between national European curricula. The UK curriculum appeared the most comprehensive in generic and specialty-specific skills. Interestingly despite longer training for UK trainees, there was less exposure to related specialties. These differences identified warrant more clarification; the next step will be to directly inquire trainees to gain insight into training opportunities and delivery of the official curriculum. Afterwards, the project will be expanded to all European countries.
Disclosure of Interest None Declared
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