EUROPEAN ASSOCIATION OF PATHOLOGY CHAIRS AND RESIDENCY PROGRAM DIRECTORS and the history of European Pathology

The EAPCP is founded in September 2005 in Paris. The goal of the Association is to promote harmonisation of specialist training, certification and practice within the different European countries. The foundation of this Association is preceded by a long history.

With the treaty of Rome in 1957 a free exchange of diplomas, also the medical ones, in the then European Economic Community (EEC) was realised. Already in 1958 representatives of the medical specialist organisations of the 6 involved countries convened to discuss the consequences of the free movement of doctors that could result from this decision. Europe at that time (and still), has a great diversity in specialities with only partial overlap in the different countries. They therefore founded a European Union of Medical Specialists (UEMS) and tackled a number of problems such as manpower planning, subspecialisation, marking out specialities, the quality of the specialists and the consequences of free movement of specialist doctors.

In 1962 the UEMS founded, within its organisation, Specialist Sections for the most important specialities that were practised in the EEC. Pathology was originally part of the Specialist Section Laboratory Medicine, representing anatomic pathology, chemical pathology and microbiology. In 1988 separate sections of respectively (Anatomic) Pathology, Pathobiology and Microbiology were created, recognising the different interests of the involved groups. In the nineties the Section Anatomic Pathology became the European Board of Pathology

The European Board of Pathology

The Specialty Pathology in the EU (and in the rest of the world) is on the one hand characterised by a relative uniformity in the contents of the profession, on the other hand by variation in training duration and training content, the required competencies at the end of training and the methods of certification. In addition there are unmistakable differences in the quality of training.

The past seventeen years the Section (Board) of Pathology has tried to change this situation with proposals concerning the different aspects of the harmonisation of training, and by the introduction of a voluntary exit examination at the end of the training period. In addition there are proposals regarding CME and other quality aspects. However the best intentions behind these proposals did not result in substantial changes in the training situations. This is on the one hand due to the fact that the UEMS is a very slowly functioning political organisation with enormous differences (and conflicts) of interest between individual specialties and between different countries. The UEMS aims for uniform regulations for all specialties, rather than supporting initiatives from individual specialties. E.g. the UEMS is against uniform European specialty examinations (although 10 specialties are already engaged in one form or another of examination) and does not want them to replace existing national examinations (if they exist). By this and other decisions the UEMS blocks new developments that are in fact the logical consequences of the imposed mutual recognition of medical specialists in the EU.

On the other hand one should not only blame the UEMS for lack of progress. Also the national pathology societies do not feel involved in harmonisation of pathology training and certification. Their main goal is still to improve the quality of their own training and practise situation.

So, although a lot of work has been done, resulting in many good initiatives for Pathology in the EU, the results at this moment are rather disappointing.

At the same moment Pathology in Europe is still mainly directed at a national level by the national pathology societies. The main goal of these societies is to guarantee an optimal discharge of the specialty both professionally and economically in their country. The interest or involvement in the same aspects of the specialty in other countries was, and is, very limited, even considering the long history of European unification.

European Association of Pathology Chairs and Residency Program Directors

With time, the feeling developed that real international changes should come from other initiatives than those of the UEMS and the national societies. It seemed logical to seek these within the group of professionals that are directly responsible for the training of medical specialists: the academic pathology chairs and residency program directors. After ample consultations, in September 2005 the "European Association of Pathology Chairs and Residency Program Directors" (EAPCP) was founded. Members are academic pathology chairs and residency program directors, and also non-academic program directors with a complete training program.

The association has five committees that deal with the major goals of the Association:

-Harmonisation of training
-Competence Testing and Examination
-Subspecialisation
-Undergraduate teaching
-Research

The Harmonisation Committee is, among others, involved in formulating general and specialty-specific competencies at the end of the training period and weights them against the length of the training period and the total number of specimens that should be studied. The Committee on Competence Testing and Examination studies the possibilities of an annual European progress test and makes an inventory whether a European exit examination is desirable and feasible. The Subspecialisation Committee goes into the dilemma of subspecialties in Pathology The Research Committee has as main task to advise the membership about relevant research developments that may have future diagnostic impact in Pathology. The Committee on Undergraduate Teaching has as main task to advise on new teaching methods in the medical curriculum, to bring Pathology closer to the students and bright students closer to Pathology.

Time will tell us whether this initiative has enough support to realise the complex issues that it pursues. However, the positive responses to this initiative justify the hope that it may be an important step towards a uniform training and practise of pathologists in Europe..