History of EBO

The European Board of Ophthalmology: The early years

J.J. De Laey, President EBO, 1996-1998
Before discussing the initial years of the European Board of Ophthalmology, it is worthwhile to give a short survey of the history of EUPO (European University Professors in Ophthalmology), which proved instrumental in the creation of EBO.

EUPO – European University Professors in Ophthalmology

The first idea to create a European Association for Professors in Ophthalmology derived from a discussion between Professors François (Ghent), Deutman (Nijmegen), Naumann (Erlangen) and Pouliquen (Paris) in the early eighties. During the International Symposium on Fluorescein Angiography, organized in September 1985 by Achim Wessing in Baden-Baden, and following a pleasant day in the Black Forest, Fritz Naumann, Achim Wessing, August Deutman and I decided that it would be worthwhile to start an organization, which from the very start was called EUPO. We were not only inspired by the German wine, but also by the presence of Steve Ryan, who was at that time the president of the American Association of University Professors in Ophthalmology (AAUPO).

EUPO’s formal creation was preceded by a number of less formal meetings where representatives of the various EU countries were invited: Aachen in September 1986, Paris in May 1987, Heidelberg in September 1987. The goals and structure of EUPO were defined, officers were appointed and it was decided to form a number of committees.

Executive Committee:

Chairman: A. Deutman

Vice chairmen: Y. Pouliquen and M. Spitznas

Secretary-general-treasurer: J.J. De Laey

Committee on Bye Laws: A. Deutman (chair), F. Naumann, B. Bagolini

Teaching: K. Heimann (chair), D. Archer, B. Jay, G. Coscas, M. Sanchez-Salmorio, G. Theodossiadis

Research: Y. Pouliquen (chair), J. Cunha-Vaz, A. Wessing

Health Care: M. Spitznas (chair), J. Castro-Correia, M. Vogel

EUPO had its first General Assembly during the SOE congress in Lisbon in May 1988. However, there were a number of problems. Some objected to the fact that this was a private initiative of self-appointed individuals. As could be expected language was another issue. Some participants threatened to boycott EUPO if English was to be its official language. The compromise was that English would be the working language or, as suggested by Professor Naumann, that the lingua franca should be broken English.

During the first general assembly in Lisbon, the goals of EUPO were officially approved and the by-laws adopted. In these by-laws the objectives of the association were defined as the promotion of medical education, research and patient care related to the field of ophthalmology within the European Union.

More precisely the aims were defined as follows:

1. To take all measures to maintain and raise the scientific standards of ophthalmology and to maintain and raise the standards in patient care

2. To be concerned with the training of ophthalmologists, their program of training, their courses of clinical instruction and the means of ensuring their proficiency on completing training

3. To organize or encourage research with scientific meetings, lectures, seminars and symposia on matters concerning ophthalmology

4.To promote exchange between ophthalmology departments and ophthalmologists but also those from other disciplines

5.To advise relevant European bodies belonging to the European Union on all matters and problems related to ophthalmology

6.To establish a European Academy of Ophthalmology that will convene once a year for teaching purposes and exchange of knowledge.

7.To establish a European Institute for Research in Ophthalmology

As can be seen the three pillars of EUPO were: 1.) patient care 2.) education and 3.) research. Those goals were very ambitious and not to be realized without the help of the professional organizations and the already existing supranational organizations within Europe. Some of the initiatives announced in 1988 will be realized later by other organizations such as EBO and EVER (European Association for Vision and Eye Research) but always with the active support of EUPO, whose members were instrumental in setting up the goals of these new associations. In fact the major task of EUPO is organizing each year a two-day course for residents in ophthalmology. The major aim of these courses is to provide the European residents with the core of knowledge necessary for their future practice and to prepare them for the European Board examination. In a four year cycle the main topics of ophthalmology are covered: 1st year: External eye and orbit; 2nd year: Chorioretina; 3rd year: Uveitis, lens and glaucoma; 4th year: Neuro-ophthalmology and strabismus. The first EUPO course was held in Nijmegen and was organized by A.Deutman.

EBO, European Board of Ophthalmology

The Union Européenne des Médecins Spécialistes (UEMS) advises the European Union on matters related to specialized medicine and is thus the direct link with the European offices. In July 1991 the UEMS adopted a motion for the creation of European Boards in its various monospecialist sections and drafted general statutes for the Boards. In each Board there are two representatives from each EU member state. One is to be designated by the professional organization, the other one from the scientific or academic organization of the country, which means that one of the two national delegates is a EUPO member and underlines the important role of EUPO in EBO.

EBO was officially created at the Royal College of Ophthalmology, then located at Bramber Court, 2 Bramber Road, London, on Saturday, October 30th 1992.

With the exception of J.Seegmuller who could not be present, and the Portuguese who were advised not to attend by their Medical Order, all those invited attended the meeting.

Ireland: P. Eustace (Chair) and J. Nolan
France: G. Coscas
Spain: M. Sanchez-Salorio
The Netherlands: A. Deutman and F. Hendrikse
Germany: GOH Naumann and K. Dilger
Greece: P. Tsibidis and A. Bouzas
Italy: L. Cerulli and E. Balestrazzi
Denmark: E. Scherfig and H. Olsen
Belgium: JP Dernouchamps and J.J. De Laey
United Kingdom: C.M. Kirkness and W.J.C.C. Rich
Finland: J. Airaksinen (as observer)

During that meeting the objective of EBO was defined. It is to guarantee the highest standards of care in ophthalmology in the countries of the EU by ensuring that the training is raised to the highest possible levels:

1. EBO shall recommend the standards required for training ophthalmologists.
2. EBO shall make proposals for the quality of training and for the core syllabus.
3. EBO shall recommend procedures to assist free movement of ophthalmologists throughout Europe.
4. EBO shall assess the content and quality of training.
5. EBO shall facilitate the exchange of trainees and of teachers between training centers.
6. EBO shall set up a system of voluntary European quality control: the EBO diploma.

The Statutes were adopted and the following appointments for officers and committees were made:

President: A. Deutman

Vice-presidents: G. Coscas, C. Kirkness, L. Cerulli and K. Dilger

Honorary secretary: P. Eustace

Honorary treasurer: J.P. Dernouchamps

Executive committee:
President, Vice Presidents, Secretary and Treasurer

Education: G. Coscas (chair), GOH Naumann, E. Balestrazzi, J.J. De Laey, C. Kirkness

Residency Exchange: L. Cerulli (chair), A. Bouzas, J.J. De Laey, F. Hendrikse

Manpower: K. Dilger (chair), W. Rich, J. Nolan

Finance: J.P. Dernouchamps, J. Seegmuller

Tasks of the various subcommittees:

1.Executive committee: to prepare the Board meetings and to legally represent the EBO.

2.The education committee is in charge of the European Board examination. At the third EBO meeting in Rome in October 1993, the principle of a European examination was accepted and the education committee was asked to prepare the examination. It was first organized by P.Eustace in Milan on June 24 and 25 1995, just prior to the Congress of the European Society. Since Milan the examinations are held on a yearly basis in Paris, first at the Foundation Ibsen, later just prior to the Congress of the French Ophthalmological Society at the Palais des Congrès in Porte Maillot.

The format introduced by P.Eustace is still in use.
In 1995, 44 candidates took the examination and 48 teachers volunteered as examiners. Both candidates and examiners represented the different countries of the EU, with the exception of Portugal, as the Medical Order of Portugal still objected to the European Boards. Of the 44 candidates, 37 successfully passed the examination and were officially declared Diplomates of the European Board of Ophthalmology at a ceremony at which I had the honour to preside as the current EBO president.

3.Residency Exchange Committee.
The purpose of that committee was to improve exchanges between various departments. Although this is a superb way to promote European ideas, it proved to be extremely difficult to organize. One has to take into account the limitations imposed in the various departments as well as the difficulties encountered by residents, who have to move, sometimes with small children and a working partner to a different country. We tried to organize twinned exchanges, where the resident of one department would be replaced at home by a resident of another department in a direct exchange. They would keep their salary from their original department and ideally reside in the apartment of the resident they are replacing. The idea sounded good, but it soon appeared very difficult to have perfect matches. Also the response from the various training centers was limited and for such a project to be successful one needs a large offer.

The Residency Review Committee was made responsible for visiting ophthalmology departments requesting the EBO approval of their training. The committee first set up the rules, which were mainly based on those in use for the inspection of eye departments by the Royal College of Ophthalmology in the UK. When a department chairman requests this EBO recognition, he/she first has to complete a number of questionnaires, concerning the training, the catchment population, the number of cases, the staff, the clinical facilities, the residents, the scientific and didactic activities. These documents are controlled by the committee and if necessary some more information is requested. Once the application is accepted, the committee appoints two members, one of the country of the applicant, one from another country and a date is proposed for a site visit. The two inspectors write their report which is submitted to the Residency Review Committee, which is then put forward to the EBO General Assembly for them to approve or reject the department as an EBO approved training center.

The very first center to get such an approval was Maastricht in the Netherlands, soon to be followed by centers in the Netherlands, Germany, France, Finland, Belgium and Ireland.

4.The Manpower committee was asked to make an inventory of the demography of ophthalmology in the EU. It was supposed to make proposals concerning the number of ophthalmologists needed.

5.The Finance Committee, chaired by the treasurer had, in the early years, only a limited task as the income of EBO was initially mainly derived from the financial support of the UEMS.

In conclusion
Looking at what EBO has achieved since its creation in 1992, one realizes that most of the projects it initiated at its inaugural meeting are now implemented. Together with SOE, EUPO and EVER, the European Board of Ophthalmology has played a major role in the improvement of ophthalmology education in Europe and thus in the improvement of patient care.

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