A few days after the German Conference for Laboratory Medicine (DKLM) closed its doors in Mannheim (27 September), just a few miles further north the Frankfurt Book Fair began (8 October). At the largest annual gathering worldwide of the literary industry the winners of this year’s European Union Prize for Literature were introduced by Danish author Janne Teller, who said, ‘Dear world, kiss a European, they need it; dear Europe, kiss the world, you need it.’
‘What does it feel like to be kissed by Europe? The best way to find out is to read European literature.’
By now, the clever visitors of many medical events – and EH readers – will have substituted the word ‘literature’ with ‘medicine or ‘diagnostics’; and strangely enough, they will feel the same sense of urgency, the same issues that need to be addressed. When Janne Teller asks, ‘How can Europe turn from a bureaucratic maze into a literary adventure’, we can relate very well to the bureaucratic maze and look for the ‘medical consensus’ rather than for the literary adventure.
Given Janne Teller’s question as to whether literature can help relieve the tensions within Europe, we can ask what can or should medicine do to relieve European tensions in healthcare. Just like Ms Teller, we can also ask what Albania and Great Britain have in common, with regard to medicine rather than literature. To make the long European story short: Struggling with Europe is not something only novelists or physicians do. It appears to be a rather widespread condition across many professions. Indeed, DKLM, the German professional association of scientists in laboratory diagnostics, offered a European overview of the emerging components of the profession ‘bioscientist’.
BNLD chairman Dr Jürgen Hallbach provided a summary of the tasks bioscientists take on in the European healthcare systems, focusing on the Netherlands, Switzerland, the United Kingdom and Germany. In the Netherlands the Nederlandse Vereniging voor Klinische Chemie en Laboratoriumgeneeskunde (NVKC) was founded in 1947. Its members are physicians and clinical chemists, the latter being mostly lab managers. Registration is required and has to be renewed every five years, but the profession is not officially recognised.
In Switzerland, in an attempt to harmonise training, the Swiss Academy for Medical Sciences (SAMW) introduced a five-year interdisciplinary continuing education programme in laboratory medical analytics, which encompasses haematology, clinical chemistry and immunology, medical microbiology and genetic lab analytics. The programme is geared towards physicians, pharmacists, chemists, biochemists, microbiologists and biologists. Graduates of the programme are specialists for clinical chemical analytics and, as such, are certified to manage a lab, including invoicing.
Nevertheless lab managers in university and large non-university hospitals are primarily clinical pathologists. Particularly between 2009 and 2013 a significant influx of German clinical pathologists was recorded. In short, while Switzerland does offer advanced interdisciplinary training for scientists and physicians, physicians fill most lab manager positions.
In the UK, physicians and scientists work in the field of laboratory medicine. Registered with the Health & Care Professions Council (HCPC) as non-medical professionals, they are called Clinical Scientists or Biomedical Scientists. The title is legally recognised and protected. The Association of Clinical Biochemistry (ACB), which was founded in 1953, registers these specialists and organises the continuing professional development.
In Germany, specialists with different backgrounds go into lab medicine. On the one hand there are medical-technical laboratory assistants (MTLA), non-academic professionals who must be under the constant supervision of specialist physicians and clinical chemists. On the other hand, there are specialist physicians in lab medicine and clinical chemists. Physicians who graduated from medical school can join a five-year specialist physician-training programme in lab medicine. They have to acquire 250 advanced training points and research activities are recommended. The State Medical Association awards the officially recognised degree.
Bioscientists can obtain a certificate as clinical chemists following their university degree. The five-year programme is designed by the Deutsche Vereinte Gesellschaft für Klinische Chemie und Laboratoriumsmedizin (DGKL), which also conducts the examination and issues the non-officially recognised certificates. Certificate holders – clinical chemists – are allowed to manage a lab, but are not allowed to invoice services.
To be able to distribute human resources and expertise in laboratory medicine more evenly across the European Union and to facilitate mobility, initial and advanced training as well as the official recognition of degrees and occupational titles need to be harmonised.
Within the EU the European Union of Medical Specialists (UEMS) and the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) represent the interests of clinical chemists and lab medicine specialists, particularly with regard to advanced training.
The main task of UEMS is to harmonise the job description so that lab medicine specialists can work throughout Europe. The organisation developed a syllabus defining the advanced training contents for both scientists (clinical chemists) and physicians (lab physicians).
EFLM is the European chapter of the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC), i.e. it represents the scientific societies of all clinical chemists and lab medicine specialists in Europe. EFLM also developed an advanced training syllabus that is, to a large extent, identical with the UEMS syllabus. Graduates of the programme are registered in the so-called EC4 register and hold a certificate and also carry the title European Specialist in Laboratory Medicine. The certificate is valid for five years and can be renewed upon presentation of 250 continuing education points.
Europe-wide, there are about 30,000 lab medicine specialists, two thirds with a science or pharmacy background, a third with a medical background. Targeted harmonisation of post-graduate training in lab medicine is a major challenge – be it on a national level, be it for the national professional associations of clinical chemists and lab medicine or clinical disciplines. No doubt it requires constructive collaboration of all lab medicine societies in all EU countries.
Moreover, harmonisation must not compromise the quality of care and the quality of research. It is the task of all actors in our discipline to get actively involved in finding solutions to these challenges. For us, Janne Teller’s question can be rephrased: ‘How can Europe find its way out of the bureaucratic maze and move towards a medical consensus?’