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					                     European Council
                    for Accreditation in
                        Hematology




   This project has been carried out by the European Hematology Association and
  partner hematology organizations and societies, with the support of the European
  Community. The content of this project does not necessarily reflect the position of
the European Community, nor does it involve any responsibility on the part of the EC.
                       Contract Number: EUR/02/C/F/TH-84902




       LEONARDO DA VINCI NATIONAL AGENCY / EUROPEAN COMMISSION


                                                                                        1
    Poor is the pupil who does not surpass his master.
                                            Leonardo da Vinci




2
FOREWORD

This booklet is an account of the goals, methods, results, and future
perspectives of the European Council for Accreditation in Hematology
(ECAH), a project initiated by the European Hematology Association (EHA)
to improve and harmonize training in hematology, and the quality of health-
care available to patients with blood disorders.

The European Commission’s Leonardo da Vinci programme funded the
ECAH project through a three-year grant (EUR/02/C/F/TH-84902) extending
from December 2002 to November 2005. The project was conducted in close
partnership with the European School of Haematology (ESH), the European
Group for Blood and Marrow Transplantation (EBMT), and national hema-
tology societies throughout the European Union and its associated states.

Modern hematology is a dynamic scientific and medical discipline. Basic
and clinical research is thriving. Rapid technological advances have
improved understanding of the molecular mechanisms underpinning blood
diseases and opened new therapeutic horizons. More effective treatment
has become available to an increasing number of patients, resulting in
prolonged survival and improved quality of life.

The ECAH partners representing hematologists throughout Europe
consider that patients are entitled to receive optimal healthcare wherever
they may live and that hematologists have a professional obligation to
continuously improve their knowledge and skills.

This position is challenged by the results of the EHA pan-European
Hematology Inquiry which revealed significant heterogeneity according to
country, in the specialty training offered to future hematologists and in
the organization of hematology at the professional level. This heterogeneity
impacts on the mobility of specialists and on the quality of healthcare
available to patients.




                                                                               3
    The ECAH project is a response to this challenge.

    Although full harmonization can only be achieved progressively over the
    long-term, during the three years of the European Commission Leonardo da
    Vinci programme contract, ECAH has achieved its initial objectives:
    • To define and implement methods to identify and facilitate access to peer
      reviewed Continuing Medical Education (CME) tailored to the individual
      hematologist’s specific needs, wherever he or she may work.
    • To develop pan-European recommendations for the basic training of
      junior hematologists and to implement a European ‘passport’ for junior
      hematologists to promote mobility.
    • To improve the professional status of European hematologists through
      various lobbying activities.

    The success of the ECAH project has surpassed all expectations,
    demonstrating that European hematologists share a common vision of the
    future of their profession and are motivated to work together to ensure the
    best quality of healthcare for all patients. However, much remains to be
    done, in particular in view of the fact that hematology is a discipline
    with important socio-economic implications for the future of Europe. The
    incidence of hematological disorders is expected to continue to grow
    significantly in coming years due to demographic factors and increased
    longevity. In this paradigm, life-long learning and a pooling of technological
    and human potential and means will be important to high-quality, cost
    effective patient care. Effective partnerships between academic, industrial,
    governmental and other authorities, and with patients, will also be vital.

    ECAH was founded to identify and address the current and forthcoming
    needs of European hematologists and their patients. It benefits from the
    contribution of Europe’s most eminent specialists in the field; it is also a
    platform for junior and senior scientists and clinicians from all over Europe
    and its associated states. We hope that this unique expertise will be called
    on and will prove useful to healthcare decision makers at the national,
    pan-European and international levels.

    The ECAH project is indebted to John Goldman, Bob Löwenberg, Dieter
    Hoelzer and Emili Montserrat, past presidents of EHA. Wieslaw Wiktor
    Jedrzejczak and Adrian Newland have ensured the liaison with the European
    Union for Medical Specialists (UEMS) and other professional organizations.
    Nancy Hamilton, Ans Steuten and the office staff in Rotterdam, as well as
    the ESH staff in Paris have provided essential managerial and moral
    support. Warm thanks to Paul Guest, of the European Commission’s

4
Leonardo da Vinci program, whose collaboration and continuing support
facilitated the administrative aspects of this project.

The European Hematology Association and all of the ECAH partners extend
sincere thanks to the European Commission for its generous support of
ECAH. We hope and trust that the work we have done together will benefit
patients with blood disorders.

Eva Hellström-Lindberg
EHA President (2005-2007)

Didi Jasmin
Chair EHA Education Committee (2001-2005)

Dimitris Loukopoulos
ECAH Project Leader (2002-2005)




ECAH Advisory Board Meeting November 19th, 2006 Versailles, France

                                                                          5
    European Council for Accreditation in
        Hematology Advisory Board

    Dimitris LOUKOPOULOS (Project Leader)
                 Jane APPERLEY
               Ole Weis BJERRUM
                 Dominique BRON
                 Jean-Yves CAHN
                   Pierre CORNU
                  Laurent DEGOS
                     Robin FOÀ
                   Roland FUCHS
            Luis HERNANDEZ NIETO
                Eliane GLUCKMAN
                 Dieter HOELZER
                   Karel INDRAK
                    Didi JASMIN
       Wieslaw WIKTOR JEDRZEJCZAK
               Francesco LO COCO
                 Gilles LUGASSY
                    Dieter LUTZ
                 Shaun McCANN
               Charis MATSOUKA
                Adrian NEWLAND
                   Lucien NOENS
                Antonio PARREIRA
               Dick STOCKELBERG
                  Edo VELLENGA




6
                    Partner Organizations

             EUROPEAN HEMATOLOGY ASSOCIATION
ÖSTERREICHISCHE GESELLSCHAFT FÜR HÄMATOLOGIE UND ONKOLOGIE
                BELGIAN HEMATOLOGICAL SOCIETY
 DEUTSCHE GESELLSCHAFT FÜR HÄMATOLOGIE UND ONKOLOGIE E.V.
    ASOCIACIÓN ESPAÑOLA DE HEMATOLOGÍA Y HEMOTERÁPIA
            INSTITUT UNIVERSITAIRE D’ HEMATOLOGIE
              EUROPEAN SCHOOL OF HAEMATOLOGY
               SOCIÉTÉ FRANÇAISE D’HÉMATOLOGIE
                 Λ Η Ι Η Ι Α Ο Ο Ι Η ΤΙ ΕΑ
               Ε Λ Ν Κ Α Μ Τ Λ ΓΚ Ε ΑΡ Ι
                 UNIVERSITY OF ATHENS, GREECE
                  UNIVERSITY OF PATRAS, GREECE
            HAEMATOLOGY ASSOCIATION OF IRELAND
                  SOCIETÀ ITALIANA EMATOLOGIA
                             NERGAL
           EUROCONGRES CONFERENCE MANAGEMENT
         NEDERLANDSE VERENIGING VOOR HEMATOLOGIE
 POLSKIEGO TOWARZYSTWAHEMATOLOGÓW I TRANSFUZJOLOGÓW
               SVENSK FÖRENING FÖR HEMATOLOGI
               BRITISH SOCIETY OF HAEMATOLOGY
  EUROPEAN GROUP FOR BLOOD AND MARROW TRANSPLANTATION
          HAEMATOLOGICA/THE HEMATOLOGY JOURNAL
           SOCIEDADE PORTUGUESA DE HEMATOLOGIA
                 DANSK HÆMATOLOGISK SELSKAB




                                                             7
                 European Hematology Association
                      Education Committee

    2001 to 2005                 2005-2009
    Didi JASMIN (Chair)          Anthony GREEN (Chair)
    Jane APPERLEY                Erik BERNTORP
    Robin FOÃ                    Laurent DEGOS
    Eva HELLSTRÖM-LINDBERG       Hartmut DÖHNER
    Dieter HOELZER               Eva HELLSTRÖM-LINDBERG
    Klaus LECHNER                Didi JASMIN
    Dimitris LOUKOPOULOS         Christine CHOMIENNE
    Emili MONTSERRAT             Charlie CRADDOCK
    Gérard SOCIÉ                 Franscesco LO COCO
                                 Alvaro URBANO-ISPIZUA



                 European Hematology Association
                        Board of Directors

    Executive Board:             Councilors:
    Eva HELLSTRÖM-LINDBERG       Erik BERNTORP
    Emili MONTSERRAT             Marc BOOGAERTS (Member
    Wim FIBBE                    from June 2004 to March 2006)
    Irene ROBERTS                Hartmut DÖHNER
    Anton HAGENBEEK              Pierre FENAUX
                                 Catherine LACOMBE
                                 Cristina MECUCCI
                                 Jesús SAN MIGUEL




8
EUROPEAN COUNCIL FOR ACCREDITATION
IN HEMATOLOGY

FOREWORD                                                   3

ECAH ADVISORY BOARD, PARTNERS, EHA EDUCATION COMMITTEE,
EHA BOARD

CHAPTER ONE: THE EUROPEAN HEMATOLOGY INQUIRY              11
Background and Objectives
Design and Methods
Results
Specific results
Interpretation and Conclusion

CHAPTER TWO: THE ORGANIZATION OF
CME IN EUROPE AT THE NATIONAL LEVEL                       16

CHAPTER THREE: PRINCIPLES OF THE ECAH CME SYSTEM
Background
Definition of Continuing Medical Education
Guiding Principles of the ECAH CME System

CHAPTER FOUR: THE ECAH CME SYSTEM:
MILESTONES AND ACHIEVEMENTS 2002-2005                     23
The Development of Electronic Tools
ECAH Accreditation of CME Events
Results
ECAH Accreditation of Enduring Materials
CME Credit Point Accounts
Accreditation of Corporate Symposia
CME Providers

CHAPTER FIVE: RECOMMENDATIONS FOR A BASIC
PAN-EUROPEAN HEMATOLOGY CURRICULUM                        28
Why a European Hematology Curriculum is needed
The philosophy of the Curriculum-Passport
Implementation of the Curriculum-Passport
Future developments for the Curriculum-Passport




                                                               9
     CHAPER SIX: LOBBYING ACTIVITIES                                   43
     The European Parliament, European Commission, European Council:
     Official Pan-European recognition of Hematology
     National Education Authorities: Official Recognition of the
     Curriculum-Passport
     National Accreditation Authorities: Official Recognition
     of the ECAH CME system
     Hematology as a Mono-Specialty at UEMS
     European Accreditation Council for Continuing Medical Education
     (EACCME)
     European Specialty Accreditation Board
     Conclusion

     CHAPTER SEVEN: Future Directions                                  47

     EXECUTIVE OFFICE CONTACT INFORMATION                              50




10
THE EUROPEAN HEMATOLOGY INQUIRY




                                                                                  CHAPTER ONE
Background and Objectives
The first step of the ECAH project was to gather information on hematological
specialist training and CME systems in Europe by sending out a questionnaire
to national hematology societies. This survey served a double purpose: to
retrieve important background information and to initiate communication
between EHA and national societies. It did not seek information on the
amount of clinical training within graduate education or on the national
systems for “internship” which vary greatly between countries. We believed
that this would have led too far outside the field of hematology.

Design and Methods
The survey was performed in several steps between January 2002 and April
2003 with the following objectives:
1. To present an overview of the requirements for specialist training in
   hematology in different European countries. In other words, to describe
   the “median” European hematologist and range, including selection of
   hematological sub-specialties, and relation to internal medicine.
2. To make an inventory of existing and planned CME credit systems in
   Europe.
3. To prepare for an EHA-based CME credit system and to learn about how
   different countries view the future of hematology.

As part of the preparatory process, ECAH performed a pilot investigation
initiated during the first part of 2002, in which representatives of 16 national
hematology societies were asked to fill in an inquiry form with questions
concerning specialist training in hematology and national CME systems.

When the initial data was processed, it was clear that these representatives
of national hematology societies were interested in CME and that they
wanted hematology to develop into an independent specialty. It was
also evident that the number of different sub-specialties in hematology
varied greatly from one country to another, i.e. hematology, experimental
hematology, hemato-oncology, coagulation, hematopathology, immuno-
hemotherapy, etc. It emerged that there are two types of hematologists in
Europe: those who are double specialists in internal medicine/hematology,
and those who are only hematologists. The results of this pilot inquiry were
reported at the 7th Annual Congress of the EHA which took place in Florence
in June 2002.




                                                                                     11
     However, the pilot survey did not always clarify the number of years of
     training hematologists receive. The survey asked the question: “What is the
     approximate time required for the whole training period?” In some cases,
     the responding hematologist provided the number of years of specialty
     training in hematology that are required in his or her country; while
     others indicated the number of years required in both internal medicine and
     hematology together. As a result, it was decided to reformulate the question
     in order to clarify the amount of time spent in different types of training.
     This also provided an opportunity to improve and enlarge the survey to
     encompass more European countries.

     In September 2002, a second more extensive survey was sent to the sixteen
     national societies who responded to the original questionnaire as well as to
     eighteen other European countries. By April 2003, twenty-nine of the thirty-
     four questionnaires had been completed and returned. All the original pilot
     respondents clarified the length of specialist training.

     Results
     The results of the survey showed that there is a considerable heterogeneity
     in content and time for training across Europe. It confirmed that there
     are two main types of hematologists, either including or excluding speciali-
     zation in internal medicine (adult or pediatric). When internal medicine is
     not included, the specialist training includes more laboratory/diagnostic
     education. The survey also demonstrated that CME accreditation systems
     exist in approximately 25% of the European Union, associated and in-
     coming countries, and that there is substantial interest in CME at the
     pan-European level.

     Specific results
     Regarding the recognition of hematology as a specialty compared to
     hematology as a branch of internal medicine, the survey showed that:
     1. Hematology is not recognized as a formal separate specialty outside
        internal medicine in 2 countries.
     2. In 17 countries, there is only one type of basic training in hematology.
        However, several sub-specialties can exist.
     3. In 10 countries, more than one type of hematological specialty exists (e.g.
        clinical hematology, transfusion medicine, medical oncology, hemato-
        pathology, clinical immunology, coagulation medicine). The most common
        second specialty is transfusion medicine.
     4. A hematologist is always a specialist in internal medicine (adult or
        pediatric) in 17 countries; while 12 countries report that hematology is
        regarded as a mono-specialty.

12
Since the survey was completed, more countries have moved from double
to mono-specialty. As of 2005, general hematology is a medical specialty
common to 19 of the 25 member states. Four member states have opted for
the specialty of biological hematology.

                                        Length of specialist training
                          Specialist in Hematology +                                          Specialist in
                              Internal medicine                                             Hematology only
    Years




                                                            Years




                                      Years of training in internal medicine
                                      Years of total specialist training period

Figure One

                            Hematology vs. Hemotology + Internal medicine
                           Hematology training (y)                                     Transplantation training (mo)
    Years of hematology




                                                            Years of transplantation




                                      Hematology + internal medicine
                                      Hematology

Figure Two

The graphs above represent specialists who were trained in hematology
and internal medicine, and those who were trained in hematology alone.
The median length of specialist training in hematology was 6 years (range
4-8 years).

                                                                                                                       13
     The median length of training in internal medicine, including in countries
     with hematology as a mono-specialty was 2 years. There were no major
     differences between the different types of countries (EU, EU candidates in
     2003, and non-EU countries).

     The results showed that the content of specialist education varies significantly
     between countries, often in relation to the geographical distribution of certain
     diseases. This has an impact on the development of sub-specialties. For exam-
     ple, in the Mediterranean countries, trans-fusion medicine developed as a part
     of hematology, from the care of thalassemia patients, whereas in northern
     Europe it developed separately from hematology.

     There are also different traditions in diagnostic medicine. For example,
     specialization in bone marrow cytomorphology is an obligatory responsibil-
     ity of the clinical hematologist in 4 European countries, while it is a part of
     hemato-pathology in others.

     The following table presents an overview of the responses to questions related
     to existing national systems for CME accreditation and mandatory recertification
     exams. It shows that exams are not mandatory for recertification in the majority
     of European countries; in most countries CME is voluntary for hematologists.



      Existing national CME systems                             NO           YES

      Obligatory exam                                            24             5

      Does your country have guidelines for CME?                 16            11

      Is CME obligatory in general?                              20             9

      Is CME obligatory in hematology?                           21             8

      Does a CME point system exist in your country?             13            16

     Figure Three

     The questionnaire also asked if it was acceptable to measure learning by
     attributing one CME credit point per hour of educational activity, as is the
     case in other CME accreditation systems such as the ones implemented
     in the United States (AMA) or the European Union of Medical Specialists
     (UEMS) (see chapter six on Lobbying Activities). Twenty-two of the 29

14
participating representatives of national hematology societies in Europe
responded positively to this suggestion; 2 did not find it acceptable and
5 did not respond.

Interpretation and Conclusion
ECAH made use of the results of the Hematology Inquiry to develop and
implement projects that it believes reflect the needs of European hema-
tologists. These include the European Hematology Curriculum-Passport,
EHA lobbying activities, the on-line CME system, and the organization of
regularly scheduled meetings between EHA and national hematology
society representatives.

The Hematology Curriculum will serve as a set of guidelines for basic hema-
tology training in Europe. The Curriculum-Passport aims to compensate for
the heterogeneity that exists between current training programs. Trainees
will be able to use it to review the basic skills that the Curriculum-Passport
project members consider necessary for all hematologists and they will be
able to identify any gaps that may exist in the training they receive. It will
also allow them to request further training from their mentors and
department heads, and to present an overview of their training to new
mentors in the event they decide to change institutions either nationally or
internationally.

The survey made it clear that the professional status of hematologists
varies from one European country to another. This was the main reason
that EHA initiated lobbying actions to defend the inclusion of hematology as
an independent specialty in the revised European Parliament Doctors’
Directive and to request a mono-specialty section for hematology at UEMS.

An on-line CME system was developed by ECAH according to the results
of the CME Inquiry. It is compatible with the system developed by the
European Accreditation Council for Continuing Medical Education (EAC-
CME) at UEMS. (see chapter three)

All of these activities will be described in detail in the chapters that
follow. They all employ integrated systems of evaluation and feedback.
EHA believes that ongoing appraisals and assessments of all its activities
are necessary. They will ensure that the services that the association
provides are a true reflection of the needs of the hematologists the system
was developed to serve.

Eva Hellström-Lindberg

                                                                                 15
              THE ORGANIZATION OF CME IN EUROPE
CHAPTER TWO


              AT THE NATIONAL LEVEL

              Representatives of national societies of hematology in Europe have pro-
              vided the following information on the status of CME in their respective
              countries.

              This information indicates growing awareness and acceptance of ECAH
              and its objectives, even though formal relationships have not yet been
              established between ECAH and all the national accreditation authorities.

              AUSTRIA (Dieter Lutz)

              In principle, the Austrian Medical Academy which is part of the Austrian
              Medical Chamber is responsible for CME in all areas of medicine. However,
              for the moment, educational seminars and workshops are offered by
              hematologists, in cooperation with the Austrian Society for Hematology
              and Oncology (ÖGHO).

              There are no immediate plans to make CME mandatory by law. CME in
              Austria is voluntary with the following incentives: collecting CME is a
              prerequisite or an advantage for contracting with institutions providing
              Health Services; it is also an advantage for being hired in the public domain
              of Health Services and for promotion.

              Any official Austrian CME project will certainly be developed in close
              collaboration with the Austrian Society for Hematology and Oncology. In
              this case, the society will recommend using the structure and principles
              proposed by ECAH.

              BELGIUM (Dominique Bron and Lucien Noens)

              Continuing Medical Education in Belgium is considered very important.

              Accreditation of medical doctors was first introduced in 1993 as a national
              agreement between professional health organizations and the medical in-
              surance sector. Concerning CME, a joint committee has been established
              for each specialty; it is composed of doctors who represent their respective
              specialties, universities and scientific organizations.
              Hematologists are encouraged by scientific and government institutions
              to participate regularly in life-long learning activities and to collect at least
              200 CME units each year. However, they are free to choose and organize

 16
these activities as they deem appropriate. The system is voluntary but it
includes some incentives and benefits.

ECAH credit points are recognized by the national accreditation system.

CZECH REPUBLIC (Edgar Faber)

CME in the Czech Republic is mandatory since January 1st, 2001. The accredi-
tation authority is the Department of Continuing Medical Education of the
Czech Medical Chamber. Czech hematologists are required to collect 120 CME
points every 5 years. Collecting CME in the Czech Republic is a prerequisite or
an advantage for being promoted.

At present, the Czech accreditation system does not recognize CME activities
taking place outside the Czech Republic automatically, however, such events
are recognized if a Czech provider (i.e. Czech Society of Hematology) applies
for it through the Czech Medical Chamber. Such applications will be issued
for selected EHA Meetings in the near future.

In the Czech Republic, the National Hematology Society is the provider of the
ECAH CME credits that could be awarded at the Annual Meeting of the Czech
Society of Hematology.

DENMARK (Ole Weis Bjerrum)

Continuing Medical Education is the responsibility of the Danish Medical
Association and the national scientific societies. However, some specialist
societies have developed CME recommendations or guidelines.

CME in Denmark is voluntary with no benefits. Danish hematologists are
encouraged to engage in life-long learning but they are not required to
produce evidence that they have done so.

Participation in ECAH activities has drawn attention to the fact that a CME
system can contribute to improve the quality of medical practice and
patient care, notably through increased communication and exchanges
with colleagues from other countries.

FINLAND (Eeva Juvonen)

CME is recommended but not mandatory by law. The Evaluation Council
for Physicians’ Continuous Professional Development (CPD) has set criteria

                                                                                  17
     for good quality CME. However, to date, no CME accreditation system has
     been officially implemented in Finland. Nonetheless, the Evaluation Council
     and the Finnish Medical Association have been liaising with EACCME for the
     evaluation of international CME events taking place in Finland.

     FRANCE (Jean-Yves Cahn)

     CME is in principle mandatory in France but until recently, no official
     body was named to overview its structure and organization. The situation is
     evolving and national accreditation procedures are now being implemented.
     Continuing Medical Education and Professional Practice will both be
     evaluated. The national CME committee is managed by the “Conseil
     National de la Formation Continue” (CNFMC), under the auspices of the
     College of Physicians (“Ordre des Médecins”). The scientific reference
     for CME accreditation in hematology will be the Société Française
     d’Hématologie (SFH).

     Recognition of ECAH credit points is foreseeable.

     GERMANY (Roland Fuchs)

     The State Chamber of Physicians (Bundesarztekammer) is the official
     accreditation authority of a national CME accreditation and quality control
     system that has been mandatory since January 2004. For German hema-
     tologists, this system is voluntary with no benefits. The scientific reference
     for CME accreditation in hematology is the German Society of Hematology
     and Oncology (DGHO).

     ECAH credit points are recognized in Germany.

     GREECE (Charis Matsouka)

     The Pan-Hellenic Medical Association which is the professional organization
     for Greek medical specialties follows the Continuing Professional Develop-
     ment criteria and regulations set by the European Accreditation Council for
     Continuing Medical Education (EACCME). CME in Greece is voluntary with
     no benefits.

     IRELAND (Eibhlin Conneally)

     Accreditation of CME in Ireland is divided between the Royal College of
     Physicians of Ireland (RCPI), the Royal College of Surgeons of Ireland and

18
the Irish College of General Practitioners (ICGP) representing respectively
internal medicine and its subspecialties. CME in Ireland is not mandatory; it
is voluntary with no benefits.

ECAH credit points are recognized in Ireland.

ISRAEL (Gilles Lugassy)

CME in Israel is the responsibility of the Israel Medical Association (IMA)
but since there is no incentive for continuing education, it is difficult to
establish it on a wide scale. Therefore, such a program was successful only
in the context of family medicine. A special committee has been created
by the IMA which is working towards establishing an appropriate financial
incentive for those doctors who pursue continuing education within the
framework of a future salary agreement.

ITALY (Francesco Lo-Coco)

CME has been mandatory in Italy since 1999. The national CME committee
is managed directly by the Italian Ministry of Health. CME providers apply
to the ministry for accreditation of their events. Only Italian CME providers
are eligible to apply for accreditation.

At present, the Italian accreditation system does not recognize CME
activities taking place outside Italy nor does it recognize CME credit points
awarded by other national or European accreditation systems.

Recognition of ECAH credit points is foreseeable.

LITHUANIA (Arthuras Slobinas)

A new system of Continuing Medical Education (CME) and medical
training was introduced in 1995, aided by three major European projects.
The aim is to increase the knowledge and practical skills of the staff of
the Lithuanian medical and public health care system to reach the
standards of the EU countries. Collaboration continues with many EU
universities. European involvement in the major medical educational
faculties and hospitals in Lithuania, communication between European
and Lithuanian Ministries of Health and Medical Associations, as well as
scientific collaboration and funding have been key factors for the success of
this initiative. The outcome is improved health care in Lithuania.


                                                                                19
     THE NETHERLANDS (Edo Vellenga)

     No national system or policy has been implemented in the Netherlands for
     CME. Each specialty has its own standards and guidelines. CME is voluntary
     although there are incentives and benefits: it is a prerequisite for recertification
     and an advantage for being promoted. For the specialty Internal Medicine,
     40 CME points/year are required. This requirement applies also for the
     subspecialties of Internal Medicine. The Dutch Society of Internal Medicine
     is responsible for applying these rules which is delegated to the different
     scientific societies.

     ECAH credit points are recognized in the Netherlands.

     POLAND (Jan Maciej Zaucha)

     A national CME accreditation program has been implemented recently
     (2005). The State Chamber of Physicians (Izba lekarska) is the official
     accreditation authority of a national CME accreditation and quality control.
     Each physician must collect 200 credit points every 4 years. CME system
     is obligatory but there no formal fines for those who do not collect enough
     points. There are no financial benefits although CME points are a prerequisite
     or an advantage for promotion. The system is not ‘specialty specific’ which
     means that participants can collect points in any medical field. The
     authorities presume that they will tend to select CME in their own specialty.
     ECAH credits points are not recognized by the Polish CME system; however
     events recognized by ECAH are also recognized by the Polish CME.

     SPAIN (Alvaro Urbano-Ispizua)

     CME has been a very active area in recent years in Spain, particularly since
     the implementation of the initiatives on CME accreditation in the 1990s and
     the passing of the Spanish Health Professions Act in 2003. The Spanish
     Accreditation Council for CME (SACCME) system started in 2003 and is
     becoming progressively integrated into the CME accreditation systems
     previously implemented by a number of scientific medical societies.

     The Spanish CME system must now respond to both national and interna-
     tional developments. In Spain, CME is voluntary without benefits. However,
     CME accreditation will probably be used for professional revalidation and
     promotion: the Health Professions Act could facilitate the introduction of
     mandatory CME initiatives in a recertification system for doctors.


20
The Spanish accreditation system signed an agreement with UEMS in 2003
by which CME credits granted by SACCME are recognized by the European
Accreditation Council for CME (EACCME). A similar agreement with the
American Medical Association is currently under preparation.

ECAH credit points are recognized in Spain.

SWEDEN (Dick Stockelberg)

CME is fully voluntary in Sweden with no national system and no benefits or
advantages for the specialists.

In Sweden the National Hematology Society is the provider of ECAH CME
credits.

SWITZERLAND (Pierre Cornu)

Currently Switzerland has a CME system in place which is mandatory
by law. Practitioners are required to present the number of CME credit
points they have earned every 3 years. CME is a prerequisite for keeping
the specialist certification.

Responsibility for accreditation and quality control of CME in hematology is
currently the responsibility of the Swiss Society of Hematology, according
to the principles of the Swiss Medical Federation (FMH).

The Swiss Society of Hematology has established a relationship with the
European Union for Medical Specialists (UEMS) and it recognizes EACCME
credit points.

ECAH credit points are recognized in Switzerland.

TURKEY (Osman Ilhan)

In Turkey CME is voluntary with no financial benefits although it is a pre-
requisite or an advantage for promotion.

The authority that provides CME in Turkey is a professional organization:
the Chamber of Medicine. The Chamber of Medicine recognizes EACCME
credit points.




                                                                               21
     ECAH CME credits are well used throughout Turkey and it is therefore
     foreseeable that the ECAH CME credits will be recognized by the national
     system of Turkey.

     UNITED KINGDOM (Adrian Newland)

     A national Continuing Professional Development (CPD) system has been
     implemented in the UK. Although this system is not mandatory, it is
     associated with incentives and benefits. CME is needed for revalidation by
     the General Medical Council (GMC). This is now part of the yearly appraisal
     process required in each hospital. Without CPD, it is impossible to apply
     for clinical excellence awards, to be nominated by the Royal College as an
     examiner or to sit on a committee. Participation in CPD is also necessary to
     stand for office in the Colleges.

     UK representatives from each specialty sit on the relevant UEMS mono-
     specialty group. They are nominated by the Royal College to the British
     Medical Association (BMA) which is the statutory body that deals with
     UEMS.

     ECAH Credit points are recognized in the United Kingdom.




22
PRINCIPLES OF THE ECAH CME SYSTEM




                                                                                  CHAPTER THREE
The decision to develop a pan-European system for the accreditation and
quality control of CME was based on the results of the EHA Hematology
Inquiry (see chapter one) which showed that most hematologists feel that
it is a moral obligation to participate in life-long learning activities. Hema-
tology organizations actively encourage their members to devote time to
maintain and improve their professional competence. Furthermore, it is
foreseeable that employers, health authorities and patients throughout
Europe will come to demand that medical specialists provide proof of their
participation in quality controlled CME activities.

The Inquiry also demonstrated that European hematologists want to
address this issue together, through unified action. They are convinced that
to be scientifically and administratively effective, CME in hematology must
be organized and regulated by hematologists, in collaboration with the
accreditation authorities at the national, pan-European and international
levels.

Background
The ECAH system for CME is inspired by the experience of others. ECAH is
indebted to pioneer accreditation systems in North America and in Europe
who generously shared their experience, allowing ECAH to learn from their
mistakes and build on their successes.

In the United States, medical doctors have participated in quality controlled
CME for several decades. The American Medical Association (AMA)
established the Continuing Education Advisory Committee to develop
standards and mechanisms for the evaluation and accreditation of all
programs of continuing medical education in 1961. The American multi-
disciplinary system has become a part of every doctor’s daily life.

Today, in Europe, there is a striking absence of coordination and harmonization
at all levels of action related to CME accreditation.

Most European countries have not yet implemented a national CME
accreditation system, despite increasing interest in the subject. In the
countries where multidisciplinary CME systems have been implemented,
there seems to have been little concern for pan-European coordination or
harmonization since these systems employ different methods and do not
always recognize each other’s CME credit points.


                                                                                      23
     Some European medical societies have designed and implemented CME
     accreditation systems in their own specialty but, again, they do not share
     the same scope or methodology.

     Before the ECAH project, there was no pan-European system for accreditation
     and quality control of CME in hematology.

     Thus, for ECAH, one of the major initial challenges was to design a CME
     accreditation system that could be adopted by hematologists throughout
     Europe and recognized by accreditation authorities at the national, pan-
     European and international levels.

     ECAH was designed as a tool to facilitate transfer of knowledge, spread of
     excellence, mobility and pan-European collaboration in hematology. This
     position motivated the application for a European Commission Leonardo da
     Vinci grant, which was awarded in 2002.

     Definition of Continuing Medical Education

     ECAH shares the position of the AMA: “CME consists of educational
     activities that serve to maintain, develop and increase the knowledge, skills,
     and professional performance and relationships a physician uses to provide
     services for patients, the public, or the profession. CME represents the
     body of knowledge and skills generally recognized and accepted by the
     profession...”

     Guiding Principles of the ECAH CME System

     1. A CME accreditation system for all hematologists
        The ECAH CME system is designed for all clinical and laboratory
        hematologists.

     2. CME accreditation of events and enduring materials
        The CME system accredits CME events and enduring materials organized
        in compliance with the ECAH standards and guidelines.

       ECAH accredited CME events can take the form of congresses, seminars,
       workshops, training courses etc. that are organized for an audience from
       more than one country.

       Enduring materials are distance-learning tools designed in such a way
       that they can be used at a time and place convenient for the user.

24
3. Applications for accreditation
   The ECAH system relies on an on-line processing system and only
   complete electronic applications are accepted. Aside from the completed
   forms, the application must include specific supporting documents
   providing the peer-review committee with the information enabling it to
   evaluate the educational quality and scientific objectivity of the event.

4. CME credit points
   The CME system uses CME credit points to measure the individual
   hematologist’s efforts to improve his or her knowledge and skills.

  For accredited CME events: one credit point is equal to one hour of CME.
  CME credit points are awarded to the scientific/educational content of
  an accredited event, excluding poster sessions and corporate symposia.
  Participants are eligible to claim credit points for the time they have
  effectively devoted to an accredited event.

  For accredited enduring materials: the peer-reviewers determine the
  number of credit points awarded to enduring materials according to the
  material’s scientific and educational value.

5. On-going evaluation and quality control
   Quality control of CME is essential to ensure that high level professional
   knowledge and skills are accessible to all European hematologists. ECAH
   has implemented several quality control checks to ensure that accredited
   activities respect its standards and guidelines.

5. a) Pilot activities
      The CME system was developed through a succession of pilot
      activities launched to test the feasibility and validity of all major
      decisions and tools. The ECAH partners and the hematologists
      using the system were asked to evaluate these pilot activities and the
      CME system has been progressively modified accordingly.

5. b) Peer-review
      All applications for accreditation of a CME event are screened to verify
      compliance with the ECAH standards and guidelines. They are
      subsequently submitted to review by three referees who score the
      application based on its scientific and educational value and objectivity.
      The organizer is then either informed of the number of CME credit
      points that have been designated to the event, or invited to revise his/
      her application in the light of its peer-review comments.

                                                                                  25
     5. c) Random on-site evaluation
           Random visits to accredited events are scheduled for on-site quality
           control purposes. These visits are made by administrative and
           scientific officers to ensure that the event is carried out as it was
           presented in the application for which it received accreditation.
           Organizers who do not comply with on-site evaluations may become
           ineligible for future accreditation.

     5. d) Disclosure forms
           Chairs, Speakers, and Editors are required to disclose to all
           participants any commercial or other affiliations that may alter the
           scientific objectivity of their presentation. The on-line CME system
           contains a database where disclosures are stored. Chairs, Speakers,
           and Editors can login to modify their affiliations when changes occur.

     5. e) Users’ evaluations
           The system relies on feedback from the individual hematologists
           participating in accredited events.

          Participants in accredited CME activities are required to complete
          evaluation forms in order to receive credit points. This distinguishes
          the system from many other accreditation programs. Information
          collected through participant evaluations should be used by the
          scientific organizer to improve future events.

     5. f) Evaluation and quality control of enduring materials
           ECAH has launched pilot activities to test its standards and guidelines
           for enduring materials. Specific quality control procedures are also
           being developed for these self-learning tools.

     5. g) Commercial support of CME
           To be eligible for accreditation, CME activities must be developed
           independently by academics and/or medical institutions and organiza-
           tions. Commercial entities are not eligible to apply for accreditation for
           the events they organize.

          However, CME activities may be supported by unrestricted educational
          grants provided by industrial partners. This support is often important
          to academic organizers of CME and it must be acknowledged in
          writing in such a way that the event’s participants are aware of this
          unrestricted support.


26
     Organizers of CME activities are expected to present physicians with
     scientifically objective and commercially unbiased information. They
     must develop the scientific program independently and they remain
     fully accountable for it.

     Speakers participating in accredited CME activities must meet
     disclosure requirements. Potential conflict of interest must be made
     available to the meeting’s participants.

     Satellite symposia are not accredited and should not compete with,
     nor take priority over, the accredited CME sessions.

     No commercial promotional activities should be held in or near the
     CME meeting room.

     ECAH will remain in a shared-value relationship with the organizers
     of CME activities and with the corporate partners that contribute to
     improve the quality and accessibility of healthcare through support of
     high quality education for hematologists.

5. h) Other forms of evaluation
      ECAH strives to be recognized as the reference for hematologists in
      the field of Continuing Medical Education. The ECAH Advisory Board
      liaises with other CME accreditation bodies and authorities at the
      national, European and international levels to make sure that hematol-
      ogists benefit from the discussions and projects developed by others.

     The CME system relies on quality control procedures designed to
     promote harmonized high quality standards for CME throughout
     Europe and to make sure that ECAH remains a true reflection of the
     needs of European hematologists.

Figure One: the number of CME meetings accredited by ECAH from June 2002
to January 2006

 Application Origin:              2002 2003 2004 2005 2006          Total
 National Societies                  2   11   15   27   12            67
 Other Academic Organizers           1    7   16   27    5            56
 Pan-European Associations           2   10   13   17   12            54
 Totals:                             5   28   44   71   29           177

Nancy Hamilton and Monique Davidse

                                                                               27
CHAPTER FOUR


               THE ECAH CME SYSTEM:
               MILESTONES AND ACHIEVEMENTS 2002-2005




               Mistakes are the portals of discovery.
                                                                    James Joyce (1882 - 1941)



               This chapter will present the development, milestones and results of the
               different ECAH pilot activities focusing on the difficulties that the project
               encountered and the solutions that were implemented.

               The Development of Electronic Tools

               When the CME project was launched in June 2002, it immediately elicited
               enthusiasm and an unanticipated level of response, thus confirming that
               ECAH was addressing an important professional need shared by hematolo-
               gists throughout Europe. Although this success was encouraging, it soon
               became administratively overwhelming.

               This led EHA, as the project’s promoting organization, to develop novel ICT
               tools which have now been interconnected to form an on-line processing
               system that deals with the flow of applications for accreditation received
               from organizers of CME events. Thousands of on-line CME accounts have
               been opened by individual hematologists in order to keep confidential
               record of their efforts to improve their knowledge and skills.

               The management of the system is assured by EHA. A full-time manager
               working at the EHA Executive Offices in Rotterdam ensures the smooth
               day-to-day operation CME system.

               The technical aspects of the on-line system have been built with an eye for
               future development. The system is a comprehensive global CME system built
               to manage online CME accreditation compromising three components:
               accreditation of CME activities with on-line peer-review, on-line collection
               of CME credits for learners, and administration of the CME system.

 28
Applications are handled by an internet based administration system which
uses different levels of password controlled access. These levels of access
permit CME organizers to follow their application at different stages
of review. They also allow the Chair and Co-Chairs, Reviewers, and the
Unit Manager of the CME system to keep track of application and review
statistics.

This on-line system has been designed to adapt to the expectations of
its users and to meet forthcoming needs. It can handle large numbers of
applications for accreditation of CME events and enduring materials, and
its archives can accommodate a wealth of active CME credit point accounts.

To our knowledge, the agility of this CME system and the tools upon which
it is based are unique in the world.

ECAH Accreditation of CME Events

The first call for applications for accreditation of CME events was launched
as a pilot activity in June 2002. All the ECAH partners actively informed
organizers of CME of the ECAH standards and guidelines via their databases
and websites, and encouraged them to apply for accreditation.

Initially, the full accreditation procedure was expected to take four weeks.
Experience led to extend this to six weeks.

Results
The CME system has grown progressively and is now used by the pan-
European hematology organizations and the national hematology societies
throughout Europe and its associated states, as well as by other independent
organizations. The system is also recognized internationally and organizers
of events taking place outside of Europe apply for accreditation.

                             National
                             Societies
                               37%



     European                                     Independent
    Associations                                   Organizers
       31%                                            32%




Figure One: breakdown of CME applications by Pan-European Associations,
European National Hematology Societies and Independent Organizers
                                                                               29
     ECAH Accreditation of Enduring Materials
     Although many CME accreditation systems in Europe do not accredit
     enduring materials, it is the conviction of European hematologists that
     distance-learning tools can be valuable and cost-effective educational tools,
     in particular in cases of reduced mobility for reasons of health or pregnancy,
     or because of lack of funds.

     This conviction was put to the test in June 2003. The participants of the
     annual EHA congress were asked to indicate their level of interest for
     self-learning tools, including those that are internet-based. One thousand
     hematologists responded to the questionnaire. The results indicated strong
     interest in the development of these tools.

     It was decided that the ECAH standards and guidelines for self-learning
     tools (see the EHA CME System Manual or visit www.ehaweb.org ) should
     first be tested on two e-learning tools developed by EHA. These tools are
     described below.

     Pilot activities will be launched in the future to test the validity of the ECAH
     standards for other enduring materials.

     European Hematology Training on-line (EHATol)
     EHATol was developed with the support of a European Commission Leonardo
     da Vinci contract (EUR/02/C/F/PP-84703 Agreement number: 2002 – 4518 /
     001 – 001, Contracting period: 01/12/2002 – 30/11/2004, Title: European
     Education, Training, and Accreditation in Hematology on-line, Contractor:
     European Hematology Association and in an academic partnership
     between the University “La Sapienza” in Rome, the Catholic University of
     the Sacred Heart in Rome, the University of Barcelona, the European School
     of Haematology (ESH) and the EHA. It was developed according to the ECAH
     standards and guidelines and its platform and content have been submitted
     to technological and scientific peer-review.

     EHATol was designed to provide a readily accessible and constantly
     up-dated environment for training, education, and CME for scientists and
     clinicians involved in the field of hematology. It is an Information and
     Communication Technology (ICT) based platform which currently offers
     clinical cases, an on-line self-assessment system, links to scientific journals
     and Pub-Med, a hematological glossary, and a preliminary morphology
     database.




30
The use of ICT has the following advantages for dissemination of education:
• ICT allows access to regularly updated, high level, peer-reviewed
  distance-learning materials at a time and place convenient to the user.
  This promotes harmonization of education and mobility, and increases
  opportunities for employment.
• ICT based distance-learning is cost effective for users, especially when it
  is freely accessible as is the case for the EHA training tools described in
  this document.
• Unlike a CME meeting, distance-learning tools offer access to training to
  an unlimited number of potential users.

EHATol has been awarded Health-on-line (HON) certification according the
HON rules (http://debussy.hon.ch/cgi-bin/find?1+submit+EHA+And).

The following articles and abstracts on EHATol have been published:

  D’Atri A., Casalino N., Sorda E., “Quality, usability and economical aspects
  in a medical web-based training service”, Proc. IASTED International
  Symposium on Web-based Education (WBE 2005), 21-23 February 2005,
  Grindelwald (Switzerland).

  Foà R., Zini G., D’Atri A., Casalino N., Vituzzi A., “EETAH on-line: European
  Education, Training and Accreditation in Hematology on-line”, poster and
  flyers, e-challenges conference, 27-29 October 2004, Vienna (Austria).

  D’Atri A., Casalino N., Zini G., Foà R., “Web-based training of European
  hematologists”, CATE 2003 - Computers and Advanced Technology in
  Education, IASTED International, 30 June - 3 July 2003, Rodi (Greece).

  G. Zini, R. Foà, A. D’Atri, Web-based European education training and
  accreditation program in hematology, Blood, November 2002, 100:11
  part 2:494b.

  D’Atri A., Casalino N., Zini G., Foà R., Pauselli E., “Web-Based Europe-
  an Education, Training and Accreditation in Hematology”, Proc. IASTED
  International Symposium on Web-based Education (WBE 2002), 20-
  22 May 2002, Cancun (Mexico).

  Zini G., Montserrat E., Foà R., “Web-based European education training
  and accreditation in hematology: Leonardo da Vinci EC Pilot Project”, The
  Hematology Journal, volume 5. Supplement 2, 2004 Abstract Book from
  the 9th Congress of the EHA. (Geneva).

                                                                                  31
     The platform is currently available in English, French, German and Italian;
     other languages are being considered.

     EHA will continue to take economic and managerial responsibility for EHATol
     which will notably be used as a teaching tool during educational activities
     organized by ESH, in academic collaboration with EHA. These activities
     include annual diagnostic work-up courses on hematological malignancies
     organized from 2004 to 2007 inclusive in Rome. The tool will also be used in
     2006 during an educational meeting organized in Brazil by the Brazilian
     School of Hematology (BSH), ESH, and EHA.

     Users of the EHATol platform may earn up to 16 CME credit points per year
     by correctly completing the self-evaluation tests. Four new tests are made
     available every three months. Each test is comprised of six multiple choice
     questions. Users are given three attempts to respond correctly to all six
     questions in order to earn one CME credit point.

     EHATol is freely available on the EHA website at www.ehaweb.org and at
     www.esh.org.
     Robin Foà and Gina Zini

     Haematologica/The Hematology Journal
     Haematologica/The Hematology Journal is an official organ of EHA. It aims
     to serve the scientific community by stimulating and promoting basic and
     clinical research on neoplastic and non-neoplastic diseases of the blood. It
     also serves to promote the European cultural identity. The journal publishes
     editorials, perspectives, research papers, papers on decision-making and
     problem-solving, review articles and scientific letters.

     Haematologica/The Hematology Journal has also developed a monthly
     CME program for distance learning in clinical hematology. This on-line CME
     program has been approved by ECAH.

     Registered physicians are invited to select the correct answer out of four
     options presented in a multiple-choice questionnaire related to a specific
     CME article. After this has been done, the user has access to the correct
     response and additional information allowing him or her to further improve
     his/her knowledge of clinical hematology. The participant’s responses are
     automatically registered in the CME program database for transfer to the
     appropriate CME credit point account.




32
Three examinations are available each month. Users of the program
can earn one credit point for each examination they pass for a total of a
maximum of 36 credit points per year.

Participants are invited to complete a program evaluation form by December
31st of each year to receive e-mail certification of credit points.

Haematologica/The Hematology Journal is available on-line at
http://www.haematologica-thj.org and at www.ehaweb.org

CME CREDIT POINT ACCOUNTS
When individual hematologists participate in an accredited CME event or
use an accredited self-learning tool, they are rewarded CME credit points.

Hematologists are encouraged to earn a minimum of 50 credit points a year,
or 250 credit points over a 5-year period.

Participation in the accreditation system is voluntary. Hematologists wishing
to claim CME credit points are required to participate in the evaluation
procedures by completing an evaluation form related to the scientific,
educational and organizational value of the meeting they have attended.
Editors of accredited enduring materials are also required to provide the
user with evaluation tools.

Registered hematologists wishing to keep record of the CME credit points
they collect over time can do so via their personal, confidential on-line
CME credit point account. They can also download CME certificates attest-
ing to their participation in CME activities.




Figure Two: Geographical distribution of CME point accounts by continent.

                                                                                33
     To date, close to 10 000 hematologists have opened an on-line CME credit
     point account.




     Figure Three: Graph representing growth of CME accounts from June 2002 to
     January 2006.

     ACCREDITATION OF CORPORATE SYMPOSIA
     The pharmaceutical and biotechnology community is supportive of edu-
     cational activities and immediately showed an interest in ECAH. They
     were also eager to be eligible to apply for accreditation for their corporate
     symposia.

     This question was discussed in depth and elicited debate within the ECAH
     Advisory Board. It was agreed that corporate symposia often address im-
     portant topics and can be highly educational. But it was in the absence of a
     real consensus that ECAH decided to launch a pilot activity to test whether
     it would be possible to control commercial bias in corporate symposia so as
     to ensure their scientific objectivity and transparency.

     This pilot activity extended from 2003 to 2004 and was restricted to
     corporate symposia organized at the annual congress of the European
     Hematology Association (EHA) and the European Group for Blood and
     Marrow Transplantation (EBMT).

     Specific, highly restrictive standards and guidelines were developed.
     Each application for accreditation was submitted to a stringent peer-review
     process during which control of commercial bias was an important issue.

     Four satellite symposia were accredited at the 30th Annual meeting of the
     EBMT in 2004. Two of the applications were approved after the first review,
     while two corporate organizers were asked to modify the content and
     presentation of their symposium before resubmitting their application for
     accreditation.

34
Six satellite symposia were approved for accreditation at 9th Congress of the
EHA in 2004. Four of these were approved after modification of their scien-
tific content and presentation subsequent to the review process.

Evaluation by users
The hematologists attending the accredited symposia were invited to ano-
nymously complete an evaluation form. Four hundred and thirty five forms
were returned and analyzed. The results indicated that although the attend-
ees generally considered that the symposia were highly educational, the
accreditation procedures were not able to control commercial bias suffi-
ciently.

Level of commercial bias in percentages:
   high      average          low         Not
                                       answered
    26%          27%          36%           10%

Level of scientific objectivity and balance in percentages:
   high         average         low          Not
                                         answered
    61%          21%           7%           10%

Did you consider this symposium educational?
     yes          no         Not
                          answered
    89%           4%           7%



Evaluation by corporate organizers
The corporate organizers were also invited to evaluate the accreditation
procedures.

Most of them expressed the sentiment that in future hematologists will
tend to attend accredited events and that CME accreditation would confer
added-value to corporate symposia. They were generally pleased with
the accreditation procedures and convinced that they would improve with
time and experience. However, two companies felt that the accreditation
procedures were too demanding and time consuming. It was also suggested
that accredited corporate symposia could be organized on a different day
than non-accredited symposia.




                                                                                35
     Conclusions
     Based on the information provided by all actors, ECAH decided that at the
     present time its standards and guidelines are not adapted to accreditation
     of CME events organized by commercial entities. Accordingly, at the end of
     2004 it was decided to suspend this pilot activity.

     CME PROVIDERS
     By 2005, ECAH was receiving a large flow of applications for accreditation
     from organizers of CME events in Europe and elsewhere. Processing
     applications for large international CME events (e.g. The International Society
     of Hematology, The International Myeloma Foundation, The International
     Society of Thrombosis and Hemostasis) has become an unanticipated focus
     of ECAH.

     This success had important consequences. As the workload progressively
     overcame the capacity of the structure, it became clear that ECAH would not
     survive in the long-term unless the duties and privileges of the system were
     more equitably shared among its partners. In recognition of the essential
     role played by the national and pan-European societies and organizations
     that partnered the ECAH project from the beginning, it was decided to for-
     malize the status of official ECAH provider.

     A provider is a society or academic organization designated by ECAH to
     review and accredit specific CME events. As official providers, the original
     ECAH partners will progressively become responsible for the administrative,
     scientific and economic aspects of the review process and eventual
     accreditation of their meetings. Other national societies of hematology
     that decide to adopt and apply the ECAH standards and guidelines will
     also be recognized as providers and will progressively enjoy the same
     prerogatives.

     In this way, the central CME offices, located in the EHA headquarters in
     Rotterdam, would be free to deal with the increasing number of applications
     for accreditation filed by other pan-European and international organizers
     of CME.

     The provider must be fully aware of and agree to implement the ECAH
     standards and guidelines and that he or she must also:
     • inform the EHA CME unit in Rotterdam of the number of credit points that
       will be attributed to the accredited event.
     • upload the scientific program onto the CME section of the EHA website.


36
• organize a CME booth or table space on-site at accredited meetings.
• submit to quality control measures.

Providers must also ensure that the content of the educational activities
to which they designate ECAH credit points, is relevant to the specialty
of hematology, scientifically balanced, objectively presented, and free of
commercial bias. The educational needs of the participants should guide
the activity and the development of its learning objectives.

The provider system is now being launched as a pilot activity. It will develop
over time, as part of an on-going learning procedure. All aspects will be
evaluated and amended according to the need.

All providers are required to sign an agreement specifying that they will
respect the ECAH standards and guidelines. They will further be required
to name a scientific board in charge of accreditation to ensure that CME
criteria, procedures and quality control are respected.

Providers will be recognized for a 3-year period after which they will be
required to submit to an audit procedure before applying for renewal of
their status.

During the first 3-year period, the national societies of hematology will
be able to designate credit points to their annual or bi-annual hematology
congress. The CME Unit will assist them through the different steps of the
review, accreditation and quality control procedures. The providers will
also be told to expect random on-site quality control visits at their accred-
ited meetings as well as a full administrative audit of all documents (con-
ference materials, speakers commercial disclosure documents, evaluation
forms etc.) at the end of the 3-year contract. After this first audit, ECAH may
decide to allow national society providers to accredit other meetings taking
place in their country.

Pan-European organizers recognized as providers should also expect ran-
dom quality control procedures and an end of contract audit before being
eligible to apply for renewal of their status.




                                                                                 37
     Figure Four: Explaining CME procedures to a participant at the 10th Congres of the EHA
     in June 2005

     Nancy Hamilton, Helen Wodrada, Ans Steuten, Frouke de Vries, and Monique Davidse




38
RECOMMENDATIONS FOR A BASIC PAN-EUROPEAN




                                                                              CHAPTER FIVE
HEMATOLOGY CURRICULUM

Why a European Hematology Curriculum is needed
European hematologists wish to work together to contribute to make
Europe a better place for future hematologists and their patients.

As previously discussed in the chapter on the European Hematology CME
Inquiry, specialty training of hematologists differs very significantly in
duration and content across European countries. These differences lead
to discrepancies in skill levels and impact negatively on the mobility and
professional status of European hematologists.

In view of this situation, the development of recommendations for a pan-
European curriculum for specialty training in hematology was an important
aspect of the ECAH application for European Commission support.

The philosophy of the Curriculum-Passport
EHA and the ECAH partners are aware and are respectful of the fact that
decisions related to educational issues are the prerogative of the national
education authorities in Europe. It is hoped that the recommendations
described below will be of use to them.

The Curriculum Committee was appointed to develop expert opinion
recommendations to improve and harmonize specialty training for the
new generation of European hematologists. This task was approached
through pan-European collaboration involving the EHA Board and Edu-
cation Committee, the ECAH Advisory Board, and the boards of national
hematology societies throughout Europe. Junior and senior hematologists
were invited to contribute to this project.

It was decided to present the recommendations in the form of a “passport”
destined to accompany the junior hematologist throughout his/her specialty
training. Thus, at the end of this training, the junior hematologist should
have a document identifying the levels of competence in the different
sub-specialties of hematology he/she has progressively acquired.

The Curriculum-Passport is also conceived as a tool to promote mobil-
ity. Pan-European harmonization of specialty training can only evolve
progressively, over time. For the time being, individual training programs
will continue to have their strengths and weaknesses. It is believed that
the Curriculum-Passport will prove useful when trainees change training

                                                                                 39
     centers. It should allow their new host institution to assess the levels of
     competence acquired by the trainee/junior hematologist and to identify
     those areas in which he or she needs further instruction.

     In keeping with the convictions expressed by European hematologists in
     response to the European Hematology Inquiry, and with the position of EHA,
     it was decided that the Curriculum-Passport’s recommendations should:
     1. consider hematology as a mono-specialty including both clinical and
        laboratory aspects.
     2. define the minimum level of competence that all junior European hema-
        tologists should share at the end of their specialty training.
     3. be based on acquired knowledge rather than on the duration of training.
     4. contribute to improve the quality of translational research and patient
        care in hematology.
     5. facilitate the professional mobility of hematologists.
     6. be compatible with the American Society of Hematology’s training program.

     With this philosophy clearly outlined, the first meeting of the Curriculum
     Committee was held in February 2004, in Paris. The goal of the meeting was
     to define sub-committees, each representing a sub-section of hematology.
     The committee identified five sub-sections: clinical hematology, diagnosis,
     thrombosis and hemostasis, transfusion medicine and general skills.

     Implementation of the curriculum-passport
     The first step was to form the sub-committees. The Curriculum Committee
     invited the national societies of hematology and the ECAH Advisory Board
     to suggest potential members. The names of over 100 hematologists were
     received, forming a pool of corresponding members willing to contribute
     to present and future educational projects. Twenty-five seats were open in
     total, for the five sub-committees. It was decided to invite both junior and
     senior hematologists selected as appropriate according to their respective
     areas of competence and with an eye for geographical balance.

     Each sub-committee was asked to prepare a list of knowledge and
     skills they considered necessary for baseline knowledge in one of the five
     identified sub-sections.

     These lists were presented, debated and further developed during
     a three-day workshop held in Sitges, Spain, in September 2004 where the
     committee also decided to recognize levels of skill ranging from aware-
     ness to knowledge to competence, with competence ranking as the highest
     level.

40
It was challenging to define a proposal that would be considered neither
too broad nor too restrictive in the different European countries. However,
by the end of the workshop, the committee felt that it had achieved this
objective.

It is noteworthy that contrary to the training curricula currently offered in
the great majority of European countries, the Curriculum-Passport states
that basic specialty training in hematology should include communication
skills in the clinical setting; ethical considerations, in particular relative to
the setting of palliative care; and Information Technology.

The recommendations defined during the Sitges Workshop were subse-
quently circulated as a draft document to all the members of the five sub-
committees, for comment and further suggestions. As a result, the draft
document evolved during a review period that extended from October 2004
to September 2005. This work was inspiringly collaborative and democratic
on the part of everyone involved, representing a genuine effort to seek
constructive solutions to the current, difficult European situation where the
duration and content of training in hematology varies according to place of
work.

Future developments for the Curriculum-passport
The leaders of the five sub-committees met in Paris in September 2005
to finalize the first draft of the European Hematology Curriculum. They
discussed how the Curriculum-Passport should be validated, how it should
be delivered to individual trainees and how it should be updated.
Possible future directions were also identified, including the accreditation
of mentors, the accreditation of training centers, and further educational
development in specific hematology sub-specialties such as Bone Marrow
Transplantation, Hematological Malignancies, Hemostasis, Benign Hema-
tology, etc.

It was agreed that the trainee, his or her mentor and his or her department
head should sign a sub-section of the Curriculum-Passport each time the
trainee has completed the corresponding specialty training. By the time the
trainee has completed his or her specialty training; all five sub-sections of
the Curriculum-Passport should be completed and signed.

The sub-committee leaders decided that the Curriculum-Passport should be
available to trainees in printed or electronic form. It will also be possible to
access the Curriculum-Passport via the EHA website: www.ehaweb.org


                                                                                    41
     Trainees who wish to participate in this project should ask their national
     hematology society for a Curriculum-Passport. They should then notify
     their mentor and department head of their intention to use the Curriculum-
     Passport to accompany their training. They should request that their
     mentor(s) and department head sign the Curriculum-Passport after the
     completion of each section.

     The Curriculum-Passport delivers recommendations for a pan-European
     curriculum for basic training in hematology. These recommendations must
     be reviewed periodically to make sure that they continue to reflect and
     respond to the needs of trainees throughout Europe and its associated
     states. A review procedure has been scheduled for 2008 when the members
     of the Curriculum Committee will reassess the recommendations and their
     future validity. The recommendations will be amended as appropriate. This
     will ensure that the Curriculum-Passport will be a useful tool for European
     hematologists and that it will benefit their patients.




     Figure One: Young hematologists discussing poster presentation in Stockholm
     June 2005.

     Laurent Degos




42
LOBBYING ACTIVITIES




                                                                                             CHAPTER SIX
Hematology organizations and hematologists throughout Europe contributed
to the design and content of the ECAH project so that it would reflect the
needs of European hematologists and their patients. This approach has
ensured the project’s initial success. However, it will take time and a number
of essential actors to fully and durably achieve the projects’ aims.

EHA and the ECAH partners have established relations with official
governmental and accreditation authorities at the national and pan-European
levels. They have also been in contact with professional organizations.

The European Parliament, European Commission, European Council:
Official Pan-European Recognition of Hematology

In 2002, EHA became aware of a proposal for a new European Parliament
Doctors’ Directive that excluded 35 of the original 52 medical specialties
previously recognized at the pan-European level. European hematologists
were concerned that they and specialists working in other important
medical disciplines were to be denied automatic pan-European recognition
of their professional credentials.

By 2003, EHA, EBMT, ESH and the national hematology societies throughout
Europe began coordinated lobbying activities under the umbrella of EHA,
to demand that hematology be reinstated. Thanks to this, and other unified
action, these efforts were successful.

As specified by a European Parliament representative:
“Medical specialties common to at least 2/5 of Member States will continue to benefit
from automatic recognition. “General haematology” is a medical specialty common to 19
Member States, and therefore it continues to benefit from automatic recognition under
the Council Common Position. For its part, only 4 Member States have opted in for the
automatic recognition of “Biological Haematology” up to now. In those conditions,
according to the Council Common Position, the medical specialists in “Biological Haema-
tology” currently graduated in one of the 4 Member States listed in the Doctors’ Directive
(DK, FR, LU and PT) will benefit from automatic recognition on the basis of specific
acquired rights. For the medical specialists in “Biological Haematology” who will graduate
in future, recognition will be granted according to the rules of the General System.”

The new Directive (2005/36/EC) was adopted on September 7, 2005. It will
become effective on October 20, 2007 when it will replace the 15 current
Directives that regulate the recognition of professional qualifications.

                                                                                                43
     National Education Authorities:
     Official Recognition of the Curriculum-Passport

     EHA and the ECAH partners have proposed recommendations for a
     pan-European basic curriculum for the specialty training of hematologists
     (see chapter 5). These recommendations aim to reconcile the diversity in
     specialist training that currently exists between European countries, and
     the fact that the majority of European hematologists aspire to pan-European
     harmonization of training at the highest level.

     While acknowledging that decisions related to education are a national
     prerogative, European hematologists hope that national education
     authorities will find the ECAH recommendations for specialty training
     useful as a tool to assess the training requirements implemented in their
     respective countries.

     National Accreditation Authorities:
     Official Recognition of the ECAH CME system

     The ECAH CME system has been adopted by close to 10 000 hematologists
     throughout Europe and its associated and in-coming states, and beyond. It
     has brought international visibility to European educational projects in this
     bio-medical field.

     However, it will be truly useful only if it receives official recognition on the
     part of the national accreditation authorities in Europe, responsible for the
     regulatory aspects of CME in their respective countries.

     This objective of pan-European harmonization constitutes a real challenge
     since each European country has its own national accreditation authority,
     and some countries have several of them (see chapter 2). Furthermore, as
     described elsewhere in this booklet, although CME accreditation systems
     have been implemented in a few European countries, they do not share the
     same scope or methods. They do not always recognize each other’s credit
     points. Nor do they always recognize CME taking place in countries other
     than their own.

     EHA and the ECAH partners have begun to liaise with the national
     accreditation authorities in France, Italy and the United Kingdom, with plans
     to pursue this question in the near future with the national accreditation
     authorities in the other European countries that have already implemented
     a national CME system.

44
EHA and the ECAH partners will also seek recognition of the ECAH CME
system in the European countries where a CME accreditation system has
not yet been implemented. This recognition would avoid redundant cost
and effort at the national level, while promoting high quality standards
developed through expert recommendations. It would also contribute to
pan-European harmonization of knowledge and expertise.

Hematology as a mono-specialty at UEMS

EHA and the ECAH partners have also contacted the European Union of
Medical Specialists (UEMS) to elicit recognition of hematology and its
expertise.

UEMS is a multidisciplinary professional organization founded in 1958, with
headquarters in Brussels. It includes specialty sections representing the
main medical disciplines in practice in Europe.

Contrary to the European Parliament’s new Doctors’ Directive, UEMS does
not recognize hematology as a mono-specialty.

In 2004, a motion proposing the creation of a mono-specialty section in
hematology was first presented to the UEMS Management Council by one
of its members, the Polish Chamber of Physicians and Dentists. EHA and
the ECAH Partners, representing the great majority of hematologists in
Europe, supported this motion. They consider that ECAH deserves recognition
by UEMS as the scientific and medical reference in European hematology
and that this expert input is necessary to all discussions and decisions
concerning their profession.

ECAH and UEMS nonetheless share common objectives including
improvement and pan-European harmonization of professional knowledge
and skills, as well as increased international visibility for European
educational projects in the bio-medical sphere. For this reason, European
hematologists continue to hope that UEMS will follow the European
Parliament Doctors’ Directive by creating a mono-specialty section for
hematology. It may then also become appropriate to elicit recognition of
ECAH by the European Accreditation Council for Continuing Medical
Education (UEMS-EACCME), as the official European Board for accreditation
and quality control for CME in hematology.




                                                                              45
     European Accreditation Council for Continuing Medical Education
     (EACCME)

     UEMS-EACCME was founded by the European Union for Medical Specialists
     in the year 2000. It is a multidisciplinary organization that acts as a clearing-
     house for CME in an effort to facilitate reciprocal recognition of CME credit
     points between different medical specialties, between European countries,
     and between Europe and North America. It also intends to promote
     professional mobility within Europe.

     Unfortunately, further to the fact that hematology is not represented at UEMS-
     EACCME, the question of pan-European harmonization of CME accreditation
     is not solved by the UEMS-EACCME initiative since UEMS has not signed
     formal agreements with all of the national accreditation authorities.

     In 2002, UEMS-EACCME established a pilot reciprocity agreement with the
     American Medical Association (AMA) involving reciprocal recognition of CME
     credit points. This pilot study will end in June 2006 when AMA will evaluate
     its results and decide if a more permanent collaboration should be pursued.

     European Specialty Accreditation Boards
     Certain pan-European scientific societies have developed CME accredita-
     tion systems in their respective specialties. Some of these have elected to
     join UEMS-EACCME.

     A certain number of these European Specialty Accreditation Boards recently
     decided to explore the possibility of leaving EACCME to initiate an
     independent multidisciplinary CME accreditation system.

     Conclusion
     Thanks to exemplary collaboration on the part of hematologists throughout
     Europe and its associated states, lobbying actions have proven essential to the
     ECAH project. They have clearly demonstrated the strength of the profession of
     hematology in Europe. Lobbying actions have also underscored the ability
     of European hematologists to work together, forming a critical mass able to
     design novel strategies and tools to improve the future of healthcare in Europe.
     During the ECAH project, contacts have been established with other actors involved
     in CME in Europe. In view of their number and diversity, pan-European harmo-
     nization in this field promises to be a complex and time-consuming venture.

     Didi Jasmin


46
FUTURE DIRECTIONS




                                                                                  CHAPTER SEVEN
The voyage of discovery is not in seeking new
landscapes but in having new eyes.
                                                      Marcel Proust (1871-1922)




The ECAH project has achieved its goals and fulfilled its obligations to the
European Commission’s Leonardo da Vinci programme.

The project has:
• provided expert recommendations to improve and harmonize specialty
  training throughout Europe and its associated and in-coming states.
• developed a hematology passport to promote professional mobility.
• developed a system for the accreditation and quality control of CME in
  hematology, as well as novel tools for its administration.
• promoted distance-learning as a means to improve and harmonize the
  professional knowledge and skills of hematologists, for the benefit of their
  patients.
• contributed to ensure that hematology is cited in the European Parliament
  Doctors’ Directive thus ensuring pan-European recognition of the
  professional credentials of hematologists.
• liaised with professional and accreditation authorities in Europe and
  beyond.
• attracted international recognition of European hematology as a leader in
  the field of education.

However, continuing efforts are necessary to continue to further validate,
improve, promote and earn extensive official recognition of these projects.

Future tasks and perspectives
Rapid scientific progress makes training in hematology a cornerstone
for the future of healthcare for blood disorders. The recommendations for
specialty training described in this booklet and in the Curriculum-Passport
are pertinent at this time. It will be an on-going task of the EHA Education

                                                                                      47
     Committee and Board, in collaboration with the national societies of
     Hematology in Europe, to regularly question the relevance of these guide-
     lines and to update them.

     As the training centers throughout Europe adopt the ECAH recommen-
     dations for specialty training, EHA and the ECAH partners may decide to
     implement procedures for the accreditation and quality control of training
     centers and mentors.

     The Curriculum-Passport corresponds to European hematology’s appraisal
     of the basic requirements to become a hematologist. Many hematologists
     will continue training, to specialize further in one of the sub-specialties
     of the field. This further specialization may warrant the development of
     pan-European expert recommendations.

     The ECAH CME system has been very widely adopted by hematologists.
     More extensive accreditation activities for e-training projects and other en-
     during materials will be launched. The development of quality control pro-
     cedures will also continue to be a major focus.

     The EHA CME Unit located at the EHA Executive offices in Rotterdam, will
     be financially responsible for the system’s central management and a man-
     ager has already been appointed to assume day-to-day administration. The
     unit’s chair and co-chairs will liaise closely with the CME system’s partners
     and providers to ensure on-going pan-European coordination of accredita-
     tion activities and to identify emerging needs. A review board designated
     by national hematology societies will continue to assure the scientific peer-
     review of new applications.

     Time will tell if the CME system will progressively evolve into a system for
     Continuing Professional Development (CPD), broader in scope than it is at
     present.

     Conclusion
     The main objective of the ECAH project was to produce novel tools and
     strategies to harmonize high quality standards of education in hematology
     throughout Europe. This has been achieved.

     However, at the end of this 3-year project, it seems clear that as long as
     unnecessarily redundant actions are implemented by many diverse ac-
     tors, often without prior dialogue and coordination, and sometimes in
     apparent conflict of interest, it will be difficult to promote cost-effective,

48
pan-European harmonization of scientific and clinical excellence. To make
high quality training and optimal patient management equitably accessible
for all, it will be essential to promote dialogue between all key players and
to prospectively coordinate their activities. This is a major challenge for the
future.

EHA and the ECAH partners feel that official action is called for at the
European level to seek solutions to this difficult problem. They offer their
experience and expertise to the European Commission, European Council
and European Parliament to this end.

In the meantime, EHA, as the promoting organization of this Leonardo
da Vinci contract, extends sincere thanks to the European Commission on
behalf of all the ECAH partners.

EHA also acknowledges the essential contribution of the ECAH partner
organizations to the development of this project. Our close collaboration
will continue to serve European hematologists and their patients.




Completing CME evaluation procedures at the airport in Hamburg at the end
of an accredited meeting using a wireless internet connection .

Eva Hellström-Lindberg, Didi Jasmin, Dimitris Loukopoulos




                                                                                  49
     EHA Executive Office
     Westblaak 71
     3012 KE Rotterdam
     The Netherlands

     Phone: +31 (0)10 436 17 60
     Alternative phone numbers:
     Education: +31 (0)10 404 5621
     Sponsorship/Annual Congress: +31 (0)10 404 5616
     Fax: +31 (0)10 436 18 17
     E-mail: info@ehaweb.org

     Monique Davidse
     CME Unit Manager
     cme@ehaweb.org

     Nancy Hamilton
     Education Committee Coordinator
     education@ehaweb.org

     Roedet Samba
     Communication / Public Relations
     Communication@ehaweb.org

     Ans Steuten
     Executive Manager and
     Fellowships & Grants
     Executive.office@ehaweb.org

     Angela de Vlaming
     Membership
     administration@ehaweb.org

     Helen Wodrada
     Corporate Sponsor Program and Annual Congress
     Sponsorship@ehaweb.org and Annual.congress@ehaweb.org




50
Partner Contact Information

European School of Haematology
Centre Hayem, Hôpital Saint-Louis
1 avenue Claude Vellefaux,
Paris 75475 Paris Cedex 10, France
Telephone: + 33 (0)1 42 06 65 40
Fax: + 33 (0)1 42 06 05 87
www.esh.org
President: Eliane GLUCKMAN
Director: Didi JASMIN didi.jasmin@paris7.jussieu.fr
Manager: Ghyslaine LEBOUGAULT ghyslaine.lebougault@paris7.jussieu.fr
Meeting Coordinator: Marie-France SIMON msimon@chu-stlouis.fr
Assistant Meeting Coordinator:
Céline CAUDROIT celine.caudroit@paris7.jussieu.fr

Österreichische Gesellschaft Für Hämatologie und Onkologie
www4.billrothhaus.at/oegho/cms1/

Belgian Hematological Society
www.bhs.be/

Deutsche Gesellschaft für Hämatologie und Onkologie e.V.
www.dgho.de/

Asociación Española de Hematología y hemoterápia
www.aehh.org/

Institut Universitaire d’ Hematologie
www.univ-paris7.fr/IUH/

European School of Haematology
www.esh.org

Société FRANÇAISE D’HÉMATOLOGIE
http://sfh.hematologie.net/

 ΛΛ Ν Κ    Ι Τ Λ ΓΚ
Ε Η Ι Η Α ΜΑ Ο Ο Ι Η Ε Α Ρ ΙΤΙΕΑ
www.mednet.gr/eae/topgr.htm

Haematology Association of Ireland
NO WEBSITE

                                                                       51
     Società ITALLIANA EMATOLOGIA
     www.sie.hematology.it

     NERGAL
     www.nergal.it

     EUROCONGRES Conference Management
     www.eurocongres.nl

     Nederlandse Vereniging voor Hematologie
     www.hematology.nl

     POLSKIEGO TOWARZYSTWAHEMATOLOGÓW I TRANSFUZJOLOGÓW
     www.pthit.pl

     Svensk Förening För Hematologi
     www.sfhem.se

     British Society of Haematology
     www.b-s-h.org.uk

     European Group for Blood and Marrow Transplantation
     www.ebmt.org

     Haematologica/The Hematology Journal
     www.haematologica-thj.org

     SOCIEDADE PORTUGUESA DE HEMATOLOGIA
     www.sph.org.pt




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