Edoardo De Robertis,
President, European Board and Section of Anaesthesiology,
Stefan De Hert,
President European Society of Anaesthesiology,
Patients expect their doctors to be fully competent from diagnosis to management of practical procedures, expect them to behave in a caring and humanistic way, and in addition increasingly want to become involved in the decision making. Training to a specialization in medicine is a learning and educational process, during which medical trainee specialists develop the ability to independently provide optimum health care in their area of expertise.
Anaesthesiology is a medical specialty that has developed from a specialty with responsibilities for intraoperative anaesthesia to a specialty with key responsibilities in pre-, per-, and post-anaesthesia care, and in addition stabilizing/sustaining vital functions in different settings.1,2
The Helsinki Declaration on Patient Safety in Anaesthesiology, jointly launched in 2010 by the European Board of Anaesthesiology (EBA) of the Union Européenne des Médecins Spécialistes (UEMS) and the European Society of Anaesthesiology (ESA),3states that Anaesthesiology shares responsibility for quality and safety in Anaesthesia, Intensive Care, Emergency Medicine and Pain Medicine, including the whole perioperative process and also in many other situations inside and outside the hospital where patients are at their most vulnerable.
The designation used in the EU since the directive 2005/36/EC is “Anaesthesia”, but the above description better reflects today’s training requirements in the speciality of anaesthesiology. This means that the skill set and knowledge required for the provision of a safe and effective anaesthesia are very high.
Over the last decade the training in anaesthesia has substantially changed and the training period in EU countries increased.An audit performed on 24-26 November 2018 among the national delegates to the European Board/Section of Anaesthesiology of the UEMS shows the actual situation in the EU (Table 1).
Table 1. Length of training in Anaesthesiology in the EU. Audit performed on 24-26 November 2018 among the national delegates to the European Board/Section of Anaesthesiology of the UEMS.
In most European countries, the current minimum duration of training in Anaesthesiology is five years. The main reason for this is the changed scope of training, well-defined in the modernised EU Directive on Professional Qualifications approved by the EU Parliament on 9 October 2013.
Key elements of the EU directive 2013 are: a)a training that shall be competency based but with minimum duration defined; b) a European professional card; c) alert mechanism set up for all professions with patient safety implications; d) possibility of setting up “common training frameworks” and “common training tests”, aimed at offering a new avenue for automatic recognition; e) continuous professional development (update of knowledge, skills, and competences).
The UEMS has always strongly supported the concept that the quality of medical care and expertise is directly linked to the quality of training provided to the medical professionals. Accordingly, great emphasis has been given to the improvement of medical training at the European level through the development of European Standards in the different medical disciplines.
Consequently, the European Board of Anaesthesiology (EBA) of the UEMS and the European Society of Anaesthesiology (ESA) have made every effort to point out the need for increasing the minimum duration of training in modern Anaesthesiology to five years. Interestingly, several European countries have even added an extra year/s of training to ensure sufficient coverage in intensive care or other anaesthesia-related sub-specializations.
The European Training Requirements in Anaesthesiology document (ETR)4has recently been licensed by the European Board of Anaesthesiology (EBA) and approved in April 2018 by the UEMS Council.
In this official European document, it is clearly stated that the practice of Anaesthesiology has significantly changed towards more extended competencies in the perioperative period, in intensive care medicine, critical emergency medicine, and pain medicine, which in many countries are integrated parts of the clinical specialty. Thus, training requires new generic competencies and common principles to be defined for the European anaesthesiology specialist.
The traditional assumption that all residents progress more or less similarly at developing proficiency in the specialty is no longer universally accepted and the length of education is today less and less considered in favour of a more visible demonstration of knowledge, skills, and behaviour attainment. Several countries have already started pure competence-based training programmes. Others will eventually follow. Nevertheless, we are convinced that the process of training, attaining defined competencies in all aspects of the specialization of anaesthesiology and applying these principles safely and efficiently in clinical practice requires at least 5 years so that trainees can mature and develop sufficiently to safely treat their patients independently. Accordingly, the ETR in Anaesthesiology states that the minimum training duration is 5 years, of which at least 1 year is to be spent at an intensive care unit. The ETR in Anaesthesiology states also that high quality training can only be provided in high quality training centres.
The goals of the ETR in Anaesthesiology are not only to cultivate residents who progressively acquire competences, but also to offer the foundation for a life-long learning, which will allow the professional anaesthesiologists to adapt to the diverse and ever-changing healthcare systems.
In this respect several tools will enrich and ample the professional life of the European anaesthesiologist:
- the European Diploma (EDAIC®), based on the ETR, will offer the certification of a uniformly high European standard of knowledge in anaesthesiology and an excellent tool for learning and validation for those outside of Europe.
- The Fellowship of the European Board of Anaesthesiology (FEBA), under definition, an accolade of excellence in Anaesthesiology, will be a mark of achievement and expertise as a doctor, recognising an ongoing influence to the profession, and contributing to the improvement of the individual quality of anaesthesiologists.
- Multiple courses and masterclasses for continuous medical education are provided by ESA, as well as the annual Euroanaesthesia Congress and Focus meeting.
The European Board of Anaesthesiology and the European Society of Anaesthesiology are strongly committed to the formation of the best competent European Anaesthesiologist who is committed to a professional life-long sentence of a never-ending learning.
- Egger Halbeis CB, Cvachovec K, Scherpereel P, Mellin-Olsen J, Drobnik L, Sondore A. Eur J Anaesthesiol2007;24(12):991-1007.
- De Robertis E, McAdoo J, Pagni R, Knape JT. Eur J Anaesthesiol2007;24(12):987-90.
- Mellin-Olsen J, Staender S. The Helsinki. Curr Opin Anaesthesiol2014;27(6):630-4.