Skip to main content

Main menu

  • Home
  • Current issue
  • ERJ Early View
  • Past issues
  • Authors/reviewers
    • Instructions for authors
    • Submit a manuscript
    • Open access
    • COVID-19 submission information
    • Peer reviewer login
  • Alerts
  • Podcasts
  • Subscriptions
  • ERS Publications
    • European Respiratory Journal
    • ERJ Open Research
    • European Respiratory Review
    • Breathe
    • ERS Books
    • ERS publications home

User menu

  • Log in
  • Subscribe
  • Contact Us
  • My Cart

Search

  • Advanced search
  • ERS Publications
    • European Respiratory Journal
    • ERJ Open Research
    • European Respiratory Review
    • Breathe
    • ERS Books
    • ERS publications home

Login

European Respiratory Society

Advanced Search

  • Home
  • Current issue
  • ERJ Early View
  • Past issues
  • Authors/reviewers
    • Instructions for authors
    • Submit a manuscript
    • Open access
    • COVID-19 submission information
    • Peer reviewer login
  • Alerts
  • Podcasts
  • Subscriptions

A harmonised European training syllabus for thoracic surgery: report from the ESTS/ERS task force group

Gilbert Massard, Nathalie Tabin, Sharon Mitchell, Hasan Batirel, Alessandro Brunelli, Stefano Elia, Anna Frick, Martin Huertgen, Antoon Lerut, Laureano Molins, Kostas Papagiannopoulos, Dragan Subotic, Paul van Schil, Gonzalo Varela, Dirk van Raemdonck
European Respiratory Journal 2018 51: 1800370; DOI: 10.1183/13993003.00370-2018
Gilbert Massard
1Dept of Thoracic Surgery, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Nathalie Tabin
2European Respiratory Society, Lausanne, Switzerland
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Sharon Mitchell
2European Respiratory Society, Lausanne, Switzerland
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Hasan Batirel
3Dept of Thoracic Surgery, Marmara University Hospital, Istanbul, Turkey
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Alessandro Brunelli
4Dept of Thoracic Surgery, St James's University Hospital, Leeds, UK
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Stefano Elia
5Dept of Thoracic Surgery, University of Rome Tor Vergata, Rome, Italy
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Anna Frick
6Dept of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Martin Huertgen
7Clinic of Thoracic Surgery, Catholic Clinic Koblenz-Montabaur, Koblenz, Germany
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Antoon Lerut
6Dept of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Laureano Molins
8Dept of Thoracic Surgery, Hospital Clinic and Sagrat Cor, University of Barcelona, Barcelona, Spain
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Kostas Papagiannopoulos
4Dept of Thoracic Surgery, St James's University Hospital, Leeds, UK
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Dragan Subotic
9Dept of Thoracic Surgery, University Hospital Basel, Basel, Switzerland
10Clinic for Thoracic Surgery, Clinical Center of Serbia, Belgrade, Serbia
11School of Medicine, University of Belgrade, Belgrade, Serbia
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Paul van Schil
12Dept of Thoracic and Vascular Surgery, Antwerp University Hospital and Antwerp University, Antwerp, Belgium
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Gonzalo Varela
13School of Medicine, Salamanca University, Salamanca, Spain
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Dirk van Raemdonck
6Dept of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Info & Metrics
  • PDF
Loading

Abstract

A harmonised European training syllabus for thoracic surgery is now available http://ow.ly/xQMP30iZ50E

As has been reported for respiratory medicine, a high variance exists among European countries in the content and modes of delivery for specialty training in thoracic surgery. According to a survey by the Union Européenne des Médecins Spécialistes (UEMS; European Union of Medical Specialists) section of thoracic surgery conducted in 2013, disparities begin at the certifying body level: the specialist diploma is delivered by the ministry of health in half of the countries, and by various other authorities in the remaining countries [1]. Additionally, the designation of the specialty differs considerably: in 13 countries, thoracic surgery is practised as a monospecialty; in eight countries, it is combined with cardiac surgery; and in two countries (Belgium and Luxembourg), the designation does not exist.

Divergence also exists in length and content of training programmes. While the median duration is 6 years, the range extends from 5 years (e.g. in Spain and Italy) to 10 years (in Switzerland) [1]. Exposure to pure thoracic surgery during training ranges from 2 to 5 years [1]. Exposure to cardiac surgery is evidently mandatory in countries preparing for a cardiothoracic diploma. However, in those countries where thoracic surgery is a monospecialty, inclusion of exposure to cardiac surgery into the curriculum is not always mandatory.

An additional conflicting question pertains to the number of operations to be performed as an operating surgeon during the training period. Since its inception, the European Board of Thoracic Surgery mandates 100 operations, which is slightly below the median number of 120 operations required in the UEMS member states (albeit a median based on a significantly large range, 35–560 operations). Indeed, there are at present nine countries that have yet to define a minimal requirement of surgical experience.

Lastly, the number of officially recognised training programmes is subject to high variability, ranging from one per 0.6 million to one per 6.1 million inhabitants (median of one per 1.6 million). The immediate consequence is that dissimilar training curricula and competence profiles add to language barriers and adversely interfere with mobility of healthcare professionals throughout Europe. Furthermore, uneven qualification of professionals may also lead to inequity of quality of care offered to patients.

The European Respiratory Society (ERS) made a pioneering step towards harmonisation of specialist training in Europe when launching the HERMES (Harmonised Education in Respiratory Medicine for European Specialists) initiative in 2006. Under the HERMES initiative, ERS established a strong curriculum design methodology, which has been used across ERS projects by task forces. Considering the disparities in training of pulmonary physicians, the first ERS task force defined a harmonised curriculum for training in adult respiratory medicine [2, 3], and a yearly examination in adult respiratory medicine has been conducted since 2008 [4]. Several satellite projects in subspecialties have followed, such as paediatric respiratory medicine [5], sleep medicine [6], critical care [7], infectious diseases [8] and thoracic oncology [9].

Given the disparity of training in thoracic surgery, but also because of an existing UEMS/European Board of Thoracic Surgery examination evolving without consensual definition of prerequisites, the need for a curriculum design task force was obvious. The European Society of Thoracic Surgeons (ESTS) were offered the opportunity to cooperate with ERS and to set up a task force group at the end of 2014, co-chaired by Dirk Van Raemdonck and Gilbert Massard. The partnership between ESTS and ERS has been largely effective. While ESTS has a clear vision on training issues in thoracic surgery, ERS masters the Delphi methodology, which has been successfully applied to eight curriculum design task forces prior to the present project. The latter begins with a problem statement, followed by the successive steps of defining a syllabus, describing the training curriculum, developing an examination, and accrediting training programmes.

The task force group has now published the recently acquired consensual European syllabus for thoracic surgery in the European Journal of Cardio-Thoracic Surgery [10]. The syllabus is presented in three parts. Part 1 contains the fundamentals, which a trainee should master at the beginning of their training; part 2 is dedicated to the knowledge of the diseases and disorders; and part 3 summarises operative skills. The task force elected to separate pure knowledge and operative skills for the sake of clarity, as the learning processes differ and, indeed, both are required to train a competent thoracic surgeon.

Some complexities stemmed from areas that are not practised in every unit, such as oesophageal surgery, paediatric thoracic surgery and lung transplantation. The latter modules were rated as “optional” by the subsequent Delphi rounds, while the core substance of the specialty is allocated to mandatory modules.

The target audience for this syllabus is primarily the European thoracic surgical trainee; however, the syllabus is also a guide for continuous professional development. Some modules may be useful to other specialty training programmes: for instance, modules concerning the oesophagus may be used by upper gastrointestinal specialists, and modules concerning paediatric thoracic surgery may be interesting for paediatric surgeons. Recent experience has demonstrated that curriculum design intended for the European continent may also find interested parties in North America [11, 12]!

Adequate training is crucial to prepare younger colleagues for safe, independent practice. There are numerous cases reported of missing training items that are exposed in the early years of autonomy [13, 14]. For this reason, we invited a Junior Member Representative (Anna Frick) into the ESTS committee for learning affairs, to take on an active role in the task force.

The present syllabus is a multifunctional tool. Chiefly, it serves for the ongoing curriculum design, which encompasses knowledge, psychomotor skills, professional attitudes, learning outcomes and modes of assessment. The task force is currently in the process of dissemination to national scientific and professional societies, with the goal of introducing a road map for the training programme to both learners and teachers. Obviously, the mandatory modules represent the prerequisite for the European Board of Thoracic Surgery examination.

In the future, online training programmes may be organised in accordance with the syllabus; such programmes are proving to be of interest for residents with intermediate learning progress [15]. Nonetheless, we should be aware that, despite any existing guidelines or regulations, there may remain differences in the content of training between programmes or between individuals in the same programme [16, 17]. Moreover, and undoubtedly, the challenge of the future of any teacher or training programme is represented by the rapid advances in the innovation of medical treatments and incoming technology [18].

Footnotes

  • Conflict of interest: N. Tabin is an employee of the European Respiratory Society.

  • Conflict of interest: S. Mitchell is an employee of the European Respiratory Society.

  • Conflict of interest: H. Batirel reports receiving honoraria from Johnson and Johnson, outside the submitted work.

  • Received January 19, 2018.
  • Accepted February 21, 2018.
  • Copyright ©ERS 2018

References

  1. ↵
    1. Depypere LP,
    2. Lerut AE
    . Thoracic surgical training in Europe: what has changed recently? Ann Transl Med 2016; 4: 89.
    OpenUrl
  2. ↵
    1. Loddenkemper R,
    2. Séverin T,
    3. Eiselé JL, et al.
    HERMES: a European Core Syllabus in Respiratory Medicine. Breathe 2006; 3: 59–69.
    OpenUrlAbstract/FREE Full Text
  3. ↵
    1. Loddenkemper R,
    2. Haslam PL,
    3. Séverin T, et al.
    European Curriculum Recommendations for Training in Adult Respiratory Medicine. Breathe 2008; 5: 80–93.
    OpenUrlFREE Full Text
  4. ↵
    1. Loddenkemper R,
    2. Haslam PL
    . Multiple choice and the only answer: the HERMES examination. Breathe 2008; 4: 242–248.
    OpenUrlFREE Full Text
  5. ↵
    1. Gappa M,
    2. Noël JL,
    3. Séverin T, et al.
    Paediatric HERMES: a European Syllabus in Paediatric Respiratory Medicine. Breathe 2009; 5: 236–247.
    OpenUrlFREE Full Text
  6. ↵
    1. De Backer W,
    2. Simonds A,
    3. Horn V, et al.
    Sleep HERMES: a European Core Syllabus in respiratory disorders during sleep. Breathe 2011; 8: 61–68.
    OpenUrlFREE Full Text
  7. ↵
    1. Artigas A,
    2. Pelosi P,
    3. Dellweg D, et al.
    Respiratory critical care HERMES syllabus: defining competencies for respiratory doctors. Eur Respir J 2012; 39: 1294–1297.
    OpenUrlFREE Full Text
  8. ↵
    1. Niculescu A,
    2. Noël JL,
    3. Aliberti S, et al.
    Introducing a new HERMES project on respiratory infections. Breathe 2016; 12: 5–7.
    OpenUrlAbstract/FREE Full Text
  9. ↵
    1. Gamarra F,
    2. Noël JL,
    3. Brunelli A, et al.
    Thoracic oncology HERMES: European curriculum recommendations for training in thoracic oncology. Breathe 2016; 12: 249–255.
    OpenUrlAbstract/FREE Full Text
  10. ↵
    1. Massard G,
    2. Tabin N,
    3. Mitchell S, et al.
    A harmonized European training syllabus for thoracic surgery: report from the ESTS-ERS task force. Eur J Cardiothorac Surg 2018; in press [https://doi.org/10.1093/ejcts/ezy206].
  11. ↵
    1. Massard G,
    2. Antonoff MB,
    3. Noel JL, et al.
    Transatlantic editorial: thoracic surgeons need recognition of competence in thoracic oncology. J Thorac Cardiovasc Surg 2017; 154: 1387–1392.
    OpenUrl
  12. ↵
    1. Groth SS,
    2. Burt BM
    . Subspecialty certification in thoracic oncology: toward your next diploma. J Thorac Cardiovasc Surg 2017; 154: 1393–1394.
    OpenUrl
  13. ↵
    1. Chu D,
    2. Vaporciyan AA,
    3. Iannettoni MD, et al.
    Are there gaps in current thoracic surgery residency training programs? Ann Thorac Surg 2016; 101: 2350–2355.
    OpenUrl
  14. ↵
    1. Kraev A,
    2. Merritt-Genore H
    . Hello from the other side: what I wish I'd done differently in training. J Thorac Cardiovasc Surg 2017; 153: 1434–1436.
    OpenUrl
  15. ↵
    1. Antonoff MB,
    2. Verrier ED,
    3. Allen MS, et al.
    Impact of moodle-based online curriculum on thoracic surgery in-training examination scores. Ann Thorac Surg 2016; 102: 1381–1386.
    OpenUrl
  16. ↵
    1. Stephens EH,
    2. Walters DM,
    3. Eilers AL, et al.
    Variability in integrated cardiothoracic training program curriculum. Ann Thorac Surg 2017; 103: 1984–1991.
    OpenUrl
  17. ↵
    1. Stephens EH,
    2. Robich MP,
    3. Walters DM, et al.
    Gender and cardiothoracic surgery training: specialty interests, satisfaction, and career pathways. Ann Thorac Surg 2016; 102: 200–206.
    OpenUrl
  18. ↵
    1. Robich MP
    . The most important lessons I learned in training. J Thorac Cardiovasc Surg 2017; 154: 1015–1016.
    OpenUrl
PreviousNext
Back to top
View this article with LENS
Vol 51 Issue 6 Table of Contents
European Respiratory Journal: 51 (6)
  • Table of Contents
  • Index by author
Email

Thank you for your interest in spreading the word on European Respiratory Society .

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
A harmonised European training syllabus for thoracic surgery: report from the ESTS/ERS task force group
(Your Name) has sent you a message from European Respiratory Society
(Your Name) thought you would like to see the European Respiratory Society web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Print
Citation Tools
A harmonised European training syllabus for thoracic surgery: report from the ESTS/ERS task force group
Gilbert Massard, Nathalie Tabin, Sharon Mitchell, Hasan Batirel, Alessandro Brunelli, Stefano Elia, Anna Frick, Martin Huertgen, Antoon Lerut, Laureano Molins, Kostas Papagiannopoulos, Dragan Subotic, Paul van Schil, Gonzalo Varela, Dirk van Raemdonck
European Respiratory Journal Jun 2018, 51 (6) 1800370; DOI: 10.1183/13993003.00370-2018

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero

Share
A harmonised European training syllabus for thoracic surgery: report from the ESTS/ERS task force group
Gilbert Massard, Nathalie Tabin, Sharon Mitchell, Hasan Batirel, Alessandro Brunelli, Stefano Elia, Anna Frick, Martin Huertgen, Antoon Lerut, Laureano Molins, Kostas Papagiannopoulos, Dragan Subotic, Paul van Schil, Gonzalo Varela, Dirk van Raemdonck
European Respiratory Journal Jun 2018, 51 (6) 1800370; DOI: 10.1183/13993003.00370-2018
del.icio.us logo Digg logo Reddit logo Technorati logo Twitter logo CiteULike logo Connotea logo Facebook logo Google logo Mendeley logo
Full Text (PDF)

Jump To

  • Article
    • Abstract
    • Footnotes
    • References
  • Info & Metrics
  • PDF
  • Tweet Widget
  • Facebook Like
  • Google Plus One

More in this TOC Section

  • Should we rewrite the natural history and prognosis of pulmonary Langerhans cell histiocytosis?
  • The importance of collecting relevant samples to understand complex diseases
  • Sing out for COPD!
Show more Editorials

Related Articles

Navigate

  • Home
  • Current issue
  • Archive

About the ERJ

  • Journal information
  • Editorial board
  • Reviewers
  • Press
  • Permissions and reprints
  • Advertising

The European Respiratory Society

  • Society home
  • myERS
  • Privacy policy
  • Accessibility

ERS publications

  • European Respiratory Journal
  • ERJ Open Research
  • European Respiratory Review
  • Breathe
  • ERS books online
  • ERS Bookshop

Help

  • Feedback

For authors

  • Instructions for authors
  • Publication ethics and malpractice
  • Submit a manuscript

For readers

  • Alerts
  • Subjects
  • Podcasts
  • RSS

Subscriptions

  • Accessing the ERS publications

Contact us

European Respiratory Society
442 Glossop Road
Sheffield S10 2PX
United Kingdom
Tel: +44 114 2672860
Email: journals@ersnet.org

ISSN

Print ISSN:  0903-1936
Online ISSN: 1399-3003

Copyright © 2022 by the European Respiratory Society