Elisabeth Van Gessel | MD – MER, Chair of HVTAP Joint ESA-EBA Committee
In 2015, during Euroanaethesia, a symposium of the Hospital Visiting and Training Accreditation Programme (HVTAP) took place entitled “Incentives and Outcomes of the European Accreditation.”
Apart from a very lively symposium, we discovered that for each of the speakers present, representing head of departments, training directors, and trainees, there was something to be said about what a European accreditation can bring.
We are all aware now that in a majority of countries, a national accreditation programme already exists and has legislative power in allowing or not an anaesthesiology department to become a training centre for the specialty. While complying with many rules and regulations related to training conditions, or hierarchical responsibilities, the existence of procedures etc….what does a European accreditation visit add to this national regulatory visit?
We asked each speaker to give his/her point of view on the subject and present the few changes, for good or bad, which took place after the HVTAP onsite visit. Three centres recently audited accepted this challenge and here is their feed-back, with a small historical introduction from an Alumnus of our Committee.
A short historical introduction to the HVTAP
Iurie Acalovschi | Cluj-Napoca, Romania
Initially named the Hospital Visiting Programme (HVP), it was one of the three main educational priorities of the European Academy of Anaesthesiology (EAA) after its foundation in 1978. Following the introduction of the European Diploma in Anaesthesiology and Intensive Care, and the publication of the European Journal of Anaesthesiology, the HVP was launched in 1989.
The aim of the programme was to develop a system of educational recognition of the training departments in Europe, to improve the quality of education and to harmonize the training in anaesthesiology throughout Europe. Up to 1996, the visits were organized at the request of the training departments. After receiving an application form, a team of two senior members of the EAA performed the evaluation of the quality of training and a report was issued. Based on this report, either an Accreditation Certificate was released when the criteria were fulfilled, or a Letter of Guidance was sent suggesting improvements. During that period, a number of 28 Teaching Departments were visited and accredited.
Starting with 1996, a Joint Permanent Committee of EAA and EBA-UEMS section of Anaesthesia was established to organize the HVP. The HVP Committee selected the EAA and EBA visitors and a third member of the visitation team from the visited country. Between 1996 and 2001, 17 more departments were accredited. Among them, 5 departments were located in Central and Eastern Europe: Ljubljana and Cluj-Napoca 1996, Poznan 1997, Pecs and Riga 1999.
The accreditation process had an important impact on these centres: the centres obtained the statute to organize Part I (MCQ) EDA examination, became organizers of FEEA courses at a national level and were able to obtain grants from the Hypnos Foundation. Their position and authority in the University and Hospital improved considerably.
In 2004, the amalgamation process of the three European anaesthesia organizations was initiated and two years later, the New ESA was born. During that period of time, the HVP was inactive for various reasons.
The new programme, under the name of Hospital Visiting and Training Accreditation Programme (HVTAP) was re-launched in November 2007. A new Joint Committee, representing the New ESA and the EBA was elected, with Professor Lennart Christiansson as Chairman.
Consequences of accreditation for the status of the centre: the point of view from a director
Humberto Machado | MD MSc PhD
Anaesthesiology Department – Centro Hospitalar do Porto, Portugal
Leadership is a relationship between leader and the ones that are led. All relations need to be cherished and appraised. To lead means we must give in order to collect, and do this as often as it is possible in a department, a hospital or any other place where people constitute the core of our vision.
An anaesthesiology department is commonly one of the biggest departments in a hospital regarding the number of doctors and other health professionals. This means that there is a special need for stimulation, risk assumption and support, in order to strengthen the team feeling and culture. These are the essential types of fuel a director must add to be able to have a constant flame that nowadays only burns very briefly out of a leadership by example or by an excellent job done.
The joint European Society and European Board of Anaesthesiology (EBA-ESA) Hospital Visitation and Training Accreditation Programmeme (HVTAP) is an extremely powerful tool that allows an almost direct result on the key features that are needed for an anaesthesiology department to stay alive and kicking. This project of having an accreditation visit gathers anaesthesiology specialists and residents for a common task and responsibility that must be encouraged by the head of the department as well as supported. Very important is that the head of the department calls it his or her “project for the department”. Training and teaching young doctors has been a very dear and challenging task for older doctors, and this should be availed and stimulated. HVTAP promotes all these aspects.
Pre audit negative feelings in the department are natural and expected as any audit process impels people to the fear of evaluation. To highlight what the department performs and is accountable for is the key feature to induce a calm environment. A department already committed to teaching and training in anaesthesiology, and knowing what is needed to obtain the accreditation from HVTAP, can be used as a benchmark by other anaesthesiology departments; thus, a network of centres of excellence, having a common language, would allow useful comparisons of what is actually happening regarding training in anaesthesiology.
The consequences of HVTAP accreditation in an anaesthesiology department are unbelievable. Increasing number of PhD students in the department, increasing number of publications, recognition from other national anaesthesiology departments, hospital recognition, increasing the place and rank of the institution within the national specialty are among the first benefits in our department. Besides this new trend, a good intangible set of feelings were also observed with the accreditation, namely, the emotion of belonging to a strong team, the consciousness of the department’s strength when facing a challenge, and above all the possibility for the department doctors to accept and to accomplish tasks way beyond their basic contracted clinical responsibilities.
As director of one of the largest anaesthesiology departments among the Portuguese university hospitals (76 anaesthesiologists and 31 residents), my words may resume to, HVTAP go for it!
Tutors’ changed perspectives after the HVTAP accreditation
Anders Enskog | Sahlgrenska University Hospital Anaesthesia Department, Gothenburg.
Sahlgrenska University Hospital, located on the west coast of Sweden, has 55 residents and 180 tutors/specialists. We are one out of seven university hospitals and the second largest education center in Sweden. Our hospital does all medical and surgical interventions including trauma and transplantations. Three different hospitals in Gothenburg create this University hospital.
During the 5 years of training to become a specialist in anesthesia and intensive care the residents rotate between the 3 hospitals.
In Sweden we have a national site visit every 5th year to evaluate the standard of education in the hospital. After the last review 2012 we felt confident enough to compare us with the rest of Europe. The HVTAP audit took place in May 2013.
The regulatory Swedish site visit, where we performed very well, did not get very much interest from our tutors. The result of the European assessment, on the other hand, has caught much attention among tutors both in our department and in the hospital. The result can be summarized as
- Pride – we are good!
- Reputation both in Sweden and “in hospital”
- Increased interest in education
- Increase attention and awareness of tutorship
- Easier to push ahead and develop educational questions
- We want to be better!
This has resulted in the implementation of feedback to our tutors from residents and the use of SETQ Smart (System for Evaluation of Teaching Qualities Standardizing Measurements in Anaesthesiology Residency Training).
We think of the result as a “Circle of success” (fig 1.)
Figure 1: the Circle of Success
HTVAP and the anaesthesia training programme in Utrecht
Dr. Marloes Otterman, Anaesthesiology | University Medical Centre Utrecht, the Netherlands
The EBA/ESA Hospital Training Visitation and Accreditation Programmeme is an important European quality tool, for evaluating and appraising resident training programmemes of individual hospital training institutions. The programme aims to guarantee the conditions for the minimal European Training guidelines in Anaesthesia, thus allowing the exchange of trainees between the various accredited training institutions in Europe. The programme also serves to provide the training institution with suggestions to further improve the quality of the individual training programmeme.
NATIONAL TRAINING ACCREDITATION
In the Netherlands we have a long tradition of national training accreditation visits for residency training programmes, which are implemented by the scientific society of medicals specialists. Our training institution for anaesthesiology of the University Medical Centre Utrecht, as all training programmes of all medical specialties, is visited at least every five years by an independent visitation committee. They inspect the clinical and training facilities. Using the high level national training requirements for the medial specialty involved as a base, the committee summarizes their findings in a report. This report not only includes a go/no go decision for continuation of training but also a number of recommendations for further improvement of the quality of the training programme involved. It is the definite responsibility not only of the training programme director but also of the training staff and in particular of the residents to undertake activities to achieve these improvements in the period after the visit.
ROLE OF THE HOSPITAL GENERAL RESIDENT TRAINING COMMITTEE
Moreover, to support training programmes we have a General Resident Training Committee (GRTC) in our hospital. In order to prevent improvement projects for the training programme to being just episodic, incidental and short-term processes, which happen only directly following a five year accreditation visit, the GRTC offers short inspection rounds of the training programmes 20 and 45 months following the national accreditation visit. Midway the five year national visitation programme a formal audit of the training programme is done.
Each of these visitations, inspections and audits are part of our continuing quality improvement cycle and provides the training team (director, staff AND residents) with new input to continuously work on quality improvement of the training programme.
EUROPEAN TRAINING ACCREDITATION
Our training institution was visited and accredited by the HTVAP Committee in 2011. We proudly presented the visitors our training programme and our continuing quality improvement cycle of which their visit was part.
Although the visitors appreciated our highly structured and comprehensive training programme and the priority given to education within our department, they nevertheless were able to provide us with some more suggestions for further improvement. These were to implement more context related learning (discussion at bedside, on clinical cases) and to give residents more autonomy in taking care of the more complex critically ill patients in the ICU; these suggestions were taken up immediately by GRTC and used to contribute to further improve the anaesthesia residency training programme.
The impact on the trainees’ situation in Porto
Dr. Blandina Gomes | Anaesthesiology Department – Centro Hospitalar do Porto, Portugal
The accreditation process in our hospital took place in 2013. By then, we were already a recognized centre for good practice and teaching of anaesthesia. However, going through this process initially raised some questions in the trainees’ minds: what does it mean to us? Will we be evaluated? What do we need to do? What will change for us?
Even though trainees are used to be regularly evaluated on their performance, this would be an external analysis of our department. But the whole process went smoothly and pleasantly.
The European accreditation was a key step for the consolidation of the already high standards of our training programme, namely the teaching sessions, research programmes, international presentations and involvement of our members in the European Society of Anaesthesia.
Today trainees in Portugal chose the department as their first choice for speciality training. Reasons are that trainees are involved in research projects, PhD programmes and department audits and protocols. Additionally, the department is now ready to receive trainees from the European Society of Anaesthesia Exchange Programme.
Two years later, we are proud to be the first Portuguese centre to achieve the Certificate of Accreditation of a European Centre for Training of Anaesthesiologists and happy to be part of a dynamic department.
A short conclusion
Dr. E. Van Gessel | MD – MER, chair of HVTAP Joint ESA-EBA Committee
On the whole, one can say that going through a European accreditation visit, implies receiving a quality feed-back on existing and usually well-structured training programmes. One could say there is always room for improvement!
Furthermore, having to prepare for this visit creates or enhances a team dynamics, a feeling of “belonging”, and major interest from tutors and residents alike. Being proud to show who we are and what we do!
Last but not least is the fact that this kind of appraisal can clearly enhance the academic level of a department and the development of relevant research and scientific programmes to the benefit of all, residents, tutors and academic staff.
Why don’t you go for it?