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Accreditation of the higher institutions in the EU – focus on Continuing Medical Education (German experience)

Workshop on Continuing Medical Education system in European Union and possibilities of its implementation in Armenia

Yerevan, 21. May 2010 PD Dr. Dr. Walter Wohlgemuth

Institut für Medizinmanagement und Gesundheitswissenschaften,Universität Bayreuth

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AGENDA

• Study course in Medicine in Germany - Lessons Learned

• Continuous Medical Education for physicians

• Accreditation of Higher Educational Institues - German experience

• Summary

Earning a medical degree in Germany

• Nationwide regulation of rules and conventions regarding the structure and process to earn a medical University degree in Germany

• Application of the study course is regulated by a central agency: „Zentrale Vergabestelle Studienplätze“ (ZVS)

• 20% of the university places via numerus clausus (best ~ 3% graduates of school)

• 20% via waiting list (waiting time weighted with school grade)

• 60% by individual selection process of Medical Universities (school grade, practical experience, personal motivation interview)

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Lesson learned: Unfavorable selection of candidates studying medicine if selected only by school grades (automatism: the „best“ study medicine)

Studying Medicine in Germany

• Minimum 6 years (mean 12.9 semesters/terms = 6.5 years))

• Preclinical sciences: 2 years 1. State Exam• Clinical sciences: 4 years, incl. 4 months of bedside training in

4 different subjects 2. State Exam

• During last year practical bedside training in an academic teaching hospital for at least 48 weeks in 3 different subjects• Mandatory: surgery and internal medicine• One elective subject (in- or outpatient speciality)

• Two State Examinations („Ärztliche Prüfungen“), written and oral, are consistent for all Medical Universities in Germany

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Subjects and specialities to be passed

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Lessons learned from different reforms of the study course in Germany

• Ongoing reforms of the University study course in medicine due to recognized weaknesses led to the current curriculum

• From 4 centralised State Exams to 2 State Exams more decentral ongoing exams at the level of the individual Medical University

• From Multiple-choice based written questions to individual interview-based oral examinations combined with written tests

• From overweight of fundamental scientific, more academic contents to more practical application-oriented skills needed in vocational practice of the physician

• Problem-focused, case-oriented/anecdotical learning (POL) in small groups

• University-internal examinations as OSCE (objective structured clinical examination) link cognitive knowledge with practical skills and also diagnostic thinking

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Permission to work as a physician

• The final grade (“Staatsexamen”) is composed of the grades of the two State Examinations with 1:2 weighting

• The “Approbation” is accepted by all EU Member States• License to practice medicine with Approbation

• Practicing as a physician allowed only under supervision of a medical specialist / consultant with advanced training in speciality

• Thus most physicians start their career in the hospital

• Establishment of a private practice as General Practitioner or in a Specialist Practice only possible after finishing the training course for a medical specialty (at least 5 years of practice + specialized examination)• Degree by the chamber of Physicians as Medical Specialist (e.g.

as Aneasthesiologist, Radiologist, Heart Surgeon, Internist etc)

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Education to Medical Specialist / Consultant

• Since 2003 new policies from the German Chamber of Physicians- “Musterweiterbildungsordnung (MusterWBO)”

• Different levels of qualification• Area (e.g. Gynecology and Obstetrics)• Core area (e.g. gynecological oncology)• Additional qualification (e.g. allergology, intensive care

medicine)

• Diploma awarded from the Chamber of Physicians of the different German countries

• Length of training depends on the area, at least 5 years, mean is 7.4 years to a degree as Medical Specialist

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MANDATORY Continuous Medical Education for physicians

• Physician are obligated to study lifelong after their degree• 2004: GMG law (Modernisation of the German compulsory

health insurance fund = SHI) :§ 95 d SGB V: obligates the SHI-authorized physician in private practice to continuous training and a mandatory certificate of the German chamber of Physicians §137 SGB V: every hospital-based Medical Specialist needs the same continuous training and certificate

• Over a period of 5 years you have to collect 250 CME points to get the mandatory certificate• 1 CME point corresponds to 45 min of education• Every vocational education activity can apply for CME points at the

Chamber of Physicians• Different ways / categories to collect CME points

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Eight categories of education

• category A• Presentation and discussion, 1 point/training unit, max. 8

points/day

• category B• Convention that last several days, national and international, 3

points/½ day or 6 points/day

• category C• Training with planned contribution of every participant, 1

point/training unit, 1 additional point for trainings up to 4 hours

• category D• Structured interactive training, 1 point/training

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• category E• Private study, within five years you can get 50 points at max

• category F• Scientific publications and presentations, authors get one point

per contribution, referees get one additional point

• category G• Hospitations, 1 point/hour, max. 8 points/day

• category H• Special curriculum, 1 point/unit

• Plus learning controls: 1 additional point in categories A and C

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Eight categories of education

• Initial resistance of the physicians• Investment in time and money

• Huge administrative workload• For the physician and for the Chamber of Physicians• Largely computer-based registration of CME points necessary

• Every physician has a unique ID number• Scanners at larger congregations• Internet

• Takes 2 years to establish this system

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Lessons Lerned until now in compulsory CME certificate for physicians

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ACQUIN: BASIC INFORMATION

• Founded in 2001 based on the initiative of the Bavarian University Rectors´ Conference to establish an independent agency

• In 2001 accredited by the German Accreditation Council, re-accredited 2006

• Non-profit organisation, independent

• Operating nationally and internationally

• Open to all subject fields

• Over 150 members, mostly Higher Education Institutions (HEI)

• So far about 1300 study programmes accredited

SCOPE OF ACTIVITIES

• Accreditation of Bachelor and Master study programmes (Germany, Bulgaria, Egypt, Poland Czech Republic, Switzerland, Korea), 2008 application to the Accreditation Council for System Accreditation

• Standard Expert Commitees (SEC): appointment of peer groups, statements to each accreditation procedure, ensuring consistency of accreditation procedures (9 SEC: Mathematics/Natural Sciences, Economics/Law/Social Sciences, Engineering, Informatics, Humanities, Architecture, Fine Arts, Music and Design, Medical Sciences, System Accreditation)

• Peer Groups: at least 5 members: 3 professors, 1 student, 1 representative of professional practice. Evaluation of the study programme on the basis of the submitted self report and the information gathered by the on-site-visit (duration 2 days), writing of a peer report

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INTERNATIONAL ACTIVITIES

• European Association for Quality Assurance in Higher Education (ENQA), full member

• International Network for Quality Assurance Agencies in Higher Education (INQAAHE), full member

• Central and Eastern European Network for Quality Assurance in Higher Education (CEEN), full member

• European University Association (EUA), associate member

• Arabic Quality Assurance and Accreditation Network (ARQAANE), associate member

PURPOSE OF THE NETWORKS

• Development of quality assurance in higher education

• Enable quality assurance agencies to share information and experiences

• Encourage and assist continuous improvement in member agencies

• Development and promotion of standards in quality assurance

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EXAMPLE OF A STUDY PROGRAMME ACCREDITATION

1. Contract between HEI and accreditation agency

2. Self-evaluation report

3. Appointment of the review team (by the Standing Expert Committee)

4. Assessment of self-evaluation report and on-site visit

5. Report including accreditation recommendations

6. Statement/ response HEI

7. Statement Standing Expert Committee

8. Final decision on accreditation through accreditation commission

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SUBJECTS OF ASSESSMENT

• Objectives/aims of the institution and the programme

• Curriculum (structure, contents, transpareny)

• Implementation (organisation and decision-making processes, resources: staff, infrastructure)

• Quality assurance mechanisms

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OBJECTIVES OF THE INSTITUTION AND THE PROGRAMME

• What were the primary reasons for introducing the joint degree programme (academic, professional, financial …)?

• Is the degree programme part of the institutional mission? Strategy of the HEI? Connection of this programme to other degree programmes?

• What are the specific objectives of the programme? Are they valid and transparent?

• What specific competences, abilities, skills and knowledge should the students gain (learning outcomes, linguistic aims)?

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CURRICULUM

• Structure of the programme (e.g. obligatory, elective courses)

• Does the curriculum achieve the defined objectives?

• Is the curriculum consistent? Is it transparent?

• What forms and methods of teaching are used? Are they suited to achieve the defined objectives?

• Organisation of the examination system (e.g. cumulative or final exam)? Grading schemes compatible on international level? How is the consistency of grading ensured across the partner institutions? What happens if a student fails an exam and has to move to another institution? Transparency of study and examination regulations?

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IMPLEMENTATION (1)

Resources

• Continuous funding assured?

• Sufficient professors, administrative, technical, and other staff?

• Is the teaching staff competent with respect to the profile and aims of the study programme? Teacher-to-student ratio?

• (International) linguistic ability of the staff?

• Support by the HEI for the programme?

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IMPLEMENTATION (2)

Organisation and decision-making processes

• Is there a professional and institutionalised coordinating body?

• Definition of responsibilities?

• Organisation of the communication?

• Organisation of the obligatory mobility phases within the joint degree programme?

• Can students participate in shaping the study programme (decision making)?

• Are professional experiences integrated in the study programme?

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QUALITY ASSURANCE

Quality assurance mechanisms

• How do the partners ensure that all legal stipulations are fulfilled?

• How are the aims and objectives of the programme validated?

• Are professionals involved in the qualitiy assurance mechanisms?

• Does the faculty/ HEI carry out quality controls of the programme?

• How are results of these controls being integrated in the further programme development?

• Are the measures taken suitable with regards to the study programme?

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POSSIBLE RESULTS OF AN ACCREDITATION PROCEDURE (1)

• Accreditation without conditions (5 years)• Conditional accreditation• Postponement of accreditation decision• Refusal of accreditation

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POSSIBLE RESULTS OF AN ACCREDITATION PROCEDURE (2)

• Unconditional Accreditation: The study programme has valid objectives, it is coherent and transparent with regards to the self-defined objectives

• Conditional Accreditation: The study programme has valid objectives and is mostly coherent and transparent, improvement in some areas is necessary for unconditional accreditation (mean 3.4 conditions per study programme)

• Postponement of accreditation decision: The study programme has potential but needs major improvement

• Refusal of accreditation: The study programme has no valid objectives, it is not coherent and transparent with regards to the self-defined objectives

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MAIN PROBLEMS IN (denied) ACCREDITATION PROCESS

• Modularisation and ECTS: • Definition of content and qualification aims of a module• Prerequisite for ECTS points

• 1 ECTS point = 30 h workload; max. 30 points per term / 60 per year

• Conceptual issues: • Coherent concept of the study course according to the qualification

aims• Interdisciplinary knowledge• Methodological and generical competences• Didactical concept

• Teaching stuff (minor issue): • Quantity and sometimes quality issues

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SUMMARY

• University study course in medicine • Unlike other University courses needs a lot of hands-on training• Examinations with a combination of cognitive knowledge with

practical skills and diagnostic thinking

• Compulsory CME certification for all physicians• Investment in time and money, but better quality due to lifelong

learning

• Accreditation of Higher Educational Institutions (HEI)• Study courses in HEI vary in quality• Accreditation process is worthwhile for everybody

(students, University staff and society)

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THANK YOU FOR YOUR ATTENTION!

PD Dr. Dr. Walter Wohlgemuth1,2,3

1) Klinikum Augsburg, Stenglinstr. 2, D-86156 Augsburg, Germany2) Institute for Management in Medicine and Health Care Sciences, University of Bayreuth, D-95444 Bayreuth, Germany3) ACQUIN e. V., Prieserstr. 2, D-95444 Bayreuth, Germany

Mobile: 0049 -179 77 98 0 99Contact: w.wohlgemuth@online.de

Institut für Medizinmanagement und Gesundheitswissenschaften,Universität Bayreuth