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Guidelines for the Introduction of Continuing Medical Education for Paediatric Surgeons in the European Union PreambleIn recent years there has been increasing public interest in how the professions govern and regulate themselves, and this interest has extended into the field of continuing education. As in any other profession, also in medicine there is widespread acknowledgement of the need for continuing education for those who have completed formal training and entered into hospital or independent practice. Continuous Medical Education (CME) is one of the most important tools in ongoing development: it helps physicians to maintain and improve their professional competence and skills, to broaden their professional outlook and to keep abreast of relevant developments, thus providing patients with up-to-date high quality healthcare. CME is an ethical and moral obligation, to which any physician is called upon: self-regulation of this type is likely to lead to enhancement of the image of the profession in the eyes of the public, fellow professionals and the European Commission. On the other hand, CME is not only an ethical and moral obligation, but also a right which has to be secured to all doctors, granting them the opportunity to participate in CME activities: it is therefore desirable to create incentives for the medical specialist to undertake this activity ("The system of remuneration of all specialists must contain elements of finance to include their activity in CME. However, whatever system is applied in the member state, the specialist must not be financially disadvantaged and therefore should be compensated for his/her CME activity" - UEMS Charter on CME, 1994).It is the intention of the UEMS Section of Paediatric Surgery as well as the European Board in Paediatric Surgery that each Paediatric Surgeon will take responsibility for the way in which he or she seeks to fulfil the recommended CME requirements. Surgeons will be responsible for choosing their CME activities in accordance with their needs, learning methods and clinical settings. There is growing emphasis on the need to ensure that participation in such education is documented and results in learning. The Board have adopted a philosophy which focuses primarily on continuing education, but also incorporates a system of identifying and assisting the minority who fail to participate in CME to the minimum level. In order to encourage cross fertilisation of ideas and harmonisation of CME practice across Europe, the Board considers mandatory a co-ordination of the CME activities among Member and Associate Countries, whether they already have an established CME program or not. The system here presented is designed to ensure uniform standards, while taking into account each country's present organisational structure. This document sets out a system of CME for Paediatric Surgeons throughout Europe, structured on the basis of the Charter on CME approved by the Management Council of the UEMS since its London Meeting of the 28-29 October 1994, the recommendations set out and accepted by the Advisory Committee on Medical Training in October 1994 as well as taking into account the functions of the European Accreditation Council on CME (EACCME) as defined in the relevant section in the UEMS website. 1. General Rules of CME1.1 Definition1.2. Credit system
CME activities are classified in two categories: as a general rule External CME activities must be formally approved beforehand (§ 4.1.1.), while Internal CME activities should not (§ 4.1.2.).
1.3.2. Internal CME
2. Participation in CME 2.1. Who should participate in CMEAll surgical hospital staff should participate in CME. Trained surgeons wholly engaged in private practice should also be included. Trainees in Paediatric Surgery, whose educational requirements are peculiar and more demanding than those involved in CME, are not included in CME registration process although this obviously does not mean that they have to be excluded by CME activities. Adequate completion of CME requirements is mandatory for all Paediatric Surgeons registered into the European Register of Paediatric Surgeons in order to maintain their status of Fellows of the European Board of Paediatric Surgery (F.E.B.P.S.). After each 5 years period on the Register will be pointed out the names of Paediatric Surgeons that have attained the minimum standard of CME credits required in the same period and have forwarded them to the Board. It is taken for granted, for Paediatric Surgeons in Countries which have an established system of CME crediting, that the Board will accept the methods of approving and reporting of CME activity which are already in place. Until the Board has overall jurisdiction in Europe, for these Surgeons a copy of the CME annual summary used in their Country could be forwarded to the Board for their records. It is nevertheless recognized that there are differences in the methods by which each Country assesses standards of surgical care and CME. This will by necessity require the Board to liaise with different organisations according to the Country in question when assessing the CME status of Paediatric Surgeons. 2.2. Verification of CME ActivityAfter completing 5 years of CME activity to the minimum recommended level required, a registered surgeon's name will be pointed out on the European Register with a specific mention of his/her CME accomplishment. The first list will be compiled in 2005 and it will be updated annually. Verification of a sample of the CME returns will take place for time to time. 2.3. How to record CME creditsNote: Implementation of items n. 2.2 and 2.3 has been temporarily delayed, waiting for the National systems to be settled and tested; the Section will then take care to collect via e-mailing the annual credit sheet, approved by the relevant National Accreditation Authorities, of the FEBPS willing to have their CME duties recorded on the European Register.(Zagreb General Assembly, 2004) 2.4. International CME activities
2.5. Arbitration mechanism
3. Provision of CME3.1. Role of the European Board in Paediatric SurgeryThe Board will facilitate the development of educational programmes in conjunction with the European Union of Paediatric Surgical Associations (EUPSA), the National Associations of Paediatric Surgeons and other National Bodies responsible for maintaining standards of care in Paediatric Surgery in that country. It will act as a promoter and facilitator of CME in Europe and will encourage the Specialist Paediatric Surgical Societies in each country to establish and further CME on a regular basis. It will play a part in setting the standards and help to monitor the quality of CME events. It will also link the National Authorities designated for CME planning with the European Accreditation Council on CME, thus improving CME exchanges between European countries. The Board will also be responsible for recording the CME activity of Paediatric Surgeons throughout Europe: this will include the continuous updating of the list of Paediatric Surgeons whose CME credits meet the minimum agreed standard and whose name can continue to be pointed out in the European Board’s Register of Paediatric Surgeons. 3.2. Role of the National Associations of Paediatric Surgeons (Associations)The Associations will provide opportunities for CME and assess the quality of educational provision in the relevant Country. It will advise locally on the requirements for and look for omissions in the provision of CME. The Associations are the appropriate body to continue to develop and provide CME through national conferences, which they can monitor and evaluate, and through specialist literature, which may incorporate self-assessments. As part of their role in assessing the quality of educational provision, the Associations will make recommendations to the Board for the approval of external meetings, courses and distance learning programmes. The Associations will plan provision of CME in conjunction with the Board, ensuring geographical availability. They will offer advice to any Paediatric Surgeon who is having difficulty in achieving the minimum number of credits. 3.3. Role of the Hospital Surgical Units and Postgraduate CentresThe hospital-based CME programme will continue to be an important and significant part of an individual surgeon's CME. It is also recognised that valuable resources for independent study are available in hospital libraries and it is hoped that the formalisation of CME will encourage the further development of audio, video, and computer-based CME material. 3.4. Other providers of CME
4. Approval of CME events4.1. Approval requirements
nternal CME activities (hospital-based CME activities) do not require formal approval unless they are aiming mainly at surgeons outside the hospital thus being regarded as Ext - 3 CME activities (Courses, Meetings, Seminars). The Board however expects such activities to be of good quality and well monitored. It is also envisaged that local mechanisms should be set in place to monitor local activities. 4.2. Application procedure for approval of CME events.
The main Authorities for the accreditation of providers of external formally planned CME and for the awarding of CME credits are the National Authorities designated for this purpose. The Board can assume these functions if no national professional CME Authority exists.
If international participation is desired and if European credits are to be awarded, the provider of an external formally planned CME activity applies both to the National Authority and to the EACCME according to the relevant procedures (D9907-D9908). Once the CME activity is reported to the EACCME, the EACCME grants the European registration of this CME activity and communicates it to the appropriate national and other professional authorities. Details on the procedure as well as Request form can be found at the EACCME Section in the UEMS website.
If an event is approved someone from the approving body may ask to attend. In the case of distance learning programmes the organiser may be called upon to show the programme materials to the approving body. After a CME approved event has taken place, the organiser would be expected to retain a list of participants and a copy of the completed event evaluation for 2 years and to make these documents available to the Board and the Association if required.
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