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Is CME Becoming International? A Viewpoint From Europe
Alliance for CME Almanac, Vol. 28, No. 4, April 2006
Article written by Hervé Maisonneuve, MD, Paris, & Ron Murray, EdD, Charlottesville, Virginia
03/28/2006

A recent Almanac article by Dennis Wentz, MD, outlined the development and growth of accredited CME in North America during the past four decades.¹ In much of Europe, formalized CME systems have only been in existence since the 1990s, and their implementation is likely to be in a state of evolution for at least the next decade. In the US, in particular, the existence of a wide range of CME providers, such as large specialty societies, academic medical centers, and more recently, medical education companies, has led to high level communication systems and demonstrated reflection among the participants in CME activities sponsored by these organizations. Progress continues in the discussion of important topics such as health care quality improvement, the financing of CME and the potential means to measure CME outcomes.

In Europe, such topics are rarely debated among countries. Clinical competencies of health care professionals are the main concerns that arise in CME across Europe. European meetings involving all the key players (eg, academicians, commercial supporters, government representatives, medical education and communication company managers) to foster understanding of the views of the various stakeholders, and to propose new concepts and explore methods of collaboration, are few and far between.

Variation in Systems Across Europe

A first glance at the organization of CME programs in Europe might lead the observer to conclude that it is complicated and unsystematic. However, progress is definitely occurring and, in order to fully understand CME in Europe, it must be appreciated that the culture of both the physicians and the health care system of each country differs across the continent. We cannot transfer North American cultural or even business mores to each European country. In Europe, most of the health care systems are under strong governmental control, and health care professionals perform their duties under varying degrees of bureaucracy and regulation. The Euro may be a common currency among most European countries, but there is no common language or culture. There are, however, some impressive developments in CME systems, such as in Spain with the Spanish Accreditation Council for CME (www.cgcom.es).²

In most European countries, the organization of CME is a national responsibility and no single organization has yet been established to provide a unified approach to accreditation and transfer of credits. A recent survey by the Federation of European Cancer Societies highlighted the differences among CME systems in the European Union (EU).³ Their report provides a comprehensive review of various aspects of CME in Europe, such as mandatory or voluntary requirements for CME, and the structure of the various CME accreditation authorities. The report points out some of the key distinctions between the European and US systems, including the lack of enduring materials, emanating from Europe, that are certified for credit. It is also interesting to note that the implementation of some European CME systems is based upon an expectation that current public scrutiny may lead to mandatory recertification of physicians, and that CME credits will play an important role in this process.

The European Accreditation Council for CME (EACCME)

The European Union for Medical Specialists (UEMS) is the political representative umbrella organization for physician specialists in the EU and associated countries. CME has been a major focal area for UEMS since 1993, and in January 2000 UEMS established the European Accreditation Council for Continuing Medical Education (EACCME) to endorse the accreditation among national CME regulatory bodies. In each country, the national accrediting authority remains the final arbiter for the accreditation of CME activities within that country. The role of the EACCME was to be a link and clearinghouse between the national regulatory bodies. Once a national regulatory body approves the accreditation of an event in its country, the regulatory bodies in the other European countries should endorse this accreditation-enabling their health professionals to participate in CME events held abroad and claim the awarded credit points. The purpose of the fledgling EACCME is to promote the harmonization and improvement of the quality of specialist medical care in Europe, by improving the quality and accessibility of CME for the medical specialists in Europe. This can be achieved by facilitating the transfer of CME credits obtained by individual specialists in CME activities that meet common quality requirements. To this end, the provider of a CME activity can request European accreditation of that event from the EACCME office in Brussels. This process is complicated by the fact that not all national authorities participate in the mutual recognition process, and there is variation among the countries in terms of whether the system involves accreditation of providers or of events.

A further complication arises from a number of specialties in the various European countries having established their own accreditation bodies, while trying to maintain a strong relationship with UEMS. For example, the European Board for Accreditation in Cardiology (www.ebac-cme.org) and the European Board for Accreditation in Pneumology (www.ebap.org) set their own policies. Whether or not such competition among accreditation bodies in Europe is beneficial remains to be seen, but the establishment of the EACCME has at least provided a platform for international cooperation. This international cooperation has extended to the US-a pilot project started in 2002, and extended to 2006, between the American Medical Association (AMA) and EACCME, allows physicians who participate in EACCME certified live events to have their EACCME credit converted to AMA Physician Recognition Award Category 1 Credit.

In commenting on this partnership with Europe through the UEMS/EACCME, Dennis Wentz stated, "We believe that it is the basis of developing an international level of CME credit based on shared values, and shared global standards of CME excellence."⁴

CME Provision for General Practitioners (GPs) in Europe

Although there are many opportunities for European GPs to attend CME activities, there is no pan-European GP organization equivalent to the specialists' EACCME. There is a group called The European Union of General Practitioners (www.uemo.org) but they have not yet developed an accreditation system. GPs do not have access to many large meetings at the national or international levels; their CME still tends to be provided at the local level by small professional organizations, and sponsored by the pharmaceutical and medical device industries. Few opportunities exist for European GPs to obtain international credits.

Common International Themes in CME

Continuous quality improvement (CQI) in health care is a concept that is now well established in most of the developed countries around the world. Various professional societies with a focus on quality of care have been formed, and a number of international congresses have attracted thousands of health care professionals. The International Society for Quality in Health Care (www.isqua.org.au), the European Forum on Quality Improvement in Health Care, which is organized by the British Medical Journal publishing group (www.bma.org.uk), and the Institute for Healthcare Improvement (www.ihi.org) run large annual meetings that provide the opportunity for the exchange of ideas among key opinion leaders.

However, the majority of international CME congresses in 2005 have been organized and conducted only on the North American continent. It seems to be an opportune time to emulate the CQI professionals and involve participants from other continents. Can we combine an examination of CME and quality of care? Do we have evidence that CME can improve quality of care? Evidence is scarce, but it will be actively discussed at the Global Alliance for Medical Education (GAME) meeting in Rome, June 18-20, 2006 (www.gamecme.org). This meeting, the first for GAME outside North America, will discuss quality of care and CME, and compare experiences in Europe and in North America.

Opportunities for Discussion of International CME

The Association for Medical Education in Europe (www.amee.org) is a very active organization whose annual meeting attracts more than 1000 participants to discuss medical education. However CME topics are not really the main focus of their meetings. In the US, the Alliance has established an International Strategies Committee that can provide a forum for open discussion of international collaboration in CME, but the vast majority of attendees at Alliance meetings are based in the US and Canada. The spirit of improving collaboration is the theme for the 2007 Alliance Annual Conference, and in this spirit GAME has planned its first meeting in Europe in collaboration with local CME professionals. The 11th annual meeting will be held June 2006, in Rome, in cooperation with UEMS and the Italian Federation of Scientific Medical Societies. This should be an excellent opportunity to explore opportunities for international collaboration and to share experiences with CME experts from North America and Europe.

References

1. Wentz DK. The development and growth of CME in the1970s. Almanac. 2006:28(2): 4-6.
2. Pardell H, Sierra G. Continuing medical education and continuing medical education accreditation in Spain. J Contin Educ Health Prof. 2003;23(4):244-246.
3. Vandendael K, Van Hemelryck F, on behalf of the Federation of European Cancer Societies. Continuing medical education and its accreditation-an overview of the situation in the European Union and in the United States. European J of Cancer. 2003;39:2430-2438.
4. Wentz DK. Lessons from comparing CME accreditation in Europe and in the United States. European J of Cancer. 2003;39:2422-2423.

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