1. Background of the UEMS

The objectives of the UEMS (Union européenne des medicines specialists – European Union of medical specialists) include the promotion of quality patient care through the harmonization and improvement of quality of specialists’ medical care throughout the European Union and the encouragement and facilitation of CME for European specialists. UEMS is the oldest of the European medical organizations founded in 1958 by medical specialists from six countries: Belgium, France, Germany, Italy, Luxembourg and The Netherlands. The UEMS is an important advisory body on medical affairs to the European Commission and the European Parliament. In this context it produces drafts for medical directives, charters and statements that are communicated to officials and politicians and it is active in lobbying on matters relevant to the quality of medical care and medical professionals.

The first of the medical directives was established in 1975 in order to make the exchange of doctors within the European Community possible. These directives have laid down the system of mutual recognition and free exchange of medical diplomas. Medical directives have mainly been concerned with basic medical education and postgraduate training. The sectoral directives, including the doctor’s directive, have been replaced by a general system of recognition. The new directive on professional recognition was accepted by the Council of Ministers in 2005. All the existing 52 specialties in the directive remain and new specialties can be created if they are represented in at least 2/5 of member states. In the future the European Commission will have to consult the medical profession i.e. the UEMS when developing the directive and training requirements.

UEMS has been very active in the field of CME/CPD. Among the corner stones in this field are Charter on CME of Medical Specialists in the European Union from 1994, Criteria for International Accreditation of CME from 1999, Charter on CPD from 2001 (Basel Declaration) and most recently UEMS document on Promoting Good Medical Care from 2004. A major concern of the UEMS has been the structure and facilitation of CME/CPD activities with the awarding of appropriate credits (hours) to individual medical specialists throughout Europe. The UEMS established the European Accreditation Council for CME (EACCME) in order to give Europe a co-ordinated system to facilitate such activity, without encroaching on the responsibility of national organizations where they exist. EACCME also has a system of mutual recognition with the American Medical Association. Over 1000 CME events were accredited through EACCME in 2007 and the number is increasing.

2. Specialist Sections and Boards

The backbone of UEMS is its European Specialist Sections and their European Boards. There are 37 Sections and Boards representing the majority of European specialties. The Specialist Sections consist of two delegates per member state that represent the national professional organization for medical specialist in a particular specialty. So, in the Section of Pathology the UK is represented by two delegates that are selected by the Royal College of Pathology. The representatives of The Netherlands are selected by the Dutch Society of Pathology, which combines professional and scientific interests. As the Sections felt the necessity to dispose of knowledge and insight of the relevant developments within their specialty the construction of European Specialist Section and Board was created by the UEMS in order to be able to incorporate members with specific expertise. In the UEMS Section and Board of Pathology this is applicable to representatives of the European Society of Pathology (ESP), the European Association of Junior Doctors (ESJD), The European Federation of Cytological Societies (EFCS) in combination with the International Academy of Cytology (IAC), Forensic Pathology and the European Confederation of European Neuropathological Societies (Euro-CNS).

Major activities of the Section and Board of Pathology include harmonization on quality criteria to assure a proper pathology practice in Europe, basic training requirements for residents, rules for post-graduate training and accreditation of training institutions, and an assessment on required competences by an annual European Board of Pathology Examination. A survey on the manpower of pathology staff and residents was held, which will be updated in the future. The results were published in the scientific journal of the ESP. Position papers were produced, e.g. about the position of the autopsy in medical practice and communicated with the Council of the UEMS. Currently the Section and Board of Pathology is active in the process to revise the Charter on specialist training.

Currently cytology or cytopathology is incorporated in the teaching program of anatomical pathology in most European countries. As a result, the minimal requirements of experience in cytopathology has been defined in the Charter on training of pathologists. The status of neuropathology varies among different countries, in most it is considered a subspecialty of pathology. The Confederation of European Neuropathological Societies has been active in CME, a European Neuropathological Examination and the delineation of a neuropathology training program. The Section and Board of Pathology will continue to provide a constructive platform for exchange of knowledge and insights on professional matters for neuropathology by a fruitful collaboration with the European Neuropathological Societies.

3. New developments
a) Recently the European Association of Pathology Chairs and Residency Program Directors (EAPCP) was founded in order to create a European network of professionals responsible for the quality of the execution of the pathology training program in their institutes. The EAPCP is active in the preparation of the description of training objectives and specialist competences and of a European progress test, allowing trainees to self-evaluate and training bodies all over Europe to compare training outcomes. The EAPCP and the UEMS Section and Board of Pathology have agreed to aim at a fruitful mutual collaboration.
b) The UEMS Sections and Boards of Dermato-Venerology and Pathology have agreed on the installation of an international dermatopathology examination under the direction of the International Committee for Dermatopathology (ICDP). In this context the dermatopathology examination has taken place in 2005, 2006, and 2007 with broad international interest and good results. Both UEMS Sections and Boards applaud this examination and regard it as an excellent instrument to improve the quality of dermatopathology. Recently the ICDP has formulated guidelines for Training Centers in Dermatopathology, that already have been approved by the Section and Board of Dermatovenerology.

4. Proposal for structural collaboration
a) Given the complementary aims and competences of the UEMS Section and Board of Pathology, the EAPCP and the ESP, it is important that these bodies engage in a durable collaboration, assuring proper input from the relevant stakeholders and representing the interests of pathology as a medical discipline adequately. Therefore it is proposed that the EAPCP acts as a bridge between the ESP, providing scientific and educational input, and the UEMS Section and Board of Pathology, providing professional input on the European level. In this structure, two EAPCP members would represent the EAPCP in the UEMS Section and Board of Pathology and in the Executive Committee of the ESP.
b) Regarding dermatopathology, one of the delegates of the UEMS Section and Board that has a special interest in this particular field would an active member of the ICDP as well. As dermatopathology is considered as an integral part of diagnostic pathology a special position within the UEMS Section and Board of Pathology is not applicable.