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

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

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 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 The Competence development includes CME + Personal, Managerial, IT, Communication and Social skills

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

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

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

Event National Accreditation Authorities National 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 Draft Flowchart Accreditation in Europe

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 European Accreditation Boards National Accreditation Authorities National Accreditation Authorities

Formal Agreements with Sections or European Speciality Accreditation Boards Current : AnaesthesiologyAnaesthesiology Child and Adolescent PsychiatryChild and Adolescent Psychiatry DermatologyDermatology Ear, Nose and Throat (ORL)Ear, Nose and Throat (ORL) EndocrinologyEndocrinology Gastro-EnterologyGastro-Enterology Geriatric MedicineGeriatric Medicine Internal MedicineInternal Medicine Medical BiopathologyMedical Biopathology

Formal Agreements with Sections or European Speciality Accreditation Boards Current : NephrologyNephrology NeurologyNeurology NeurosurgeryNeurosurgery Nuclear MedicineNuclear Medicine Occupational MedicineOccupational Medicine OphtalmologyOphtalmology Oral and Maxillofacial Surgery - StomatologyOral and Maxillofacial Surgery - Stomatology OrthopaedicsOrthopaedics Paediatric SurgeryPaediatric Surgery

Formal Agreements with Sections or European Speciality Accreditation Boards Current : PathologyPathology Physical and Rehabiitation MedicinePhysical and Rehabiitation Medicine Plastic SurgeryPlastic Surgery PsychiatryPsychiatry RadiologyRadiology RheumatologyRheumatology Emergency MedicineEmergency Medicine Intensive Care MedicineIntensive Care Medicine Sport MedicineSport Medicine Oncology (ACOE)Oncology (ACOE)

Formal Agreements with Sections or European Speciality Accreditation Boards Signed recently : Cardiology (EBAC) Cardiology (EBAC) Infectious Diseases (EBAID) Infectious Diseases (EBAID) Pneumology (EBAP) Pneumology (EBAP) Genetics (MJC) Genetics (MJC) Vascular Surgery Vascular Surgery Surgery Surgery Urology Urology Gastro Enterology Gastro Enterology Pending in the future : Allergology Allergology

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 30th 2006 : Pilot project for 2 years each time Pilot project for 2 years each time From July 1st 2006 : Real agreement for 4 years Real agreement for 4 years From July 1st 2010 : Agreement including also e-learning Agreement including also e-learning

International Agreements United States Formal agreement Formal agreement Live events as well as e-learning Live events as well as e-learningCanada Pilot agreement for one year Pilot agreement for one year Only live events 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 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 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 : JapanAustralasia South Africa South America Middle East DubaiEgypt Russian Federation ?

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

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

BelgiumIreland CyprusIsrael Czech RepublicLuxembourg DenmarkNorway EstoniaPortugal FinlandSpain GreeceSweden CME/CPD recommended for doctors but voluntary

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

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

MotivationMotivation IncentivesIncentives Control mechanismsControl mechanisms The carrot is more effective than the stick… Voluntary versus Mandatory 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 Financing of CME

European CME Credits (ECMEC‘s) CreditsUEMS 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 SpainSpain 1 ECMEC = 0,12 Spanish Credits BelgiumBelgium 1 ECMEC = 1 CP RomaniaRomania 1 ECMEC = 1 Romanian Credit SwedenSweden 1 ECMEC = 1 Swedish Credit GermanyGermany 6 ECMEC = 8 German Credits

e-Learning The big project started on April 6th 2009 with the inclusion of e-learning programmes The big project started on April 6th 2009 with the inclusion of e-learning programmes The quality criteria for e-learning material have been revised 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 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 750 € for the first module and 750 € per next hour We do not envisage authorising provider accreditation for e-learning We do not envisage authorising provider accreditation for e-learning

Feed-back form for participants Did I learn something Did I learn something Did the meeting change my practice Did the meeting change my practice Was the meeting well organised Was the meeting well organised Quality of content Quality of content Quality of speakers Quality of speakers Was the venue appropriate Was the venue appropriate Did I feel the meeting was biased Did I feel the meeting was biased YesNeutralNo 12345

Systematic evaluation of meetings by the participantsSystematic evaluation of meetings by the participants Enduring materialEnduring material More agreements with the SectionsMore agreements with the Sections More agreements with the National Accreditation AuthoritiesMore agreements with the National Accreditation Authorities Contacts with other parts of the worldContacts with other parts of the world Contacts with UEMOContacts with UEMO Future

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