1 - Definition

Continual Medical Education (CME) is an ethical and moral obligation of maintenance and upgrading knowledge and skill after postgraduate training and during entire career. In some European countries it became a legal obligation (Belgium, Italy etc). It has by definition to be organized by an official instance (National Health Services, University, etc) of each country and in each specialty. Continual Medical Education is measured in credit hours, part of the so-called accreditation. Today from the 25 countries with National Delegates members of the European Society of Neuroradiology, only 15 seem to have an organized accreditation.

2 - European accreditation

The European Union of Medical Specialties (UEMS) (www.uems.be) was created to realize a harmonization in the different medical specialties over all Europe based on the following Charter of CME of medical specialists in the European Union.

Chapter 1: Professional coordinating authority
Should be competent (University, Public National Health Care), divided in sections linked to each speciality, giving credits to their activities, keeping a register at national level etc.

Chapter 2: Structure of CME
Should cover the whole field of the speciality.

Chapter 3: Availability of CME
Although CME is an ethical obligation subject to the disciplinary authority of the profession in some countries, it basically remains on a voluntary responsibility. Absence of accreditation does not change anything about the title of a specialist, but in some countries, refused accreditation can be penalized by a lower reimbursement of the performed examinations.

Chapter 4: Assessment and accreditation of CME
CME should of course follow standards, be reliable, valid and comparable and credit hours should be harmonized over all Europe.

Chapter 5: Quality assurance of CME
Is provided by a good monitoring of the meetings during which credits hours can be obtained.

Chapter 6: European coordination of the CME
Harmonization of the accreditation per specialty should be realized over all Europe. This is the task of the European Specialists Boards, of the section of the UEMS or in case of Neuroradiology the task of the ESNR.

Chapter 7: Migration of medical specialist in the European Union
To assure the highest quality of Neuroradiology in each country and to give each young Neuroradiologist the best education is the final goal of the CME concept.

3 - European accreditation council for CME (EACCME)

This council was created by the UEMS in 1999 to realize the harmonisation of CME in the different specialties over all Europe. (www.uems.be  D. 0231)Accreditation whoever still remains a strictly national affair and the EACCME is not mandated by the national authorities, is not a supranational European accreditation authority but is just a clearinghouse. It will rely on the experience of the professional bodies in each speciality and will give an additional mark of quality to the scientific events.

4 - Practical approach of CME and accreditation (EACCME)

CME and accreditation can be subdivided into two groups:
  • CME and accreditation of meetings
  • CME and individual accreditation
The accreditation of a meeting organized in one of the European countries should of course follow the national accreditation rules.

To obtain an additional international European accreditation just follow:
  • The Quality criteria for international accreditation of CME developed by the EACCME (www.uems.be   D. 9908). EACCME will ask for more information about objectives, program, provider, commercial interest and quality assurance of the meeting. Industry presented education, for example, cannot meet for CME accreditation.
  • The additional CME guidelines provided by the ESNR. (cfr. Addendum)
  • Ask for the application form of the UEMS (EACCME). E-mail: uems@skynet.be
This specific application form should contain the full data from the provider and the approval by the national authorities where the activity takes place. This should be sent through to the secretary of the ESNR Professor Marco Leonardi, who will provide for the ESNR approval and will forward the documents to the EACCME settled in Brussels to obtain the additional European accreditation quality mark. A fee will have to be paid for this procedure (100 to 1.000 Euro) During 2001, 104 additional European quality accreditations were asked for, coming from many countries as Austria, Belgium, Denmark, France and Switzerland.

B. CME and individual accreditation

Each candidate neuroradiologist should follow the guidelines of his own country. Additionally, the CME guidelines proposed by the ESNR can be followed. CME guidelines of the ESNR for individual accreditation. The program of continual education should cover a period of 5 years, to be approved each year.

CME is subdivided in 3 groups:

a. CME for attendance: congress, courses (passive).

b. CME for teaching, research (active).

c. CME for personal education (self-assessment)

250 credit hours should be achieved during the period of 5 years, which means 50 credits per year. But maximal 125 credits can be gathered in a, b or c group.

For your purpose:
  • 1 credit hour = 1 hour of CME
  • 1 lecture = 1 credit
  • 1 local meeting = 1 credit
  • 1 publication = 10 credits
  • 1 chapter in a book = 10 credit
  • 1 poster = 1 to 10 credits
  • self-education = maximum 10 credits per year
5 - Discussion

CME is very important to maintain and increase the quality of Neuroradiology over the world. National accreditation systems should be stimulated and the use of the additional mark of quality provided by the EACCME with the purpose of harmonization of Neuroradiology over Europe should be increased. Every international meeting should be provided with an additional European accreditation. The CME regular body of each country should accept the mutual recognition of EACCME credits by written confirmation The final goal is a free exchange of young neuroradiologists with equal value of knowledge and skill all over Europe and the world. Agreements exists between EACCME and the American Medical Association ( AMA ) for a transatlantic mutual recognition of their credits (www.uems.be D 0234, June 2002).

At this particular time an EACCME accreditation is only provided per activity but evolution of CME is in discussion about (D 2050):
  • Accreditation for all activities during a period of time.
  • Accreditation for all activities provided by the same Society.
  • European accreditation for distance learning programs.
  • CME and Continual Professional Development (CPD), which includes visitations of hospitals and private practices.
6 - Conclusion

Proposals for Countries with own accreditation system: The official organizer of accreditation (CME regular body) of the country should accept the additional European accreditation by written confirmation send to Brussels. All international meetings should be organized with additional quality mark of the UEMS. All individual neuroradiologists who have a national accreditation should keep a personal log-sheet book containing their additional European accreditations.

Proposals for Countries without national accreditation system: All international meetings should be organized with additional quality mark of the UEMS. The country should accept the European accreditation by written confirmation send to Brussels. The country should try to organize an own national accreditation system following the rules of the UEMS. All individual neuroradiologists should keep a personal log-sheet book containing their European accreditations

Addendum:

Quality assesment of international neuroradiological meetings suitable for european cme accreditation following the rules of the ESNR and the UEMS..

Recommendations on general content and organization of the meeting.
  • Subject

    Specific Neuroradiology with broad view on: basic sciences, anatomy, pathophysiology, clinical aspects, technical and diagnostic neuroradiology and/or therapeutical approach. Content should be relevant and educational positive. If meeting is organized by another medical specialty, the content of the meeting should be relevant to Neuroradiology and a neuroradiologist should be member of the scientific committee.

  • Scientific sessions

    Introductive lectures,plenary lectures, panel discussions, work in progress etc. Session time should be at least 60 minutes to allow credits.

  • Speakers

    Proved scientifical level, known experience, from different countries and from different disciplines related to Neuro- Sciences.

  • Impact of the meeting

    List of attendees, CME credit hours ( national and EACCME ) evaluation forms to be filled out by the attendees for feed- back information.

  • Organizer

    Proved scientific level, proved experience in organizing meetings. Broad scientific committee, preferentially independent from political and commercial influence.

  • Venue

    Centrally located or accessible to everybody.

  • Main language

    Preferably English or available simultaneous translations.

  • National approval

    Programme, organization should have been approved by national authorities (CME regulation body, Postgraduate training committee). The final decision is the responsibility of the CME committee.