19-09-2015_Zografos G. Training in General Surgery in Greece.pdf

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.

DURATION OF TRAINING IN

SURGERY

• 6 Years

• 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 1st/2nd assistance

BASIC

• Medical knowledge

• Minor, moderate

procedures

• Basic laparoscopic

procedures

ADVANCED

• Medical knowledge

• Major 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

Committee of examiners

• 3 Surgeons

• 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