EFSUMB Newsletter
EFSUMB Newsletter European Federation of Societies for Ultrasound in Medicine and Biology
Education and Professional Standards Committee (EPSC)
What is the EPSC? „Naděje není přesvědčení, že něco dopadne dobře, nýbrž jistota, že něco má smysl, lhostejno jak to dopadne“ Václav Havel
Jan Tuma
„Hope is not the conviction that something will turn out well, but the certainty that something is meaningful, no matter how it turns out“ Václav Havel
The EPSC maintains, together with the Executive Bureau, Publications Committee and Safety Committee, the EFSUMB website. Thus, EPSC has been publishing since 2006 together with other authorities of EFSUMB a number of recommendations and guidelines http://www.efsumb. org/guidelines/guidelines01.asp of which “Minimum Training Recommendations for the Practice of Medical Ultrasound in Europe” has 15 chapters. Many of the recommendations and guidelines are reflective of our general professional level but still have not become part of the daily routines of most teachers and trainers of ultrasound in Europe. In practice, however, only a few teachers use these guidelines. A bylaw regulating “Euroson Schools” was recently modified and thus allowed significant expansion of quality educational ultrasound programs into many countries. Euroson Schools have already been organised and carried to completion in Germany, England, France, Italy, Austria, Denmark, and Norway, as well as in Romania, Slovak and Czech Republic, Croatia, Slovenia and Latvia. This year we have had our first school in Greece and also one in Switzerland later this year... We think that EPSC and even EFSUMB are currently facing decisive steps. Either we popularize learning initiatives across Europe so that they gradually become an integral part of education in each country, or remain a “paper tiger” or rather an
“electronic tiger”, which hangs in the Internet, but otherwise is actually useless ... In our opinion, it is necessary to carry out the following steps in the near future:
Integration of European sonographic courses ▼▼
In the same way that the “Ultraschall in der Medizin “ became the basis of the “European Journal of Ultrasound,” the “Course Curriculum” of abdominal ultrasound courses OEGUM, DEGUM and SGUM http://www.efsumb.org/euroson-sch/es -home.asp should become the basis for the common European platform of ultrasound courses. The Harmonisation Commission of OEGUM, DEGUM and SGUM agreed to this curriculum in 2010 and decided that it would be supplemented and improved every 3 years. It is now possible to offer this curriculum to other European ultrasound societies and invite delegates of these societies to participate in and extend the harmonisation commission, to introduce this course curriculum in their countries and to actively take part in its continuous improvement. This will lay the foundation for a pan-European ultrasound educational system that will continue to expand and adapt to the needs of practices. Each national society will thus be able to organize basic, advanced and final abdo-
minal courses in the form of “Endorsed Courses” (EFSUMB BYLAW No. 11) in their national language. These courses should then be marked with the official logo, the “EFSUMB Endorsed Course” so that when the trainee pays a set fee for this accredited course, a certain amount of the fee (similar to the accreditation fees in Germany, Austria and Switzerland) will be received by a national ultrasound society and a small part by EFSUMB, thereby financially providing for further integration, harmonisation and development of European ultrasound education. In the same way that OEGUM, DEGUM and SGUM mutually recognize certain courses, it must be obvious that harmonised courses in other European countries would have mutual recognition. The common textbook for these courses “EFSUMB Course Book” is available on the internet http://www.efsumb.org/ecb/ecb-01.asp.
e-learning ▼▼
E-learning is a buzz word, but also something we take very seriously and try to implement together with the Executive Bureau and Publications Committee of EFSUMB. Besides CEUS EUROSON-schools, whose lectures are being filmed, we plan also live demonstrations on patients, as well as live internet discussions with experts.
EFSUMB Lynne Rudd 36 Portland Place, London W1B 1LS, United Kingdom Tel: +44 (0) 20 7099 7140 Fax: +44 (0) 20 7436 7934 Email: efsumb@efsumb.org
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EFSUMB Newsletter European Centres of Excellence ▼▼
In addition to common courses, we need to do more to integrate ultrasound training in Europe. Every beginner learns to investigate not only within the courses, but also during a systematic practical training. And no matter whether you’ve confirmed that you’ve completed the required number of investigations under didactically experienced teachers, additional controlling of your investigations in the department where you practice is rarely possible. It is therefore essential to define and establish learning “European Centres of Excellence in UItrasound” (ECEUS), able to ensure quality in practical training. The ECEUS should be defined by a minimum frequency of annual investigations as well as a guarantee of expert quality at the centre. In practice, the ECEUS could be gradually recognised by local societies, medical chambers, or state authorities; in short, those who are responsible for overseeing the teaching of ultrasound in the country. Even though we know it will not be easy to introduce this educational system in Europe, the ramifications will be meaningful and extensive. Courses in countries that accede to this model will be recognised in all other countries based on this model. Ultrasound training will gradually become so transparent that each candidate will be able to attend courses and practical training in all countries of the model.
Teaching ultrasound at the University ▼▼
Ultrasound diagnosis has become a modern stethoscope for each clinician. The function of the stethoscope is to equip a medical student with a device for learning during the first clinical semester. Although both the U.S. and Europe have included ultrasound diagnostics in the teaching curriculum of medical students at universities, it has been implemented with timid steps. Medical students at European universities first learn the function of ultrasound devices at the time of studying for the state exams. Occasionally, students may attempt to take an ultrasound probe into their own hands. But the training of ultrasound as an integral part of the curriculum is needed. Students are not taught how to make detailed ultrasound diagnosis in various diseases until it is time for postgraduate training. But the point of the use of the ultrasound device
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should be as obvious as a stethoscope. It could thus be considerably more enjoyable teaching anatomy and physiology with this device so that the student would not have to learn on corpses and frog legs, but rather with their living classmates using ultrasonic devices. Students should already have learned to use the device during their studies of knobology and be motivated to use this technique throughout their studies and even more intensively during their practice. Instead of leaving the advancement of ultrasound teaching to specialist societies we need to promote practical and theoretical ultrasound education at the university level, preferably in support of inter-
disciplinary ultrasound societies and their Federation EFSUMB. Ultrasound would thus be able to be, a few million years after the bat and dolphin, quite common place for man as well. Associate Prof. Jan Tuma, Chairman of EPSC Members Prof. Dieter Nürnberg Prof. Gebhard Mathis Prof. Hilde Berner Hammer, Prof. Radu Badea Dr Vito Cantisani Assoc Prof František Záťura
Euroson
Future Schools
▶▶In collaboration with the Working Group Interventional Ultrasound of DEGUM the second EFSUMB EUROSON-School ‚Interventional Ultrasound` will take place from 10 – 13 May 2012 in Berlin. The intensive course is designed to provide the basis for sonographic intervention and mediation of interventional techniques that are performed using ultrasound as an imaging method. ▶▶Course organisers: Prof. Dieter Nürnberg (Neuruppin), Prof. Klaus Schlottmann (Unna) and all speakers would appreciate your participation. For more information, visit www.efsumb.org
▶▶International course in CEUS University Hospital Basel, Switzerland June 29–30, 2012 ▶▶Course organisers: Dr. Daniel Weiss, Dr. Joachim Hohmann Course secretary: Claudia Miescher miescherc@uhbs.ch Registration fee EUR 250 For course details visit www.efsumb.org
▶▶Microbubble ultrasound imaging course 25–26 June 2012 The Holyrood Hotel Edinburgh This 2 day meeting will aim to present the most significant applications and advances in the various fields of clinical diagnostic and interventional use of Contrast Enhanced Ultrasound (CEUS) in the evaluation of various organs. CME points applied for. ▶▶For more information please contact Mr Behzad Mokri psycy1@hotmail.com
EFSUMB Newsletter
▶▶S. Orsola-Malpighi Hospital, Bologna, Italy 10–12 September 2012 Course organisers: Fabio Piscaglia, Carla Serra and Mirko D’Onofrio ▶▶Topics will include clinical issues in liver and gastro-intestinal diseases and comparative role of multiple imaging modalities. Practical teaching will be held in small groups (max. 4–5 participants per group). Visit www.efsumb.org
▶▶The EFSUMB Course Book on Ultrasound, edited by Christoph F Dietrich, is now published. Prof. Luigi Bolondi writes that that the book „fills the gap of learning material about the basic core of ultrasound [and] written by the greatest international experts is beautifully illustrated, but nonetheless extremely cheap“. Order your copy at 60 € (plus P&P) via the EFSUMB website www.efsumb.org
Ultrasound education
A Major Step For Medical Student Education In the last decade, ultrasound examination has undergone extremely interesting technological developments. The range of procedures has diversified, the classic two-dimensional ultrasound technology has evolved into 3D/4D technology, and Doppler ultrasound has been complemented by image processing procedures. Intravenous contrast ultrasound examination is rapidly expanding and elastography has become a standard method in many clinical applications. Endocavitary ultrasound is the most efficient imaging procedure in detecting small and deep lesions. Simultaneously, newer smaller, portable, and even miniaturized equipment has appeared. There is also the idea of connecting the transducers to smartphones. The technology of wireless transmission of ultrasound information is being developed. Ultrasound examination is available in extreme situations such as in an ambulance, helicopter or even outer space. Similarly, the range of clinical applications has diversified a lot, going through a process of clinical integration. Ultrasound is now accessible to all medical specialties, the only condition being a structured training in order to obey the rules of good governance and practice. Despite the great progress that the method has gone through, it still remains operator-dependent. Obviously, knowing the basic principles of ultrasound and assimilating a specific language are important elements that enhance this procedu-
Radu Badea
re as an imaging diagnostic entity. The integration of clinical data and understanding the situations when „ultrasound helps the clinical diagnosis“ are complimented by situations in which „clinical diagnostic helps validate the ultrasound image“. Education in ultrasound is perhaps more important than other imaging techniques. This concept is well understood and applied by EFSUMB (European Federation of Societies for Ultrasound in Medicine and Biology). But what could be the impact of the use of ultrasound in medical schools? This is a challenge worth considering! Ultrasonography can be an educational „tool“ in medicine. Heartbeat, normal and pathological blood flow, fetal activity, digestive dynamics are physiological events that could be better explained using ultrasound. There is anatomical information that can be illustrated using ultrasound and can sometimes be more useful to the medical student than the dissection of a corpse. Classical semiology could be com-
plemented by ultrasound methods in order to complete the patient‘s physical examination. Then, once the relationship between the medical student and the patient is set, ultrasound becomes the diagnostic tool integrated in the clinical judgment. Further, there is the clinically integrated feature and the value of the ultrasound method as part of the elementary clinical gestures: inspection, palpation, percussion, auscultation and, why not, „sonographic visualization“. The medical student must finally consider ultrasound as a natural step of his medical examination. The same goes for the resident physician. How can this goal be achieved? First, medical schools prove that the concept is both modern and natural. Evidence is needed and medical literature started publishing extremely encouraging experiences. The students involved in such projects are very content, they feel the acceleration of the educational process and the teachers confirm this. There is need for restructuring or curricular additions. One must understand that 21st century medicine allows education by means of imaging and ultrasound may be at the forefront of this concept. It requires the use of simulators in order to help exercise ultrasound guided invasive gestures. Simple, miniaturized equipment is needed for teaching. Therefore, the support of the companies producing this equipment is necessary. What else can be done? Organizing conferences on educational topics focused on ultrasound; Involving medical students; ▶▶ Organizing student sessions in addition to national and international ultrasound conferences; ▶▶ Training courses for the education of the students; ▶▶ Identifying medical schools interested in participating in such projects; ▶▶ Developing models to be followed, exchanging in order to increase the quality and efficiency of teaching. EFSUMB proposes an addition to the educational paradigm addressed to medical students by introducing ultrasound on all levels of training. It is a good step for the method and even better for medical practice. Prof. Radu Badea, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj Napoca, Romania rbadea@umfcluj.ro
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