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U.E.M.S EBOT Union Européenne des Médecins Specialistes European Board of European Union of Medical Specialists Orthopaedics and Traumatology Section of Orthopaedics and Traumatology 2005-13

MINUTES OF THE MEETING OF THE SECTION ON 28-29 OCTOBER 2005 AT SANA LISBOA HOTEL, LISBON, PORTUGAL

PRESENT: AUSTRIA : Dr. Thomas Motycka BELGIUM : Prof. Dr. Jean-Jaques Rombouts Prof. Dr. Hugo Boeck DENMARK : Dr. Hans Jeremiassen FINLAND : Dr. Ilkka Kiviranta FRANCE : Dr Patrice Papin GERMANY : Dr. Günter Abt Prof. Dr. Joachim Grifka GREECE : Assoc prof. Aristides Zoubos : Dr Savas Sourmelis IRELAND : Dr. Paraic Murray : Dr. John Corrigan ITALY : Prof. Dr. Francesco Marotti : Prof. Lamberto Perugia LUXEMBURG : Dr. Henri Schlammes THE NETHERLANDS : Prof. Rob Nelissen NORWAY : Dr. Kari Indrekvam PORTUGAL : Dr. Jorge Mineiro ROMANIA Dr. Christian Ioan Stoica SPAIN : Prof. José Cordero SWEDEN : Dr. Richard Wallensten : Dr. Hanne Hedin TURKEY : Prof. Dr. Mehmet Demirhan UNITED KINGDOM : Mr. David Finlayson

President: Dr. Richard Wallensten Secretary: Dr. Hanne Hedin Treasurer: Dr. Henri Schlammes

FIRST PART OF THE MEETING ON FRIDAY 28 OCTOBER 2005

1. OPENING 1.1. The president opened the meeting, welcomed the delegates to Lisbon and thanked Dr Jorge Mineiro and the Portuguese Orthopaedic Association for hosting the meeting. Dr. Mineiro gave some practical information about the meeting and the social programme.

2. APOLOGIES 2.1. Apologies were received from Dr Maroudias and Dr Georgiou, Cyprus; Dr Matějovsky, Czech Republique; Dr Jensen, Denmark; Dr Järvinen, Finland; Dr Szepesi, Hungary; Dr Oosterhout, The Netherlands; Dr. Witsö, Norway; Prof. Dick and Dr Lehmann, Switzerland; Mr 2

Albert, United Kingdom; Dr. Hašpl, Croatia. Not present: Prof. Alfred Engel, Austria; Prof George Zafiroski, Macedonia; Dr Torlough O’Malley PWG, Prof Puget, France, Dr Lubos Rehak, Slovakia.

3. WELCOME AND RESIGNATIONS 3.1. The president welcomed the new delegate. From The Netherlands: Dr Rob Nelissen replacing Dr Marc Speeckaert. Since the last meeting the president has again tried to contact the new member countries that have not yet appointed delegates: Estonia, Latvia, Lithuania, Malta, Poland and Slovenia. So far he has received positive answers from Poland, Lithuania and Malta, but they have not yet sent delegates. Bulgaria has applied to be an observer country and will be invited to the next meeting. The president will also try to address other countries, members in EFORT but not in the EU, Albania, Boznia-Herzegovia and Iceland.

4. MINUTES OF THE MEETING OF THE SECTION IN ISTANBUL 13-14 MAY, 2005 4.1. No more remarks were made and the minutes were approved.

5. COMMUNICATIONS 5.1. THE PRESIDENT 5.1.1 Incoming post: A. The president has received a letter from Dr Romain Seil, General Secretary in ESSKA, (European Society of Sports Traumatology, Knee Surgery and Arthroscopy) concerning the position of the Orthopedic Section of UEMS towards sub- specialization. The president has proposed that ESSKA work with our section the same way as we have worked with EPOS (European Pediatric Orthopedic Society), i.e. ESSKA can be a scientific adviser in matters of mutual interest such as our Minimal Requirements for training and the EBOT-exam. Discussion about how to co-operate with the sub-specialties in general. Decision to invite all interested sub-specialties to our meeting in Switzerland in autumn 2006 for discussion. B. A letter from David Limb, member of the Editorial Board of the Journal ‘Current Orthopaedics’ about CME points for journal reading. An answer will be sent with recommendation to send the actual papers to Dr Abt for evaluation and if possible clarification. 5.1.2. Outgoing post: The president has sent a letter to Mr. Michael Benson, president of BOA concerning non clinically trained personnel operating with a copy to the Medical Council and the General Secretary in UEMS. According to David Finlayson it has had no impact so far. Decision to go on and write again to Central UEMS with a demand for action. Follow-up at the next meeting.

5.2. THE SECRETARY 5.2.1. The secretary asked for corrections in the list of members (2005-11). It seems that the list now is almost correct and that the e-mail list is functioning for nearly all delegates.

5.3. THE TREASURER. 5.3.1. The treasurer went through the finances. Not so much had happened since our last meeting. We still have not received money from EFORT for the EBOT-exam. We need the money for the exam in Madrid. A reminder will be sent. Three countries have not yet paid their fee for 2004 and eight countries have not paid for 2005. Reminders will be sent. The key for fees according to size of the country and population has been presented and will be used for fees from 2006 and forward. The treasurer will notice the countries about the amount.

5.4 UEMS 5.4.1. The president went shortly through some of the documents from central UEMS. The documents have been mailed to all delegates and can be found on UEMS home page www.uems.net and even on our own home-page www.uems-ortho.org. Since the last meeting the news letters 05.07, 05.08, 05.09, 05.11, 05.12, 05.13 have been mailed to all delegates. 5.4.2. Report on a meeting for Surgical Disciplines within UEMS with the intension to build an European federation of Surgical Specialties on May 20, 2005. The federation was established and two Convenors was elected: Professor Holschneider and Professor Greenhalgh with the task of carrying the view of the surgeons to the Management Council. Some of the subjects discussed 3

were the log-book with an European Board qualification, a recommendation that the UEMS Boards should run the examinations not the European Specialist Societies and that a task force will be set up within the Cardiothoracic Section to investigate litigation matters. Decision the president will write a letter telling that our section is interested in participating. One problem has not been solved yet and that is the financing of participation of the sections in the federation. 5.4.3. Prof. Jean-Jacques Rombouts reported from the meeting for presidents and secretaries in Brussels May 21. The minutes from the meeting has been sent to all delegates. The most important items was the definition of the Medical Art. The definition that was accepted was the one our section found most valuable. Another important item was the working hour directive. The implementation has been postponed until 2009.

5.5 EFORT 5.5.1.Dr Mineiro reported from the EFORT congress in Lisbon June 2005. The congress was a success. More than 3000 papers were accepted. Our section participated in 2 symposia. One on Training in Europe with Dr Mineiro and Dr Wallenstein as participants and one on CME in Europe with Dr Cordero as participant. 5.5.2. Dr Marc Speeckaert has been in charge of EFORT on Tour with courses mostly in Eastern and Southern Europe on different subjects. It was a personal initiative of Dr Speeckaert and supported by our section but paid for by EFORT. The next course will be in Cyprus March 2006. After that Dr Speeckaert has a wish that another delegate in our section takes over the responsibility. Dr Rob Nelissen agrees to continue the work of Dr Speeckaert.

6. CONSEQUENCES OF THE WORKING HOUR DIRECTIVE FOR TRAINING AND WORKING ENVIRONMENT IN ORTHOPAEDICS QUESTIONNAIRE RESULTS A questionnaire concerning EWHD and its implementation in different member countries and some questions about work environment has been sent out to all delegates before the last meeting. Still only delegates from 16 countries have answered. Dr Kari Indrekvam presented the results. There are some differences between the countries concerning numbers of trainees, vacancies in different positions, retirement ages, the length of maternity and paternity leave and the use of it etc. The results will be completed with answers from the remaining countries that have not yet answered. The final results will be presented at the next meeting in Helsinki and after approval added to the web site.

7. REPORT FROM THE WORKING GROUP ON PAEDIATRIC ORTHOPAEDICS IN CO-OPERATION WITH THE ORTHOPAEDIC SECTION OF UEMS The working group consisting of Prof. Hugo de Boeck and Dr Hanne Hedin from our section and Prof Franz Grill and Prof Gerard Bollini from EPOS (European Paediatric Orthopaedic Society) has had a meeting just before this meeting. Prof. Grill is chairman of the educational committee of EPOS. He expressed four items that are important for EPOS. 1. A wish to create a subsection for paediatric orthopaedic surgery, as he thinks there is a big difference between paediatric orthopaedics and the other sub-specialties. 2. To participate in validation and construction of paediatric orthopaedic questions for the EBOT- exam. 3. Providing examiners for the paediatric orthopaedic section of the EBOT-exam. 4. In co-operation with the working group make minimal requirements for training centres training orthopaedic surgeons to sub- specialize in paediatric orthopaedics. After discussion and voting it was decided it is too early for creation of a sub-section. We will wait for the combined meeting with the other sub- specialties at our meeting in Switzerland before we decide in the matter. The three other items were approved. EPOS represents the scientific part in paediatric orthopaedic matters and the orthopaedic section of UEMS the ‘political’ part. Prof. Grill will be the liaison officer between EPOS and our section.

8. MANPOWER DATA Mr David Finlayson went through subjects that can be important for manpower data such as number of operations per surgeon, future trends with respect to EWHD, early retirement, part- time work, gender issues etc. It all depends on what we want to know. What we will use it for and whom we will bring the results to. Decision Mr Finlayson will lead a group of people looking into what is important data and how to collect them. The group will consist of David 4

Finlayson., Rob Nelissen, John Corrigan and Christian Stoica. The result will be presented at the next meeting.

9. REPORT FROM THE 5th EBOT-EXAMINATION IN MADRID OCTOBER 6-8, 2005 Dr Jorge Mineiro reported from the examination in Madrid. Only eleven candidates had applied for the exam. The passing rate was 50%. Discussion about whether the sub-specialties should validate and provide questions for the exam. One risk is that the questions can be too specialized. The exam is for orthopaedics in general. Another discussion was about how to get more applicants. One way could be to let the exam replace the national exam as is used in other specialties i.e. Urology. Decision all delegates will ask their national societies on their opinion. The president will send a reminder to the delegates. Another proposal was to make it possible to do the MCQ’s in your own country the same day through internet and after passing the test do the oral part together with the other that have passed. This will save time and money. Nothing was decided but the matter will be discussed further at the next meeting. The venue for the next exam will be Torino in Italy with Elena Brach de Priver as the local organizer. The dates are 7-8 October, 2006. The address for the homepage is www.ebotexam.20m.com and the mail address is [email protected] Theresa Neves secretary of Dr Mineiro presented a database for organizing the exam. It will make it much easier to administrate the exam and easier for the next delegate to take over the responsibility when Dr Mineiro finishes his term. The database was impressing and seems to be very useful. The delegates thanked Theresa Neves for her great work with creating the database.

10. INFORMATION ABOUT THE WEB SITE Dr Abt informed shortly about the home page. The address is www.uems-ortho.org. There is a link to central UEMS the address is www.uems.net. A search machine is under construction. All new documents will be placed on the home page.

11. EUROPEAN SCALE OF IMPAIRMENT In our last minutes it was informed that Dr Marc Speeckaert has tried to collect information about the European Scale of Impairment that originate from a French scale produced by CEREDOC, a group of experts of several European countries. The scale originates from a poorly translated French scale. The scale is used by the Commission for its personnel and the fear is that it can be imposed in every country. The scale is very different from the scale used in many countries. Dr Speeckaert has tried to gather information about the system in the different member countries. This work will now be continued by Dr Frank Oosterhout the new delegate of the Netherlands. Dr Oosterhout was not present at this meeting. Dr Nelissen has tried to get information if anything has been done and it seems not to be the case. The impression was that we should make our own scale. This is not the intension. The scale already exists and we need to look into it and protest if it is incorrect and very far from our national scales. Most of the scales are made by the insurance companies and there should be a harmonization throughout Europe. Decision will be asked to present the scale in question together with the scale of AMA at the meeting in Helsinki.

SECOND PART OF THE MEETING ON SATURDAY OCTOBER 29 2005

12. LIABILITY Dr Patrice Papin, France has taken over the responsibility for continuing the work of Marc Speeckaert on collecting data on the different systems in Europe. He gave a background for the question. The trend is to increase patient safety, safety accountability and how to compensate if anything has gone wrong. It is in the health care system but there are big differences throughout Europe. Dr Wallensten made a short summary of the Swedish system. This was a paper presented at the EFORT congress in Lisbon. Dr Maillet, General Secretary of UEMS stressed that there is no system for noticing if a doctor has been suspended in another country. Decision Dr Papin will prepare a questionnaire about liability systems in the different countries and send it to all delegates. The result will be presented at our next meeting in Helsinki.

13. EACCME AND CENTRAL UEMS INFORMATION 5

The General Secretary of UEMS Dr Bernard Maillet visited our section again and was welcomed by our president. Dr Maillet shortly went through the latest news from UEMS. The Management Council has changed its name to UEMS Council. From 1 January, 2006 a new Executive and President has been elected. The new president will be Dr Slatko Fras from Slovenia. Dr Maillet will continue as General Secretary. Dr Gerd Hoffman from Germany will be the new liaison officer. The new Statutes and Rules and the new definition of Medical Art have been adopted. Two new Joint Committees has been created, one in Emergency Medicine and one in Sports Medicine. Discussion about our sections representation in both Committees. All Joint Committees are open for all sections that have interest in the committees. The president will write to the liaison officer to get more information on how we can participate. Dr Abt went shortly through the work on CME/CPD. 42 events have been evaluated. We have an evaluation form. Dr Maillet thinks it is too simple. Discussion about an e-form for evaluation. Dr Abt presents a proposal for an agreement between our section and EACCME. All delegates get a copy to read. If no objections are made within the next weeks the agreement will be signed.

14. TRAINING DEPARTMENTS IN EUROPEAN COUNTRIES Dr Marc Speeckaert was asked by the executive committee of EFORT to investigate the number of training centres for orthopaedics in Europe. Dr Speeckaert has not yet been able to complete the list. As soon as it is completed it will be sent to EFORT and placed on our web site.

15. REPORT FROM WORKING GROUP ON CONTROL OF TRAINING CENTRES Dr José Cordero represented the group. Members of the group are Dr. Kari Indrekvam, Dr José Cordero, Mr Paraig Murray and Dr Nicholas Maroudias. The information gathered earlier can be found as an excel sheet on the web site. The task of the group was to present a paper with Minimal Requirements for training centres. The intension is to harmonize how to control training centres. Dr Cordero presented a questionnaire that will be sent to every delegate. The questionnaire should give the answer how each national society define the minimal requirements for training centres. Discussion about some of the questions. The first part really concerns minimal requirements for training which we have already agreed upon. According to Prof Rombouts we should only answer that part on whether we agree on the Minimal Requirements or not. Dr Maillet stressed that the minimal requirements for training centres should be general guidelines. We should not go into national societies requirements. The questionnaire will have to be answered within the next 4 month in order to allow the group to present a proposal for Minimal Requirements for Training Centres.

16. PRESENTATION OF NATIONAL SOCIETIES At this meeting three delegates presented the organisation of orthopaedics in their countries. They were Mr David Finlayson from United Kingdom, Dr Mineiro from Portugal and Dr Schlammes from Luxemburg. All presentations will be added to the web site

17. FUTURE ACTIVITIES OF THE SECTION The president summarised all activities that go on just now in the section. We will make contact with the two new Joint Committees within UEMS. Dr Jorge Mineiro will contact the Joint Committee for Emergency Medicine. Prof. Mehmet Demirhan and Mr Paraic Murray will contact the Joint Committee on Sports Medicine. The list of Training centres will be completed. A meeting for sub-specialties will be arranged at our meeting in Switzerland. The work with the EBOT-exam will go on. Other tasks that will be completed are the working hours, liability, the impairment scale, and minimal requirements for training centres.

18. DATES AND VENUES OF FORTHCOMING MEETINGS 18.1. Meeting in Helsinki, Finland, May 26-27, 2006 18.2. Meeting in Switzerland 13-14 or 20-21 October, 2006 18.3. Meeting in Athens, Greece, 28 April- May 1, 2007 18.4. Meeting in France, autumn 2007 18.5. Meeting in Berlin, Germany spring 2008

19. ANY OTHER BUSINESS No other business was announced. 6

20. CLOSURE Dr Wallensten closed the meeting again, thanking Dr Mineiro and the Portuguese Orthopaedic Association for hosting the meeting and also thanked all the delegates for coming to Lisbon.

Dr Hanne Hedin, Secretary

Saturday afternoon we had a sight-seeing tour of Lisbon. Unfortunately it was raining. We understood however that the rain was most welcomed after a long dry period. In the evening we had a delicious dinner at the Eleven Restaurant with a magnificent view of Lisbon.