european recommendations to ensure quality of care€¦ · cpd in rheumatology european...

CPD in Rheumatology

European RecommendationsEuropean Recommendationsto Ensure Quality of Careto Ensure Quality of Care

Anthony D Woolfon behalf of the

UEMS Section of Rheumatology& European Board of Rheumatology

WFME March 2003

Quality of Health Care

The public need to be confidentthat they are receiving the highestquality of health care and achievingthe expected health gain

Ensuring the highest standards ofhealth care is essential for anyhealth care provider - organisationor individual

Post-graduate training should furnish theindividual with knowledge and skills whichenable him to be competent in the entire field ofRheumatology.Continuing medical education and professionaldevelopment is to guarantee the maintenanceand up-grading of knowledge, skills andcompetence following completion of post-graduate training.This process of lifelong learning is to enable theindividual to expand and fulfil their personaland professional potential to meet the presentand future needs of patients.

CPD in Rheumatology

What is happening in Europe?

Practicalmovement of doctorsmovement of citizensfree communication of ideas

Legalright to free movement of labourwithin the European Union

Free Movement RequiresHarmonisation

Training– content and qualityClinical practice– similar outcomes assessed by auditContinuing medical education– similar standards and requirements– mutual recognition of educational

activities

European Union of MedicalSpecialists (UEMS)

The statutory purpose of the UEMS is the harmonisation andimprovement of the quality of medical specialist practice in theEuropean UnionEducation is a key element to achieving thisCharters have been developed on Training and on ContinuingMedical Education and Professional Development of Medicalspecialists in the European CommunityThe UEMS Section of Rheumatology and the European Boardof Rheumatology have developed recommendations specific torheumatology. Consensus was achieved by review of existingtraining requirements and programmes followed byworkshops with representation from the various Europeancountries.The recommendations for CME / CPD are presented

Chapter 1 Professional Co-ordinating AuthorityChapter 2 Structure of CMEChapter 3 Availability of CMEChapter 4 Assessment and Accreditation of CMEChapter 5 Quality Assurance of CMEChapter 6 European Co-ordination of CMEChapter 7 Migration of medical specialistsChapter 8 Financing of CME

U.E.M.S. CHARTER ON CONTINUINGMEDICAL EDUCATION (October 1994)

What is happening in rheumatology?

Charter on CME in RheumatologyCore curriculum for CME / CPDStandards for quality assurance ofCME activities

U.E.M.S. Section of Rheumatology /European Board of Rheumatology:

Setting Standards for CMESetting Standards for CME

Process of DevelopmentCommittee with an academic and a professionalrepresentative from each European countryReviewed specialist training programmes andregulations for CME / CPD in the differentcountriesSurvey of competencies utilised by rheumatologiststhroughout EuropeWorkshops to achieve consensus with review ofrecommendations by member nationalorganisations



Charter on CME in Rheumatology

Individual responsibilitiesCurriculum and standards to be maintained– 5 year cycle– maintainance of competency and delivery of highest

standards of care– demonstrate by participation and competency

Requirements of CME– national / European recommendations

Assessment of educational need by individuals (casereview, audit)Demonstration of competency (log book, assessmentsof competency)

European Board of Rheumatology:Core Curriculum for CME

General remarks– Description of the discipline– Goals of CME and CPD

General knowledge, skills and attitudesSkills of the SpecialityOptional skills of the Speciality

General Principles

A rheumatologist must maintain theirclinical skills by regular contact with peoplewith muscuolskeletal conditions, and haveresponsibility for their diagnosis andmanagement, and by participating inappropriate coursesThere should be ongoing experience of thespectrum of musculoskeletal conditions

General knowledge, skills and attitudes , e.g– basic knowledge– knowledge of the rheumatic diseases– clinical skills– laboratory tests– imaging– bone measurement– drug therapies– role of allied professionals and other medical specialties– patient education and self management– socioeconomic and legal aspects– research– communication skills– health care delivery


Skills of the Speciality– arthrocentesis– synovial needle biopsy– soft tissue injections– counselling skills– management skills– audit methodology and outcome measures


Optional skills of the SpecialityPerform, and interpret where appropriate:– various biopsies– x-ray examinations, ultrasonography, peripheral MRI– bone densitometry– laboratory investigations– electromyography– arthroscopy– non-surgical synovectomy– epidural and regional nerve blocks– manipulation and mobilisation techniques– capillaroscopy– intervertebral disc aspiration, injection or nucleolysis


CME Activities

Reading journals and textbooksMeetings - local, national, internationalIn-hospital activitiesInformal contacts discussing cases withcolleaguesDistance learningAudit

But tendency to teaching not learning

Evidence Based MedicineSackett and Haynes 1995

Convert information needs into answerablequestions which must be specific giving precisedetails of patient, clinical intervention andoutcome of interestIdentify best evidenceCritically appraise that evidence for validity(closeness to truth) and usefulness (clinicalapplicability)Apply results of this appraisal in clinicalpracticeEvaluate performance

U.E.M.S. CHARTER ON CONTINUINGMEDICAL EDUCATION

European Accreditation Council for CMEumbrella structure for the affiliatedprofessional CME authoritiesclearing house for accreditation and CMEcredits in Europe

AssessmentTo demonstrate that we havethe highest level of skillsTo demonstrate a high standardof clinical practice producingthe best outcome for the patient

AssessmentMCQ at EULAR 1998 GENEVA

A quiz open to all participants from differentcountries based on Swiss examinationMCQ– true / false single correct answer– true / false multiple correct answers– matching statements / pictures

Language not a problemPerformed well with good discrimination

SET STANDARDS

OBSERVE PRACTICE

COMPARE WITH STANDARDS

AGREE CHANGESNEEDED

INTRODUCECHANGE

REVIEWSTANDARDS

The Decade ofthe Bone and

Joint

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