36th European Congress of Cytology Istanbul, September 22 – 25th, 2011

Martin Tötsch, Laszlo Vass, Ambrogio Fassina

United in Split

History

• Decision of the UEMS section pathology to rewrite the training charter

• Revision launched in the Ghent meeting (2008) – task force members L. Vass and A. Verhest

• Cytology is respected as a subspeciality of pathology

History

• Newcastle meeting (2009) – corresponding UEMS Chapter 6 does not fit in the Charter on Training in Pathology

• task force experts from the Royal College of Pathology, (Rasmussen, Ruiter, Kirkham, Cuvelier, Bailey)

• EFCS was not accepted to become member of that task force

History

• Revised version was sent out January 2009– Training to gain deepened knowledge in systemic

pathology, …, diagnostic cytopathology, including fine-needle cytology and diagnostic molecular pathology

– To gain knowledge of specialist areas such as neuropathology, cardiovascular p., gynaecopathology, paediatric p., digestive p., ….in order to be able to provide specialist advice

History

• Graz meeting (2009) – – Due to differences in countries, a general rather

than a detailed Charter is preferred– Questionable wether numerical requirements

should be included due to a lack of such requirements in many countries

– Desirability of having subspecialities „part“ of pathology widely recognized as optimal

• BUT

History

• Cytology is not considered as subspeciality, but as an integral part of pathology and does not need to be emphasized in the training charter

• Veto by M.Tötsch, supported by some representatives (Hungary, Croatia).

• „Decision had already be made at the UEMS level“, statement by the secretary-general

History

• Invitation of Claude Cuvelier to the 35th European Congress of Cytology, 2009

History

Meeting in Porto, April 2010

– Claude Cuvelier– Fernando Schmitt– Martin Tötsch

Building a bridge

History

• Berlin meeting (June 2010) – The trainee should satisfactorily complete training

in • Clinical histiopathology including surgical pathology,

autopsy and basics of cytopathology• Sub-specialist areas of pathology in which more

extensive knowledge, skills and expertise is required, which may include areas such as cytopathology, dermatopathology, forensic pathology, molecular pathology, neuropathology and paediatric pathology

History

• Berlin meeting (June 2010) – The empire strikes back….:• It was agreed (???) that there should be no strict

numerical requierements mentioned in regard with e.g. the number of specimens• It is important to mention cytology, neuropathology

and forensic pathology as subspecialities to keep them in line• Concerning cytology it was emphasized, on the other

hand, that in UK pathology trainees do not do PAP smears – do we really need this subspeciality??

Restarting the discussion or a battle lost?

• Board discussion

• Letter to UEMS• Activating the EFCS members– Website– Personal communication

• Lobbying at UEMS-level– Turkey and others

Italy• Dear Colleagues, • The Directory Board of the Società Italiana di Anatomia Patologica e Citopatologia diagnostica, divisione

italiana dell’International Academy of Pathology (SIAPEC IAP) has discussed the letter sent by the Colleagues Schmitt, Vielh, and Toetsch of the European Federation of Cytology Societies (EFCS), about the declaration of Cytology as a new subspecialty in the program of Pathology Standardization among the European Countries. This proposal will be discussed during the 27th Annual Meeting of the European Union of Medical Specialists (UEMS), Saturday, May 21, 2011, in Split and scheduled at point 9 of the agenda. The SIAPEC Directory Board want to stress its strong support and approval to the position of the EFCS, as clearly conveyed by President Schmitt and Colleagues. Harmonization of Medicine practice all over Europe has the mandatory obligation to guarantee patients and referring doctors of the quality of the Cytology Diagnoses. Important and evident efforts in order to obtain well-trained professionals has been achieved in the last decades by EFCS all over Europe and in east-European countries as well.

• Professor Ambrogio Fassina has been nominated by the SIAPEC Directory Board as its representative in the discussion of this relevant point.

• With best regards

• Claudio Clemente, MD

Croatia• Dear Philippe, Fernando and Martin, dear friends and colleagues! • I agree with Prof. Claudio Clemente that the harmonization of Medicine practice all over Europe has the mandatory

obligation to guarantee patients and referring doctors of the quality of the Cytology Diagnoses.• Which model to choose?• 1. simultaneously training in cytology and pathology during 5 years (too short for pathology, and too short for cytology)• 2. subspecialisation in cytology/cytopathology (1 year too short, 2 years optimal for cytopathology) after 5 years of

training in pathology (all together too long and too expensive).• In UEMS board internal medicine, as general specialisation lasting 4 years with subspecialisations (in hematology,

cardiology, pulmology, gastroenterology , nefrology etc.) has been replaced with common trunk (in internal medicine) lasting 3 years and with advanced program lasting 2 years, resulting with new specialisations (hematology, cardiology, pulmology, gastroenterology , nefrology etc.) This saves time and money and new experts are suitable to work in the new age.

• The new pathology and cytology residency program can be consisted of basic (common trunk) program and advanced program, with the duration of 60 months. The aim of the common trunk (three-year) education is to acquire both knowledge and skills in the field of general pathology. Depending on the advanced program education (two-year) in pathology or cytology chosen, candidates become specialists in pathology or clinical cytology/cytopathology (enough education for future pathologists, enough education for future cytopathologists).

• I am sending Croatian training model in clinical cytology which suits the proposed guidelines.• Best regards,• Assist. Prof. Ika Kardum-Skelin, MD, PhD• President of Croatian Society for Clinical Cytology

Greece• Dear Fhilippe, Martin, Fernando, and all colleagues, • Concerning the next UEMS meeting scheduled in Split , Croatia , on May 21, 2011, for the EFCS proposal about

cytopathology, we have some points to comment.

• All previous comments from Dr Clemente and Dr Ika Kardum-Skelin, are strong, very important and well proved.• Our position, ιn the new evolution era that everything is high specialized, is most close with that of Ika’s, . and we agree

with her in quite all her points, (for example from her mail, points 1 and 2 ……• 1. simultaneously training in cytology and pathology during 5 years (too short for pathology, and too short for

cytology)• 2. subspecialisation in cytology/cytopathology (1 year too short, 2 years optimal for cytopathology) after 5 years of

training in pathology (all together too long and too expensive). • As you know we have five years of training , two of pathology and three of a very advanced program of cytopathology,

exclusively, with all modern and current methods and techniques for the best training of cytopathologists Our complete five years training program is very specific and complete and we can propose it, if requested

• To our opinion, this is enough education for medical doctors to acquire knowledge on clinical cytology and cytopathology and guarantee high quality of cytology diagnosis for patients .

• My best regards to all• Chara Margari• President of the Hellenic Society of Clinical Cytology

EFCS-Board• Dear all, • this statement is of great value, but it´s very important that Greek Society

contacts the Greek representative at the UEMS meeting who should support the voting, that Cytology is a subspeciality of Pathology. If this fact is not accepted, cytology will be regarded as integral part of pathology which does not need specific training and we might vanish on long terms in whole Europe.

• My best • Martin Tötsch

Netherlands• Dear All• We have told our representative at the UEMS meeting to state The Netherlands

Society for Pathology (NVVP) represents all (cyto)pathologists in the Netherlands. Like the Danes and the Swiss, we feel that cytopathology is an integral part of pathology and its training should be an integral part of the common trunk. Currently, training for neuropathology, dermatopathology and forensic pathologic are equally integrated in the specialization of pathology while additional courses support the detailed knowledge that is required these pathology branches, but they remain within the speciality. Therefore, it is currently not desirable to fence off cytopathology as a separate subspeciality.

• It should be clear that we feel that the EFCS should play a role in formulating teaching requirements for cytopathology for the UEMS.

• EFCS representatives for the NVVP• Dr B Lelie, Dr A Grefte• Netherlands Society for Pathology

EFCS-BoardDear colleagues from Netherlands,

the aim is not to “ fence off cytology as a (sub)speciality its own” and we want to assure as well that the basic training in cytology is considered an integral part of the common trunk. Furthermore I completely agree with you that additional courses supporting the detailed knowledge that is required in cytology remains within the speciality of pathology.However, someone passing the training as a pathologist (the common trunk) AND doing additional training for a certain period (we are talking about 1 year plus) in cytology should have the right to claim being a pathologist with subspecialisation in cytology. My best Martin Tötsch

TurkeyDear Colleagues,

We would like to thank EFCS for issuing this important matter at UEMS. Unfortunately, UEMS representative of Turkey will not be able to attend Split meeting on 21 May, however we submit the comments below and in the attachment. In Turkey, medical training in histopathology and cytopathology are largely carried out at postgraduate level. Histopathology requires 4 years’ specialty training and for cytopathology 'super-speciality' is another 2 year with MD thesis. For training in cytopathology, histopathology qualification is essential. Training in histopathology and cytopathology were organized locally, by the institutions so far; last year Health Ministry took the step to organise it at national level. Two commissions, histopathology and cytopathology are formed, each composed of 11 MD’s and cytopathology commission is all of members of Turkish Society of Cytopathology. Both commissions are working on training programs, curriculums and examinations in histopathology and cytopathology, aiming completing in one year. We believe that cytopathology is an integral part of histopathology; therefore the basic training in the common trunk needs to be sufficient to train pathologists in the principles of cytopathology as a whole, so they can decide whether to specialise in it further or apply it competently . 6-12 months should be dedicated to cytopathology during histopathology training.Regarding the cytopathology representation at UEMS, EFCS should be the representative and continue its ongoing activities concerning guidelines and formulating teaching requirements.

Best wishes,Prof.Dilek Yılmazbayhan Assoc.Prof.Binnur ÖnalPresident, Turkish Society of Cytopathology Cytopathology commission, Health Ministry

Dear friends, dear Martin, dear Fernando,

As you already know Martin, Fernando and I had an excellent meeting in San Antonio!

……I fully agree with our common established statements that we made in Porto now almost a year ago andI will support formal agreement with regard to Cytology at the UEMS meeting in Split next May.

I am convinced that our cozy meeting will have contributed to a further good relationship between the EFCS and the UEMS section/board of Pathology.

Best wishesClaude

United at Split

Defeat the Lions

Mina Desai

Amanda Herbert

Gabrijela Kocjan

To Dr. Philippe Vielh, Secretary-General of the EFCS,

• At our meeting in Split 21st May 2010 your letter dd 30 June 2012 on the position of Cytopathology in the training charter of Pathology was discussed.

• It is my pleasure to announce you that the European Section/ Board of Pathology agreed upon the following:– The position of Cytopathology in the curriculum is an

imminent integral part of the training in Pathology.– We decided on a common trunk in Pathology training

consisting of preferentially 4 years.– UEMS decided to replace subspecialisation by advanced

training in areas of interest such as Neuropathology, Cytopathology and others.

To Dr. Philippe Vielh, Secretary-General of the EFCS,

– Advanced training in Cytopathology ending with a certificate for that level of competence can be added and stays within the authority of the national Board of recognition.

– UEMS encourages EFCS to evaluate the situation and training of Cytology in Europe.

– UEMS encourages EFCS as well to elaborate recommendations for minimal requirements of basic and advanced training in Cytopathology.

Hoping that these decisions are fully acceptable to EFCS I present you my best regards

Claude Cuvelier