Training in Pediatric Surgery - A Comparison of 24 Countries in Europe and Other Countries Around the World

Abstract

What is the training in pediatric surgery like, how is pediatric surgery defined in other countries and what are the possibilities of quality control for training in pediatric surgery? The results of an inquiry together with information about training in pediatric surgery in 24 countries are summarised to show the different possibilities of organising training in pediatric surgery inside and outside Europe. The number of trainees in pediatric surgery (ranging from 0 to 339 trainees per country), the density of pediatric surgeons (ranging from 424 to 35 714 live births/year per pediatric surgeon) and the number of Centres of Pediatric Surgery (ranging from 4167 to 65,000 live births or 450,000 to 5,300,000 inhabitants per Centre) varies a lot in the different countries. Countries with a higher density of pediatric surgeons often also have a higher number of trainees irrespective of the birth rate and the number of inhabitants within the country, indicating a good infrastructure for pediatric surgery. In 87.5 % of the countries pediatric surgery is recognised as a specialty. The mean duration of training is about 6 years and 3 months, excluding the countries where it is necessary to become a fully accredited general surgeon before doing pediatric surgery. The mean duration of stay in general surgery is 2 years and 10 months. In one third of the countries it is obligatory to spend some time (3 to 12 months) in pediatrics. An elective or a compulsory period of time (1 - 6 months) in other specialties such as orthopedic surgery, plastic and reconstructive surgery, thoracic surgery and urology exists in 41.7 % of the nations. The most common subspecialties within pediatric surgery practised during the training by the resident are abdominal surgery, thoracic surgery, oncological surgery, head and neck surgery and urology. Possible means of control to guarantee a high quality of training include a defined time of stay in each subspecialty, the number of operations done by the trainee or the number of cases treated by the resident in the respective subspecialty and the distinction of different levels of surgery done by the trainee during his residence. In many cases the type of control is not specified.

Opinions of the Pediatric Surgery Specialists in Turkey on Ultrasonography (USG) Training

“…Türkiye'de bu kadar çok cerrahi ve dahili branşın eğitiminde radyoloji rotasyonu olması-na rağmen çocuk cerrahisi eğitiminde bulunmamaktadır. Dünyaya bakıldığında da, Ortadoğu, Avrupa ve Amerika gibi diğer ülkelerdeki çocuk cerrahlarının yazılı eğitim müfredatlarında, özellikle radyoloji rotasyonu ya da USG eğitiminin olmadığı görülmekte-dir (3)(4)(5)(6) . Radyoloji rotasyonu olan branşların pratikte USG yapamıyor olmaları, aksine radyoloji rotasyonu olmayan kadın doğum uzmanlarının USG becerileri düşünüldüğünde müfredata yalnızca USG eğitiminin eklenmesinin yeterli olmayacağı düşünülebilir.…”

Frontiers in Pediatric Urology – Specialty Grand Challenge

“…In the US, rotations in pediatric urology are mandatory in the course of training in urology so that a few individuals become interested in pursuing further training. In contrast in Europe, many trainees in urology have minimal or no exposure to pediatric urology whereas many pediatric surgery training programs include rotations in urology (11). …”

Consistency and quality in written accreditation protocols for pediatrician training programs: a mixed-methods analysis of a global sample, and directions for improvement

“…One major best practice guide for postgraduate medical education (PGME) was published by the WFME in 2015 and revised in 2023 via a consensus-based approach among global medical education experts [ 7 , 8 ]. Some work has been done looking at variability in accreditation of surgical training programs [ 9 , 10 ], and a 2021 scoping review in LMICs examined barriers to implementation of the separate undergraduate WFME accreditation standards. Challenges at the undergraduate level included leadership and governance, engagement of students as stakeholders, and curricular development [ 11 ].…”