d2.4 technical, legal and scientific feasibility of an online course for primary care staff

7/30/2019 D2.4 Technical, Legal and Scientific Feasibility of an Online Course for Primary Care Staff

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D2.4Technical,legalandscientificfeasibility

ofanonlinecourseforprimarycarestaff

TELLMETransparentcommunicationinEpidemics:LearningLessonsfromexperience,deliveringeffectiveMessages,providingEvidence.

Project cofunded by theEuropean Commissionwithin the7th FrameworkProgrammeHEALTHtheme

1stReportingperiod

WP2Newchallengesandnewmethodsforoutbreak

communication

ResponsiblePartner:Zadig

Contributingpartners:CSSC,UEMO

Duedateofthedeliverable:M11(January2013)

Actualsubmissiondate:M10(December21th2012)

Disseminationlevel:PU


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D2.4Technical,legalandscientificfeasibilityofanonlinecourseforprimarycarestaff

TELLMEprojectGA:278723

2

D2.4Studyoffeasibilityofanonlinecourseforprimarycarestaff

Task:2.4

Leader:ZADIGOthercontributors:CSSC,UEMO

Allrightsreserved2012TELLMEProject

http://www.tellmeproject.eu

PROJECTFULLTITLE Transparent communication in Epidemics: Learning Lessons from

experience,deliveringeffectiveMessages,providingEvidence.

PROJECTACRONYM TELLME

CollaborativeProjectfundedunderThemeHEALTH.2011.2.3.33

Developmentofanevidencebasedbehaviouralandcommunication

packagetorespondtomajorepidemicsoutbreaks

GRANTAGREEMENT 278723

STARTINGDATE 01/02/2012

DURATION 36months


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3

TableofContents

EXECUTIVESUMMARY....................................................................................................................................................................4

1. Legal................................................................................................................................................................................................5

1.1Introductionandbackground..........................................................................................................................................5

1.2Conclusions............................................................................................................................................................................38

2. Technical....................................................................................................................................................................................40

2.1Introductionandbackground.......................................................................................................................................40

2.2Conclusions............................................................................................................................................................................55

3. Scientific.....................................................................................................................................................................................57

3.1Introductionandbackground.......................................................................................................................................57

3.2Conclusions............................................................................................................................................................................64

4. References.................................................................................................................................................................................66


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4

EXECUTIVESUMMARY

TheaimofTellMeProjectistodevelopanElearningtoolforhealthworkerstorapidlydisseminate

informationincaseofapandemicsituation.

Toachievethisgoalhasbeenmadearesearchonthreelevels:

Legal:collectinformationabouttheContinuingMedicalEducation(CME)systeminthe27EuropeanUnioncountries;

Technical:identifythebestopensourceLMSsystemforthedevelopmentofaprototypeofElearningthatcouldbeimplementedacrossall27countriesoftheEuropeanUnion;

Scientific:identifythebesttrainingapproachtodelivertohealthworkersofallthe27countriesoftheEuropeanUniontheinformationnecessarytocoordinateatimelyresponsetoacriticevent

(pandemic).

Theresultsofthefirstpartofresearch(Legal)suggestthatitcouldbepossibletodevelopaprotocolofE

learning,suchastheTellMeProject,thatcouldbeconsistentlyappliedindifferentcountries.Mostof

EuropeanUnioncountrieshaveCMEsystemswithsimilaraccreditationsystems,recognizedistance

learningandhavemutuallyrecognizedcreditsbecausetheybelongtoacommonsystem(UEMS).Theresultsofthesecondpartoftheresearch(Technical)showthatMoodleseemstobetheopensource

LMSplatformthatbestmeetstheTellMeProjectrequirementsforthefollowingreasons:

Userfriendly Manualsareavailableinallofficiallanguagesofthe27EuropeanUnioncountries Availabilityofmaterialtosupporttheuseofthesystem(tutorials,guidelinedocumentsandforum

discussions)

Largeandactivecommunityofusersanddevelopersassistingwithproblemresolution(e.g.,bugs),platformapplicationsandhelpingtoidentifystrengthsandweaknessesofthesystem

Availabilityofnumerousfunctions,pluginsandmodulestocustomizethesystem.Theseexpandthefunctionalityandenhancetheadaptivecapabilityoftheplatformtoanytechnicaland/orcultural

requirementsofthe27EuropeanUnioncountriesinvolvedinTellMeproject.

Adoptedinlargescaletrainingprogramsasitcansupportahighnumberofendusers.ThisfeatureisdirectlyrelatedtotheaimsoftheTellMeProjectasitenablesarapidandwidespreaddisseminationof

theinformationacrossthe27EuropeanUnioncountries.

Theresultsofthelastpartoftheresearch(Scientific)supporttheadoptionofacasebasedelearning

approachintheTellMeprojectasitallows1)torapidlyandeffectivelydisseminateandupdatecritical

informationnecessarytoefficientlyreacttoinfectiousdiseaseemergenciesinEurope,and2)topromote

activelearningandskillacquisitionbyusingclinicalcasestorecreateauthenticandrealisticclinicallearning

scenarios,whichultimatelyenableaneffectivetransferofthetheoreticalknowledgeintopracticalproblem

solving.


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5

1. Legal1.1Introductionandbackground

WeconductedasurveytocollectinformationabouttheContinuingMedicalEducation(CME)systeminthe

27EuropeanUnioncountries.TheMinistryofHealth'swebsiteandCMEnationalwebsiteforeachcountry

wereexamined.Inaddition,InternetsearcheswereconductedusingtheGooglebrowserwiththefollowing

acronyms,keywordsandphrases:CME,CPD,continuingmedicaleducation,continuingprofessional

development,accreditationandnameofthecountry.Internetsearcheswereconductedinthe

countriesnativelanguageandweretranslatedusingtheGoogleTranslatetool.

FromeachcountrysHealthActsthemostdetailedinformationaboutregulationoftheCMEsystemwas

taken.

FerencHajnalfromtheEuropeanUnionofGeneralPractioners(UEMO)wascontactedforfurtherinputand

additionalinformationonUK,Denmark,Hungary,Germany,Malta,CzechRepublic,France,Slovakiaand

Poland.Thisdatahavebeenintegratedintothefinalreport.

Keypeoplewerecontacteddirectlyforcountrieswheretherewasinsufficientinformationontheirwebsite

orfromtheInternetsearch.Addresseswerefoundonwebsites.Anemailrequestforinformationwassent

torepresentativesfrom12countries(tworequestssenttwoweeksapart)including:Denmark,Bulgaria,

Cyprus,Estonia,Finland,Greece,Hungary,Latvia,Luxemburg,Malta,PortugalandSweden.

Atable(seebelow)wasdesignedtocollectrelevantinformationincluding:

DetailsoftheInformationCollected

Country EUMemberState

PresenceofCMESystem Presence/absenceofaCMEsystem(date)

CMEcompulsory Mandatory/optionalCMEsystem(date)

CMEsystemrequirements OrganizationandrequirementsoftheCMEsystem

CMEcredits(unit) Measurementofcredits

RecognisedtypesofCME

activities

RecognisedtypesofCMEactivitiessuchasElearning

CMEtarget Targetofthecontinuingeducationprogramme(e.g.,doctors,nurses)

ParticipationintheUEMS

EACCMEsystem

WhetherthesystemparticipatesintheUEMSEACCMEsystem

NameofthecompetentCME

authority

DetailsoftheCMEauthority

Website Weblink

Nomenclature

UEMS


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6

TheEuropeanUnionofMedicalSpecialists(UnionEuropennedesMdecinsSpcialistesUEMS)isanon

governmentalorganisationrepresentingnationalassociationsofmedicalspecialistsintheEuropeanUnion

andassociatedcountries.

EACCME

TheEuropeanUnionofMedicalSpecialists(UEMS)setuptheEuropeanAccreditationCouncilfor

ContinuingMedicalEducation(EACCME)inordertoharmoniseandimprovethequalityofspecialist

medicalcareinEuropebystructuringandfacilitatingthemutualrecognitionofaccreditationofCME/CPD

activitiesthroughtheawardingofEuropeanCMEcredits(ECMECs)toindividualmedicalspecialists.

CME

Continuingmedicaleducation(CME)canbedefinedaseducationalactivitiesthatservetomaintain,

developorincreasetheknowledge,skillsandprofessionalperformanceandrelationshipsthataphysician

usestoprovideservicesforpatients,thepublicortheprofession.Allcontinuingeducationalactivitiesthat

assistphysiciansinundertakingtheirprofessionalresponsibilitiesmoreeffectivelyandefficientlyare

consideredasfallingintothescopeofthisdefinition.

CPD

ContinuingProfessionalDevelopment(CPD)istheeducativemeansofupdating,developingandenhancing

howphysiciansapplytheknowledge,skillsandattitudesrequiredintheirworkinglives.CPDratherthan

CMEisthepreferredterm,asphysiciansmayperformmanyrolesthatindirectlyaffectthequalityof

healthcare,suchasteaching,researchandmanagement.

CMECreditSystem,typeofactivities:

External

Externalcreditsmaybeearnedbyattendanceatcourses,conferences,lectures,scientificmeetingsor

workshopswherethecoursehaspriorassessmentofcontentandrelevancebytherelevantNational

authority(s).

Internal

Internalcreditsmaybeawardedforhospitalandlocallybasededucationalactivitiesincludingteaching,

audit,andpublishedmaterialaswellasselfdirectedlearning(e.g.,distancelearning).

Reading

Specialistsshouldspendonaveragetwoormorehoursaweekreadingauthoritativemedicalliterature.

ThisisexpectedinadditiontoCMEcreditrequirements.

Asummaryofalltheinformationcollectedaboutthe27EuropeanUnioncountriesislistedbelow.


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Country Austria1

PresenceofCME Yes,since1995

CMEcompulsory Yes,since2001

CMEsystem 150CMEcreditseverythreeyears:

Ofthese150CMEcredits,aminimumof120havetobeacquiredthroughclinicalCPD

and

up

to

30

credits

may

be

acquired

through

non

clinical

CPD

CPDprovidedinahospitalsettingorbydoctorsemployedbythesamelegalentityshallnotexceedtwothirdsofcredits

Creditscollectedbeyond150creditsduringthreeyearsarenotcreditabletothenextcollectionperiod

ClinicalCPDcoversexclusivelycertifiedCPDactivitiesinthemedicalfield,basedonthedisciplinesofthecurriculumoftheAustrianMedicalUniversities

NonclinicalCPDdoesnothavetobepurelypatientorientedandcaninclude:coursesinmedicalEnglish,ataxseminarforpracticeowners,amedicallawseminar

andanyotheractivitieswithinthescopeofCPD

CMEcredits(unit) OneCMEcreditisawardedperCPDactivityof45minutes(withoutbreaksand

interruptions);maximum10CMEcreditsperday

Recognisedtypesof

CMEactivity

Elearningisallowedandincludesinteractivearticles,onlinecoursesand

interactiveonlineCPD.ThistypeofCPDhastocomplywiththegeneralcriteria

forCPDandansweringquestionsprovidesevidenceofparticipation.Correct

answeringofaminimumoftwothirdsofquestionsisnecessaryforearningDFP

pointsbyElearningandprofessionalreading.

AllCPDeventswherethemedicaldoctorispresentinperson(forexample,

lectures,journalclubs,courses,symposia,workshops,congresses,seminarsor

Balintgroups)andwhicharenotclassifiableasanyothertypeofCPDactivity

mentionedlater,areconsidered(formal)events.

Otherrecognisedactivitiesinclude: Qualitycircles(usuallyundertheleadershipofamoderator) Scientificactivities:Publicationsinpeerreview,medicaljournals Supervisions:Aspecialformofmid andlongtermcounsellingofteamsand

organisationsaimedatenhancingprofessionalizationofworkwithcustomers,clients,

patients,teammembers,contractingpartiesordifferentmanagementlevels

Traineeship:IstheparticipationinapracticalCPDeventinvolvingmedicalactivitiesinanintra and/orextramuralinstitutionorpracticeandcomprisesconclusive

discussion,analysisandappraisalofthedoctorsparticipation

Professional(directed)readingCMEtarget Licenseddoctors,generalmedicalpractitionersandspecialistsofallspecialisations

Participationinthe

UEMSEACCME

system

Yes,participatesintheUEMSEACCMEsystem.TheEuropeanCMEcredits(ECMEC)

recognisedbytheEACCME(EuropeanAccreditation CouncilforContinuingMedical

Education)oftheUEMS(UnionEuropennedesMdecinsSpcialistes)arerecognisedto

thesameextentasDFP(DiplomFortbildungsProgrammeoftheAustrianacademyof

physicians)credits

NameoftheCME

competentauthority

Arztakademie(AustrianMedicalChamber)

1CPD(continuingprofessionaldevelopment)Regulations(2010).http://www.arztakademie.at.AccessedApril,2012


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Website http://www.arztakademie.at


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Country Belgium2


CMEcompulsory No,voluntary.InordertoencouragedoctorstotakepartinCPDthereexistsafinancially

beneficialsystemofCPDaccreditation

CMEsystem 60 CMEcreditseverythreeyears,atleast20CMEcreditsperyear.Physiciansaregenerally

free

to

choose

which

CME

activities

they

participate

in.

However,

there

are

twoactivitieswhichmustbeundertakeneachyearinordertogainaccreditation:

AtleastthreecreditsperyearbytakingpartinsomeformofCMErelatedtoethicsandeconomics

Atleasttwolocalmedicalevaluationgroupmeetingsperyear(peerreviews),forwhichtheymustgainatleasttwocredits

CMEcredits(unit) OneCMEcreditpointisawardedperhour(formostactivities)

Recognisedtypesof

CMEactivity

In2005theInstitutebeganaccreditingCMEElearningmodulesfordoctors,

whichincludespecialtyspecificmodules.ElearningCMEisworthonecredit

pointperhouranddoctorsmustreceiveindividualfeedbackontheirElearning

performancefromtheElearningprovider.

Otherrecognisedactivitiesinclude:

Workshops Regionalseminars Nationalsymposia Internationalcongresses Didacticpublications Staffmeetingsinahospital Scientificpresentations(courses,abstracts,posters) Actingasamoderator(ofaCMEactivity)

CMEtarget Allmedicaldoctors

ParticipationintheUEMSEACCME

system

Yes,participatesintheUEMSEACCMEsystem.TheInstitutehasautomaticallyrecognisedaccreditedEACCMEeventssinceJanuary2007andinthesameyearchangeditssystem

ofCMEcreditstoalignitselfwiththeEACCME

NameoftheCME

competentauthority

INAMI/RIZIV(InstitutNationaldAssuranceMaladieInvalidit)

Website http://www.inami.fgov.be

2InstitutNationaldAssuranceMaladieInvalidit.http://www.inami.fgov.be.AccessedApril,2012


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10

Country Bulgaria3,4



CMEsystem 150CMEcreditseverythreeyears,atleast50CMEcreditsperyear

CMEcredits(unit) OneCMEcreditpointisawardedperhour(1hourminimum=45minutes)

Recognisedtypes

of

CMEactivityForms

of

continuous

medical

education

through

distance

learning

are

accepted.

Onepointisawardedforoneacademichour:60pointsforthreeyears

(maximum).


Lectures Congresses,symposiums,national/internationalconferences Formsofcontinuousmedicaleducationsuchaspracticalexercisesorindividual

trainingcourses

Trainingwithmedicalliteraturesuchasscientificmedicalmagazines,textbooksandmonographs

Authorshipofareport,lecture,academicpublication(thethirdcoauthor),poster,reportofadversereactionsordocumentcertifiedbytheBulgarianMedical

Association(BDA)


Participationinthe

UEMSEACCME

system

Yes,participatesintheUEMSEACCMEsystem.ThepointsaccreditedtoBulgariandoctors

throughparticipationinEACCMEaccreditedeventsarenotautomaticallyrecognizedby

theBulgarianMedicalAssociation

NameoftheCME

competentauthority

BulgarianMedicalAssociation

Website http://www.blsbg.com

3BulgarianMedicalAssociation.http://www.blsbg.com.AccessedApril,20124BulgarianMedicalAssociationCME/SDODepartment.E:[email protected]


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11

Country Cyprus5


CMEcompulsory No,voluntary

CMEsystem 150CMEcreditseverythreeyears(fromwhich50%mustcomefromactivitiesrelatedto

the

doctors

specialty)

CMEcredits(unit) OneCMEcreditpointisawardedperhour

Recognisedtypesof

CMEactivity

Elearningisaccepted


Participationinthe

UEMSEACCME

system

Yes,participatesintheUEMSEACCMEsystem

NameoftheCME

competentauthority

CyprusMedicalAssociation,CMECommitteeofCyprusMedicalAssociation

Website http://www.cyma.org.cy

5CyprusMedicalAssociation.http://www.cyma.org.cy.AccessedApril,2012


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12

Country CzechRepublic6,7



EachphysicianmemberoftheCzechMedicalChamber(CMC)hastheobligationto

participateinthesystemofcontinuoustraining

CMEsystem 120CMEcreditseveryfiveyears

CMEcredits(unit) OneCMEcreditpointisawardedperhour(1hour(minimum)=45minutes)

SixCMEcreditsperday(maximum)

Recognisedtypesof

CMEactivity

Elearningisaccepted.


EducationaleventsorganizedbytheCMC EducationaleventsorganizedbyotherorganisationsincollaborationwithCMC Educationaleventsorganizedbyrecognisedentities Clinicalpractice Publishingandlecturing:

Conferenceattendance(lectureorposter) Articleinajournalwithanimpactfactor Articleinaninternationalpeerreviewedjournal ArticleinaCzechreviewedjournal Contributioninproceedings(inaforeignlanguageorinCzech) Scientificmonograph Chapterinascientificmonograph Universitytextbook

StudyoftherelevantliteratureintegratedbyselfevaluationoflearningCMEtarget Allmedicaldoctors

Participationinthe

UEMSEACCME

system


NameoftheCME

competentauthority

CMC

Website http://www.lkcr.cz

http://www.eclk.cz/(distancelearning)

6CzechMedicalChamber.http://www.lkcr.cz.AccessedApril,20127CzechMedicalChamberelearningsystem.http://www.eclk.cz.AccessedApril,2012


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13

Country Denmark8,9

PresenceofCME Yes


CMEsystem 200CMEhourseveryfiveyears,atleast50CMEhoursperyear(recommendation).In

Denmarkgeneralpractitioners(GP)areorganisationallyandfinanciallyencouragedto

participate

in

CME

and

outreach

visits.

Each

GP

has

a

personal

account

that

may

cover

thecostofatleastthreefulldaysofCMEactivitiesayear(includingcompensationfor

lostearningsandcoursefees).GPsalsohavetheopportunitytoparticipateinlocally

financedCMEgroups,forwhichtheyarepaidasmallfee


Recognisedtypesof

CMEactivity

Elearningisaccepted


Participationinthe

UEMSEACCME

system


NameoftheCME

competentauthority

DanishMedicalAssociation

Website http://www.laeger.dk

8DanishMedicalAssociation.http://www.laeger.dk.AccessedApril,20129UEMS.(2008).Dentmark.http://www.ipcaa.org/assets/Denmark86423.pdf.RetrievedApril,2012


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14

Country Estonia10

PresenceofCME Yes

CMEcompulsory No


CMEcredits

(unit)

One

CME

credit

point

isawarded

per

45

minutes

Recognisedtypesof

CMEactivity

Elearningisnotaccepted


Participationinthe

UEMSEACCME

system


NameoftheCME

competentauthority

EstonianMedicalAssociation

Website http://www.arstideliit.ee

10EstonianMedicalAssociation.http://www.arstideliit.ee.AccessedApril,2012


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15

Country Finland11,12

PresenceofCME Yes


ByvirtueoftheirprofessionalactivitiesphysicianshavebotharighttoCMEandan

ethicalobligationtoparticipateinit

CMEsystem FinnishMedicalAssociation(FMA)recommendsthateverydoctorshouldhaveatleast

twoweekseachyearinexternalCME/CPDactivity.AccordingtosurveysbytheFMA,the

averageamountofexternalCMEforFinnishdoctorsisaroundeightdaysperyear.

Therequirementsandresponsibilitiesareasfollows: EachphysicianmusthavearighttoexternalprofessionalCMEforatleasttwoweeks

(10workingdays)peryear,attheexpenseofhisorheremployer.TheCMEmust

meetagreedqualitycriteria.InestablishingquantitativeminimaforCME,individual

practicerequirementsmustbetakenintoaccount

Physiciansshouldhavethepossibilityofkeepingupwithdevelopmentsintheireverydayfieldsofpractice

TheweeklyworkinghoursofaphysicianmustallowatleastfivehoursforonthejobtrainingandpersonalCME

PhysiciansmustdocumentandassesstheirCMEandlearningactivitiesCMEcredits(unit) ThereisntaCMEsystembasedoncredits

Recognisedtypesof

CMEactivity



Trainingsessionsandliterature Participationintheevaluationofqualityprojects Groupdiscussions Writingarticles Consultationactivities Peerreview

CMEtarget Allmedicaldoctors(allspecializations)

Participationinthe

UEMSEACCME

system


NameoftheCME

competentauthority

ProMedico

Website http://www.promedico.fi

11FinlexDataBank.http://www.finlex.fi.AccessedApril,201212FinnishMedicalAssociation.E:[email protected]


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16

Country France13




150

credits

in

two

categories

(categories

1to

3),

and

100

credits

in

category

4

1) Fieldtrainingwithtutoring2) Individualtraininganddistancelearning3) Situationprofessionaltrainers4) Evaluationofprofessionalpractices

Canaccumulateupto50creditspertypeofgroup(infiveyears) Apackageof100creditsisassignedtoeachdoctorwhohasmettheassessment

requirementundertheconditionssetbytheHighAuthorityHealth

CMEcredits(unit) OneCMEcreditpointisawardedperhour(1hour=4560minutes)

Recognisedtypesof

CMEactivity

1) Fieldtrainingwithtutoring2) Individualtraininganddistancelearning.Thiscategoryincludesindividualtraining

anddistancelearningusinganymedium(physicalorelectronic)

3) SituationsprofessionaltrainersProfessionalsituationtrainersaredividedinto4groups:

Group1:includestheemployeesofNationalHealthService

Group2:includestheaccomplishmentofmissionsofgeneralinteresttotheservice

qualityandtheorganizationofcareandprevention,includingelectedoffice,aspart

oforganizedstructures

Group3:includesactivitiesandteacherparticipationinjuries,inthefieldofhealth

Group4:includesresearchandpersonalpublicationsinthefieldofhealth

4) Evaluationofprofessionalpractices(mandatoryforanyphysician)CMEtarget Medicaldoctors,dentistsandhospitalpharmacistsParticipationinthe

UEMSEACCME

system


NameoftheCME

competentauthority

NationalCouncilsforContinuingMedicalEducation(CNFMC)

Website http://www.cnfmc.fr

13NationalCouncilsforContinuingMedicalEducation.http://www.cnfmc.fr.AccessedApril,2012


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17

Country Germany14

PresenceofCME Yes

CMEcompulsory Yes

CMEsystem 150CMEcreditseverythreeyears(withatleast50CMEcreditsperyear)or250CME

creditseveryfiveyears(withatleast50CMEcreditsperyear)

For

the

five

years

cycle:

150CMEcreditsmustbegainedintopicsspecifictothedoctorsspecialty,withtheother

100CMEcreditsfromtopicsoftheirchoice.Generalpractitionersandspecialistsworking

inambulatorycaredonothaveanyrestrictionsplacedontheCMEtopicstheycancover

CMEcredits(unit) OneCMEcreditpointisawardedperhour(1hour(minimum)=45minutes)

Recognisedtypesof

CMEactivity

Interactiveelearningeducation(printandonline)isaccepted(onepointper

exerciseunit)


Lectureanddiscussiongroups Congressattendance Activeparticipationforexampleataworkshop Selfstudyofscientificliterature Author/Referent Practicaltraining Curriculumbasedcontentincludingcurricularcontinuingeducationmeasures,

specialisttrainingcoursesprescribedforaspecialistqualificationunderthe

RegulationsSpecialistTrainingorsupplementarycoursesofstudy


Participationinthe

UEMSEACCME

system

Yes,participatesintheUEMSEACCMEsystem.ECMECscreditsarerecognised

NameoftheCMEcompetentauthority

TheGermanMedicalAssociation(Bundesrtzekammer)Duetothesystemofsixteenstates(Lnder)inGermanythereareactuallyseventeen

(twoinoneofthelargeststates)primaryorganizationsinvolvedinoverseeingCME

Website http://www.bundesaerztekammer.de

14TheGermanMedicalAssociation.http://www.bundesaerztekammer.de.AccessedApril,2012


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18

Country Greece15

PresenceofCME Yes


CMEsystem 100CMEhourseveryfiveyears

CMEcredits

(unit)

There

isnt

aCME

system

based

on

credits

Recognisedtypesof

CMEactivity

Emailandlongdistancelearningisnotcurrentlyreceivingaccreditation


Participationinthe

UEMSEACCME

system


NameoftheCME

competentauthority

ThePanhellenicMedicalAssociation(PHMA)

Website http://www.pis.gr

15UEMS(2007).Greece.http://www.ipcaa.org/assets/Greece77669.pdf.RetrievedApril,2012


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19

Country Hungary16

PresenceofCME Yes


CMEsystem 250CMEcreditseveryfiveyears,atleast50CMEcreditsperyear.


Recognisedtypes

of

CMEactivityDistance

learning

isallowed.

An

Elearning

program

must

include

at

least

three

questionsandhasamaximumof20CMEcreditsinayear.


Trainingcoursesorganizedoutsidetheworkplace(preclassified)includingapprovedcontinuingeducationcourses,lectureseriesorparticipationina

professionaleventsprogram(evaluatedonthebasisofduration)

Trainingcoursesorganizedattheworkplace Aprofessionalstudytour Publishingactivity:

Scientificpapersacceptedorpublishedinpeerreviewedjournals Articlesinajournalwithanimpactfactor Scientificconferenceattendanceincludingpresentationoraposter(in

Hungarian

oraforeignlanguage)

Participationinaninternationalornationalscientificconference PhDthesis PhDcandidate Scientifictextbook,includingcontributingtoachapter Chapterforauniversity,collegeorothereducationalmaterials

CMEtarget Medicaldoctors,dentists,pharmacistsandclinicalpsychologists

Participationinthe

UEMSEACCME

system

Yes,participatesintheUEMSEACCMEsystem.ECMECscreditsarerecognised

NameoftheCME

competentauthority

TheAssociationofHungarianMedicalSocietyMOTESZ

Website http://www.motesz.hu

16TheAssociationofHungarianMedicalSociety.http://www.motesz.hu.AccessedApril,2012


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20

Country Ireland17



CMEsystem 250CMEcreditseveryfiveyears,withatleast50CMEcreditsrequiredperyear.A

common

framework

for

all

approved

Professional

Competence

Schemes

sets

requirementsthatparticipantsneedtomeetincluding:

External(maintenanceofknowledgeandskills):20creditsperyear(minimum),100creditsperfiveyearcycle(minimum)

Internal(practiceevaluation&development):20creditsperyear(minimum),100creditsperfiveyearcycle(minimum)

Personallearning(mayinvolvereadingjournals,preparationforgivinglecturesoronlinelearning):

Fivecreditsperyear(minimum),25creditsperfiveyearcycle(minimum)

Researchorteaching:Twocreditsperyear(desirable),10creditsperfiveyearcycle(desirable)


Recognisedtypesof

CMEactivity

Personallearningincludingjournalcontributionsandparticipatinginjournal

clubs.


Otheracceptedactivitiesinclude:

External:International/nationalmeetings,college/societymeetings,coursesaccreditedbythetrainingbody,medicallyrelatedadvanceddegreesoronline

courses

Internal:Clinicalclubs,morbidityandmortalitymeetings,clinicalriskmeetings,casepresentations,chartreviews,grandrounds,multidisciplinarymeetingsorpeer

reviewgroups

Researchorteaching:Accreditedpostgraduatetrainer,lectures,examinerforpostgraduatetrainingbody,publishingarticles,posterpresentation,national

standardsdevelopmentorquestionsetting

CMEtarget Allmedicaldoctors(allspecialities)

Participationinthe

UEMSEACCME

system

Yes,participatesintheUEMSEACCMEsystemanddoctorswhoattendinternational

conferencesareawardedcreditpoints

NameoftheCME

competentauthority

RoyalCollegeofPhysiciansofIreland

Website http://www.rcpi.ie

17RoyalCollegeofPhysiciansofIreland.http://www.rcpi.ie.AccessedApril,2012


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21

Country Italy18



CMEsystem 150CMEcreditseverythreeyears,atleast50CMEcreditsperyear(minimum25,

maximum75)


Recognisedtypesof

CMEactivity

Selflearningwithouttutor(FAD)(includingjournalsanddistancelearning

programs(onecreditperhour))orselflearningwithtutor(FAD,1.5creditsper

hour).90CMEElearningcreditsinthreeyearsfornurses(maximum),nolimits

fortheotherhealthoperators

Otherrecognizedactivitiesinclude:

Residentialeducation:Congresses,conferences,courses,seminars,meetingsorsymposia

Interactiveresidentialeducation:Discussiongroups,roleplaysorclinicalcasediscussion

Individualtraining Improvementgroups:Commissionsorguidelines Research:Design,objectivesorstudygroupsfinalized Publishing

Journalwithanimpactfactor Journalwithoutanimpactfactor Bookormonography(chapter)

Clinicalaudit Teachingandtutoring:

Relations,teachingoraccreditedresidentialevents Tutoring Coordinationoftrainingactivities Tutoringforinternships

CMEtarget Allhealthprofessionals(notonlymedicaldoctors)

Participationinthe

UEMSEACCME

system

Yes,participatesintheUEMSEACCMEsystem.Creditsthathealthprofessionalsmay

acquireabroad(EUcountries,USAandCanada)arerecognizedwithavalueofCME

creditsequalto50%ofthoseassignedtotheevent

NameoftheCME

competentauthority

Agenas

Website http://www.agenas.it/

18NationalAgencyforRegionalHealthServices.http://www.agenas.it.AccessedApril,2012


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22

Country Latvia19

PresenceofCME Yes

CMEcompulsory Yes

CMEsystem 250CMEcreditseveryfiveyearswithatleast50CMEcreditsperyear


Recognisedtypesof

CMEactivity

Distancelearningprogramsareaccepted(onecreditperhour)


Workinaprofessionaladvisoryboard,workinggroups,expert Workcertification,examcommissions WorkintheLatvianMedicalAssociation(electedbodies) Workforinternationalprofessionalassociations Workasregularteacher Workingforcontinuingeducation Lecturesandcourses Congresses,conferences,symposia,rallies,roundtablediscussionsorprofessional

associationmeetings

Subscriptiontoarelevantmagazineaboutprofessionalspecialization Relatoratmeetingsofprofessionalassociations,congressesandconferences(in

Latvian)

Participation inLatvianorinternationalcongresses,conferencesorsymposia Speakingaboutmedicalinstitutionsinclinicalconferences,clinicalcasestudiesand

literaturereviewsorpublichealthtopicsinmassmedia

Internationalcongressesandconferencereports Presentations(oralreport)atinternationalcongressesandconferences Publications Researchactivity PhDthesis Fulltime/parttimelecturerinuniversities


Participationinthe

UEMSEACCME

system


NameoftheCME

competentauthority

TheAssociationofPhysiciansofLatvia

Website http://www.arstubiedriba.lv

19LatvianMedicalAssociation.http://www.arstubiedriba.lv.AccessedApril,2012


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23

Country Lithuania20

PresenceofCME Yes

CMEcompulsory Yes

CMEsystem 120CMEcreditseveryfiveyears(24creditsperyear)

CMEcredits(unit) Notavailable

Recognisedtypesof

CMEactivity

Elearningisaccepted


Participation inthe

UEMSEACCME

system


NameoftheCME

competentauthority

MinistryofHealthoftheRepublicofLithuania.

TheStateHealthCareAccreditationAgencyattheMinistryofHealthisresponsiblefor

assessingCMEcertificatestodetermineCMEhours(credits)

Website http://www.sam.lt,http://www.vaspvt.gov.lt

20TheStateHealthCareAccreditationAgencyattheMinistryofHealth.http://www.vaspvt.gov.lt/node/168.AccessedApril,

2012


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24

Country Luxembourg21,22,23

PresenceofCME Yes


CMEsystem CMEisconductedonavoluntarybasis,eachphysicianisresponsibleforthe

identification

of

his/her

own

needs

and

participation

to

local

or

international

events

to

keepupdated.

CMEcredits(unit) Notavailable

Recognisedtypesof

CMEactivity

Notavailable


Participation inthe

UEMSEACCME

system


NameoftheCME

competentauthority

TheAssociationofDoctorsandDentists(AMMD)

LuxembourgAssociationforContinuingMedicalEducation(ALFORMEC)

Website http://www.ammd.lu

http://www.alformec.lu/

http://www.institutfmc.lu/

21LuxembourgInstituteforContinuingMedicalEducation.http://www.institutfmc.lu.AccessedApril,201222TheLuxembourgAssociationforContinuingMedicalEducation.http://www.alformec.lu.AccessedApril,201223UEMS(2008).Luxembourg.http://www.ipcaa.org/assets/Luxembourg44760.pdf.RetrievedApril,2012


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25

Country Netherlands24,25,26

PresenceofCME Yes


CMEsystem 200CMEhourseveryfiveyearswithatleast40CMEhoursperyear.Doctorsmusttake

part

in

40

hours

of

CME

per

year

and

general

practitioners

(GPs)

must

take

part

in

at

leasttwohourspeerreviewperyear.Doctorshavetodemonstratethattheyhave

undertaken16hoursperweekofgeneralpracticeworkineachyear,overtheprevious

fiveyears.ItiscompulsoryforGPstoundertakeatleast10hoursofpeerreview


Recognisedtypesof

CMEactivity

Distancelearning(Elearning)isaccepted.Everydistancelearningprogramlasts

fromonetofourhours,onehourformodules(onlinesystemcalledGAIA)


Continuingeducationmeetingsabroad(congressesorsymposia) Writingathesis Publicationinascientificjournal Givingalectureatanaccreditedmeeting GPTrainers(viaBIAGPtraining) Editorialmembershipofascientificjournal Participationinworkgroupsforguidelinedevelopment PersonalCurriculum(PL) Peerreview

CMEtarget Physicians,pharmacists,physiotherapists,healthcarepsychologists,psychotherapists,

dentists,midwivesandnurses

Participation inthe

UEMSEACCME

system


NameoftheCME

competentauthority

RoyalDutchMedicalAssociation(KNMG)

GAIA(JointAccreditationInternetApplication,elearning)

Website http://knmg.artsennet.nl

24RoyalDutchMedicalAssociation.http://knmg.artsennet.nl.AccessedApril,201225TheAccreditationBoardCluster1.http://www.cvah.net.AccessedApril,201226UEMS(2008).Netherlands.http://www.ipcaa.org/assets/Netherlands42818.pdf.RetrievedApril,2012]


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26

Country Malta27

PresenceofCME Yes


CMEsystem Notavailable

CMEcredits

(unit)

Not

available

Recognisedtypesof

CMEactivity

Notavailable

CMEtarget Generalpractitioners

Participatesinthe

UEMSEACCME

system


NameoftheCME

competentauthority

TheMedicalAssociationofMalta

Website http://www.mam.org.mt/

27TheMedicalAssociationofMalta.http://www.mam.org.mt.AccessedApril,2012


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27

Country Poland28



CMEsystem 200CPDcreditseveryfiveyearswhichmustinclude140CMEpointsand60CPDpoints.

There

are

two

categories

of

activities

including:

Basic Additional(100creditsmaximum)


Recognisedtypesof

CMEactivity

Basicactivities:

Implementationofaspecializationprogram Participation incoursesfordoctors(outofprogram) Nationalorinternationalcourseofclinicalpractice Nationalorinternationalconferences,congressesorscientificsymposiums Scientificsocietymeetings Internaltrainingorganizedbythestructureinwhichthephysicianisemployed Lesson,report(oral)orposteratconferences,conventionsorscientificmeetings Testaccreditedbyascientificsocietyorspecialitycollege Doctorateinmedicine,professortitle,assistanttitleAdditionalactivities(100creditsmaximum):

Distancelearning(Elearning) Publishingabookabouthealth,chaptersinatextbookoraneducationalprogram Writingandpublishingbooks,achapteroramultimediaeducationalprogram Translationandpublicationofprofessionalmedicalbooks,chaptersinabookor

educationalmultimediaprogram

Writingandpublishinganarticle Translationandpublicationofanarticlefromamedicaljournal Postgraduatemanagementexperienceoracquisitionofspecializationfordoctorsor

dentists

Specializationtitle Subscriptiontoaprofessionalmedicaljournal Membershiptoascientificsocietyorprofessionalcollege

CMEtarget Allmedicaldoctorsanddentists

Participation inthe

UEMSEACCME

system


NameoftheCMEcompetentauthority

Polish(Supreme)ChamberofPhysiciansandDentistsandRegionalChambersofPhysiciansandDentists

Website http://www.nil.org.pl

28PolishChamberofPhysicians.http://www.nil.org.pl.AccessedApril,2012


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28

Country Portugal29


CMEcompulsory CMEisvoluntary,withnoplanstomakeitmandatory

CMEsystem InthePublicService15dayspaidleaveisallowedperyearforCMEactivity

CMEcredits

(unit)

There

isno

system

of

credits

Recognisedtypesof

CMEactivity

Elearningisntrecognised


Participation inthe

UEMSEACCME

system


NameoftheCME

competentauthority

PortugueseMedicalAssociation(OrdemDosMedicos)

Website http://www.ordemdosmedicos.pt

29UEMS.(2008).Portugal.http://www.ipcaa.org/assets/Portugal81875.pdf.RetrievedApril,2012


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29

Country Romania30

PresenceofCME Yes

CMEcompulsory Yes,compulsorysince2006

CMEsystem 200CMEcreditseveryfiveyears,atleast40CMEcreditsperyear

More

than

one

third

of

the

minimum

score

must

comprise

educational

activities

not

directlyrelatedtothebasicspecialtyofeachindividual

AtleastonethirdoftherequiredCMEcreditsmustberepresentedbyparticipationincourses

CMEcredits(unit) OneCMEcreditpointisawardedper hour

Recognisedtypesof

CMEactivity

Distancelearning(Elearning)isaccepted:18hoursperprogram,10questionspersix

hours(75%thresholdrequireinordertopasstheprogram).Bothemailandonline

programsareallowed.


CMEcourses Attendanceatinternational,national,regional,localevents,congress,conference,

symposium/seminaroraworkgroup

Publications: Articlesinascientific/medicaljournal Chapterinascientific/medicalbook Medical/scientificbookmonograph Publicationofamedical/scientificbooks Publishinginajournalwithanimpactfactor

Subscriptionstomedicaljournals(nationalandinternational) Obtaininganyofthefollowingtitles:

ResidentphysicianconfirmedbytheMinistryofPublicHealth Specialist,includingtheacquisitionofotherspecialties Acertificateoffurthereducation MD,includingasecondspecialty Doctorinmedicine Master TraineraccreditedbytheMinistryofPublicHealth Traineroftrainers,accreditedbytheMinistryofPublicHealth Statusofateacherwithuniversityfunction,lecturer,associateprofessorwith

appointmentsconfirmedbytheGraduateInstitute

CMEtarget Physicians

Participation intheUEMSEACCME

system


NameoftheCME

competentauthority

RomanianPhysiciansBoard

Website http://www.cmr.ro

30RomanianPhysiciansBoardwebsite,http://www.cmr.ro[lastaccessed:April2012]


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30

Country Slovakia31


CMEcompulsory Yes,butvoluntaryforpublicphysicians,compulsoryforprivatephysicians

CMEsystem 250CMEcreditseveryfiveyears,atleast50CMEcreditsperyear

150

allocated

for

external

officially

planned

medical

education

(CME)

including

seminars,conferences,posters,paneldiscussions,scientificandexploratory

activities

100creditsforpersonalstudy(CPD) 100creditsperfiveyearsisautomaticallyallocatedtodoctorsperformingeveryday

practice

CMEcredits OneCMEcreditpointisawardedperhour

Recognisedtypesof

CMEactivity

Immeasurablecomponents:

Performanceofapracticewithinthediscipline MedicalassessmentactivityMeasurablecomponents:

Distantlearning(correspondenceorimplementedviacomputernetworks).Elearningiscreditedinthesamewayasautodidactictestsandisnotincluded

underpersonalstudy.For80100%correctanswersdoctorscollecttwo

credits,for6080%theycollectonecredit

Notsupervisedpersonallearningactivitiesintheareaofthespecialisation discipline

Attendanceatcourses Attendanceatscientificmeetingsorganizedincooperationwitheducational

institutions

Studystays Local,regionalandinternationalprofessionallyorientedmeetings Lecturingincludingpedagogicalactivities Publications Scientificresearch

CMEtarget Allmedicaldoctors,dentist,nurses,midwivesandassistantsinlearningactivity

Participation inthe

UEMSEACCME

system


NameoftheCME

competentauthority

SlovakAccreditationCouncilforCME(SACCME)

Website http://www.saccme.sk

31SlovakAccreditationCouncilforCME.http://www.saccme.sk.AccessedApril,2012


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31

Country Slovenia32

PresenceofCME Yes


CMEsystem 75CMEcreditseverysevenyears

CMEcredits

One

CME

credit

point

isawarded

per

hour

Recognisedtypesof

CMEactivity

Elearningcoursesaccepted.


Lecturesorpassiveinvolvementinseminarsandmeetings(nationalandinternational)

Publicationinamedical/peerreviewedjournalorbook Participationinpeerreview Selfstudy Literaturestudywithtest Studytripsandvisits Participationinaspecificprofessionallecture

CMEtarget Allmedicaldoctorsanddentists

Participation inthe

UEMSEACCME

system


NameoftheCME

competentauthority

MedicalChamberofSlovenia

Website http://www.zzsmcs.si

32MedicalChamberofSlovenia.http://www.zzsmcs.si.AccessedApril,2012


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32

Country Spain33



CMEsystem Therearenorecommendationsorguidelinesastothenumberofcreditstobecollected

annually.

The

CME

credits

are

currently

serving

for

career

purposes

(e.g.,

salary

of

doctorsemployedbypublichealthservices).Doctorsmaybeabletoearnmoremoney

bytakingpartinCMEprogrammes

CMEcredits 1ECMECcredit(EuropeanCMECredits)=0,12SACCME(SpanishAccreditation Council

forCME)credit

Recognisedtypesof

CMEactivity

Traditionallectures,meetings,trainingseminars,distancelearningactivities

CMEtarget Allmedicaldoctors,pharmacists,dentists,veterinaries,nurses

Participation inthe

UEMSEACCME

system


NameoftheCME

competentauthority

SpanishAccreditationCouncilforCME(SACCME)

Website http://www.cgcom.es/seaformec

33GeneralCouncilofOfficialCollegesofPhysiciansofSpain.http://www.cgcom.es/seaformec.AccessedApril,2012


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33

Country Sweden34



CMEsystem Notbasedoncredits.TheInstituteforProfessionalDevelopmentofPhysicians(IPULS)

reviews

CME/CPD

events

in

accordance

with

criteria

that

comply

with

Swedish

regulationsandareinagreementwiththeEACCMEsrecentlyrevisedcriteriaforlive

educationalevents.ApprovedeventsarepublishedinIPULSDoctorsonline

educationalcatalogue.TheSwedishMedicalAssociationrecommends10daysof

externalCME/CPDperyearfordoctors

CMEcredits Nocreditsareused

Recognisedtypesof

CMEactivity

Elearningisaccepted

CMEtarget ThereisnosystemforCMEaccreditationofhealthcareworkers.IPULScertifies

educationaleventsandelearningcourses

Participation inthe

UEMSEACCME

system


NameoftheCME

competentauthority

InstituteforProfessionalDevelopmentofPhysiciansinSweden(IPULS)

Website http://www.ipuls.se

34InstituteforProfessionalDevelopmentofPhysiciansinSweden.http://www.ipuls.se.AccessedApril,2012


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34

Country UnitedKingdom35

PresenceofCME Yes

CMEcompulsory Yes

CMEsystem 250CMEcreditseveryfiveyears,withatleast50CMEcreditsperyear.Ofthese,atleast

125

should

be

clinical

external

and

at

least

25

should

be

non

clinical

external

credits.

A

maximumof50personalcreditsmaybeclaimed,andonly50RCP(RoyalCollegesof

Physicians)approveddistancelearningcreditsand60MRCPUK(Membershipofthe

RoyalCollegesofPhysiciansoftheUnitedKingdom)examiningcreditsmaycount

towardsthetotalexternalcreditsclaimed.CPDcreditscanbeeitherclinicalornon

clinicalandcanbederivedfrompersonal,internalorexternalactivities.Exemption

creditsmayonlybeclaimedinexceptionalcircumstanceswhenaphysicianisunableto

meettheannualminimumrequirementsduetoillness,maternityleaveorlongterm

absencefromwork

CMEcredits OneCPDcreditpointisawardedperhour

Recognisedtypesof

CMEactivity

Distancelearningisaccepted.However,onlythefirst10RCPapproveddistancelearning

creditscanbecountedasexternalandtheremaindercanbeclaimedaspersonal.The

FederationoftheRoyalCollegesofPhysiciansoftheUKhasanapproveddistance

learningcreditcategoryinordertoacknowledgetheincreasinglyavailablehighquality

onlineeducationalopportunities.Physicianscanregisterupto10approveddistance

learningcreditstowardstheirminimumannualrequirementof25externalcredits.

Physicianscanonlyregisterdistancelearningcreditsfromdistancelearning

materials/productsthathavebeenapprovedforthispurposebytheFederation.


Unlistedexternalmeetings(external) WorkrelatedMSc(MasterofScience)orequivalentactivity(external) InternalCPDmeetings(internal) Internaltrustoremployermandatorytraining(internal) Participationinauditmeetingsormorbidityandmortalitymeetings(internal) Participationingrandroundsorspecialityclinicalmeetings(internal) Participationinseminars/workshops(internal) Internaltrustoremployermandatorytraining(internal) Undertakinginformationsearches(personal) Presentationsatconferences(personal) Participationincommittees/workingparties(personal) Readingjournalsandtexts(personal)

Refereeing

articles

and

texts

(personal)

Undertakingaresearchproject(personal) Writingexaminationquestionsorexamining(personal) Writingreviewarticlesandtexts(personal)

CMEtarget Allmedicaldoctorswhohavealicencetopractise

Participatesinthe

UEMSEACCME


35AcademyofMedicalRoyalColleges.http://www.rcplondon.ac.uk.AccessedApril,2012


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35

system

NameoftheCME

competentauthority

AcademyofMedicalRoyalColleges

Website http://www.rcplondon.ac.uk


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36

Resultsofthesearch:

Thetableshavebeencompletedfor22countriesincluding:

Austria,Belgium,Bulgaria,Cyprus,Denmark,Estonia,Finland,France,Germany,Greece,Ireland,Italy,

Latvia,Netherlands,Poland,Portugal,Spain,UnitedKingdom,CzechRepublic,Romania,Slovakia,Slovenia,

SwedenandHungary.

ThetablesofLithuaniahasbeenpartiallycompleted.

Thetablesoftwocountrieshavenotbeenfilledduetoalackofdataincluding:

Luxembourg,Malta.

Thefollowingtablesummarisestheresultsoftheresearchaccordingtosixfundamentalcategories:the

presenceorabsenceofaCMEsystem,theCMErequirements(compulsory,voluntary),thenumberof

creditsperyear,theunitofaccreditation,therecognitionofelearningandtheendusersofthetraining.


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37

Summarytableoftheresearch

Country Presenceof

aCME

system

CME

requirement

Credit/year CMEcredits

(credits/minutes)

Elearning

recognised

CMEtarget

Austria Yes Compulsory 150/3 1/45min Yes Allmedicaldoctors

Belgium Yes Voluntary 60/3 1/60min Yes AllmedicaldoctorsBulgaria Yes Compulsory 150/3 1/45min Yes Allmedicaldoctors

Cyprus Yes Voluntary 150/3 1/60min Yes Allmedicaldoctors

CzechRepublicYes Compulsory 120/5 1/45min Yes Allmedicaldoctors

Denmark Yes Voluntary 200/5 1/60min Yes Allmedicaldoctors

Estonia Yes Voluntary 300/5 1/45min No Allmedicaldoctors

Finland No Voluntary Notbasedon

credits

Yes Allmedicaldoctors

France Yes Compulsory 250/5 1/4560min Yes Allmedicaldoctors,dentistsand

hospitalpharmacists

Germany Yes Compulsory 150/3250/5 1/45min Yes Allmedicaldoctors

Greece Yes Voluntary 100/5 NA No Allmedicaldoctors

Hungary Yes Compulsory 250/5 1/60min Yes Allmedicaldoctors,dentists,

pharmacistsandclinical

psychologists

Ireland Yes Compulsory 250/5 1/60min Yes Allmedicaldoctors

Italy Yes Compulsory 150/3 1/60min Yes Allthehealthprofessionals

Latvia Yes Compulsory 250/5 1/60min Yes Allmedicaldoctors

Lithuania Yes Compulsory 120/5 NA Yes Allmedicaldoctors

Luxembourg Yes Voluntary NA NA NA Allmedicaldoctors

Netherlands Yes Compulsory 200/5 1/60min Yes Allmedicaldoctors,pharmacists,

physiotherapists,healthcare

psychologists,psychotherapists,

dentists,midwivesandnurses

Malta Yes Voluntary NA NA NA Generalpractitioners

Poland Yes Compulsory 200/5 1/60min Yes AllmedicaldoctorsanddentistsPortugal Yes Voluntary Notbasedon

credits

No Allmedicaldoctors

Romania Yes Compulsory 200/5 1/60min Yes Allmedicaldoctors

Slovakia Yes Voluntary 250/5 1/60min Yes Allmedicaldoctors,dentist,nurses,

midwivesandassistantsinlearning

activity

Slovenia Yes Compulsory 75/7 1/60min Yes Allmedicaldoctorsanddentists

Spain Yes Voluntary NA 1ECMECcredit=

0,12SACCME

Yes Allmedicaldoctors

Sweden Yes Voluntary Notbasedon

credits

Yes

United

Kingdom

Yes Compulsory 250/5 1/60min Yes Allmedicaldoctors

NA=NotAvailable


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38

1.2Conclusions

In this report we give an overview of the CME system in the 27 countries of the European Union.

Importantly,the27countriesarefullmembersofUEMSandfollowtheEACCMEdirective.Thus,although

therearedifferent typesofCME systems ineachcountry,with some systems still in their development

phase,there

exists

acommon

framework

(UEMS)

to

which

all

countries

tend

to

align.

This

helps

to

reduce

theheterogeneityacrossthedifferentCMEsystems.

All27EuropeanUnioncountrieshavetheirownCMEsystemexceptFinland,wherethesystemisstillbeing

developed.Morethanhalfofcountriesanalyzed(15countries,56%)havemandatoryparticipationtotheir

CME system. In the remaining countries participation is voluntary and based on the assumption that

continuingmedicaleducation isacivicdutyand, insomecases,participation isencouragedbyeithertax

incentivesorfinancialrewards.

There isareasonablehomogeneity inthetypeofCMEsystemacrosscountriesandformostofthem(15

countries,56%)itcanbedividedintotwomaintypes:

CMEsystemwithafiveyearscycleforatotalof200/250credits(11countries,41%) CMEsystemwithathreeyearscycleforatotalof150credits(5countries,19%)

TheremainingCMEsystemsaresomewhatdifferentincludingforexample,afiveyearscycleforatotalof

100/120credits,andSloveniawhosesystemrequires75creditsinsevenyears.Swedenisuniquebecauseit

hasaCMEsystemthatisnotbasedoncredits.ForLuxembourg,Malta,PortugalandSpainfulldetailsabout

CME system were not available through the literature search or via email requests (and reminders) to

relevantcontacts.

There was large homogeneity on the accreditation unit across countries: 14 countries (52%) award one

credit

for

one

hour

of

activity

and

six

countries

(22%)

award

one

credit

for

45

minutes

of

activity.

Informationonaccreditationunitwasnotavailablefortheremainingfourcountrieswithasystembased

oncredits(15%).

Some types of activities were accepted for credit across all 27 European Union countries including:

internal/externalactivities,publicationsandrefereeduties.Distance learning (Elearning)wasrecognized

fortheacquisitionofcreditsin22countries(81%)andnotrecognizedinonlytwo(7%,GreeceandEstonia).

For the remaining three countries (11%, Luxembourg, Malta and Portugal) information on accepted

activitiesforaccreditationwasnotavailable.

Most CME systems (17 countries, 63%) are targeted to medical doctors (all specializations). Only seven

countries(26%),Italyincluded,haveaCMEsystemalsoopentootherhealthoperators.

Italy inparticular is theonlycountry inwhichallhealthoperatorsareobliged tocarryout thecontinue

medicaleducation.

Overall,basedon the similarityacross theCME systemsof the27EuropeanUnioncountries the results

suggestthatitcouldbepossibletodevelopaprotocolofElearning,suchastheTellMeProject,thatcould

beconsistentlyappliedindifferentcountries.MostcountrieshaveCMEsystemswithsimilaraccreditation

systems, recognize distance learning and have mutually recognized credits because they belong to a

commonsystem(UEMS).However,apotentiallimitationisthatmostCMEsystemsaretargetedtomedical


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39

doctors and, in thecase of global events requiring organised actions (which is the focus of the Tell Me

Project),differenttypesofhealthoperatorswouldbeexpectedtobeinvolvedandeachoneofthemwould

havetomatchspecifictrainingrequirements.However,numeroushealthtrainingactivitiesareoperating

acrossthedifferentcountrieswhichmayneedtobeincorporatedintoeachaccreditationsystemandtaken

intoaccountincaseofacoordinatedEuropeanaction.


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40

2. Technical2.1Introductionandbackground

WehaveconductedareviewoftheliteratureandInternetbasedsearchestofindcomparisonstudies,

reportsordiscussionaboutopensourceLearningManagementSystems(LMS),withafocusontheir

strengthsandweaknesses.TheaimwastoidentifythebestLMSsystemtoreleaseCMEduringapandemic

situationacrossall27countriesoftheEuropeanUnion.

Theanalysisfocusedexclusivelyonopensourcetechnologiesthathavenolimitationsontheirdistribution.

Thus,commercialproductswereexcludedfromtheevaluation.Themaincriteriafortheevaluationofthe

mostrelevantdistancelearningactivitiesareasfollows:

UsabilityTheLMSmustbefairlyintuitivetouse;documentation,howtoguides,support,trainingandonlinehelphavetobeavailableandaccessibleforadministrators,teachersandstudents

AdoptionBothaconsistentdevelopmentcommunityandafairnumberofsimilarinstitutionsusingtheLMShavetobedocumented

Numberoflanguages(localisation,translationguidelinesandmanuals)Thesystemhastosupporttheofficiallanguagesofthe27EuropeanUnioncountries

ScalabilityTheprogramhastobesuitableforbothsmallandlargeinstallations;theLMSneedstotransparentlyfollowtheincreaseofusers,contentsandfunctionality

Ifoneormoreofthesecriteriawasnotreachedthesoftwarewasexcludedfromfurtherreview.Secondary

criteriawerealsoconsideredincluding:

Hardware/softwarecompatibilityThesoftwareshouldrununderthemostusedserversystems(Windowsserver,Appleserver,LinuxandUnix)andhavelowhardwarerequirements

CustomizedlookThemescustomisationthatismaintainedthroughoutthedifferentpagesandlearningobjects

UserpresenceloggingAvailability ChatAvailability ForumsAvailability Onlinesupport/helpAvailabilityofasystemforhelp/bugtrackingforadministratorsandteacherson

thedevelopers'site

Basedonareviewof35Elearningplatformsfivewereselectedformoredetailedassessment.Thesefive

platformswerefrequentlypresentincomparisontochartsofbenchmarksanalysedfrom2003to2011and

include:LRN(dotLRN),ILIAS,Dokeos,ATutorandMoodle.

ThefirstpartoftheanalysisismoreindepthandretainedthespecificdescriptionoftheLMS.This

informationwasretrievedfromtheLMSsdocumentationandhasbeenintegratedwithrelevantdata

documentedincasestudies,productcomparisonsanddiscussionthreads.

ThefollowingtablessummarisethecharacteristicsofthefivemainElearningplatformsselected:dotLRN,

ILIAS,Dokeos,ATutor,Moodle


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41

Table1

Name .LRN/dotLRN(pronounced"dotlearn")

Logo

Platformhomepage

Lastversion .LRNStablerelease2.5.0(asofJune2012)

Link http://www.dotlrn.org/index.html

Dissemination 35installations.Noexactdataareavailableonhowmanyrealrunninginstallations

thereare,butfromthedownloadpagesomeversionshavebeendownloadedas

manyas76.748times.However,theavailabilityofastableversionsuitablefor

differentLinuxoperatingsystems,itislikelythatinstallationsofdotLRNarehigher

thananticipated.

About .LRNisaglobalcommunityofeducators,designersandsoftwaredevelopers.

.LRNisbackedbythe.LRNConsortium,anonprofitorganizationcommittedto

advancinginnovationineducationaltechnologythroughopensourceprinciples.

Consortiummemberinstitutionsworktogethertosupporteachother's

deploymentsandtoaccelerateandexpandtheadoptionanddevelopmentof.LRN.

TheConsortiumensuressoftwarequalitybycertifyingcomponentsas.LRN

compliant,coordinatessoftwaredevelopmentplansandmaintainstieswith

OpenACS(theopensourcetoolkitwhichformsthebasisfor.LRN).The.LRNBoard

ofDirectors,representingConsortiummembers,setsstrategyandhasultimate

oversightresponsibilitiesfortheproject.The.LRNLeadershipTeammanages

operations,workswiththeopensourcecommunityofusersanddevelopersand

executesthegoalsoftheConsortiumasdefinedbytheBoard


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42

Generalconsideration .LRNisagroupsupportedenvironmenttowhichElearningfeatureshavebeen

added.Itslogicalunitistheuser,whohasapersonalworkspace.Thisspacealso

providesaccesstosharedspaces(classes).The.LRNsystemwasoriginally

developedbyMITaspartoftheIntellectualCommonsproject.Itisanopensource

projectcreatedaccordingtothemotto"Learn,search,network"tosupport

innovationinlearningandresearchcooperativecommunity.Thetypical

characteristicsof.LRNresideinthequalityofsupportanddevelopmentcommunity

Technical Technology.LRNisbuiltusingOpenACS(OpenArchitectureCommunitySystem),an

advancedenterpriseframeworkforbuildingscalable,communityorientedweb

applications.TheOpenACS"core"hasbeenindevelopmentfornearlyadecade,

withaninvestmentoftenmilliondollars

OperatingsystemLinuxandUnix.OnotherplatformsaUnixlikevirtualmachineor

OShastobeinstalledpriorthe.LRNinstallation process.Version2.5.0isinthe

standardDebianStablerepository

LicenseGeneralPublicLicense(GPL)

Referencemodel/ContentPackagingspecificationsHTML4.01Strict,WCAG

doubleAcompliant,LRNcompatiblecodeisalsoavailablewhichusesRSS,Web

Services,LearningObjectRepositorySystemandvariouscomponentsbasedonIMS

andSCORMstandards

TranslationTranslatedinto41languages,includingonly19languagesofthe27

EuropeanUnioncountries

Integratedfeatures Forums,filestorage,calendar,news,survey,FAQ,homeworkdropboxandgroup

email.

Modulesforweblogs,assessment,RSSnewsaggregator,HTMLeditor,web

presentation,complexsurvey,photoalbumandlearningobjectrepositoryarealso

availablebutnotyetcertifiedforrelease

Attheinfrastructurelevelthecurrentreleasecontainsprovisionsforbothbasic

andexternalauthentication,permissioning,generalnotifications,

internationalization,contentmanagementandWebDAV

Teacherscanadministerclassesoronlinecommunitiesbycustomizingthelayout,

choosingthelanguageandadjustingthetimezonefortheirclasses

Eachusercancustomizethelayout,languageandtimezone(thisoptionis

particularlyusefulincaseofappointments)

Classesandcommunitiescanbecreatedbyanadministratorwhoselectsthe

accessmodalities

Strengths .LRNprovidesmanytoolsformanagingonlinecommunities.Itispossibletodefinedifferenttypesofcommunitieswithavarietyoftoolsandresourcesfor

shareworking,discussionsandresearch.

.LRNisextensible .LRNbenefitsfromthehighscientificandtechnologicalvaluesofinstitutions

thatsponsortheprojectincluding:MIT,theUniversityofHeidelberg,

WirtschaftsuniversittVienna,theUniversityofBergeninNorway,theFreie

UniversittofBerlin,GreenPeaceandtheWorldBank


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Weaknesses Theplatformfor.LRN isacombination ofmodules createdbydifferentdesigners

atdifferentstagesofdevelopmentandmanyfeaturesandtoolsarenotalwayseasy

tointerpret.Theinterfaceisnothomogeneousandattimessuffersfrompoor

qualitymakingitdifficulttouse,especiallyforteachers.Inaddition,thepage

reloadsandtheuseofbookmarksdontalwaysworkasexpected

.LRNseemsmoreacollaborativespacethatanLMSduetothefactthatithasonly

basicfunctionsforfilemanagement

Therearenorealtimechatrooms

Installationisnoteasy


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Table2

Name ILIAS

Logo

Platformhome

page

Lastversion ILIAS4.2.5(asofJuly2012)

Link http://www.ilias.de/

Dissemination 5.000productiveinstallations

About ILIASisapowerfulsystemforwebbasedteachingandlearning.Itisamultipurposetoolthat

canbeusedasaflexiblecourseplayer,asanauthoringtoolandalsoasacommunicationand

collaborationplatform.ItwasthefirstOpenSourceLMSthathasbeencertifiedasSCORM1.2

andSCORM2004compliant.ILIASisanopensourcesoftwarepublishedundertheGeneral

PublicLicenseandisfreeofchargeforeveryinstitutionandorganizationnomatterthe

numberofusers.ItisasecureLMSthathasbeencertifiedbyNATOandcanbeusedontheir

system.Thesystemdevelopmentfollowsstrictlydefinedguidelinesandiscoordinatedbythe

ILIASopensourceELearningsocietyscoordinationteam

General

consideration

ILIASisawebbasedLMSdeveloped,since1997,withinthe VIRTUS projectbytheUniversity

ofCologne(FacultyofEconomicsandSocialSciences)andbecamein2000anopensource

productlicensedundertheGNU/GPL.ILIASwasthefirstopensourceLMSwithSCORM

certification.ILIAShastoolsforlearning,contentcreation,accessinginformationand

cooperativework.Authorscancreateentirecoursesandpublishthemonline.Studentscan

setupworkinggroupsandgothroughlearningmaterialsaswellascommunicatewitheach

otherandwiththeirteachers


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Technical TechnologyPHP,Apache,MySQL

OperatingsystemVariousplatformspecificbundlesofApache,MySQL,PHP(AMPtrilogy):

Windows,MACOS,Linux,Unix,etc.


Referencemodel/ContentPackagingspecificationsSCORM1.2andSCORM2004modules

ConformanceADLLMSRTE3,AICC

TranslationTranslatedinto23languages,includingonly17languagesofthe27European

Unioncountries

Integrated

features

Personaldesktopforeachuserwithalltheinformationonvisitedcourses,newmessagesornewpostsontheforum

Learningenvironmentwithpersonalannotations,test,glossaryandprint,searchanddownloadfunctions

Coursemanagementsystem Functionsforcommunicationsuchasmail,forumsandchatting Functionalitybasedonaccessrole Toolsfortestingandevaluation Integratedauthoringtoolsthatallowauthorstoadd/editcontents,metadataand

subcomponentsateachlevelwithoutadvancedtechnicalknowledge

Authoringtoolsforstudentstotrackmaterials(texts,imagesorgraphics),retrievealltherecords/annotationandalsosharethisinformationwithotherstudents

Installationandsystemadministrationdocumentationisavailablebothon andoffline Possibletostructurecoursesatdifferentlevels,inhierarchicalorsequentialorder

includingmodules,chapters,pagesandelements

MetadatadefinedinonelevelareavailabletoallLOs(learningobjects) Contextualhelpandacustominterfaceisavailableforteachers/authorsandstudents

Strengths Integratedenvironmentforauthorsandforcoursescreation Metadatasupportforallavailablelearningobjects Multipleclientssupportedonthesameinstallation Manytoolsforusersandadministrators Functionalitybasedonaccessrole PossibletoimportSCORM/AICC/HTMLmodules Testingandevaluationtoolsavailable Goodinbusinessasitallowsmanagementofacomplexcentralisedarchivewithalarge

amountofdata


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Weaknesses InstallationinWindowsisnotsuitableforaproductiondeploymentasitusesXAMPasserverbackend

Usabilityislimitedassomefeaturesaredifficulttomanageandtoomanystepsarerequiredtoaccomplishotherwisesimpletasks.Theaccesstothevariousfunctionsisnot

immediateandsometools,likethebookmarkfunction,cannotbeused

The

role

based

high

differentiation

can

be

difficult

to

cope

with

even

for

experienced

users

Theheterogeneousgroupofdevelopersmightincreasesystemcomplexity Installationisdifficult ILIASisoneofthemostcompleteandpowerfulLMScurrentlyavailableintheOpenSource

world.ILIAShasadifferentapproachcomparedtootheravailableproductsandismore

complex.However,withtheappropriateknowledgeitallowsuserstodevelopthemost

appropriateenvironmentaccordingtoneedsthroughtheuseoftherichvarietyoftoolsand

featuresoffered


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Table3Name Dokeos

Logo

Platformhomepage

Lastversion Dokeos2.0(free asofJune2012)Link http://www.dokeos.com/en

Dissemination 11.525installations

About Dokeosisanopensourceonlinelearningsuite.Itprovidesallthefeaturesneededfor

Elearningandblendedlearningmanagement:fromauthoringtoreporting.

DokeosisacompanydedicatedtoopensourceLearningManagementSystems.Its

mainproductisaSCORMcompliantopensourcelearningsuiteusedbymultinational

companies,governmentagenciesanduniversities.Dokeosoperatesonaprofessional

opensourcebusinessmodelbasedonopencode,communitydevelopment,

professionalconsulting,

quality

assurance

services

and

subscription

based

customer

support


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Generalconsideration TheprojectisarecentdevelopmentofClaroline,anacademictechnologicalplatform.

ComparedtoClaroline,theinterfacehasbeenslightlymodifiedandnewfeatures

added,includingSCORMsupportandaruntimeengine.QuicklyDokeosbecamean

independentproduct,withfourmaingoals:tohelpteacherstorealizepedagogical

contents,structureactivitiesonthebasisoflearningpathway,interactwithstudents

andfollowprogresswithatrackingsystem.Specifically,Dokeosallowsthecreationof

"educationalpathways"forstudents.Eacheducationalpathwaycanbebuiltby

creatingoneormoremodulesthatcontainall(orpart)oftheresourcesofthecourse.

Oncethemodulesarecreatedinternalhierarchiescanbedefined.Studentsand

teachersfromvariousuniversities,mainlyinEurope,supporttheproject


OperatingsystemServerOperatingsystemsupportingwebservice,MySQLandPHP,

e.g.,WindowsServer,MACOSServer,Linux,etc.


Referencemodel/ContentPackagingspecificationsPartiallySCORMcompliant.IEEE

LOMonlyfordocumentsandgroups(TheIEEE1484.12.12002Standardfor

LearningObjectMetadataisaninternationallyrecognizedopenstandardpublished

bytheInstituteofElectricalandElectronicsEngineersStandardsAssociation, New

Yorkforthedescriptionoflearningobjects)

TranslationTranslatedinto44languages,includingalllanguagesofthe27European

Unioncountries,exceptEstonian

Integratedfeatures Highusabilityandreliability Supportoflearningpaths Chat,forums,video/audioconferences PartialsupportofSCORM Highmodularitywithpluginuse

Strengths Learningpathsapproach Organizationoftools Flexible,allowingthepossibilitytobuildandaddnewplugins(sinceversion1.6.0)

Weaknesses InstallationinWindowsisnotsuitableforaproductiondeploymentasitusesXAMPasserverbackend

Authorstoolsneedtobeimproved Insitesearchnotavailable Documentationisincomplete Thecustomizationofstylesheetscanbedoneonlyattheplatformlevelsuchthat

userscannotcustomizeplatformdefaultsettings

OntheofficialsiteguidesandtutorialsareonlyinPDF(sometutorialsarealsoinFlash)

LackofXMLsupport


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Table4Name ATutor

LogoPlatformhomepage

Lastversion ATutor2.0.3(asofJune2012)Link http://atutor.ca/

Dissemination58.593officialinstallations

About ATutorisanOpenSourceWebbasedLearningandContentManagementSystem(LCMS)

designedwithaccessibilityandadaptabilityinmind.AdministratorscaninstallorupdateATutor

inminutes,developcustomtemplatestogiveATutoranewlookandeasilyextendits

functionalitywithfeaturedmodules.Educatorscanquicklyassemble,packageandredistribute

Webbased

instructional

content,

easily

retrieve

and

import

prepackaged

content

and

conduct

theircoursesonline.Studentslearninanadaptivelearningenvironment

Generalconsideration

TheATutorprojectstartedin2002andwasdevelopedbytheAdaptiveTechnologyResource

Centre(ATRC)attheUniversityofToronto;aninternationallyrecognizedleaderinthe

developmentanddistributionofElearningtodisadvantagepeople.

ATutorisreleasedundertheGeneralPublicLicense(GPL)releasinglicenseandiscurrently

consideredamongthebestdistancelearningplatforms.ThisLCMSallowsdeveloperstobuild

reusablecontentthatcanbesharedthroughdifferentElearningsystems;inthesameway,

contentsrealizedwithIMSorSCORMcompliantsystemscanbeeasilyimported

Technical TechnologyHTTPwebserver(Apache,IIS,etc.),MySQL,PHP

OperatingsystemServerOperatingsystemsupportingwebservice,MySQLandPHP;e.g.,WindowsServer,MacOSServer,Linux,etc.


Referencemodel/ContentPackagingspecificationsSCORM1.2,SCORM1.2RuntimeEnvironment(LMSRTE3),IMSPackaging,W3CXHTML1.0,W3CWCAG1.0accessibility

specificationsattheAA+level

TranslationTranslatedinto69languages,includingalllanguagesofthe27EuropeanUnion

countries


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Integrated

features

Separateinterfaceforadministratorsofthecourses Coursescanbebuiltfromsetsofpages CreationofreusableandinteroperablelearningobjectsthroughtheadoptionofIMSContentPackagingspecification/SCORM

Abilitytodefinetagstoexpandthesearchmechanismacrossthecourses

Easycreation

of

courses,

although

skills

in

HTML

are

desirable

ContextualhelpandfurthersupportisavailableontheATutorwebsite ATutorisunderconstantdevelopment,implementingleadingedgestandardsofElearningandtryingtointegrateWYSIWYGeditortoallowteacherstocreatecourse

contentswithouthavingtoknowHTML

ATutorwebsiteincludesseveralforum:asupportforum,abugtrackingforumanda"wishlist"forum

Strengths OneofthemainfocusesisonaccessibilityandforthisreasonATutoristheonlydistancelearningproductinaccordancewiththeW3CWCAG1.0LevelAA+standards

Thesystemisadaptable,resourcesparingandfunctional.ATutorisverysimpleandintuitiveevenforthemostinexperiencedusers,bothadministratorsandteachers.

Teacherscandeveloponlinelearningenvironmentsthatarehighlyadaptableand

customised.Inaddition,ATutorhassimultaneousandasynchronouscollaborationand

communicationsystems(forums,chat,messaging).Userscancustomizedthepresentation

ofcontentbasedontheirlearningneedsandstyles

Weakpoints Nobookmarkstodifferentelementsofthecoursesisavailable DifficultyinextendingthefunctionalityofATutor AuthenticationismadeonlyagainsttheinternaldatabaseofATutor Requiresafairlylongtrainingperiod Notenoughinstallationandmaintenancedocuments ManyshortcomingsmakeATutorunsuitablefornonacademicareas


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Table5

Name Moodle

Logo

Platformhome

page

Lastversion Moodle2.3(asofJune2012)

Link http://moodle.org/

Dissemination 66.000currentlyactivesites

About MoodleisaLearningManagementSystem(LMS)orVirtualLearningEnvironment(VLE).Itisa

softwarepackageforproducingInternetbasedcoursesandwebsites.Itisaglobal

developmentprojectdesignedtosupportasocialconstructionistframeworkofeducation.

Trainersareavailablearoundtheworldmakingitaneffectivetoolforcreatingandconductingonlinecourses.ThemainobjectiveoftheMoodleprojectistoprovideeducators/teachersthe

besttoolstomanageandpromotelearning.Itcanbeusedinsmall(e.g.,smallschoolor

independenttraining)orverylarge(e.g.,hundredsofthousandsofstudents)learning

environments.ManyinstitutionsuseMoodleasanenvironmentforentirelyonlinecourses

whileothersuseittosupportcoursesinblendedlearning.TheMoodlesactivitymodules

(suchasforums,Wikianddatabases)areoftenusedtobuildlearningcommunities(inthe

traditionofsocialconstructivism).Alternatively,someuserspreferitasatoolforcontent

distribution(suchasSCORMpackets)andtoevaluatelearningthroughquizzesandhomework


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General

consideration

Moodlestartsfromasocialconstructionistpedagogicalmodel.Itisanopensourceproject

promotedbytheUniversityofTechnologyinAustralia.Moodleprovidestoolsforcourse

managementandintegrationofitscontent(documentsandexercises)bybothteachersand

students.Moodleisawebbasedopensource(underGNUPublicLicense)projectthatis

activelybeingdeveloped.Ithasmanyfeatures,mostofwhichareaimedtowards

collaborativeworksuchasforums,instantmessaging,anintegratedsystemofemail,

managementofworkinggroups,sharedagenda,blogs,wikiandquizzes.TheMoodle

communityisorganizedaroundmoodle.org.In2007theUKgovernmentfundedOSSWatch

reportedthatMoodlehadbecometheLMSofchoicefor56%ofUKFEinstitutions.According

totheMoodleTrust,therearealmost4millionMoodlecoursesintheworld,usedby38

millionparticipants


OperatingsystemMoodlecanbeinstalledonanycomputerthatcanrunaHTTPwebserver,

PHPandcansupportaSQLtypedatabase(forexampleMySQL).ItcanberunonLinuxand

Windowsoperatingsyst

d2.4 technical, legal and scientific feasibility of an online course for primary care staff

Documents