The drive toward improved continuing medical education learning outcomes in Europe is complicated by the fact that European countries don’t all follow the same model when it comes to CME regulatory frameworks, the position of CME within the medical education path of that country’s healthcare providers, and how CME is funded. At the Global Alliance for Medical Education Annual Meeting, held in Toronto in May, Madeleine Schaffer, chief executive officer of the European Institute for Medical and Scientific Education, walked attendees through the different influences that shape how CME is conducted in the different European countries. The presentation was based on a scientific study EIMSED conducted in cooperation with White Cube Health Care that was published recently in the Journal of European CME.
As she said, “Harmonization of the CME systems across Europe seems to be on its way”—10 of the 11 countries studied have implemented a credit-based CME system, and 10 countries have made participation in certified CME mandatory. However, that doesn’t mean that there aren’t still significant differences to overcome. For example, while CME may officially be mandatory in a country, there may not be any consequences for not completing the required hours. In the Ukraine, physicians who don’t complete the required credits lose their licenses; in Germany, while the loss of one’s license is a possibility, the more certain consequence is a 30 percent lower reimbursement rate for those who do not complete the required CME. The other countries included in the study were Austria, Belarus, the Czech Republic, France, Great Britain, Italy, Hungary, Spain, and Switzerland.
Using a structured questionnaire, online research, and interviews, the researchers looked at the full spectrum of medical education, from pre- and post-graduate medical education through CME. They also looked at how each country’s healthcare system and culture factored into the quality of individual CME programs and multi-country collaborations. Specifically, they determined the roles and responsibilities related to CME in each country, such as who makes the decisions, who provides the regulatory framework, and what the funding model is. They found that, with some variations, the countries fell into one of three main CME models: physician-centric, politician-centric, and university-centric.
Docs in the Driver’s Seat
Germany, Austria, Italy, and the Czech Republic fell squarely into the physician-centric model, as do the U.K. and Switzerland, with some variations. In this model, the country’s medical chamber, association, or other official physician representative organization develops the regulatory framework for CME and approves activities.
On the plus side, the doc-centric model gives learners more choice, is more flexible, and enables lots of different providers to develop CME activities. However, this model’s unstructured approach lacks a cohesive curriculum, is highly dependent on commercial supporters (which may lead concerns about bias), and doesn’t encourage university involvement in CME.
Government Takes Charge
In Spain, France, and somewhat in Italy, the ministry of health provides the regulatory framework for CME and is responsible for the organization and management of CME through an executive body. While this model provides a more structured approach and independent funding through the tax system, it also keeps CME separate from the university realm, and because there are fewer CME providers, it may be slower to develop new programs. There also is the possibility of bias, in this case toward government priorities.
University as CME Hub
When universities are responsible for managing CME and are the main providers, as is the case in Ukraine and Belarus, the CME system tends to be centralized, clearly structured, curriculum-based, and closely integrated with the full career arc of physicians from pre- to post-graduate. The rub is that there is a high risk of governmental bias, and that funding can be tight. In this model, the regulatory framework is provided by the ministry of health.
What They Learned
“It’s essential to know about the CME management system of each country—how their physicians are accustomed to learning, and what they are legally obligated to learn,” said Schaffer. “Providers need to understand the structure and systemic differences among countries that may on the surface look similar” if they want to provide education that will resonate with learners in other countries. While it was not part of this study, she said that EIMSED also has outcome data that clearly show that learning outcomes improve when this type of background information is integrated into the entire educational planning process.
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