ORTHOPAEDICS AND TRAUMATOLOGY DISCIPLINE IN ITALY HISTORY AND EVOLUTION 01

ITALY GEOGRAPHICAL CHALLENGES Inhabitants km2 - length of coastline 7600 km - Italy has a particular shape of a boot, much longer than it is wide. The heel is in the region of Puglia, while the toe in the region of Calabria, points towards the island of Sicily - Medicine doctors O (4.1 Inhabitants, second only to Greece 4.8) - Specialists in Orthopaedics and Traumatology: the members of the Italian Society of Orthopaedics and Traumatology are 4641; women only 204 (4.4%) 02

Since 1840 in Naples University First Course of Traumatology. Since the end of XV Century in Rome “Teaching of Chirurgia Istantanea” to-day is “Traumatology”. Since 1871/72 in the University“la Sapienza” in Rome Regular Courses of Traumatology Since 1885 in Naples University the First Chair of Orthopaedics hosted beside the Surgycal Clinic Since 1910 in The University “La Sapienza” in Rome the First Fusion of Orthopaedics and Traumatology DISCIPLINE HISTORY 03

1931 Bologna First School of Specialisation in Orthopaedics Three Years Length 1934/35 Rome First Teaching in Medical School of Orthopaedics and Traumatology of Motor Apparatus 1946 Rome One year after the end of the Second World War The First School of Specialisation in Orthopaedics and Traumatology of Motor Apparatus THE ORGANIZATION OF THE POST GRADUATE SPECIALISATION SCHOOLS: HISTORY AND EVOLUTION. I 04

THE ORGANIZATION OF THE POST GRADUATE SPECIALISATION SCHOOLS: HISTORY AND EVOLUTION. II 1982: THE LEGISLATIVE DECREE n.162, THAT RISED THE LENGTH FROM THREE TO FIVE YEARS FOR ALL THE SCHOOLS OF SPECIALISATION OF SURGICAL AREAS 1991: THE LEGISLATIVE DECREE n. 257, THAT INTRODUCED THE EDUCATIONAL GRANTS LASTING ALL OVER THE FIVE YEARS LENGTH. THE TRAINEES PROGRAMMED NUMBER. 05

IN YEAR 2000 THE MINISTRY OF EDUCATION CHARGED A “TEAMWORK“ OF FULL PROFESSOR SPECIALISTS IN THE VARIOUS SPECIALTIES FROM ALL THE UNIVERSITIES. THE FIRST ACTION FOR THE QUOTED “TEAMWORK“ WAS TO SOLVE THE PROBLEM TO REDUCE THE EXCESSIVE NUMBER OF SCHOOLS OF SPECIALISATION OF “MEDICAL AREA”. THIS WAS A BIG AND DELICATE PROBLEM, BUT FINALLY THE NEW NUMBER IS: 59 OF DIFFERENT TYPOLOGY. THE DIFFERENT TYPOLOGY SCHOOLS ARE GROUPED IN FOUR AREAS: MEDICAL - SURGICAL - DIAGNOSTIC SERVICES - PUBLIC MEDICINE 06 THE ORGANIZATION OF THE POST GRADUATE SPECIALISATION SCHOOLS: HISTORY AND EVOLUTION. III

IN YEAR 2005 THE MINISTERIAL “TEAMWORK“ OF FULL PROFESSORS OF THE DIFFERENT SPECIALTIES CONCLUDED THE ACTIVITY. THE REORGANIZATION OF THE SCHOOLS OF SPECIALISATION OF HEALTH AREA IS A REALITY. COMMON TRUNC, ACCURACY FOR PROFESSIONAL TRAINING, MULTIDISCIPLINAR APPROACH, MINIMAL REQUIREMENTS, ETC., ARE ACTUALLY ESTABILISCED BY LAW. THE NEW LAW DECRETS “1° M ” and “29 MARCH 2006” ACCORDING WITH U.E.M.S. GUIDE LINES. OUR PROPOSALS (PERUGIA, MAROTTI), WILL BE APPLIED AND OPERATING BY LAW SINCE NOVEMBER THE ORGANIZATION OF THE POST GRADUATE SPECIALISATION SCHOOLS: HISTORY AND EVOLUTION. IV

IN YEAR 2005 THE MINISTERIAL “TEAMWORK“ OF FULL PROFESSORS IN THE VARIOUS SPECIALTIES HAS CONCLUDED THE ACTIVITY, PRODUCING ALSO THE TEACHING ORGANISATION PART OF DIFFERENT SCHOOLS “ATTACH n°1” TO THE QUOTED NEW LAW DECRET “ ”. AT THE SAME TIME WITH A LIMITED NUMBER OF “TEAMWORK“ WAS NAMED “OBSERVATORY” AND WAS CHARGED TO POINT OUT THE “ATTACH n°2”: “ THE DEFINITION OF STANDARDS AND MINIMAL REQUIREMENTS OF DIFFERENT SCHOOLS OF SPECIALISATION”. THE M.I.U.R. “OBSERVATORY” IN JOINT TEAMWORK COLLABORATION WITH THE SIMILAR “OBSERVATORY” OF HEALTH MINISTRY WILL HAVE VERY IMPORTANT FUNCTIONS: A)TO CONTROL THE CORRECT APPLICATION OF THE STANDARDS OF THE SCHOOLS REORGANISATION. B)TO CHECK THE CORRECT RUNNING OF THE ORGANISATION AND OF THE LAW ENFORCEMENT. 08 THE ORGANIZATION OF THE POST GRADUATE SPECIALISATION SCHOOLS: HISTORY AND EVOLUTION. V

TORINO BRESCIA TORINO PISA PALERMO CATANIA BARI UDINE TRIESTE ANCONA PADOVA VERONA 2 Schools SIENA PAVIA CATANZARO CAGLIARI BOLOGNA MODENA FERRARA PARMA PERUGIA Firenze SASSARI GENOVA VARESE CHIETI Geographical distribution of the 35 Schools of Specialisation 09 ORTHOPAEDIC AND TRAUMATOLOGY

THE NUMBER OF THE TRAINEES IS ESTABLISHED YEARLY FOR EACH SCHOOL BY THE MINISTRY OF HEALTH IN COLLABORATION WITH THE MINISTRY OF EDUCATION, UNIVERSITY AND RESEARCH (M.I.U.R.), ACCORDING TO THE NEEDS IN DIFFERENT REGIONS. CHIEF OF THE SCHOOL: A FULL PROFESSOR OF THE UNIVERSITY IN THE SPECIALTY. AT PRESENT TIME FIVE YEARS: - ONE-TWO YEARS: COMMON TRUNC (FUNCTIONAL ANATOMY, PHISYOLOGY, GENERAL SURGERY, ETC.). - THREE-FOUR YEARS OF GENERAL ORTHOPAEDICS AND TRAUMATOLOGY:LECTURES,ACTIVITY IN SURGERY, ETC., ACCORDING WITH U.E.M.S. MINIMAL REQUIREMENTS. THE UNIVERSITIES MAY HAVE CONVENTIONS WITH OTHER REGIONAL HOSPITALS WHICH MUST HAVE THE MINIMAL REQUIREMENTS FOR TEACHING. 10 ACTUAL ORGANISATION OF SCHOOLS

MATRICULATION EXAMINATION. - ONE EXAME YEARLY - LOG-BOOK SIGNED CONTINOUSLY BY THE TUTOR AND COUNTERSIGNED BY THE CHIEF OF THE SCHOOL - FINAL THESIS WHICH COULD BE PROPOSED FOR PUBBLICATION. - RESEARCH IS PART OF THE TRAINING IN THE FUTURE, THE PROPOSAL IS SIX YEARS: DURING LAST YEAR COMPULSORY ATTENDANCE FOR A SUBSPECIALTY: HAND, ARTHROSCOPY, SPINE, PAEDIATRICS, ETC.). 11 ACTUAL ORGANISATION OF SCHOOLS

Genealogical Threes Of Two Most Important Orthopaedics Schools ROMA BOLOGNA Riccardo Dalla Vedova Alessandro Codivilla Perugia Marotti 12

S.O.I. “Societa’ Ortopedica Italiana” Founded on By laws – First Meeting Organisation of IV SICOT Congress 1936 Bologna - Roma Presidents: VITTORIO PUTTI and CARLO MARINO ZUCO The First Journals: “Archivio di Ortopedia” 1841 “Chirurgia Organi di Movimento” 1951 At Present: “Giornale Italiano di Ortopedia e Traumatologia” 1974 (Monticelli) “Journal of Orthopaedics and Traumatology” 2000 THE SCIENTIFIC SOCIETY HISTORY Foundation of the S.I.O.T SOCIETA’ ITALIANA di ORTOPEDIA E TRAUMATOLOGIA

14 NATIONAL SOCIETY S.I.O.T. Societa’ Italiana di Ortopedia e Traumatologia Regional Societies -S.E.R.T.O.T. Società Emiliana Romagnola Triveneta Ortopedia Traumatologia One-Two meeting yearly -S.P.L.L.O.T. Società Piemontese Ligure Lombarda di Ortopedia e Traumatologia One-Two meetings yearly -S.O.T.I.C Società Ortopedia T Traumatologia Italia Centrale One-Two meeting yearly -S.O.T.I.M.I. Società Ortopedia Traumatologia italia medridonale ed insulare Two meeting yearly EVERY SOCIETY HAS ITS OWN JOURNAL

NATIONAL SOCIETY S.I.O.T. Societa’ Italiana di Ortopedia e Traumatologia There are 25 Affiliates Sub-Specialties: Oncology; Pa ediatrics; Sport Traumatology; Knee and Arthroscopy; Shoulder; Spine;etc.. - One meeting yearly - Many of them have their own Journal etc, etc,. 15

ANSWERS TO THE LAST QUESTIONNAIRE THE SPECIALIST SHOULD HAVE: ABILITY To diagnose and treat osteporosis To diagnose and treat scoliosis in children To diagnose and treat with coservative means orthopaedic rheumatology To arrange for and interpret lab test To perform punction to get body fluids or other materials To perform indication and supervision of physical therapy To perform indication and control of orthopaedics aids (braces, etc.) To act as an orthopaedic expert witness To perform injections near spine (peridural, etc.) for diagnosis and therapy To perform trauma emergency management also coworking with others To perform operations in orthopaedics anb orthopaedic trauma To perform certain numbers of performed operations required (bone, joint, tendon) classified by degrees of difficulties 16

ANSWERS TO THE LAST QUESTIONNAIRE THE SPECIALIST DOES NOT NEED: NO ABILITY - Of certification to perform x-rays - To perform osteo-densitometry - To perform regional anesthesia but only local anesthesia - To perform getting central venous access, CPR etc. - To perform and control transfusions, infusions. To perform chirotherapy (chiropractics) NO ABILITY TO PERFORM BUT ABILITY TO INTERPRET - Sonographic examinations in orthopaedics - Sonographic examination in infant hips - Sonographic examination of trauma lesions (muscles, tendons, etc.) No possibility to get officially sub- specialties 17

Health Organisation in Italy At present there are four Organisation levels: - Ministry of Health - Regional Councils - Provincial Councils - City Councils The managemeny of this situation is really very complex and we hope that it will be modified and semplified by the the future Governement. 18

Health Organisation in Italy To day the Italian organisation is exactly the same of the Norwegians Hospital Reform. Hospitals are organised as enterprises and are no longer part of the public administration. The Hospitals are organised as separate areas of responsibility. The Hospitals are independent legal subjects with their own responsibility as employers. The Hospitals have an executive board and a general management. The Ministry of Health, represented by the Minister, is responsible for overall general management but there is extensive delegation to the underlying enterprises. The regional health enterprises have responsibility for ensuring the provision of health services to inhabitants in their geographical area. The Hospitals have more clearly defined roles and responsibilities as enterprises. The Are responsible for use of capital and for their own finances 19

20 Thank you