Review Article
Phlebology education, training and certification in Europe
Phlebology 2014, Vol. 29(1S) 186–187 ! The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0268355514528136 phl.sagepub.com
Eberhard Rabe1, Alun H Davies2, HA Martino Neumann3 and Cees HA Wittens4
Chronic venous diseases belong to the most frequent diseases in the world. According to recent CEAPbased epidemiological studies approximately 25 % of the adult population suffer from C2 and C3 disease with varicose veins or venous oedema. Approximately 5 % of the population has severe chronic insufficiency with skin changes up to healed or active venous ulcers.1–4 Main risk factors for the development of chronic venous insufficiency are higher age and obesity.5 As the population older than 65 years of age will increase in the European countries up to 2050 and as obesity is a still unsolved problem with a growing proportion in the European societies we have to face a growing number of patients with chronic venous disease. Based on the data of the Bonn Vein Study we will have an increase of varicose veins and CVI of up to 25 % per 1.000 inhabitants until 2050. To manage this problem we need more physicians educated in phlebology who are able to diagnose and treat venous diseases.
Phlebology training in Europe Phlebology is a multidisciplinary speciality which is in parts represented in the education system of vascular surgery, surgery, internal medicine and dermatology. Because of the high prevalence of venous diseases it is also an important issue for general practitioners. They should be able to select patients with signs or symptoms of chronic venous disease for further diagnosis and treatment by venous specialists. Despite the huge number of affected patients phlebology is not a recognized speciality in the European medical system (European Union of Medical Specialists (EUMS)) up to now. In Germany phlebology is a subspeciality for surgeons, internal medical doctors and dermatologists. In Austria and Switzerland phlebology is included in a sub-speciality angiology, which is applicable for internal medicine doctors and dermatologists. In several European countries universitybased specialisations exist with a master study in phlebology or phlebo-lymphology like in Italy, Spain or France. In the future phlebological issues should be
more completely implemented in the curricula of vascular surgery, internal medicine, dermatology and other associated specialities. In addition the authors strongly recommend the recognition of phlebology in the European Union of Medical Specialities as an interdisciplinary sub-group. For this reason the authors have founded the European College of Phlebology (ECoP) in 2012 and applied, at the UEMS, for recognition of phlebology as a multidisciplinary speciality in 2014. Based on the expected recognition by the UEMS as a Multidisciplinary board of Phlebology a European Curriculum in Phlebology and an educational system as a basis for a European Certificate will be implemented. The phlebological training will consist of theoretical and practical parts; it will be a modular system with certified training modules and with a final exam and certification. As a basis for the training curriculum the European College of Phlebology will use the UIPtraining curriculum, which was published in 2010 by a group of international specialists under the auspices of the UIP. It includes anatomy, basic sciences, pharmacology, clinical sciences, diagnostic evaluation, and treatment modalities in phlebology.6 The European phlebological training curriculum and the certification system will be developed in consensus with all involved medical disciplines and societies. The ECoP needs the acceptance and cooperation of the national societies involved in phlebology to succeed and establishing a European phlebological educational system and an accepted European exam in phlebology. The majority of the vascular community has recognized that phlebology is a real challenge for the future 1
Department of Dermatology, University of Bonn, Germany Department of Vascular Surgery, Imperial College London, UK 3 Department of Dermatology, Erasmus MC, Rotterdam, The Netherlands 4 European Venous Centre Aachen-Maastricht, Maastricht University, The Netherlands, Uniklinik Aachen, Germany 2
Corresponding author: Eberhard Rabe, Department of Dermatology, University of Bonn, Sigmund-Freud-Str. 25, 53105 Bonn, Germany. Email: [email protected]
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with growing numbers of patients and it has also been recognized that phlebology must have a multidisciplinary approach. We hope the European Venous Community will work together in the future with the same intention: for a better care of our venous patients! Declaration of conflicting interests All the authors have no conflict of interest and nothing to disclose.
Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
References 1. Rabe E, Pannier-Fischer F, Bromen K, Schuld K, Poncar Ch, Wittenhorst M, Bock E, Weber S and Jo¨ckel KH. Bonner Venenstudie der Deutschen Gesellschaft fu¨r Phlebologie – epidemiologische Untersuchung zur Frage der Ha¨ufigkeit und Auspra¨gung von chronischen Venenkrankheiten in der sta¨dtischen und la¨ndlichen Wohnbevo¨lkerung. Phlebologie 2003; 32: 1–14.
2. Chiesa R, Marone EM, Limoni C, Volonte´ M, Schaefer E and Petrini O. Demographic factors and their relationship with the presence of CVI sigs in Italy. The 24-Cities Cohort Study. Eur J Vasc Endovasc Surg 2005; 30: 674–680. 3. Criqui MH, Jamosmos JM, Fronek AT, Denenberg JO, Langer RD, Bergan J and Golomb BA. Chronic venous disease in an ethnically diverse population. The San Diego Population Study. Am J Epidemiol 2003; 158: 448–456. 4. Jawien A, Grzela T and Ochwat A. Prevalence of chronic venous insufficiency in men and women in Poland: multicenter cross-sectional study in 40095 patients. Phlebology 2003; 18: 110–121. 5. Meissner MH, Gloviczki P, Bergan J, Kistner RL, Morrison N, Pannier F, Pappas PJ, Rabe E, Raju S and Villavicencio JL. Primary chronic venous disorders. J Vasc Surg 2007; 46(Suppl S): 54S–67S. 6. Parsi K, Zimmet S, Allegra C, et al. International Union of Phlebology. Phlebology training curriculum. A consensus document of the International Union of Phlebology (UIP)2010. Int Angiol 2010; 29: 533–559.
Downloaded from phl.sagepub.com at University of Manitoba Libraries on June 19, 2015
Phlebology education, training and certification in Europe
Phlebology 2014, Vol. 29(1S) 186–187 ! The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0268355514528136 phl.sagepub.com
Eberhard Rabe1, Alun H Davies2, HA Martino Neumann3 and Cees HA Wittens4
Chronic venous diseases belong to the most frequent diseases in the world. According to recent CEAPbased epidemiological studies approximately 25 % of the adult population suffer from C2 and C3 disease with varicose veins or venous oedema. Approximately 5 % of the population has severe chronic insufficiency with skin changes up to healed or active venous ulcers.1–4 Main risk factors for the development of chronic venous insufficiency are higher age and obesity.5 As the population older than 65 years of age will increase in the European countries up to 2050 and as obesity is a still unsolved problem with a growing proportion in the European societies we have to face a growing number of patients with chronic venous disease. Based on the data of the Bonn Vein Study we will have an increase of varicose veins and CVI of up to 25 % per 1.000 inhabitants until 2050. To manage this problem we need more physicians educated in phlebology who are able to diagnose and treat venous diseases.
Phlebology training in Europe Phlebology is a multidisciplinary speciality which is in parts represented in the education system of vascular surgery, surgery, internal medicine and dermatology. Because of the high prevalence of venous diseases it is also an important issue for general practitioners. They should be able to select patients with signs or symptoms of chronic venous disease for further diagnosis and treatment by venous specialists. Despite the huge number of affected patients phlebology is not a recognized speciality in the European medical system (European Union of Medical Specialists (EUMS)) up to now. In Germany phlebology is a subspeciality for surgeons, internal medical doctors and dermatologists. In Austria and Switzerland phlebology is included in a sub-speciality angiology, which is applicable for internal medicine doctors and dermatologists. In several European countries universitybased specialisations exist with a master study in phlebology or phlebo-lymphology like in Italy, Spain or France. In the future phlebological issues should be
more completely implemented in the curricula of vascular surgery, internal medicine, dermatology and other associated specialities. In addition the authors strongly recommend the recognition of phlebology in the European Union of Medical Specialities as an interdisciplinary sub-group. For this reason the authors have founded the European College of Phlebology (ECoP) in 2012 and applied, at the UEMS, for recognition of phlebology as a multidisciplinary speciality in 2014. Based on the expected recognition by the UEMS as a Multidisciplinary board of Phlebology a European Curriculum in Phlebology and an educational system as a basis for a European Certificate will be implemented. The phlebological training will consist of theoretical and practical parts; it will be a modular system with certified training modules and with a final exam and certification. As a basis for the training curriculum the European College of Phlebology will use the UIPtraining curriculum, which was published in 2010 by a group of international specialists under the auspices of the UIP. It includes anatomy, basic sciences, pharmacology, clinical sciences, diagnostic evaluation, and treatment modalities in phlebology.6 The European phlebological training curriculum and the certification system will be developed in consensus with all involved medical disciplines and societies. The ECoP needs the acceptance and cooperation of the national societies involved in phlebology to succeed and establishing a European phlebological educational system and an accepted European exam in phlebology. The majority of the vascular community has recognized that phlebology is a real challenge for the future 1
Department of Dermatology, University of Bonn, Germany Department of Vascular Surgery, Imperial College London, UK 3 Department of Dermatology, Erasmus MC, Rotterdam, The Netherlands 4 European Venous Centre Aachen-Maastricht, Maastricht University, The Netherlands, Uniklinik Aachen, Germany 2
Corresponding author: Eberhard Rabe, Department of Dermatology, University of Bonn, Sigmund-Freud-Str. 25, 53105 Bonn, Germany. Email: [email protected]
Downloaded from phl.sagepub.com at University of Manitoba Libraries on June 19, 2015
Rabe et al.
187
with growing numbers of patients and it has also been recognized that phlebology must have a multidisciplinary approach. We hope the European Venous Community will work together in the future with the same intention: for a better care of our venous patients! Declaration of conflicting interests All the authors have no conflict of interest and nothing to disclose.
Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
References 1. Rabe E, Pannier-Fischer F, Bromen K, Schuld K, Poncar Ch, Wittenhorst M, Bock E, Weber S and Jo¨ckel KH. Bonner Venenstudie der Deutschen Gesellschaft fu¨r Phlebologie – epidemiologische Untersuchung zur Frage der Ha¨ufigkeit und Auspra¨gung von chronischen Venenkrankheiten in der sta¨dtischen und la¨ndlichen Wohnbevo¨lkerung. Phlebologie 2003; 32: 1–14.
2. Chiesa R, Marone EM, Limoni C, Volonte´ M, Schaefer E and Petrini O. Demographic factors and their relationship with the presence of CVI sigs in Italy. The 24-Cities Cohort Study. Eur J Vasc Endovasc Surg 2005; 30: 674–680. 3. Criqui MH, Jamosmos JM, Fronek AT, Denenberg JO, Langer RD, Bergan J and Golomb BA. Chronic venous disease in an ethnically diverse population. The San Diego Population Study. Am J Epidemiol 2003; 158: 448–456. 4. Jawien A, Grzela T and Ochwat A. Prevalence of chronic venous insufficiency in men and women in Poland: multicenter cross-sectional study in 40095 patients. Phlebology 2003; 18: 110–121. 5. Meissner MH, Gloviczki P, Bergan J, Kistner RL, Morrison N, Pannier F, Pappas PJ, Rabe E, Raju S and Villavicencio JL. Primary chronic venous disorders. J Vasc Surg 2007; 46(Suppl S): 54S–67S. 6. Parsi K, Zimmet S, Allegra C, et al. International Union of Phlebology. Phlebology training curriculum. A consensus document of the International Union of Phlebology (UIP)2010. Int Angiol 2010; 29: 533–559.
Downloaded from phl.sagepub.com at University of Manitoba Libraries on June 19, 2015
