Harmonization of Post Graduate Training and CMECPD in Europe. A Challenge for UEMS Dr. Bernard Maill

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Harmonization of Post Graduate Training and
CME/CPD in Europe.A Challenge for UEMSDr.
Bernard MailletSecretary GeneralUEMS - EACCME
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Question to be asked

• How is the profession organized
• on national level
• on European level
• How is PGT and CME/CPD organized and who is
  responsible in the EU Member states
• What is the role of UEMS in Europe ?

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• Phases of Medical Life
• Undergraduate 5 years average
• Exam/Assessment Diploma
• University
• Specialist Training 5 years average
• Exam/Assessment Certificate
• University and Profession
• Professional Life Lifelong
• Formal Requirement to show CME/CPD activity ?
• Profession

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Aims
How can we improve and harmonise the mutual
recognition of qualifications at the level of

• Undergraduate training
• Specialist training
• Lifelong training

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Basic principles of the EU

• Free movement of - services - funds -
  products - manpower
• Free transfer of people and services applies to
  health care
• No discrimination regarding free movement on the
  basis e.g. language

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Keywords in Europe
Mobility

• Free movement of students
• Bologna process
• Free movement of doctors
• Directive on Recognition of Qualifications
• Free movement of patients

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Health and the EU

• Subsidiarity The organisation and delivery of
  health care is the responsibility of each member
  state
• Co-ordination of health matters is difficult at
  European level
• The concept of public health is not well
  defined

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Questions

• How is the profession organized
• on national level
• on European level
• How is PGT and CME/CPD organized and who is
  responsible in the EU Member states
• What is the role of UEMS in Europe ?

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How is the Medical Profession organized on
National level
Very different Orders (mandatory
membership) Professional Organization Specialty
driven National Trade Union National Scient
ific Society Specialty
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National Medical Associations
Very different organisation depending on the EU
Member State From Professional Organisation to
Trade Union General Practioners / Family
Medicine included or not National versus
regional structure
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How is the Medical Profession organized in Europe
CPME Standing Committee of European
Doctors UEMS European Union of Medical
Speciallists UEMO European Union of GP/Family
Medicine PWG Junior Doctors Organization
(trainees) AEMH Hospital Doctors
Organization FEMS Salaried Doctors
Organization EANA Self Employed Doctors
Organization CEO Organization of European
Medical Orders
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New Directorate Health and Consumer Protection
(SANCO)

• Task Public Health in the EU
  (not national !)
• Priorities
• Improving health information and knowledge
• Rapid response to health threats
• Addressing health determinants

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Key determinant in Europe Subsidiarity

• The organization of Health Care and the Provision
  of Services is a National Issue
• Europe can only give advises
• Mobility in this respect can create some tensions

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Questions

• How is the profession organized
• on national level
• on European level
• How is PGT and CME/CPD organized and who is
  responsible in the EU Member states
• What is the role of UEMS in Europe ?

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Specialist training at the national level in the
EULicensing Authority
Subsidiarity National rules and regulations
prevail Not as in educational matters where the
EU can have effects Directives can be
introduced Difficulties to implement them on
national level
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Specialist training at the national level in the
EU
The national medical authority responsible for
specialist training can be - a university -
an independent professional academic body - a
medico-political organization - representatives
of the competent authority or health ministry
of the country
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National Licensing Authority

• Ministry of Health Health Authority
• Ministry of Social Affairs
• Professional Bodies
• Medical Associations
• Universities
• Not existing

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How is the Specialist Training assessed in the
different EU Member States
Final Examination Certificate (CCST) License to
Practice License to be reimbursed Diploma of
the University Different things to compare...
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Continuum Graduate - Post-Graduate Training

• Knowledge is not perpetual
• Knowledge must be implemented in daily practice
• A good collaboration between the Academic and
  the Professional world is fundamental

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Qualification

• Based on a clear training program
• Linked to a time scale and log book
• Assesment of competence
• Following the Directive on Mutual Recognition it
  gives some rights
• Different from License to Practice

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License to Practice

• Granted by each European Union Member State to
  individual practitioners
• Based on the portfolio of each candidate
• Is open for any candidate also from outside the
  European Union
• Gives no automatic rights towards the Directive
  on Mutual Recognition

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What do we need to avoid problems and confusion

• Make a clear distinction between Qualification
  and License to Practice
• Have in each European Union Member State
  registers for both items
• Implement on National level the Training Programs
  proposed by the UEMS Sections and Boards
• Define clear rules and nomenclature

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Questions

• How is the profession organized
• on national level
• on European level
• How is PGT and CME/CPD organized and who is
  responsible in the EU Member states
• What is the role of UEMS in Europe ?

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U. E. M. S.

• Union Européenne des Médecins Spécialistes
• European Union of Medical Specialists
• Umbrella organization of National Associations
  of Medical Specialists located in Brussels

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1957 EEC Treaty of Rome
Foundation of the UEMS in 1958 by the
professional organisations of medical specialists
of Belgium France Germany Italy Luxembourg the
Netherlands
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Structure
National Medical Associations Sections and
Boards EACCME
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National Medical Associations
26 EU Full Members 3 EEA Full
Members 4 Associate Member
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National Medical Associations
Meet in the Council of UEMS Parliament of the
UEMS Can adopt or endorse documents presented by
other organs of the UEMS to be distributed on to
the National Medical Associations
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Structure
Council National Medical Associations Executive
Committee President Tresurer Liaison
Officer Secretary General 4 Vice - Presidents
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Executive 1st January 2006
President Dr. Zlatko Fras (Slovenia) Tresurer
Dr. Vincent Lamy (Belgium) Liaison Officer
Dr. Gerd Hofmann (Germany) Secretary General
Dr. Bernard Maillet (Belgium) Vice President
Dr. Giorgio Berchicci (Italy) Dr. Edwin Borman
(U.K.) Dr. Gunilla Brenning (Sweden) Dr. Zoltan
Magyari (Hungary)
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Sections and Boards
Are a fundamental and specific structure Are the
backbone of the UEMS Propose minimal training
schemes for specialisation Facilitate the
harmonisation of training About 2000 specialists
active in the work in Europe
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Sections and Boards
37 Sections Divisions 7 Multidisciplinary
Joint Committees
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Task of Sections and Boards
Organized on the base of Specialty Are made up
of two delegates from each EU member
state Propose training schemes for the
Specialty Collaborate with EACCME for the
evaluations of meetings organized in their
Specialty
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Task of Sections and Boards
Propose a Core Curriculum Draw a log book for
training Write Chapter 6 of the Training Charter
of the UEMS for each Specialty
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Task of Sections and Boards

• Essential in the Directive on Mutual Recognition
  of Qualification
• Can also have an important taks in the Visitation
  procedure of Departments
• Help in the Accreditation process

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Task of Sections and Boards

• Determine Core Curicullum for training
• Propose a log-book
• Helps in the harmonization of training and
  qualification
• Helps in the harmonization of health care
  services with visitation

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What is needed for a good (specialist) training

• Harmonization
• Clear Definition of Specialties throughout Europe
• Harmonized training program
• Log book
• Decent working conditions for the trainees
  (income and working times)

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Harmonization

• Definition from the dictionary
• to bring things into harmony, or to make things
  compatible
• to provide the harmony for a melody

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Harmonization

• How we approach this
• We have some goal
• We start from different situations
• We do want to achieve the goal
• Different pathways are possible

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E A C C M E

• UEMS policy first defined in the UEMS Charter on
  CME 1994
• A need for a system for the exchange of CME
  credits at European level for countries where
  credit points are used
• The Management Council of the UEMS decided to
  develop such a system in March 1998

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E A C C M E

• Purpose UEMS policy
• Contribute to quality and harmonization of CME in
  Europe
• To make life easier for our colleagues by easing
  access to international CME
• Developing quality guidelines
• Maintaining national authority

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Continuing Medical Education (CME)
Maintenance of Academic Knowledge and Skills
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Continuing Professional Development (CPD)

• Means of Updating, Developing and Enhancing how
  Doctors apply the Knowledge, Skills and Attitudes
  required in their working lives.
• The Competence development includes CME
  Personal, Managerial, IT, Communication and
  Social skills.

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Quality of CME

• No scientific proof of efficacy of attending
  congresses, courses, symposia by individual
  professionals.
• Abundant evidence of rapid improvement of medical
  practice through utilisation of new developments.

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Quality aspects CME

• Need orientation
• Definition learning objectives
• Description target audience
• Assessment relevance CME objects
• No accreditation promotional activities
• No accreditation useless activities

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Quality Requirements CME

• Written statement learning objectives
• Submitting full data provider
• Disclosure potential conflict interest
• Attendance, mechanism for feed-back
• Report, assessment by Provider
• Non-biased education, either commercial or
  otherwise

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Financing of CME

• CME is paid by patients
• insurance premiums
• hospital and other bills
• fees of doctors and other professionals
• taxes
• prices pharmaceutical products
• outside funding is the exception

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Mandatory CME
AustriaCroatiaFranceGermany (in hospitals
practices)Great BritainHungaryIcelandItalyThe
Netherlands (for specialists)PolandSloveniaSwi
tzerland (for specialists)
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CME/CPD recommended for doctors but voluntary
Belgium IrelandCyprus IsraelCzech
Republic LuxembourgDenmark NorwayEstonia Po
rtugalFinland SpainGreece Sweden
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Shift to mandatory CME in Europe

• Policy UEMS CME is an ethical obligation and
  should not be mandatory
• Voluntary CME is effective on macro-level
• But, on individual level participation has to be
  encouraged
• Mandatory CME is not effective in the weeding
  out of bad apples

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Effects Mandatory CME

• Recognition CME credits by a National Regulating
  body, preferably a professional body
• Quality of CME activities is being assessed by a
  scientific body
• End of freedom of CME providers to determine the
  content of their programs themselves

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What Activities are granted?

• Currently
• Individual Events
• Conferences
• Scientific Meetings
• Future
• CME Providers
• Enduring Materials CD Rom
• Internet Courses

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Draft Flowchart Accreditation in Europe
National AccreditationAuthorities
National International
Event
European Accreditation Bodies
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Draft Flowchart Accreditation in Europe
Event
National
National AccreditationAuthorities
Evaluate the value of the meeting Grant the
credits according to the National rules
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Draft Flowchart Accreditation in Europe
Event
International
European Accreditation Bodies Evaluate the
value of the meeting Propose a number of
credits National Accreditation
Authorities Accept the scientific evaluation by
the UEMS Sections and Boards Apply the number of
credits relating to the national rules
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Accreditation

• Two major partners in the process
• European Accreditation Boards
• National Accreditation Authorities

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Scientific approval

• Done by Accreditation Boards of the
• involved specialty
• UEMS Sections and/or Boards
• European Accreditation Boards

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National Accreditation Authority

• Ministry of Health Health Authority
• Ministry of Social Affairs
• Professional Bodies
• Medical Associations
• Universities
• Not existing

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Organiser Request gt 3 months UEMS -
EACCME N.A.A. Sections Evaluation lt 3
weeks Evaluation UEMS - EACCME Certificate
of Recognition Organiser
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Summary

• Harmonisation
• Simplification
• Same criteria
• Two major partners
• National Accreditation Authority
• European Accreditation Boards

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Draft Flowchart Accreditation in Europe
Credits
UEMS suggestion
Full credits (E CME C) No weighted factors 1
ECMEC per hour of activity 3 ECMEC for a half
day / 6 ECMEC for a full day activity Translation
of these E CME Cs to National credits can
follow the rules of the National Accreditation
Authority For instance can have a
maximum weighting factors can be introduced
nationally
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Agreement with the American Medical Association
on Mutual Recognition of Credits

• Till June 30th 2006
• Pilot project for 2 years each time
• From July 1st 2006
• Real agreement for 4 years

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Accreditation Requests
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U.E.M.S.

• Union Européenne des Médecins Spécialistes
• European Union of Medical Specialists
• www.uems.net