Enquête européenne – European poll (Sagalés, Stälberg, De Weerd & Cruccu, ) Clinical Neurophysiology (CN) training programs Subjects taught during CN training Timing of CN training Post-graduate training standards and protocols Belgium Croatia Denmark Finland France Germany Ireland Italy Luxemburg Netherlands Norway Poland Portugal Romania Spain Sweden United Kingdom

? Countries with ( ) or without ( )residence / internship in Clinical Neurophysiology

75% des pays enquêtés ont un programme d’enseignement complet en Neurophysiologie clinique (full CN program) 66% des pays ont un Diplôme National autorisant l’exercice de la Neurophysiologie clinique (CN National Board) Les pays délivrant un diplôme national ont en plus grande proportion des programmes d’enseignement complets (4 – 5 ans, type internat) enseignement complet (type internat) enseignement ponctuel / partiel Diplôme National Pas de diplôme National

In almost all CN programs, trainees expend some time of their training in Neurology The relative duration of time spent in Neurology and in CN gives rise to 3 types of training: type A: 25% Neurology, 75% CN (61% of countries) type B: 62.5% Neurology, 37.5% CN (5.5% of countries) type C: 92% Neurology, 8% CN (11% of countries) (note : responses obtained from 77.5% of countries only) Training in Neurology Training in CN 61% 5.5% 11%

Pays avec enseignement spécifique de NPC Pays avec enseignement de NPC intégré dans une autre spécialité

Specific examples 1- Italy The speciality of Clinical Neurophysiology exists as separate speciality since 1980, at least. The specific training (5 years) was revised according to the indications of European community 10 years ago. Nine Universities have School of Clinical Neurophysiology The access is possible after the training of basic medical school that is 1 year. Not necessary to be neurologist. Most of regional Italian hospitals have both neurological and clinical neurophysiologic services, each of them with a head. In the local hospitals the clinical neurophysiology is often a section of neurological service, without independent head. A clinical neurophysiologist cannot be head of a neurological service, vice- versa a neurologist can be head of both neurological and clinical neurophysiologic services (this condition may change in 2005).

Specific examples 2- Spain (similar: Sweden, Norway, Denmark) Clinical Neurophysiology exists as separate speciality since 1981 Specific training (4 years) was revised according to the indications of EC The access is possible after the training of medical school. Not necessary to be neurologist. Most of regional Spanish hospitals have both neurological and clinical neurophysiologic services, each of them with a head. In the local hospitals the clinical neurophysiology may a section of neurological service, without independent head. A clinical neurophysiologist cannot be head of a neurological service, and vice-versa a neurologist cannot be head of a clinical neurophysiologic services Clinical neurophysiology medical acts can be legally performed by certified clinical neurophysiologists, or under their supervision

Specific examples 3- United Kingdom Clinical Neurophysiology is a separate specialty Training in CNP in the UK consists of 2 years (usually) post qualification training in general medicine after which an exam must be passed (MRCP - Membership of the Royal College of Physicians) - this is an entry requirement for CNP training ! 4 years in a recognized training post in clinical Neurophysiology of which 1 year must be in Neurology There are approximately 70 full time Clinical Neurophysiologists in the UK A few Neurologists also do some CNP but usually in a specialised clinic (epilepsy or peripheral nerve disease) Similarly a few Clinical Neurophysioloigists also do a little Neurology, but in general the two specialites are separate.