We are a clinical unit that aims to offer high-quality, cross-cutting care and teaching, as well as developing research excellence in the area of musculoskeletal and connective tissue diseases. We have extensive experience in training specialists in rheumatology. We guarantee rigorous, high-quality training in all the professional care, research and teaching skills in our area.

The training programme includes residents in the Rheumatology research group’s lines of research, so that they receive general training in research methodology, conventional and new areas of research, such as precision medicine, as well as evidence-based precision medicine, evidence-based medicine and research based on healthcare outcomes.  Furthermore, our residents have the chance to undertake training periods in internationally renowned centres in both Europe and the United States.

Experience in research allows us to offer students a high-quality doctoral programme to carry out a thesis project and become a Doctor of Medicine. We also offer the opportunity to actively collaborate on research projects assessed by national and European public research bodies, and to co-author the resulting papers.

Why do your residency at Vall d’Hebron University Hospital?

• Because we cover all specialisations in the area of Rheumatology, for adult and paediatric patients.
• Because we have a Rheumatology hospitalisation floor, where you can see and treat the most serious and complex cases. We also have a day hospital for outpatients under treatment with selective immunosuppressants administered via parenteral injections.
• Because we are a highly cohesive team, made up of doctors, nurses, psychologists, physiotherapists, biologists, bioinformaticians, engineers and mathematicians.
• Because you can learn about rheumatic pathologies at all stages of life, from early childhood to senescence and even during pregnancy, given that we have a unit dedicated to pregnancy in patients affected by chronic inflammatory and systemic autoimmune diseases. Because the Paediatric Rheumatology Unit is a leading centre in Spain for juvenile idiopathic arthritis and other systemic and musculoskeletal diseases.
• Because we offer highly specialised care to patients with chronic inflammatory arthritis, and treatments with selective immunosuppressants, specifically for patients with rheumatoid arthritis, psoriatic arthritis and spondyloarthropathies.
• Because we care for a large number of patients with systemic autoimmune diseases, especially systemic lupus erythematosus, inflammatory myopathies and cancer patients treated with immunotherapy. 
• Because you will be able to see patients with metabolic bone pathologies, collaborate with the Pneumology Department to control transplant patients with secondary osteoporosis and with the AIS Nord Fracture Coordination Unit (UCF).
• Because you can conduct activities associated with the Ultrasound rooms (diagnosis and intervention) and Capillaroscopy, as well as other highly specialised techniques, such as ultrasound-guided synovial biopsy or saliva gland, vascular and lung ultrasounds. In our department there are professionals who are professors in the Spanish Rheumatology Society’s Ultrasound School, for both adult and paediatric patients. 
• Because we are the leading department for patients with central sensitisation syndromes, more specifically for patients with fibromyalgia and chronic fatigue syndrome. In addition, we offer specialised, multi-disciplinary care to patients, so you can acquire the knowledge required for quality care provision.
• Because we work in a multi-disciplinary way with multiple services from various medical and surgical specialities (Paediatrics, Dermatology, Oncology, Pneumology, Nephrology, Internal Medicine, Rehabilitation, Ophthalmology, Obstetrics and Gynaecology, Orthopaedic Surgery and Traumatology, Anaesthesia, etc.)  and in close collaboration with the departments of Immunology, Pharmacy and Clinical Pharmacology and Radiodiagnosis, among others. The multi-disciplinary work in all of these areas provides patients with better quality care.
• Because the unit's accessible and committed teaching enables continuous close assessment of residents, maximising their skills and providing support for designing their future careers.
• Because we have extensive experience of training rheumatology and paediatric residents from other teaching units, as well as residents from abroad.
• Because we are interested in providing high-quality training and we give our residents every facility for doing training courses, as well as attending national and international congresses. We also stimulate and support the preparation of presentations and papers at leading conferences, and encourage residents to acquire oral and written communication skills.
• Because we encourage stays abroad during the residency, at centres such as the Giannina Gaslini Institute in Genoa, Italy; Inselspital Bern Hospital in Bern, Switzerland; the NHS Trust Rheumatology Department in London, UK; and the Division of Clinical Rheumatology and Immunology in Birmingham, USA. 

The ENT Teaching Unit is led by the Ear, Nose and Throat Department, with participation from the Paediatric ENT Department, Clinical Neurophysiology, Neurosurgery, Radiology, Pathological Anatomy, Microbiology, Plastic Surgery and Burns, General Surgery, Radiotherapy and Oncology, Internal Medicine and Rehabilitation Departments. We work on the prevention, diagnosis, treatment and rehabilitation of diseases of the ear and upper aerodigestive tract, as well as pathology in related organs.

We offer a training programme that includes an introduction to research methods; training that advances in parallel with the specialisation.

Residents actively and progressively participate in clinical sessions in the unit, which help them to acquire the necessary knowledge to design their own research, observational or experimental study.

Why specialise at Vall d’Hebron?

• Because thanks to the high volume of activity in our unit, we offer the chance to work with a wide range of pathologies and procedures. The unit receives an average of 16,000 first visits and 15,000 follow up visits per year. On average we also perform 270 major surgical procedures per year and around 800 minor operations, giving residents the chance to see all kinds of cases.
• Because our clinics include head and neck specialisations, in addition to paediatric ENT, otology and neurotology, facial plastic and reconstructive surgery, laryngology, endoscopic skull base surgery, allergy and immunology specialisations. All specialisations are carried out by physicians of international renown, with a high number being world leaders in their field.
• Because your training doesn’t stop here. We offer educational conferences throughout your residency through different professional development activities, scientific publications and presentations.
• Because we have the best facilities for your training. We have our own temporal milling laboratory. In addition, we have an agreement with the Anatomy Department at the Autonomous University of Barcelona to allow us to perform dissections in their facilities.
• Because we encourage residents to undertake external rotations through other hospital departments and the Radiodiagnosis Department.
• Because our VHIR Research Institute allows you to enhance your research training and will support you during your residency when preparing your doctoral thesis.

The Radiation Oncology Teaching Unit is provided by the Radiation Oncology Department, with the involvement of Haematology, Internal Medicine, Medical Oncology, Radiology, Radiophysics, A&E, and Palliative Care. In Radiation Oncology we attend to patients at the hospital and in the Vall d’Hebron healthcare area of influence, but we are also active in other parts of the country as we are a leading centre for several complex diseases.

We offer a training programme in radiation oncology that includes learning in research. This means taking part in multidisciplinary committees that analyse different pathologies and generate hypotheses for future research projects. Residents integrate into a line of research when they join the programme, assisted by a consultant. 

We are part of the Vall d’Hebron Research Institute (VHIR) and the Vall d'Hebron Institute of Oncology (VHIO). We  actively participate in different national and international research groups, such as the European Organisation for Research and Treatment of Cancer (EORTC), the International Society of Paediatric Oncology (SIOP), and the Radiation Oncology Clinical Research Group (GICOR).

Why specialise at Vall d’Hebron?

• Because the training we offer is some of the best, thanks to the exceptional environment in which it takes place. During your training, you will have the chance to carry out rotations in leading hospital departments, such as Medical Oncology, a department at the forefront of translational research and clinical trails, Internal Medicine and Radiodiagnosis.
• Because during your training you will be able to take part in highly complex treatments, such as radiosurgery, intensity-modulated radiation therapy, extracranial radiosurgery, image-guided treatments, total body irridation, and treatments combined with latest generation drugs that would be hard to find in other centres in Catalonia.
• Because the department has some of the highest admissions figures in Spain, enabling you to acquire experience in different areas of knowledge.
• Because we have the most advanced technology to be able to provide highly complex treatments. As a centre, we carry out the greatest number of intensity-modulated radiation therapy treatments for genitourinary disease, head and neck tumours and breast neoplasms in Catalonia. We have regularly incorporated advanced technology, such as extracranial radiosurgery for lung cancer, and tightly-focused treatments that can be delivered much faster, such as RapidArc technology.
• Because we have pioneered the establishment of internal control commissions and the development of protocols for controlled image-guided treatments; proof of our vocation to care quality and safety.
• Because we are a young and dynamic group and a member of several national and international scientific associations, whilst also actively participating in research and teaching activities.
• Because, in parallel, you can acquire basic oncological knowledge from the Radiation Oncology International Master's programme, a distance learning course accredited by Francisco de Vitòria University.
• Because in the final year of your residency you have the option to choose an external rotation in a hospital abroad to deepen your knowledge. This is a chance to learn how a large European or North American oncology centre works in a specific oncological context.
• Extensive technological endowment, with 4 linear accelerators that provide state-of-the-art treatments to a large number of patients, with routine performance of complex stereotactic techniques such as SBRT and SRS (radiosurgery), in addition to new procedures such as radioablation of cardiac arrhythmias and TBI (total irradiation) with modulated intensity technique.
• Because we value teamwork and having a good working environment, fostering a good relationship between all members of the service to enhance both the professional and human development of the resident.
• Attendance at accredited national and international training courses in the field of radiotherapy (radiobiology, imaging, pediatric oncology…) is encouraged and facilitated throughout all years of residency, as well as conferences and other training activities.

The core of this teaching unit is provided by the Medical Oncology Department, with participation from Haematology, Internal Medicine, Radiation Oncology, Radiology, Pathological Anatomy, Infectious Diseases and Palliative Care, the Intensive Care Unit and the A&E Department. The Unit can accommodate three residents per year. Residents’ training in Medical Oncology takes five years in total. The two first years are spent on core training, with the following three years dedicated specifically to specialisation.

Residents in medical oncology are expected to have in-depth knowledge of preventative, diagnostic and therapeutic choices for cancer. For this reason it is important that they continuously update their knowledge of cancer biology. To this end, they must take part in research projects that promote excellence in research. They will also have the opportunity to become familiar with the main lines of research in the Department and to take part in some of them. Over the course of training, residents learn to have a critical and open approach to the high volume of clinical studies and advances in the specialisation, whilst always keeping ethical considerations at the forefront of their work.

Why do your residency at Vall d’Hebron?

• Because you will be working in a friendly and professional environment where you will learn to manage relationships with patients, families and colleagues, and to apply the ethical principles that govern clinical practice, teaching and research.
• Because team work and education is encouraged in our unit.
• Because we encourage residents to improve their English as it is the official language of the medical sciences.
• Because we encourage you to take part in each of the rotation areas, in all of the specialists’ day to day activities; aspects relating to patient care and those related to training, research and clinical management.
• Because you will train in the right surroundings and throughout your training will be supported and supervised by senior residents and consultants.
• Because we promote active participation in national and international congresses of the specialisation and the presentation of papers and posters. 

Why specialise at Vall d’Hebron?

• Because we care for a high volume of patients, which enables residents to gain knowledge and experience.
• Because we are a tertiary hospital with leading departments in the different areas that make up residents’ essential training.
• Because you will have the opportunity to see complex pathologies and to use ground-breaking diagnostic methods and treatments.
• Because our training programme provides different options to adapt to the personal initiative and vocation of each resident; from the most patient-facing roles to those more focused on research in collaboration with different laboratories from the Vall d’Hebron Research Institute; one of the most important in the country.
• Because we have a demanding programme with all the necessary resources for professional advancement in academic neurosurgery and all its components.
• Because our objective is to stimulate the personal growth of future neurosurgeons who wish to work in centres where research and education are not optional extras, but form an integral part of the department.

The cornerstone of Thoracic Surgery is the Thoracic Surgery Department, with participation from General Surgery, Radiology, Respiratory Medicine, Cardiac Surgery, Vascular Surgery and Intensive Care Medicine.

Resident doctors can carry out pioneering techniques such as video-assisted thoracoscopic surgery for pulmonary, pleural, and mediastinal pathologies; and other procedures such as thoracic sympathectomy treatment for hyperhidrosis palmaris and thoracic wall and diaphragm surgery. Surgery to treat pleural disorders and lung transplants in adults and children is also carried out. Residents also take part in oncology treatment through tracheal reconstruction and lung cancer surgery.

In addition, resident doctors must familiarise themselves with diagnostic imaging; be it in pneumology, radiology, ultrasound, or direct or video-assisted endoscopy.

During their rotation in the Intensive Care Unit, specialists have the chance to apply their knowledge of pulmonary function and physiopathology of chronic and acute respiratory failure for the proper management of patients with critical respiratory disorders.

The Thoracic Surgery Department has carried out multiple experimental surgery studies as part of the General Surgery research group (trachea transplant, new therapies using aerostatic products, ex vivo lung perfusion, etc.) and is currently researching lung transplants using animal models.

We encourage residents to take part in sessions, seminars, committees and the different courses and conferences to complement their training in organ transplant and donation, advances in respiratory medicine and pleural disorders. They are also urged to take part in scientific events held by the Catalan Thoracic Surgery Society, to keep up to date with scientific methodology and research. 

Why specialise at Vall d’Hebron? 

• Because we are a leading centre for  lung cancertreatment, due to the fact that we treat this disease using a multidisciplinary approach.
• Because in 1990 we were the first centre in Spain to perform a successful lung transplant, and we are currently a national leader in transplants in adults and children , and the only centre carrying out lung transplants in infants.
• Because we carry out  the highest number of lung transplants of any hospital in Spain.
• Because our programme started in 1973, meaning we have extensive experience in training specialists.
• Because training the specialists of the future is a large part of the work our team does, fostering residents’ surgical education, but also training them in complete preoperative and postoperative patient care, conducting rounds, and the multidisciplinary committees and  many training sessions  held.
• Because residents are part of the lung transplant team during their entire residency. As well as performing donor extractions and implantation into recipients, they also carry out preoperative assessments and manage transplant patients' postoperative care.
• Because we encourage specialists in training to take up a temporary stay in an internationally renowned centre elsewhere, to become familiar with the most innovative techniques in the specialisation and to develop their doctoral thesis and obtain their Doctor of Medicine.
• Because when you complete your training, you will be equipped to work independently as a healthcare practitioner.

Healthcare activity in neurology combines writing medical histories, diagnostic data collection, correct use of complementary exploratory procedures, and accurate clinical and aetiologic diagnosis, as well as choosing appropriate palliative treatments. We also emphasise the role of the relationship between resident doctors and patients in the basic areas of Neurology.

A large number of medical conditions and neurological illnesses can result in critical emergency situations, such as strokes and lupus. With this in mind, from the second year the duty shifts in neurological emergencies become a key aspect of residents’ work, and are always carried out under supervision. Neurologists are also required to carry out a rotation in neurological outpatient care.

Research studies are part of the practical work that neurologists must deepen and develop, with particular emphasis on ethical competence when carrying out research.

Neuroscience research should be done under supervision of a tutor, and requires solid training in scientific methodology as well as in bioethics and scientific communication.

Summary of Rotations for Residents

During the first year, the training pathway focuses on clinical training through rotations in different departments, including the Emergency Department, Psychiatry, Internal Medicine, and related areas. In addition, during the first year residents may already begin their training in Neurology through a rotation in the outpatient Neurology Unit and inpatient care at a tertiary-level center with complex and diverse pathology.

During the second year, the program provides a deeper exposure to inpatient Neurology. Residents rotate through the Stroke Unit and the Neurology inpatient ward, where conditions such as neuroimmunological and neurodegenerative diseases, epilepsy, and headaches, among others, are managed. In addition, residents complete specific rotations in Neurosurgery and Neuroradiology.

During the third and fourth years, residents follow a specialized training pathway that includes rotations and collaboration with the different subspecialty units within our department: the Epilepsy Unit, Clinical Neuroimmunology Unit, Memory Disorders Unit, Movement Disorders Unit, Neuromuscular Diseases Unit, Headache Unit, Clinical Neurophysiology, and Pediatric Neurology. During each subspecialty rotation, residents are offered the opportunity to participate in research projects that facilitate and encourage attendance at both national and international conferences.

In the final months of specialized training, residents complete a final rotation in the Neurology inpatient ward, which allows them to further develop and consolidate their knowledge and to work with a certain degree of autonomy. In addition, a two-month external rotation at an international center with a high level of scientific activity is encouraged. Recent destinations have included the John Walton Muscular Dystrophy Research Centre (Newcastle, UK), Cooper Neurological Institute (Philadelphia, USA), and the French National Reference Center for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (Lyon, France).

There are also other departments or institutions where residents may undertake optional rotations if they wish, including Pathology, Immunology, research areas of the Vall d’Hebron Research Institute (VHIR), and the Intensive Care Unit.

Regarding on-call duties, during the first year residents undertake general medical emergency shifts (approximately four per month), and from the second year onward they undertake Neurology on-call shifts (approximately three per month) with continuous on-site supervision by an attending physician. During on-call activity, the hospital is a referral center for the evaluation and management of stroke, status epilepticus, and suspected acute myelopathy.

Thus, completing residency training in the Department of Neurology at Vall d’Hebron University Hospital guarantees comprehensive and well-rounded training in Neurology. The program is full of stimulating challenges and opportunities, offering excellent resources in a pleasant environment and alongside outstanding professionals.

Why should I specialise at Vall d’Hebron?

• Because our expertise and high number of patients underscore the fact that we are a leading hospital for the treatment of neurological disorders.
• Because we offer the chance to take part in applied research.
• Because residents have the chance to work under supervision when treating complex neurological conditions, both on the wards and in critical cases in the Accident and Emergency Department.
• Because residents are encouraged to attend conferences and training sessions to develop new approaches.

The intensive care medicine resident doctors undertake training in various areas: emergencies, medical specialities, surgery and, mainly, high-acuity areas, such as the General Intensive Care Unit and the Traumatology and Burns.

Its caring activities are characterised by a constant presence in high-acuity areas, as well as hospital duty shifts throughout the residency. Residents are therefore familiarised with intensive care medicine and acquire the ability to address the problems of critical patients and carry out necessary therapies from the first day of their residencies. They learn the basics of haemodynamics, mechanical ventilation, extracorporeal treatment, the pharmacological management of vasoactive drugs and antibiotics, among other things. Furthermore, they are an essential part of the cardiorespiratory arrest emergency and care team.

The acquisition of the speciality's specific skills is complemented by training in cross-cutting abilities, such as communication, teamwork and leadership, which allows residents to progressively acquire autonomy, always under the supervision of the appropriate specialists.

We are a teaching unit with various research groups, including the Respiratory Pathology, Sepsis, Haemodynamics, Infections, Neurocritical Patients, Renal Medicine, Polytrauma and Burns Group. In the Vall d'Hebron Research Institute (VHIR), we are represented by the SODIR (Shock, Organic Dysfunction and Resuscitation) Group, which is very active in a wide range of projects and clinical trials. Furthermore, we are part of the UNINN (Neurotraumatology and Neurosurgery Research Unit) and with the Plastic Surgery and Burns group, which are worldwide pioneers in achieving the first full-face transplant and the treatment of burns with enzymatic debridement.

The Department promotes and facilitates the presentation of communications in congresses concerning the speciality and the drafting of articles for the sector's most influential journals, activities which lay the foundations for developing the doctoral theses of their members.

Why practise this speciality at Vall d'Hebron?

• We are one of the Intensive Care Medicine Teaching Units that have a Smart ICU and three monographic ICUs (Post-operative Cardiac Surgery, Polytrauma and Burns) and two semicritical units.
• We are a leading centre for lung transplants, ECMO, spinal cord injuries, burns, oncohematology and serious obstetric pathology. We also have extensive experience with neurocritical patients, with the most advanced neuromonitoring systems.
• From the first day, our residents are always included in all the unit's activities, as it is the first rotation in their training itinerary.
• We develop specific courses for residents, where we include simulation as an essential methodology for their training (technical abilities, diagnostic algorithms and teamwork).
• We are part of the SODIR (Shock, Organic Dysfunction and Resuscitation) research group in the VHIR, which facilitates work with renowned researchers at national and international levels.

Geriatrics residents must:

• Know the most prevalent diseases in elderly people, their symptoms, the diagnostic processes and the interdisciplinary pharmacological and non-pharmacological therapeutic approaches.
• Know and be able to identify geriatric syndromes: delirium, falls, immobility, malnutrition or pressure ulcers. -ç
• Know and be able to identify frail patients in routine clinical practice.
• Know and be able to use geriatric assessment tools. These are tools specific to the field of geriatrics.
• Be aware of the proper use of drugs, taking into account the pharmacokinetic and pharmacodynamic changes that occur in elderly patients, the proper prescription of drugs, possible adverse events, polypharmacy and drug interactions.

Residents are thus trained to offer a high quality service whereby a strong focus on the patient, with the help of the interdisciplinary team (medicine, nursing, social work, physiotherapy, psychology, etc.) and coordination with other primary care specialists, the intermediate care hospital and acute care hospital are vital.

This 4-year specialisation programme is split into two training periods:

• Basic training period over the first two years of the residency, including general rotations in the Internal Medicine, Neurology, Cardiology, Psychiatry, Radiology and A&E departments in addition to various elective rotations.
• Specific geriatrics training period over the next two years, in which the geriatrics resident will rotate between intermediate and acute care facilities.
  • Intermediate care (third year): Parc Sanitari Pere Virgili Intermediate Care Hospital. Rotations in sub-acute, palliative, convalescent and long-stay hospitalisations. Specific outpatient appointments and home care services. Casernes-Vall d’Hebron Complex Care Support Team. Consultations and day hospital.
  • Acute care (fourth year). Functional Geriatrics Unit (consultation team). Acute Fragile Patient Hospitalisation Unit (acute medical hospitalisation). Orthogeriatrics Unit (acute traumatic hospitalisation). Cardiogeriatrics (external consultations). Oncogeriatrics (external consultations).

Both the basic and specialised formative periods offer ample opportunities for elective rotations, including an external rotation during the final year.

The Geriatrics Teaching Unit encourages research, and offers the opportunity to do a doctoral thesis at the Autonomous University of Barcelona (UAB). Attendance at national and international geriatrics congresses, as well as that of the Catalan Geriatrics and Gerontology Society (SCGiG), is always encouraged.

Why practise this speciality at Vall d'Hebron?

• Because our residents receive training in a tertiary hospital that is considered world-leading in many areas.
• Because the volume of patients at our hospital offers great potential for teaching and gaining experience.
• Because the hospital covers most medical specialities, and you'll have the chance to study complex pathologies and apply cutting-edge diagnostic and treatment methods.
• Because you’ll have the opportunity to do rotations in other centres that specialise in geriatrics, palliative care and psychogeriatrics.
• Because in this unit we place an emphasis on the functional recovery of patients, allowing them to carry out their day-to-day activities with confidence.
• Because we understand the importance of the doctor-patient relationship and other recurring aspects in the field of geriatrics, such as the appropriate treatment of patients suffering from chronic pathologies.

The Cardiac Surgery Teaching Unit  works with teams from General Surgery, Thoracic Surgery, Vascular Surgery and Anaesthesia and Resuscitation. There are three accredited places available. Residents in this specialisation assist in the operating room and with preoperative assessments, where they provide surgical indications according to their level of training. In addition, they work in intensive care, postoperative care, and carry out patient monitoring on the hospital wards.

Cardiac surgery residents are incorporated into the team gradually according to the relevant stage of their training. Their work is based in state-of-the-art operating theatres, Intensive Care, hospital wards and rooms, and outpatient appointments. During this time, they become familiar with the different surgical and preparatory techniques for cardiac surgery, as well as preoperative and postoperative monitoring.

Rotations through different Departments is essential. Residents therefore spend time in Cardiology and Pacemakers, giving them the chance to learn about cardiac disorders and surgical indications. The rotation in Thoracic and Vascular Surgery, and active participation in lung transplants, enables them to broaden their knowledge of the most advanced surgical techniques in the specialisations.

The final year is spent on duty shifts and in Adult Cardiac Surgery, with three months in Paediatric Cardiology.

We are an active research group applying scientific methodology that allows residents to get closer to basic research or experimental surgery projects in the unit. We also offer the chance to obtain grants.

In terms of research, we undertake to help residents present a research project and to write their doctoral thesis.

Why specialise at Vall d’Hebron? 

• Because right from the start we encourage residents to get involved in writing scientific papers and publications for national and international congresses.
• Because we are committed to quality through the analysis of surgical outcomes, and we keep up to date with the specific features of the specialisation.
• Because we hold a weekly professional development, literature review and research training session, a session on surgery, a session on mortality, a medical-surgical session, and a session on medical-surgical advances given by a guest physician of national or international prestige in the field.
• Because we strive for quality through a system of monitored training objectives, which includes meetings between tutors, residents, consultants, heads of department and section, and the Training Department.
• Because we create value for residents and assess their internal and external rotations with contributions from the attending physicians, tutors, heads of section, heads of department and the Training Department.
• Because we support attendance at the annual Cardiac surgery course for residents, and we organise weekly clinical sessions and various courses on key areas such as basic resuscitation, the latest cardiac surgery advances, and treatment for arrhythmia and pacemakers.
• Because we work to attract financing for the European Cardiac Surgery course in Bergamo (Italy), which accredits surgeons to perform cardiac surgery throughout the European Union.