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Purpose: European training pathways for surgeons dedicated to treating severely injured and critically ill surgical patients lack a standardized approach and are significantly influenced by diverse organizational and cultural backgrounds. This variation extends into the realm of mentorship, a vital component for the holistic development of surgeons beyond mere technical proficiency. Currently, a comprehensive understanding of the mentorship landscape within the European trauma care (visceral or skeletal) and emergency general surgery (EGS) communities is lacking. This study aims to identify within the current mentorship environment prevalent practices, discern existing gaps, and propose structured interventions to enhance mentorship quality and accessibility led by the European Society for Trauma and Emergency Surgery (ESTES)., Methods: Utilizing a structured survey conceived and promoted by the Young section of the European Society of Trauma and Emergency Surgery (yESTES), we collected and analyzed responses from 123 ESTES members (both surgeons in practice and in training) across 20 European countries. The survey focused on mentorship experiences, challenges faced by early-career and female surgeons, the integration of non-technical skills (NTS) in mentorship, and the perceived role of surgical societies in facilitating mentorship., Results: Findings highlighted a substantial mentorship experience gap, with 74% of respondents engaging in mostly informal mentorship, predominantly centered on surgical training. Notably, mentorship among early-career surgeons and trainees was less reported, uncovering a significant early-career gap. Female surgeons, representing a minority within respondents, reported a disproportionately poorer access to mentorship. Moreover, while respondents recognized the importance of NTS, these were inadequately addressed in current mentorship practices. The current mentorship input of surgical societies, like ESTES, is viewed as insufficient, with a call for structured programs and initiatives such as traveling fellowships and remote mentoring., Conclusions: Our survey underscores critical gaps in the current mentorship landscape for trauma and EGS in Europe, particularly for early-career and female surgeons. A clear need exists for more formalized, inclusive mentorship programs that adequately cover both technical and non-technical skills. ESTES could play a pivotal role in addressing these gaps through structured interventions, fostering a more supportive, inclusive, and well-rounded surgical community., Competing Interests: Declarations. Conflict of interest: Stefano P. B. Cioffi, Marit Herbolzheimer, Enrico Marrano, Gabriele Bellio, Wouter Kluijfhout, Frans-Jasper Wijdicks and Annika Hättich are founding members of Young ESTES. Jonathan Tilsed is Chair of the UEMS European Board of Surgery Examination in Emergency Surgery. Diego Mariani is the ESTES Chair of Education, Christine Rey Valcarel is Chair of the ESTES Advisory Council. Shahin Mohseni is Chair of the Visceral Trauma Section of ESTES and is a Section Editor for the European Journal of Trauma and Emergency Surgery (EJTES). Carlos Yanez is Chair of the Emergency Surgery Section of ESTES. Jan P.A.M. Verbruggen is Chair of the Skeletal Trauma and Sports Medicine Section, and President-Elect of ESTES. Frank Hildebrand is Vice-Chair of the ESTES Research Committee and Immediate Past-President of ESTES. Christine Gaarder is President of ESTES. Hayato Kurihara is Vice-President of ESTES. Gary Alan Bass is the ESTES Chair of Research and is a Section Editor for EJTES. All other authors declare no competing interests., (© 2024. The Author(s).)

Backgrounds: Team leadership skills of physicians working in high-performing medical teams are directly related to outcome. It is currently unclear how these skills can best be developed. Therefore, in this multi-national cross-sectional prospective study, we explored the development of these skills in relation to physician-, organization- and training characteristics of Helicopter Emergency Medicine Service (HEMS) physicians from services in Europe, the United States of America and Australia., Methods: Physicians were asked to complete a survey regarding their HEMS service, training, and background as well as a full Leader Behavior Description Questionnaire (LBDQ). Primary outcomes were the 12 leadership subdomain scores as described in the LBDQ. Secondary outcome measures were the association of LBDQ subdomain scores with specific physician-, organization- or training characteristics and self-reported ways to improve leadership skills in HEMS physicians., Results: In total, 120 HEMS physicians completed the questionnaire. Overall, leadership LBDQ subdomain scores were high (10 out of 12 subdomains exceeded 70% of the maximum score). Whereas physician characteristics such as experience or base-specialty were unrelated to leadership qualities, both organization- and training characteristics were important determinants of leadership skill development. Attention to leadership skills during service induction, ongoing leadership training, having standards in place to ensure (regular) scenario training and holding structured mission debriefs each correlated with multiple LBDQ subdomain scores., Conclusions: Ongoing training of leadership skills should be stimulated and facilitated by organizations as it contributes to higher levels of proficiency, which may translate into a positive effect on patient outcomes., Trial Registration: Not applicable., (© 2024. The Author(s).)

Understanding the variation in training and nuances of trauma provider practice between the countries in Europe and the United States is a daunting task. This article briefly reviews the key specialties of trauma care in Europe including emergency medical services (EMS), emergency medicine, anesthesia, trauma surgery, and critical care. The authors hope to inform U.S. military clinicians and medical planners of the major differences in emergency and trauma care that exist across Europe. Emergency medicine exists as both a primary specialty and a subspecialty across Europe, with varying stages of development as a specialty in each country. There is heavy physician involvement in EMS in much of Europe, with anesthesiologists having additional EMS training typically providing prehospital critical care. Because of the historical predominance of blunt trauma in Europe, in many countries, trauma surgery is a subspecialty with initial orthopedic surgery training versus general surgery. Intensive care medicine has various training pathways across Europe, but there have been great advances in standardizing competency requirements across the European Union. Finally, the authors suggest some strategies to mitigate the potential negative consequences of joint medical teams and how to leverage some key differences to advance life-saving medical interoperability across the North Atlantic Treaty Organization alliance., (Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2023. This work is written by (a) US Government employee(s) and is in the public domain in the US.)

Introduction: In the context of free movement, EU-citizens need assurance that dental practitioners providing their care have a degree/license to practice that meets EU-standards and that they maintain their knowledge and skills through ongoing education., Aim: One aim of the 'DentCPD' project (HYPERLINK 'http://www.dentcpd.org' www.dentcpd.org) was to identify and agree essential CPD requirements for EU dentists. This paper reports the consensus process and outcomes., Methods: Agreement on core components of CPD was achieved through a three stage process: an online survey of dental educators' (n = 143) views on compulsory topics; a paper-based questionnaire to practitioners (n = 411); leading to a proposal discussed at the Association for Dental Education (ADEE) 2011 Lifelong Learning special interest group (SIG)., Results: From the online survey and practitioner questionnaire, high levels of agreement were achieved for medical emergencies (89%), infection control (79%) and the medically compromised patient (71%). The SIG (34 attendees from 16 countries) concluded that these three CPD topics plus radiation protection should be core-compulsory and three CPD topics should be core-recommended (health and safety, pain management, and safeguarding children & vulnerable adults). They also agreed that the teaching of all topics should be underpinned by evidence-based dentistry., Conclusion: Building four core topics into CPD requirements and making quality-approved education and training available will ensure that all dentists have up-to-date knowledge and skills in topic areas of direct relevance to patient safety. In turn, this will contribute to patients having access to comparably high standards of oral health care across Europe., (© 2013 John Wiley & Sons A/S.)

We tested the hypothesis that application of the principles learned from the European Paediatric Life Support (EPLS) course improves child health assessment and care. In a retrospective study, residents from five paediatric emergency departments were included. For each of them, we analysed five medical records of infants and children suffering from diarrhoea; three were in ambulatory care and two were in-hospital care with IV hydration. Two independent observers analysed the records using a standardized checklist of 14 clinical points, as well as three items to evaluate the adequacy of treatment according to hydration status. Agreement between readers was evaluated the kappa coefficient of concordance. Statistical associations between each item and the EPLS course status was assessed by logistic regression taking into account the clustered data structure. Fifty residents and 240 medical records were included. Twenty-six residents were EPLS trained (intervention group) and 24 residents were not (control group). The results of the analyses of the medical records by the observers were concordant (kappa >0.91). Medical records in the intervention group contained more clinical information on circulatory status (P < 0.0001). Residents in the intervention group prescribed goal-directed therapy more often (P = 0.006). For children with shock, they administered volume resuscitation (P = 0.01) with goal-directed therapy more often (P = 0.003). This is the first evaluation of an educational program focusing on the actions of "learners" in the clinical environment. Our findings highlight that the EPLS course is associated with a better clinical analysis of hydration and circulation status as well as with goal-directed therapy.

Introduction: Emergency medicine is a new academic discipline, as well as a recent independent clinical specialization with the specific principles of practice, education and research. It is also a very important segment of the overall health care and health system. Emergency medicine as a distinct specialty was introduced in the U.S. in 1970. Ten years later and relatively quickly emergency medicine was introduced in the health system in Bosnia and Herzegovina as a specialty with a special education program for specialist and a final exam., Goal: Compare the development of emergency medicine in Bosnia and Herzegovina with the trends of development of this discipline in the world as a specialization and an academic discipline. Identify specific problems and possible solutions and learn lessons from other countries., Methods: Reviewed are the literature data on the development of emergency medicine in the world, programs of undergraduate and postgraduate teaching, the organizational scheme of emergency centers and residency. This is then compared with data of the current status of emergency medicine as an academic discipline and a recognized specialization, in Bosnia and Herzegovina., Results: There are substantial differences in the development of emergency medicine in the United States, European Union and Bosnia and Herzegovina. Although Bosnia and Herzegovina relatively early recognized specialty of emergency medicine in academia, it failed to mach the academic progress with the practical implementation. A&E departments in the Community Health Centers failed to meet the desired objectives even though they were led by specialists in emergency medicine. The main reason being the lack of space and equipment as well as staff needed to meet set standards of good clinical practice, education and research. Furthermore the Curriculum of undergraduate education and specialization does not match modern concept of educational programs that meet the principles set out in emergency medicine and learning through practice., Conclusion: The Development of emergency medicine as a separate specialization and independent academic discipline has had different way and pace of development, and there is no ideal model that can be applied in all countries. However experiences from countries with well developed emergency medicine, suggest that the model of the simultaneous development of emergency medicine as a distinct academic discipline on independent recognized residencies with a strong national association is the best way for the formation of an efficient health system. The establishment of Emergency centers--departments for emergency medicine at university and cantonal hospitals, introduction of emergency medicine as an academic discipline, implementation of specific post-graduate teaching and continuing medical education through appropriate courses, as well as academic development program for the teaching staff is the most important element of future development of this discipline. It would also contribute to it achieving the appropriate status in both the academic institutions and in practice within the health system of Bosnia and Herzegovina.

Throughout the past quarter century, there have been slow but dramatic changes in the nature and practice of trauma surgery, and this field increasingly faces potent economic, logistic, political, and workforce challenges. Patients and emergency physicians have much to lose by this budding crisis in our partner discipline. This article reviews the specific issues confronting trauma surgery, their historical context, and the potential directions available to this discipline. Implications of these issues for emergency physicians and for trauma care overall are discussed.

Objective: To measure the effectiveness of a 9-month emergency medicine 'train the trainers' program in Tuscany, Italy., Methods: A total of 81 physicians with emergency department experience completed a training course in Italy. The course included 120 h of didactic lectures, 700 h of clinical rotations and 30 h of practical workshops. The effect of the training course was measured by written multiple-choice and oral case-simulation examinations, and a precourse and postcourse self-assessment instrument using a four-point Likert scale, to describe the ability to care for different types of emergency medicine patients., Results: Twenty-four physicians completed the course in 2003-2004 and 57 physicians completed the course in 2004-2005. A comparison of an identical examination given as a posttest to the first group and a pretest to the second group demonstrated significant improvement on a 75-question multiple-choice examination (38.7 vs. 46.2 points, P<0.001). Improvement was also seen in oral case examinations, in pediatrics (17.8 vs. 37.3 points, P<0.001) and neurology (24.8 vs. 34.5, P<0.001). In the self-assessment survey, when asked to describe the ability to diagnose and provide initial treatment for several types of patients before and after the course, significant improvement was reported by 13 of 20 participants (65%). When asked to describe the ability to perform a variety of procedures, significant improvement was seen in seven of sixteen (44%)., Conclusions: When measured by written examinations, oral examinations and physician self-assessment, a train the trainers program, designed as part of an international emergency medicine collaboration, was efficacious.

Advanced Trauma Life Support (ATLS) is a concept for rapid initial assessment and primary management of an injured patient, starting at the time of injury and continuing through initial assessment, lifesaving interventions, re-evaluation, stabilization and, when needed, transfer to a trauma centre. Despite some shortcomings, it is the only standardized concept for emergency room management, which is internationally accepted. Because of its simple and clear structure, it is flexible and can be universally integrated into existing emergency room algorithms under consideration of local, regional as well as national and international peculiarities in the sense of a "common language of trauma". Under these aspects ATLS also seems to be a valid concept for Europe.

Over the last 30 years the Advanced Trauma Life Support (ATLS) course has become the most successful training program in the world for the early care of severely injured patients. It has shaped trauma care systems in many countries and is now on the verge of being introduced into Germany by the German Society of Trauma Surgery (DGU). However, after publication of the latest edition in 2004 there are rising concerns regarding the lack of multi-disciplinarity, out-dated contents and lack of adaptability to regional needs. This article questions the beneficial effect of ATLS on the advanced German trauma care system and concludes that ATLS is not likely to improve trauma care in Germany.

Objectives: As part of the I SEE (Interactive Simulation Exercise for Emergencies) project, financially supported by the Leonardo da Vinci Programme 2000-2006 of the European Commission, a study was planned to assess the type of disaster and to establish the tasks to be included in an emergency exercise to be developed, according to the possible target groups, physicians, nurses, ambulance personnel, dispatchers and first responders. A secondary objective was a description of the actual computer-based training situation in the training centres. A study involving different actors or target groups has not yet been conducted., Methods: A questionnaire was developed, validated and subsequently distributed to the training centres for the different target groups in the partner countries. Each partner had to contact and interview the person responsible for the training in disaster medicine in the training institution. Data entry and analysis was carried out using the SPSS software on Apple Macintosh. Apart from descriptive statistics of the variables, differences between groups were analysed using analysis of variance and the Kruskal-Wallis test., Results: In 75 questionnaires out of a total of 206, the combination of a major road traffic accident and a chemical accident was indicated as the first choice (36.4%). These priorities were present for the different countries and all target groups. Concerning the medical procedures to be included in the training exercise, the highest priority was given to medical coordination, medical management on site, medical alert procedures, assessment of immediate needs, medical resources management, victim transport and protection and safety procedures. Only minor differences were noted between countries, different target groups and the institutions irrespective of whether they are involved in response in case of a major accident or disaster. With regard to the secondary objective, 27% of the institutions used computer-based training in disaster medicine and, of those not using computer-based training, 23% plan its use in the near future., Conclusions: The European centres surveyed, put the emphasis for disaster medicine training on a mass casualty scenario. In accordance with this choice, prehospital aspects of medical care and management were considered as priorities for training. The I SEE project will develop a template and pilot exercise, serving all countries and providing team training. Among the institutions involved in the survey, a limited number will be invited to participate in the formative evaluation of the pilot exercise.

Mountain medicine education programs have been described and discussed from several perspectives. A Union Internationale des Associations Alpinistes-Internationale Kommission für Alpines Rettungswesen-International Society for Mountain Medicine (UIAA-IKAR-ISMM) label was defined and subsequently awarded to courses that comply with certain minimal requirements. These courses can award an international UIAA-IKAR-ISMM diploma to their successful candidates. The need for mountaineering training was listed in those minimal requirements, but no exact recommendations were given. A complete analysis of existing mountain medicine education programs in Europe is done, providing information about the practical mountaineering and climbing techniques taught in the different courses and, if applicable, the practical requirements and examinations to obtain the above-mentioned diploma. The analysis clearly shows the widely varying requirements for proficiency in mountaineering and climbing in European mountain medicine courses.

Objective: To record the current standards of management and education in trauma surgery in 12 geographically and socioeconomically diverse countries in Europe., Design: Questionnaire study., Setting: Teaching hospital, Austria., Intervention: Questionnaire sent to experts on trauma in Austria, France, Germany, Italy, The Netherlands, Norway, Portugal, Romania, Spain, Sweden, Turkey, and the United Kingdom., Main Outcome Measure: Comparison of management of patients before, during, and after admission to hospital, and opportunities for initial and in-service training., Results: Management of patients and opportunities for training varied considerably from country to country, ranging from an organised trauma service throughout with specialised training to a haphazard and variable service that depended more on individual hospitals, doctors and patients., Conclusions: Standardisation of management and training would be desirable, and should be possible at least in countries that are members of the European Union.

The perception of emergency medicine as a defined specialty may vary widely in different locations around the world. While no single emergency medical system can fulfil the needs of all countries, there are three main models of delivery: the European model, the Anglo-American model, and the neglect model. This article reviews aspects of emergency medical systems around the world and compares the European and Anglo-American models of emergency care. The current state of emergency medicine in Hong Kong is also presented, including challenges facing the specialty as we enter the 21st century.

Emergency medicine has emerged as a specific medical specialty for 30 years. To be efficient, the emergency clinician frequently needs the contribution of radiological examinations. This is the reason why emergency radiology has emerged as a new radiologic subspecialty. The aim of this paper is to review the recent history of emergency medicine and to summarize the present state of the radiological organisation for emergency care in the Western countries.

The European Academy of Anaesthesiology was founded in 1978 at the time of the introduction of the Medical Directives of the European Union. This article reviews the development of some of the educational work of the Academy including the foundation of its journal, the European Journal of Anaesthesiology. The article also considers in some details the development of the European Diploma in Anaesthesiology and Intensive Care since its inception in 1984 to the present time.

There is a rapidly growing interest in emergency medicine (EM) and emergency out-of-hospital care throughout the world. In most countries, the specialty of EM is either nonexistent or in an early stage of development. Many countries have recognized the need for, and value of, establishing a quality emergency health care system and are striving to create the specialty. These systems do not have to be high tech and expense but can focus on providing appropriate emergency training to physicians and other health care workers. Rather than repeatedly "reinventing the wheel" with the start of each new emergency care system, the preexisting knowledge base of EM can be shared with these countries. Since the United States has an advanced emergency health care system and the longest history of recognizing EM as a distinct medical specialty, lessons learned in the United States may benefit other countries. In order to provide appropriate advice to countries in the early phase of emergency health care development, careful assessment of national resources, governmental structure, population demographics, culture, and health care needs is necessary. This paper lists specific recommendations for EM organizations and physicians seeking to assist the development of the specialty of EM internationally.

Objective: To analyze the status of the teaching of critical care at the postgraduate and undergraduate levels in Europe., Data Sources: Two types of questionnaires were sent in order to collect data. The first questionnaire was sent to the heads of the intensive care units (ICUs) of at least five of the major hospitals in each western country of the European Region of the World Health Organization and to the people responsible for specialist training in the Eastern countries. Countries in the former USSR and former Yugoslavia were excluded; 50 questionnaires (of 105) were returned. The second questionnaire was sent to the 374 medical schools in the European Region; 253 were returned although only 185 were selected for this article., Results: Postgraduate and undergraduate training differ widely in terms of the content of, and disciplines in charge of, the teaching of critical care. Even countries of the World Health Organization's European Region, where critical care is a recognized clinical specialty, do not have an academic discipline of critical care. This lack of an established academic discipline of critical care contributes to the diversity in teaching critical care in medical schools in the countries we studied. Postgraduate training is more formally regulated, and objectives and guidelines have been established in many countries. The topics in medical schools that correspond to critical care medicine do not encompass a distinct body of knowledge and are distributed among more traditional disciplines, most frequently internal medicine, anesthesiology, and surgery. The critical care medicine experience afforded to undergraduates varies widely between and within countries. The repetition of critical care conditions for which patients receive critical care in several disciplines, as described by the responses, leads us to wonder whether these conditions are really included in the curriculum., Conclusions: The standardization of curriculum content on critical care medicine, the clear definition of competence (the combination of knowledge, attitudes, skills, and judgment necessary to practice) in medical schools, and better coordinated postgraduate training are needed to clarify an educational approach in the field. Practitioners of critical care medicine will have to participate actively on curriculum committees. The recognition of critical care medicine as a specialty or subspecialty and as an academic discipline will facilitate the achievement of a comprehensive critical care education program.

A panel session on undergraduate education in Emergency Medicine from a worldwide perspective was conducted at the Seventh World Congress of Emergency and Disaster Medicine in Montreal, in May, 1991. Desmond Colohan MD, of the University of Toronto (Canada) was the panel moderator. Panel speakers were: Louis Binder MD, Texas Tech University Health Services Center (USA); Wolfgang Dick MD, University of Mainz (Germany); Bernard Nemitz MD, Faculty de Medicine d'Ameins (France); Yoel Donchin MD, Hadassa Medical Organization (Israel); and Noriyoshi Ohashi MD, Tsukuba Medical Center (Japan).