The Harmonization of CME-CPD in Europe A Challenge

The Harmonization of CME-CPD in Europe A Challenge for the UEMS Dr. Bernard Maillet Former Secretary General UEMS

Disclosure • Former Secretary-General UEMS • Pathologist in a Private Lab near by Brussels • Member of EUCOMED’s Compliance Panel • Board Member of Mdeon • Member of the Rome Group

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

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

National Accreditation Authorities • Have different credit systems • Have different approaches on the procedure • UEMS tries to harmonize the process • Is the main player • We have to look at who is giving the license to practise

Mutual Recognition • • Based on trust Similar criteria Different Health Care Systems Must be only a part of the entire « portfolio » of the Doctors • Borders are vanishing

Draft Flowchart Accreditation in Europe National Accreditation Authorities National Event International European Accreditation Bodies

Draft Flowchart Accreditation in Europe Event National Accreditation Authorities Evaluate the value of the meeting Grant the credits according to the National rules

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

Organiser Request > 3 months UEMS - EACCME N. A. A. Sections Evaluation < 3 weeks Evaluation UEMS - EACCME Certificate of Recognition Organiser

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

Formal Agreements with Sections or European Speciality Accreditation Boards Current : • • • Anaesthesiology Child and Adolescent Psychiatry Dermatology Ear, Nose and Throat (ORL) Endocrinology Gastro-Enterology Geriatric Medicine Internal Medicine Medical Biopathology

Formal Agreements with Sections or European Speciality Accreditation Boards Current : • • • Nephrology Neurosurgery Nuclear Medicine Occupational Medicine Ophtalmology Oral and Maxillofacial Surgery - Stomatology Orthopaedics Paediatric Surgery

Formal Agreements with Sections or European Speciality Accreditation Boards Current : • • • Pathology Physical and Rehabiitation Medicine Plastic Surgery Psychiatry Radiology Rheumatology • • • Emergency Medicine Intensive Care Medicine Sport Medicine • Oncology (ACOE)

Formal Agreements with Sections or European Speciality Accreditation Boards Signed recently : • • Cardiology (EBAC) Infectious Diseases (EBAID) Pneumology (EBAP) Genetics (MJC) Vascular Surgery Urology Gastro Enterology Pending in the future : • Allergology 25 -11 -2007 13 -1 -2009 17 -2 -2009 22 -11 -2008 10 -4 -2010

Formal Agreements with National Accreditation Authorities Current : Spain, Cyprus, Greece, RCSI, Malta, RCPI, Turkey, Slovakia, Norway, Luxemburg, Belgium, Romania, Slovenia, Sweden, Regione Lombardia, Finland, Austria, Czech Republic, United Kingdom (Federation of Royal Colleges) Near Future : France, Regione Veneto, Regione Frluli… Future : Germany, Poland, Portugal, Italy…

Core for International recognition Substantial equivalency Systems are different Criteria must be similar Only valid for “international attendance” Is not replacing the local system in place Recognizes the validity of the differrent systems Borders are vanishing

Agreement with the American Medical Association on Mutual Recognition of Credits Till June 30 th 2006 : • Pilot project for 2 years each time From July 1 st 2006 : • Real agreement for 4 years From July 1 st 2010 : • Agreement including also e-learning

International Agreements United States • Formal agreement • Live events as well as e-learning Canada • Pilot agreement for one year • Only live events

Territoriality issues in International Agreements • Credits granted to events taking place in the United States or Canada and approved by an ACCME or RCPSC accredited provider are recognized in Europe • Credits granted to events taking place in Europe approved by EACCME can be recognized in the US as AMA PRA Category I®credits and in Canada as Maintenance of Certification (MOC) Section 1 – Accredited Group Learning credits

International Agreements on Mutual Recognition of Credits Other systems : Japan Australasia South Africa South America Middle East Dubai Egypt Russian Federation ?

What means “Mandatory” • Only theoretical measures • “Last call” • Real effect on the license to practise or on the payment of the practitioner “Mandatory” is not always what we think it means…

Mandatory CME Austria Croatia France Germany (in hospitals & practices) Great Britain Hungary Iceland Italy The Netherlands (for specialists) Poland Slovenia Switzerland (for specialists)

CME/CPD recommended for doctors but voluntary Belgium Cyprus Czech Republic Denmark Estonia Finland Greece Ireland Israel Luxembourg Norway Portugal Spain Sweden

Mandatory CME Legal : Austria, France, Italy, Netherlands, Switzerland Financial : Belgium, Norway Professional : Germany, Ireland, Spain, United Kingdom Voluntary : Denmark, Finland, Greece, Iceland, Luxembourg, Portugal, Sweden

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

Voluntary versus Mandatory CME • • • Motivation Incentives Control mechanisms The carrot is more effective than the stick…

Financing of 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

European CME Credits (ECMEC‘s) Credits UEMS suggestion Full credits E(uropean) CME C(redit)’s 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 C’s to National credits can follow the rules of the National Accreditation Authority For instance : can have a maximum weighting factors can be introduced nationally Translation table

Updating of Agreements Spain Financial aspects (fee) Credits translation table 1 ECMEC = 0, 12 Spanish Credits

Conversion Table • Spain 1 ECMEC = 0, 12 Spanish Credits • Belgium 1 ECMEC = 1 CP • Romania 1 ECMEC = 1 Romanian Credit • Sweden 1 ECMEC = 1 Swedish Credit • Germany 6 ECMEC = 8 German Credits

e-Learning • The big project started on April 6 th 2009 with the inclusion of e-learning programmes • The quality criteria for e-learning material have been revised • Costs of evaluation of e-learning events are different because the workload in assessment is more demanding • 750 € for the first module and 750 € per next hour • We do not envisage authorising provider accreditation for e-learning

Feed-back form for participants • Did I learn something • Did the meeting change my practice • Was the meeting well organised • Quality of content • Quality of speakers • Was the venue appropriate • Did I feel the meeting was biased Yes Neutral 1 2 3 4 No 5

Future • Systematic evaluation of meetings by the participants • Enduring material • More agreements with the Sections • More agreements with the National Accreditation Authorities • Contacts with other parts of the world • Contacts with UEMO

Webbased application form www. eaccme. eu

“If you think education is expensive, you should consider ignorance. ” Socrates (469 – 399 BC)

Go raibh maith agaibh Vielen Dank Muito obrigado Благодаря Շնորհակալություն Merci Dekuji Gracies Dank U сбасиво Paldies Tänas Teşekkürler Hvala Thank you ﺷﻜﺮﺍ ﺟﺰﻳﻼ Grazzi Tack Dakujem Muchas gracias Multumesc Takk תודה רבה ευχαριστώ Faleminderit Köszönöm Ginkuje მადლობა Grazie mille Kiitos Dėkoju

U. E. M. S. Union Européenne des Médecins Spécialistes European Union of Medical Specialists www. uems. net