TRAINING IN SURGERY IN GREECE George N Zografos Consultant Surgeon, Athens General Hospital General Secretary Hellenic Surgical Association National Delegate, UEMS Division of General Surgery
STATISTICAL DATA Panhellenic Medical Association Panhellenic Association NHS Nursing staff Greek Statistics Authority ( statistics.gr)
64.003 Doctors ( 38.508 male, 25.495 female) 2.208 Surgeons 1125 Surgeons in Athens - Peireus 1.143 Members of the Hellenic Surgical Society
NATIONAL HEALTH SYSTEM 15.407 Doctors 3.161 Consultants 845 Chairman 2.183 Staff Grade A 1846 Staff Grade B 31.567 Nursing staff
141 National Hospitals, Infirmary( 30.400 beds) 169 Private Clinics, Infirmary (15.587 beds) 314 Total National + Private Clinics, Infirmary 483 beds / 100.000 habitants 251 Hospital Doctors/ 100.000 habitants 440 Nursing Staff / 100.000 habitants Greek Statistics Authority
CENTRAL STATE CONTROL OF SURGICAL TRAINING Ministry of Health Central Committee of Health ( KESY)
36 Basic Medical Specialties Surgery, Vascular Surgery, Hematology, Radiology, Allergiology, Anesthesiology, Internal Medicine, Gastroenterology, genetics, General Medicine, Maxillofacial surgery, Dermatology, Endocrinology, Social medicine, Public Health, Cardiology, Cytology, Gynecology Obstetrics, Neurosurgery, Nephrology, Orthopaedics & Traumatiology, Urology, Ophthalmology, Pathology, Psychiatry, Paediatrics, Paediatric Psychiatry, Plastic surgery, Pneumonology, Nuclear Medicine, Reumatology, Rehabilitation medicine, Thoracic surgery, Paediatric surgery, ENT, Forensic medicine.
6 Years DURATION OF TRAINING IN SURGERY 5 Years General Surgery Two 6-month period in other surgical specialties: Gynecology, Vascular surgery, Urology, Neurosurgery, Orthopaedics, Plastic surgery, ENT, Pediatric surgery
SURGICAL TRAINING IN GREECE Application at a District State office and transmission to the Hospital and Ministry of Health Waiting list in chronological order ( 1-2 years in General Surgery) Only National Health System Hospitals ( + University Hospitals) can offer surgical training Large Hospitals usually cover the whole 6-year training period District and Military Hospitals cover 1-3 years
Choice of the Hospital from the trainee Usually the training is completed for all the 6 years in the same Hospital The trainee can select to start with low volume Hospitals and cover the initial 1-3 years ( District Hospitals, Military Hospitals) There is a fixed number of trainees per hospital ( 1/3-4 beds)
SPECIAL SUPERNUMERARY CATEGORIES Military doctors Doctors with severe chronic diseases Overseas doctors sponsored by their own countries
DURING THE TRAINING A Number of surgical procedures ( perform/assist) Spectrum of procedures Surgical research, Medical thesis Visiting clinician overseas Postgraduate courses Chairman/ Staff surgeons of the Department of Surgery Chairman sign a testimonial in order to apply for the exam
DURING THE TRAINING Hands on courses, Congresses, Meetings, Medical knowledge courses Hellenic Surgical Society, Other smaller societies (Endocrine, breast, colon, HPB etc) International societies University Departments National Health System Departments Private Clinics Departments Support from Pharmaceutic/ medical supplies companies
FINAL CENTRAL EXAM Three Examiners ( 1 from the University, 2 from the NHS - determined by Ministry of Health) MCQs & Oral exam the following day Success rate 70-80 % Possibility up to 3 attempts Further failure repeat 6 months training in another hospital and new final exam
SPECIAL ISSUES IN SURGICAL TRAINING IN GREECE Full Training Hospitals are not of equal volume and spectrum Departments within Hospitals or same Hospital are not equal and the level of training varies Absence of national principles/guidelines for training Rotation of trainees is not legislated Medical research is not encouraged in all Hospitals Log book kept on volunteer basis Failed trainees can not be removed
SPECIAL ISSUES IN SURGICAL TRAINING IN GREECE There is no Hospital/ Department evaluation (quality control) There is no surgical trainee evaluation There are no criteria for selection of trainees at the stage of program entrance Endoscopy is not included in the surgical training A number of high quality trainees do not wait at the list of the Ministry of Health and enter residency programs abroad ( U.K, USA, Germany, Sweden, France, Switzerland)
SPECIAL ISSUES IN SURGICAL TRAINING IN GREECE Several attempts to establish panhellenic entrance exams to commence specialty training Severe reaction from Athens Medical Association and student unions - syndicalism Repeat hesitation from the Governements to establish criteria for training commencement and transfer competence/responsibilities to the Hellenic Surgical Society
THE ROLE OF EUROPEAN AND US HOSPITALS Significant number of young surgeons/trainees go overseas after the final exam or during the training ( UK, USA, Germany, France) To enrich surgical training of Greek doctors During After basic training
There is no official involvement of the Hellenic Surgical Society in the surgical training and exams in Greece
PROPOSALS OF THE HELLENIC SURGICAL SOCIETY
SUBJECT OF TRAINING Theoretical backround and practical training of the resident on basic rules of surgical science and diagnosis & treatment of several diseases, malformations, trauma of human organs as well as the technique of various surgical procedures
CONTENT OF GENERAL SURGERY Oesophagus Stomach Small bowel, Large bowel, Anus Head & Neck, Endocrine surgery Thorax, Vascular Liver, Biliary tract, Pancreas, Spleen Breast Uterus, ovaries, kidney Abdominal wall Skin, soft tissue
TRAINING INCLUDES PROCEDURES ON: Retroperitoneum, pelvis Various diseases of other organs Trauma Laparoscopic/Robotic surgery
Selection criteria for entering the residency program in Surgery Panhellenic exams / chronological list
Training program in Surgery only in eligible Hospitals Responsible for trainees tutor in cooperation with the chairman of the Department Training classified as basic and advanced, 3 years each Number of procedures: 400-750 ( minor, moderate, major) as a surgeon Double the number for 1 st /2 nd assistance
BASIC Medical knowledge ADVANCED Medical knowledge Minor, moderate procedures Major procedures Basic laparoscopic procedures Advanced laparoscopic procedures
Responsible for trainees at least at the level of staff grade A, or associate professor In cooperation with the team evaluation of the trainee every year a) medical knowledge- multiple choice questions b) skill evaluation c) attitude d) communication with the medical nursing staff
LOG BOOK Subject of training per year Number, spectrum, category of surgical procedures ( dates, initials, Hospital number, exact operation)
REPORT AT THE END OF THE BASIC 3 YEARS Conducted by chairman/tutor Training centres Scoring at the annual evaluation Number, spectrum of procedures Obligatory participation at the postgraduate courses of the Hellenic Surgical Society Total score Entrance to the exam
REPORT EXAM AT THE END OF THE ADVANCED 3 YEARS Conducted by chairman/tutor Training centre Scoring at the annual evaluation Number, spectrum of procedures Obligatory participation at the postgraduate courses of the Hellenic Surgical Society Total score Entrance to the exam
FINAL EXAM Multiple choice questions ( 150-200) Short written elucidation on current knowledge, topics, clinical scenario, innovation Oral exam
3 Surgeons Committee of examiners Professor/Chairman NHS, Assoc. Professor/ Consultant Surgeon The list of examiners is proposed exclusively by the Hellenic Surgical Society vs The society decides for 1 of the 3 examiners The Board changes synthesis every 2 years Exam centre are large hospitals with significant number of trainees
TRAINING CENTRES - ELIGIBILITY General, or University or Prefecture* Hospitals Fully equiped laboratories Departmnent of Orthopaedics, Urology, Gynecology, ENT, Ophthalmology, Endoscopy Unit Intensive care Unit Admit emergencies 100-150 surgical procedures under G.A. per trainee ( including surgical oncology) Systematic training program *administrative area/county
CONTRIBUTION OF THE HELLENIC SURGICAL SOCIETY To improve standards of surgical training in Greece Achieve homogeneity of training in General Surgery in Europe