© Gunther Eysenbach 1998

Unauthorised redistribution without consent of the editor is not allowed. Vervielfältigung ohne Erlaubnis des Herausgebers nicht gestattet.
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Eysenbach, G. (ed.):
Medicine and Medical Education in Europe - The Eurodoctor,
Stuttgart-New York: Thieme 1998,
ISBN 3-13-115221-4

Medicine and Medical Education in Europe

 

Preface

This book has many possible target groups; among the primary audiences are:

 

The first and foremost goal of this book is to provide concrete information for doctors wishing to spend part of their career abroad in another European country – this is the more practical aspect of this volume (I will talk about the second aspect – the more "scientific" aspect - below). Mobility of doctors is an increasingly important issue, not least because of the extremely uneven distribution of medical manpower in Europe (for example, there is a lack of doctors in the UK and Norway, while thousands of doctors are unemployed in Germany and Italy). Mobility of doctors is one possible answer to this problem.

 

The book consists of two main sections. The first, introductory section covers such issues as the European legal framework for mutual recognition of medical diplomas, but also provides important practical information on going abroad as a doctor. The second section is a "country-by-country section" supplying general information about each European country, including information about the educational and health care system, information about the structure of postgraduate training, employment possibilities for doctors, formalities to work in the country and - perhaps the most important part of each chapter - addresses of all relevant medical organisations, bodies, etc. in each country.

 

I tried to inject life into the sometimes quite dry subject matter by introducing, into some chapters, personal stories of doctors who have been abroad. Further, we featured peculiar health issues of the respective countries, e.g. euthanasia in the Netherlands, needle parks in Switzerland etc. – which the hope that the book would also be interesting and exciting to read and browse through, rather than being a mere reference work. Perhaps this may awaken the curiosity of some of our readers and provide the stimulation to go and study or work abroad. Last but not least, the book also aims to widen the horizon of European doctors – to help them realise that their potential role in Europe is not confined to the country they were born and raised in.

 

Although the medical EU directives guarantee free mobility of doctors and mutual recognition of diplomas throughout the EEA, anyone who has tried to obtain information about the formalities involved knows how difficult the actual process can be. Although the EU has designated so-called information centres which should help doctors planning to train or practise abroad to master the formalities, sometimes these centres do not even reply to requests (the editor experienced this when writing to various centres to obtain information for this book – only 20% actually replied). Dealing with these kinds of problems can be extremely frustrating and lack of information is probably the main reason for the current restricted state of mobility of doctors.

 

The second objective of this book – we may call it a theoretical, political or scientific aspect – was to provide a complete inventory of the diverse approaches and various aspects of medical education and training in Europe. To collect and structure this information has, to our knowledge, never been done before on this scale, in this detail and in this format. This book represents more than 4 years of research by, and personal involvement of, the editor and the authors in these issues. To create a more or less complete picture and to distribute this information as a book will undoubtly be a primer for further analyses and comparison of medical education in Europe. It will also, hopefully, stimulate the discussion on this subject and contribute to the development of medical education in Europe.

 

With both of these "objectives" – to give practical information, thereby encouraging doctors to go abroad, and to give a "theoretical" basis for comparison of medical training systems – we are persuing the "higher" goal of fostering international understanding and collaboration in the field of health care.

 

The information provided in this book will hopefully help doctors in experiencing foreign health care and medical education systems first hand, to learn from the differences and to come back to their own countries and fertilize discussion at home.

 

Learning from each other does not of course mean that the final aim should be a completely uniform health care and medical training system in Europe. It is the very diversity of approaches, which have grown from the individual history and culture of the different European countries, that makes Europe such an interesting place to live in. "Harmonisation" is necessary only to a degree to remove unnecessary barriers and to reduce "paperwork"; the aim is not to construct a uniform European system.

 

Some words of warning (and perhaps apology) follow. It is impossible to write such a work which does not contain outdated material or even errors. The information and publications available until today concerning medicine and medical education in Europe represent a mosaic pieced together from a number of different organisations and individuals with different cultural backgrounds and sometimes even languages. Trying to compile this scattered information and to amalgamate it into a monograph is certainly a huge task (some would call it impossible) and obviously prone to mistakes and misunderstandings.

Research in this area is rendered significantly difficult by language and terminology complications and differences. Quite often, different terms are used in different countries to mean the same thing or the same or similar terms will have two totally different meanings.

 

While undergraduate medical education is comparably homogeneously organised in Europe, there are much more significant differences in the system and organisation of specialist training and accreditation. In many specialist fields the desired mutual recognition of specialist certificates is not possible without further training, as some specialised areas simply do not exist in other countries or have a totally different training structure. From this diversity confusion arises.

 

Being aware of these difficulties, I am looking forward to receiving active feedback from readers to correct possible mistakes or clarify unclear or outdated issues.

 

A second related problem is of course the short half-life time of the kind of information provided here. Medical training is in a state of upheaval worldwide and methods and organisation frameworks are frequently being changed. This is because tradtitional teaching methods based on the absorption and memorising of factual information have been critizised as not preparing the (undergraduate and postgraduate) student adequately, placing far too little emphasis on reasoning skills or critical analysis.

 

Since, we are dealing with an ever-changing subject matter, we intend to publish important changes and updates on the world wide web, which is a much more suitable medium for publishing quickly outdated information.

 

Medicine and Medical Education in Europe - Website

http://www.thieme.de/medeuro/

 

We hope that this website will grow over time and provide a platform for discussions and exchange of information between the readers, authors and editor.

 

Finally a few words about the history of this book. When in 1994 I first had the idea and started to make a draft of a compilation called "Medicine and Medical Education in Europe", I was still a medical student. Being Communication Director and later Vice-President of the European Medical Students' Association (EMSA) I was about to fly to Romania, where the EMSA had its General Assembly, and I quickly tried to compile a booklet for this meeting, containing some rough information about the general and medical education systems in each country. The booklet has had an impressive number of pages, but most of the key information which I intended to include was simply not available and therefore missing. It was probably at this point that I decided that a reference work of this nature must be written by experts from the respective countries, rather than by a single person.

 

Luckily, when starting on this book, I was rather naive with regard to estimating the amount of work and research necessary to compile the book. I knew that it was going to be a ambitious project, but I did not know that it was close to being impossible. I had always wondered why there had previously been no such book of this kind – now I know!

 

As the making of the book took much longer than initially expected, heavy editing and additions to the original manuscripts of the chapters were necessary to keep them up-to-date. Therefore, errors that may occur in the chapters may be the responsibility of the editor rather than the authors.

 

Despite all the difficulties encountered during the writing of this book and the possible flaws in the end-result, I am confident that this book may become a useful compilation suitable for breaking down barriers, fostering international understanding and collaboration in the field of health care, and finally bringing us all a little bit closer to a united Europe.

 

 

Gunther Eysenbach

Editor

January 1998

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