Harmonising respiratory knowledge throughout Europe (and beyond)

Harmonising respiratory knowledge throughout Europe (and beyond) - article image

Even although this blog should be about the vision of an allied health professional on the respiratory field it is hard to start it without a reflection on the events in Brussels in the week before Easter. 32 people were killed and many injured in blind attacks at the heart of Europe. Bombs exploded in an airport where many of us have passed through in the past and hopefully will continue to pass by in the future, as well as in the city centre of Brussels, a stone’s throw away from the European Respiratory Society’s Brussels office.

It was amazing to see how –within minutes- people on the streets as well as big hospital facilities joined forces to ensure the best care for the people injured in body and mind. It is fitting to pay tribute to all these healthcare workers who changed their Easter holiday plans to ensure the best care in days that are traditionally dedicated to family gatherings packed with chocolate (this is Belgium…) or short holiday breaks. We hope that Belgium recovers quickly and that you will all continue to travel confident that you’ll make it home safely. Only then we’ll be able to turn the page and move on, without forgetting both the events, but especially the unforgettable reaction of our crisis managers in hospitals and all those healthcare workers that gave everything in the #brusselsattacks.

All those healthcare workers are very well trained, but it is sometimes challenging to find properly trained staff in healthcare. A growing number of healthcare workers from all over Europe take part in our healthcare system and the same happens in and outside Europe. A legal framework for such mobility is created in Europe through directive 2005/36/EC. The legal framework, however, does not assure that knowledge, skills and attitudes of such health workers can blend in well with an existing healthcare system.

Here is where the European Respiratory Society does an excellent job. Programmes for harmonised medical education in the respiratory field have been build, under the HERMES program (Harmonised Education in Respiratory Medicine for European Medicine). HERMES is a suitable acronym as Hermes, son of Zeus in Greek mythology, is a god of transitions, boundaries and travelers. Over the last few years several HERMES programs have been developed that are suited for medical doctors as well as allied health professionals (see hermes.ersnet.org). Putting together international ‘standards’ for education is a challenge in itself, and this is particularly true for allied health professionals. Two initiatives under the HERMES umbrella are geared specifically towards allied health professionals.

A first initiative, which proved to be a huge success, has been the Spirometry Driver’s License. This project fills the need for standardised training in spirometry, one of the basic assessments in pulmonary medicine. Despite the existence of international guidelines in how to perform spirometry the technical and skills training of professionals actually doing the work could surely be further harmonised across the EU, and beyond. The HERMES Spirometry project has surely filled that gap by training more than 140 experts that can subsequently deliver training courses in their regions all over the world. I’ve been told that the first spirometry training course is being planned in Latin America, so HERMES flies further than Europe, that’s obvious!

A second project, currently underway is the “Respiratory physiotherapy” project. I have the privilege to share this working group together with Prof Fabio Pitta. In this project we have surely been faced with the difficulties of setting up a ‘harmonised’ post-graduate formation. Three main hurdles need to be taken. First, there is a very large variety in basic professional training for physiotherapists in Europe. According to a survey conducted by the working group this varies from less than 3 years of professional training up to more than 4 years of academic (MSc) training. Needless to say that the starting point in terms of knowledge, but also the type of education, varies enormously across European countries and the world. This is surely a challenge when designing post-graduate formation.

At the same time it underpins the need for such an education to allow mobility. A second hurdle is the need for proof of postgraduate formation in order to be professionally active. In most countries, physiotherapy is a ‘general’ degree and no further requirements are needed in order to be legally allowed to work with respiratory patients. Once somebody is registered as a physiotherapist in a country, that person is typically allowed to work with any kind of patients, provided that he or she is not conducting ‘illegal medical acts’. This leads to a last hurdle and that is the fact that the ‘tasks’ attributed to physiotherapists are very different across European countries. Other allied health professionals (nurses, technicians) may face very similar challenges. A last hurdle for the respiratory physiotherapy project is the wide variety of patients that are seen by respiratory physiotherapists. Patients can be receiving care by a respiratory physiotherapist from the neonatal respiratory intensive care unit all the way to the geriatric palliative care unit. Respiratory physiotherapists are involved in the care provided to acute patients and those with chronic stable disease. This would make a harmonised education very broad and almost impossible, in particular, when practical skills also need to be taught.

Nevertheless the task force has managed to find a way to ‘make it happen’. Two tracks are constructed and several modules are proposed (some of which are optional). We hope that this will help in the future to make mobility possible or also to further improve the physiotherapy care provided to specific populations (acute or stable and children or adults). It is important to note that, despite the broad spectrum of professional/academic formation it was relatively easy to come to consensus with a large group of participants on the content of a syllabus for respiratory physical therapy. Once the curriculum is finalised (and we are close to that) this can perhaps serve as a blueprint to local policymakers to outline the tasks for respiratory physiotherapists and to implement local and perhaps European postgraduate formation.

I’m sure that the European Respiratory Society will continue to support the capacity building of allied health professionals well-trained in knowledge skills and attitudes to take care of our patients. In the meantime it has been a joy to work with the dedicated team of ERS-HERMES staff: Sharon Mitchell and Alexandra Niculescu, but also with a number of experts from all over the world that dedicated much of their time to help developing the syllabus and the curriculum under the wings of ERS. It has to be said, much of the advances in the field of education, harmonisation and dissemination are done by clinicians and researchers who dedicate their scarce free time to these developments. A BIG thank you to all those that have contributed in the working groups of the HERMES programs. I’m convinced (and many with me) that these harmonised programmes are paving the way into a more harmonised 21th century where healthcare workers will end up being more mobile. That is, off course, if reckless radicalism does not preclude us from taking the plane, boat or train without being worried, and this brings me back to where this blog started.


  • Mitchell S, Fabio P, and Thierry T. 2013. “Standardised Education and Training for Respiratory Physiotherapists.” Breathe 9 (3): 171–74. doi:10.1183/20734735.001013.
  • Pitta F, Mitchell S, Chatwin M, Clini E, Emtner M, Gosselink R, Grant K, et al. 2014. “A Core Syllabus for Post-Graduate Training in Respiratory Physiotherapy.” Breathe 10 (3): 220–28. doi:10.1183/20734735.007614.
  • Development of a syllabus for postgraduate respiratory physiotherapy education: the Respiratory Physiotherapy HERMES project. Troosters T, Pitta F, Oberwaldner B, Lewko A, Inal-Ince D, Grant K, Gosselink R, Burtin C, Emtner M, Clini E, Chatwin M, Mitchell S. Eur Respir J. 2015 May;45(5):1221-3. doi: 10.1183/09031936.00037215.

You may also be interested in:

Spirometry HERMES project:

The aim of the Spirometry HERMES project is to train health professionals to produce high quality spirometry tests and be awarded the ERS Spirometry Driving Licence. The course is designed for healthcare professionals who perform spirometry including nurses, physiotherapists, clinical researchers, general practitioners, doctors, technicians and scientists as well as any other individuals using spirometry in their practice. For more information about the Spirometry Training Programme and to find courses in your country, visit the HERMES website.

The Spirometry HERMES Project Group:

The Spirometry HERMES Project Group

Physiotherapy HERMES project:

The aim of the Physiotherapy HERMES project is to develop post-graduate respiratory physiotherapy programme with a specific training period defined by task force members. The project will closely follow the development strategy for educational standards defined through HERMES. The course is designed for those who have completed postgraduate training in respiratory physiotherapy as well as allied health professionals working in this field. For more information about this project, please visit the HERMES website https://hermes.ersnet.org/projects/respiratory-physiotherapy.html.

The HERMES Respiratory Physiotherapy Task Force group in Leuven working towards the completion of a Physiotherapy Curriculum (March 2016):