Cardiology Training in Europe: Assessing Standards

Dr Jim Hall Vice-President Training UEMS-Cardiac Section

Middlesbrough UK

CONFLICTS ON INTEREST

1. Honoraria for lectures – None for >5 years

2. Honoraria for advisory board activities – None for >5 years

3. Participation in clinical trials – No current CI or PI roles

4. Research funding – No current personal grants – No institutional grants relevant to this topic

2 low financial conflicts

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Cardiology Training in Europe: Assessing Standards

➢Background – my background ➢Topic background - mobility of physicians ➢Links to political strategy – EU directives ➢What is UEMS ➢Training Requirements for the Specialty of

Cardiology ➢Assessment strategy

➢EEGC European Examination in General Cardiology

➢EDGC European Diploma in General Cardiology

MIDDLESBROUGH

Health professional mobility in a changing Europe Buchan et al European Observatory on Health Services and Policies 2014

EXAMPLE OF MOBILITY OF PHYSICIANS IN EUROPE

GERMANY 1995 – 2012

DOCTORS REGISTERED WHO QUALIFIED OUTSIDE GERMANY

MOBILITY OF PHYSICIANS IN EUROPE – POLITICAL STRATEGY

The European Union has 28 member states total population of 505 million people

• EU Directives 2005/36/EC and 2013/55/EU on the Recognition of Professional Qualifications

– Aim to facilitate the free movement of EU citizens by making it easier for professionals qualified in one Member State to practise their profession in another

MOBILITY OF PHYSICIANS IN EUROPE – POLITICAL STRATEGY

The European Union has 28 member states total population of 505 million people

• EU Directives 2005/36/EC and 2013/55/EU on the Recognition of Professional Qualifications

– Aim to facilitate the free movement of EU citizens by making it easier for professionals qualified in one Member State to practise their profession in another

“CARDIOLOGIST = 4 years training”

UEMS

The European Union of Medical Specialists (UEMS) - formed in 1958

✓ representative organisation for National Associations of Medical Specialists in Europe - over 1.6 million medical specialists 

✓ aims to promote harmonization of postgraduate specialty training to common high standards

✓ works through 43 Specialist Sections  - each addressing training in their respective Specialty

Cardiac Section – cardiologists delegated through their NMA - Training Requirements for the Specialty of Cardiology - Assessment of training – EDGC, EEGC - CME accreditation – EBAC and CCC - journal - Continuing Cardiology Education

UEMS

The European Union of Medical Specialists (UEMS) - formed in 1958

✓ representative organisation for National Associations of Medical Specialists in Europe - over 1.6 million medical specialists 

✓ aims to promote harmonization of postgraduate specialty training to common high standards

✓ works through 43 Specialist Sections  - each addressing training in their respective Specialty

Cardiac Section – Training Requirements for the Specialty of Cardiology “CARDIOLOGIST = 4 years training that is …….…..”

http://www.uems-cardio.eu

UEMS 2012/29: Training Requirements for the Speciality of Cardiology

Defines: • Training

– Expectations of training environment – Expectations of trainers – Expectations of trainees

• Competences to be achieved

• Assessment strategy

MILLER’S TRIANGLE

MILLER’S PRISM

European Diploma General Cardiology

In addition to a National Licence as a Cardiologist

European Diploma in General Cardiology (EDGC) will provide confidence to a patient or regulator or employer that training was to a satisfactory level of competence

EDGC requires assessment of

✓ knowledge ✓ skills ✓ professionalism

European Diploma General Cardiology

In addition to a National Licence as a Cardiologist

European Diploma in General Cardiology (EDGC) will provide confidence to a patient or regulator or employer that training was to a satisfactory level of competence

EDGC requires assessment of

✓ knowledge – European Examination in General Cardiology ✓ skills ✓ professionalism

EEGC - ASSESSMENT OF LEARNING

• What are we wanting to determine? – Knowledge and its use in clinical reasoning

• Pass/fail or ranking? – Pass/fail

• Utility – a composite function of Validity, Reliability,

Educational Impact, Acceptability, Cost and Defensibility

• REMEMBER - Assessment drives learning

EEGC

• An assessment of knowledge • Mapped to the curriculum • MCQs • Clinical scenarios • Interpretation -aimed at understanding

and use of knowledge • Pass/fail (expectation 85-95% pass rate)

Multiple Choice Question

a clinical stem + possibly an image still image (approx 16%) or video loop (approx 8%)

followed by a single question

then a series of five choices (single correct)

Collaborative venture

EEGC

National Cardiac

SocietiesESC

University of

Cologne

UEMS Cardiac Section

Delivery in testing centres

• 120 MCQs in 3 hours

• Individual computers

• Invigilated sitting at exam centre

How it fits in with cardiology training

Common Trunk Internal

Medicine

CARDIOLOGY TRAINING CORE ADVANCED

EEGC

Integrating with subsidiarity principle

Medical School

Certification Completion of

trainingNat

ion

al

lev

el

How to Prepare

Advice:

Cardiology training prepares trainees for a career in cardiology and hence an aptitude for lifelong learning is essential. No limited list of appropriate sources of information. Trainees are encouraged to read widely and use whatever means they prefer for keeping up-to-date.

How to Prepare

Advice:

Cardiology training prepares trainees for a career in cardiology and hence an aptitude for lifelong learning is essential. No limited list of appropriate sources of information. Trainees are encouraged to read widely and use whatever means they prefer for keeping up-to-date.

Examples of good sources of knowledge include: ✓ Textbooks e.g. ESC textbook of Cardiovascular Medicine ✓ Guidelines e.g. ESC clinical practice guidelines ✓ Educational articles e.g. Education in Heart ✓ On-line reviews e.g. Uptodate ✓ On-line educational material e.g. Continuing Cardiology Education ✓ Academic journals e.g. NEJM, EHJ, Lancet, Heart

Running the EEGC

Question Writing Group

Meet twice a year 3-5 nominated writers per country ~ 25 MCQs submitted/writer/year Peer review groups (4-6 reviewers / group)

Editing / accept / return to sender / reject ~ 10 accepted to the MCQ bank/writer

Question Selection Group

Meets once a year 1 member per country

Focus on a category of MCQs from the bank Selects 36 MCQs

Selection template 50% new 25% used 2 yrs 25% used 3 yrs quarter of questions should have image(s) still (16%) or video (8%) avoid repetition of topic

Standard Setting Group

Meets once a year 1-2 members per country ➔ 8-10 strong

Group not all are Question Writing Group members trainees included cannot be a Question Selector

Each reviews and scores all 150 MCQs what % of ‘just-passing’ candidates would get this right?

Exam Board

• Exam performance review

• ‘examinology’ – psychometric analysis – review of item performance – review of candidate performance – passmark adjudication – independent scrutiny of high stakes exam

by University of Cologne

How it is developing

Pilot phase

First pilot in the UK 2009

– 60 candidates – 22 ST3, 31 ST4 – Mean score ST3 or below 61.4 (n=23) – Mean score ST4 or above 65.5 (n=37) – Validation of exam template

→ mandatory annual exam since 2010 ~100 candidates/year

European Pilot in 2012

Spain, Portugal, UK, Netherlands and Ireland

80 candidates Pearson Vue centres in 5 countries

Raw Score out of 117 Min, Max and Interquartile Range

7 Countries had exam candidates in 2016 – Greece – Ireland – Netherlands – Spain – Portugal – United Kingdom – Malta

Current status

EEGC candidates/year

0

100

200

300

400

2012 2013 2014 2015 2016

EEGC

• New countries - candidates 2017 – Switzerland, Cyprus

• New countries at QWG – candidates 2018 – Finland, Sweden, Germany

EDGC – skills assessment

Skills • the Eucardia logbook will document - the type and

numbers of procedures performed during training; the procedural and/or disease variables; the results of Directly Observed Procedural Skills assessments

• a final statement of the trainer(s) regarding the level of competence achieved

Methods of Assessment

EEGC knowledge based assessment

DOPS directly observed procedural skills

Mini-CEX mini clinical evaluation exercise

CBD case based discussion

Multi-rater feedback of behaviour & attitudes

EDGC - assessment of professionalism

Proof of valid licence

• 360° appraisal using relevant documents online

• If not feasible: courses in communication skills etc

• document additional qualifications/research activities/educational activities/participation in quality assurance activities etc

The management platform for the EUROPEAN DIPLOMA GENERAL CARDIOLOGY

Training in Cardiology in Europe: assessing standards

Dr Jim Hall Vice-President Training UEMS-Cardiac Section

THANK YOU FOR YOUR ATTENTION - ANY QUESTIONS?