The history of the (Young) AEMI(E) and the EFIM

1. Introduction 

In 1969, some members of the UEMS (Union Européenne de Médicins Specialistes) committee of internal medicine (IM) decided that, in addition to discussing and carrying out European rules and regulations, it was important to stimulate IM in Europe and, in particular, to discuss ethical, scientific, and professional issues [1]. As a result, the Association Européenne de Médicine Interne (d' Ensemble) was formed (Table 1). The AEMI(E) was composed of individual members practicing IM in Europe. Its statutes were drawn up under Belgian law and the official headquarters was located in Brussels.

Table 1. Founding members of the Association Européenne de Médicine Interne d' Ensemble (AEMIE)

	J. Stahl (Strasbourg, President)
	V. Horth (Bamberg)
	J. Dagnelie (Brussels)
	Lord J. Richardson (London)
	H. Ludwig (Basel)
	M. Sangiorgi (Rome)
	N. Swartz (Stockholm)
	R. Schaus (Luxembourg)
	L. Stuyt (The Hague)

2. AEMI(E) 

The most important activity of the AEMI(E) was the organization of conferences every 2 years. These were generally of good quality, but they attracted fewer and fewer participants (Table 2). One of the reasons for this was the fact that the official language of the AEMI(E) was French; another was that each prospective member of the Association had to be discussed at length and voted upon before he/she could be accepted. As a result, the AEMI(E) was not widely known. Because the age of the limited number of AEMI(E) members continued to increase, there was a need to initiate a “young” AEMI(E).

Table 2. Overview of AEMI(E) congresses

	1971	London (J. Stahl, President)
	1973	Bonn (Lord J. Richardson)
	1975	The Hague (E.F. Pfeiffer)
	1977	Strasbourg (L. Stuyt)
	1979	Dublin (C. Laroche)
	1981	Florence (D. Mitchell)
	1983	Vienna (M. Sangiorgi)
	1985	Lausanne (L. Stuyt)
	1987	Bologna (P. Magnenat)
	1989	Brussels (E.Coche)
	1991	Lisbon (U.E.F. Carcassi)
	1994	Alicante (J. Merino)
	1995	Athens (S.A. Raptis)

Most AEMI(E) Board members were UEMS delegates at the same time. A list of AEMI(E) Presidents, Secretaries, and Treasurers is presented in Table 3.

Table 3. AEMI(E) presidents, secretaries, and treasurers

	Presidents	1969–1973	J. Stahl (Strasbourg)
		1973–1977	M. Dorner (Strasbourg)
		1977–1981	M. Sangiorgi (Rome)
		1981–1985	P. Magnenat (Lausanne)
		1985–1989	E. Coche (Brussels)
		1989–1994	U.E.F. Carcassi (Rome/Cagliari)
		1994–1996	Y. Le Tallec (Toulouse)
	Secretaries: (up to 1989 also Treasurer)
		1969–1977	J. Dagnelie (Brussels)
		1977–1985	J.M. Brogard (Strasbourg)
		1985–1989	J.F. Blickle (Strasbourg)
		1989–1993	C. Davidson (Brighton)
		1993–1996	J. Merino (Alicante)
	Treasurers:	1989–1994	J.F. Blickle (Strasbourg)
		1994–1995	J.W.F. Elte (Rotterdam)
		1995–1996	M. Lambert (Brussels)

3. Young AEMI(E) 

In 1978, “Young” AEMI(E) was founded with Overbosch (Leiden) as its first chairman. The aims of Young AEMI(E) were similar to those of AEMI(E), with two important additions: (1) a transition to English as the official language of the association and (2) easy accessibility for all (young) internists in Europe without formal voting [2], [3]. Young AEMI(E) organized three “Eurotherapeutics” conferences (Marbella 1982, Eastbourne 1986, and Amsterdam 1988); the proceedings were published in the Postgraduate Medical Journal with the help of its editor, Hoffbrand (London).

In 1983, Elte (Leiden) took over the chairmanship, and after 1985 Young AEMI(E) had its own session during the AEMI(E) congresses. As a further development, in 1986, European Medical Research Group (EMRG) meetings were organized, initially in London and later also in the Netherlands. These were supported by the Fellowship of Postgraduate Medicine (London). For these meetings an expert was usually invited to talk about a clinically important subject and there were sometimes some short oral presentations and posters [4], [5], [6]. Although the meetings were of a high standard and the attendees very enthusiastic, it appeared that, at least in the Netherlands, the number of participants was too low to make future meetings feasible. Moreover, the AEMI(E) had started to change.

4. AEMI(E) (continued) 

In 1989, AEMIE was at a low point. Attendance had been decreasing and the congress in Brussels attracted only 50 regular participants. Carcassi (Cagliari, Italy) was elected President and began to initiate changes that were to bring about a recovery. The first problem was the name; this was changed to AEMI as it had never been clear what “d'ensemble” meant exactly in the context of IM. It was also obvious that the AEMI needed to enlarge its membership. The English language was introduced alongside French and new members were elected to the AEMI executive committee. Membership rules were relaxed and Young AEMI(E) merged with the AEMI (partly at the latter's request) during the congress that took place in Lisbon in 1991. This congress was organized in close collaboration with Barros Veloso, the President of the Portugese Society of IM, and attracted more than 1000 participants. The chairman of Young AEMI(E) became second Vice President and later Treasurer of the AEMI.

In Lisbon, as a further initiative of Carcassi, the Forum of Presidents was founded in order to ensure involvement of national societies through their presidents. It was at this meeting that there was strong support for a federation of national societies of IM to share the common problems faced by each in their own country. These included the rise of medical sub-specialties, including geriatrics, and the changing health care structures that all tended to reduce the influence of IM.

In 1989, the European Journal of Internal Medicine (EJIM) was founded with Carcassi as Editor-in-Chief. He worked with three deputy editors (Blickle, Elte, and Singer), all of whom had been involved with Young AEMI(E). This journal gave the Association a “voice” and attracted articles from all over Europe as well as other parts of the world. The language was English with the abstracts also being translated into French.

In 1994 and 1995, there were two well-attended AEMI congresses held in Alicante (Merino) and Athens (Raptis), again organized in close collaboration with strong national societies of IM. In-between these congresses there were intense discussions about the change to a federation, led principally by Carcassi (President) and Merino (Secretary). The statutes of the AEMI had to be changed under Belgian law to facilitate the transition of the AEMI to the EFIM, which eventually took place in May 1996 in Paris (Fig. 1). Le Tallec (Toulouse) was the last AEMI and the first EFIM President. Merino (Alicante), already Secretary of the AEMI, became the first Secretary General and Muller (Blaricum, NL) the first Treasurer of the EFIM. Davidson (Brighton), a former AEMI Secretary, became Secretary-adjoint and later Secretary General (Table 4).

View Large Image Download to PowerPoint

Fig. 1. EFIM council during the founding meeting in Paris, 1996.

Table 4. European Federation of Internal Medicine (EFIM) presidents, secretaries, and treasurers

	Presidents:	1996–1998	Y. Le Tallec (Toulouse)
		1998–2001	P. Jaeger (Bern)
		2001–2003	J. Merino (Alicante)
		2003–2006	D. Sereni (Paris)
		2006–present	S. Lindgren (Malmö)
	Secretaries:	1996–1998	J. Merino (Alicante)
		1998–2005	C. Davidson (Brighton)
		2005–present	J.W.F. Elte (Rotterdam)
	Treasurers:	1996–2003	H.P. Muller (Blaricum)
		2003–2005	J.W.F. Elte (Rotterdam)
		2005–2006	W. Bauer (Zürich)
		2006–present	F. Ferreira (Lisbon)

5. EFIM 

Since 1996, EFIM has grown steadily and now comprises a Federation of 33 national societies of IM. It includes representation from all of the countries of the enlarged European Union and Scandinavia, with only a few Eastern European countries missing. Even from outside Europe there is interest: Israel and Turkey are full members. Tunisia, Algeria, Morocco (and possibly, in the near future, Egypt) are Associate Members. In all, this represents a body of over 30,000 internists.

The Federation comprises an Administrative Council that meets twice a year. Each country has two delegates, one of whom is often the current President of the national society. The Administrative Council elects a smaller Executive Committee from among its members. This is responsible for the day-to-day running of the Federation and is supported by a small secretariat.

There are close links with other international bodies representing IM. Collaboration with the American College of Physicians (ACP) and the American Board of Internal Medicine (ABIM) resulted in the publication of the widely recognized “Physicians Carter” as part of the joint Professionalism Project. Discussions with the Royal College of Physicians (RCP) in London, together with the UEMS, led to the development of the new European Diploma in IM, launched in late 2006. There are also ties with the Australian and New Zealand IM Society (IMSANZ) and with the International Society of Internal Medicine (ISIM).

The present EFIM is very active. What follows is a brief description of some of the activities.

6. Congresses 

For EFIM, the congresses organized every 2 years are of great importance as they allow large groups of internists from all over Europe to meet and share their common interests, both scientific and professional. The first EFIM congress was held in 1997 in Maastricht with approximately 1000 participants. Maastricht was a well-considered choice: a well-known name in European affairs and an attractive city with a reasonably central location.

Hillen (who later became Editor-in-Chief of the EJIM) was President of the congress and Elte (Rotterdam) was Secretary (Table 5). This was the start of a series of successful congresses with similar numbers of participants in Florence (1999, Dammacco), Edinburgh (2001, Kennedy), Berlin (2003, Köbberling) and, recently, Paris (2005, Sereni) (Table 5).

Table 5. Overview of EFIM congresses

	1997	Maastricht	(H.F.P. Hillen, President)
	1999	Florence	(F. Dammacco)
	2001	Edinburgh	(J. Kennedy)
	2003	Berlin	(J. Köbberling)
	2005	Paris	(D. Sereni)
	2007	Lisbon	(F. Ferreira, A. Martins Baptista)
	2008	Rome	(G. Gasbarrini)
	2009	Istanbul	(S. Ünal)

For the first time, in 2004, a “European Day” was held during the national Turkish congress of IM in Antalya (Unal, Ankara); a second European Day took place in 2006 in Katowice–Krakow, Poland (Kucharz) during the centenary celebrations of that society. The EFIM congress in 2007 will take place in Lisbon (Ferreira, Martins Baptista), in 2008 in Rome (Gasbarrini), and in 2009 in Istanbul (Ünal).

7. EJIM 

After its foundation in 1989, the EJIM was led by Carcassi and published by MacMillan Press Ltd (up to 1992) and later by Luigi Pozzi (Rome). In 1999, Hillen took over as Editor-in-Chief, with De Leeuw, Farge, and Singer as Associate Editors and Carcassi as Editor-in-Chief Emeritus. Since 2003, De Leeuw has been the Editor-in-Chief (Associate Editors: Kellett, Vanderschueren, and Dimopoulos). Elsevier became the Publisher in 1999.

Although the first issue in 1989 was judged to be of good quality by the Lancet, the EJIM has been slow to develop because of a lack of sufficient financial support and the absence of an impact factor. During recent years, a significant improvement has occurred, both in the quality and the number of submitted manuscripts from Europe and elsewhere in the world. Circulation has also been helped by the fact that an EJIM subscription is included in the registration fee for congresses, the so-called “regiscription”, and also because a number of national societies have taken “bulk” subscriptions for their members. Much work has been done by the respective Editors-in-Chief, as well as by Pamela Falger who, as editorial assistant, handles all practical issues.

8. ESIM 

Another early success was the European School of Internal Medicine (ESIM). This was the brainchild of Merino, who directed the School from 1998 until 2006. It has been held each year in Alicante, in a resort complex owned by a Spanish medical syndicate. Approximately 60 young physicians in training, selected and financed by the national societies (including some from the US and Australia), took part each year with presenters/teachers who were selected and financed in the same way in order to keep sponsoring limited. The course has been very popular with residents, not only because of the clinical content, but also because the setting provides an excellent opportunity to learn more from one another about IM in Europe. Evaluation of the School has been consistently judged to be very high.

Sadly, Merino has decided to retire as Director. This means that, starting in 2006, the ESIM will be held at a different venue with a new director, but within the same framework. In 2006, the ESIM was held in Sintra, near Lisbon, with Martins Baptista as director and Davidson as co-director. The same will hold for 2007. The Federation is also creating a “young physicians network” within the EFIM, based on (ex)participants of the ESIM.

9. Working groups 

A number of working groups, sometimes in collaboration with other bodies, have been active during recent years.

10. Finally… 

The EFIM has had its share of problems, but it has now emerged more active than ever. Much has been contributed by motivated EFIM Presidents – Jaeger, Merino, and Sereni, respectively (Table 4) – who built on the many achievements of Carcassi in the AEMI. In 2006, Lindgren (Malmö) took over the Presidency in an equally enthusiastic way. Davidson (Brighton), supported by his excellent assistant, Janet Stevens, has acted for many years as a Secretary General, both for the AEMI and the EFIM. As such, he has been involved in nearly every EFIM activity to date. He was succeeded in Paris in 2005 by Elte who, after some years as Treasurer, has taken over the secretariat with the help of Irene Huis in 't Veld from the NIV (Netherlands Association of Internal Medicine).

Internal medicine in Europe is alive and well, and the EFIM is playing its part with increasing success. The EFIM and the UEMS are working together again in the European Board of Internal Medicine. Thus, the origin and the sequel are reunited. The circle is closed at last!