The historical roots of the European Union lie in the Second World War. Europeans were determined to prevent such killing and destruction from ever happening again. Soon after the war, Europe was split into East and West as the 40-year-long Cold War began. West European nations created the Council of Europe in 1949. It was a first step towards cooperation between them, but six countries wanted to go further. As of 1950, the European Coal and Steel Community began to unite European countries economically and politically in order to secure lasting peace. The six founding countries were Belgium, France, Germany, Italy, Luxembourg and the Netherlands. In 1957, the Treaty of Rome created the European Economic Community (EEC), or ‘Common Market’. But Europe was still a politically divided continent with striking asymmetries in the quality of medical care delivered to the various populations. Medical specialist training was completely different and regulated by each country individually.
In 1971 the European Association of Neurosurgical Societies (EANS) was founded in Prague. One of the main concerns of the founding fathers was to improve the quality of neurosurgical education in Europe because there was a clear disparity in the quality of training in the various countries of Europe. This was at least in part due to different educational methods and different ways of assessing what had been accomplished during the training. The primary goal of a training programme is to provide the trainee with a broad knowledge base, the necessary operative and procedural skills and experience, as well as the professional judgement for independent neurosurgical practice. Further goals are to teach the trainee self-criticism, critical assessment of his/her results, and the ability for self-directed learning which will eventually lead to continued growth, expert practice, and professionalism.
In the 1970s, the EANS Training Courses were established - an annual 4-day course during 4 consecutive years covering the main topics of neurosurgery (Head injury/functional/ spine/oncology/vascular/peripheral nerves). Participants were trainees from all EANS member societies. Initially this course was run once a year but the number of applicants increased steadily; 15 years ago a second course cycle was added, and this year a third course cycle started. We now offer a spring course, a summer course and a winter course cycle. The excellence of the courses and their scientific and social value is acknowledged throughout the neurosurgical community.
In order to obtain optimum benefit from the courses, it is recommended that new candidates be in their third or fourth year of specialist training. Applicants who are successful are automatically admitted for the full 4 years and must attend 4 consecutive courses in their cycle. Applicants must have a high level of both written and spoken English, and all trainees must attend the course unaccompanied. The European Exam is compulsory for all fourth-year trainees (unless they have already passed it). It is taken at the training course site the day before the start of the fourth training course.
The second important development was the European Directive 93/16 EEC from April 5th, 1993 towards medical specialist training in Europe. Each medical specialty had a charter within the UEMS (Union of European Medical Specialists). For Neurosurgery this was developed under the leadership of Prof. Reulen who became the chairman of the Joint Residency and Advisory and Accreditation Committee (JRAAC). It defined the principles of teaching in a structured training programme, the surgical training plan, and the position and responsibilities of the training programme director and the teaching staff. It described the problem-based learning during residency and the tutorial process for training and education in neurosurgery, the necessity for a research rotation in a trainee’s curriculum as well as the periodic progress evaluation process and the accreditation of the training centres. The European Neurosurgical Log-Book was established and has been adopted throughout Europe. (For detailed information see: (1) Training in Neurosurgery in the countries of the EU: a guide to organize a training programme. H-J Reulen (editor), Springer Verlag, 2004; (2) Neurosurgical Training. UEMS charter on training of medical specialists in the EU – the neurosurgical training charter (as of February 2007), Acta Neurochir (Wien) (2007) 149: 843–855).
Harmonisation of neurosurgical training throughout Europe has been established through standards of training and monitoring, and centralized registration of approval of neurosurgical training programmes in the EU and associated countries. This is done by the JRAAC. National professional bodies (responsible for the recognition of medical specialists in individual countries) can monitor and recognize neurosurgical training programmes using UEMS standards based on the training charter.
Professor Andre Grotenhuis
President of European Association of Neurosurgical Societies (EANS)