The aims of the 2021 European Training Requirements (ETR) in Paediatric Endocrinology and Diabetes (PED) are to (1) provide standards to harmonize training programmes in PED between different European countries, (2) establish clearly defined standards of knowledge and skills required to practice PED at the tertiary care level, (3) foster the development of a network of competent tertiary care centres for PED in Europe and globally, and (4) improve the quality of care for children and adolescents requiring PED services. This ETR in PED specifies the requirements for training institutions, trainers, and trainees. It also provides the detailed syllabus/core content that trainees are expected to achieve in order to become competent independent clinicians in PED. References to consensus guidelines produced and/or endorsed by ESPE are included. The target users are trainees in PED, trainers, and all involved with quality assurance and accreditation. The process to develop and approve this 2021 ETR has been rigorous and involved trainees and consultants in paediatric and adult Endocrinology, ESPE (Syllabus Task Force, Education and Training Committee, Council), European Academy of Paediatrics (Tertiary Care Council, Assembly), European Board of Paediatrics, and Union of European Medical Specialists. Implementing the ETR will complement professional regulatory requirements for postgraduate training in PED in different countries and allow harmonizing standards across Europe. ETR is publicly available at www.eurospe.org/education/education-training-syllabus and at https://www.uems.eu/__data/assets/pdf_file/0007/133990/UEMS-2021.17-European-Training-Requirement-in-Paediatric-Endocrinology.pdf.
This study presents the rationale that underpins the European standards for training in medical (sub)specialities, the roles of various organisations involved in developing the 2021 European Training Requirements (ETR) in Paediatric Endocrinology and Diabetes (PED), and an overview of what it comprises . ETR is publicly available at www.eurospe.org/education/education-training-syllabus and at https://www.uems.eu/__data/assets/pdf_file/0007/133990/UEMS-2021.17-European-Training-Requirement-in-Paediatric-Endocrinology.pdf. The 2021 ETR in PED aims to (1) provide standards to harmonize training programmes in PED between different European countries, (2) establish clearly defined standards of knowledge and skills required to practice PED at the tertiary care level, (3) foster the development of a network of competent centres for PED in Europe and globally, and (4) improve the quality of care for children and adolescents requiring PED services.
Rationale for European Training Requirements and Roles of Various Organisations
Union Européenne Des Médecins Spécialistes/Union of European Medical Specialists (UEMS)
UEMS is a non-governmental organisation representing national associations of medical specialists from member countries of the European Union and specialist sections of European Boards . UEMS aims to ensure high standards for training across Europe. These standards are intended to complement the training standards in individual countries and to pave the way to improve the quality of care for all citizens.
The European Commission Directive 2005/36/EC legally enables automatic mutual recognition of medical qualifications and free movement within all European member states on the basis of harmonized minimum training requirements . UEMS has set out the minimum requirements for training in the ETR for each discipline. Each ETR specifies the standards for curricula which includes syllabus (i.e., content) and the practical (process and practice for instructional methods and assessments) and productive (outcomes) aspects that are planned, purposeful, systematic, and progressive.
European Academy of Paediatrics (EAP) and European Board of Paediatrics (EBP)
The EAP is a not-for-profit and non-governmental association that aims to improve standards in training, service, and research and to represent the professional interests of paediatricians in Europe . EAP’s Secondary/Tertiary Care Council includes representatives from paediatric subspecialities, such as ESPEs “Accreditation and Syllabus Convener.” The latter is a member of ESPE’s Education and Training Committee.
EBP is the Executive of the Paediatric Section of UEMS . Its key role is to maintain the highest possible standards of training in paediatrics across Europe, and the primary output is therefore ETRs. The EBP sits within the EAP and thus provides the link between EAP and UEMS (Fig. 1).
The ETRs are developed jointly between the EAP, EBP, and European specialist societies. They are voted on at a General Assembly meeting of the EBP and then submitted to a council meeting of the UEMS for official approval. Together, EAP and the subspecialities are responsible for maintaining the ETR documents.
Subspeciality Training Requirements in Paediatric Endocrinology and Diabetes in Europe since the 1990s
Regular updates that reflect scientific and medical progress are recommended for the ETR and at approximately 5-year intervals. The first comprehensive training syllabus in PED was developed in 1995 and was last revised in 2014 [6-8].
The 2021 ETR in PED was initially prepared by ESPE’s Syllabus Taskforce on behalf of the Education and Training Committee. Contributions were obtained from paediatric and adult trainees and specialists in endocrinology and diabetes representing countries within Europe and beyond. Thereafter, the Chair and members of the Education and Training Committee and members of the ESPE council in 2020, EAP’s Secondary/Tertiary Care Council in 2020–21, and UEMS in 2021 peer-reviewed the ETR. Finalized ETR was approved by the Tertiary Care Council and General Assembly of the EAP and the EBP in January 2021 and ratified by UEMS in April 2021. The process used to develop the ETR strengthens the validity of the recommendations.
Summary of Contents of the 2021 European Training Requirements in Paediatric Endocrinology and Diabetes
The aim of tertiary care training in PED is to equip clinicians with the competencies required to provide safe high-quality care for children and adolescents who present with common as well as rare endocrine problems. By the end of training, the subspecialist is expected to display the characteristics and competencies for each of the 7 roles described by the CanMEDS framework  that are Medical expert, Communicator, Collaborator, Leader, Health advocate, Scholar and researcher, and Professional plus the additional role of mentor. To facilitate achieving these, the ETR in PED specifies the requirements for the following: training period, research training, training institutions, trainers, and trainees. It also provides details for a range of nontechnical skills (Fig. 2) and the subspeciality syllabus/core content.
Each item in the subspeciality syllabus is categorized as B for basic knowledge; C for core and essential clinical knowledge, skills, and reasoning, for problems that are routinely encountered; and D for desirable clinical knowledge, skills, and reasoning, for problems that are rare and therefore may not be encountered during training (Fig. 2). Trainees are expected to assimilate and integrate these from their training experiences and different modes of learning.
The 5 levels of clinical competence from novice to competent independent clinician defined by UEMS have been adapted for PED for the 7 components which are (1) knowledge base, (2) clinical assessment, (3) management and follow-up, (4) clinical reasoning: diagnostic, clinical judgement, and decision-making skills, (5) clinical communication and team working, (6) medical record keeping and written communication, and (7) reflective practice (Table 1). References to consensus guidelines and statements produced and/or endorsed by ESPE and seminal papers relevant for practicing clinicians are included. Continuous monitoring and evaluation, using a range of measures and including workplace-based assessments, will provide information about trainees’ progress and contribute to quality assurance.
Use of the 2021 European Training Requirements in Paediatric Endocrinology and Diabetes
National Level and Training Institutions in Different Countries
The ETR is intended to complement the standards and regulatory requirements for postgraduate training in PED in each country and not to supersede them. Adopting the standards in the ETR is a prerequisite for centre accreditation. Training institutions and tertiary care centres can use the ETR as a tool for quality assurance and undertake a self-assessment against the standards provided. The standards can also be used by national training authorities and organisations such as ESPE and EBP for accreditation of training centres.
Trainers and Trainees
The requirements for trainers and trainees are presented in separate sections of the ETR. Each trainee should be actively involved in the care of children and adolescents. They are required to keep a portfolio with an up-to-date logbook of case encounters and evidence of their learning, development, and progress. Formative assessments and using different tools are recommended throughout training . At regular intervals throughout training, they should self-assess their level of competence for the items in the syllabus and jointly review with their trainer/educational supervisor. To facilitate this, an online PED Content/Syllabus tracking tool is available from the ESPE website (Fig. 3) .
Approval and Accreditation
Further to UEMS recommendations, the EBP initiated a European Training centre Visitation program for accreditation of tertiary care paediatric specialities in 2008. It has proposed that the visitation program is arranged jointly with EAP-UEMS, paediatric subspeciality organisations such as ESPE, and national training authorities. An independent process of accreditation of training centres has benefits for centres, trainers, and prospective trainees, by providing objective evidence about the standards of training and formal recognition.
This 2021 ETR in PED specifies the up-to-date requirements for training institutions, trainers, and trainees. It also provides the detailed syllabus/core content that trainees are expected to achieve in order to become competent independent clinicians in PED. Implementing the ETR will complement professional regulatory requirements for postgraduate training in PED in different countries. This allows harmonizing standards across Europe and provides a model to use globally.
We are grateful to all listed below who have provided constructive comments and contributed to the 2021 ETR in PED: Trainees: Amish Chinoy, Paediatric Endocrine Research Fellow, Department of Paediatric Endocrinology, Royal Manchester Children’s Hospital, United Kingdom. Chris Worth, Paediatric Endocrine Research Fellow, Department of Paediatric Endocrinology, Royal Manchester Children’s Hospital, United Kingdom. Maria-Cristina Antoniou, Paediatric Endocrine Trainee, Endocrinology, Diabetology and Obesity unit, Lausanne University Hospital, Lausanne University, Switzerland. María de los Ángeles Gómez Cano, Paediatric Endocrine Trainee, Department of Paediatric Endocrinology, Hospital 12 de Octubre, Madrid, Spain. Patricia Pérez Mohand, Paediatric Endocrine Trainee, Department of Paediatric Endocrinology, Hospital 12 de Octubre, Madrid, Spain. Specialists in paediatric, adolescent and adult endocrinology: Claire Higham, Consultant Endocrinologist, The Christie Hospital, Manchester, UK. Daphne Yau, Consultant Pediatric Endocrinologist, University of Saskatchewan, Canada. Indraneel Banerjee, Consultant Paediatric Endocrinologist, Department of Paediatric Endocrinology, Royal Manchester Children’s Hospital, United Kingdom. John Schulga, Consultant Paediatrician and Lead for Paediatric Diabetes & Endocrinology, NHS Forth Valley; Honorary lecturer, Glasgow University, Scotland. Meghna Chawla, Consultant Paediatric Endocrinologist, Grant Medical Foundation, Ruby Hall Clinic Group of Hospitals, Pune, India. Mya Sandar Thein, Consultant Paediatric Endocrinologist, Yangon Children’s Hospital, Myanmar. Philip Murray, Consultant Paediatric Endocrinologist, Department of Paediatric Endocrinology, Royal Manchester Children’s Hospital, United Kingdom. Raja Padidela, Consultant Paediatric Endocrinologist, Department of Paediatric Endocrinology, Royal Manchester Children’s Hospital, United Kingdom. Members of the ESPE Education and Training Committee (ETC): Rasa Verkauskiene, Chair of ESPE ETC 2016–2019. Professor and Head of Department, Department and Institute of Endocrinology, Lithuanian University of Health Sciences, Kaunas, Lithuania. Abdelhadi Habeb, Consultant Pediatric Endocrinologist, Chairman of Pediatrics, PMBAH, National Guard Ministry, Madinah, Kingdom of Saudi Arabia. Andrea Luczay, ESPE Accreditation and Syllabus Convener 2016–2019. Head of Endocrinology, Department of Paediatrics, Semmelweis University, Budapest, Hungary. Annemieke Boot, Pediatric Endocrinologist, University Medical Center Groningen; Beatrix Children’s Hospital, Groningen, the Netherlands. Francesco Chiarelli, Professor of Paediatrics and Paediatric Endocrinology, Department of Paediatrics, University of Chieti, Chieti, Italy. Ieuan Hughes, Emeritus Professor of Paediatrics, University of Cambridge, United Kingdom. Jan Lebl, Professor and Head, Department of Pediatrics, Charles University in Prague, 2nd Faculty of Medicine, Prague, Czech Republic. Justin Davies, Consultant Paediatric Endocrinologist, Southampton Children’s Hospital, Southampton, United Kingdom. Violeta Iotova, Paediatric Endocrinologist, Professor and Head, Clinic of Paediatric Endocrinology, UMHAT “St Marina,” Varna, Bulgaria. Members of the ESPE Council: Agnès Linglart, Professor of Paediatrics, Bicêtre Paris Sud Paris Saclay University and Hospital, Paris, France. Evangelia Charmandari, Professor of Pediatric and Adolescent Endocrinology, Division of Endocrinology, Metabolism and Diabetes, First Department of Pediatrics, National and Kapodistrian University of Athens Medical School, “Aghia Sophia” Children’s Hospital, Athens, Greece. Syed Faisal Ahmed, Samson Gemmell Chair of Child Health, University of Glasgow, UK. Members of UEMS: Nada Cikes, UEMS Vice President, Enlarged Executive Committee, Rheumatology Section and Board. Professor, Division of Clinical Immunology and Rheumatology, Department of Medicine, University Hospital Centre Zagreb, Croatia. Tibor Ertl, UEMS ETR Review Committee. Emeritus Professor of Pediatrics and Neonatology, University of Pécs, Association of Hungarian Medical Societies.
Statement of Ethics
An ethics statement was not required for this study type, as no human or animal subject or material was used.
Conflict of Interest Statement
The authors have no conflicts of interest to declare.
No funding was received for this study.
K.B. prepared the first draft and all co-authors provided comments which helped finalize the manuscript. L.P. prepared the table and figures.
Data Availability Statement
There were no research data generated during this publication. ETR is publicly available at https://www.eurospe.org/education/education-training-syllabus/.
Rasha T. Hamza contributed on behalf of members of ESPE Education and Training Committee.