The 18th European Network of Trainees in Obstetrics and Gynaecology (ENTOG) meeting was held in Lisbon, Portugal. Lisbon is an architecturally eclectic city built on seven hills and located on the banks of the river Tagus. It is a city full of cobble stoned squares, cathedrals, churches and winding streets with old 1950's trams making their way up impossibly steep hills. The conference centre was situated next to the spectacular suspension bridge ‘25 de Abril' which bears a remarkable resemblance to the Golden Gate Bridge in San Fransisco.
For the first time in ENTOG history, the exchange programme and meeting were held with the EBCOG (European Board and College of Obstetrics and Gynaecology) Scientific Congress. This provided trainees with the opportunity to take part in the ENTOG exchange and meeting, in addition to spending time at the scientific conference.
A total of 34 trainees took part in the exchange programme. In future years, the plan is to incorporate ENTOG into the EBCOG conference every alternate year. The traditional ENTOG exchange and meetings will continue to occur annually. At present, we are looking forward to ENTOG in Hungary 2009 and a joint meeting of ENTOG and EBCOG in Belgium in 2010 and Estonia in 2012.
This years meeting was titled ‘Working Conditions Across Europe' and we had the opportunity to hear from a diverse group of speakers.
Erica Werner, President of ENTOG and Filomena Nunes former ENTOG President presented a short history of ENTOG.
Mr Leonard Harvey from UEMS (European Union of Medical Specialists) gave an overview of developments throughout Europe due to the EWTD. He outlined the regulations affecting all European workers. UEMS are at present concerned that we continue to provide a high standard of patient care whilst at the same time maintaining high quality specialist training with adequate surgical experience and continuity of care within the confines of the EWTD. In addition, the aim should be to avoid excessive time spent in training or waiting for training.
Mr Rui Guimaraes from PWG (Permanent Working Group of European Junior Doctors) presented a view that health systems in Europe are too reliant on doctors in training working extended hours in order to deliver patient care. He expressed the view that there is clear evidence that disrupted sleep patterns lead to an increase in human error. He argued that the opt-out clause from the EWTD should be abolished and discussed the problems in European countries where the majority of doctors' pay is made up of out of hours pay.
We heard a viewpoint from Mr Manuel Antuntes, a Portuguese cardiothoracic surgeon, who felt that it is not possible to train the in the hours provided by the EWTD. In his own words, he had been asked to play ‘devil's advocate', but he made some stark observations regarding the reduction in the number of hours spent in training.
These issues were debated by all, and the general consensus was that at present no one can be entirely sure of the outcomes of the new training systems in use. Many trainees felt that with a properly structured training system good training can be achieved. A suggestion was made that we need a more evidence based approach to support the recommendation for the number of hours needed to be spent in training. In addition, it was felt that the system where a newly qualified specialist continues to receive mentoring from senior colleagues would be beneficial to doctors and patients alike.
The ENTOG executive committee presented the results of a survey of working conditions across Europe. This survey was last conducted 10 years ago. Previous recommendations after the 1997 survey included a minimum of 5 years in training, a tutor/trainee system with continuous assessment and appraisal and log books and a system whereby hospitals are recognised for training by an external review body.
A total of 24 countries were included in the survey which was sent out to 28 countries. Average time to gain a training position is 1.5 years from graduation and the average time in training is 5 years (range 4-6 years). Twenty three out of 24 countries have a majority of female trainees but at consultant/specialist level the majority are still male. There was no clear relationship between population and number of trainees or consultants. Twenty one countries have log books, 15 of which have been directly inspired by the EBCOG model. There is still no consensus on the type or presence of exams. Working hours now average 51 hours/week. However, concern was expressed that this figure is not accurate as in many cases it only takes into account contracted hours and not overall hours worked. Quality of life as well as salaries appeared to vary widely. The results will be available on the ENTOG website in the near future.
Our final talk of the day came from Mr Pietro Gambadauro from Italy. He discussed the improvements that Italian trainee doctors have been working towards since 2002 when they took the radical step of industrial action. Italian trainees are now recognised as employees and as a result have since 2007 had an employment contract, receive a salary, are entitlted to a pension and other benefits such as maternity and sick pay and have other legal rights normally given to any other employees.
At the Council meeting on the 4 th of March, ENTOG was pleased to welcome Malta as it's newest member country, bringing the total number of member countries to 29. We also heard from three exchange participants including Clare Lipetz, from the UK about their experiences in Portugal. The topic for the 2010 ENTOG meeting was voted on and will be titled ‘The future of O&G in the next century'
The trainees' prizes were awarded as follows: The ENTOG/PONTOG/WYETH prize for the best poster was won by Aboim et al for ‘Pregnancy outcome after pre-eclampsia in hypertensive women'. The ENTOG/PONTOG/ORGANON prize for the best oral presentation was won by Torrance et al. for ‘Maternal treatment with allopurinol diminishes fetal cardiac oxidative stress following repeated episodes of ischaemia-reperfusion in sheep'.