Subspecialist training program in Reproductive Medicine

UEMS – OB/GYN Section

European Board and College of Obstetricians and Gynaecologists (EBCOG)

ESHRE

Introduction

In Europe approximately 14% of the couples have difficulties to conceive. The treatment demand is probably increasing because couples try to conceive later and fertility decreases with the age of the partners. The management of infertile couples and the development of assisted reproductive techniques (ART) need a multidisciplinary approach and require special training, such as in endocrinology, andrology, reproductive surgery, reproductive biology, genetics, psychology of both partners.

EBCOG noted with approval the development of subspecialty practice in a number of countries and considered that reproductive medicine should be recognized as a subspecialty in Europe.

Educational objectives and requirements for training in these sub-specialist areas have been defined with acknowledged experts from the European Society of Human Reproduction and Embryology (ESHRE). The role of a sub-specialist is complementary and not competitive to the specialist in Obstetrics and Gynaecology.

Definition of the Reproductive Medicine Sub-specialist

The Reproductive Medicine sub- specialist is a specialist in Obstetrics and Gynaecology who has had theoretical and practical training in:

1. medical and surgical management of infertility. This may involve treatment of the male if practiced by the gynaecologists in the country. It will involve a range of assisted reproductive techniques (ART)
2. reproductive endocrinology

Comprehensive management of these problems includes diagnostic, therapeutic procedures and audit of outcome.

Sub-specialists, after completion of their training, continue to devote at least half, and probably more, of their working time to the field of Reproductive Medicine.

Aim of the training

The aim of the training is to improve the care of patients with disorders of reproductive function in collaboration with other care providers.

Objectives of the training

To train a sub- specialist to be capable of:

improving knowledge, practice, teaching, research and audit;

co-ordinating and promoting collaboration in organizing the service;

providing leadership in the development and in research within the subspecialty.

Organisation of training

the number of training positions should be strictly regulated by the relevant national body in order to provide sufficient expertise.

training program should be in a multidisciplinary centre and should be organised by a sub-specialist or an accredited sub-specialist. (Initially there will be a transitional period when accreditation for training will be given by the national appointing authority to a Specialist in Obstetrics and Gynaecology with proven scientific and clinical expertise in reproductive medicine. Subsequently only individuals with training in the subspecialty should hold such a position)

centre should use guidelines and protocols finalised by national professional bodies reviewed at regular intervals.

training as a sub-specialist in reproductive medicine does not imply an exclusive activity in that field.

Means of training

Entry requirements:

a recognised specialist qualification in Obstetrics & Gynaecology or have completed a minimum of five years in an approved training program . 

the availability of a recognised training positions.

An adequately remunerated position in a recognised training program is a basic condition. Each Fellow must be allocated an appointed tutor for guidance and advice.

For each country, the number of training positions should reflect the national need for subspecialists in reproductive medicine as well as the facilities and finance available for training.

Training should be directed towards achieving competence. Fellows should participate in all hospital activities such as the care of out-patients and in-patients, on call duties, performing endoscopic surgery, assisted reproductive techniques such as ovulation induction, insemination, IVF/ICSI and participating in educational activities, including the teaching of other health professionals. Participation in audit and clinical or basic research is essential.

Arrangements for postgraduate training must be compatible with national employment legislation in relation to remuneration, hours of work and rights of employees in such matters as sick leave, maternity and paternity leave and compulsory military service.

Duration of subspeciality training should include a minimum of two years in an approved program and should cover the clinical and research aspects of the following areas :

Andrology

Counselling and psychology

Endocrinology

Genetics

Reproductive biology

Reproductive surgery

Ultrasound imaging

Training should be structured throughout with clearly defined targets to be met after specified intervals. An educational plan should be drawn up in consultation with the Fellow at the beginning of each attachment and progress should be monitored regularly by mean of the log book.

A Fellow may spent some training time in an another (1 or 2) centre(s) recognised by EBCOG and ESHRE after approval by the national committee.

Assessment of training

In all European countries approval of training and trainers should be the responsibility of a national or regional authority which has the power to withdraw recognition if necessary.

Approval of institutions as training centres should be based on :

Annual statistics -Internal quality control and audit

Organised teaching sessions

Availability of:
-Multidisciplinary team regularly involved in the management of reproductive medicine
-Reproductive biologist
-Ultrasound unit
-Optional: unit of genetics and urology

Fulfilment of defined criteria for minimum activity:

100 new infertility cases per year for a first Fellow and 60 more for a second one would be the minimum number necessary to provide quality care, fellowship training and research. participation in Reproductive Medicine courses, in particular those recognised by EBCOG, advised by ESHRE; completion of a log book of clinical experience in Reproductive Medicine; peer review publications in a nationally recognised journal.

On completion of training, Fellows should have performed the minimum number of diagnostic and therapeutic procedures and technical acts under supervision, and be able to carry these out independently, properly and safely.

A representative of the EBCOG/ESHRE Postgraduate Training and Assessment Working Party may be an observer on the national or federal assessment committee.

EBCOG in conjunction with the European Society of Human Reproduction and Embryology is willing to organize an evaluation visit to a sub-specialist unit if requested .

Procedure to apply for visitation of a reproductive medicine center

1. Application by the Centre to ESHRE (or to EBCOG/Subspecialties Subcommittee, which forwards it to ESHRE).
2. The EBCOG/Subspecialties Subcommittee is notified to log the application, check if the Ob/Gyn Department of the applying Centre has been visited or has applied for visitation, and provide (at the initial phase) one experienced visitor.
3. ESHRE nominates 2 additional visitors. After experience is accumulated, all 3 visitors will be nominated by the ESHRE.
4. The visiting Committee prepares the report and submits it to the ESHRE Board for approval.
5. The report is submitted to the EBCOG Board for approval.
6. EBCOG and the ESHRE jointly issue the Diploma for the Centre.

ESHRE Accreditation Committee

Chair :

Prof. Basil C. Tarlatzis

Geniki Kliniki Infertility & IVF Centre

2 Gravias Street

54645 Thessaloniki

Greece

Tel +30 - 231 0866 477 & 0821 681

Fax +30 - 231 0821 420

E-mail basil.tarlatzis@gmail.com

Members :

Prof. Dr. Klaus Diedrich

Medizinische Universitaet zu Luebeck

Klinik für Frauenheilkunde & Geburtshilfe

Ratzeburger Allee 160

23538 Luebeck

Germany

Tel +49 451 5002134

Fax +49 451 5002139

E-mail diedrich@medinf.mu-luebeck.de

Dr. Pedro Barri

Instituto Universitari Dexeus

Jefe del Servicio de Medicina de la Reproducción

Dpto. de Obstetricia y Ginecología

Pso Bonanova 67

08017 Barcelona

SPAIN

Tel +34 93 227 47 00

Fax +34 94 205 79 66

E-mail pbarri@iudexeus.uab.es

E-mail perbar@dexeus.com

Prof. Anders Nyboe Andersen

The Fertility Clinic - Section 4071

Rigshospitalet

Blegsdamsvej 9

2100 Copenhagen O

Denmark

Tel +45 35 45 13 15

Fax +45 35 45 49 46

E-mail anyboea@rh.dk

Professor Bart C.J.M. Fauser

University Medical Center Utrecht
Chair, Division Woman & Baby
Heidelberglaan 100
PO Box 85500
3508 GA Utrecht
The Netherlands
Tel +31 88 755 75 24
Fax +31 30 250 5433
E-mail B.C.Fauser@umcutrecht.nl
Mobile + 31 6 532 474 04
 

Downloads

1. Sub-specialist Training Program in Reproductive Medicine (full text - pdf)

2. Procedure to apply for a visitation of a reproductive medicine centre (pdf)

3. List of visitors(pdf)

4. Suggested schedule for a visit (pdf)

5. Visiting report (pdf)

6. Head of Centre questionnaire regarding sub-specialist training in reproductive medicine (pdf)

7. Fellow questionnaire regarding sub-specialist training in reproductive medicine (pdf)

8. Logbook for training in reproductive medicine (pdf)