Education of specialists on laboratory medicine in the EU

The European Union has no administrative responsibility in healthcare. The European Commission’s Directorate-General for Health and Consumers seeks to align national laws on the safety of food and other products, on consumers’ rights and on the protection of people’s health, to form EU wide laws. National laws, however, regulate healthcare exclusively, unlike to other fields where EU Legislation has to be obeyed in all EU countries.The situation becomes challenging when certain targets are adressed both by EU and by national legislation, such as cross-border healthcare services or free migration of European professionals.

Several processes are now well embedded in Laboratory Medicine to ensure quality and patient safety. Previously, the standardisation and harmonisation of methods and laboratory practices have been core activities of the international and national societies for Laboratory Medicine. There is a similar view, that harmonisation can also be achieved for individuals working in medical laboratories and that voluntary technical standards developed to facilitate world trade (i.e. ISO norms) can be used. However, ISO standards do not assess clinical outcomes.

The patients’ well-being is the primary focus of all procedures performed in healthcare such that, by implication, healthcare is different from trade. Specific ethical guidelines from the WMA regulate healthcare issues.

Changes in the perception of medicine as a vocation to that of a commodity are also calling into question the Medical Act, notably challenging the grey zone between qualified and nonqualified practitioners. Without doubt. some simple, brief and clearly defined processes of the Medical Act can be delegated and even substituted by non-physician professionals.

The relevance of the Medical Act in Clinical Pathology is particularly challenged by this. The personal contact between Clinical Pathologist and patients in most cases is indirect, nonetheless laboratory physicians play an important role in improving clinical outcomes for individual patients and there are legal issues which prohibit delegation of certain tasks to nonqualified practitioners.

By the statutory length of undergraduate and postgraduate training  training, physicians in Laboratory Medicine are well placed to ensure provision of appropriate test repertoires, guiding test selection and thus ensuring cost-effective use of finite resources. Political pressures to use free movement of professionals across the EU to plug workforce shortfalls should not be used as an excuse to dilute the rigor of training.

Conclusions

Physicians in laboratory medicine do not practice in isolation. Instead a high-quality laboratory medicine service is critically dependent on the complementary roles of medical doctors, scientists and related laboratory personnel. Self-empowerment of patients, direct to consumer testing, free movement and internet technology currently challenge the established role of the laboratory-based physician and the standards included in the Medical Act, necessary to ensure the practice of high quality Laboratory Medicine. In the last few decades, the role of the physician in Laboratory Medicine has changed fundamentally to focus now on the diagnosis and management of disease, interacting with both physicians and patients. There is an urgent need for training curricula in Laboratory Medicine to reflect and support these changes in practice.

Keywords : postgraduate training graduate training, syllabus, physician in Laboratory Medicine, CME, patient empowerment, clinical pathology,

Figure :

Title: Heterogeneity of Laboratory Medicine among EU member states



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