Arguably, the cornerstones of building competence for health professionals are education and training. Country practices vary starting from entry requirements for higher education, for which there is no standardization at EU level. In Europe, national authorities are responsible for the recognition of health education institutions (e.g. via accreditation) and educators in their jurisdiction. For medical education specifically, the European Union of Medical Specialists (Union Europeene des Medecins Specialistes, UEMS) established the Network of Accredited Skills Centres in Europe (NASCE). NASCE evaluates and subsequently accredits institutions of medical education and training in European countries, but this pertains to particular skill sets rather than entire curricula of basic medical education .
The regulation of curricula for the health professions at the national level usually aims to ensure uniformity across educational programmes. National regulations for the basic curricula of professional education in Europe and the European Economic Area are determined by the EU Directives on the mutual recognition of professional qualifications. Directive 2013/55/EU of 20 November 2013 amending Directive 2005/36/EC of the European Parliament and of the Council of 7 September 2005 set out the legal foundation to ensure that health professionals can move freely and practise across Member States. The EU Directives mainly regulate the minimum duration of training to ensure comparability and equivalence of diplomas, but not the details of its content. For instance, medical education requires a minimum of 5 years of university-based theoretical and practical training, but the detailed composition and set-up beyond this remains a national (or sub-national) responsibility. Starting in 1999, the Bologna process has aimed to enhance the comparability of higher-education qualifications in Europe and ensure their quality. It applies to educational programmes for health professionals and has drastically influenced the way they are organized.
Physicians usually complete studies in medicine at university level and require (additional) training at a hospital in order to obtain a medical degree and be able to practice. They then undergo specialist training mostly by means of on-the job learning; completing specialist training is usually a prerequisite to deliver patient care independently. In contrast to the approach towards basic education described above, self-regulation plays the main role for determining the requirements for specialist training or residency programmes. This leads to considerable variability across European countries regarding admission policy, duration, scope, terminology and significance of diplomas, and general structure of residency training. The EU Directives primarily list the titles and minimum duration of specialist training for physicians in EU countries. The UEMS, founded in 1958, is the representative organization of all medical specialists in the European Community, aiming to encourage the harmonization of specialist training across Europe. Already in the 1990s, it issued guiding principles for a European approach for specialist medical training to ensure quality and comparability, meant to guide but not replace existing national structures. The UEMS also established the European Council for Accreditation of Medical Specialist Qualifications (ECAMSQ®), which developed a voluntary competence-based framework for the assessment and certification of medical specialists in Europe . By virtue of their voluntary nature, these initiatives are primarily of value when they are recognized by the relevant national bodies in each country.
Compared to medical education, the regulation of nursing education is even less uniform across countries and can apply at national or sub-national level. The European Directives mandate a minimum requirement of 4.600 h theory and practice (Directive 55/2013/EU) and certain skills and competencies which need to be obtained by nurses (e.g. ascertaining the need for nursing care, to plan, organize and implement nursing care, to empower individuals and patients), but the contents of curricula remain highly heterogeneous across countries. As a result of the Bologna process, nursing education is performed increasingly at higher educational institutions (via Bachelor and Master programmes), but primary education in nursing schools also co-exists in many countries. This shift towards degree-level nursing education paved the way for advanced practice and the expansion of professional roles for nurses. Some form of specialized training is available in most European countries, albeit with varying titles, levels and length of education. Depending on the type and level of education and specialization, professionals are qualified to take over different tasks and responsibilities. This has implications for the regulation of task and responsibility division between professions and the complexity of ensuring comparability for professionals moving across borders.
European countries have different requirements for granting the right to practice for both physicians and nurses, but the successful completion of basic professional education is the minimum. The successful completion of an examination is usually required, and this can be integrated in the prerequisites to obtain the academic degree or be additional. Obtaining a license to practice is often linked to obligatory registration in a health professional register, which aims to inform the public and potential employers about the professional’s qualifications. Such registries are operated in most European countries for physicians, while only few have a nurse registry in place. Licensing and registration for doctors and nurses are mostly regulated at national or sub-national level. Competent bodies vary from governmental ministries to self-regulating professional bodies, with varying degrees of statutory control and professional associations playing a key role in most countries . There is no EU-wide licensing authority or registry for either physicians or nurses.