BioMed Central World Journal of Emergency Surgery ss Open AcceCommentary Isn't it time to start speaking about "European surgeons"? Federico Coccolini*1 and Daniel Lazzareschi2 Address: 1General, Emergency and Transplant Unit, Sant'Orsola-Malpighi University Hospital, Bologna, Italy and 2University of Berkeley, Berkeley, CA, USA Email: Federico Coccolini* - fedecocco@iol.it; Daniel Lazzareschi - vascolazz@calmail.berkeley.edu * Corresponding author Abstract Background: Emergency surgery has become a neglected specialization in Europe and in many other parts of the world. In certain medical fields, emergency surgery isn't even considered an autonomous specialization. However every emergency surgeon must have a good formation in General Surgery but exist huge disparities between different European surgical formative systems. Methods: An analysis of the main problems of the European surgical formative system was conducted. Results: This discrepancy between formative systems is absolutely unacceptable and presents a notable hazard for the European Union, considering that surgical certifications are reciprocally recognized between programs within all European Union states. Conclusion: Considering the increasing possibilities to move inside the European Union, is necessary to improve the European surgical formative system to warrant an uniform formation for all surgeons. Commentary In the January issue of your journal there was an editorial [1] denouncing the grave problem regarding many sur- geons' insufficient preparation when faced with emer- gency surgeries. Emergency surgery has become a neglected specialization in Europe and in many other parts of the world. In certain medical fields, emergency surgery isn't even considered an autonomous specializa- tion. The flawed logic behind this idea is that every sur- geon, skilled and proficient in his or her specific field of expertise, should also be capable of operating normally in the high stress environment of emergency surgery. How- ever, this assertion is incontrovertibly false; this problem must be addressed, beginning with the restructuring of training programs for young surgeons. Both general sur- gery training and emergency surgery specialization must be crafted to better prepare surgeons for emergency inter- ventions. Furthermore, every emergency surgeon should have substantial experience in general surgery before spe- cializing. The stark disparities between different European surgical formative systems are becoming increasingly distinct and recognizable. There are 27 individual countries in the European Union (EU), each of which having a distinctly different formative program. Some of these systems pro- vide young surgeons with satisfactory theoretical and practical instructional backgrounds for the emergency sur- gery field. However, other less fortunate formative sys- tems lack the support and training opportunities necessary to foster competent surgeons. If research were to be conducted, the results would inevitably demonstrate Published: 25 July 2009 World Journal of Emergency Surgery 2009, 4:27 doi:10.1186/1749-7922-4-27 Received: 26 May 2009 Accepted: 25 July 2009 This article is available from: http://www.wjes.org/content/4/1/27 © 2009 Coccolini and Lazzareschi; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Page 1 of 2 (page number not for citation purposes) http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Abstract&list_uids=19630987 http://www.wjes.org/content/4/1/27 http://creativecommons.org/licenses/by/2.0 http://www.biomedcentral.com/ http://www.biomedcentral.com/info/about/charter/ World Journal of Emergency Surgery 2009, 4:27 http://www.wjes.org/content/4/1/27 Publish with BioMed Central and every scientist can read your work free of charge "BioMed Central will be the most significant development for disseminating the results of biomedical researc h in our lifetime." Sir Paul Nurse, Cancer Research UK Your research papers will be: available free of charge to the entire biomedical community peer reviewed and published immediately upon acceptance cited in PubMed and archived on PubMed Central yours — you keep the copyright Submit your manuscript here: http://www.biomedcentral.com/info/publishing_adv.asp BioMedcentral that the most stagnant and inflexible systems exist where there is the least amount of opportunities to learn and practice as a developing surgeon. This is common sense and hardly newsworthy, but it has dramatic implications for those dedicated and capable individuals who wish to improve their surgical skills, yet are hindered by such dys- functional preparatory systems. The main problem is that certain systems do not mandate a minimum theoretical and practical understanding of a given field, whether ini- tially during general surgery exercises or later during spe- cialization. This instructional laxity is absolutely unacceptable and presents a notable hazard for the EU, considering that surgical certifications are reciprocally rec- ognized between programs within all EU states. Every high-risk endeavour requires uniform preparation and training for its respective operatives, just as it is for the standardized emergency protocols regarding airports and airplanes. In this way, standardized courses of action are indoctrinated, thereby encouraging sensible responses when stressful environments prevent one from making calm, calculated decisions on an individual basis. Every- one would benefit from a unified system throughout the EU, one that has been scrupulously cross-examined by dif- ferent parties to ensure high treatment standards. This could only be achieved by actively preparing medical stu- dents, the future doctors of tomorrow, for such a signifi- cant institutional transition. One of the main problems of the aforementioned "lax sys- tem" is the absolute, incontestable authority conferred to its directors, a jurisdiction that can never be effectively challenged or disputed by surgeons in training. Further- more, surgical students cannot choose between programs. Young impressionable surgeons are often forced to remain in the same facility for the duration of the forma- tive program without having the opportunity to experi- ence different systems and techniques, even if the instruction they receive is clearly inadequate. There is no independent oversight governing these programs and consequently no one is ever truly held accountable. Often, the very instructors themselves are the only individuals that scrutinize performance reviews, consider suggestions, or investigate complaints. The EU as an institution has already experienced great political and economic success by embracing the poorer European states alongside their wealthier counterparts, thereby spreading prosperity across the continent. But what about cultural, formative, and scientific discrepan- cies? Shouldn't these be acknowledged as well? Why is it so difficult to continue taking innovative steps in this direction to pioneer a uniform system for medical stu- dents? There are many people ready and willing to make this transition; they need only the support of academic institutions and the ability to demonstrate the transition's effectiveness in an international context throughout the EU. Why don't we rally for a uniform European formative program to standardize the different systems, choosing the best qualities from each of them? Why don't we sup- port an efficient and user-friendly exchange program for young surgeons who desire to broaden their professional and cultural horizons? Why don't we allow individuals to freely choose certain features of one's program, thereby creating a personalized curriculum that more closely reflects the needs and interests of a given student? Why don't we mandate that every young surgeon change his or her hospital at least once during their course of study to widen their professional perspectives? Perhaps these aren't the only solutions, but maybe they could begin to reinvigorate these stagnant systems, better preparing young surgeons both during general surgery training and later during specialization. Competing interests As a Resident Surgeon and as a Student both willing to learn as much as possible to improve our theoretical and surgical skills, we tried to give our contribution to the improvement of a perfectible formative system. The authors declare that they have no financial competing interests Authors' contributions Both authors gave substantive intellectual contributions to the elaboration of the article. F.C. resumed and elabo- rated the information from the different European forma- tive systems. D.L. played an essential role on the evaluation of the information and on the definitive draft of the article. All authors read and approved the final manuscript. References 1. Catena F, Moore E: Emergency surgery, acute care surgery and the boulevard of broken dreams. World Journal of Emergency Sur- gery 2009, 4:4. Page 2 of 2 (page number not for citation purposes) http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Abstract&list_uids=19178687 http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Abstract&list_uids=19178687 http://www.biomedcentral.com/ http://www.biomedcentral.com/info/publishing_adv.asp http://www.biomedcentral.com/ Abstract Background Methods Results Conclusion Commentary Competing interests Authors' contributions References