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Paediatric Endocrinology Subspecialty

Paediatric Endocrinology Subspecialty – The European Map, 55 years later

In July 1962, Professor Andrea Prader, Director of the University Children’s Hospital (Kinderspital) in Zurich, organised an informal two-day meeting for paediatricians who had attended the 4thActaEndocrinologica Congress in Geneva the days before and who were known to be interested in foetal, neonatal and paediatric endocrinology. The main reason for Andrea Prader’s invitation might have been his disappointment with the main congress programme that had not included any paediatric topics. Thirty-two paediatricians and endocrinologists who attended the meeting in Zurich agreed to found a “Paediatric Endocrinology Club”, three years later transformed to European Society of Paediatric Endocrinology (ESPE). The Zurich meeting counts as the 1st annual meeting in ESPE history that has been held annually since then (1,2). The original purpose of the society was to challenge and support the high-level science and to outline future directions.

The need for harmonised education and training was formulated by Professor Leo Van den Brande in 1976. He proposed to develop a Europe-wide training programme in paediatric endocrinology aimed to increase the level of knowledge and skills across the continent His vision was to start with a course lasting four to six weeks The first “schools” were initiated within the oncoming two decades (Summer School since 1987, Dr. Paul Czernichow; Winter School since 1995, Dr. Ze’ev Hochberg) but never to such extent as Leo Van den Brande had proposed. This was the beginning of a broad and comprehensive teaching programme of ESPE, which continues in different formats and in different parts of the world until today

In March 1999, after an assessment of its first comprehensive training programme that was being developed since 1995 under the aegis of Professor Peter Hindmarsh, Paediatric Endocrinology and Diabetes was recognised as a subsection of Paediatrics by the Union of European Medical Specialists (UEMS). Nevertheless, the system and organisation of postgraduate education in medicine is under exclusive responsibility of national governmental bodies. Any UEMS decision aiming at harmonisation of postgraduate medical training throughout Europe is only optional and works as a recommendation for EU member states and third countries. Therefore, the subsequent steps to implement paediatric endocrinology subspecialty were far from straightforward. Within the past 18 years, the subspecialty was officially recognised by governmental bodies of several but not all European countries.

The initial enthusiasm to implement a unified training programme into general use at multinational level was finally considered unrealistic at this stage. Its implementation remains a challenge for the future. Nevertheless, the training programme has been periodically updated in order to reflect the developments of the subspecialty of paediatric endocrinology and diabetes and it is available as an optional template for countries within and beyond Europe. The latest update, which is from 2013, was supervised by Professor Feyza Darendeliler in collaboration with Professors Sten Drop, Stefano Cianfarani, Wilma Oostdijk, Giorgio Radetti, Stefan Riedl, Jan Lebl, and Lars Sävendahl. After its approval at the Annual ESPE Meeting in Dublin, the revised training programme and the portfolio were finally approved at the General Assembly of European Academy of Paediatrics (EAP) meeting in Brussels and subsequently put on the website of EAP in December 2014

To advocate the recognition of paediatric endocrine subspecialisation in more European countries and with a view to ensuring the best possible care for children with endocrine conditions, the ESPE Council issued a statement regarding Paediatric Endocrinology subspecialty. It was published in Hormone Research in Paediatrics in 2016and it summarises arguments in favour of a separate and independent medical subspecialty based on a completed training in paediatrics and thus ensuring deep understanding of developmental aspects of child’s growth and physical, intellectual, psychosocial and emotional maturation.

The ESPE Accreditation and Syllabus convenors, working under the umbrella of ESPE Education and Training committee, initiated a survey to gain a comprehensive view of legal status of paediatric endocrinology subspecialty in 2017. A close collaboration of colleagues from 42 countries allowed drawing a nearly complete European map displaying the different levels of the subspecialty recognition (Fig. 1).

ESPE map

Authors:

Jan Lebl1

Andrea Luczay

FeyzaDarendeliler

Rasa Verkauskiene3

Acknowledgements

The following colleagues participated to collect the full data for the European map of paediatric endocrinology:

Agim Gjikopulli, Tirane, Albania; Elena Aghajanova, Yerevan, Armenia; Peter Blümel, Wien, Austria; Gunduz Ahmadov, Baku, Azerbaijan; Julia Boiko, Minsk, Belarus; Dominique Beckers, Leuven, Belgium; Talat Mushtaq, Leeds, United Kingdom; Violeta Iotova, Varna, Bulgaria; Miroslav Dumic, Zagreb, Croatia; Katharina Main, Copenhagen, Denmark; Wilma Oostdijk, Leiden, The Netherlands; Vallo Tillmann, Tartu, Estonia; Paivi Miettinen, Helsinki, Finland; Michel Polack, Paris, France; Nino Kheladze, Tbilisi, Georgia; Wieland Kiess, Leipzig, Germany; George Chrousos, Athens, Greece; Kolbeinn Gudmundsson,  Reykjavik, Iceland; Hilary Hoey, Dublin, Ireland; Mohamad Maghnie, Genova, Italy; Iveta Dzivite, Riga, Latvia; Rimma Bazarbekova, Almaty, Kazakhstan; Cedomir Dimitrovski,    Skopje, Macedonia; Michael Witsch, Luxembourg, Luxembourg; John Torpiano, Valetta, Malta; Hilde Johanne Bjørndalen, Oslo, Norway; Elzbieta Petriczko, Szczecin, Poland; Lurdes Lopes, Lisboa, Portugal; Otilia Marginean, Timisoara, Romania; Anatoly Tiulpakov, Moscow, Russia; Tatjana Milenkovic, Beograd, Serbia; Ludmila Kostalova, Bratislava, Slovakia; Primoz Kotnik, Ljubljana, Slovenia; Lourdes Ibanez, Barcelona, Spain; Ola Nilsson, Gothenburg, Sweden; Valérie Schwitzgebel, Bern, Switzerland; Evgenia Globa, Kiev, Ukraine; Gulnara Rakhimova, Taskent, Uzbekistan;