Orthopaedic
surgery in SPAIN
UEMS Orthopaedic Section
2008 2nd annual meeting
Edimburgh, September 27th
Orthopaedic surgery in SPAIN
► Spain
2008
► Health care
► Orthopaedic surgery
► SECOT (Sociedad Española de Cirugía
Ortopédica y Traumatología)
► Orthopaedic training
Orthopaedic surgery in SPAIN
►Spain
►
►
►
►
2008
Health care
Orthopaedic surgery
SECOT (Sociedad Española de Cirugía Ortopédica y Traumatología)
Orthopaedic training
Spain 2008
► 45.000.000
people
► Aprox. 500.000 Km2 (2nd in Europe)
► Weather:



Atlantic (north)
Mediterranean (east, south)
Continental (interior)
► European
Comunity since 1986
► Euro since 2002
► GNP: 80-90% “euro-zone”
Spain 2008
► Constitutional
monarchy
 Andalucía
 Aragón
 Asturias
 Cantabria
 Castilla La Mancha
 Castilla-León


Cataluña
Extremadura
► 18
autonomic regions
(regional governments
and parlaments):
 Galicia
 La Rioja
 Madrid
 Murcia
 Navarra
 País Vasco
 Valencia
Orthopaedic surgery in SPAIN
►
Spain 2008
►Health
►
►
►
care
Orthopaedic surgery
SECOT (Sociedad Española de Cirugía Ortopédica y Traumatología)
Orthopaedic training
Health care
► Public
medicine
 National Health System
► Universal
coverage
► Paid with taxes
► Free assistance & free medicines for retired
► Private
medicine
 Urban areas
 Aprox. 20% population
 Mostly HMO
Health care
► Public
medicine: National Health System
 Regional organization
►“Consejerías
de sanidad” (Health Regional Councils)
 Supra-regional control
►Health
Ministery
►Pros:
competence among regions promotes
improvement
►Contras:
 Difficulties in coordination among regions
 Division of economical funds
Health care
► National
Health System
 Primary medicine:
►GPs
►Health
Centers
 Specialized medicine:
►Hospitals
►Out-patient
facilities
Health care
► Hospitals
 University hospitals
►All
Departments
►500-2000 beds
 Small hospitals
►“High
demand” specialities
►100-500 beds
Health care
► Hospitals
 Hyerarchic organization:
►Physicians:




Chief of Department
Chiefs of sections / units
Members of staff
Residents
►Nurses
►Nurse-assistants
Orthopaedic surgery in SPAIN
►
►
Spain 2008
Health care
►Orthopaedic
►
►
surgery
SECOT (Sociedad Española de Cirugía Ortopédica y Traumatología)
Orthopaedic training
Orthopaedic surgery
► All
pathology in limbs and spine
 Reumathologists:
►Treatment
of inflammatory pathology
 Rehabilitation physicians:
►direction
of physiotherapy
 Vascular surgeons:
►surgical
treatment of vascular pathology
Orthopaedic surgery
► All
pathology in limbs and spine
 Traumatic / non traumatic
 Diagnostics / Treatment / Follow-up
 Surgical / Medical / Physical therapy /
Conservative
Orthopaedic surgery
► Aprox
5.000 physicians practising orthopaedic
surgery
► (not
► Typical
all official title)
weekly work-schedule
 Surgery: 1-2 weekly sessions (7 hours)
 Out-patient clinic: 2-4 weekly sessions
► 1-2
highly specialised (hospital)
►1-2 low specialisation (peripheral facilities)
 Emergency: 1 weekly session (24 hours)
Orthopaedic surgery
 NO official sub-specialities
 In practical setting: areas of special interest
►Hand
surgery
►Spine surgery
►Shoulder / upper limb
►Arthroscopy / sports / soft knee
►Arthroplasty / lower limb reconstructive
►Trauma
Orthopaedic surgery in SPAIN
►
►
►
Spain 2008
Health care
Orthopaedic surgery
►SECOT
(Sociedad Española de
Cirugía Ortopédica y
Traumatología)
►
Orthopaedic training
SECOT
► 1)
Members
► 2) Relations
► 3) Organization
► 4) Activities
SECOT
► 1)
MEMBERS
 Aprox 4000 members
►(not
all with official title)
►2000-2500 certified orthopaedic surgeons
 Full-members
►500 residents
 Associate members
►Aprox
1000 non-certified physicians practising
orthopaedic surgery
 Associate members
►Honour members
 Retired full-members
SECOT
► 2)
RELATIONS
 Internal Study Groups (variables)
 Infection, spine, pain, TED, dynamic OS, …
 Fraternal relation
►Spanish sub-speciality societies
 Spine, Shoulder&Elbow, Hand, Hip, Knee, Arthroscopy,
Foot&Ankle, Pediatrics,…
►Spanish
regional societies
SECOT
► 2)
RELATIONS
 Member of EFORT & UEMS
 Special relations:
►AAOS
 crossed symposia
 shared book
►Latin
America societies
 crossed symposia
SECOT
► 3)
ORGANIZATION
 General Assembly
 Executive Committee
 Senate
SECOT
► 3)
ORGANIZATION
 General Assembly
►Once
yearly, in Annual Congress
►Direct vote
 Election of Vice-President (future President) every two
years
 Election of Journal editor
 Legislative
SECOT
► 3)
ORGANIZATION
 Executive Committee
►1
President (elected 2 years before)
►1 elected Vice-President
 elected by General Assembly every 2 years
►1
Past-President
►Treasurer, General Secretary, Members
 number variable
 Elected by President
 Head of Committees: Education, Publications, Annual
Congress, Associated Members, Legal issues
SECOT
► 3)
ORGANIZATION
 Senate
►Past-Presidents
►Counseling
activity for President
SECOT
► 4)





ACTIVITIES
Annual Congress
Annual Basic Course
Journal
Publications
Grants & Prizes
SECOT
► 4)
ACTIVITIES
 Annual Congress
►3
full days / aprox 2000 participants
► Rotating location: Madrid / Barcelona / Other
► End of September / Beginning of October
► Educational:
 Official Themes
 Instructional Courses
 Industry symposia
► Research:
 Free papers
 Posters
SECOT
► 4)
ACTIVITIES
 Annual Basic Course
►2-3
days / 150-200 participants
►Variable location all along country
►June
►Basic Monographic Course for Residents
SECOT
► 4)
ACTIVITIES
 Journal
►“Revista
española de Ortopedia y Traumatología”
►Elsevier / Masson
►6 issues / year
►Editor in chief elected by General Assembly
SECOT
► 4)
ACTIVITIES
 Publications (Books)
►Instructional
Courses
►“Up-to dates”
►Monographies
►Hand-book
►Annual Case-Report Book
►Cross-publication with other societies
SECOT
► 4)
ACTIVITIES
 Grants
►Congress
& Basic Grants
►Travelling grants
►Foreign & National visits
►Research projects
 Prizes
►Best
Basic & Clinical research study
►Best published paper
Orthopaedic surgery in SPAIN
►
►
►
►
Spain 2008
Health care
Orthopaedic surgery
SECOT (Sociedad Española de Cirugía Ortopédica y Traumatología)
►Orthopaedic
training
Orthopaedic training
► 1)
► 2)
► 3)
► 4)
► 5)
Access
General organization
Activities
Control of training
Control of training centers
Orthopaedic training
► 1)
ACCESS
 Medical degree
 National exam
►250
MCQ about medicine
 Ranking according to exam + qualifications in
Medical School
 Election by ranking
►Medical
►Hospital
speciality
Orthopaedic training
► 2)





GENERAL ORGANIZATION
Five years
175 residents / year
50% female / male (nowadays)
Public hospitals
Laboral contract, worker’s rights
►35
hours/week + hours / days on duty
 Difficulties with EWDT because of days on duty
►Free
day after 24h on duty (not always possible)
Orthopaedic training
► 3)
ACTIVITIES
 Rotations
►External:
 Compulsory: Anaesthesia, Plastic Surgery, Vascular
 Optative: most surgical, Rehabilitation, Rheumatology
►Internal:
 Compulsory: Pediatrics
 Advisable: tumours, hand, arthroscopy, spine
Orthopaedic training
► 3)
ACTIVITIES
 On duty
►Periods
of 24 hours on duty
►From 4 to 8 days / month
►Heavy work in Emergency Department
►Light work in hospitalization ward
►Most hospitals: first call
Orthopaedic training
► 3)
ACTIVITIES
 Surgery
►Progressive
responsibility
►2nd assistant / 1st assistant / supervised surgeon
►7 hours / session
►1 - 4 sessions / week
►NO compulsory number / type of surgeries
Orthopaedic training
► 3)
ACTIVITIES
 Out-patient office
►Assistant
/ assisted
►In practice, irregular
►No compulsory
►No in many hospitals
Orthopaedic training
► 3)
ACTIVITIES
 In-hospital patients
►Variable
organization according to Departments
►Clinical & burocratic tasks
►Main medical worker for hospitalization ward
Orthopaedic training
► 3)
ACTIVITIES
 Theoretical teaching
►Daily
/ weekly / monthly sessions
►Sessions of 15 min – 2 hours
►Irregular, great variability
►Types of sessions:
 Emergency cases / Surgical cases / Hospitalization ward /
Bibliography / Monographics / Radiological / Histological
Orthopaedic training
► 4)








Control of training
Head of teaching: Head of Department
Tutor
Logbook
Continuous evaluation
Annual evaluation (logbook + staff opinion)
NO compulsory exams
NO intermediate exams
Voluntary final exam (launching)
Orthopaedic training
► 5)




Control of training centers
Ministery of Health
Periodical audits
Control of logbooks
Beds / facilities / surgical activity / out-patient
activity / library
Thank you