EBCOG guidelines in Ob/Gyn-training or How does EBCOG promote post- graduate training in Ob/Gyn ? Rolf Kirschner Dept of Gynaecology, Women and Childrens´ Division Oslo University Hospital Secretary General, EBCOG

The aims and objectives of EBCOG are to improve the health of women and their babies by seeking to achieve the highest possible standards of training and care in the field of obstetrics and gynaecology in all European countries. EBCOG is the Board of the Section of Gynaecology and Obstetrics of the Union Européenne des Médecins Specialistes (UEMS). As such, the functions of EBCOG are bound by the statutes of UEMS, by national regulations, and by the relevant European Economic Area directives Founded by the amalgamation of the European College of Obstetrics and Gynaecology (ECOG) and the European Board of the UEMS Section of Ob/Gyn (EBGO)

The objectives shall be achieved as follows: The aims and objectives of EBCOG are to improve the health of women and their babies by seeking to achieve the highest possible standards of training and care in the field of obstetrics and gynaecology (referred to hereinafter as O & G) in all European countries Recommend the standards required for the training of specialists and the means of maintaining those standards Examine the content and quality of training in all countries of Europe Recommend the criteria to which the specialist training centers should conform. Make proposals for unifying the training programs to achieve specialist status Ensure that knowledge and skills of specialist obstetricians and gynaecologists are maintained and updated at regular intervals. Develop, with the sub-specialties in O & G, a system to assess and recognize the quality of training and practice. Promote research relevant to the health of women and their babies. Facilitate the exchange of specialist trainees between training centers throughout Europe to harmonise and improve the quality of training.

EBCOG shall have the following bodies:· The Council which is the governing body of EBCOG. The Executive Committee which is the administrative body of EBCOG. The General Assembly which is the advisory body of EBCOG. Any European country is entitled to membership of EBCOG providing the requirements laid down in the Constitution and By Laws are fulfilled. The Council of EBCOG shall comprise two delegates from each member- country. One delegate will be nominated by the National Scientific Society or Universities; the other will be one of the two national delegates to the Section, from the Professional Society. The mandates of all delegates must be endorsed by the National Medical Association which is recognized by UEMS

SCTA: Standing Committee on Training and Assessment (SCTA) Log book/ curriculum SCTR: Standing Committee on Trainng Recognition (SCTR) Hospital visitation/ dept accreditation SCTTT/V: Standing Committee on Training the Trainers/Visitors Training educational trainers/supervisors/hosptal visitors SC e-L: Standing Committee on e-learning Registration and structuring e-learning methods SCMS: Standing Committee on Medical Standards Elaborating European treatment standards CCME-CPD: Committee on Continuing Medical Education/Professional development Elaborating European Standards for post-specialization learning EBCOG Simulation Consortium Four recognized subespecialties EAPM (Perinatal); ESHRE (Reproduction); EUGA (Uro-gynaecology); ESGO (Oncology). Societies of Areas of Special Interest Colposcopy, Endocrinology, Infection, Contraception, Sexology, Psychosocial. Pain….. Collaboration with European Network of Trainees in Obstetrics and Gynaecology (ENTOG) Visitation and exchange European Congress of Obstetrics and Gynaecology Management-/scientific- and local committees. FIGO Observer status/ official representative of European ObGyn

NAAs ECAMSQ Section Board European Individual Certification : How does it Work ? ECAMSQ: European Council for Accreditation of Medical Specialist Qualifications NAAs: National Accreditation Authorities

Universities Scientific Societies Teaching Hospitals Others EACCME (Sections & Boards) + NAAs Education Accreditation Individual Certification ECAMSQ (Sections & Boards) + NAAs EACCME: European Accreditation Council for Continuing Medical Education European Education Quality Policy

Eurolingo: Harmonisation = Sharing of Competency

UEMS: Article III. Objectives UEMS aims for the following international non profit-making objectives: - The study, promotion and harmonisation of the highest level of training of the medical specialists, medical practice and health care within the European Union; Summary: Undergraduate 5 years average, Exam/Assessment Specialist Training 5 years average, Exam/Assessment Professional Life Lifelong, Formal Requirements

UEMS: CHARTER on TRAINING of MEDICAL SPECIALISTS in the EUROPEAN COMMUNITY Charter adopted by the Management Council of the UEMS, October 1993 ” with an aim to set the basis for high quality medical training. This charter outlines the guiding principles for high level Medical Training and provides the essential criteria for medical training programs”. UEMS 2003 / 49 FINAL PROMOTING GOOD MEDICAL CARE ECAMSQ: The aim of this body is to address this issue through establishing a comprehensive mechanism of appraisal of knowledge, skills and professionalism of post- graduate medical trainees according to the highest standards of medical training in Europe. With a view to assess the competence of European medical specialists according to these high standards of medical training Background information: UEMS 2006 / 18 FINAL BUDAPEST DECLARATION on ENSURING THE QUALITY OF MEDICAL CARE

SCTA: Standing Committee on Training and Assessment (SCTA) Log book/ curriculum RECOMMENDATIONS FOR POSTGRADUATE TRAINING AND ASSESSMENT IN OBSTETRICS AND GYNAECOLOGY MISSION RECOMMENDATIONS EDUCATIONAL OBJECTIVES OF TRAINING IN OBSTETRICS AND GYNAECOLOGY ORGANISATION OF TRAINING SUMMARY Trainees must have an adequately remunerated hospital post and participate in all activities of the training department. The number of training posts should reflect the country's need for specialists as well as the country's capacity to train. The minimum duration of postgraduate training in Obstetrics and Gynaecology is five years, at least four of which must be spent in a department of Obstetrics and Gynaecology. It is recommended that part of the training should take place in another European country. A specialist qualification should be granted at the end of training after an assessment of the trainee's theoretical knowledge and practical skills. The training syllabus will be regularly updated by EBCOG (Standing Committee on training and Assessment). LOG BOOK

SCTR: Standing Committee on Training Recognition (SCTR) Hospital visitation/ dept accreditation Application for specialist training & visiting What are the objectives? What are the benefits? What is the focus of the Visit? Who conducts the Visit? Who pays for the Visit? How to apply for an EBCOG Visit? Questionnaire regarding specialist training. (HEAD OF DEPARTMENT) Questionnaire regarding specialist training. (TRAINEES)

SCTTT: Standing Committee on Training the Trainers Training educational trainers/supervisors Trainers are medical doctors who have usually not had any formal education in how to teach. In human affairs generally there is less progress than in technology. Training the Trainers courses (TTT) give trainers tools to deliver better adult education, something which was demanded by the European Network of Trainees in Obstetrics and Gynaecology (ENTOG) from the European Board and College of Obstetrics and Gynaecology (EBCOG). An RCOG course was organized for EBCOG trainers who then started to spread TTT courses within EBCOG countries. What are Training the Trainers (TTT) courses? TTT courses are interactive, with around 15 % of the time spent on lectures and 85 % of the time spent on discussion and feedback. The main topics are listed below. Basic adult medical education theory Giving proper feedback. Practical skills training in a four-step cognitive training method: Differences between assessment and appraisal are stressed.. “When training becomes fun for trainers and trainees”, available free online

SC e-L: Standing Committee on e-learning Registration and structuring e-learning methods UEMS 2011 / 20 The Accreditation of e-Learning Materials by the EACCME Modern medical education should be based on the best available tools. Developing new modalities to achieve appropriate educational goals is in the scope of medical faculties in Europe. One of these novel approaches is E-Learning. EBCOG founded a Working Group on E-Learning in E-Learning offers an additional tool for creating a virtual electronic network between individuals but not replacing human contact and clinical work. It enables the effective use of electronic learning materials as well as human interaction between trainees and trainers in Europe. E-Learning is an opportunity to form a bridge between basic and post-graduate medical training and continuing professional development in the medical community. Professionals in Obstetrics and Gynaecology can benefit from using electronic materials such as telecommunication with video cameras from lecture rooms to other hospitals and decentralised teaching units and health care centres. This technology opens up additional opportunities for distributing expertise and promoting new ways of human interaction in basic and post-graduate training locally, nationally and internationally. In many EBCOG member countries, E-Learning is already in active use. One of EBCOG’s E-Learning Working Group’s tasks is to collect the material available in Europe including teaching videos and teaching courses (e.g. colposcopy, ultrasound, prenatal counselling, pelvic floor diseases). The Working Group has proper technical assistance and appropriate solutions to support a well functioning E- learning section of the website which registered users can benefit from. This process has now started

SCMS: Standing Committee on Medical Standards Elaborating European treatment standards Why do we need standards of care in Europe? Paper prepared in January 2011 for a meeting with EU Parliamentarians in Brussels. Over the past decade, there has been an unprecedented emphasis on the quality of clinical care. This has involved three main stakeholders, namely consumers, healthcare providers, and commissioners. The consumers of healthcare expect a safe, effective and equitable service. A survey carried out by the Department of Health (DH) in England suggested that the public seems to perceive the inclusion of a quality framework to be important for good quality. Remit To review current evidence based published Standards of care in the member states of the European Union To develop agreed Standards for maternity care, from pre-pregnancy through to the post natal period including care of the newborn To develop agreed Standards of gynaecological care for benign and malignant conditions affecting the health of women

Collaboration with European Network of Trainees in Obstetrics and Gynaecology (ENTOG) Visitation and exchange 29 Countries Council Executive ENTOG Sessions at Congress EBCOG trainee fellowship ENTOG Yearly Exchange: The Exchange guidelines ENTOG annual meeting European Training Project ENTOG Delegate in Visitation and Accreditation

EBCOG Simulation Consortium Head: Professor Rudi Campo, Leuven, Executive Member President European Society of Gynaecological Endoscopy Endoscopy Colposcopy Ultrasound Imaging Obstetrics Etc… Simulation Corner at Congess

CCME-CPD: Committee on Continuing Medical Education/Professional development Elaborating European Standards for post-specialization learning European CME/CPD is needed for the accreditation of any CME/CPD-Event/Product in Medicine at the European level  Need for Harmonisation  European CME/CPD must be independent Need for an Independent Accreditor: EACCME

Four recognized subespecialties EAPM (Perinatal); ESHRE (Reproduction); EUGA (Uro-gynaecology); ESGO (Oncology). Council Executive. Sub- specialization Documents and Demands Sub- specialization Visitations and Accreditations Sub- specialization Sessions at Congresses Representations and sessions at Sub- specialization Congresses

Societies of Areas of Special Interest Colposcopy, Endocrinology, Infection, Contraception, Sexology, Psychosocial. Pain….. SCTA- representation MDJC-UEMS Multidisciplinary Joint Committees. Sessions at Congresses Simulation Consortium Exchange of Sessions/ EBCOG at Special-Interest Congresses

European Congress of Obstetrics and Gynaecology Management-/scientific- and local committees May 2014, HOT/ENTOG/Young Scientists/Practical Sessions/Symposia/Head Sessions

FIGO Observer status/ official representative of European ObGyn American College Congresses Trainee Exchange

Certification systems are already in place in many European countries. Some countries approach the implementation of a certification system Some specialties/subspecialties are already running European exams (without coordination and without a common framework). Europe is slowly striving towards obligatory certification and maybe even re- certification Free movement of MDs and patients within the EU, Pressure from national authorities, Health insurance companies etc. Economic squeeze in many countries Current Situation of European Certification

SO: How does EBCOG promote post-graduate training in Europe? ---by continously and structurally working with and towards national and international associations inside the EU/EEA to make possible good quality and life-long learning! Rolf Kirschner Dept of Gynaecology, Women and Childrens´ Division Oslo University Hospital Secretary General, EBCOG