1. Orthopaedic surgery in SPAIN UEMS Orthopaedic Section 2008 2nd annual meeting Edimburgh, September 27th

2. Orthopaedic surgery in SPAIN ► Spain 2008 ► Health care ► Orthopaedic surgery ► SECOT (Sociedad Española de Cirugía Ortopédica y Traumatología) ► Orthopaedic training

3. Orthopaedic surgery in SPAIN ► Spain 2008 ► Health care ► Orthopaedic surgery ► SECOT (Sociedad Española de Cirugía Ortopédica y Traumatología) ► Orthopaedic training

4. Spain 2008 ► 45.000.000 people ► Aprox. 500.000 Km 2 (2nd in Europe) ► Weather:  Atlantic (north)  Mediterranean (east, south)  Continental (interior) ► European Comunity since 1986 ► Euro since 2002 ► GNP: 80-90% “euro-zone”

5. 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

6. Orthopaedic surgery in SPAIN ► Spain 2008 ► Health care ► Orthopaedic surgery ► SECOT (Sociedad Española de Cirugía Ortopédica y Traumatología) ► Orthopaedic training

7. 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

8. 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

9. Health care ► National Health System  Primary medicine: ► GPs ► Health Centers  Specialized medicine: ► Hospitals ► Out-patient facilities

10. Health care ► Hospitals  University hospitals ► All Departments ► 500-2000 beds  Small hospitals ► “High demand” specialities ► 100-500 beds

11. Health care ► Hospitals  Hyerarchic organization: ► Physicians:  Chief of Department  Chiefs of sections / units  Members of staff  Residents ► Nurses ► Nurse-assistants

12. Orthopaedic surgery in SPAIN ► Spain 2008 ► Health care ► Orthopaedic surgery ► SECOT (Sociedad Española de Cirugía Ortopédica y Traumatología) ► Orthopaedic training

13. 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

14. Orthopaedic surgery ► All pathology in limbs and spine  Traumatic / non traumatic  Diagnostics / Treatment / Follow-up  Surgical / Medical / Physical therapy / Conservative

15. Orthopaedic surgery ► Aprox 5.000 physicians practising orthopaedic surgery ► (not all official title) ► Typical 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)

16. 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

17. Orthopaedic surgery in SPAIN ► Spain 2008 ► Health care ► Orthopaedic surgery ► SECOT (Sociedad Española de Cirugía Ortopédica y Traumatología) ► Orthopaedic training

18. SECOT ► 1) Members ► 2) Relations ► 3) Organization ► 4) Activities

19. 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

20. 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

21. SECOT ► 2) RELATIONS  Member of EFORT & UEMS  Special relations: ► AAOS  crossed symposia  shared book ► Latin America societies  crossed symposia

22. SECOT ► 3) ORGANIZATION  General Assembly  Executive Committee  Senate

23. 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

24. 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

25. SECOT ► 3) ORGANIZATION  Senate ► Past-Presidents ► Counseling activity for President

26. SECOT ► 4) ACTIVITIES  Annual Congress  Annual Basic Course  Journal  Publications  Grants & Prizes

27. 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

28. SECOT ► 4) ACTIVITIES  Annual Basic Course ► 2-3 days / 150-200 participants ► Variable location all along country ► June ► Basic Monographic Course for Residents

29. SECOT ► 4) ACTIVITIES  Journal ► “Revista española de Ortopedia y Traumatología” ► Elsevier / Masson ► 6 issues / year ► Editor in chief elected by General Assembly

30. SECOT ► 4) ACTIVITIES  Publications (Books) ► Instructional Courses ► “Up-to dates” ► Monographies ► Hand-book ► Annual Case-Report Book ► Cross-publication with other societies

31. SECOT ► 4) ACTIVITIES  Grants ► Congress & Basic Grants ► Travelling grants ► Foreign & National visits ► Research projects  Prizes ► Best Basic & Clinical research study ► Best published paper

32. Orthopaedic surgery in SPAIN ► Spain 2008 ► Health care ► Orthopaedic surgery ► SECOT (Sociedad Española de Cirugía Ortopédica y Traumatología) ► Orthopaedic training

33. Orthopaedic training ► 1) Access ► 2) General organization ► 3) Activities ► 4) Control of training ► 5) Control of training centers

34. Orthopaedic training ► 1) ACCESS  Medical degree  National exam ► 250 MCQ about medicine  Ranking according to exam + qualifications in Medical School  Election by ranking ► Medical speciality ► Hospital

35. 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)

36. Orthopaedic training ► 3) ACTIVITIES  Rotations ► External:  Compulsory: Anaesthesia, Plastic Surgery, Vascular  Optative: most surgical, Rehabilitation, Rheumatology ► Internal:  Compulsory: Pediatrics  Advisable: tumours, hand, arthroscopy, spine

37. 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

38. 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

39. Orthopaedic training ► 3) ACTIVITIES  Out-patient office ► Assistant / assisted ► In practice, irregular ► No compulsory ► No in many hospitals

40. Orthopaedic training ► 3) ACTIVITIES  In-hospital patients ► Variable organization according to Departments ► Clinical & burocratic tasks ► Main medical worker for hospitalization ward

41. 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

42. 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)

43. Orthopaedic training ► 5) Control of training centers  Ministery of Health  Periodical audits  Control of logbooks  Beds / facilities / surgical activity / out-patient activity / library

44. Thank you