EBP meeting Rzeszow, 28-29 May 2014

Jean-Christophe Mercier

Agenda

1. Approval of the agenda

2. Approval of the minutes of the last EBP meeting, Brussels, 14th Dec 2014

3. Report of the EBP Chair

4. Discussion of the project of an European Diploma in general paediatrics.

5. Accreditation of Centres of Excellence in paediatrics.

6. Others

EBP Chair Report

1. RCPCH meeting, London, 27th February, 2014. 2. UEMS meeting on CME-CPD, Brussels, 28th February,

2014. 3. UEMS meeting with S & Boards, Brussels, 1st March,

2014. 4. UEMS council meeting, Brussels, 11th-12th April, 2014. 5. MJC in ICM meeting, Brussels, 11th April, 2014. 6. ESPNIC Job Analysis Task Force meeting, London, 28th-

29th April, 2014. 7. UK Department of Health, NHS England, European

Observatory on Health Systems & Policies meeting on ‘Reducing avoidable mortality in England’, London, 12th May, 2014.

8. EAPS Barcelona 2014 SC meeting, Amsterdam, 25th-26th May 2014.

RCPCH meeting, London, 27th February, 2014

• Key objectives : – To update the RCPCH about the EAP – To share informations about the national structures and training

programs, particularly in the UK & France

• Discussion on the possible involvement of the RCPCH in the development of a European Diploma in Paediatrics: – Common Trunk, Chapter 6 for paediatrics? – ‘Exit’ exam (EAP) vs. ‘entry’ exam into the paediatric speciality (UK)?

• Sharing informations on the respective medical workforces: – Relatively poor paediatric health indicators in the UK (Wolfe I et al,

Lancet 2013) – Decrease in the number of academic paediatric centers in order to

match the respective numbers of consultants and trainees – Challenge of the UK GP-model by developing ambulatory care

paediatricians and improving training in paediatrics of the GPs

The MRCPC four exams

MRCPCH Foundation of Practice

MRCPCH Part 1a

MRCPCH Theory and Science MRCPCH Part 1b

MRCPCH Part 2 – Applied Knowledge in Practice

MRCPCH Part 2 Written

MRCPCH Clinical

MRCPCH Part 2 Practical

www.rcpch.ac.uk/training-examinations

Communication Skills 2

Clinical: Cardiovascular 6

History taking and Management Planning

3 (22 mins)

Clinical: Abdomen

8

Clinical: Neurological/

Neurodisability 10

Clinical: Respiratory 7

Child Development 1

Clinical: Musculoskeletal

9

Video Scenario 4

(22 mins)

History taking with child and parent. Identification of key issues, and management plan

2 stations testing ability to give and discuss information with a child, parent or colleague (9min each)

10 short clinical videos, testing acute assessment, diagnosis, initial management

Short cases: testing clinical approach, examination skills, and interpretation of clinical signs

(9 mins each)

Clinical assessment of development in a young child (not psychometric testing) (9 mins)

The MRCPCH Clinical Examination circuit ( total examination time 152 minutes, with 4 minutes between stations)

Communication Skills 5

The Clinical Examination circuit – 10 stations

UEMS meeting on CME-CPD, Brussels, 28th Feb, 2014 • Session 1 – The Political Environment

Keynote Speaker : Dr. Andrzej Rys, Director, DG Health & Consumers, European Commission

Speaker : Mr. András Zsigmond, Policy Officer, DG Internal Market & Services

• Session 2 – The view of the profession

Implementation of the new criteria for the accreditation of Live Educational Events (LEEs) – Dr. Edwin Borman, UEMS Secretary-general

Recent developments and upcoming trends in CME-CPD in Europe – Dr. Len Harvey, UEMS Honorary member

The International perspective:

– Dr. Alejandro Aparicio, Director, Div. of Continuing Physician Professional Development, American Medical Association

– Dr. Murray Kopelow, President and Chief Execitive Officer, ACCME

• Session 3 – The view of external partners

The view of European Organisations:

– Ms Aline Lautenberg, EUCOMED General Counsel, Director Legal & Compliance

– Ms Nicole DEnjoy, COCIR Secretary general

The view of Providers:

– Ms Julie Simper, Director of Continuing Education, Kenes Education

– Mr Eugene Pozniak, Managing Director, Siyemi Learning

– Dr. Sophie Wilson, Director, CME Services, International Medical Press

– Ms Rachel Clark, CEO, SSIF

The view of Funders:

– Conversation with representative from major funding companies

• Session 4 – Team-working session

Participants were divided into 6 groups that each dealt with the following topics:

The Future:

– Areas for further development

– Responding to new technologies

– What more should the EACCME® accredit?

Conflict of Interest (actual, potential, resolution)

Needs assessment, learning objectives and educational outcomes

• Session 5 – Looking ahead www.uems.eu/news-and-events/news/news-more/uems-conference-on-cme-cpd-in-europe

UEMS meeting with S&B, Brussels, 1st March, 2014

• The European political agenda: establishing European Reference Networks Dr. Andrzej Rys, Director, and Dr. Enrique Terol, Policy Officer DG for Health and Consumers, European Commission

• Overview of the UEMS’ activities UEMS activities and future challenges. Prof Romuald Krajewski, UEMS President CME Accreditation for LEEs and e-learning materials. Dr. Edwin Borman, UEMS Secretary general Harmonisation of Specialist Training. Dr. Zlatko Fras, UEMS Past-President

• Areas of cooperation between UEMS and European Scientific Societies • Elaborating Training Requiremeents for European Radiotherapists and Radiation Oncologists. Prof. Vincenzo Valentini

from the European Society for Radiotherapy and Oncology • Drafting a European Curriculum for Respiratory Physicians: an inclusive approach paving the way to successful outcomes.

Dr. Martin Balzan. Section of Pneumology. • Organising high quality European assessment and visitation of Training Centres: the European Board of Ophtalmology’s

leading role in Europe. Prof. Hank Bonnemaijer. Section of Ophtalmology. • Robust evaluation of EEs for Allergologists in the framework of EACCME. Prof. Pascal Demoly, European Academy of

Allergy and Clinical Immunology, together with Dr. Jacques Garaud, Section of Allergology and Clinical Immunology. • EU standards on access to care for women in Europe. Prof. Chiara Benedetto, European Board and College of Obstetrics

and Gynaecology. • Constructive dialogue and effective cooperation in Surgery: key success factors for major achievements. Prof. Vassilios

Papalois, Section of Surgery. • Cooperation for the benefit of European Cardiologists. Dr. Zlatko Fras, Section of Cardiology. • European Anaesthesiology: strong partnership for high quality perioperative care. Prof. Lennart Christiansson, European

Board of Anaesthesiology. • Current and future challenges of the medical profession • Interactive session chaired by Dr. R. Krajewski. • Wrap-up discussion and conclusion

www.uems.eu/news/news-more/european-societies-and-uems-discussed-increased-co-operation

UEMS Council meeting, Brussels, 11th April, 2014 (morning)

• European Reference Networks (DG Health & Consumers): – Directive 2011/24/EV on the application of cross-border healthcare – The EC seeks help from the UEMS to develop Reference Networks – Two candidates already:

• Network on paediatric oncology • Network on complexe neurological diseases (refractory epilepsy)

– Calendar: • 23rd June, 2014: Brussels awareness calendar • June-Dec, 2014: Preparation of network proposals • March-April, 2015: call for proposals

• UEMS proposal to host section websites within a single portal ‘UEMS central’: – Section websites should have a similar look as the UEMS one!

UEMS Council meeting, Brussels, 11th April, 2014 (afternoon)

• UEMS WG on CME-CPD (Prof. Emeritus, Nigel D.S. Bax, U. of Sheffield) – In the 2000’s, very weak student education and related matters – U. of Sheffield decided to develop e-learning and e-assesment – Very efficient system (15,000 hits a day), very simple, very robust – We offer the platform for free to the UEMS.

• UEMS WG on PGT (Prof. Zeev Goldick, Haifa, IL) – Two meetings a year, next one in Innsbruck – Very impressive list of the specialities running diploma

• UEMS’ call to identify the specialities officially recognised by NTAs in Europe.

• Discussion forum on malpractice and medical liability in Europe (Dr. Santo Davide Ferrara, U. di Padua) – Int J Legal Med 2013; 127(3):541-13

UEMS Council meeting, Brussels, 12th April, 2014 (General Assembly)

1. Approval of the agenda, minutes of Paris GA 2. Report of the Secretary general (Edwin Borman) 3. Continuing Medical Education (Trevor Duffy) 4. Medical Specialist Qualifications (Zlatko Fras)

– The EULOG project (U. Sheffield & U. Maastricht) – UEMS documents on MCQs development

5. Specialist Issues (Romuald Krajewski): see next slide) 6. Statutory issues (not really discussed)

– Admendment to the Rules of Procedures (UEMS 2014/xx) – Admission of Morocco as an observer

7. EU affairs: – Electronic professional card – EU Healthcare Workforce

European Training Requirements (Chapter 6 for the speciality, rewritten according to the UEMS rules)

1. Child and Adolescent Psychiatry and Psychotherapy (Dr. Brian Jacobs, UK) 2. Paediatric Surgery (presenter?) 3. Paediatric Urology (Dr. Jorge Thorup, DK)

– « There is a definite need to organise a meeting between the UEMS section of paediatrics and its specialities and other specialities (eg, Respiratory medicine, or Emergency medicine) ». JCM

– We plan to organise a full day meeting one day before the next UEMS Council meeting (Granada, 17-18th October, 2014). Edwin Borman

4. Rheumatology (Pr. Nada Cikes) 5. Position paper on EU strategy and Health at work 6. Declaration on molecular biology (not approved) 7. Isernia declaration on diet (Dr. Giorgio Berchini) 8. Standards of care in Gynaecology (Prof. Chiara Benedetto) 9. Explanatory notes on the functioning of UEMS specialist sections (Dr.

Ronald Krajewski) 10. Creation of a MJC in phlebology (Dr. Cees Wittens, NL) 11. Creation of a MJC on accredited skill centers (Prof. Vasilios Papalois, UK)

MJC on ICM, Brussels, 11th April, 2014

• E-meeting, 28th October, 2013: – Appointment of an interim President (Prof. Benoît Vallet => Prof.

Christiannsson) – Elaboration of European Training Requirements in ICM: Select from

COBATRICE the recommended and only desirable items for each section

• E-meeting, 29th January, 2014: – Election of a President, postponed since the Medical Intensivists were

not part of the process – Delays in the elaboration of the European requirements in ICM (see

HERMES document on respiratory critical care)

• Elections, 11th April, 2014: – President: Prof. Kai Zacharowski (Anästhesiologie, Frankfurt) – Vice-president: Prof. Jean-Christophe Mercier (Paed, Paris) – Secretary general: Dr. Joseph Galea (Surgery, Malta)

• Chapter 6 for Intensive Care Medicine in process

ESPNIC Job Task Analysis, London, 28-29th April, 2014 • ESPNIC has commissioned a Job Task Analysis from Kenes Intl for

the Diploma in Neonatal and Paediatric Intensive Care exam. • Purpose:

– To create a list of tasks and knowledge related to the work performed in PICU or NICU

– To develop the test specifications needed

• Participants: – Dr. Joe Brierley, GOSH, London, UK, ESPNIC Elect-President – Odile Frauenfelder, Erasmus, Rotterdam, NL, ESPNIC Nurse President – Andy Darbyshire, Alderhey, UK – Benedict Wagner, Inselspital, CH – Jean-Christophe Mercier, Robert Debré, Paris, F, EBP/MJC on ICM – herting@paedia.ukl.mu-luebeck.de – Marek Migdal, Children’s Memorial Health Institute, Warsaw, PL – virginija.zilinskaite@vuvl.lt – jozsef.stankovics@aok.pte.hu – tsoins@hkucc.hku.hk – sunit.singhi@gmail.com – nakagawa-s@ncchd.go.jp

Reducing Avoidable Mortality in England: Closing the gap with European countries and

identifying scope for action • Poor health indicators in England as compared to other

European countries • 4 topics:

– COPD: improving treatment through better integration - lessons from France, & Finland

– Liver disease:otimising detection and treatment - lessons from Scotland – Child health: saving lives through improving care – lessons from Sweden, &

France – Older women: gender-based approach in treating heart disease end cancer:

lessons from Sweden (Eurocare 5 countries)

• Two questions: – Do the patients differ? – Is the UK GP-model deficient?

Important issues emerging include:

• the organisation of first-contact models

• professional training

• provision of out-of-hours services

Flexible first-contact models could offer

a way to balance the need to provide

expertise with ready acces.

• ‘The French health-care system is often seen as one of the best’: ranked first of 191 states by WHO.1

• Indeed, France has: – A higher life expectancy (82 vs 79 yrs),

– A lower maternal mortality ratio (8 vs 20 p. 100,000 livebirths),

– And spends twice as much of per capita total expenditure on health.2

• However, despite universal coverage – ie, Sécurité sociale, CMU, AME, etc.

– and a public-private mix of hospital and outpatient care,

– health inequalities are increasing.3

• Reform to tackle chronic financial deficits incurred by French national health insurance.4

« I want to make health services more efficient by: • Reforming the system of payments to providers • Fostering interdisciplinary team practice • Reforming the delivery systems • Strengthening health information to help consumer choice • And facilitating access to health care data. »

The ‘National health strategy’ will reinforce Regional Health Agencies & propose a unique access to Health Care, ie, the GP.

Marisol Touraine, French Ministry of Social Affairs and Health

1. World Health Orgnization. 2000

2. www.oecd.-ilibrary.org/economics/country-statistical-profile-france-2013

3. European Commission, Health inequalities in the EU, 2013

4. Lang T. Haut Conseil de la Santé, 2010

A European Diploma in Paediatrics is desperatly needed!

Project of a European Diploma in General paediatrics

• Q1: What kind of exam do we need? – ‘Exit’ exam vs. ‘Entry’ exam into the paediatric

speciality (as the RCPCH organises it)?

– MCQs vs. MiniCEX?

• Q2: What program?

• Q3: How to develop it? – Independent EAP/EBP writing committee?

– Or working in close synergy with the RCPPH?

– Constituted of National experts in education

What program?

New (final?) draft pending May 2014

How to develop it?

• An independent EAP/EBP primary/secondary, tertiary care writing committee?

• Made of voluntary National experts.

• How many meetings? – Face-to-face (traveling and

housing expenses)

– Skype conferences?

• What about specialised paediatrics?

• An EAP/EBP writing committee

• Working in close harmony with the RCPCH experts (the full job is almost done…)

• A Franco-British alliance CNUP-RCPCH?

• Extended to other educational groups?

Rep. of Ireland

Malaysia

Hong Kong

Singapore

Egypt

Sudan

Malawi Zimbabwe

Malta

Nepal

Myanmar Jamaica

Trinidad

MIDDLE EAST CENTRES:

• Amman, Jordan

• Riyadh, S. Arabia

• Abu Dhabi

• Jeddah, S. Arabia

• Oman

• Kuwait

• Bahrain

• Qatar

• Iraq

Libya

Overseas Centres: One exam, 21 countries

• Questionnaire Chief of Training: – Basic data

– Medical personnel

– Clinical facilities

– Structure of the training center

– Records

– Quality assurance/Medical audit

– Registration of training

– Evaluation of trining

– Research activities

• Questionnaire for Trainees: – Personnel data

– Clinical experience (logbook)

– Process of the training

– Facilities for trainees

– Division of tasks among trainees and between trainees and staff

– Working hours

– Comments

• Checklist for Visitors: – Check informations provided by the chief of

training – Check the informations on the training

institution – Structure of out-patient department – Check #trainees and staff – Check #specialist diplomas w/i 3 yrs – Check #beds a trainee responsible for – Organisation of clinics, rounds – Admission arrangements – Emergency arrangements – Interaction with other disciplines – Interaction with Labs and X-Ray Dept – Clinical pathological conference – Intensive Care – Discharge – Research – Library – Interview of trainees

• Model Visitation Report: – Part 1 – Basic data teaching staff, trainees – Part 2 – Basic data training institution – Part 3 – Clinical activities

• # Admissions, hospitalisation times, yearly number of diagnostic and therapeutic procedures

• Records and database availability • Contact with other specialities • # Trainees, frequency of teaching rounds,

clinical conferences, etc.

– Part 4 – Research activities – Part 5 – Information from trainees – Part 6 – Conclusions – Part 7 – Recommendations – Part 8 – Visiting Committee

European Training Centre Visitation Program for Tertiay Care Paediatric Specialities

• Background: – CESP response to Paediatric Tertiary

care specialities by creating subsections in liaison with Scientific Societies

– European tertiary care Syllabi as a guidelines for national training programs.

– To achieve more objective evidence of training capacity, the UEMS has recommended visitation program

– The following outline summarises logistical details of such European Training Centre visitations

• Principles to be followed: – Visitation program results from

ccoperation between the EBP and the respective Scientific Societies.

– In order to ensure homogeneity between the various subsections, it’s mandatory to follow the same protocol.

– The Paediatric speciality societies contribute to this program by supplying manpower for these visitations.

– The liaison officer between the Paediatric speciality societies and CESP is responsible for coordination.

– The EBP chair supervises the entire visitation program Max Zach & Peter Milla, January 2003

European Training Centre Visitation Program for Tertiay Care Paediatric Specialities

• The Centre visitation task force consists of the following members:

– Task force chair (ie, liaison officer)

– Second international expert

– National training delegate

– National pediatric society representative

– Representative of junior doctor’s formation

• Visitation follows a standardised protocol which is well described

• A standardised approach in the training centre visitation:

– Centre assessment questionnaire

– Centre visitation report

– Centre visitation certificate

– Travel expenses reimbursement form

– Training centre list

• Financial aspects:

– A visitation is expensive: costs of Secretariat, traveling, lodging

– Honoraria (€1,000 for international and €500 for national members)

– Estimated total costs €6,000-7,000

– Who pays for it? Max Zach & Peter Milla, January 2003

Should we have a voluntary policy of accreditation of training centers in paediatrics in Europe?

• How to get involved the European Paediatric speciality Societies in the process? – Through UEMS paediatric subspeciality delegates?

– Should we organise a meeting between the EAP/EBP and European paediatric supseciality Societies?

• How to get involved the National training authorities in the process? – Through National academic delegates?

– Should we organise a meeting with the National Societies of Paediatrics in Brussels, next December?

• How to get it funded?

Conclusions

• As compared with other UEMS sections, the EAP is particularly slow in implementing UEMS requirements: – Training charter in a speciality (so-called Chapter 6 in Paeds).

– Diploma in (general?) paediatrics.

– Accreditation of training centres in paediatric specialities.

• As a general rule, EAP officers and delegates should be more active and at least involved in one task: – We certainly need you for writing MCQs and setting the Diploma, within

one year or so.

– We hopefully expect that every speciality delegates would liaise with the European Paediatric specialist Society and national delegates with the corresponding National Society to identify training centers of excellence.

– We also need to identify rapidly the officially recognised paediatric specialities by the European states in order to provide accurate data to the UEMS.