g the Google browser with the following acronyms, keywords and phrases: “CME”, “CPD”, “continuing medical education”, “continuing professional development”, “accreditation”, “Europe” or “name of the country”.

Internet searches were conducted also using keywords in the countries’ native language. Most of the sites viewed had the English version; for those which hadn’t the English version was used Google Translate tool and the data that were found have been checked crossing available sources.

The review was carried out also using PubMed combining the same keywords (“Education, Medical, Continuing”, “accreditation”, “European Union”). We included studies published from January 2008 to present. Articles were selected based on their title and abstract. Articles not in English were excluded. Four articles were included in the main analysis (Christodoulou, 2007; Vlassis, 2010; Pardell, 2013; Costa, 2010).

The Health Acts of each European country was examined and relevant information extracted.

Members of the European Union of General Practioners (UEMO) were contacted to obtain additional information on UK, Denmark, Hungary, Germany, Malta, Czech Republic, France, Slovakia and Poland. In addition, we attempted to obtain information from countries with insufficient information on CME systems by directly contacting key members of the national competent CME authority. Requests were sent via email to representatives from 12 countries including: Denmark, Bulgaria, Cyprus, Estonia, Finland, Greece, Hungary, Latvia, Luxemburg, Malta, Portugal and Sweden.

2.2. Research Targets

The information we searched for each country were:

−      the presence or absence of a CME system;

−      the type of CME system (compulsory, voluntary);

−      the CME requirements (number of credits per year);

−      the unit of accreditation;

−      the learning activities recognised;

−      the end-users of the training;

−      the participations in UEMS EACCME system;

−      the name and the website of the competent CME authority of the country;

These relevant informations have been collected in tables like Table 1 for each countries.

3. Results and Discussion

Complete information about CME system was obtained from 24 European countries including: Austria (Akademie der arzte, 2010), Belgium (INAMI, 2012), Bulgaria (BLSBG, 2012; BLSBG CME/SDO Department, 2012), Cyprus (Christodoulou, 2007; CyMA, 2012), Czech Republic (ČLK, 2012; ČLK e-learning system, 2012; ČLK Board of Directors, 2012), Denmark (Van Hemelryck, 2009; UEMS. Denmark, 2008b; Lægeforeningen, 2012), Estonia (EAL, 2012), Finland (Finlex Data Bank, 2012; FMA, 2012), France (CNFMC, 2012), Germany (Bundesärztekammer, 2003; Bundesärztekammer, 2004; Bundesärztekammer, 2006; Van Hemelryck, 2009; Murgatroyd, 2011; Bundesärztekammer, 2012), Greece (UEMS. Greece, 2007; Vlassis, 2010), Hungary (MOTESZ, 2006; MOTESZ, 2012), Ireland (Van Hemelryck, 2009; Murgatroyd, 2011; RCPI, 2011; RCPI, 2012), Italy (Van Hemelryck, 2009; Agenas, 2010; Murgatroyd, 2011; Agenas, 2012), Latvia (Van Hemelryck, 2009; LAB, 2012), Lithuania (Van Hemelryck, 2009; SMM, 2009; VASPVT, 2012), Netherlands (UEMS. Netherlands, 2008a; Van Hemelryck, 2009; Murgatroyd, 2011; KNMG, 2012a, b), Poland (Van Hemelryck, 2009; NIL, 2009; Murgatroyd, 2011; NIL, 2012), Portugal (UEMS. Portugal, 2008d; Van Hemelryck, 2009), Romania (Van Hemelryck, 2009; CMR, 2011; CMR, 2012), Slovakia (SACCME, 2008; Van Hemelryck, 2009; Murgatroyd, 2011; SACCME, 2012), Slovenia (Van Hemelryck, 2009; Murgatroyd, 2011; ZZS, 2012), Spain (Pardell, 2008; Van Hemelryck, 2009; Costa, 2010; Murgatroyd, 2011; SEAFORMEC, 2012; Agencia estatal, 2012; Pardell, 2013) 

Table 1. Example of a table used for collecting information on the CME system of each country.          

Sweden (Van Hemelryck, 2009; Murgatroyd, 2011; IPULS, 2012), and United Kingdom (Van Hemelryck, 2009; RCP, 2011; RCP, 2012). For the three remaining countries (Lithuania, Luxembourg and Malta) partial information were found (UEMS. Luxembourg, 2008c; Van Hemelryck, 2009; SMM, 2009; Murgatroyd, 2011; VASPVT, 2012; Institut FMC, 2012; ALFORMEC, 2012; MAM, 2012).

Table 2 summarises the results of the research according to six fundamental categories: 1) the presence or absence of a CME system, 2) the CME requirements (compulsory, voluntary), 3) the number of credits per year, 4) the unit of accreditation, 5) the recognition of e-learning and 6) the target of CME.

The 27 countries are full members of UEMS and follow the EACCME directive. While there are various types of CME systems in each country, with some systems still in early development, the results suggest the existence of a common European framework (UEMS). The UEMS represents an important attempt to reduce the heterogeneity across the different CME systems.

A CME system is present in 26 EU countries (96%), but some systems do not have a format based on credits system (11%).

More than half of countries (15 countries, 56%) are characterised by a mandatory participation to their CME system. In the remaining countries participation is voluntary and based on the assumption that CME is a civic duty and, in some cases, participation is encouraged by either tax incentives or financial rewards.

There is a reasonable homogeneity in the type of CME system across countries and for most of them (15 countries) it can be divided into two main types:

−      CME system with a five years cycle for a total of 200/250 credits (11 countries);

−      CME system with a three years cycle for a total of 150 credits (5 countries).

The remaining CME systems are somewhat different including for example, a five years cycle for a total of 100/120 credits, and a system requiring 75 credits in seven years (Slovenia).

However, among the countries that provide CME credits (21 countries), the majority of these (16) requires healthcare operators to acquire 40 to 60 credits per year.

The case of Sweden is unique since the CME system is not based on credits. Details on the CME system were not available for Luxembourg, Malta, Portugal and Spain.

A large homogeneity on the accreditation unit across countries was observed. Specifically, 14 countries award one credit for one hour of activity and 6 countries award one credit for 45 minutes of activity. Information on accreditation unit was not available for the remaining 4 countries with a system based on credits. In addition, if we assume that 45 minutes are equal to an hour of training, all the countries with a system based on credits (21) utilises the same accreditation unit.

The type of activities accepted for credit across all 27 European Union countries includes: 1) internal/external activities, 2) publications and 3) referee duties. Distance learning (E-learning) was recognized for the acquisition of credits in 22 countries (81%) and not recognized in Greece and Estonia. Three countries (Luxembourg, Malta and Portugal) did not provide information on accepted activities for accreditation.

Table 2. Synthesis of information collected by the research about European CME systems.                          

Most CME systems (17 countries) are targeted to medical doctors (all specialties). Seven countries, Italy included, have a CME system open to other health operators (i.e. nurses, obstetricians, pharmacists and so on). Italy in particular is the only European country in which all health operators are obliged to enrol in a continuing medical education programme.

4. Conclusions

The results show there is a lack of standardisation between European countries’ CME systems and the development of a protocol of e-learning that could be consistently applied in different countries is warranted.

Most countries have CME systems with similar accreditation systems, recognize distance learning and have mutually recognized credits because they adhere to a common system (UEMS).

A potential limitation is that most CME systems are targeted only to medical doctors. However, global events requiring organized actions (which is the primary focus of the Tell Me Project) may require the involvement of different health operators who would be expected to follow specific training recommendations. Numerous health training activities are now operating in different countries which may need to be incorporated into each accreditation system and taken into account in case of a coordinated European action to rapidly spread information in case of a pandemic situation.

Few studies have reported a complete overview of the CME system in the 27 EU countries and this article may provide a useful update of the existing literature.

Acknowledgements

This report has been produced as a study of feasibility for an online course for primary care staff in the context of the European Project Tell Me-Transparent communication in Epidemics: Learning Lessons from experience, delivering effective Messages, providing Evidence (http://tellmeproject.eu).

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