The Harmonization of The Harmonization of CME-CPD in EuropeCME-CPD in EuropeA Challenge for the UEMSA Challenge for the UEMS

DrDr. Bernard Maillet. Bernard Maillet

Former Secretary GeneralFormer Secretary General

UEMSUEMS

• Former Secretary-General UEMSFormer Secretary-General UEMS

• Pathologist in a Private Lab near by Pathologist in a Private Lab near by BrusselsBrussels

• Member of EUCOMED’s Compliance Member of EUCOMED’s Compliance PanelPanel

• Board Member of MdeonBoard Member of Mdeon

• Member of the Rome GroupMember of the Rome Group

DisclosureDisclosure

Continuing Medical Education Continuing Medical Education (CME)(CME)

Maintenance of Academic Knowledge Maintenance of Academic Knowledge and Skillsand Skills

Continuing Professional Continuing Professional Development (CPD)Development (CPD)

• Means of Updating, Developing and Means of Updating, Developing and Enhancing how Doctors apply the Enhancing how Doctors apply the Knowledge, Skills and Attitudes Knowledge, Skills and Attitudes required in their working livesrequired in their working lives

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

• Have different credit systemsHave different credit systems

• Have different approaches on the Have different approaches on the procedureprocedure

• UEMS tries to harmonize the processUEMS tries to harmonize the process

• Is the main playerIs the main player

• We have to look at who is giving the We have to look at who is giving the license to practiselicense to practise

National Accreditation National Accreditation AuthoritiesAuthorities

• Based on trustBased on trust

• Similar criteriaSimilar criteria

• Different Health Care SystemsDifferent Health Care Systems

• Must be only a part of the entire Must be only a part of the entire « portfolio » of the Doctors« portfolio » of the Doctors

• Borders are vanishingBorders are vanishing

Mutual RecognitionMutual Recognition

EventEvent

EuropeanEuropeanAccreditation BodiesAccreditation Bodies

National AccreditationNational AccreditationAuthoritiesAuthorities

NationalNational

InternationalInternational

Draft FlowchartDraft FlowchartAccreditation in EuropeAccreditation in Europe

EventEvent

National AccreditationNational AccreditationAuthoritiesAuthorities

NationalNational

Evaluate the value of the meetingEvaluate the value of the meeting

Grant the credits according to the National rulesGrant the credits according to the National rules

Draft FlowchartDraft FlowchartAccreditation in EuropeAccreditation in Europe

EventEvent InternationalInternational

European Accreditation BodiesEuropean Accreditation Bodies

Evaluate the value of the meetingEvaluate the value of the meetingPropose a number of creditsPropose a number of credits

National Accreditation AuthoritiesNational Accreditation Authorities

Accept the scientific evaluation by the UEMS Sections and BoardsAccept the scientific evaluation by the UEMS Sections and BoardsApply the number of credits relating to the national rulesApply the number of credits relating to the national rules

Draft FlowchartDraft FlowchartAccreditation in EuropeAccreditation in Europe

OrganiserOrganiser

RequestRequest > > 3 months3 months

UEMS - EACCMEUEMS - EACCME

N.A.A.N.A.A. SectionsSections

EvaluationEvaluation < < 3 weeks3 weeks EvaluationEvaluation

UEMS - EACCMEUEMS - EACCME

Certificate of RecognitionCertificate of Recognition

OrganiserOrganiser

AccreditationAccreditation

TTwwo mao majjor partners in the process :or partners in the process :

• EuEurropopeean an AAccreditaticcreditatioon Boardsn Boards

• NatiNatioonal Accrenal Accreddiittaattion Authoritiesion Authorities

Formal AFormal Aggreemreemeents with Sectionts with Sectionns or European s or European SpecialSpecialiity Accreditation Boardsty Accreditation Boards

Current :Current :

• AnaesthesiologyAnaesthesiology• Child and Adolescent Psychiatry Child 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 AFormal Aggreemreemeents with Sectionts with Sectionns or s or European SpecialEuropean Specialiity Accreditation Boardsty Accreditation Boards

Current :Current :• NephrologyNephrology

• NeurologyNeurology• NeurosurgeryNeurosurgery• Nuclear MedicineNuclear Medicine• Occupational MedicineOccupational Medicine• OphtalmologyOphtalmology• Oral and Maxillofacial Surgery - StomatologyOral and Maxillofacial Surgery - Stomatology• OrthopaedicsOrthopaedics• PaPaeeddiiatric Surgeryatric Surgery

Formal AFormal Aggreemreemeents with Sectionts with Sectionns or s or European SpecialEuropean Specialiity Accreditation Boardsty Accreditation Boards

Current :Current :• PathologyPathology• PhysPhysiical and Rehabiitation Medicinecal 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 AFormal Aggreemreemeents with Sectionts with Sectionns or European s or European SpecialSpecialiity Accreditation Boardsty Accreditation Boards

Signed recently :Signed recently :

• Cardiology (EBAC)Cardiology (EBAC) 25-11-200725-11-2007• Infectious Diseases (EBAID)Infectious Diseases (EBAID) 13-1-200913-1-2009• Pneumology (EBAP)Pneumology (EBAP) 17-2-200917-2-2009• Genetics (MJC) Genetics (MJC) 22-11-200822-11-2008• Vascular SurgeryVascular Surgery 10-4-201010-4-2010• SurgerySurgery• UrologyUrology• Gastro EnterologyGastro Enterology

Pending in the future :Pending in the future :

• AllergologyAllergology

Formal AgreeFormal Agreemments withents withNatiNatioonal Accreditation Anal Accreditation Auutthhoritiesorities

Current :Current :

SpSpaaiin,n, Cy Cypprus, Greece, RCSrus, Greece, RCSI, Malta, RCPI, Turkey, I, Malta, RCPI, Turkey, SloSlovvakia, akia, Norway, Luxemburg, Norway, Luxemburg, BelgiBelgiuum, Romania, m, Romania, Slovenia, Sweden, Regione Lombardia, Slovenia, Sweden, Regione Lombardia, Finland, Finland, Austria, Czech Republic, United Kingdom (Federation Austria, Czech Republic, United Kingdom (Federation of Royal Colleges)of Royal Colleges)

Near Future :Near Future :

France, Regione Veneto, Regione Frluli…France, Regione Veneto, Regione Frluli…

Future :Future :

GermGermaany, ny, Poland, Portugal,Poland, Portugal, Italy…Italy…

Core for International recognitionCore for International recognition

Substantial equivalencySubstantial equivalencySystems are differentSystems are different

Criteria must be similarCriteria must be similar

Only valid for “international attendance”Only valid for “international attendance”

Is not replacing the local system in placeIs not replacing the local system in place

Recognizes the validity of the differrent Recognizes the validity of the differrent systemssystems

Borders are vanishingBorders are vanishing

AAggreemreemeent with the American Medical nt with the American Medical Association on Mutual Recognition of Association on Mutual Recognition of

CreditsCredits

Till June 30th 2006 :Till June 30th 2006 :

• Pilot project for 2 years each timePilot project for 2 years each time

From July 1st 2006 :From July 1st 2006 :

• Real agreement for 4 yearsReal agreement for 4 years

From July 1st 2010 :From July 1st 2010 :

• Agreement including also e-learningAgreement including also e-learning

International AInternational Aggreemreemeentsnts

United StatesUnited States

• Formal agreementFormal agreement

• Live events as well as e-learningLive events as well as e-learning

CanadaCanada

• Pilot agreement for one yearPilot agreement for one year

• Only live eventsOnly live events

Territoriality issues in Territoriality issues in International AgreementsInternational Agreements

• Credits granted to events taking place in Credits granted to events taking place in the United States or Canada and approved the United States or Canada and approved by an ACCME or RCPSC accredited by an ACCME or RCPSC accredited provider are recognized in Europeprovider are recognized in Europe

• Credits granted to events taking place in Credits granted to events taking place in Europe approved by EACCME can be Europe approved by EACCME can be recognized in the US as AMA PRA recognized in the US as AMA PRA Category ICategory I®®credits and in Canada as credits and in Canada as Maintenance of Certification (MOC) Section Maintenance of Certification (MOC) Section 1 – Accredited Group Learning credits 1 – Accredited Group Learning credits

International AInternational Aggreemreemeents on Mutual nts on Mutual Recognition of CreditsRecognition of Credits

Other systems :Other systems :

JapanJapan

AustralasiaAustralasia

South AfricaSouth Africa

South AmericaSouth America

Middle EastMiddle East

DubaiDubai

EgyptEgypt

Russian Federation ?Russian Federation ?

• Only theoretical measuresOnly theoretical measures

• ““Last call” Last call”

• Real effect on the license to practise or Real effect on the license to practise or on the payment of the practitioneron the payment of the practitioner

““Mandatory” is not always what we Mandatory” is not always what we think it means…think it means…

What means “Mandatory”What means “Mandatory”

AustriaAustriaCroatiaCroatiaFranceFranceGermany (in hospitals & practices)Germany (in hospitals & practices)Great BritainGreat BritainHungaryHungaryIcelandIcelandItalyItalyThe Netherlands (for specialists)The Netherlands (for specialists)PolandPolandSloveniaSloveniaSwitzerland (for specialists)Switzerland (for specialists)

Mandatory CMEMandatory CME

BelgiumBelgium IrelandIrelandCyprusCyprus IsraelIsraelCzech RepublicCzech Republic LuxembourgLuxembourgDenmarkDenmark NorwayNorwayEstoniaEstonia PortugalPortugalFinlandFinland SpainSpainGreeceGreece SwedenSweden

CME/CPD recommended for CME/CPD recommended for doctors but voluntarydoctors but voluntary

Legal :Legal : Austria, France, Italy, Austria, France, Italy, Netherlands, SwitzerlandNetherlands, Switzerland

Financial :Financial : Belgium, NorwayBelgium, Norway

Professional :Professional : Germany, Ireland, Spain, Germany, Ireland, Spain, United KingdomUnited Kingdom

Voluntary :Voluntary : Denmark, Finland, Greece, Denmark, Finland, Greece, Iceland, Luxembourg, Iceland, Luxembourg, Portugal, SwedenPortugal, Sweden

Mandatory CMEMandatory CME

• Policy UEMS : CME is an ethical Policy UEMS : CME is an ethical obligation and should not be mandatoryobligation and should not be mandatory

• Voluntary CME is effective on macro-Voluntary CME is effective on macro-levellevel

• But, on individual level participation has But, on individual level participation has to be encouragedto be encouraged

Mandatory CME is not effective in the Mandatory CME is not effective in the weeding out of bad applesweeding out of bad apples

Shift to mandatory CME in Shift to mandatory CME in EuropeEurope

• MotivationMotivation

• IncentivesIncentives

• Control mechanismsControl mechanisms

The carrot is more effective than the The carrot is more effective than the stick…stick…

Voluntary versus Mandatory Voluntary versus Mandatory CMECME

CME is paid by patientsCME is paid by patients

– insurance premiumsinsurance premiums

– hospital and other billshospital and other bills

– fees of doctors and other fees of doctors and other professionalsprofessionals

– taxestaxes

– prices pharmaceutical productsprices pharmaceutical products

– outside funding is the exceptionoutside funding is the exception

Financing of CMEFinancing of CME

European CME CreditsEuropean CME Credits(ECMEC‘s)(ECMEC‘s)

CreditsCredits UEMS suggestionUEMS suggestion

FullFull credits credits E(uropean)E(uropean) CME C(redit)’sCME C(redit)’s

No weNo weiighted factorsghted factors

1 ECMEC per hour of activity1 ECMEC per hour of activity

3 ECMEC for a half day / 6 ECMEC for a full day activity3 ECMEC for a half day / 6 ECMEC for a full day activity

TTrraansnsllation of these E CME C’s ation of these E CME C’s tto Natio Natioonal credits can nal credits can ffololllow tow thhee rules rules oof tf thhe National Accreditation Authorite National Accreditation Authorityy

For instance :For instance : cacann have a maxim have a maximuummwweeighting factors can be intrighting factors can be introoduced nationallyduced nationally

Translation tableTranslation table

Updating of AgreementsUpdating of Agreements

SpainSpainFinancial aspects (fee)Financial aspects (fee)

Credits translation tableCredits translation table

1 ECMEC = 0,12 Spanish Credits1 ECMEC = 0,12 Spanish Credits

Conversion TableConversion Table

• SpainSpain1 ECMEC = 0,12 Spanish Credits1 ECMEC = 0,12 Spanish Credits

• BelgiumBelgium1 ECMEC = 1 CP1 ECMEC = 1 CP

• RomaniaRomania1 ECMEC = 1 Romanian Credit1 ECMEC = 1 Romanian Credit

• SwedenSweden1 ECMEC = 1 Swedish Credit1 ECMEC = 1 Swedish Credit

• GermanyGermany6 ECMEC = 8 German Credits6 ECMEC = 8 German Credits

e-Learninge-Learning

• The big project started on April 6th 2009 with The big project started on April 6th 2009 with the inclusion of e-learning programmesthe inclusion of e-learning programmes

• The quality criteria for e-learning material have The quality criteria for e-learning material have been revisedbeen revised

• Costs of evaluation of e-learning events are Costs of evaluation of e-learning events are different because the workload in assessment different because the workload in assessment is more demandingis more demanding• 750 € for the first module and 750 € per next hour750 € for the first module and 750 € per next hour

• We do not envisage authorising provider We do not envisage authorising provider accreditation for e-learningaccreditation for e-learning

Feed-back form for Feed-back form for participantsparticipants

• Did I learn somethingDid I learn something

• Did the meeting change my practiceDid the meeting change my practice

• Was the meeting well organisedWas the meeting well organised

• Quality of contentQuality of content

• Quality of speakersQuality of speakers

• Was the venue appropriateWas the venue appropriate

• Did I feel the meeting was biasedDid I feel the meeting was biased

YesYes NeutralNeutral NoNo11 22 33 44 55

• Systematic evaluation of meetings by Systematic evaluation of meetings by the participantsthe participants

• Enduring materialEnduring material

• More agreements with the SectionsMore agreements with the Sections

• More agreements with the National More agreements with the National Accreditation AuthoritiesAccreditation Authorities

• Contacts with other parts of the world Contacts with other parts of the world

• Contacts with UEMOContacts with UEMO

FutureFuture

Webbased application formWebbased application form

www.eaccme.euwww.eaccme.eu

““If you think education is If you think education is expensive, you should expensive, you should

consider ignorance.”consider ignorance.”

Socrates (469 – 399 BC)Socrates (469 – 399 BC)

Thank youThank you

MerciMerci

Muito obrigadoMuito obrigadoVielen DankVielen Dank

Grazie milleGrazie mille

Muchas graciasMuchas graciasTackTack

Dank UDank U

KiitosKiitosευχαριστώευχαριστώ

сбасивосбасиво

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KöszönömKöszönöm

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GinkujeGinkuje

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MultumescMultumesc TakkTakk

БлагодаряБлагодаря

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GraciesGracies

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HvalaHvalaTeşekkürlerTeşekkürlerTänasTänas

תודה רבהתודה רבה

PaldiesPaldies

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U.E.M.S.U.E.M.S.

Union Européenne des Médecins Union Européenne des Médecins SpécialistesSpécialistes

European Union of Medical SpecialistsEuropean Union of Medical Specialists

www.uems.netwww.uems.net