January 24th is the International Day of Education, so it seemed fitting that EAP has decided to dedicate this month’s blog to the educational challenges of paediatric training across Europe.

the situation

UNESCO states “Education is a human right, a public good and a public responsibility”[1]. High standard education is particularly crucial for paediatric trainees as it has direct consequences on the health of children across Europe.

At the moment, different countries across Europe have different approaches to specialty postgraduate training: paediatric trainees’ pathways vary in:

• duration (e.g. 5 years in Italy and 8 years in UK);
• patient exposure (training in university hospitals only or mix of smaller hospital and university hospitals) and
• assessment modalities (e.g. oral VIVA only, written tests, combination of written and clinical examinations etc).

This is mainly due to historical reasons related to different national health service setups, and the variable connections existing between the health service and postgraduate education. For instance, in some countries postgraduate training is organised by Universities and attracts a bursary; while in others hospitals are directly in charge, with direct contracts of employment.

At the same time, the equivalence of specialist titles in Europe is a crucial factor in reducing barriers to freedom of movement, and facilitating exchanges, whilst protecting and promoting patient safety. As a result, there is a considerable effort to harmonise training across Europe, so that doctors are trained and assessed in a comparable manner.

What are we doing to harmonise paediatric training? The role of the european board of paediatrics

The UEMS (European Union of Medical Specialists) is a non-governmental organisation founded in 1958 which represents national associations of medical specialists at the European Level. UEMS works towards ensuring the highest level of training and improving the quality of care for the benefit of European citizens. Its areas of expertise include Continuing Medical Education, Post Graduate Training and Quality Assurance.

As the Paediatic Section of UEMS, the European Board of Paediatrics (EBP) is responsible for harmonising the quality and the content of training in all fields of medical paediatrics within the member states of the European Union (EU) and other European countries. It acts as a link between the UEMS and the EAP. Specifically, EBP cooperates with national professional authorities and scientific organisations in the process of standardisation of paediatric curricula. It is also responsible for setting standards for the assessment of training and of training centres. CESMA (Council of European Specialist Medical Assessment) is an advisory body of the UEMS which provides recommendations on the organisation of European examinations for medical specialists.

As part of this project aimed at harmonising training across Europe, EAP and EBP have designed a training model composed of a period of core training (‘Common Trunk’), to be followed by a further period of sub-specialty training aimed at giving specific competences to doctors who may then become primary care paediatricians, acute paediatricians working in hospitals or subspecialists. The training requirements for core training and for many of the subspecialties have been developed with specialist groups, and been approved by UEMS.

Following the agreement on the content of core training, the need for a knowledge based examination for European paediatricians emerged and the European Board of Paediatrics Examination (EBPE) was developed. For the first time this year, trainees and paediatricians will have the opportunity to sit the exam during the October EAPS 2020 meeting in Barcelona. The EBPE is an assessment of the theoretical knowledge of paediatrics expected at core training level. Successful candidates will receive a certificate demonstrating they reached a level to satisfy the UEMS core paediatrics training curriculum knowledge.

Applications are open to:

• trainees who are in a recognised training institute, whether within Europe or elsewhere;
• paediatricians post-training interested in assessing their knowledge, and
• practitioners in primary care who have an interest in paediatrics.

Our recommendations

It is worth noting that the EBPE is not intended to assess the completion of paediatric training. Firstly, because it tests knowledge expected at core training level only, and secondly because knowledge is only one component of the broader assessment.  For the completion of training, EAP strongly supports the need for concurrent clinical skills and competency-based assessments (better evaluated with a clinical examination) and logbooks (to demonstrate volume of experience). However, those additional assessments are usually better arranged within countries, and conducted in the native language of the trainees. At this stage, the EAP is looking to provide a high-quality knowledge based exam, although the possibility of future clinical examinations remains the ambition.

European recommendations provide a harmonised platform for training evaluation, however they are not binding and each country is left to assess competency independently. Nevertheless, the EBPE will be valuable evidence of a level of training recognised across Europe. In the last 40 years, more than 30 specialties have developed European exams, such as European Diploma of Anaesthesiology, and the European Board of Paediatric Surgery; and Paediatrics will soon join them. CESMA has been involved in the exam from its inception, and their approval of the exam will likely happen in the next few years.

We believe the EBPE will quickly become popular and recognised worldwide as an effective assessment of paediatrics core knowledge. Together with other European initiatives, we hope the new paediatric exam will significantly contribute to the harmonisation of paediatric postgraduate training across Europe, facilitating exchanges and movement of trainees and fully qualified paediatricians whilst promoting high standards of knowledge.

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 References

[1] https://en.unesco.org/commemorations/educationday

About the authors

Francesca Seregni is a Young EAP representative and a Paediatric Registrar based in East of England, UK.

Sian Copley represents UK paediatric trainees within Young EAP, and is the Young EAP Representative for Advocacy. She is a 5th year resident from the UK working in the North East of England.

Robert Ross Russell is the chair of the European Board of Paediatrics and a member of the Executive Committee of the European Academy of Paediatrics. He is a Consultant Paediatrician at Cambridge University Hospitals Foundation Trust in the UK.