Diversity of allergy and clinical immunology reunified by training at the EU level
Authors: S. G. Del Giacco, H. J. Malling
Journal: Allergy (2004)

Allergology and Clinical Immunology represent a peculiar specialty, because, whereas the majority of other specialties are, in general, organ or system-oriented, this specialty is patient-oriented. In fact patients with immune-mediated syndromes typical of the specialty may have a simultaneous or consecutive involvement of different organs and/or systems (varying from skin to lungs, from ear, nose and throat to bronchi, from eye to kidney, liver and so on). This peculiarity, on the contrary, can be seen as a kind of weakness because other organ-oriented specialties involved in immune-mediated syndromes, during the years, because of their longer tradition, have been largely involved the fields of Allergology and Clinical Immunology from clinical, formation and training. Concerning Allergology, this relates to specialties like Pneumology, ENT, Dermatology, Ophthalmology, Paediatrics and for Clinical Immunology Rheumatology, Immunohaematology. The reality at the beginning of 2000 is that Allergology and Clinical Immunology, although it has been one of the areas of the medicine with the greatest advancement in scientific research and the largest increase of patients (they are, in Western countries, usually over 30% of the total population), has not yet reached the appropriate place among other recognized specialties and is not yet recognized in an unanimous and uniform way by EU National Health Authorities. This problem is not only in Europe but all around the world. In Europe, in 1958, 1 year after the Treaty establishing the European Community in Rome, the European Union of Medical Specialists (whose acronym is Union Européenne des Medecins Specialistes from the French version at that time adopted) was constituted and since then it represents the official organization including all the specialties recognized in European countries. The goal of UEMS is to harmonize the training and the formation of the specialists in Europe, regulate the free circulation of the doctors in the Union and keeping the official relationships with the European Council, Commission and Parliament and with national governments for every problem concerning the specialties. Every UEMS specialty has a Section, including in general two members for each country of EU, coming from Professional Associations where they are existing or ad hoc designed by other Societies or Associations, and a Board, including two members from Scientific and Academic Societies for each country. So there is a Section/Board for each specialty, with one President and one Secretary elected by the various members for the terms chosen by each Section/Board. The right of voting is only for the members belonging to the Section and one country has only one vote. The Section/Board of Allergology and Clinical Immunology stands on the Charter on Training and Training Formation, present in the Chapter 6 of UEMS documents from 1994; since then it has been modified by various amendments till June 2003 in Paris. The Charter indicates the rules for the institutions, teachers, trainees and the duration of training. These rules have been declared on theoretical principles but when a survey is performed among EU countries concerning Allergology and Clinical Immunology training, it reveals that every country has its individual training programme different from the others. Moreover, some countries recognize the specialty as a ‘full specialty’ (e.g. Italy, Spain, Greece, Portugal, Switzerland), whereas in some countries it is a sub-specialty (for instance of Dermatology as happens in German-speaking countries, or of Internal Medicine, Paediatrics, Pneumology); in others the specialty does not exist per se but it is performed by specialists of other disciplines (Pneumology, Dermatology, Paediatrics and so on). The name itself varies: it is Allergology and Clinical Immunology in Italy, Greece, Switzerland for instance but it is only Allergology, or Immunoallergology or Allergology and Immunopathology in others; Clinical Immunology in some countries is not a clinical specialty but a laboratory; in others it is related to Rheumatology. The duration of training varies in different countries: from 3 to 5 years, with or without a common trunk during the first 2 years (in general in Internal Medicine or Paediatrics, but in some countries also in other disciplines). However starting from the diversity found at all levels for the specialties it has been reached a general agreement in EU to have a common model of training with a common trunk in Internal Medicine for all the specialties of medical area and probably this will be implemented in the near future. In our Committee and Section/Board it has been taken into consideration the situation of Allergology and Clinical Immunology: the fact that Chapter 6 of UEMS can be considered an important recommendation able to suggest how to modify within few years situations based on traditions, history, academic and political influences, prompted the Section/Board of Allergology and Clinical Immunology to unanimously perform a Core Curriculum containing the minimal requirements of theoretical and practical competences that a specialist in Europe should acquire for circulating and practising Allergology and Clinical Immunology specialty on the basis of a good clinical practice in the interest of the patients with immune-mediated syndromes. The Core Curriculum has been developed based on educational programmes from a number of countries trying to incorporate the best practice for future specialists. The work has been going on for some years initially with two working groups dealing with theoretical and practical issues. Along with the progression of the educational programme the final Core curriculum has been concluded in plenary sessions of the Section/Board of Allergology and Clinical Immunology. Because of national regulations the Core Curriculum may not be implemented immediately, but the intention is to provide a platform for a common European training with time. We are fully aware that traditions and the actual training in some countries make the implementation problematic, but we believe that the quality and the comprehensiveness of the training programme with time will ensure the implementation in all European countries. The idea is that the Core Curriculum should be adapted to national regulations in individual countries, but the minimal competencies should always be fulfilled. Because of the varying organization in different countries, competencies in Allergology relate to all trainees but some competencies in the Core Curriculum only are related to specialized training in Clinical Immunology. Evaluation of competencies and progression in the learning process will be by the use of a logbook. The individualized training programme and the logbook should be based on national regulations and the possibilities of providing specialized training in separate training institutions. In parallel with the guidelines of the Core Curriculum, Chapter 6 of the UEMS document has been modified. This Core Curriculum will be an important way to ensure harmonization of Allergology and Clinical Immunology in EU having as the main goal not only the qualification of the specialists in Allergology and Clinical Immunology but the best care of the patients with allergic and immunological diseases.