EUROPEAN FEDERATION OF INTERNAL MEDICINE In order to improve the better knowledge of EFIM´s activities we would be very grateful if you translate this text in your own language and published in your National Internal Medicine Journal or distribute it by any other means

European Federation of Internal Medicine (EFIM) Object and Perspectives: You and all the internists of your country are part of EFIM, or to put it in a different way, the Federation belongs to you. We are an Institution that groups together over 30 thousand internal medicine practitioners in Europe, their activities are not well known. For this reason allow me to distract your attention for a few moments to tell you about our objectives, our future projects and our difficulties.

Origins and Members: EFIM was born in Paris, in 1996, by a transformation of the European Association of IM . This Society was formed by about 400 members and at that time had many problems. During this transformation two people played an important role, the last president of AEMI, Prof. Ugo Carcassi, and the first president of EFIM, Prof. Yves Le Tallec. EFIM is, now recognised as a Non-Governmental Organisation (NGO) by the European Union. In essence it a federation that groups 27 European Internal Medicine Societies, more than 30 thousand European Internal Medicine Practitioners. Table 1 contains the list of National Societies of IM which form EFIM.

EFIM Organization and Structure: The structure of EFIM is simple. It has an Executive Council formed by 5 members that runs the everyday activities of the Federation. Each member must be from a different European country. They have been elected by the Administrative Council which is formed by 2 representatives from each European IM Society. The Administrative Council controls EFIM´s activities. Every National Society supports EFIM´s activities financially by an annual of 1 Euro for each of its members. Our website is http://www.efim.org

Objectives: Our objectives are the development of Internal Medicine in many fields: training internists, developing a larger clinical presence in hospitals, research, quality control, etc. Furthermore we wish to establish strong links between all the European Societies for Internal Medicine, connect them with other International Organizations related with IM and promote collaboration between practitioners worldwide. Function: We are currently a very young organization, having only been established for 5 years. Table 2 contains a list of projects that we are developing. In the next paragraphs I will explain more in detail some of them.

1.- The European Journal of Internal Medicine, EJIM: The European Journal of Internal Medicine (EJIM) is the official journal of the European Federation of Internal Medicine (EFIM). The journal is devoted to promoting research on internal medicine in Europe. To this end, the journal publishes original scientific articles, review articles, editorials, case reports, short communications, and other information relevant to IM and related fields. The journal also publishes news and articles concerning the activities and policies of the Federation, as well as those

relevant of National Internal Medicine

Societies in Europe. Prof. H. Hillen, from Holland is the chief editor. The journal has a restricted editorial council and a National Representatives Council. Your country has nominated Dr. XXX1 for 1

Enter for each country or omit?

this post. We have been editing 6 issues a year, but from January 2002 we shall be issuing 8 per year. Articles submitted for publication will be referred and, if accepted, printed within six months. Your papers and subscriptions are welcome and necessary to make a vigorous and respected international journal.

2.-European Congresses for Internal Medicine: These are an excellent opportunity for European internists to make their investigations public and for them to be debated. With these congresses clinical and scientific investigation is promoted, favouring the relationship between internists and the mutual knowledge of all. We started in 1997 with the first congress, which was held in Maastricht, The Netherlands. The second was held in Florence, Italy in 1999, and the latest one was held in Edinburgh, UK, in May of this year. Nearly 1000 internists attended the latest congress, from all over Europe and many from Israel and USA. There were 125 oral presentations and 600 posters, all of which were discussed. Our next congress will be in September 2003, in Berlin, and the following one shall be in Paris, in 2005. 3.- European School of Internal Medicine, ESIM: At the meeting of the Administrative Council on of EFIM on 16th October 1997, it was agreed that the Federation set up a European School of Internal Medicine. The aim is to bring together internists in training from across Europe to share common experiences in Internal Medicine. The school is located in Alicante, Spain, and has successfully organized 4 courses for IM residents during September from 1998 till 2001. The School works in a simple fashion; there is a scientific council that decides the title and content of the course. The professors are proposed by the European IM Societies that, also, offer grants so that a number of residents of that country may attend . All their activities are in English. The course programme offers: lectures, seminars and discussion groups covering a wide range of topics on IM and the trainees are themselves involved in case presentations. The programme also allows room for more general discussion on IM training, IM working and

other issues. Virtual European School of Internal Medicine (VESIM): Since the number of IM residents of ESIM courses is limited to 65 a year, we are currently developing a Virtual School; the object of which is to aid European internists in their search for further knowledge, especially on continuous medical education activities. (CME). We’ve created a website, the URL is http://www.efim-esim.org. Here you can find medical education activities: the ESIM courses and other medical training activities, clinical cases, first sight diagnosis, new and unusual diseases, surprising medicine, discussion forums, medical humour, evidence based internal medicine, news and interesting links, etc. 4.- Working Groups on Research in IM: The objective of the group is to promote research programs of interest to Internists that should be developed by them across the European countries. The project coordinator is Prof. L. Guillevin; he has developed an interesting project focusing on “the use of corticosteroids by internists”. Our clinical activity as internists is so diverse and our experience in treating many different diseases so great, that every subject should be of our interest and we to many of them an enormous experience. Multicentre studies are of particular importance especially in “orphan” diseases, but also including clinical epidemiology studies as well. There are many other areas which are not always of interest to large pharmaceutical companies to be studied. We are also planning to develop European Guidelines oriented at subjects of interest for internists. 5.-Young European Internists Network: This is a project yet to be developed. We want to establish a network of young European internists. This might have many activities, including information about grants, job offers, on-going training courses, ESIM courses, etc. Such a network will also let us know more about European training programs and promote investigational activities between young internists. This project will include the long-established “European Exchange Programme” the coordinator of which is Prof. J. Schifferli of Switzerland. It has allowed many young IM residents to train in other countries within Europe. 6:- Continuous Medical Education: EFIM has a strong commitment to offer European internists CME activities and keep them up to date. We’re working with UEMS

(European Union IM mono-speciality) to develop several projects in this area, so that our projects can have the official backing of the European Union. Our proposals include: To facilitate the “update” training of internists, to establish a title or certificate for European IM specialists (European Board), to organize a periodical evaluation system for re certification of specialists, and to establish an evaluation system through which continued medical education activities in IM shall be scrutinized within Europe. 7.- Medical Professionalism Project: Ever since Hippocrates, the need to regulate medical activities in relation to the patient has been necessary. In these modern days, where science and medical technology develops at an ever-increasing rate, and ,we have the possibility of making life last longer, there are many conflicts of interest between doctors and healthcare providers, Pharmaceutical Companies, etc. So the need has arisen to re-evaluate this relationship, not only with internists but with all doctors, and not only with patients but with the whole society. This needs to be developed on an ethical basis and as a new form of social contract. The main objective of this project has been: to create a code to regulate and strengthen the relationship between doctors and society in terms of healthcare. This has been developed by EFIM, the American Board of IM, and the American College of Physicians Foundations. The finished text was presented at the 3r d EFIM congress, in Edinburgh, in May 2001, and will be published next February in the Annals of IM, in the European Journal of IM (and probably in the Lancet). In the second phase we hope that the different European Journals of IM will publish the text, that it will be discussed at national IM congresses, and be presented to the different Health authorities and the general population in each European country. 8.-Ethics of Internal Medicine: The object of this project relates to the previous one, it is to determine the posture of European internists on various ethical problems. Drs. Alberto Malliani and Jaime Merino are coordinating it. We have developed a validation survey that will let us know the opinion of Internists on the following points: ethics in the internist´s clinical practice; ethics in research and in relation with Journals; and finally ethics in the relation with the pharmaceutical industry and the health industry. We are

ready to distribute the survey throughout Europe to Internists and then analyse the results. 9.- EFIM Fellows: This project has two objectives, to honour individuals that have played an important part in developing some aspect of IM (Honorary Fellows), and to create a network of people that are especially committed to the development of IM in Europe. To be nominated as a Fellow an internist has to ask his National Society to put him forward. Each European Society can put forward internists to be nominated Fellows. In EFIM there is an Credentials Committee that will assess the candidate’s curriculum vitae; the nominees will be formally presented with their Fellowship at the next European congress. 10.-European IM White Book: Europe is a geographical and political reality, but its historical development has led to the different development of IM in different countries. With a White Book we intend to discover the reality of IM in Europe. To plan our future is important to know our reality. It’s a project that is still in the development stage. We are discussing 3 fundamental pillars: How IM specialization takes place in each country, how people work in IM departments in Europe and how European internists find their work (they are satisfied with their job, their prestige, the difficulties they have, what they earn, etc.). We are developing a questionnaire, that will help us determine and value the points listed above, which we shall distribute to the European IM Society Boards, IM department heads and internists in general or in training. 11.-Quality in IM Project: Internal Medicine in Europe is diverse, but one thing we all have in common is that we want to work maintaining high quality. Knowing the quality of what we do is a way of improving ourselves. This project intends to create a group of people, not necessarily internists, which will be capable of defining the criteria for evaluating the quality of internists and the quality of the IM departments. We intend to offer this evaluation system to all internists and IM Department Heads. We must try to create a philosophy of quality for all our activities . Maybe this could be the core of a European Agency for IM evaluation in the future. This project is in a very early phase; we have

contacted several European IM Societies that may be interested in the project and that will lend their expertise in a working group. 12.-European IM Foundation: It is impossible to develop all our projects without extra funding from outside the contribution of the European Societies to the Federation. Philippe Jaeger (Switzerland) has coordinated a project for the development of a Foundation that will help us find the funds necessary to take on new projects and activities. There are currently 27 National Societies of EFIM that form the founding members of the Foundation, that is currently being registered in Switzerland. 13.- EFIM Newsletter: An important and possibly not well appreciated point is the circulation of information relating to all EFIM activities. For this reason we have set up a Newsletter that will be sent once or twice a year to our 30.000 members. Chris Davidson (U.K.) co-ordinates this activity. It aims to be an efficient way of transmitting information about all our activities

So this is our reality, and it is up to you to judge if, in the last 5 years, we’ve been heading in the right direction, and at the right speed. The Federation does have some weak points, the most important being our limited resources, both economic and structural. We are at the beginning of our road and the beginning is always difficult. The activities we already undertake are time consuming and we all know that, in general, internists have little time outside of clinical activities. The diversity of our speciality in Europe and the intrinsically difficult task of defining exactly our role in European Health Systems, makes our duty more exciting but more difficult. Perhaps we haven’t been thorough enough in spreading information about all our activities On the other hand we have many strong points. Possibly the most important is that the Federation has a dynamic, open, creative and versatile structure, with hardly any bureaucracy, where collaboration is open to all, and generosity is a common mark in the people involved in all our projects. I believe that we are full of good hope and that we are

rich in the sense that our members, the internists, will bring an important and high quality element to Health Systems. The members of the EFIM Executive Council will be happy to receive any suggestions, criticism or help from you. Prof. J. Merino / President of EFIM / e-mail: [email protected]

Table 1 MEMBER COUNTRIES

1.- Austrian Society of Internal Medicine 2.- Belgian Society of Internal Medicine 3.- Czech Society of Internal Medicine 4.- Danish Society of Internal Medicine 5.- Irish Society of Internal Medicine 6.- Federation of Royal College of Physicians of UK 7.- Estonian Society of Internal Medicine 8.- Finnish Society of Internal Medicine 9.- French Society of Internal Medicine 10.- German Society of Internal Medicine 11.- Hellenic Society of Internal Medicine 12.- Hungarian Society of Internal Medicine 13.- Israeli Society of Internal Medicine 14.- Italian Society of Internal Medicine 15.- Latvian Society of Internal Medicine 16.- Lithuanian Society of Internal Medicine 17.- Luxembourg Society of Internal Medicine 18.- Association of Physicians of Malta 19.- Polish Society of Internal Medicine 20.- Portuguese Society of Internal Medicine 21.- Slovak Society of Internal Medicine 22.- Slovenian Society of Internal Medicine 23.- Spanish Society of Internal Medicine 24.- Swedish Society of Internal Medicine 25.- Swiss Society of Internal Medicine

26.- The Netherlands Society of Internal Medicine 27.- Turkish Society of Internal Medicine

Table 2.1.- The European Journal of Internal Medicine, EJIM 2.-European Congresses for Internal Medicine 3.- European School of Internal Medicine (ESIM) Virtual European School of IM (VESIM) 4.- Working Group on research on IM 5.- Young European Internists Network 6.- Continuous Medical Education Activities 7.- Medical professionalism Project 8.- Ethics in IM 9.-EFIM´S Fellows 10.- European IM White Book 11.- Quality in IM Project 12.- European IM Foundation 13.- EFIM´s Newsletter