Anaesthesiology Intensive Therapy, 2011,XLIII,1; 4-6

How to adopt the European Diploma in Anaesthesiology as the National Board examination in anaesthesiology and intensive therapy – from euro (€) to EDA I – three-year experience in Poland

*Krzysztof Kusza1, Zeev Goldik2


1Department of Anaesthesiology and Intensive Therapy, Collegium Medicum Nicolaus Copernicus University in Bydgoszcz


2Post-Anaesthesia Care Unit, Department of Anaesthesia and Intensive Care, Lady Davis Carmel Medical Centre, Haifa

Poland joined the European Union (EU) in 2004 [1]. The Polish population now stands at 38, 135,876 [2]. At the end of 2009, only 2778 anaesthesiologists worked in the country, giving 7 anaesthesiologists per 100,000 inhabitants. By the end of 2009, there were 1097 registered residents in anaesthesiology and intensive care [3].

By joining the EU, the Polish people knowingly agreed to assume some responsibilities as well as to respect rules and laws that jointly and equally apply to all member states. The implementation of these rights and obligations will take time yet should be considered the overriding goal, a common interest of all EU citizens [4], which will lead to the integration of EU societies and economies. Such a process requires directives that harmonise the policies of member states and regulate areas of social and economic life [5, 6]. The sense of security enjoyed by EU citizens should be grounded in the awareness that the quality of health care in the EU is defined by standards and is therefore the same for all, regardless of their place of residence [7]. Harmonisation should be urgently applied to the area of education, including the field of medical science and medical specialities, so that the skills mastered by medical specialists may be uniform [8]. Subscribing to this philosophy of thinking about common Europe, prof. Leon Drobnik, President of the Polish Society of Anaesthesiology and Intensive Therapy, turned to the appropriate Polish authorities to outline the potential benefits to Polish patients and anaesthesiologists of adopting the EDA I exam as the first National Board test examination for residents. To launch the process of harmonisation, the meeting was held in Warsaw in 2006, attended by heads of anaesthesiology departments, a representative of the Minister of Health and the director of the Centre for Medical Examinations in Poland. Present at the meeting were also members of ESA, namely its president, Sir Peter Simpson, and dr. Zeev Goldik, Chairman of the EDA Examination Committee. The letter of intent was created, in which the Polish Society of Anaesthesiology and Intensive Therapy declared the will to adopt the EDA I examination as the national examination for medical specialists in Poland [9].

Nobody enjoys sitting examinations. And even less do we like changes that could make the exam more difficult or even impossible to pass. We prefer to deal with what we know, rather than with what is unknown and uncertain. This was precisely the obstacle that the declaration of intent to adopt EDA I rules for the State Examination ran into in Poland. The intent was suddenly subjected to profound and universal criticism by anaesthesiologists. The purpose of unification may have been misrepresented or perhaps public opinion simply did not understand it and thus saw no need for change. The same happened to the euro – the common currency of the EU. The European currency was introduced to replace national currencies and is now the sole legal tender in 16 European countries inhabited by over 322,500,000 Europeans [10]. The important differences between unification of currency and unification of examination procedures notwithstanding, the social features of both processes are remarkably similar. Prior to the declaration regarding the adoption of EDA I in Poland, the residency exam in anaesthesiology and intensive care was offered to candidates who had completed a six-year cycle of training consistent with their specialisation, of which four years were devoted to broadly understood training in anaesthesiology and two years to training in intensive care [11].

When observing the adoption of the euro, one cannot but notice that coins of the same denomination are different in each country, featuring on both sides the elements characteristic of a given country. Only the denomination and the symbol € are the same in each country where the currency is in use. Thus, even though a 2 euro coin minted in France is the same as a 2 euro coin minted in Germany, as far as the value is concerned, this is not so obvious to citizens of these two countries [10]. We were often met with resistance when trying to pay with French euros in Germany or vice verse, and the explanation offered was simple: yes, it is an euro, but “it is not our euro”. The proposed introduction of the EDA I examination as the sole national examination in anaesthesiology and intensive care in Poland faced the same difficulties. Yes, it is true that the EDA I exam tests knowledge in the field of anaesthesiology and intensive care in general, but it does not test knowledge in this field in Poland. The supposition that it does is tantamount to an attack on civil rights, on the sovereignty of medicine and a different interpretation of medical facts. The same obstacles exist on the path to harmonisation that we have seen in the earlier attempts to standardise currency [10].

Most of the opposition in medical circles have focused on the argument that the EDA I examination does not reflect the requirements that a Polish resident must satisfy, since it does not put enough emphasis on intensive care and too much on testing knowledge in the field of basic science - areas that are played down in the Polish curriculum. Such arguments were spurious, since the residency curriculum did and still does include these disciplines of science [11]. On the other hand, it was known that the bulk of primary sources in anaesthesiology and intensive care were available only in English, and only some were translated into Polish. Therefore, candidates sitting the EDA I exam would have to read English literature recommended by the EDA in the form of a “reading list” posted on the ESA website [12]. Thus, the language barrier became a stumbling block for the opponents of EDA I introduction in Poland. Those hostile towards the exam have tried to convince candidates that medicine, including anaesthesiology and intensive care, is different in a foreign language and, contrary to common sense, the laws of physics can be different in English and in Polish. Incredulous readers should have a look at Hagen-Poiseuille’s law in English (ryc 1.) [13] and the same law in Polish (ryc 1.) [14] and should recall the obstacles to introduction of the euro [10].  We must understand that while physics may be the same regardless of geographical location and language, it is still true that “our Poiseuille’s law “is more readily comprehended.

After consultations with the president of the Polish Society of Anaesthesiology and Intensive Therapy and with the National Consultant, and having read a letter from Zeev Goldik, Chairman of the EDA Committee, Minister Ewa Kopacz enacted a legal act to empower the National Consultant to select questions from the EDA pool, while allowing EDA I to serve as the first part of the Board examination for anaesthesiology and intensive care residents in Poland [15]. In view of these decisions, a review of preparations for the exam was carried out. After the assessment of literature availability and the teaching level in basic sciences, the National Consultant appointed a working group to recruit young scientists, who declared to make the residency curriculum fully compliant with EDA I requirements. The National Consultant made a number of lectures available on his website [11]. The lectures were presented during a conformity certification session, held 2 weeks before the EDA I exam. During this course, participants had the opportunity to sit a mock exam in accordance with EDA I rules.

The first EDA I exam was administered in Poland on October 4, 2008 as the first part of the National Board examination in anaesthesiology and intensive care taken by residents. There were 73 candidates, including 72 from Poland. The Polish candidates passed the EDA I exam exceptionally well. One of them achieved the highest score in all of Europe. In 2009, 97 candidates took the EDA I exam in Poland, representing a 24% increase compared to the previous year and in 2010 – 113 candidates, an increase by 37% compared to 2008. Just as in 2008, a training program for candidates was designed and a mock exam was held prior to the 2009 and 2010 sessions.

In conclusion, despite the initial difficulties in making the EDA I exam officially recognized in Poland, it is currently popular among candidates, thanks mainly to its clarity. Requirements imposed by the EDA I exam have been accepted by candidates primarily due to the introduction of a special training program in the field of anaesthesiology and intensive care offered by representatives of national supervision authorities. The creation of an educational system based on literature guidelines presented by the EDA and the administration of a mock exam played a key role. Objective promotion of EDA I among health professionals, scientists and politicians was of fundamental importance in winning support for its adoption as the official exam in Poland. Naturally, the process of adapting the EDA exam to national legislation enacted by the national parliament should accompany the process of adapting legal acts regulating the Pass rate of the National Board exam in a given EU member state, including Poland, to the Pass rate level set for the EDA I exam.

We consider the process of fundamental changes implemented into the programme of resident training in anaesthesia and intensive care in Poland according to UEMS, ESA and EDA guidelines, as our practical contribution to enforcement of the contents of the Helsinki Declaration.

The next step required to achieve full compatibility with the EU EDA exam in Poland, is the introduction of an oral exam – the EDA part II as in Austria and Switzerland. Based on the experience presented above, adaptation of EDA II in Poland will be a truly challenging task.

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1Head  of Chair and Department of Anaesthesiology and Intensive Therapy, Nicolaus Copernicus University in Torun, Ludwik Rydygier Collegium Medicum  in Bydgoszcz, Chair of Anaesthesiology and Intensive Therapy, Karol Marcinkowski University of Medical Sciences, Poznań, Poland 

2Chairman Examination Committee European Diploma in Anasthesiology Head of Post-Anaesthesia Care Unit, Department of Anaesthesia and Intensive Care Lady Davis Carmel Medical Centre, Haifa

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REFERENCES

1.    PolskawUE.Gov.Pl. Ministerstwo Spraw Zagranicznych. c2010. http://polskawue.gov.pl/Dokumenty,polskie,114.html.

2.    Central Statistical Office (GUS) c1995-2010. Baza Demografia. http://demografia.stat.gov.pl/BazaDemografia/Tables.aspx.

3.    Kusza K: Zasoby kadr medycznych w Polsce – wstęp do studium dotyczącego analizy niezbędnego minimum kadry medycznej oraz planowania w zakresie potrzeb wynikających z unijnej polityki spójności. Analiza przyczyn deficytów kadrowych w oparciu o własne doświadczenia zawodowe i konsultanta krajowego w dziedzinie anestezjologii i intensywnej terapii. In: Warsztaty nt. zwiększenia możliwości dokonywania analiz polityki, planowania i zarządzania w odniesieniu do zasobów ludzkich dla zdrowia. Raport końcowy. Wersja rozszerzona (Ed.: Opolski J, Danielewicz R) Warszawa,  Biuro WHO 2009: 137-155.

4.    EUR-Lex Treaty establishing a Constitution for Europe. http://eur-lex.europa.eu/JOHtml.do?uri=OJ:C:2004:310:SOM:EN:HTML.

5.     Council of the European Union.  http://www.consilium.europa.eu.

6.    European Commission. Resolution on the report from the Commission to the Council and the European Parliament “Efficiency and Accountability in European Standardisation under the New Approach”. Official Journal of the European Communities C 150/624. http://ec.europa.eu/enterprise/policies/european-standards/files/standards_policy/document/ep_resolution/ojc150en_en.pdf.

7.    European Commission Enterprise and Industry. European Standards. http://ec.europa.eu/enterprise/policies/european-standards/documents/harmonised-standards-legislation/list-references/.

8.    Scherpereel P, Sondore A: The evolution of human resource needs in Europe. Best Pract Res Clin Anaesthesiol 2002; 16: 443-457.

9.    Goldik Z: European Diploma Examination in Poland -Evolution or Revolution? Anestezjologia i Ratownictwo 2008; 2: 238-242.

10.    Atis D: The Mastricht road to monetary union. J Common Mark Stud 1992; 30: 299-309.

11.    Collegium  Medicum UMK. Katedra i Klinika Anestezjologii i Intensywnej Terapi. www.anestezjologia.bydgoszcz.pl.

12.    European Society of Anaesthesiology. Recommended reading list for candidates preparing for the European Diploma in Anaesthesiology and Intensive Care. http://www.euroanesthesia.org/sitecore/content/Education/~/media/Files/Education/EDA/Recommended%20Reading%20List%20for%20EDA.ashx.

13.    Lin SE: Physiology of the circulation. In: Fundamentals of Anaesthesia (Ed.:  Pinnock C, Lin T, Smith T). University Press, Cambridge 2007: 333-360.

14.    Mushambi MC, Smith G: Podstawy fizyki w praktyce anestezjologicznej. In: Anestezjologia t. 1(Ed.: Aitkenhead AR, Smith G, Rowbotham DJ), Urban&Partner, Wrocław 2008: 192.

15.    Rozporządzenie Ministra Zdrowia z dnia 19 września 2008 zmieniające rozporządzenie w sprawie specjalizacji lekarzy i lekarzy dentystów 2008; 170; 1050, 9058.

16.    Kusza K, Goldik Z: Adoption of the European Diploma in Anaesthesiology as the National Board examination in anaesthesiology and intensive care: 2 yr of experience in Poland. Br J Anaesth 2011; 106: 148-149.

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Correspondence:

Krzysztof Kusza

address: ul Skłodowskiej-Curie 9
85-094 Bydgoszcz
Poland
telephone: +48 52 585 47 50
fax: + 48 52 585 40 22
e-mail: k-kusza@wp.pl