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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