Future of PGT and CME – CPD of European specialist physicians : Challenges UEMS faces to

1. Future of PGT and CME – CPD of European specialist physicians : Challenges UEMS faces to Dr. Bernard Maillet Former Secretary General UEMS

2. 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

3. Items for discussion • General issues • How is the profession organized • on national level • on European level • What is the role of UEMS in Europe ? • How is PGT and CME-CPD organized and who is responsible in the EU and Member States

4. Phases of Medical Life • Undergraduate 6 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

5. Aims How can we improve and harmonise the mutual recognition of qualifications at the level of : • Undergraduate training • Specialist training • Lifelong training

6. How can we improve and harmonise the mutual recognition of qualifications at the level of 1. Undergraduate training Define a time based training period on clearly defined topics in the undergraduate medical training (i.e. anatomy, biochemistry, endocrinology) : ECTS systemscale : months

7. How can we improve and harmonise the mutual recognition of qualifications at the level of 2. Postgraduate training Define a time based training period on clearly defined topics in the program for speciality training : similar to ECTS system scale : months

8. How can we improve and harmonise the mutual recognition of qualifications at the level of 3. Lifelong learning Define a time based training period on clearly defined topics in the program for CME / CPD : ECMEC System scale : hours

9. 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

10. Basic principles of the EU Mobility • Free movement of students • Bologna process • Free movement of doctors • Directive on Recognition of Qualifications • Free movement of patients

11. 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

12. Keywords in the EU • Mobility • Free movement of - services - funds - products - manpower • Subsidiarity • The organisation and delivery of health care is the responsibility of each Member State

13. Europe EU : 27 Member States Accessing countries : Croatia, Turkey EFTA : Iceland, Norway, Switzerland Euro zone : currency agreement Schengen area : free movement agreement Council of Europe : 47 Member States

14. European Union 1957 : Treaty of Rome European Economic Community Six Member States Admission of new Member States 1983 : 12 Member States 1993 : Treaty of Maastricht Name changed in European Union 2004 : 10 new Member States 2007 : 2 new Member States

15. Items for discussion • General issues • How is the profession organized • on national level • on European level • What is the role of UEMS in Europe ? • How is PGT and CME-CPD organized and who is responsible in the EU and Member States

16. How is the Medical Profession organized on National level Very different : Orders (mandatory membership) Professional Organization Specialty driven National Trade Union National Scientific Society Specialty

17. National Medical Associations Very different organisation depending on the EU Member State From Professional Organisation to Trade Union General Practitioners / Family Medicine included or not National versus regional structure

18. How is the Medical Profession organized in Europe CPME Standing Committee of European Doctors UEMS European Union of Medical Specialists UEMO European Union of GP/Family Medicine EJD Junior Doctor’s Organization (trainees) AEMH Hospital Doctor’s Organization FEMS Salaried Doctor’s Organization EANA Self Employed Doctor’s Organization CEOM Organization of European Medical Orders

19. Items for discussion • General issues • How is the profession organized • on national level • on European level • What is the role of UEMS in Europe ? • How is PGT and CME-CPD organized and who is responsible in the EU and Member States

20. Union Européenne des Médecins Spécialistes European Union of Medical Specialists Umbrella organization of National Associations of Medical Specialists located in Brussels U. E. M. S.

21. 1957 EEC Treaty of Rome Foundation of the UEMS in 1958 by the professional organizations of medical specialists of Belgium France Germany Italy Luxembourg the Netherlands

22. UEMS political involvement in EU Affairs European Commission Prepares & proposes Consulation with other European Medical Organisations: AEMH – CEOM – CPME – EANA – EJD– FEMS – UEMO EU Legislation EU Council European Parliament Decide jointly The EU institutional triangle (simplified)

23. Relevant UEMS Policies • Charter on Training of Medical Specialists (1993) • Charter on Continuing Medical Education (1994) • The European Training Charter (1995) • Charter on Quality Assurance in Specialist Practice in the EU (1996) • Charter on Visitation of Training Centres (1997) • Charter on Continuing Professional Development - Basel Declaration (2001) • Policy Statement on Assessments during Postgraduate Medical Training (2006)

24. History and backgrounds • UEMS – established 1958 • UEMS Specialist Sections – first created in 1962 • Doctors Directives – 75/362/EEC and 75/363/EEC (mutual recognition of diplomas) • ACMT and CSOPH – created in 1975 • Consolidation of Doctors Directives – Directive 93/16/EC • Launch of EACCME • Recognition of Professional Qualifications Directive – Directive 2005/36/EC + 2006/100/EC • Launch of ECAMSQ

25. Items for discussion • General issues • How is the profession organized • on national level • on European level • What is the role of UEMS in Europe ? • How is PGT and CME-CPD organized and who is responsible in the EU and Member States

26. Specialist training at the National level in the EU Licensing 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

27. 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

28. 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...

29. 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)

30. 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

31. CME in Europe • In most countries the internal structure of CME has been in evaluation • Mandatory systems (legal, financial or professional) developed in several countries

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

33. 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

34. 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

35. 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

36. Countries have different media they are granting credits on • Common : • Individual Events • Conferences • Scientific Meetings • But also : • Enduring Materials – CD Rom • Internet Courses • Articles • Reviewing of litterature • Case reviews • Other…

37. Minimal Criteria • Non-biased education • Control of attendance • Report after the event • Have clear learning objectives • Precise the target audience

38. European Accreditation Council for 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

39. Develop harmonised curricula in each specialty Ensure that all Medical Specialists have the same main core competencies in their specialty across Europe Ensure that all member states adopt the curricula and translate them into their national system How to assess Medical Specialists qualifications?

40. How can we assess PGT • Examinations • In training evaluation • Visitations • 360° appraisal

41. UEMS ECAMSQ - Scope To • survey • monitor, and • assess specialist medical education and training for the purpose of accreditation of medical practitioners across Europe. • Ensure • sufficient experience • education, training • supervision • assessment • evaluation • support • safe working environment to enable doctors in training to meet the objectives of their training programmes.

42. UEMS ECAMSQ - Aims • to invite the NMAs, UEMS S&Bs, and national authorities responsible for accreditation of medical education and training in each of the 27 member states to reach consensus on the core essentials that inform high quality medical specialist education & training programmes, • to convey the agreed outcome of these deliberations to the European authorities with a view to having these agreed principles formally incorporated into EU legislation, • to offer and ensure the appropriate tools in order to implement the comprehensive process of individual/organisational/institutional PGMST accreditation at the European level.

43. European Council for Accreditation of Medical Specialist Qualification (ECAMSQ) • “Conjunction” of the Working Group PGT of the Council and CESMA • Electronic Platform • Certification • CME activities • Re-certification

44. Council for European Specialist Assessment (CESMA) • Initiated by the Section of Pediatric Surgery in February 2007 • Started with 11 involved Sections and now 28 are participating • Proposed the “Glasgow declaration” • Delegates from the Sections of UEMS and one delegate from PWG • Harmonization of the Assessment process in Europe

45. Council for European Specialist Assessment (CESMA) • Chairman : Zeev Goldik (Anesthesiology) • Board : John Boorman, Robert Carachi, Vassilios Papalois, Alfred Tenore, (Zlatko Fras, Bernard Maillet) • Next meeting : November 3rd 2012 in Brussels • Exams have no legal value but can help in portfolio

46. Council for European Specialist Assessment (CESMA) • Negotiations have been started with American Board of Medical Specialties to have a kind of mutual recognition over the Atlantic Ocean

47. UEMS Working Group on Post Graduate Training • Chairman : Dr. Hans Helmqvist • Rapporteur : Dr. Umut Akyol • Dr. Zlatko Fras is very much involved as past Chairman • Wide representation

48. UEMS Working Group on Postgraduate (Medical Specialist) Training • HARMONIZATION of various aspects • of Medical Specialist Training in Europe • Access to training • Curricula - Chapter 6 (UEMS Charter PGT) • Quality of training – provisions on trainees & trainers, quality indicators, monitoring and visitations • Certification • Recognition of qualifications

49. Glasgow Declaration • 1. European Board Examinations does not give the right to practice in any European Country • 2. European Board Examinations is complimentary to National Examinations • 3. Promotion of the European Examinations • 4. To be considered as a Label of Excellence • 5. Clear Curriculum and Reference Book • 6. Clear Eligibility criteria • 7. Certificates for successful application

50. European Examinations • Allergology • Anaesthesiology • Cardiology • Dermatology • Ear, Nose and Throat • Hand Surgery • Internal Medicine • Neurology • Neurosurgery • Nuclear Medicine • Ophthalmology • Oral & Maxillofacial Surgery