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Background: Since there is sound evidence that communication skills training (CST) programs modify communication behavior of oncology clinicians, they have been widely implemented over the last decades. However, more recently, certain aspects of this training have been criticized., Methods: Based on this background, a call to re-launch a discussion about the future of CST led to the third European consensus meeting on communication in cancer care, organized by the Swiss Cancer League. During this meeting, which brought together European experts in the field of clinical communication and training of communication in the oncology setting, oncology clinicians, representatives of the European Society of Medical Oncology and a member of the European Oncology Nursing Society, the recommendations of the second European consensus meeting were updated and expanded., Results: The expanded recommendations recall the guiding principles of communication in cancer care, underline the important role of clinician's self-awareness, and of relational and contextual factors in clinical communication, and provide direction for the further development of communication training., Conclusion: This third European consensus meeting defines key elements for the development of a next generation of communication training for oncology clinicians.

This paper reports on the recent activity of the pan‐European consensus of the ADEE Special Interest Group for Pre‐Clinical Operative Skills. Following the previous recommendations from the group, and in order to support teachers and to harmonise the delivery of skills training across Europe, a more formal curriculum relating to pre‐clinical operative skills needs to be created. This paper reports European consensus surrounding the categorisation (level of importance, and difficulty) of basic operative dental clinical skills within the undergraduate curriculum and provides recommendations relating to session structure and timing of curricular elements for basic operative dental clinical skills teaching. [ABSTRACT FROM AUTHOR]

Background: The EAPC White Paper addresses the issue of spiritual care education for all palliative care professionals. It is to guide health care professionals involved in teaching or training of palliative care and spiritual care; stakeholders, leaders and decision makers responsible for training and education; as well as national and local curricula development groups. Methods: Early in 2018, preliminary draft paper was written by members of the European Association for Palliative Care (EAPC) spiritual care reference group inviting comment on the four core elements of spiritual care education as outlined by Gamondi et al. (2013) in their paper on palliative care core competencies. The preliminary draft paper was circulated to experts from the EAPC spiritual care reference group for feedback. At the second stage feedback was incorporated into a second draft paper and experts and representatives of national palliative care organizations were invited to provide feedback and suggest revisions. The final version incorporated the subsequent criticism and as a result, the Gamondi framework was explored and critically revised leading to updated suggestions for spiritual care education in palliative care. Results: The EAPC white paper points out the importance of spiritual care as an integral part of palliative care and suggests incorporating it accordingly into educational activities and training models in palliative care. The revised spiritual care education competencies for all palliative care providers are accompanied by the best practice models and research evidence, at the same time being sensitive towards different development stages of the palliative care services across the European region. Conclusions: Better education can help the healthcare practitioner to avoid being distracted by their own fears, prejudices, and restraints and attend to the patient and his/her family. This EAPC white paper encourages and facilitates high quality, multi-disciplinary, academically and financially accessible spiritual care education to all palliative care staff. [ABSTRACT FROM AUTHOR]

Purpose: No study to date has described the overall landscape of sleep disorders management and training in otolaryngology departments of different countries. The aim of our study was to investigate and compare settings, diagnostic and therapeutic approaches and training programmes., Methods: An international online survey was developed with the collaboration of the YO-IFOS (Young Otolaryngologists-International Federation of Otorhinolaryngological Societies) to assess the current practice of otolaryngologists in the management of sleep disorders. The survey also included a session dedicated to training., Results: A total of 126 otolaryngologists completed the survey. The larger part of responses was collected from Central/South America and Europe. The majority of responders from South/Central America (97%) declared to be certified as sleep specialist while 49% of Europeans stated the opposite. Of responders 83% perform a drug-induced sleep endoscopy (DISE) before planning a possible surgical intervention. Soft palate and base of tongue interventions were the most common procedure, respectively performed in 94% and 79% of the cases. Residents were allowed to perform soft palate surgery in 77% of the cases. Upper airway stimulation (26% vs 10%), trans-oral robotic surgery (36% vs 11%) and radiofrequency of the base of the tongue (58% vs 25%) were preferred more frequently by European responders. The highest caseloads of soft palate surgery and bi-maxillary advancement were registered in the academic institutions., Conclusion: Significant concordance and few interesting divergences in diagnosis and treatment of sleep disorders were observed between nationalities and types of institution. Economic resources might have played a significant role in the therapeutic choice. Trainees' lack of exposure to certain interventions and to a sufficient caseload appeared to be the main burden to overcome., (© 2020. Springer Nature Switzerland AG.)

There is a need for implementation and maturation of an inclusive trauma system in every country in Europe, with patient centered care by dedicated surgeons. This process should be initiated by physicians and medical societies, based on the best available evidence, and supported and subsequently funded by the government and healthcare authorities. A systematic approach to organizing all aspects of trauma will result in health gain in terms of quality of care provided, higher survival rates, better functional outcomes and quality of life. In addition, it will provide reliable data for both research, quality improvement and prevention programs. Severely injured patients need surgeons with broad technical and non-technical competencies to provide holistic, inclusive and compassionate care. Here we describe the philosophy of the surgical approach and define the necessary skills for trauma, both surgical and other, to improve outcome of severely injured patients. As surgery is an essential part of trauma care, surgeons play an important role for the optimal treatment of trauma patients throughout and after their hospital stay, including the intensive care unit (ICU). However, in most European countries, it might not be obvious to either the general public, patients or even the physicians that the surgeon must assume this responsibility in the ICU to optimize outcomes. The aim of this paper is to define key elements in terms of trauma systems, trauma-specific surgical skills and active critical care involvement, to organize and optimize trauma care in Europe. [ABSTRACT FROM AUTHOR]

Objectives: Compassion in nursing and interventions to support it are of international relevance and concern. Prior care experience as a prerequisite for entry into pre-registration nurse education is suggested as a means of improving compassion. The impact of prior care experience has not been comprehensively reviewed, therefore the potential effectiveness of prior care experience as a means of improving compassion is unknown. The scoping review question was 'What is known about the impact of care experience prior to commencing pre-registration nurse education and training?' The primary objective was to scope and synthesise existing literature relating to the topic and ascertain key themes pertaining to impact. A secondary objective was to appraise literature, to contextualise findings and assess the state and stage of knowledge and research in the area., Design: The review was guided by Arksey and O'Malley's methodological framework and is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews Checklist., Data Sources: Health sciences databases CINAHL, Medline and PubMed., Methods: Databases were searched in February 2019, updated August 2021. Data (study characteristics, findings, methodological observations) were extracted from papers meeting inclusion criteria (including peer-reviewed empirical papers with English language, electronic full-text available) and findings thematically analysed., Results: Forty-five papers from 14 countries were included. The majority (64.4 %) were published in Europe (31.1 % in the United Kingdom) between 2010 and 2021 (69 %), 60 % from 2013. Four qualitative themes (compassionate care, commitment, competence and communication) describe the impact of prior care experience, which was variable., Conclusions: Evidence to support the effectiveness of prior care experience as a prerequisite for entry into nurse education to improve compassion, is inconsistent and insufficient. The literature displays methodological limitations and conclusions should be interpreted in light of these caveats. Recommendations are made for future research, to improve quality and comparability., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Introduction: Continuing Professional Development (CPD) is mandatory in most European countries and evidence shows a move towards mandatory CPD across all Member States in the near future. Malta is one of seven Member States where dental CPD is still voluntary., Discussion: Although dental CPD is a legal requirement for recertification in many countries, integral aspects of dental CPD remain under debate, like whether CPD is truly effective. This is because the methods with which CPD programmes are evaluated are not sufficiently robust to give concrete evidence to determine whether CPD will actually improve quality of care, treatment outcomes and safety for the public. Evaluating the effect of CPD programmes on the public is an extremely difficult task that would require an enormous amount of resources and logistics. The minimum requirements for the number of compulsory CPD hours imposed by regulatory bodies are not evidence-based but purely arbitrary, and the core topics selected for CPD programmes, although supported by research to some extent, may not reflect the public's and profession's needs. The Dental Association of Malta recognised need for further research on dental CPD and embarked on a 3-year Dental CPD Research Project. This project will be presented in a two-part series of articles. This first article is focused on the background of dental CPD in Europe. An understanding of the current issues with CPD and flaws in methods of evaluation formed the basis of the Malta CPD Pilot Project, which will be covered in the next paper., (© 2021 The Authors. European Journal of Dental Education published by John Wiley & Sons Ltd.)

Background and purpose: Neurology residency programmes, which were first established at the beginning of the 20th century, have become mandatory all over Europe in the last 40–50 years. The first European Training Requirements in Neurology (ETRN) were published in 2005 and first updated in 2016. This paper reports the most recent revisions of the ETRN. Methods: Members of the EAN board performed an in depth revision of the ETNR 2016‐version, which was reviewed by members of the European Board and Section of Neurology of the UEMS, the Education and Scientific Panels, the Resident and Research Fellow Section and the Board of the EAN, as well as the presidents of the 47 European National Societies. Results: The new (2022) ETRN suggest a 5‐year training subdivided in three phases: a first phase (2 years) of general neurology training, a second phase (2 years) of training in neurophysiology/neurological subspecialties and a third phase (1 year) to expand clinical training (e.g., in other neurodisciplines) or for research (path for clinical neuroscientist). The necessary theoretical and clinical competences as well as learning objectives in diagnostic tests have been updated, are newly organized in four levels and include 19 neurological subspecialties. Finally, the new ETRN require, in addition to a programme director, a team of clinician‐educators who regularly review the resident's progress. The 2022 update of the ETRN reflects emerging requirements for the practice of neurology and contributes to the international standardization of training necessary for the increasing needs of residents and specialists across Europe. [ABSTRACT FROM AUTHOR]

Objectives: To gain insight into current methods and practices for the assessment of competences during rheumatology training, and to explore the underlying priorities and rationales for competence assessment., Methods: We used a qualitative approach through online focus groups (FGs) of rheumatology trainers and trainees, separately. The study included five countries-Denmark, the Netherlands, Slovenia, Spain and the United Kingdom. A summary of current practices of assessment of competences was developed, modified and validated by the FGs based on an independent response to a questionnaire. A prioritising method (9 Diamond technique) was then used to identify and justify key assessment priorities., Results: Overall, 26 participants (12 trainers, 14 trainees) participated in nine online FGs (2 per country, Slovenia 1 joint), totalling 12 hours of online discussion. Strong nationally (the Netherlands, UK) or institutionally (Spain, Slovenia, Denmark) standardised approaches were described. Most groups identified providing frequent formative feedback to trainees for developmental purposes as the highest priority. Most discussions identified a need for improvement, particularly in developing streamlined approaches to portfolios that remain close to clinical practice, protecting time for quality observation and feedback, and adopting systematic approaches to incorporating teamwork and professionalism into assessment systems., Conclusion: This paper presents a clearer picture of the current practice on the assessment of competences in rheumatology in five European countries and the underlying rationale of trainers' and trainees' priorities. This work will inform EULAR Points-to-Consider for the assessment of competences in rheumatology training across Europe., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Primary health care and its strengthening through performance measurement is essential for sustainably working towards universal health coverage. Existing performance frameworks and indicators to measure primary health care capture system functions like governance, financing and resourcing but to a lesser extent the function of services delivery and its heterogeneous nature. Moreover, most frameworks have weak links with routine information systems and national health priorities, especially in the context of high- and middle-income countries. This paper presents the development of a tool that responds to this context with the aim to create primary health care performance intelligence for the 53 countries of the WHO European Region., Methods: The work builds-off of an existing systematic review on primary care and draws on priorities of current European health policies and available (inter)national information systems. Its development included: (i) reviewing and classifying features of primary care; (ii) constructing a set of tracer conditions; and (iii) mapping existing indicators in the framework resulting from (i). The analysis was validated through a series of reviews: in-person meetings with country-nominated focal points and primary care experts; at-distance expert reviews; and, preliminary testing with country informants., Results: The resulting framework applies a performance continuum in the classical approach of structures-processes-outcomes spanning 6 domains - primary care structures, model of primary care, care contact, primary care outputs, health system outcomes, and health outcomes - that are further classified by 26 subdomains and 63 features of primary care. A care continuum was developed using a set of 12 tracer conditions. A total of 139 indicators were mapped to the classification, each with an identified data source to safeguard measurability. Individual indicator passports and a glossary of terms were developed to support the standardization of the findings., Conclusion: The resulting framework and suite of indicators, coined the Primary Health Care Impact, Performance and Capacity Tool (PHC-IMPACT), has the potential to be applied in Europe, closing the gap on existing data collection, analysis and use of performance intelligence for decision-making towards primary health care strengthening.

This is an expert opinion paper on oral health policy recommendations for older adults in Europe, with particular focus on frail and care‐dependent persons, that the European College of Gerodontology (ECG) and the European Geriatric Medicine Society (EUGMS) Task and Finish Group on Gerodontology has developed. Oral health in older adults is often poor. Common oral diseases such as caries, periodontal disease, denture‐related conditions, hyposalivation, and oral pre‐ and cancerous conditions may lead to tooth loss, pain, local and systemic infection, impaired oral function, and poor quality of life. Although the majority of oral diseases can be prevented or treated, oral problems in older adults remain prevalent and largely underdiagnosed, because frail persons often do not receive routine dental care, due to a number of barriers and misconceptions. These hindrances include person‐related issues, lack of professional support, and lack of effective oral health policies. Three major areas for action are identified: education for healthcare providers, health policy action plans, and citizen empowerment and involvement. A list of defined competencies in geriatric oral health for non‐dental healthcare providers is suggested, as well as an oral health promotion and disease prevention protocol for residents in institutional settings. Oral health assessment should be incorporated into general health assessments, oral health care should be integrated into public healthcare coverage, and access to dental care should be ensured. [ABSTRACT FROM AUTHOR]

Introduction: The management of critically ill patients is challenged by increasing population age and prevalence of comorbid diseases. High-quality intensive care nursing practice is imperative to accommodate these issues. The roles of the nurse practitioner (NP) and the acute care NP have existed for decades in the USA, Canada and Australia but are still evolving in Europe. Some European countries have introduced the advanced practice nurse (APN), but the current standard of the advanced level of nursing is variable and consensus regarding the framework, role and definition is lacking. Literature and evidence are sparse as well. Identification of skills and competencies required for the APN is warranted. Mapping skills and competencies will enable future educational harmonisation and facilitate mobility of the advanced-level intensive care nursing workforce across Europe. The aim of our scoping review is to identify literature describing skills, competencies and policies characterising advanced nursing practice in intensive care across Europe., Methods and Analysis: We will apply a five-stage scoping review methodology with a comprehensive systematic literature search as outlined by Arksey and O'Malley. In collaboration with a research librarian, we will search nine interdisciplinary databases and grey literature for publications originating in European countries in 1992-2018. Using a two-stage screening process with Covidence to remove duplicates, we will first scan the title and abstract and then perform full-text review to determine the eligibility of the papers. Qualitative content analysis will be used to chart the data., Ethics and Dissemination: Our study is a part of the European Union-funded INACTIC project (International Nursing Advanced Competency-based Training for Intensive Care) with the overall aim of developing a common European curriculum for advanced practice critical care nursing. Results from this scoping review mapping the evidence of APNs in Europe will be presented at national and international conferences and published in a peer-reviewed journal., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Accessible summary In the Western world, many people who have mental health problems experience poor physical health. Research suggests that those with mental illness often have difficulties in accessing health care services, reporting that when they do, their physical health needs are often overlooked., Nurses are expected to deliver safe and effective care that meets the needs of service users. In order to help mental health nurses address physical health care needs, changes to nurse education, supported by government policy, have been made in the United Kingdom. Despite these changes, mental health nurses still feel less confident and prepared to address physical health needs of service users. However, this same problem is also reported by nurses throughout Europe and in other Western countries, who have undergone different training and education programmes., This paper discusses important factors affecting the mental health nurses' ability to deliver physical care and how they impact on confidence and competence., The paper concludes by highlighting the role of the mental health nurse being key in addressing the physical health needs of those in their care, and how this will only be realized when education and practice provide sufficient opportunity for them to develop and maintain their knowledge and skills., Abstract In the Western world, there is increasing concern regarding the ability of health care professionals to meet the physical health care needs of those diagnosed with mental illness. This discussion paper seeks to explore some of the issues facing mental health nurses in delivering care to those who have both mental and physical illness. Criticism of the National Health Service for failing to meet the physical health needs of people with serious mental illness has generated a number of political strategies aimed at addressing inequalities between mental and physical health care, a consequence being a change in pre-registration nurse education. It is envisaged that such changes will enable all nurses to deliver safe, effective care to service users, with adult and mental health nurses being more adept at meeting both the mental and physical health needs of those in their care. The impact of three key areas identified within the literature will be considered: the impact of co-existing physical and mental illness; the role of mental health nurses and perceptions of service users re physical health care; and education, training and learning from others in the Western world. In conclusion, the complexities of delivering such care will be addressed. [ABSTRACT FROM AUTHOR]

Purpose: This discussion paper aims to explore the need of a clarified definition of master's level mental health nursing competencies in terms of knowledge, skills and attitudes in a European context. Mental health service users have, in spite of their right to equal overall health, higher rates of physical illness and are more likely to experience premature death than the general population. Implementation of a holistic concept of health comprising mental, physical and social aspects of health in mental health services has previously proved to be challenging., Methods: Master's level mental health nursing competencies in recent literature are discussed and illuminated in terms of knowledge, skills and attitudes in order to enable the promotion of equal overall health among service users in mental health services., Results: The discussion show contents, values and utility of master's level mental health nursing competencies in mental health services and contribute to reduced role ambiguity by distinguishing master's level responsibilities from undergraduate nursing tasks and obligations of other professionals in mental health care., Conclusion: This discussion paper shapes implications for developments in master's level mental health nursing education curricula.

This paper presents perspectives and controversies surrounding the use of milestones to assess competency in outcomes-based medical education. Global perspectives (Canada, Europe, and the United States) and developments supporting their rationales are discussed. In Canada, there is a significant movement away from conceptualizing competency based on time, and a move toward demonstration of specific competencies. The success of this movement may require complex (rather than reductionist) milestones that reflect students' progression through complexity and context and a method to narrate their journey. European countries (United Kingdom, France, and Germany) have stressed the complexity associated with time and milestones for medical students to truly achieve competence. To meet the changing demands of medicine, they view time as actually providing students with knowledge and exposure to achieve various milestones. In the United States, milestones are based on sampling throughout professional development to initiate lifelong learning. However, the use of milestones may not imply overall competence (reductionism). Milestones must be developed alongside outcomes-based curriculum with use of faculty and competency committees. The perspectives outlined in this paper underscore emerging challenges for implementing outcomes-based medical education and call for new conceptualizations of competence. [ABSTRACT FROM AUTHOR]

Mental health disorders (MHD) in elite athletes is a topic that has received increased attention in recent years. The overall aim of this position statement is to enhance awareness of this important topic and to critically discuss optimal service provision for athletes who suffer from MHD. In the first part of the paper a short overview of the research on MHD in elite athletes is provided. Elite athletes seem to have comparable prevalence rates for the most common MHD when compared to non-athletic peers, but there are still many disorders that have not been investigated in athletes. Sport specific situations such as injuries, periods of overtraining and career termination may put athletes at an increased risk of developing MHD. In the second part of the paper, models of service provision for elite athletes suffering from MHD from six European countries are presented, focusing on 1) professional service providers, 2) support systems, 3) diagnostic assessment, 4) clinical treatment, 5) performance during treatment, 6) screening, and 7) education systems. It emerges that competencies, certification issues, and professional boundaries of the involved service providers, as well as the structure of the National Health Care systems differ strongly across European countries, which makes defining a golden standard difficult. In the third part of this paper, the authors provide general recommendations for athletes and coaches, clubs, federations, organizations and scholars that hopefully will inspire stakeholders to optimize their support systems. [ABSTRACT FROM AUTHOR]

Recent evidence brought by novel anti-human epidermal growth factor receptor 2 (HER2) antibody-drug conjugates is leading to significant changes in HER2-negative breast cancer (BC) best practices. A new targetable category termed 'HER2-low' has been identified in tumors previously classified as 'HER2-negative'. Daily practice in pathology and medical oncology is expected to align to current recommendations, but patient access to novel anticancer drugs across geographies might be impeded due to local challenges. An expert meeting involving ten regional pathology and oncology opinion leaders experienced in BC management in four Central and Eastern Europe (CEE) countries (Bulgaria, Croatia, Serbia, Slovenia) was held. Herein we summarized the current situation of HER2-low metastatic BC (mBC), local challenges, and action plans to prevent delays in patient access to testing and treatment based on expert opinion. Gaps and differences at multiple levels were identified across the four countries. These included variability in the local HER2-low epidemiology data, certification of pathology laboratories and quality control, and reimbursement conditions of testing and anticancer drugs for HER2-negative mBC. While clinical decisions were aligned to international guidelines in use, optimal access to testing and innovative treatment was restricted due to significant delays in reimbursement or limitative reimbursement conditions. Preventing delays in HER2-low mBC patient access to diagnosis and novel treatments is crucial to optimize outcomes. Multidisciplinary joint efforts and pro-active discussions between clinicians and decision makers are needed to improve care of HER2-low mBC patients in CEE countries. [ABSTRACT FROM AUTHOR]

Background: Competence profiles are purposed to provide a blueprint in support to develop and/or benchmark the learning outcomes of undergraduate dental curricula. This study aims to investigate whether a competence profile as proposed by academic- and clinical experts is able to represent the real clinical reality. Methods: A questionnaire was developed including questions about gender and age, perception about required competences, and educational organisation and was distributed among Flemish dentists via email and on paper during a symposium. The data was analysed using descriptive statistics, Chi-square and non-parametric Mann-Whitney U-tests. Results: A total of 312 questionnaires were completed (=6.5% of dentist population, with similar gender and age characteristics). All competences in the European competence profile were rated between 7.2 and 9.4 on a 10-point scale. In dentists under 50 years, females rated the importance of identifying/managing anxiety and abnormal patient behaviour; and promoting/improving oral health as significantly higher than males. In dentists of 50 years and above, females rated 8 competences significantly higher than males, including obtaining/recording a complete history; identifying/managing anxiety and abnormal patient behaviour; obtaining/interpreting radiography; identifying temporomandibular and associated disorders; identifying orthodontic needs; awareness of own limitations/when to refer; managing dental urgencies; and basic-life-support/defibrillation. Clinical practice management was most frequently reported as additional competence to address in dental education. Furthermore, the respondents suggested an undergraduate dental curriculum based on 34% theoretical education, 26% preclinical skills training, and 40% clinical education and 86% agreed with a duration of 5 years. Finally, the respondents also illustrated the dynamic nature of dentistry including a reduction of amalgam fillings, a shift from individual practice to group practices, an increased administrative load, and more assertive patients. Conclusion: Findings in the present study suggest the validation of the proposed competences for graduating European dentists within the clinical reality of dental professionals in daily practice. Nevertheless, the results have also demonstrated heterogeneity regarding gender and age within the dentist population and emphasised a continuously evolving dental profession and required competences. Hence, to maintain high quality of dental care, a strategy should be developed in which dental curricula are continuously benchmarked against an evolving clinical reality. [ABSTRACT FROM AUTHOR]

Introduction: For open and endoscopic inguinal hernia surgery, it has been demonstrated that low-volume surgeons with fewer than 25 and 30 procedures, respectively, per year are associated with significantly more recurrences than high-volume surgeons with 25 and 30 or more procedures, respectively, per year. This paper now explores the relationship between the caseload and the outcome based on the data from the Herniamed Registry.Patients and Methods: The prospective data of patients in the Herniamed Registry were analyzed using the inclusion criteria minimum age of 16 years, male patient, primary unilateral inguinal hernia, TEP or TAPP techniques and availability of data on 1-year follow-up. In total, 16,290 patients were enrolled between September 1, 2009, and February 1, 2014. Of the participating surgeons, 466 (87.6 %) had carried out fewer than 25 endoscopic/laparoscopic operations (low-volume surgeons) and 66 (12.4 %) surgeons 25 or more operations (high-volume surgeons) per year.Results: Univariable (1.03 vs. 0.73 %; p = 0.047) and multivariable analysis [OR 1.494 (1.065-2.115); p = 0.023] revealed that low-volume surgeons had a significantly higher recurrence rate compared with the high-volume surgeons, although that difference was small. Multivariable analysis also showed that pain on exertion was negatively affected by a lower caseload <25 [OR 1.191 (1.062-1.337); p = 0.003]. While here, too, the difference was small, the fact that in that group there was a greater proportion of patients with small hernia defect sizes may have also played a role since the risk in that group was higher. In this analysis, no evidence was found that pain at rest [OR 1.052 (0.903-1.226); p = 0.516] or chronic pain requiring treatment [OR 1.108 (0.903-1.361); p = 0.326] were influenced by the surgeon volume. As confirmed by previously published studies, the data in the Herniamed Registry also demonstrated that the endoscopic/laparoscopic inguinal hernia surgery caseload impacted the outcome. However, given the overall high-quality level the differences between a "low-volume" surgeon and a "high-volume" surgeon were small. That was due to the use of a standardized technique, structured training as well as continuous supervision of trainees and surgeons with low annual caseload. [ABSTRACT FROM AUTHOR]

Background: Health care organizations need to be responsive to the needs of increasingly diverse patient populations. We compared the contents of six publicly available approaches to organizational responsiveness to diversity. The central questions addressed in this paper are: what are the most consistently recommended issues for health care organizations to address in order to be responsive to the needs of diverse groups that differ from the majority population? How much consensus is there between various approaches?Methods: We purposively sampled six approaches from the US, Australia and Europe and used qualitative textual analysis to categorize the content of each approach into domains (conceptually distinct topic areas) and, within each domain, into dimensions (operationalizations). The resulting classification framework was used for comparative analysis of the content of the six approaches.Results: We identified seven domains that were represented in most or all approaches: organizational commitment, empirical evidence on inequalities and needs, a competent and diverse workforce, ensuring access for all users, ensuring responsiveness in care provision, fostering patient and community participation, and actively promoting responsiveness. Variations in the operationalization of these domains related to different scopes, contexts and types of diversity. For example, approaches that focus on ethnic diversity mostly provide recommendations to handle cultural and language differences; approaches that take an intersectional approach and broaden their target population to vulnerable groups in a more general sense also pay attention to factors such as socio-economic status and gender.Conclusions: Despite differences in labeling, there is a broad consensus about what health care organizations need to do in order to be responsive to patient diversity. This opens the way to full scale implementation of organizational responsiveness in healthcare and structured evaluation of its effectiveness in improving patient outcomes. [ABSTRACT FROM AUTHOR]

Despite the significant emphasis placed on incorporating 21st century skills into the educational framework, particularly at the primary level, recent scholarly works indicate considerable variation in the implementation of these skills across different countries and regions, suggesting a demand for further research specifically focusing on primary education. The indications of the Digicomp framework and 21st-century skills in Europe have outlined the key competences for lifelong learning needed for all citizens, including teachers and students. In this perspective, Education plays a fundamental role in ensuring that citizens acquire the required skills. The objective in the common European framework is clear: to initiate a transition from the culture of knowledge to the culture of competence. Nowadays, technological advancement allows the researchers to create and combine different frameworks with the perspective of an even more tailored, and engaged education, some examples derived from the implementation of Virtual Reality (VR) and Augmented Reality (AR), in the combination of Gamification and AI, or the development of Intelligent Tutoring Systems (ITS) to foster and create an even more personalized learning and teaching. Following these premises, in this paper, we want to point out new research reflections and perspectives that could help researchers, teachers, educators (and consequently students) to reflect on the introduction of new technologies (e.g., artificial intelligence, robot tutors) and on how these can affect on human behavioral development and on the acquisition of new skills and competences (Specifically: Creativity, Critical Thinking, Problem Solving, and Computational Thinking) for the educational context. The analysis carried on, suggests a perspective on how creativity, critical thinking, and problem-solving can be effective in promoting computational thinking, and how Artificial Intelligence (AI) could be an aid instrument to teachers in the fostering of creativity, critical thinking, and problem-solving in schools and educational contexts. • Point out new research reflections and perspectives on the introduction of new; technologies (e.g., artificial intelligence, robot tutors) in educational context; • Outline activities and lines of research on Creativity, Critical Thinking, Problem Solving, and Computational Thinking; • Propose solutions to be able to implement AI and new technologies for the development of skills in human behavior; • Suggestions for implementing technologies in the school context; • The fundamental role of the network of schools in the European context. [ABSTRACT FROM AUTHOR]

Background: Aim of Com.HeNet is among others to identify competences which are needed to implement and manage a health network on regional level in European countries. Description: All participating countries have used the same method for data gathering. Templates in terms of method guidelines were developed and used uniformly. First, a structured literature search was conducted to gather data regarding circumstances, structures and challenges in relation to RHNM. Relevant existing papers, reports and officially released documents from public facilities or e.g. reports from governmental authorities have been included. Grey literature from online websites and resources were also accessed. The second method represents semi-structured guided expert interviews. The interview guideline was developed by European experts (n = 10) from divers fields e.g. Public Health, Sport science and Management. Afterwards pre-testing the interview guideline, relevant experts and stakeholders from diverse fields, were interviewed e.g. Public Health, Health Promotion, clinical services, politics, practitioners or research. Overall n = 33 interviews were carried out [Austria = 5, Bulgaria = 5, Germany = 5, Hungary =5, Spain= 6, Poland =7]. Afterwards the interviews have been transcribed and analysed. The statements were evaluated in a structured and summarizing analysis for homogeneity / diversity / quantity of the various opinions. All results were incorporated in a uniform predefined template (competence profile). Conclusions: Semi-structured/ guided interviews represent a suitable method to gather data in terms of required competences for health network management. Desktop research / literature search is appropriate to support the qualitative data gathering. [ABSTRACT FROM AUTHOR]

Management of critically ill patients is changing due a rise in population age, comorbidity and complexity. To accommodate these changes, the demand is increasing for advanced practice nurses. More knowledge is needed regarding the role of advanced practice critical care nurses in European countries. The aim of the study was to review the literature describing skills and competencies required for advanced practice critical care nursing in Europe and to investigate related policy. We performed a scoping review including papers published in 1992–2019 targeting policy and the intersection of advanced practice nursing (level of practice), critical care nursing (specialty area) and Europe (geographical origin). Main sources of evidence were PubMed, EMBASE, PsycINFO, CINAHL, Cochrane Library, SweMed+, Scopus, ERIC and Social Sciences Citation Index. We also searched grey literature, webpages, reference lists and performed hand-search. The search identified 11,478 papers/references of which 42 were included. Four levels of practice were identified with unclear boundaries: professional nurse, specialized nurse, advanced practice nurse and advanced critical care practitioner (nurse or other). Most skills and competencies described in the literature were generic to advanced practice and only few were area specific to critical care. Advanced practice critical care nurses were often unable to fulfil their role because education, supportive policy and legislation were lacking. This scoping review informs the policy makers and the INACTIC study of existing advanced practice in critical care nursing in Europe. The advanced role in critical care nursing is characterized by inconsistency regarding policy, education, titles, roles, scope of practice, skills and competencies. Levels of practice and areas of specialization need to be clarified. Most skills and competencies identified were generic for advanced practice nursing and many were generic for any profession. Task-shifting from physician to nurse needs to be more clearly defined and patient outcomes described. Given the scarcity of papers in our target area, we believe it might be too early to conduct a systematic review at this time. [ABSTRACT FROM AUTHOR]

Objective: European harmonisation of training standards in postgraduate medical education in Obstetrics and Gynaecology is needed because of the increasing mobility of medical specialists. Harmonisation of training will provide quality assurance of training and promote high quality care throughout Europe. Pan-European training standards should describe medical expertise outcomes that are required from the European gynaecologist. This paper reports on consensus development on the medical expertise outcomes of pan-European training in Obstetrics and Gynaecology.Study Design: A Delphi procedure was performed amongst European gynaecologists and trainees in Obstetrics & Gynaecology, to develop consensus on outcomes of training. The consensus procedure consisted of two questionnaire rounds, followed by a consensus meeting. To ensure reasonability and feasibility for implementation of the training standards in Europe, implications of the outcomes were considered in a working group thereafter. We invited 142 gynaecologists and trainees in Obstetrics & Gynaecology for participation representing a wide range of European countries. They were selected through the European Board & College of Obstetrics and Gynaecology and the European Network of Trainees in Obstetrics & Gynaecology.Results: Sixty people participated in round 1 and 2 of the consensus procedure, 38 (63.3%) of whom were gynaecologists and 22 (36.7%) were trainees in Obstetrics & Gynaecology. Twenty-eight European countries were represented in this response. Round 3 of the consensus procedure was performed in a consensus meeting with six experts. Implications of the training outcomes were discussed in a working group meeting, to ensure reasonability and feasibility of the material for implementation in Europe. The entire consensus procedure resulted in a core content of training standards of 188 outcomes, categorised in ten topics.Conclusion: European consensus was developed regarding the medical expertise outcomes of pan-European training in Obstetrics and Gynaecology. The outcomes will be described in core trainings standards, aimed at harmonising training in Obstetrics and Gynaecology in Europe to promote high quality care. [ABSTRACT FROM AUTHOR]

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Users show a growing interest in expanding the implementation of digital tools as a support of technical and management issues in healthcare. This medical care has focused on telemedicine but does not include the recognition of needs as an important part of patient-centred healthcare. Nurses interact with patients at critical times in their life journeys, including birth and death, which are historical events linked with religious beliefs. Furthermore, large migration flows have led to multicultural societies in which religion and spirituality are experienced in distinct ways by different people. Finally, most healthcare professionals lack the proper skills to handle the spiritual needs of their patients, especially for core and digital competences. This article shows the results of qualitative research applying as a research tool an open-ended questionnaire, which allows detecting the educational needs for nurses' interventions aimed at providing spiritual support to their patients using digital tools. The results obtained reveal that nurses need education and training on fundamental spiritual concepts and digital competencies to meet the multiple demands of their patients' spiritual needs. Finally, we present an open digital educational proposal for the development of competencies for nurses and other health professionals to provide spiritual care with the support of digital tools. [ABSTRACT FROM AUTHOR]

As competency-based curricula get increasing attention in postgraduate medical education, Entrustable Professional Activities (EPAs) are gaining in popularity. The aim of this survey was to determine the use of EPAs in anesthesiology training programs across Europe and North America. A survey was developed and distributed to anesthesiology residency training program directors in Switzerland, Germany, Austria, Netherlands, USA and Canada. A convergent design mixed-methods approach was used to analyze both quantitative and qualitative data. The survey response rate was 38% (108 of 284). Seven percent of respondents used EPAs for making entrustment decisions. Fifty-three percent of institutions have not implemented any specific system to make such decisions. The majority of respondents agree that EPAs should become an integral part of the training of residents in anesthesiology as they are universal and easy to use. Although recommended by several national societies, EPAs are used in few anesthesiology training programs. Over half of responding programs have no specific system for making entrustment decisions. Although several countries are adopting or planning to adopt EPAs and national societies are recommending the use of EPAs as a framework in their competency-based programs, few are yet using these to make "competence" decisions. [ABSTRACT FROM AUTHOR]

Aims: This study aimed to explore mentoring competence in nursing student mentors during clinical practice by identifying different mentor profiles and connections between different competence areas among five European countries and Japan. Methods: The study implemented a cross‐sectional design in Finland, Italy, Lithuania, Slovenia, Spain, and Japan during 2016 and 2019. In total, 6208 mentors were invited, and 1862 participated from 58 healthcare organizations. The data were collected with a survey questionnaire by including background question items with the Mentor Competence Instrument. K‐clustering and structural equation modeling were used for data analysis. Results: Four mentor profiles, A (43%), B (30%), C (18%), and D (9%), were identified according to the seven mentoring competence areas with high statistical significance (p < 0.001). Higher mentoring competence (mean >3.50) was observed among Finnish, Lithuanian, and Slovenian mentors with university education in nursing, older ages, more work experience, and previous education in mentoring. Lower competence (mean <2.49) was observed among Japanese and Italian mentors with diplomas in nursing, younger ages, less work experience, and no previous education in mentoring. Conclusion: Mentoring requires motivated, highly competent mentors since mentoring is a critical aspect of nursing education. Mentoring roles should be given to nurses with higher education and mentoring training. Younger, less experienced nurses without formal mentoring training may need support from senior nurses when performing mentoring roles and could also facilitate a more balanced workload between patient care and mentoring for senior nurses. [ABSTRACT FROM AUTHOR]

Aims: To describe the mentoring competence of clinical practice nurse mentors and identify different mentor profiles. Design: Cross‐sectional research design, secondary analysis. Methods: An international, cross‐sectional study design was performed in five European countries. A total of 1 604 mentors from 33 healthcare organizations participated in the study between 2016–2019. The Mentors' Competence Instrument (MCI), which includes seven sub‐dimensions and 44 items, was used to collect data. K‐means cluster and binary regression analyses were performed to detect mentor profiles and determine how various factors affect competence, respectively. Results: The K‐means cluster analysis identified three distinct profiles: A (n = 926); B (n = 566); and C (n = 85). The profiles showed significantly different values (p <.001) across all seven areas of mentoring competence. In comparison with the other profiles, nurses in profile A were older, had more work experience and were more probably to have completed mentoring‐specific training. [ABSTRACT FROM AUTHOR]

Pediatrics and society are closely related. This link is as old as the history of Pediatrics, and dates to the second half of the eighteenth century. The vocation of the first European pediatric schools, indeed, was clinical and scientific, as well as social. The founding fathers of Pediatrics were scientists of great talent, and many of them benefactors and philanthropists. They spent their lives assisting the suffering childhood, and became promoters and organizers of social securities for the poorest and most vulnerable categories. The attention to the problems of abandonment was closely linked to study, prevention, and treatment of pathologies (especially infectious, deficiency and neurological ones). The profile and activity of pediatricians grew in the following decades after the birth of the first pediatric schools. The University institutions contributed to provide a further impulse to childcare as well as cultural authority, also thanks to the foundation of the first chairs and scientific journals of Pediatrics. The relevance and prestige of the studies performed rapidly spread throughout Europe, and also reached our country, contributing to a progressive and relevant improvement in the quality of children's care, and in the meantime to the decrease of neonatal and infant mortality rates. Today's pediatricians, as in the past, must spend his efforts to face the needs of children and their families, be their social receptor, interpreter if necessary, and credible and authoritative interlocutor beside institutions. The current coronavirus pandemic dramatically exposed social inequalities and inequities. In this new scenario, the pediatrician's role of defender of all children becomes even more necessary and indispensable. Here we trace the historical steps which led to the birth and development of pediatrics, as independent medical discipline with ethical and social vocation. Its rise within the University institutions is analyzed, as well as the contribution of the greatest European and Italian masters. Finally, the role of today's pediatrician is described, his responsibilities also in dealing with new health critical issues, related to the biological, cultural, and psychological changes of the patients of present days. He must have holistic competences, to effectively take care of all children. In addition, he must socially act to guarantee the best possible context for the well-being of the child. [ABSTRACT FROM AUTHOR]

The purpose of this study was to explore nursing students' perceptions of their final clinical learning environment and its association with their self‐assessed competence, satisfaction with nursing education, and turnover intentions at graduation in six European countries. A multi‐country comparative cross‐sectional study was conducted with nursing students (n = 1746) from the Czech Republic, Finland, Italy, Portugal, Slovakia, and Spain using the Nurse Competence Scale and the Clinical Learning Environment and Supervision scale. Nursing students' overall perceptions of their final clinical learning environment and supervision were positive in all the countries studied. The correlation between the students' perceptions of their final clinical learning environment and competence was statistically significant and positive. Satisfaction with the nursing program and clinical practicum and no consideration of career change were related to positive perceptions of the final clinical learning environment. Highlighting the importance of the supervisory relationship and pedagogical atmosphere, nursing students' positive perceptions of the final clinical learning environment and supervision contribute to a better level of self‐assessed competence and satisfaction with the nursing program and clinical practicum, leading to lower turnover intentions. [ABSTRACT FROM AUTHOR]

A group of 22 medical educators from different European countries, gathered in a meeting in Utrecht in July 2019, discussed the topic of learning analytics (LA) in an open conversation and addressed its definition, its purposes and potential risks for learners and teachers. LA was seen as a significant advance with important potential to improve education, but the group felt that potential drawbacks of using LA may yet be under-exposed in the literature. After transcription and interpretation of the discussion's conclusions, a document was drafted and fed back to the group in two rounds to arrive at a series of 10 caveats educators should be aware of when developing and using LA, including too much standardized learning, with undue consequences of over-efficiency and pressure on learners and teachers, and a decrease of the variety of 'valid' learning resources. Learning analytics may misalign with eventual clinical performance and can run the risk of privacy breaches and inescapability of documented failures. These consequences may not happen, but the authors, on behalf of the full group of educators, felt it worth to signal these caveats from a consumers' perspective. [ABSTRACT FROM AUTHOR]

Assessment in competency-based dental education continues to be a recognized area for growth and development within dental programs around the world. At the joint American Dental Education Association (ADEA) and the Association for Dental Education in Europe (ADEE) 2019 conference, Shaping the Future of Dental Education III, the workshop on assessment was designed to continue the discussion started in 2017 at the ADEA-ADEE Shaping the Future of Dental Education II.1 The focus of the 2019 conference involved examining the potential of entrustable professional activities (EPAs) and current thinking about workplace-based assessment (WBA) within competency-based education in the 21st century. Approximately 30 years ago, George Miller wrote about the assessment of competence in medical education and challenged faculty to reach for higher levels of assessment than knowledge or skill.2 Acknowledging that no one assessment method can result in a valid assessment of competence, Miller proposed a four-level framework for assessment. The lowest level involves measuring what students know ("knows"), followed by assessment of the skill with which knowledge is applied in relevant tasks or problems ("knows how"). Next is an assessment of task performance in standardized settings ("shows how"), and finally, the highest level assesses the student's performance in the unstandardized clinical workplace ("does"). The 2019 assessment workshop focused on advances in the assessment of learners in the unstandardized workplace-the highest level of Miller's assessment pyramid ("does"). Research has shown that dental education has struggled to implement assessment strategies that meet this level.3 The workshop brought together individuals from around the world, with an interest in assessment in dental education, to consider how assessment in the "does" level, specifically EPAs and WBA, factors into competence assessment in dentistry/dental education. [ABSTRACT FROM AUTHOR]

Summary: The growing number of medical procedures performed in children that require cooperation of patients, lack of movement, anxiolysis or/and analgesia triggers the increased need for procedural sedation. This document presents the consensus statement of the European Society for Paediatric Anaesthesiology about the principles connected with the safe management of procedural sedation and analgesia (PSA) by anaesthesiologists for elective procedures in children. It does not aim to provide a legal statement on how and by whom PSA should be performed. The document highlights that any staff taking part in sedation of children must be appropriately trained with the required competencies and must be able to demonstrate regularly that they have maintained their knowledge, skills and clinical experience. The main goal of creating this document was to reflect the opinions of the community of the paediatric anaesthesiologists in Europe regarding how PSA for paediatric patients should be organized to make it safe. [ABSTRACT FROM AUTHOR]

Adapting and providing quality services for people as they age is a common challenge across Europe. The perspective of older people is fundamental in a person-centred care approach. Expanding research at the European level that explicitly includes their views can offer a relevant contribution to the development of evidence-based guidelines that can be shared in education and training across health and social care professions. This study aimed to identify common meaningful dimensions of professional competence in health and social care emphasised by older people from six countries in different regions of Europe according to their experiences. A qualitative approach was chosen with a total of 95 semi-structured interviews conducted in Austria, Finland, Lithuania, Portugal, Turkey and UK, following a common topic guide. Participants in this study were aged 60 and above, and recruitment considered age, gender, level of education and living arrangements. Results identified a set of universal skills and practices that according to older people, health and social care professionals should meet. Competences at the interpersonal level were central in older people's discourses, and its core dimensions are anchored in relational, communication and socio-emotional skills of professionals. These findings reinforce the aspiration of establishing best practices in care that relies on the harmonisation of a competence framework that can be shared in the training and education of health and social care professionals across Europe and that voices older people's preferences, expectations and needs. [ABSTRACT FROM AUTHOR]

Background: Substantial variations are still to be found in the strength of general practice/family medicine (GP/FM) across Europe regarding governance, workforce competence and performance, as well as academic development and position. Governments are encouraged by the WHO to secure high quality primary health care to their population, a necessity for reaching the goal "Health for all". The present study aimed at investigating the opinions of council members of the European Academy of Teachers in General Practice (EURACT) on necessary actions to strengthen the position of GP/FM in their country. Methods: The study used a mixed methods exploratory sequential design. EURACT representatives from 32 European countries first participated in brain-storming on how to strengthen GP/FM in Europe. Later, representatives from 37 countries were asked to individually score the relevance of the proposed actions for their country on a 9-point Likert scale. They were also asked to evaluate the status of GP/FM in their country on four dimensions. Results: Respondents from 30 European countries returned complete questionnaires. To build and secure GP/FM as an academic discipline comprising teaching and research was seen as essential, regardless the present status of GP/FM in the respective country. To build GP/FM as a specialty on the same level as other specialties was seen as important in countries where GP/FM held a strong or medium strong position. The importance of common learning objectives and a defined bibliography were stated by respondents from countries where GP/FM presently has a weak position. Conclusions: In order to strengthen GP/FM throughout Europe, EURACT and other professional organizations must establish common goals and share expertise between countries. To influence decision makers through information on cost-effectiveness of a GP/FM-based health care system is also important. [ABSTRACT FROM AUTHOR]

Introduction Pediatric surgery is essential for the surgical treatment of children in Europe and is generally a well-accepted specialty in Europe. There are still limited data on the training conditions within the European national associations of pediatric surgery. Materials and Methods A questionnaire designed by the executive committee of UEMS Section of Pediatric Surgery was distributed among all ordinary and associated UEMS members, which have national pediatric surgical associations, and to Russia. These questionnaires were completed by colleagues of the national associations and returned to the authors. Results In this study, 29 out of 37 (78%) national associations of pediatric surgery answered the questionnaire. In 90% of these countries, pediatric surgery is a distinct specialty. Training usually starts with a common surgical trunk (75%) of 1 to 2 years; the whole training lasts ~ 6 years. Nonsurgical parts of the training, such as pediatrics, are part of the training program in 54% of countries. The content of the training comprises general pediatric surgery and newborn surgery in all countries, pediatric surgical oncology and pediatric urology in most countries, and pediatric traumatology and pediatric neurosurgery only in some countries. More than 90% of countries use a training logbook, and 79% require a final examination. The European Board of Pediatric Surgery exam is recognized only in 54% of the countries. Conclusion This study reveals that a uniform training schedule in pediatric surgery throughout Europe has not been achieved. This situation mandates urgent attempt to harmonize both training curricula and final exams at European level. [ABSTRACT FROM AUTHOR]

This study explores whether there is a common core of competencies in European gerontology education programs by doing a cross-comparison of five undergraduate-level programs. Content analysis of competency profile documents at the five European educational programs were studied using thematic analysis. Study results document that there indeed is a common core of elements in gerontological educational programs. Three clusters which included a total of 15 categories were identified. The clusters were labeled professional attitude, communication skills, and service provision. Clusters and categories varied across the five programs. One program in particular included fewer clusters and categories. This may reflect a difference in focus in the program but could also reflect a less elaborately formulated competency profile document. The results of this study show that, at least at the level of formulating competencies, there is a strong agreement on the major components that are important for a gerontologist at the undergraduate level. [ABSTRACT FROM AUTHOR]

Aim The aim was to assess the potential trends in Periodontology and Periodontics in Europe that might be anticipated by the year 2025, using the Delphi method. Material and Methods The expert opinion of 120 experts was sought through the use of an open-ended questionnaire, developed by an advisory group, containing 40 questions concerning the various trends in periodontology. Results The experts (113 responders) expect a stabilization of the prevalence of periodontitis, both for the chronic as well as the aggressive cases, but an increase in implant-related diseases up to the year 2025. Concurrently, the importance of implants is seen to be increasing. They foresee an increased demand for postgraduate periodontology and implantology training. This is mirrored in an increase in publications for implant dentistry and increase in demand and need for training. Concerning the patients, better-informed individuals seeking more routine check-ups are expected. Conclusion A continued need for specialized periodontists, but also well trained dental practitioners is foreseen for next decade in Europe. Apart from periodontology they will be increasingly exposed to and trained in implant dentistry. [ABSTRACT FROM AUTHOR]

Aim: To examine the activities and concerns of critical care nurses and professional critical care nursing organizations around the world and to identify expectations held of nursing leaders and policy makers to help address their concerns. Background: This study is the fourth worldwide review of its type. Previous surveys were undertaken in 2001, 2005 and 2009. Methods: An online descriptive survey was emailed to 88 potential participants from countries with critical care nursing organizations or known critical care nursing leaders. Responses were downloaded into Survey Monkey™ (Version 22) and analysed by geographical region and income level. Results: Fifty ‐ nine respondents from 58 countries completed the questionnaire, of whom 43 had critical care nursing organizations established in their countries and 29 were members of the World Federation of Critical Care Nurses. The services provided by the organizations to be of most value were national conferences, website, professional representation, and practice standards and guidelines. Professional policies had been developed by some organizations on workforce, education and practice, while almost half provided their members with either a newsletter or journal. Collectively, the most important issues for critical care nurses were working conditions, provision of formal practice guidelines and competencies, staffing levels and access to quality education programmes. Conclusions: Important issues continue to challenge the specialty of critical care nursing as new developments, priorities, clinical issues and other global events and influences impact critical care nursing worldwide. Implications for Nursing and Health Policy: This study will help guide nursing leaders and policy makers to address the needs of critical care nurses and their patients. Collaborative approaches between the specialty, nursing leaders and health policy advisors will assist to inform appropriate change in areas recommended for further action. [ABSTRACT FROM AUTHOR]