Orthopaedic Orthopaedic surgery in SPAINsurgery in SPAIN
UEMS Orthopaedic SectionUEMS Orthopaedic Section2008 2nd annual meeting2008 2nd annual meeting
Edimburgh, September 27thEdimburgh, September 27th
Orthopaedic surgery in SPAINOrthopaedic surgery in SPAIN►Spain 2008Spain 2008►Health careHealth care►Orthopaedic surgeryOrthopaedic surgery►SECOT (Sociedad Española de Cirugía SECOT (Sociedad Española de Cirugía
Ortopédica y Traumatología)Ortopédica y Traumatología)►Orthopaedic trainingOrthopaedic training
Orthopaedic surgery in SPAINOrthopaedic surgery in SPAIN►Spain 2008Spain 2008► Health careHealth care► Orthopaedic surgeryOrthopaedic surgery► SECOT (Sociedad Española de Cirugía Ortopédica y SECOT (Sociedad Española de Cirugía Ortopédica y
Traumatología)Traumatología)► Orthopaedic trainingOrthopaedic training
Spain 2008Spain 2008►45.000.000 people45.000.000 people►Aprox. 500.000 KmAprox. 500.000 Km2 2 (2nd in Europe) (2nd in Europe)►Weather:Weather:
Atlantic (north)Atlantic (north)
Mediterranean (east, south)Mediterranean (east, south)
Continental (interior)Continental (interior)
►European Comunity since 1986European Comunity since 1986►Euro since 2002Euro since 2002►GNP: 80-90% “euro-zone”GNP: 80-90% “euro-zone”
Spain 2008Spain 2008► Constitutional Constitutional
monarchymonarchy
AndalucíaAndalucía
AragónAragón
AsturiasAsturias
CantabriaCantabria
Castilla La ManchaCastilla La Mancha
Castilla-LeónCastilla-León
CataluñaCataluña
ExtremaduraExtremadura
► 18 autonomic regions 18 autonomic regions (regional governments (regional governments and parlaments):and parlaments):
GaliciaGalicia
La RiojaLa Rioja
MadridMadrid
MurciaMurcia
NavarraNavarra
País VascoPaís Vasco
ValenciaValencia
Orthopaedic surgery in SPAINOrthopaedic surgery in SPAIN► Spain 2008Spain 2008
►Health careHealth care► Orthopaedic surgeryOrthopaedic surgery► SECOT (Sociedad Española de Cirugía Ortopédica y SECOT (Sociedad Española de Cirugía Ortopédica y
Traumatología)Traumatología)► Orthopaedic trainingOrthopaedic training
Health careHealth care► Public medicine Public medicine
National Health SystemNational Health System►Universal coverageUniversal coverage►Paid with taxesPaid with taxes►Free assistance & free medicines for retiredFree assistance & free medicines for retired
► Private medicinePrivate medicine Urban areasUrban areas Aprox. 20% populationAprox. 20% population Mostly HMOMostly HMO
Health careHealth care►Public medicine: National Health SystemPublic medicine: National Health System
Regional organization Regional organization ►““Consejerías de sanidad” (Health Regional Consejerías de sanidad” (Health Regional
Councils)Councils) Supra-regional control Supra-regional control
►Health MinisteryHealth Ministery
►Pros: competence among regions promotes Pros: competence among regions promotes improvementimprovement
►Contras: Contras: Difficulties in coordination among regionsDifficulties in coordination among regions Division of economical fundsDivision of economical funds
Health careHealth care►National Health SystemNational Health System
Primary medicine: Primary medicine: ►GPs GPs ►Health CentersHealth Centers
Specialized medicine: Specialized medicine: ►Hospitals Hospitals ►Out-patient facilitiesOut-patient facilities
Health careHealth care►HospitalsHospitals
University hospitals University hospitals ►All DepartmentsAll Departments►500-2000 beds500-2000 beds
Small hospitalsSmall hospitals►““High demand” specialitiesHigh demand” specialities►100-500 beds 100-500 beds
Health careHealth care►HospitalsHospitals
Hyerarchic organization:Hyerarchic organization:►Physicians:Physicians:
Chief of DepartmentChief of Department Chiefs of sections / unitsChiefs of sections / units Members of staffMembers of staff ResidentsResidents
►NursesNurses►Nurse-assistantsNurse-assistants
Orthopaedic surgery in SPAINOrthopaedic surgery in SPAIN► Spain 2008Spain 2008► Health careHealth care
►Orthopaedic surgeryOrthopaedic surgery► SECOT (Sociedad Española de Cirugía Ortopédica y SECOT (Sociedad Española de Cirugía Ortopédica y
Traumatología)Traumatología)► Orthopaedic trainingOrthopaedic training
Orthopaedic surgeryOrthopaedic surgery►All pathology in limbs and spineAll pathology in limbs and spine
Reumathologists: Reumathologists: ►Treatment of inflammatory pathologyTreatment of inflammatory pathology
Rehabilitation physicians: Rehabilitation physicians: ►direction of physiotherapydirection of physiotherapy
Vascular surgeons: Vascular surgeons: ►surgical treatment of vascular pathology surgical treatment of vascular pathology
Orthopaedic surgeryOrthopaedic surgery►All pathology in limbs and spineAll pathology in limbs and spine
Traumatic / non traumaticTraumatic / non traumatic Diagnostics / Treatment / Follow-upDiagnostics / Treatment / Follow-up Surgical / Medical / Physical therapy / Surgical / Medical / Physical therapy /
ConservativeConservative
Orthopaedic surgeryOrthopaedic surgery► Aprox 5.000 physicians practising Aprox 5.000 physicians practising
orthopaedic surgery orthopaedic surgery ►(not all (not all officialofficial title) title)
► Typical weekly work-scheduleTypical weekly work-schedule Surgery: 1-2 weekly sessions (7 hours)Surgery: 1-2 weekly sessions (7 hours) Out-patient clinic: 2-4 weekly sessionsOut-patient clinic: 2-4 weekly sessions
►1-2 highly specialised (hospital)1-2 highly specialised (hospital)►1-2 low specialisation (peripheral facilities)1-2 low specialisation (peripheral facilities)
Emergency: 1 weekly session (24 hours)Emergency: 1 weekly session (24 hours)
Orthopaedic surgeryOrthopaedic surgery NO official sub-specialitiesNO official sub-specialities In practical setting: areas of special In practical setting: areas of special
interestinterest►Hand surgeryHand surgery►Spine surgerySpine surgery►Shoulder / upper limbShoulder / upper limb►Arthroscopy / sports / soft kneeArthroscopy / sports / soft knee►Arthroplasty / lower limb reconstructiveArthroplasty / lower limb reconstructive►TraumaTrauma
Orthopaedic surgery in SPAINOrthopaedic surgery in SPAIN► Spain 2008Spain 2008► Health careHealth care► Orthopaedic surgeryOrthopaedic surgery
►SECOT (Sociedad Española SECOT (Sociedad Española de Cirugía Ortopédica y de Cirugía Ortopédica y Traumatología)Traumatología)
► Orthopaedic trainingOrthopaedic training
SECOTSECOT►1) Members1) Members►2) Relations2) Relations►3) Organization3) Organization►4) Activities4) Activities
SECOTSECOT►1) MEMBERS1) MEMBERS
Aprox 4000 membersAprox 4000 members►(not all with official title)(not all with official title)►2000-2500 certified orthopaedic surgeons2000-2500 certified orthopaedic surgeons
Full-membersFull-members►500 residents500 residents
Associate membersAssociate members►Aprox 1000 non-certified physicians practising Aprox 1000 non-certified physicians practising
orthopaedic surgeryorthopaedic surgery Associate membersAssociate members
►Honour membersHonour members Retired full-membersRetired full-members
SECOTSECOT►2) RELATIONS2) RELATIONS
Internal Study Groups (variables)Internal Study Groups (variables) Infection, spine, pain, TED, dynamic OS, …Infection, spine, pain, TED, dynamic OS, …
Fraternal relationFraternal relation►Spanish sub-speciality societiesSpanish sub-speciality societies
Spine, Shoulder&Elbow, Hand, Hip, Knee, Spine, Shoulder&Elbow, Hand, Hip, Knee, Arthroscopy, Foot&Ankle, Pediatrics,…Arthroscopy, Foot&Ankle, Pediatrics,…
►Spanish regional societies Spanish regional societies
SECOTSECOT►2) RELATIONS2) RELATIONS
Member of EFORT & UEMSMember of EFORT & UEMS
Special relations:Special relations:►AAOSAAOS
crossed symposiacrossed symposia shared bookshared book
►Latin America societiesLatin America societies crossed symposia crossed symposia
SECOTSECOT►3) ORGANIZATION3) ORGANIZATION
General AssemblyGeneral Assembly
Executive CommitteeExecutive Committee
SenateSenate
SECOTSECOT►3) ORGANIZATION3) ORGANIZATION
General AssemblyGeneral Assembly►Once yearly, in Annual CongressOnce yearly, in Annual Congress►Direct voteDirect vote
Election of Vice-President (future President) every Election of Vice-President (future President) every two yearstwo years
Election of Journal editorElection of Journal editor Legislative Legislative
SECOTSECOT►3) ORGANIZATION3) ORGANIZATION
Executive CommitteeExecutive Committee►1 President (elected 2 years before)1 President (elected 2 years before)►1 elected Vice-President1 elected Vice-President
elected by General Assembly every 2 yearselected by General Assembly every 2 years►1 Past-President1 Past-President►Treasurer, General Secretary, Members Treasurer, General Secretary, Members
number variablenumber variable Elected by President Elected by President Head of Committees: Education, Publications, Head of Committees: Education, Publications,
Annual Congress, Associated Members, Legal issuesAnnual Congress, Associated Members, Legal issues
SECOTSECOT►3) ORGANIZATION3) ORGANIZATION
SenateSenate►Past-PresidentsPast-Presidents►Counseling activity for PresidentCounseling activity for President
SECOTSECOT►4) ACTIVITIES4) ACTIVITIES
Annual CongressAnnual Congress Annual Basic CourseAnnual Basic Course JournalJournal PublicationsPublications Grants & PrizesGrants & Prizes
SECOTSECOT► 4) ACTIVITIES4) ACTIVITIES
Annual CongressAnnual Congress►3 full days / aprox 2000 participants3 full days / aprox 2000 participants►Rotating location: Madrid / Barcelona / Other Rotating location: Madrid / Barcelona / Other ►End of September / Beginning of OctoberEnd of September / Beginning of October►Educational:Educational:
Official Themes Official Themes Instructional CoursesInstructional Courses Industry symposiaIndustry symposia
►Research:Research: Free papers Free papers Posters Posters
SECOTSECOT►4) ACTIVITIES4) ACTIVITIES
Annual Basic CourseAnnual Basic Course►2-3 days / 150-200 participants2-3 days / 150-200 participants►Variable location all along country Variable location all along country ►JuneJune►Basic Monographic Course for ResidentsBasic Monographic Course for Residents
SECOTSECOT►4) ACTIVITIES4) ACTIVITIES
JournalJournal►““Revista española de Ortopedia y Revista española de Ortopedia y
Traumatología”Traumatología”►Elsevier / MassonElsevier / Masson►6 issues / year6 issues / year►Editor in chief elected by General AssemblyEditor in chief elected by General Assembly
SECOTSECOT►4) ACTIVITIES4) ACTIVITIES
Publications (Books)Publications (Books)►Instructional CoursesInstructional Courses►““Up-to dates”Up-to dates”►MonographiesMonographies►Hand-bookHand-book►Annual Case-Report BookAnnual Case-Report Book►Cross-publication with other societiesCross-publication with other societies
SECOTSECOT►4) ACTIVITIES4) ACTIVITIES
Grants Grants ►Congress & Basic GrantsCongress & Basic Grants►Travelling grantsTravelling grants►Foreign & National visitsForeign & National visits►Research projectsResearch projects
PrizesPrizes►Best Basic & Clinical research studyBest Basic & Clinical research study►Best published paperBest published paper
Orthopaedic surgery in SPAINOrthopaedic surgery in SPAIN► Spain 2008Spain 2008► Health careHealth care► Orthopaedic surgeryOrthopaedic surgery► SECOT (Sociedad Española de Cirugía Ortopédica y SECOT (Sociedad Española de Cirugía Ortopédica y
Traumatología)Traumatología)
►Orthopaedic trainingOrthopaedic training
Orthopaedic trainingOrthopaedic training►1) Access1) Access►2) General organization2) General organization►3) Activities3) Activities►4) Control of training4) Control of training►5) Control of training centers5) Control of training centers
Orthopaedic trainingOrthopaedic training►1) ACCESS1) ACCESS
Medical degreeMedical degree National exam National exam
►250 MCQ about medicine250 MCQ about medicine Ranking according to exam + Ranking according to exam +
qualifications in Medical Schoolqualifications in Medical School Election by rankingElection by ranking
►Medical specialityMedical speciality►HospitalHospital
Orthopaedic trainingOrthopaedic training►2) 2) GENERAL ORGANIZATIONGENERAL ORGANIZATION
Five yearsFive years 175 residents / year175 residents / year 50% female / male (nowadays)50% female / male (nowadays) Public hospitalsPublic hospitals Laboral contract, worker’s rightsLaboral contract, worker’s rights
►35 hours/week + hours / days on duty 35 hours/week + hours / days on duty Difficulties with EWDT because of days on dutyDifficulties with EWDT because of days on duty
►Free day after 24h on duty (not always possible)Free day after 24h on duty (not always possible)
Orthopaedic trainingOrthopaedic training►3) ACTIVITIES3) ACTIVITIES
RotationsRotations
►External:External: Compulsory: Anaesthesia, Plastic Surgery, VascularCompulsory: Anaesthesia, Plastic Surgery, Vascular Optative: most surgical, Rehabilitation, RheumatologyOptative: most surgical, Rehabilitation, Rheumatology
►Internal:Internal: Compulsory: PediatricsCompulsory: Pediatrics Advisable: tumours, hand, arthroscopy, spineAdvisable: tumours, hand, arthroscopy, spine
Orthopaedic trainingOrthopaedic training►3) ACTIVITIES3) ACTIVITIES
On dutyOn duty►Periods of 24 hours on dutyPeriods of 24 hours on duty►From 4 to 8 days / monthFrom 4 to 8 days / month►Heavy work in Emergency DepartmentHeavy work in Emergency Department►Light work in hospitalization wardLight work in hospitalization ward►Most hospitals: first callMost hospitals: first call
Orthopaedic trainingOrthopaedic training►3) ACTIVITIES3) ACTIVITIES
SurgerySurgery►Progressive responsibilityProgressive responsibility►2nd assistant / 1st assistant / supervised 2nd assistant / 1st assistant / supervised
surgeonsurgeon►7 hours / session7 hours / session►1 - 4 sessions / week1 - 4 sessions / week►NO compulsory number / type of surgeriesNO compulsory number / type of surgeries
Orthopaedic trainingOrthopaedic training►3) ACTIVITIES3) ACTIVITIES
Out-patient officeOut-patient office►Assistant / assistedAssistant / assisted►In practice, irregular In practice, irregular ►No compulsoryNo compulsory►No in many hospitalsNo in many hospitals
Orthopaedic trainingOrthopaedic training►3) ACTIVITIES3) ACTIVITIES
In-hospital patientsIn-hospital patients►Variable organization according to Variable organization according to
DepartmentsDepartments►Clinical & burocratic tasksClinical & burocratic tasks►Main medical worker for hospitalization ward Main medical worker for hospitalization ward
Orthopaedic trainingOrthopaedic training►3) ACTIVITIES3) ACTIVITIES
Theoretical teachingTheoretical teaching►Daily / weekly / monthly sessionsDaily / weekly / monthly sessions►Sessions of 15 min – 2 hoursSessions of 15 min – 2 hours►Irregular, great variabilityIrregular, great variability►Types of sessions:Types of sessions:
Emergency cases / Surgical cases / Hospitalization ward / Emergency cases / Surgical cases / Hospitalization ward / Bibliography / Monographics / Radiological / HistologicalBibliography / Monographics / Radiological / Histological
Orthopaedic trainingOrthopaedic training►4) Control of training4) Control of training
Head of teaching: Head of DepartmentHead of teaching: Head of Department TutorTutor LogbookLogbook Continuous evaluationContinuous evaluation Annual evaluation (logbook + staff opinion)Annual evaluation (logbook + staff opinion) NO compulsory examsNO compulsory exams NO intermediate examsNO intermediate exams Voluntary final exam (launching)Voluntary final exam (launching)
Orthopaedic trainingOrthopaedic training►5) Control of training centers5) Control of training centers
Ministery of HealthMinistery of Health Periodical auditsPeriodical audits Control of logbooksControl of logbooks Beds / facilities / surgical activity / out-Beds / facilities / surgical activity / out-
patient activity / library patient activity / library
Thank youThank you