1
ACADEMIC VETERINARY MEDICINE EDUCATION IN EUROPE
Focus on Laboratory Animal Veterinary Medicine
Aquatic Animal Veterinary Medicine Honeybee Veterinary Medicine One Health interdisciplinary education
Despoina Iatridou
Mapping the implementation of European Union policies in the
European veterinary curricula to uncover elements for
consideration within a policy reform aiming at facilitating One Health
Interdisciplinary
collaboration.
Academic Veterinary Medicine Education in Europe
Mapping the implementation of European Union policies in the European veterinary curricula to uncover elements for consideration
within a policy reform aiming at facilitating One Health Interdisciplinary collaboration
Despoina Iatridou
Supervisors: Prof. Dr. Jimmy Saunders, Prof. Dr. Ana María Bravo Moral
A dissertation submitted to Ghent University in partial fulfilment of the requirements for the degree of Doctor of Veterinary Medicine.
Academic year 2020-2021
2
Academic Veterinary Medicine Education in Europe: Mapping the implementation of European Union policies in the European veterinary curricula to uncover elements for consideration within a policy reform aiming at facilitating One Health Interdisciplinary collaboration.
Despoina IATRIDOU
Department of Medical Imaging of Domestic Animal and Small Animal Orthopaedics Faculty of Veterinary Medicine
Ghent University Belgium
No part of this work may be reproduced in any form without permission of the author.
3
«Δόξα τῷ Θεῷ μου·
διατελῶ γηράσκουσα δ’ ἀεὶ πολλά διδασκόμενη»
4
5 To my husband Vassilis
& my son Athanasios
6
7
TABLE OF CONTENTS
List of abbreviations ... 12
CHAPTER I ... 15
GENERAL INTRODUCTION ... 15
1. Introduction ... 16
2. Regulation of education in the European Union ... 16
3. Regulation of veterinary education and recognition of professional qualifications of veterinarians in the European Union ... 19
4. Quality assurance of education in the European Union ... 25
5. Quality assurance of veterinary education in the Europe ... 26
5.1. European System of Veterinary Training ... 26
5.2. Systems of evaluation of post-graduate veterinary training in Europe ... 28
6. Current challenges for the veterinary profession ... 29
7. References ... 30
CHAPTER II ... 35
SCIENTIFIC AIMS ... 35
References ... 37
CHAPTER III ... 40
TEACHING OF LABORATORY ANIMAL VETERINARY MEDICINE ... 40
1. Abstract ... 41
2. Introduction ... 41
3. Materials and methods ... 41
4. Results ... Error! Bookmark not defined. 5. Discussion ... 50
6. References ... 53
CHAPTER IV ... 57
TEACHING OF AQUATIC ANIMAL VETERINARY MEDICINE ... 57
1. Abstract ... 58
2. Introduction ... 58
3. Materials and methods ... 59
8
4. Results ... 59
5. Discussion ... 65
6. References ... 69
CHAPTER V ... 73
TEACHING OF HONEYBEE VETERINARY MEDICINE ... 73
1. Abstract ... 74
2. Introduction ... 74
3. Materials and methods ... 75
4. Results ... 76
5. Discussion ... 80
6. References ... 84
CHAPTER VI ... 89
ONE HEALTH INTERDISCIPLINARY ACADEMIC VETERINARY EDUCATION ... 89
1. Abstract ... 90
2. Introduction ... 90
3. Materials and methods ... 91
4. Results ... 93
5. Discussion ... 101
6. References ... 105
CHAPTER VII ... 109
GENERAL DISCUSSION ... 109
1. Introduction ... 110
2. Major findings ... 111
3. Limitations of the study and future perspectives ... 117
4. General Conclusion ... 117
5. References ... 118
Summary ... 123
Samenvatting ... 127
Curriculum Vitae ... 131
Bibliography ... 133
9
Acknowledgements ... 137
Appendices ... 139
Appendix1 ... 140
Appendix 2 ... 140
Appendix 3 ... 140
Appendix 4 ... 141
11
List of abbreviations
AVBC: Australasian Veterinary Boards Council 3Rs: Replacement, Reduction, Refinement
CertAVP: Certificate in Advanced Veterinary Practice
COE -AVMA: Council on Education® of the American Veterinary Medical Association CPD: Continuous Professional Development
EAEVE: European Association of Establishments of Veterinary Education EACCME: European Accreditation Council for Continuing Medical Education EBVS: European Board of Veterinary Specialisation
EC: European Community
ECAAH: European College of Aquatic Animal Health ECCVT: European Coordinating Committee
ECEVT: European Credit System for Vocational Education and Training ECLAM: Diplomate of the European College of Laboratory Animal Medicine ECOVE: European Committee on Veterinary Education
ECTS: European Credit Transfer and Accumulation System EFTA: European Free Trade Area
EHEA: European Higher Education Area
ENQA: European Association for Quality Assurance in Higher Education EQAR: European Quality Assurance Register for Higher Education EQF: European Qualifications Framework
ESEVT: European System of Evaluation of Veterinary Training
ESG: Standards and Guidelines for Quality Assurance in the European Higher Education Area ESLAV: European Society of Laboratory Animal Veterinarians
ET: Education and Training EU: European Union
EURATOM: European Atomic Energy Community EUROSTAT: European Statistical Office
Eurydice: Education Information Network in Europe
EVERI: European Veterinarians in Education, Research and Industry FELASA: Federation of European Laboratory Animal Science Associations FVE: Federation of Veterinarians of Europe
HACCP: Hazard Analysis and Critical Control Points
ISVPS: International School of Veterinary Postgraduate Studies LAS: Laboratory Animal Science
LASM: Laboratory Animal Science and Medicine LAVA: Laboratory Animal Veterinary Association MUMS: Minor Uses and Minor Species of animals OIE: World Organization for Animal Health PQD: Professional Qualifications Directive QA: Quality Assurance
SAVC: South African Veterinary Council SOP: Standard Operational Process
UEVP: Union of European Veterinary Practitioners
UNESCO: United Nations Educational, Scientific and Cultural Organization UK: United Kingdom
VEE(s): Veterinary Education Establishment(s) VET: Vocational Education and Training
CHAPTER I General Introduction
Despoina IATRIDOU et al. 13
VetCEE: Veterinary Continuous Education in Europe WAVMA: World Aquatic Veterinary Medical Association WHO: World Health Organization
CHAPTER I
1
GENERAL INTRODUCTION
2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
CHAPTER I: General Introduction
16 Academic Veterinary Medicine Education in Europe: Mapping the implementation of European Union policies in the European veterinary curricula to uncover elements for consideration within a policy reform aiming at facilitating One Health Interdisciplinary collaboration.
1. Introduction
21
This dissertation investigates whether there is a need for a policy reform of the legislative 22
requirements used for the automatic recognition of veterinary diplomas and competences in the 23
European Union (EU). The research starts by screening the EU legislation relevant to undergraduate 24
and postgraduate veterinary education. Each veterinary education establishment (VEE) in EU and the 25
European Free Trade Area (EFTA) must implement and follow the requirements laid down in these 26
pieces of legislation to develop a curriculum that leads to a diploma in veterinary medicine, which is 27
automatically recognised in all Member States of the European Union.
28
This chapter presents an overview of the governance of the undergraduate and postgraduate 29
education and veterinary education in the European Union and the European Free Trade Area. It also 30
indicates some trends and challenges that the veterinary profession faces today and for which 31
veterinary students must be prepared during their studies. Figure 1 depicts in short what are the 32
issues that veterinary education establishments should minimum consider, and which are analysed 33
further below.
34
35
Figure 1: Factors to be considered by each veterinary education establishment in preparation of the 36
curricula and overall veterinary training.
37 38
2. Regulation of education in the European Union
39
EU treaties set out the EU objectives, the rules for the EU institutions, how decisions are made and 40
the relationship between the EU and its member countries. Under the Treaty of Lisbon (last EU 41
Treaty signed 13 December 2007)1, education is a policy area where the Union supports, 42
CHAPTER I General Introduction
Despoina IATRIDOU et al. 17
complements or supplements the actions of the Member States (Article 6, Treaty on the Functioning 43
of the European Union (TFEU)), but does not foresee harmonisation of national laws and regulations 44
(Articles 165 and 166, TFEU). Each Member State assumes full responsibility for the organisation of 45
its education and vocational training systems and the content of its teaching. Education falls under 46
the subsidiarity principle2,3. No binding legal act, such as an EU Regulation*, an EU Directive† or an EU 47
Decision‡ applies for educational matters.
48
Eurydice database of the EU presents a detailed overview of national education systems at all 49
levels4. Eurydice includes information as provided by 42 national units based in the 38 countries 50
participating in the Erasmus+ programme, namely the 27 EU Member States plus Albania, Bosnia 51
and Herzegovina, the Republic of North Macedonia, Iceland, Liechtenstein, Montenegro, Norway, 52
Serbia, Switzerland, Turkey and the United Kingdom. Information includes descriptions of the 53
organisation of the national educational systems on 14 chapters, as following:
54
1. Political, Social and Economic Background and Trends 55
2. Organisation and Governance 56
3. Funding in Education 57
4. Early Childhood Education and Care 58
5. Primary Education 59
6. Secondary and post-Secondary non-Tertiary Education 60
7. Higher Education 61
8. Adult Education and Training 62
9. Teachers and Education Staff 63
10. Management and Other Education Staff 64
11. Quality Assurance 65
12. Educational Support and Guidance 66
13. Mobility and Internationalisation 67
14. Ongoing Reforms and Policy Developments 68
Nevertheless, recognition of competences achieved over completion of education is not automatic 69
among the EU countries. Mutual recognition processes of upper secondary qualifications and 70
learning outcomes, especially for study periods abroad, are underdeveloped. Holders of such 71
qualifications giving access to higher education in one Member State often lack certainty about 72
access to higher education in another Member State. Only the European Baccalaureate gives the 73
same rights and benefits to its holders and access to all higher edication institution in all EU 74
countries5. 75
Tools for recognition of qualifications are more developed in higher education, but even then 76
recognition procedures are in many cases much complicated, expensive and time-consuming 4,6. 77
Only few groups of Member States, e.g. BENELUX, Nordic countries, Baltic countries, as well as 78
mutual agreement between Italy and Austria, have stated since 2018 to implement automatic 79
recognition for all higher education diplomas4. 80
While the responsibility for education and training systems lies within the individual Member States, 81
EU has set a number of tools to support Member States to develop their national education systems 82
* A "Regulation" is a binding legislative act. It must be applied in its entirety across the EU.
† A "Directive" is a legislative act that sets out a goal that all EU countries must achieve. However, it is up to the individual countries to devise their own laws on how to reach these goals.
‡ A "Decision" is binding on those to whom it is addressed (e.g. an EU country or an individual company) and is directly applicable.
CHAPTER I: General Introduction
18 Academic Veterinary Medicine Education in Europe: Mapping the implementation of European Union policies in the European veterinary curricula to uncover elements for consideration within a policy reform aiming at facilitating One Health Interdisciplinary collaboration.
in line with the vision for a European Education Area, where qualifications are recognised across the 83
EU, where learning, studying and doing research would not be hampered by borders7,8 anchored to 84
transparency and integrity in and through education and research9,10,11,12. These tools provide 85
support through policy guidance [European Policy Cooperation (ET 2020 framework)]13. 86
Harmonisation of education of future professionals is fundamental and should encompass both an 87
updated list of day one competences as well as 14, funding [Erasmus+ programme15; European 88
Structural and Investment Funds]16 and yearly evaluation of education and training systems across 89
Europe [The Education and Training monitor]17. 90
Regarding higher education, EU works towards a European Higher Education Area (EHEA)18, which 91
encompass the political will of over 50 countries. Countries of EHEA agree on the adoption of a more 92
harmonised approach through the application of structural reforms on higher education and the 93
implementation of quality assurance with a view to facilitate recognition of competences and free 94
movement of university educated students, professionals, researchers or academics in EU and 95
beyond. The first step towards a EHEA was made by signing the Convention on the Recognition of 96
Qualifications concerning Higher Education in the European Region developed by the Council of 97
Europe and the United Nations Educational, Scientific and Cultural Organization (UNESCO) [Lisbon 98
Recognition Convention]19 in 1997 followed by the agreement on the establishment of an 99
intergovernmental higher education reform process in 199820, the so-called Bologna declaration21. 100
Bologna process aims at facilitating recognition of degrees, periods of study and professional 101
qualifications by proposing a 3-cycle system of study (bachelor/master/doctorate) and strengthening 102
quality assurance 21. 103
The Lisbon Recognition Convention19 and its subsidiary texts22,23,24 had been the only legal 104
framework for the recognition of higher education until the adoption of the Council 105
Recommendation (2018/C 444/01) on 26 November 201825, when EU Member States made a 106
political commitment to introduce automatic recognition of diplomas and qualifications by 2025 in 107
the European Education Area. Council recommendations25 investigate fostering transparency and 108
building trust within the EHEA by linking national qualification systems with the European 109
Qualifications Framework (EQF)26; by organising higher education systems in line with the Bologna 110
process21; and by implementing external QA in compliance with the Standards and Guidelines for 111
Quality Assurance in the European Higher Education Area (ESG)27. This commitment was reiterated 112
during the Rome Ministerial Conference in November 2020 aiming at building an inclusive, 113
innovative, and interconnected EHEA by 2030 based on transparency and integrity in education and 114
research9,10,11,12. 115
Additionally, EU promotes life-long learning in the European Education Area and works towards the 116
establishment of a European Credit System for Vocational Education and Training (ECEVT)28 to 117
facilitate the transfer, recognition, and accumulation of assessed learning outcomes of individuals 118
who are aiming to achieve a qualification. The recommendation of the European Parliament and the 119
European Council of 18 June 200929 promotes ECVET to facilitate transnational mobility and the 120
recognition of learning outcomes in vocational education and training (VET) as well as borderless 121
lifelong learning.
122
Currently, EU provides several tools to help Member States with the recognition of qualifications and 123
learning outcomes achieved abroad, such as the Europass30, the European Qualifications 124
Framework26, the European Credit Transfer and Accumulation System (ECTS§)31, the Diploma 125
§ One ECTS is overall considered the teaching time equivalent to 25 to 30 hours.
CHAPTER I General Introduction
Despoina IATRIDOU et al. 19
Supplement32 and the European Credit System for Vocational Education and Training (ECEVT)28, 126
among others.
127
However, despite the political calls19,33,34 for promoting cooperation of Member States on mutual 128
recognition of higher education and upper secondary education diplomas, and the support by the 129
European Commission, so far progress on automatic recognition of diplomas and qualifications 130
continues to be slow or non-existent5. 131
132
3. Regulation of veterinary education and recognition of professional qualifications of
133
veterinarians in the European Union
134
While Council Recommendation 2018/C 444/0125 promotes automatic mutual recognition of higher 135
education to facilitate recognition of competences and qualifications in the European Education 136
Area, it clearly states that this is without prejudice to the system for mutual recognition of 137
professional qualifications and harmonised minimum training requirements for several professions 138
pursuant to Directive 2005/36/EC of the European Parliament and the Council35 as amended by 139
Directive 2013/55/EU of the European Parliament and of the Council36, the so called “Professional 140
Qualifications Directive or PQD”.
141
Directive 2005/36/EC has been established in line with Article 47 of the Treaty laying down that 142
directives shall be issued for the mutual recognition of diplomas, certificates, and other evidence of 143
formal qualifications. It provides a general system for the recognition of training and automatic 144
recognition of professional experience for a limited number of professions (sectoral professions), 145
based on harmonised minimum training requirements. Sectoral professions that benefit from an 146
automatic recognition of their diplomas and qualifications through the EU are architects, dental 147
practitioners, doctors, midwifes, nurses responsible for general care, pharmacists, and veterinary 148
surgeons. These are the so-called regulated professions in EU, for which the legislators clearly 149
envisage specific provisions as public health or safety of the EU citizens directly rely on their 150
professional competences.
151
With regard to the veterinary profession, automatic recognition of diplomas, and consequently of 152
competence to practice as veterinary surgeon, relies on the recognition of any of the veterinary 153
qualifications listed in Annex V, point 5.4.2 of the Directive 2005/36/EC[Table1].
154
Directive 2005/36/EC Annex V, 5.4.2
Evidence of formal qualifications of veterinary surgeons
Country Evidence of formal
qualifications Body awarding the evidence of
qualifications Certificate
accompanying the evidence of qualifications
Reference date
België/Belgique/Belgien Diploma van dierenarts/Diplôme de docteur en médecine vétérinaire
— De universiteiten/Les universités
— De bevoegde Examen- commissie van de Vlaamse Gemeenschap/Le Jury compétent d'enseignement de la Communauté française
21 December 1980
Česká republika — Diplom o ukončení studia ve studijním programu veterinární lékařství (doktor veterinární medicíny, MVDr.)
Veterinární fakulta univerzity v
České republice 1 May 2004
CHAPTER I: General Introduction
20 Academic Veterinary Medicine Education in Europe: Mapping the implementation of European Union policies in the European veterinary curricula to uncover elements for consideration within a policy reform aiming at facilitating One Health Interdisciplinary collaboration.
— Diplom o ukončení studia ve studijním programu veterinární hygiena a ekologie (doktor veterinární medicíny, MVDr.)
Danmark Bevis for bestået
kandidateksamen i veterinærvidenskab
Kongelige Veterinær- og
Landbohøjskole 21 December 1980
Deutschland Zeugnis über das Ergebnis des Dritten Abscnitts der Tierärztlichen Prüfung und das Gesamtergebnis der Tierärztlichen Prüfung
Der Vorsitzende des Prüfungsausschusses für die Tierärztliche Prüfung einer Universität oder Hochschule
21 December 1980
Eesti Diplom: täitnud
veterinaarmeditsiini õppekava
Eesti Põllumajandusülikool 1 May 2004
Ελλάς Πτυχίo Κτηvιατρικής Πανεπιστήμιο Θεσσαλονίκης και
Θεσσαλίας 1 January 1981
España Título de Licenciado en
Veterinaria — Ministerio de Educación y Cultura
— El rector de una universidad
1 January 1986
France Diplôme d'Etat de docteur
vétérinaire 21 December 1980
Ireland — Diploma of Bachelor in/of Veterinary Medicine (MVB)
— Diploma of Membership of the Royal College of Veterinary Surgeons (MRCVS)
21 December 1980
Italia Diploma di laurea in medicina
veterinaria Università Diploma di abilitazione
all'esercizio della medicina veterinaria
1 January 1985
Κύπρος Πιστοποιητικό Εγγραφής
Kτηνιάτρου Κτηνιατρικό Συμβούλιο 1 May 2004
Latvija Veterinārārsta diploms Latvijas Lauksaimniecības
Universitāte 1 May 2004
Lietuva Aukštojo mokslo diplomas (veterinarijos gydytojo (DVM))
Lietuvos Veterinarijos Akademija 1 May 2004
Luxembourg Diplôme d'Etat de docteur en
médecine vétérinaire Jury d'examen d'Etat 21 December 1980
Magyarország Állatorvos doktor oklevél —
dr. med. vet. Szent István Egyetem Állatorvos-
tudományi Kar 1 May 2004
Malta Liċenzja ta' Kirurgu
Veterinarju Kunsill tal-Kirurġi Veterinarji 1 May 2004
Nederland Getuigschrift van met goed gevolg afgelegd
diergeneeskundig/veeartse- nijkundig examen
21 December 1980
Österreich — Diplom-Tierarzt
— Magister medicinae veterinariae
Universität — Doktor der
Veterinärmedizin
— Doctor medicinae veterinariae
— Fachtierarzt
1 January 1994
Polska Dyplom lekarza weterynarii 1. Szkoła Główna Gospodarstwa Wiejskiego w Warszawie 2. Akademia Rolnicza we
Wrocławiu
3. Akademia Rolnicza w Lublinie 4. Uniwersytet Warmińsko-
Mazurski w Olsztynie
1 May 2004
Portugal Carta de curso de licenciatura
em medicina veterinária Universidade 1 January 1986
Slovenija Diploma, s katero se podeljuje strokovni naslov ‘doktor veterinarske
Univerza Spričevalo o
opravljenem državnem 1 May 2004
CHAPTER I General Introduction
Despoina IATRIDOU et al. 21
medicine/doktorica
veterinarske medicine’ izpitu s področja
veterinarstva Slovensko Vysokoškolský diplom o
udelení akademického titulu
‘doktor veterinárskej medicíny’ (‘MVDr.’)
Univerzita veterinárskeho
lekárstva 1 May 2004
Suomi/ Finland Eläinlääketieteen lisensiaatin tutkinto/Veterinärmedicine licentiatexamen
Helsingin yliopisto/Helsingfors
universitet 1 January 1994
Sverige Veterinärexamen Sveriges Lantbruksuniversitet 1 January 1994
United Kingdom 1. Bachelor of Veterinary
Science (BVSc) 1. University of Bristol 21 December 1980
2. Bachelor of Veterinary
Science (BVSc) 2. University of Liverpool 3. Bachelor of Veterinary
Medicine (BvetMB) 3. University of Cambridge 4. Bachelor of Veterinary
Medicine and Surgery (BVM&S)
4. University of Edinburgh
5. Bachelor of Veterinary Medicine and Surgery (BVM&S)
5. University of Glasgow
6. Bachelor of Veterinary
Medicine (BvetMed) 6. University of London
TABLE 1. Annex V, point 5.4.2 of the Directive 2005/36/EC 155
All these qualifications meet the basic criteria for automatic recognition, namely an at least 5- years 156
full-time theoretical and practical training (article 38.1 of the Directive 2013/55/EU) including the 157
coverage of the subjects listed in Annex V, point 5.4.1 [Table 2] of the Directive 2005/36/EC as well 158
of the competences and skills laid down in Article 38.3 of the Directive 2013/55/EU, namely:
159
(a) adequate knowledge of the sciences on which the activities of a veterinary surgeon are based and 160
of the Union law relating to those activities;
161
(b) adequate knowledge of the structure, functions, behaviour and physiological needs of animals, as 162
well as the skills and competences needed for their husbandry, feeding, welfare, reproduction and 163
hygiene in general;
164
(c) the clinical, epidemiological and analytical skills and competences required for the prevention, 165
diagnosis and treatment of the diseases of animals, including anaesthesia, aseptic surgery and 166
painless death, whether considered individually or in groups, including specific knowledge of the 167
diseases which may be transmitted to humans;
168
(d) adequate knowledge, skills and competences for preventive medicine, including competences 169
relating to inquiries and certification;
170
(e) adequate knowledge of the hygiene and technology involved in the production, manufacture and 171
putting into circulation of animal feedstuffs or foodstuffs of animal origin intended for human 172
consumption, including the skills and competences required to understand and explain good practice 173
in this regard;
174
(f) the knowledge, skills and competences required for the responsible and sensible use of veterinary 175
medicinal products, in order to treat the animals and to ensure the safety of the food chain and the 176
protection of the environment.’
177 178 179
CHAPTER I: General Introduction
22 Academic Veterinary Medicine Education in Europe: Mapping the implementation of European Union policies in the European veterinary curricula to uncover elements for consideration within a policy reform aiming at facilitating One Health Interdisciplinary collaboration.
Directive 2005/36/EC Annex V, 5.4.1
Study programme for veterinary surgeons
The programme of studies leading to the evidence of formal qualifications in veterinary medicine shall include at least the subjects listed below.
Instruction in one or more of these subjects may be given as part of, or in association with, other courses.
A. Basic subjects Physics Chemistry Animal biology Plant biology Biomathematics B. Specific subjects
a. Basic sciences:
Anatomy (including histology and embryology) Physiology
Biochemistry Genetics Pharmacology Pharmacy Toxicology Microbiology Immunology Epidemiology Professional ethics b. Clinical sciences:
Obstetrics
Pathology (including pathological anatomy) Parasitology
Clinical medicine and surgery (including anaesthetics)
Clinical lectures on the various domestic animals, poultry and other animal species Preventive medicine
Radiology
Reproduction and reproductive disorders Veterinary state medicine and public health Veterinary legislation and forensic medicine Therapeutics
Propaedeutics c. Animal production
Animal production Animal nutrition Agronomy Rural economics Animal husbandry Veterinary hygiene
Animal ethology and protection d. Food hygiene
Inspection and control of animal foodstuffs or foodstuffs of animal origin Food hygiene and technology
Practical work (including practical work in places where slaughtering and processing of foodstuffs takes place) Practical training may be in the form of a training period, provided that such training is full-time and under the direct control of the competent authority, and does not exceed six months within the aggregate training period of five years study.
The distribution of the theoretical and practical training among the various groups of subjects shall be balanced and coordinated in such a way that the knowledge and experience may be acquired in a manner which will enable veterinary surgeons to perform all their duties.
TABLE 2. Annex V, point 5.4.1 of the Directive 2005/36/EC 180
Veterinarians holding any degree of the ones included in Annex 5.4.2 (Table 1) are automatically 181
qualified for their registration to the competent authority or veterinary statutory body in any 182
country of EU and EFTA, and may ask for a license to practice in the country.
183
CHAPTER I General Introduction
Despoina IATRIDOU et al. 23
184
Figure2: Factor influencing vision and mission of veterinary education establishments in EU.
185
The veterinary statutory body in each Member State or, in the case of absence of a veterinary 186
statutory body, the respective competent authority, e.g. a Ministry, supervises the quality of the 187
competence of the veterinarians practicing in the country, and is responsible for their license and 188
registration.
189
Directive 2005/36/EC of the European Parliament and the Council35 as amended by Directive 190
2013/55/EU36 calls also on Member States to encourage, in particular, continuous professional 191
development for doctors of medicine, medical specialists, general practitioners, nurses responsible 192
for general care, dental practitioners, specialised dental practitioners, veterinary surgeons, 193
midwives, pharmacists and architects. It considers particularly important that those professionals 194
can update their knowledge, skills and competences in order to maintain a safe and effective 195
practice and keep abreast of professional developments, although no harmonisation is foreseen in 196
this area.
197
Over the years, more references to the specific competences of the veterinarians and their 198
responsibilities have been included in different pieces of EU legislation, such as the Animal Health 199
Law37, the regulation on veterinary medicinal products38 and on medicated feed39, the official 200
controls40, the directive on protection of animals used for scientific purposes41 and the Directive on 201
radioprotection42. 202
Regulation (EU) 2016/429 of the European Parliament and of the Council of 9 March 2016 on 203
transmissible animal diseases and amending and repealing certain acts in the area of animal health 204
(‘Animal Health Law’)37 recognises that veterinarians play a crucial role in all aspects of animal health 205
management by having the necessary knowledge, skills and competencies to diagnose diseases, to 206
treat animals, to inform about prevention and to raise overall awareness about animal health, 207
animal welfare and public health. Additionally, article 12.3 highlights the need for continuous 208
professional development, by calling on veterinarians to maintain and develop their professional 209
capabilities related to their areas of activities which fall within the scope of this Regulation.
210
CHAPTER I: General Introduction
24 Academic Veterinary Medicine Education in Europe: Mapping the implementation of European Union policies in the European veterinary curricula to uncover elements for consideration within a policy reform aiming at facilitating One Health Interdisciplinary collaboration.
Regulation (EU) 2019/6 of the European Parliament and of the Council of 11 December 2018 on 211
veterinary medicinal products38 as well as Regulation 2019/4 on the manufacture, placing on the 212
market and use of medicated feed39, consider the veterinarian as the gatekeeper of health and 213
welfare of all animal species without any exemption. Both pieces of law highlight veterinarian’s role 214
and obligations about prescription of veterinary medicines; responsible use of medicines – especially 215
of antimicrobials; retail and use of veterinary medicinal products within EU; prescription and use of 216
medicines off-label; reporting of adverse events in animals and people; and determination of 217
withdrawal periods.
218
Regulation (EU) 2017/625 of the European Parliament and of the Council of 15 March 2017 on 219
official controls40, together with Regulation (EC) No852/2004of the European Parliament and of the 220
Council of 29 April 2004 on the hygiene of foodstuffs43 and Regulation (EC) No 853/2004 of the 221
European Parliament and of the Council of 29 April 2004 laying down specific hygiene rules for food 222
of animal origin44, also highlight competences and responsibilities for the EU veterinarians working 223
as hygienists or official veterinarians, that is to say veterinarians appointed by a competent 224
authority, either as staff or otherwise. Official veterinarians should be appropriately qualified to 225
perform official controls in relation to products of animal origin intended for human consumption in 226
slaughterhouses, game-handling establishments and border control posts. These controls include a 227
long list of important activities, such as: ante-mortem inspection and post-mortem inspection in 228
slaughterhouses; verification of the compliance of meat and meat products with hygiene 229
requirements, determination of the maximum residue limits or presence of contaminants in 230
products of animal origin; audit of the implementation of good hygiene practices and procedures 231
based on HACCP principles (Hazard Analysis and Critical Control Points) while processing animals for 232
human consumption as well as of the handling and disposal of animal by-products and of specified 233
risk materials; verification of the compliance with the requirements for laboratory testing as well as 234
health and welfare of the animals. Additionally, official veterinarians are responsible for the 235
supervision of official auxiliaries and remain responsible for the decisions taken during the official 236
controls.
237
Overview of the pieces of legislation of the European Union relevant to the veterinary profession
• Directive 2005/36/ EC (PQD), 5 years of education / Annex 5.4.1
• Regulation (EU) 2017/625 (on Official Controls)
• Regulation (EC) No852/2004 (on the hygiene of foodstuffs)
• Regulation (EC) No 853/2004 (specific hygiene rules for food of animal origin)
• Directive (EU) 2010/63 (on protection of animals used for scientific purposes)
• Regulation (EU) 2016/429 (on transmissible animal diseases and amending and repealing certain acts in the area of animal health);
• Regulation (EU) 2019/6 (on veterinary medicinal products); and
• Regulation (EU) 2019/4 (on the manufacture, placing on the market and use of medicated feed)
• Council Directive 2013/59/Euratom (basic safety standards for protection against the dangers arising from exposure to ionising radiation
TABLE 3: Veterinary legislation 238
Directive 2010/63/EU41 of the European Parliament and of the Council of 22 September 2010 239
establishes measures for the protection of animals used for scientific or educational purposes. It 240
recognises the need to ensure the ongoing monitoring of the welfare of those animals by providing 241
appropriate veterinary care available at any times. It also puts particular emphasis on the 3Rs 242
CHAPTER I General Introduction
Despoina IATRIDOU et al. 25
principle, namely the Replacement and Reduction of the use of animals in procedures and the 243
Refinement of the breeding, accommodation, care and use of these animals. The legislator foresees, 244
particularly, that each breeder, supplier, and user shall have a “designated veterinarian” charged 245
with advisory duties in relation to the well-being and treatment of the animals.
246
Whereas the EU legislative framework described above lays down the requirements, competences, 247
and responsibilities of qualified veterinarians in EU, there are some other policies and 248
recommendations which are relevant to the veterinary and other professions. The Council Directive 249
2013/59/Euratom of 5 December 2013, which lays down basic safety standards for protection 250
against the dangers arising from exposure to ionising radiation, is such an example as it applies 251
equally on both medical and veterinary practices. Besides this, current challenges, such as 252
antimicrobial resistance, climate change, natural or mankind disasters, digitalisation, telemedicine, 253
and implementation of new technologies are important elements that would similarly impact 254
veterinary and medical practice. Many EU and global policy recommendations already address these 255
novel needs and call for action, such as the EU One Health Action Plan against Antimicrobial 256
Resistance45, Recommendations of the World Animal Organisation (OIE) at the 4th OIE Congress on 257
Veterinary Education46, tripartite policy recommendations and many others47. These are elements 258
that must be considered when building upon future veterinary curricula, concept of teaching, and 259
learning outcomes.
260
Further to the undergraduate education, the EU Law36 calls for continuous professional development 261
of the professionals who benefit from the automatic recognition of their professional qualifications, 262
such as veterinarians. Legislators acknowledge the importance of lifelong learning to ensure safe and 263
effective practice and requests Member States to make such opportunities available for 264
veterinarians as well as to share them with the Commission and other Member States. This 265
recommendation is also in line with the Code of Conduct and Veterinary Act48 for the European 266
veterinarians, which lays down that veterinarians should update their knowledge, skills and 267
competences in order to maintain a safe and effective practice and keep abreast of professional 268
developments.
269 270
4. Quality assurance of education in the European Union
271
Quality assurance (QA) is one of the cornerstones of improving transparency and building trust in 272
the European Higher Education Area (EHEA). In most European countries, higher education 273
institutions or study programmes are submitted to regular external review by a QA agency. QA 274
ensures that students have achieved the same minimum learning outcomes and competences, when 275
graduating from different establishments adhered to the same set of policies and processes. It 276
promotes a harmonised approach in education and training, thus being of great importance for 277
mutual recognition of each other’s educational systems. That is why QA is highlighted as a 278
fundamental element within the Bologna process21, ET 202013,14, Council Recommendation (2018/C 279
444/01) on 26 November 201825 for recognition of qualifications and facilitating mobility of students, 280
professionals, academics, and researchers in EHEA as well as in the last EHEA Rome Ministerial 281
Communication9. 282
QA in higher education is promoted by the European Association for Quality Assurance in Higher 283
Education (ENQA)49 across all the Bologna Process signatory countries. ENQA together with other 284
stakeholders in European academia have proposed the “Standards and Guidelines for Quality 285
Assurance in the European Higher Education Area (ESG)”, which have been adopted by the Ministers 286
responsible for higher education and updated in 201527. The ESG 2015 provides guidance, covering 287
CHAPTER I: General Introduction
26 Academic Veterinary Medicine Education in Europe: Mapping the implementation of European Union policies in the European veterinary curricula to uncover elements for consideration within a policy reform aiming at facilitating One Health Interdisciplinary collaboration.
the areas which are vital for the successful quality provision and learning environments in higher 288
education.
289
ESG together with EQF26, ECTS31 and Diploma Supplement32 are tools assisting higher education 290
establishments to increase transparency and to build mutual trust in EHEA. The ESG 2015 is also the 291
basis for the external assessment of national or international QA agencies in the EHEA, which aim to 292
become accredited by ENQA and placed or maintained on the list of ENQA members50 and on the 293
European Quality Assurance Register for Higher Education (EQAR)51. In addition, a Database of 294
External Quality Assurance Results (DEQAR) is being developed looking to enhance access to reports 295
and decisions on higher education institutions/programmes externally reviewed against the ESG, by 296
an EQAR-registered agency52. 297
298
5. Quality assurance of veterinary education in the Europe
299
5.1. European System of Veterinary Training
300
Although quality assurance is nationally implemented in different European countries, a study on the 301
transposition of the Professional Qualifications Directive conducted on behalf of the Commission in 302
2009 clearly indicated that “the Member States lack trust in each other’s educational systems and it 303
is important to establish this trust if the Directive (2005/36/EC) is to work properly”53. The veterinary 304
profession has shown unique responsibility and has established the European System of Evaluation 305
of Veterinary Training (ESEVT)54, which has been running successfully since 1985. The veterinary 306
academia in Europe represented by the European Association of Establishments for Veterinary 307
Education (EAEVE)**, 55, together with the whole veterinary profession in Europe represented by the 308
Federation of Veterinarians of Europe (FVE)††,56, have created this professional peer evaluation 309
system for veterinary education establishments. Veterinary education establishments participating 310
in this system are evaluated against a set of standards by a team of experts that visit each 311
establishment and prepare a report to be reviewed by the European Committee of Veterinary 312
Education (ECOVE)57, which is the decision body of ESEVT. The establishments that meet the 313
requirements of the Standard Operating Procedure of ESEVT get to the status of ‘‘approval’’ or 314
‘‘accreditation.’’‡‡
315
ESEVT was initially focused on the professional requirements for veterinary surgeons laid down in 316
Professional Qualifications Directive and aimed to ensure that veterinary education establishments 317
help all their students to effectively acquire the minimum learning outcomes and competences 318
required by the EU legislation. Currently, this system the appropriate tool for providing the minimum 319
standard regarding veterinary training. ESEVT Standard Operating Procedure58 is set up based among 320
others on the minimum requirements set in both the European Directives35,36 and the list of 321
**Members of EAEVE are veterinary education establishments that commit to its mission and vision for veterinary education in Europe and are evaluated by the European System of Evaluation of Veterinary Training.
††Members of FVE are national veterinary associations and/or national veterinary chambers in European countries. FVE also embraces four Sections each one of which represents a vital part of the profession, namely the Union of European Veterinary Practitioners (UEVP); the European Association of Veterinary State Officers (EASVO); the Union of European Veterinary Hygienists (UEVH); and the European Veterinarians in Education Research and Industry (EVERI).
‡‡“Approved” or “Non-approved” are the veterinary education establishments that have been assessed under the Stage 1 of the “Budapest Standard Operating Procedure 2012” of the European System of Evaluation of Veterinary Training (ESEVT). “Accredited” or “Non-accredited” are those veterinary education establishments that have been assessed against Stage I&II of the “Budapest Standard Operating Procedure of 2012” or any following update of the SOP, i.e. the “Standard Operating Procedure 2016” or the current “Standard Operating Procedure 2019”, of the ESEVT.
CHAPTER I General Introduction
Despoina IATRIDOU et al. 27
subjects35 and Day One Competences59. It therefore encompasses several other than only Annex V 322
requirements to ensure up-to-date training of veterinary students and competence of all graduate 323
veterinarians to take up entry roles in different areas of the veterinary profession. That way the 324
academia and the veterinary profession work together towards providing assurance to the public 325
and strengthening their trust in the quality of graduate veterinary surgeons and the services they 326
deliver.
327
Over the years, more references to veterinary competences and responsibilities have come on the 328
different pieces of the EU legislation. At the same time, veterinary education establishments have 329
been also part of the European Higher Education Area and had to follow the Bologna Process and 330
general provisions for all higher-education institutions in this area. This raised the need for 331
incorporating the implementation of quality assurance within the ESEVT processes as well.
332
EAEVE together with FVE have been following closely all those developments and presented a more 333
holistic list of Day One Competences for veterinarians59. Prevention and biosecurity; examination;
334
early detection of diseases by carrying out proper diagnosis and differential diagnosis to rule out or 335
confirm a disease; prescription and implementation of the right treatment; raising awareness of 336
resistance to treatments, including antimicrobial resistance, and its implications; food inspection;
337
One Health approach; and 3Rs principle are now considered as core competences59 that all graduate 338
veterinarians should have acquired by the time of their graduation and must be able to apply in the 339
different domestic species, including minor uses and minor species of animals (MUMS). Further to 340
this, quality assurance has been fully incorporated in the ESEVT Standard Operating Procedures and 341
EAEVE sought external accreditation by ENQA.
342
In 2018, EAEVE passes successfully the ENQA assessment and became the first European-wide 343
profession-specific accreditation body accredited by ENQA, gaining more international recognition.
344
Even though the ESEVT is not legally binding, the number of veterinary education establishments 345
that strive to meet the requirements and ask for the EAEVE-FVE evaluation increases year by year.
346
This is representative of the wide acceptance of ESEVT by the European community of the veterinary 347
education establishments. Similarly, the number of approved and accredited veterinary education 348
establishments in and beyond the EU is steadily increasing. EAEVE has now 83 full-members, 18 349
candidate members and 4 associate-members60,61. 350
EAEVE and FVE have been pioneers in the implementation of profession-specific Europe-wide quality 351
assurance within the European Higher Education Area by running the European System of Evaluation 352
of Veterinary Training from 1985 to date. Hence, ESEVT contributes to the transparency and trust to 353
the veterinary education systems across EU and beyond62. Currently, EAEVE and the Council on 354
Education® (COE) of the American Veterinary Medical Association (AVMA)63 are the bigger 355
accreditation institutions for veterinary training in the world. Many veterinary education 356
establishments, both in Europe and globally ask for accreditation by both bodies in order to enlarge 357
potentials in the global market for their graduates. In the European Union, seven veterinary 358
education establishments are currently accredited by both EAEVE and COE-AVMA and three of them 359
are also accredited by the Australasian Veterinary Boards Council (AVBC)64 as well. Table 4 presents 360
an overview of the existing systems of accreditation of veterinary training globally along with the 361
requirements for recognition of veterinary diplomas and licensing of veterinarians in the different 362
parts of the world.
363 364 365
CHAPTER I: General Introduction
28 Academic Veterinary Medicine Education in Europe: Mapping the implementation of European Union policies in the European veterinary curricula to uncover elements for consideration within a policy reform aiming at facilitating One Health Interdisciplinary collaboration.
EU and EFTA US & Canada Oceania South Africa Duration of studies 5-7 years 7-9 years 5-7 years 7 years Veterinary-specific
Accreditation
Voluntary Obligatory
for licensing
Obligatory for licensing
No
Accrediting body EAEVE, Royal College of Veterinary
Surgeons (RCVS)65
COE - AVMA AVBC -
Recognition of diplomas
Automatic recognition of diplomas as set down in EU legislation Annex 5.4.2 of Dir 2005/36
COE - AVMA AVBC According to Veterinary and Para- Veterinary Professions Act, Act 19 of 1982 License exams for the
veterinarians
Only for the graduates with a third-country qualification
according to national requirements for each Members State
Obligatory for all graduates, run by COE - AVMA
Only for the graduates with a non- recognised qualification by AVBC
Only for graduates with a qualification not
recognised by the Act 19 of 1982 Registration of
veterinarians
Obligatory registration by a competent authority/Veterinary Statutory Body in a EU Member State
Obligatory, run by COE - AVMA
Obligatory by AVBC
Obligatory by the South African Veterinary Council (SAVC)66 TABLE 4: Overview of accreditation bodies of veterinary education worldwide 366
367
5.2. Systems of evaluation of post-graduate veterinary training in Europe
368
Continuous Professional Development (CPD) is an obligation for each veterinarian48, 67 and other 369
health professionals68. Nevertheless, as it generally occurs with lifelong learning in EU, no common 370
framework exists so far. Even though the importance of the CPD, especially for all professionals 371
contributing to public health and safety who has been recognised within legislation36, there is a great 372
variation between the different countries in the way that CPD is implemented and regulated. A study 373
conducted in 2013 under the EU Health Programme, mapping and reviewing continuous professional 374
development and lifelong learning for doctors, nurses, dentists, midwives and pharmacists in the 31 375
member countries of the EU, and EFTA countries, has highlighted the great diversity in the ways that 376
different European countries regulate CPD68. CPD for these five health professions in EU and EFTA 377
can be mandatory, voluntary, or a combination of these two approaches. European Commission has 378
CHAPTER I General Introduction
Despoina IATRIDOU et al. 29
not conducted a similar structured survey for veterinary profession which is also a regulated 379
profession. Anecdotal and small-scale case-studies show, however, that landscape for veterinary 380
CPD is similar and a great variation of systems apply per country.
381
CPD of veterinarians can be achieved via many ways, such as through participation in scientific 382
events, in seminars, in online training or through the enrolment in a complete academic programme 383
leading to a formal qualification. Kinds of CPD falling in the last category which lead to qualifications 384
at EQF level 7, are a certificate or a Master programme, or at EQF level 8, a PhD programme or a 385
specialisation programme. Enrolment in structured CPD at EQF level 7 in some countries can lead to 386
the acknowledgement of the level of competences via a particular title, such as ‘vakdierenarts’ in 387
Belgium, ‘Fachtierarzt’ and ‘Zusatzbezeichnung’ in Germany, ‘CertAVP’ in the United Kingdom or 388
other national specialisation titles.56 Enrolment in programmes at higher level (EQF 8) lead to a 389
“Doctor” qualification or a formal qualification as “Diplomate” or “Specialist”. Society, especially 390
nowadays, needs high-level veterinary services and veterinarians with advanced skills and 391
knowledge to cover these needs.
392
The implementation of a system for the accreditation of CPD varies also per country. Although there 393
are not complete data on accreditation systems for veterinary CPD, available case studies about CPD 394
for companion animals indicate that the situation is similar. Only few countries have established 395
national CPD committees to take care of the registration and accreditation of available CPD for 396
veterinarians, e.g. Belgium, Germany, Ireland, Poland, The Netherlands, Spain, UK69. 397
In order to bridge inconsistencies between the different national CPD systems, academia, veterinary 398
specialists and the veterinary profession set up jointly VetCEE in 201470. VetCEE is a joint initiative of 399
EAEVE48, FVE49, EBVS71 and UEVP72 established with a view to propose a scheme for QA and mutual 400
recognition of lifelong learning for veterinarians throughout Europe, thus facilitating recognition of 401
their competences achieved through structured CPD (EQF 7).
402
Except VetCEE, private initiatives try to take a role as international accreditors for veterinary CPD in 403
Europe, such as the International School of Veterinary Postgraduate Studies (ISVPS).
404
One level higher, the European Board of Veterinary Specialisation (EBVS)71 provides the framework 405
of competences and assures the quality of training for veterinary specialists at level EQF 8 by 406
recognising and monitoring the 27 veterinary speciality Colleges73 in Europe. Specialists have a very 407
important role in animal health and welfare, public health, sustainable production, development of 408
research for all the diverse disciplines of veterinary medicine, and make a valuable contribution to 409
the society. However, EU legislation has not yet introduced a system for the recognition of 410
veterinary specialists in each territory. EBVS comes to fill that gap by regulating veterinary specialists 411
qualified by its colleges in thirty-eight distinct areas of veterinary medicine, which can be species 412
specific or discipline specific73. College programmes account for an equivalent of 180 ECTS acquired 413
through a 3-year full-time residency programme, or an equivalent part-time dedication as defined by 414
the EBVS Policies and Procedures74. EBVS assures the quality of the training provided by each 415
College, ensures transparency of qualification, which is awarded with the title of European 416
Veterinary Specialist™ in the particular field of veterinary medicine.
417 418
6. Current challenges for the veterinary education establishments
419
Veterinary profession contributes to society in many different roles. With their competences, 420
knowledge and skills, ensure the health and welfare of different species of animals used for different 421
purposes; contribute to productivity, profitability and sustainability in farming; ensure food safety 422
CHAPTER I: General Introduction
30 Academic Veterinary Medicine Education in Europe: Mapping the implementation of European Union policies in the European veterinary curricula to uncover elements for consideration within a policy reform aiming at facilitating One Health Interdisciplinary collaboration.
and security of products delivered from animals; contribute to public health; contribute to research 423
and innovation; as well as to ecosystem conservation. Legislators in the European Union 424
acknowledge the need for the veterinary contribution in many different pieces of legislation as 425
presented above under Subchapter 3.
426
Veterinary curriculum must prepare efficiently veterinary students to meet current global challenges 427
in any career path they select to follow graduation. Such challenges include, for example, the control 428
of zoonotic diseases, antimicrobial resistance, sustainable production, climate change, disaster 429
management or ethical research. All of them require the combination of multi-disciplinary 430
knowledge as well as the close collaboration of professionals coming from different backgrounds, 431
what it is now called One Health interdisciplinary practice.
432
This thesis focuses on four areas of veterinary medicine - namely laboratory animal veterinary 433
medicine, aquatic animal veterinary medicine, honeybee veterinary medicine and One Health - for 434
which European Union legislators foresee the involvement of veterinarians and other professionals.
435
Now, these sectors are somehow less popular career paths, with about 15% of veterinarians being 436
occupied in academic or industrial research, 4% in aquatic animal health, 9% in One Health and 13%
437
in practice with exotic species75. Nevertheless, these are all very dynamic sectors, and overall 438
outlooks for them are very positive. It is therefore of utmost importance to ensure that veterinarians 439
will be active participants of their future development. By mapping the veterinary curricula in the EU 440
and EFTA, this investigation tries to find out how the European veterinary education establishments 441
incorporate teaching in those fields in their curricula. By analysing the results, this study investigates 442
in identifying the elements that need to be considered within a policy reform of the Professional 443
Qualifications Directive, in a way that will enable future veterinarians to meet efficiently current and 444
future challenges.
445 446
7. References
447
1 Treaty of Lisbon [Internet]. Brussels: European Union; 2007 Dec 17. Available from: https://eur- lex.europa.eu/legal-content/EN/TXT/?uri=celex:12007L/TXT.
2 EUR-Lex Access to the European Union law. Glossary of summaries: Subsidiarity. http://eur- lex.europa.eu/summary/glossary/subsidiarity.html.
3 European Committee of Regions. Subsidiarity monitoring in the area of education, vocational training and youth. https://portal.cor.europa.eu/subsidiarity/policyareas/Pages/Education.aspx.
4 Eurydice: National Education Systems - http://eacea.ec.europa.eu/national-policies/eurydice/national- description_en
5 European Commission proposal for a Council recommendation on promoting automatic mutual recognition of higher education and upper secondary education diplomas and the outcomes of learning period abroad.
6 Making Integration Work, Organisation for Economic Co-operation and Development (2017):
http://www.oecd.org/migration/making-integration-work-humanitarian-migrants-9789264251236-en.htm
7 Education in the EU. European Education Area - https://ec.europa.eu/education/education-in-the- eu/european-education-area_en
8 Communication from the Commission to the European Parliament, the Council, the European Economic and Social Committee and the Committee Of The Regions: Strengthening European Identity through Education and Culture; The European Commission's contribution to the Leaders' meeting in Gothenburg, 17 November 2017 - https://eur-lex.europa.eu/legal-content/EN/TXT/?uri=COM%3A2017%3A673%3AFIN
9 Rome Ministerial Communiqué. 19 November 2020 –
http://www.ehea.info/Upload/Rome_Ministerial_Communique.pdf
10 Rome Ministerial Communiqué - Annex I - Statement on Academic Freedom - http://www.ehea.info/Upload/Rome_Ministerial_Communique_Annex_I.pdf
