Orthopaedic surgery in SPAIN - UEMS
Transcript of Orthopaedic surgery in SPAIN - UEMS
Orthopaedic Orthopaedic surgery in SPAINsurgery in SPAIN
UEMS Orthopaedic SectionUEMS Orthopaedic Section2008 2nd annual meeting2008 2nd annual meeting
Edimburgh, September 27thEdimburgh, September 27th
Orthopaedic surgery in SPAINOrthopaedic surgery in SPAIN►Spain 2008Spain 2008►Health careHealth care►Orthopaedic surgeryOrthopaedic surgery►SECOT (Sociedad Española de Cirugía SECOT (Sociedad Española de Cirugía
Ortopédica y Traumatología)Ortopédica y Traumatología)►Orthopaedic trainingOrthopaedic training
Orthopaedic surgery in SPAINOrthopaedic surgery in SPAIN►Spain 2008Spain 2008► Health careHealth care► Orthopaedic surgeryOrthopaedic surgery► SECOT (Sociedad Española de Cirugía Ortopédica y SECOT (Sociedad Española de Cirugía Ortopédica y
Traumatología)Traumatología)► Orthopaedic trainingOrthopaedic training
Spain 2008Spain 2008►45.000.000 people45.000.000 people►Aprox. 500.000 KmAprox. 500.000 Km2 2 (2nd in Europe) (2nd in Europe)►Weather:Weather:
Atlantic (north)Atlantic (north)
Mediterranean (east, south)Mediterranean (east, south)
Continental (interior)Continental (interior)
►European Comunity since 1986European Comunity since 1986►Euro since 2002Euro since 2002►GNP: 80-90% “euro-zone”GNP: 80-90% “euro-zone”
Spain 2008Spain 2008► Constitutional Constitutional
monarchymonarchy
AndalucíaAndalucía
AragónAragón
AsturiasAsturias
CantabriaCantabria
Castilla La ManchaCastilla La Mancha
Castilla-LeónCastilla-León
CataluñaCataluña
ExtremaduraExtremadura
► 18 autonomic regions 18 autonomic regions (regional governments (regional governments and parlaments):and parlaments):
GaliciaGalicia
La RiojaLa Rioja
MadridMadrid
MurciaMurcia
NavarraNavarra
País VascoPaís Vasco
ValenciaValencia
Orthopaedic surgery in SPAINOrthopaedic surgery in SPAIN► Spain 2008Spain 2008
►Health careHealth care► Orthopaedic surgeryOrthopaedic surgery► SECOT (Sociedad Española de Cirugía Ortopédica y SECOT (Sociedad Española de Cirugía Ortopédica y
Traumatología)Traumatología)► Orthopaedic trainingOrthopaedic training
Health careHealth care► Public medicine Public medicine
National Health SystemNational Health System►Universal coverageUniversal coverage►Paid with taxesPaid with taxes►Free assistance & free medicines for retiredFree assistance & free medicines for retired
► Private medicinePrivate medicine Urban areasUrban areas Aprox. 20% populationAprox. 20% population Mostly HMOMostly HMO
Health careHealth care►Public medicine: National Health SystemPublic medicine: National Health System
Regional organization Regional organization ►““Consejerías de sanidad” (Health Regional Consejerías de sanidad” (Health Regional
Councils)Councils) Supra-regional control Supra-regional control
►Health MinisteryHealth Ministery
►Pros: competence among regions promotes Pros: competence among regions promotes improvementimprovement
►Contras: Contras: Difficulties in coordination among regionsDifficulties in coordination among regions Division of economical fundsDivision of economical funds
Health careHealth care►National Health SystemNational Health System
Primary medicine: Primary medicine: ►GPs GPs ►Health CentersHealth Centers
Specialized medicine: Specialized medicine: ►Hospitals Hospitals ►Out-patient facilitiesOut-patient facilities
Health careHealth care►HospitalsHospitals
University hospitals University hospitals ►All DepartmentsAll Departments►500-2000 beds500-2000 beds
Small hospitalsSmall hospitals►““High demand” specialitiesHigh demand” specialities►100-500 beds 100-500 beds
Health careHealth care►HospitalsHospitals
Hyerarchic organization:Hyerarchic organization:►Physicians:Physicians:
Chief of DepartmentChief of Department Chiefs of sections / unitsChiefs of sections / units Members of staffMembers of staff ResidentsResidents
►NursesNurses►Nurse-assistantsNurse-assistants
Orthopaedic surgery in SPAINOrthopaedic surgery in SPAIN► Spain 2008Spain 2008► Health careHealth care
►Orthopaedic surgeryOrthopaedic surgery► SECOT (Sociedad Española de Cirugía Ortopédica y SECOT (Sociedad Española de Cirugía Ortopédica y
Traumatología)Traumatología)► Orthopaedic trainingOrthopaedic training
Orthopaedic surgeryOrthopaedic surgery►All pathology in limbs and spineAll pathology in limbs and spine
Reumathologists: Reumathologists: ►Treatment of inflammatory pathologyTreatment of inflammatory pathology
Rehabilitation physicians: Rehabilitation physicians: ►direction of physiotherapydirection of physiotherapy
Vascular surgeons: Vascular surgeons: ►surgical treatment of vascular pathology surgical treatment of vascular pathology
Orthopaedic surgeryOrthopaedic surgery►All pathology in limbs and spineAll pathology in limbs and spine
Traumatic / non traumaticTraumatic / non traumatic Diagnostics / Treatment / Follow-upDiagnostics / Treatment / Follow-up Surgical / Medical / Physical therapy / Surgical / Medical / Physical therapy /
ConservativeConservative
Orthopaedic surgeryOrthopaedic surgery► Aprox 5.000 physicians practising Aprox 5.000 physicians practising
orthopaedic surgery orthopaedic surgery ►(not all (not all officialofficial title) title)
► Typical weekly work-scheduleTypical weekly work-schedule Surgery: 1-2 weekly sessions (7 hours)Surgery: 1-2 weekly sessions (7 hours) Out-patient clinic: 2-4 weekly sessionsOut-patient clinic: 2-4 weekly sessions
►1-2 highly specialised (hospital)1-2 highly specialised (hospital)►1-2 low specialisation (peripheral facilities)1-2 low specialisation (peripheral facilities)
Emergency: 1 weekly session (24 hours)Emergency: 1 weekly session (24 hours)
Orthopaedic surgeryOrthopaedic surgery NO official sub-specialitiesNO official sub-specialities In practical setting: areas of special In practical setting: areas of special
interestinterest►Hand surgeryHand surgery►Spine surgerySpine surgery►Shoulder / upper limbShoulder / upper limb►Arthroscopy / sports / soft kneeArthroscopy / sports / soft knee►Arthroplasty / lower limb reconstructiveArthroplasty / lower limb reconstructive►TraumaTrauma
Orthopaedic surgery in SPAINOrthopaedic surgery in SPAIN► Spain 2008Spain 2008► Health careHealth care► Orthopaedic surgeryOrthopaedic surgery
►SECOT (Sociedad Española SECOT (Sociedad Española de Cirugía Ortopédica y de Cirugía Ortopédica y Traumatología)Traumatología)
► Orthopaedic trainingOrthopaedic training
SECOTSECOT►1) Members1) Members►2) Relations2) Relations►3) Organization3) Organization►4) Activities4) Activities
SECOTSECOT►1) MEMBERS1) MEMBERS
Aprox 4000 membersAprox 4000 members►(not all with official title)(not all with official title)►2000-2500 certified orthopaedic surgeons2000-2500 certified orthopaedic surgeons
Full-membersFull-members►500 residents500 residents
Associate membersAssociate members►Aprox 1000 non-certified physicians practising Aprox 1000 non-certified physicians practising
orthopaedic surgeryorthopaedic surgery Associate membersAssociate members
►Honour membersHonour members Retired full-membersRetired full-members
SECOTSECOT►2) RELATIONS2) RELATIONS
Internal Study Groups (variables)Internal Study Groups (variables) Infection, spine, pain, TED, dynamic OS, …Infection, spine, pain, TED, dynamic OS, …
Fraternal relationFraternal relation►Spanish sub-speciality societiesSpanish sub-speciality societies
Spine, Shoulder&Elbow, Hand, Hip, Knee, Spine, Shoulder&Elbow, Hand, Hip, Knee, Arthroscopy, Foot&Ankle, Pediatrics,…Arthroscopy, Foot&Ankle, Pediatrics,…
►Spanish regional societies Spanish regional societies
SECOTSECOT►2) RELATIONS2) RELATIONS
Member of EFORT & UEMSMember of EFORT & UEMS
Special relations:Special relations:►AAOSAAOS
crossed symposiacrossed symposia shared bookshared book
►Latin America societiesLatin America societies crossed symposia crossed symposia
SECOTSECOT►3) ORGANIZATION3) ORGANIZATION
General AssemblyGeneral Assembly
Executive CommitteeExecutive Committee
SenateSenate
SECOTSECOT►3) ORGANIZATION3) ORGANIZATION
General AssemblyGeneral Assembly►Once yearly, in Annual CongressOnce yearly, in Annual Congress►Direct voteDirect vote
Election of Vice-President (future President) every Election of Vice-President (future President) every two yearstwo years
Election of Journal editorElection of Journal editor Legislative Legislative
SECOTSECOT►3) ORGANIZATION3) ORGANIZATION
Executive CommitteeExecutive Committee►1 President (elected 2 years before)1 President (elected 2 years before)►1 elected Vice-President1 elected Vice-President
elected by General Assembly every 2 yearselected by General Assembly every 2 years►1 Past-President1 Past-President►Treasurer, General Secretary, Members Treasurer, General Secretary, Members
number variablenumber variable Elected by President Elected by President Head of Committees: Education, Publications, Head of Committees: Education, Publications,
Annual Congress, Associated Members, Legal issuesAnnual Congress, Associated Members, Legal issues
SECOTSECOT►3) ORGANIZATION3) ORGANIZATION
SenateSenate►Past-PresidentsPast-Presidents►Counseling activity for PresidentCounseling activity for President
SECOTSECOT►4) ACTIVITIES4) ACTIVITIES
Annual CongressAnnual Congress Annual Basic CourseAnnual Basic Course JournalJournal PublicationsPublications Grants & PrizesGrants & Prizes
SECOTSECOT► 4) ACTIVITIES4) ACTIVITIES
Annual CongressAnnual Congress►3 full days / aprox 2000 participants3 full days / aprox 2000 participants►Rotating location: Madrid / Barcelona / Other Rotating location: Madrid / Barcelona / Other ►End of September / Beginning of OctoberEnd of September / Beginning of October►Educational:Educational:
Official Themes Official Themes Instructional CoursesInstructional Courses Industry symposiaIndustry symposia
►Research:Research: Free papers Free papers Posters Posters
SECOTSECOT►4) ACTIVITIES4) ACTIVITIES
Annual Basic CourseAnnual Basic Course►2-3 days / 150-200 participants2-3 days / 150-200 participants►Variable location all along country Variable location all along country ►JuneJune►Basic Monographic Course for ResidentsBasic Monographic Course for Residents
SECOTSECOT►4) ACTIVITIES4) ACTIVITIES
JournalJournal►““Revista española de Ortopedia y Revista española de Ortopedia y
Traumatología”Traumatología”►Elsevier / MassonElsevier / Masson►6 issues / year6 issues / year►Editor in chief elected by General AssemblyEditor in chief elected by General Assembly
SECOTSECOT►4) ACTIVITIES4) ACTIVITIES
Publications (Books)Publications (Books)►Instructional CoursesInstructional Courses►““Up-to dates”Up-to dates”►MonographiesMonographies►Hand-bookHand-book►Annual Case-Report BookAnnual Case-Report Book►Cross-publication with other societiesCross-publication with other societies
SECOTSECOT►4) ACTIVITIES4) ACTIVITIES
Grants Grants ►Congress & Basic GrantsCongress & Basic Grants►Travelling grantsTravelling grants►Foreign & National visitsForeign & National visits►Research projectsResearch projects
PrizesPrizes►Best Basic & Clinical research studyBest Basic & Clinical research study►Best published paperBest published paper
Orthopaedic surgery in SPAINOrthopaedic surgery in SPAIN► Spain 2008Spain 2008► Health careHealth care► Orthopaedic surgeryOrthopaedic surgery► SECOT (Sociedad Española de Cirugía Ortopédica y SECOT (Sociedad Española de Cirugía Ortopédica y
Traumatología)Traumatología)
►Orthopaedic trainingOrthopaedic training
Orthopaedic trainingOrthopaedic training►1) Access1) Access►2) General organization2) General organization►3) Activities3) Activities►4) Control of training4) Control of training►5) Control of training centers5) Control of training centers
Orthopaedic trainingOrthopaedic training►1) ACCESS1) ACCESS
Medical degreeMedical degree National exam National exam
►250 MCQ about medicine250 MCQ about medicine Ranking according to exam + Ranking according to exam +
qualifications in Medical Schoolqualifications in Medical School Election by rankingElection by ranking
►Medical specialityMedical speciality►HospitalHospital
Orthopaedic trainingOrthopaedic training►2) 2) GENERAL ORGANIZATIONGENERAL ORGANIZATION
Five yearsFive years 175 residents / year175 residents / year 50% female / male (nowadays)50% female / male (nowadays) Public hospitalsPublic hospitals Laboral contract, worker’s rightsLaboral contract, worker’s rights
►35 hours/week + hours / days on duty 35 hours/week + hours / days on duty Difficulties with EWDT because of days on dutyDifficulties with EWDT because of days on duty
►Free day after 24h on duty (not always possible)Free day after 24h on duty (not always possible)
Orthopaedic trainingOrthopaedic training►3) ACTIVITIES3) ACTIVITIES
RotationsRotations
►External:External: Compulsory: Anaesthesia, Plastic Surgery, VascularCompulsory: Anaesthesia, Plastic Surgery, Vascular Optative: most surgical, Rehabilitation, RheumatologyOptative: most surgical, Rehabilitation, Rheumatology
►Internal:Internal: Compulsory: PediatricsCompulsory: Pediatrics Advisable: tumours, hand, arthroscopy, spineAdvisable: tumours, hand, arthroscopy, spine
Orthopaedic trainingOrthopaedic training►3) ACTIVITIES3) ACTIVITIES
On dutyOn duty►Periods of 24 hours on dutyPeriods of 24 hours on duty►From 4 to 8 days / monthFrom 4 to 8 days / month►Heavy work in Emergency DepartmentHeavy work in Emergency Department►Light work in hospitalization wardLight work in hospitalization ward►Most hospitals: first callMost hospitals: first call
Orthopaedic trainingOrthopaedic training►3) ACTIVITIES3) ACTIVITIES
SurgerySurgery►Progressive responsibilityProgressive responsibility►2nd assistant / 1st assistant / supervised 2nd assistant / 1st assistant / supervised
surgeonsurgeon►7 hours / session7 hours / session►1 - 4 sessions / week1 - 4 sessions / week►NO compulsory number / type of surgeriesNO compulsory number / type of surgeries
Orthopaedic trainingOrthopaedic training►3) ACTIVITIES3) ACTIVITIES
Out-patient officeOut-patient office►Assistant / assistedAssistant / assisted►In practice, irregular In practice, irregular ►No compulsoryNo compulsory►No in many hospitalsNo in many hospitals
Orthopaedic trainingOrthopaedic training►3) ACTIVITIES3) ACTIVITIES
In-hospital patientsIn-hospital patients►Variable organization according to Variable organization according to
DepartmentsDepartments►Clinical & burocratic tasksClinical & burocratic tasks►Main medical worker for hospitalization ward Main medical worker for hospitalization ward
Orthopaedic trainingOrthopaedic training►3) ACTIVITIES3) ACTIVITIES
Theoretical teachingTheoretical teaching►Daily / weekly / monthly sessionsDaily / weekly / monthly sessions►Sessions of 15 min – 2 hoursSessions of 15 min – 2 hours►Irregular, great variabilityIrregular, great variability►Types of sessions:Types of sessions:
Emergency cases / Surgical cases / Hospitalization ward / Emergency cases / Surgical cases / Hospitalization ward / Bibliography / Monographics / Radiological / HistologicalBibliography / Monographics / Radiological / Histological
Orthopaedic trainingOrthopaedic training►4) Control of training4) Control of training
Head of teaching: Head of DepartmentHead of teaching: Head of Department TutorTutor LogbookLogbook Continuous evaluationContinuous evaluation Annual evaluation (logbook + staff opinion)Annual evaluation (logbook + staff opinion) NO compulsory examsNO compulsory exams NO intermediate examsNO intermediate exams Voluntary final exam (launching)Voluntary final exam (launching)
Orthopaedic trainingOrthopaedic training►5) Control of training centers5) Control of training centers
Ministery of HealthMinistery of Health Periodical auditsPeriodical audits Control of logbooksControl of logbooks Beds / facilities / surgical activity / out-Beds / facilities / surgical activity / out-
patient activity / library patient activity / library
Thank youThank you