Education And Debate

Harmonisation of specialist training in Europe: is it a mirage?

BMJ 1995; 311 doi: (Published 29 July 1995) Cite this as: BMJ 1995;311:297
  1. Stephen Brearley, consultant surgeona
  1. aWhipps Cross Hospital, London E11 1NR
  • Accepted 1 May 1995

For the past 18 years there has been a proliferation of European committees, boards, associations, colleges, and working groups set up to promote the harmonisation of specialist training in Europe. It has been taken as read that this objective is desirable. The fact that these bodies have achieved remarkably little is telling, and it is time to question their activity. There are good practical reasons behind the evolution of Europe's disparate training schemes, and the arguments for retaining diversity rather than continuing to strive for homogeneity are persuasive.

Harmonisation of specialist training is a concept that has pervaded—even dominated—European medical bodies for at least a quarter of a century. The adoption of the medical directives (75/362/EEC and 75/363/EEC) in 1976, and the resulting legal equivalence between basic and specialist qualifications awarded in all member states of the European Community, reinforced the notion of harmonisation in the minds of many and led to an assumption that national systems of training leading to those qualifications would inevitably converge.

Since 1976, obsession with harmonisation has spawned numerous new craft related or specialty based organisations, each of which has worked to further develop the concept. Innumerable person hours of committee work and countless air miles have been devoted to its promotion. Nowhere can a voice be heard to question it. Yet, 18 years after the directives were signed, remarkably little has been achieved in concrete terms and a cogent argument in favour of harmonisation has yet to be put forward.

Why the drive to harmonise?

The most cynical explanation of the harmonisation bandwagon is the opportunity which it affords to representatives to travel to attractive places and to meet interesting foreigners. Cynical, but not entirely without foundation. Foreign travel is undoubtedly attractive and the opportunity to do it at someone else's expense is even more so. The durability of …

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