Abstract
Chronic venous diseases belong to the most frequent diseases in the world. According to recent CEAP-based epidemiological studies approximately 25 % of the adult population suffer from C2 and C3 disease with varicose veins or venous oedema. Approximately 5 % of the population has severe chronic insufficiency with skin changes up to healed or active venous ulcers.1–4 Main risk factors for the development of chronic venous insufficiency are higher age and obesity. 5 As the population older than 65 years of age will increase in the European countries up to 2050 and as obesity is a still unsolved problem with a growing proportion in the European societies we have to face a growing number of patients with chronic venous disease. Based on the data of the Bonn Vein Study we will have an increase of varicose veins and CVI of up to 25 % per 1.000 inhabitants until 2050.
To manage this problem we need more physicians educated in phlebology who are able to diagnose and treat venous diseases.
Phlebology training in Europe
Phlebology is a multidisciplinary speciality which is in parts represented in the education system of vascular surgery, surgery, internal medicine and dermatology. Because of the high prevalence of venous diseases it is also an important issue for general practitioners. They should be able to select patients with signs or symptoms of chronic venous disease for further diagnosis and treatment by venous specialists.
Despite the huge number of affected patients phlebology is not a recognized speciality in the European medical system (European Union of Medical Specialists (EUMS)) up to now. In Germany phlebology is a sub-speciality for surgeons, internal medical doctors and dermatologists. In Austria and Switzerland phlebology is included in a sub-speciality angiology, which is applicable for internal medicine doctors and dermatologists. In several European countries university-based specialisations exist with a master study in phlebology or phlebo-lymphology like in Italy, Spain or France. In the future phlebological issues should be more completely implemented in the curricula of vascular surgery, internal medicine, dermatology and other associated specialities. In addition the authors strongly recommend the recognition of phlebology in the European Union of Medical Specialities as an interdisciplinary sub-group. For this reason the authors have founded the European College of Phlebology (ECoP) in 2012 and applied, at the UEMS, for recognition of phlebology as a multidisciplinary speciality in 2014.
Based on the expected recognition by the UEMS as a Multidisciplinary board of Phlebology a European Curriculum in Phlebology and an educational system as a basis for a European Certificate will be implemented. The phlebological training will consist of theoretical and practical parts; it will be a modular system with certified training modules and with a final exam and certification. As a basis for the training curriculum the European College of Phlebology will use the UIP-training curriculum, which was published in 2010 by a group of international specialists under the auspices of the UIP. It includes anatomy, basic sciences, pharmacology, clinical sciences, diagnostic evaluation, and treatment modalities in phlebology.6
The European phlebological training curriculum and the certification system will be developed in consensus with all involved medical disciplines and societies. The ECoP needs the acceptance and cooperation of the national societies involved in phlebology to succeed and establishing a European phlebological educational system and an accepted European exam in phlebology.
The majority of the vascular community has recognized that phlebology is a real challenge for the future with growing numbers of patients and it has also been recognized that phlebology must have a multidisciplinary approach. We hope the European Venous Community will work together in the future with the same intention:
Footnotes
Declaration of conflicting interests
All the authors have no conflict of interest and nothing to disclose.
Funding
This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.