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CPD in Rheumatology
European RecommendationsEuropean Recommendationsto Ensure Quality of Careto Ensure Quality of Care
Anthony D Woolfon behalf of the
UEMS Section of Rheumatology& European Board of Rheumatology
WFME March 2003
Quality of Health Care
The public need to be confidentthat they are receiving the highestquality of health care and achievingthe expected health gain
Ensuring the highest standards ofhealth care is essential for anyhealth care provider - organisationor individual
Post-graduate training should furnish theindividual with knowledge and skills whichenable him to be competent in the entire field ofRheumatology.Continuing medical education and professionaldevelopment is to guarantee the maintenanceand up-grading of knowledge, skills andcompetence following completion of post-graduate training.This process of lifelong learning is to enable theindividual to expand and fulfil their personaland professional potential to meet the presentand future needs of patients.
CPD in Rheumatology
What is happening in Europe?
Practicalmovement of doctorsmovement of citizensfree communication of ideas
Legalright to free movement of labourwithin the European Union
Free Movement RequiresHarmonisation
Training– content and qualityClinical practice– similar outcomes assessed by auditContinuing medical education– similar standards and requirements– mutual recognition of educational
activities
European Union of MedicalSpecialists (UEMS)
The statutory purpose of the UEMS is the harmonisation andimprovement of the quality of medical specialist practice in theEuropean UnionEducation is a key element to achieving thisCharters have been developed on Training and on ContinuingMedical Education and Professional Development of Medicalspecialists in the European CommunityThe UEMS Section of Rheumatology and the European Boardof Rheumatology have developed recommendations specific torheumatology. Consensus was achieved by review of existingtraining requirements and programmes followed byworkshops with representation from the various Europeancountries.The recommendations for CME / CPD are presented
Chapter 1 Professional Co-ordinating AuthorityChapter 2 Structure of CMEChapter 3 Availability of CMEChapter 4 Assessment and Accreditation of CMEChapter 5 Quality Assurance of CMEChapter 6 European Co-ordination of CMEChapter 7 Migration of medical specialistsChapter 8 Financing of CME
U.E.M.S. CHARTER ON CONTINUINGMEDICAL EDUCATION (October 1994)
Charter on CME in RheumatologyCore curriculum for CME / CPDStandards for quality assurance ofCME activities
U.E.M.S. Section of Rheumatology /European Board of Rheumatology:
Setting Standards for CMESetting Standards for CME
Process of DevelopmentCommittee with an academic and a professionalrepresentative from each European countryReviewed specialist training programmes andregulations for CME / CPD in the differentcountriesSurvey of competencies utilised by rheumatologiststhroughout EuropeWorkshops to achieve consensus with review ofrecommendations by member nationalorganisations
U.E.M.S. Section of Rheumatology /European Board of Rheumatology:
Setting Standards for CMESetting Standards for CME
Charter on CME in Rheumatology
Individual responsibilitiesCurriculum and standards to be maintained– 5 year cycle– maintainance of competency and delivery of highest
standards of care– demonstrate by participation and competency
Requirements of CME– national / European recommendations
Assessment of educational need by individuals (casereview, audit)Demonstration of competency (log book, assessmentsof competency)
U.E.M.S. Section of Rheumatology /European Board of Rheumatology:
Setting Standards for CMESetting Standards for CME
Charter on CME in RheumatologyCore curriculum for CME / CPDStandards for quality assurance ofCME activities
European Board of Rheumatology:Core Curriculum for CME
General remarks– Description of the discipline– Goals of CME and CPD
General knowledge, skills and attitudesSkills of the SpecialityOptional skills of the Speciality
General Principles
A rheumatologist must maintain theirclinical skills by regular contact with peoplewith muscuolskeletal conditions, and haveresponsibility for their diagnosis andmanagement, and by participating inappropriate coursesThere should be ongoing experience of thespectrum of musculoskeletal conditions
General knowledge, skills and attitudes , e.g– basic knowledge– knowledge of the rheumatic diseases– clinical skills– laboratory tests– imaging– bone measurement– drug therapies– role of allied professionals and other medical specialties– patient education and self management– socioeconomic and legal aspects– research– communication skills– health care delivery
European Board of Rheumatology:Core Curriculum for CME
Skills of the Speciality– arthrocentesis– synovial needle biopsy– soft tissue injections– counselling skills– management skills– audit methodology and outcome measures
European Board of Rheumatology:Core Curriculum for CME
Optional skills of the SpecialityPerform, and interpret where appropriate:– various biopsies– x-ray examinations, ultrasonography, peripheral MRI– bone densitometry– laboratory investigations– electromyography– arthroscopy– non-surgical synovectomy– epidural and regional nerve blocks– manipulation and mobilisation techniques– capillaroscopy– intervertebral disc aspiration, injection or nucleolysis
European Board of Rheumatology:Core Curriculum for CME
CME Activities
Reading journals and textbooksMeetings - local, national, internationalIn-hospital activitiesInformal contacts discussing cases withcolleaguesDistance learningAudit
But tendency to teaching not learning
Evidence Based MedicineSackett and Haynes 1995
Convert information needs into answerablequestions which must be specific giving precisedetails of patient, clinical intervention andoutcome of interestIdentify best evidenceCritically appraise that evidence for validity(closeness to truth) and usefulness (clinicalapplicability)Apply results of this appraisal in clinicalpracticeEvaluate performance
U.E.M.S. Section of Rheumatology /European Board of Rheumatology:
Setting Standards for CMESetting Standards for CME
Charter on CME in RheumatologyCore curriculum for CME / CPDStandards for quality assurance ofCME activities
U.E.M.S. CHARTER ON CONTINUINGMEDICAL EDUCATION
European Accreditation Council for CMEumbrella structure for the affiliatedprofessional CME authoritiesclearing house for accreditation and CMEcredits in Europe
AssessmentTo demonstrate that we havethe highest level of skillsTo demonstrate a high standardof clinical practice producingthe best outcome for the patient
AssessmentMCQ at EULAR 1998 GENEVA
A quiz open to all participants from differentcountries based on Swiss examinationMCQ– true / false single correct answer– true / false multiple correct answers– matching statements / pictures
Language not a problemPerformed well with good discrimination
SET STANDARDS
OBSERVE PRACTICE
COMPARE WITH STANDARDS
AGREE CHANGESNEEDED
INTRODUCECHANGE
REVIEWSTANDARDS
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