THE Ped. Surg. C.M.E. COMMITTEE

Piotr Czauderna (Poland)

Udo Rolle (Germany)

Continuing Medical Education for Paediatric Surgeons in the European Union

Preamble

In 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 CME

2. Participation in CME

3. Provision of CME

4. Approval of CME events

2. Participation in CME

2.1. Who should participate in CME

All 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 Activity

The Board will publish on its Internet website the appropriate documents for recording CME activity (§ 2.3.). Each registered Paediatric Surgeon willing to join the European CME program shall download the documents and fill it regularly. Completed forms should be mailed or e-mailed to the Board.

After 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 credits

There will be two forms of documentation for recording CME, a personal log book and an annual summary sheet, available on the Section website. The log book will be an ongoing record of activities in which will be recorded the nature and duration of each CME activity undertaken. From the log book, an annual summary will be completed which will be returned to the Board. The log book  is the personal record of participation in CME. It is advised that this should be retained for seven years in case there is any dispute in due course about the central CME record and the surgeon’s inclusion on the list of those who have participated satisfactorily. In order to claim CME credits for external meetings, courses and distance learning programmes, the event must have been formally approved by the National Authority or by the Board for CME purposes prior to the event taking place.

Note: 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

The participation in EACCME registered CME activities outside their own country by Paediatric Surgeons entitles them to the recognition of the credits they obtained by the Authority of their own country. Specialists apply for the recognition of these CME credits in the same way as for CME credits obtained in their own country (D9907).

2.5. Arbitration mechanism

Any disagreement in recording and awarding CME credits should be referred to the Chairman of the Board's Committee on CME. Appeal body against Chairman’s decisions will be first the Executive Committee of the Board and then –further disagreement should persist- the Executive Committee of the UEMS as well as the European Accreditation Council for CME.

1. General Rules of CME

1.1 Definition

Continuing Medical Education (CME) is a programme of educational activities to guarantee the maintenance and upgrading of knowledge, skills and competence following completion of Postgraduate training. CME is an ethical and moral obligation for each Paediatric Surgeon throughout his/her professional career in order to maintain the highest possible professional and continually rising standards of the medical care provided to the population. It consists of the continuous renewal, extension and updating of scientific knowledge and technical skills necessary to maintain these professional standards. UEMS Section of Paediatric Surgery as well as the European Board in Paediatric Surgery (from now on: the Board) recommends CME as the most important and efficacious method for keeping abreast of the newest techniques and information in our speciality and for maintaining and enhancing competence.

1.2. Credit system

A credit is a unit of CME and corresponds basically to one hour of educational activity. One credit does not have to be always identical with a clock hour, but can be different depending on the type of education (D9909). Credits will be awarded according to the CME activity involved (§1.3.).

The initial basic minimum target for CME is 50 credits per year. In one year not more than 100 credits should be recognised (D9907).

There should be an appropriate mix of CME activities, with at least 25 hours being spent on External CME activities and at least 25 of Internal CME activities (§ 1.3.).

Though the workings of the system and individual participation will be reviewed annually, the cycle will be five-yearly for a total of at least 250 credits. Out of these 250 credits, at least 100 should be in external formally planned CME and 100 in internal personal learning activities (D9907).

In cases where 250 credits are not achieved there will be an appeal system for extenuating circumstances. Paediatric Surgeons who fail to achieve 250 credits in 5 years should receive counselling from the National Professional Authority or the Board itself.

Credits in excess of the required 250 will not be carried forward into the following 5 year cycle.

Credits cannot be earned for service on committees or working parties whether local, national or international.

1.3. Categories of CME

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.).

1.3.1. External formally planned CME

Ext - 1 : Scientific Congress, EACCME registered

Ext - 2 : Scientific Congress, no EACCME registered (local)

Ext - 3 : Courses, Workshops, Seminars

Ext - 4 : Distance learning programs

1.3.2. Internal CME

Int - 1 : Hospital based CME

Postgraduate meetings, Research meetings, Department meetings, Hospital grand rounds, Journal club, Clinical outcome meetings (audit)

Int - 2 : Independent based CME

Reading medical literature, medical writing, editorial or refereeing work, Internet learning, self assessment examination, medical audiotapes and videos

Int - 3 : Other CME activities

Visit to specialised units, preparation and delivery of formal lecture or seminar, preparation and delivery of audit report, publication or presentation of scientific papers or books, teaching, postgraduate examination work

CME activities (awarding of credits)

External Minimum: 25 credits / year

Ext - 1 : Scientific Congress (1 credit/hour, max 25 credits)

EACCME registered

Ext - 2 : Scientific Congress (1 credit/hour, max 15 credits)

Ext - 3 : Courses, Meetings, Seminars (1 credit/hour, max 10 credits)

Ext - 4 : Distance learning programs (1 credit/hour, max 10 credits/program)

Internal Minimum: 25 credits / year

Int - 1 : Hospital-based (1 credit per meeting - Supporting documentation to be provided)

Postgraduate meetings,

Research meetings,

Department meetings,

Hospital grand rounds,

Journal club,

Clinical outcome meetings (audit)

Int - 2 : Independent-based (Maximum 10 credits/year)

Reading medical literature,

Preparing lectures,

Medical writing,

Editorial or refereeing work,

Internet learning,

Self assessment examination,

Medical audiotapes and videos

Int - 3 : Other activities

Visit to specialised units (10 credits/week)

Preparation and delivery of (3 credits - Supporting documentation to be provided)

formal lecture or seminar/audit report

Publication of books (Up to 10 credits per chapter)

Postgraduate examination work (1 credit/day, max 5 credits/year)

4. Approval of CME events

4.1. Approval requirements

4.1.1. External formally planned CME

CME activities which will require beforehand formal approval are those listed in External formally planned CME (§ 1.3.). In order to qualify for CME approval an event should:

Be aimed at a defined target group(s);

Set out clear and relevant objectives;

Include a mechanism for evaluation - so that the organisers and presenters can obtain feedback on the relevance, quality and effectiveness of the activity;

Have an appropriate programme - which reflects the needs of the intended participants;

Reflect a broad consensus of current expert opinion;

Neither to be biased nor to be overtly promotional where there is a commercial sponsor;

Have a nominated organiser who will keep records of attendance and evaluation; Have a nominated organiser who will keep records of attendance and evaluation;

Meet the criteria for international accreditation of CME (D9908) in order to be recognised as Ext - 1 CME activity (EACCME registered formally planned interactive CME).

4.1.2. Internal CME

Internal 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

4.2.1.

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.

4.2.2.

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.

4.2.3.

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.