ORTHOPAEDICS AND TRAUMATOLOGYDISCIPLINE

INITALY

HISTORYAND

EVOLUTION01

ITALY GEOGRAPHICAL CHALLENGES

    - 58.462.375 Inhabitants - 301.230 km2

- length of coastline 7600 km - Italy has a particular shape of

a boot, much longer than it is wide. The heel is in the region of Puglia, while the toe in the region of Calabria, points towards the island of Sicily

    - Medicine doctors 406.92O (4.1 Inhabitants, second only to Greece 4.8)   - Specialists in Orthopaedics and Traumatology:   the members of the Italian Society of              Orthopaedics and Traumatology are 4641;   women only 204 (4.4%)

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Since 1840 in Naples University First Course of Traumatology.

Since the end of XV Century in Rome “Teaching of Chirurgia Istantanea”

to-day is “Traumatology”.

Since 1871/72 in the University“la Sapienza” in Rome Regular Courses of Traumatology

Since 1885 in Naples University the First Chair of Orthopaedics hosted beside the Surgycal Clinic

Since 1910 in The University “La Sapienza” in Rome the First Fusion of Orthopaedics and Traumatology

DISCIPLINE HISTORY

03

 1931 Bologna First School of Specialisation in Orthopaedics Three Years Length

    1934/35 Rome First Teaching in Medical School of Orthopaedics and Traumatology of Motor Apparatus

1946 Rome One year after the end of the Second World War    The First School of Specialisation in Orthopaedics and Traumatology of Motor Apparatus

THE ORGANIZATION OF THE  POST GRADUATE

SPECIALISATION SCHOOLS: HISTORY AND EVOLUTION.

I

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THE ORGANIZATION OF THE  POST GRADUATE SPECIALISATION SCHOOLS:

HISTORY AND EVOLUTION.II

1982: THE LEGISLATIVE DECREE n.162, THAT RISED THE LENGTH FROM THREE TO FIVE YEARS FOR ALL

THE SCHOOLS OF SPECIALISATION OF SURGICAL AREAS

1991: THE LEGISLATIVE DECREE n. 257, THAT INTRODUCED THE EDUCATIONAL GRANTS

LASTING ALL OVER THE FIVE YEARS LENGTH.THE TRAINEES PROGRAMMED NUMBER.

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IN YEAR 2000 THE MINISTRY OF EDUCATION CHARGED A “TEAMWORK“ OF FULL PROFESSOR SPECIALISTS IN

THE VARIOUS SPECIALTIES FROM ALL THE UNIVERSITIES.THE FIRST ACTION FOR THE QUOTED “TEAMWORK“ WAS

TO SOLVE THE PROBLEM TO REDUCE THE EXCESSIVE NUMBER OF SCHOOLS OF SPECIALISATION OF

“MEDICAL AREA”. THIS WAS A BIG AND DELICATE PROBLEM, BUT FINALLY

THE NEW NUMBER IS: 59 OF DIFFERENT TYPOLOGY. THE DIFFERENT TYPOLOGY SCHOOLS ARE GROUPED IN FOUR AREAS: MEDICAL - SURGICAL - DIAGNOSTIC

SERVICES - PUBLIC MEDICINE

06

THE ORGANIZATION OF THE  POST GRADUATE SPECIALISATION SCHOOLS:

HISTORY AND EVOLUTION.III

IN YEAR 2005 THE MINISTERIAL “TEAMWORK“ OF FULL PROFESSORS OF THE DIFFERENT SPECIALTIES CONCLUDED THE

ACTIVITY. THE REORGANIZATION OF THE SCHOOLS OF SPECIALISATION OF HEALTH AREA IS A REALITY. COMMON TRUNC,

ACCURACY FOR PROFESSIONAL TRAINING, MULTIDISCIPLINAR APPROACH, MINIMAL REQUIREMENTS, ETC., ARE ACTUALLY

ESTABILISCED BY LAW. THE NEW LAW DECRETS “1° M 5-11-2005” and “29 MARCH 2006”

ACCORDING WITH U.E.M.S. GUIDE LINES.OUR PROPOSALS (PERUGIA, MAROTTI),

WILL BE APPLIED AND OPERATING BY LAW SINCE NOVEMBER 2006

07

THE ORGANIZATION OF THE  POST GRADUATE SPECIALISATION

SCHOOLS: HISTORY AND EVOLUTION.

IV

IN YEAR 2005 THE MINISTERIAL “TEAMWORK“ OF FULLPROFESSORS IN THE VARIOUS SPECIALTIES HAS CONCLUDED

THE ACTIVITY, PRODUCING ALSO THE TEACHING ORGANISATION

PART OF DIFFERENT SCHOOLS “ATTACH n°1” TO THE QUOTED NEW

LAWDECRET “5-11-2005”. AT THE SAME TIME WITH ALIMITED NUMBER OF “TEAMWORK“ WAS NAMED

“OBSERVATORY”AND WAS CHARGED TO POINT OUT THE “ATTACH n°2”: “ THEDEFINITION OF STANDARDS AND MINIMAL REQUIREMENTS OFDIFFERENT SCHOOLS OF SPECIALISATION”. THE M.I.U.R.“OBSERVATORY” IN JOINT TEAMWORK COLLABORATION

WITH THE SIMILAR “OBSERVATORY” OF HEALTH MINISTRY WILL

HAVEVERY IMPORTANT FUNCTIONS:• TO CONTROL THE CORRECT APPLICATION OF THE

STANDARDS OF THE SCHOOLS REORGANISATION.• TO CHECK THE CORRECT RUNNING OF THE

ORGANISATION AND OF THE LAW ENFORCEMENT.

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THE ORGANIZATION OF THE POST GRADUATE SPECIALISATION SCHOOLS:

HISTORY AND EVOLUTION. V

TORINO

BRESCIA

TORINO

PISA

PALERMO

CATANIA

BARI

UDINE

TRIESTE

ANCONA

PADOVA

VERONA

2 Schools

SIENA

PAVIA

CATANZAROCAGLIARI

BOLOGNA

MODENA

FERRARAFERRARA

PARMA

PERUGIA

Firenze

SASSARI

GENOVA

VARESE

CHIETI

Geographical distribution

of the 35Schools of

Specialisation

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ORTHOPAEDIC AND TRAUMATOLOGY

THE NUMBER OF THE TRAINEES IS ESTABLISHEDYEARLY FOR EACH SCHOOL BY THE MINISTRY OF HEALTH IN COLLABORATION WITH THE MINISTRY OF EDUCATION, UNIVERSITY AND RESEARCH (M.I.U.R.), ACCORDING TO THE NEEDS IN DIFFERENT REGIONS.

CHIEF OF THE SCHOOL: A FULL PROFESSOR OF THE UNIVERSITY IN THE SPECIALTY.

AT PRESENT TIME FIVE YEARS:- ONE-TWO YEARS: COMMON TRUNC (FUNCTIONAL ANATOMY, PHISYOLOGY, GENERAL SURGERY, ETC.).- THREE-FOUR YEARS OF GENERAL ORTHOPAEDICS AND TRAUMATOLOGY:LECTURES,ACTIVITY IN SURGERY, ETC., ACCORDING WITH U.E.M.S. MINIMAL REQUIREMENTS. THE UNIVERSITIES MAY HAVE CONVENTIONS WITH OTHER REGIONAL HOSPITALS WHICH MUST HAVE THE MINIMAL REQUIREMENTS FOR TEACHING. 10

ACTUAL ORGANISATION OF SCHOOLS

MATRICULATION EXAMINATION.- ONE EXAME YEARLY- LOG-BOOK SIGNED CONTINOUSLY BY THE

TUTOR    AND COUNTERSIGNED BY THE CHIEF OF THE

             SCHOOL- FINAL THESIS WHICH COULD BE PROPOSED

FOR PUBBLICATION.

- RESEARCH IS PART OF THE TRAINING

IN THE FUTURE, THE PROPOSAL IS SIX YEARS: DURING LAST YEAR COMPULSORY ATTENDANCE FOR A SUBSPECIALTY: HAND, ARTHROSCOPY, SPINE, PAEDIATRICS, ETC.).

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ACTUAL ORGANISATION OF SCHOOLS

Genealogical Threes Of Two Most Important Orthopaedics Schools

ROMA BOLOGNARiccardo Dalla Vedova Alessandro Codivilla

1871-1942 1861-1912

QuickTime™ e undecompressore TIFF (LZW)

sono necessari per visualizzare quest'immagine.

Perugia

Marotti

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S.O.I.“Societa’ Ortopedica Italiana”

Founded on 18911892 By laws – First Meeting

Organisation of IV SICOT Congress1936 Bologna - Roma

Presidents:  VITTORIO PUTTI and CARLO MARINO ZUCO

The First Journals: “Archivio di Ortopedia” 1841

“Chirurgia Organi di Movimento” 1951At Present:

“Giornale Italiano di Ortopedia e Traumatologia”

1974 (Monticelli)“Journal of Orthopaedics and

Traumatology”2000

THE SCIENTIFIC SOCIETYHISTORY

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1935 Foundation of the S.I.O.T

SOCIETA’ ITALIANA di

ORTOPEDIA E TRAUMATOLOGIA

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NATIONAL SOCIETYS.I.O.T.

Societa’ Italiana di Ortopedia e Traumatologia

Regional Societies -S.E.R.T.O.T.

Società Emiliana Romagnola Triveneta Ortopedia TraumatologiaOne-Two meeting yearly

-S.P.L.L.O.T. Società Piemontese Ligure

Lombarda di Ortopedia e Traumatologia

One-Two meetings yearly

-S.O.T.I.CSocietà Ortopedia T

                     TraumatologiaItalia CentraleOne-Two meeting yearly

-S.O.T.I.M.I.Società Ortopedia Traumatologiaitalia medridonale ed insulareTwo meeting yearly

EVERY SOCIETY HAS ITS OWN JOURNAL

NATIONAL SOCIETYS.I.O.T.

Societa’ Italiana di

Ortopedia e Traumatologia

There are 25 Affiliates Sub-Specialties:

Oncology; Paediatrics; Sport

Traumatology; Knee and

Arthroscopy; Shoulder; Spine;etc..

- One meeting yearly

- Many of them have their own Journal

etc, etc,. 15

ANSWERS TO THE LAST QUESTIONNAIRE

THE SPECIALIST SHOULD HAVE:ABILITY

To diagnose and treat osteporosisTo diagnose and treat scoliosis in childrenTo diagnose and treat with coservative means

orthopaedic rheumatologyTo arrange for and interpret lab testTo perform punction to get body fluids or other materials To perform indication and supervision of physical therapyTo perform indication and control of orthopaedics aids (braces, etc.)To act as an orthopaedic expert witness To perform injections near spine (peridural, etc.) for        

                   diagnosis and therapyTo perform trauma emergency management also         

                   coworking with othersTo perform operations in orthopaedics anb orthopaedic traumaTo perform certain numbers of performed operations

required                   (bone, joint, tendon) classified                  by degrees of difficulties 16

ANSWERS TO THE LAST QUESTIONNAIRE

THE SPECIALIST DOES NOT NEED:

NO ABILITY- Of certification to perform x-rays- To perform osteo-densitometry- To perform regional anesthesia but only local anesthesia- To perform getting central venous access, CPR etc.- To perform and control transfusions, infusions. To perform chirotherapy (chiropractics)

NO ABILITY TO PERFORM BUT ABILITY TO INTERPRET- Sonographic examinations in orthopaedics- Sonographic examination in infant hips- Sonographic examination of trauma lesions (muscles, tendons,

etc.)

No possibility to get officially sub-specialties 17

Health Organisation in Italy

At present there are four Organisation levels:

- Ministry of Health- Regional Councils- Provincial Councils- City Councils

The managemeny of this situation isreally very complex and we hope that it will be modified and semplified by the the future Governement.

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Health Organisation in ItalyTo day the Italian organisation is exactly the

same of the Norwegians Hospital Reform.Hospitals are organised as enterprises and are no

longer part of the public administration.The Hospitals are organised as separate areas of

responsibility.The Hospitals are independent legal subjects with

their own responsibility as employers.The Hospitals have an executive board and a general

management.The Ministry of Health, represented by the Minister,

is responsible for overall general management but there is extensive delegation to the underlying enterprises.

The regional health enterprises have responsibility for ensuring the provision of health services to inhabitants in their geographical area.

The Hospitals have more clearly defined roles and responsibilities as enterprises. The Are responsible for use of capital and for their own finances 19

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Thank you