CME Worldwide

1. Federazione delle Società Medico -Scientifiche Italiane CME Worldwide BRAIDO F. FISM Task Force CANONICA G.W. FISM Secretary General

2. Continuing Medical Education: an international reality Braido F., Popov T., Ansotegui IJ., Gayraud J., Nekam K.L., Delgado J.L., Malling H.J., Olson S, Larchè M., Negri A., Canonica G.W. EAACI CME Accreditation Committee In press 2005

4. Applicants Bulgaria Ceska Rep. Estonia Cypros Lettonia Latvija Magyarorszag Malta Polska Romanja Slovenja Slovackia. Turkiye Belgium Denmark Germany Greece Spain France Ireland Italy Luxemburg Holland Portugal Austria Finland Sweden Great Britain EU Member Countries

5. BELGIUM Mandatory or Voluntary CME? •  Voluntary, but incentives exist for accredited doctors (they can ask for higher fees, about 4.5%, + a yearly premium of 490 Euro.) There are no sanctions besides exclusion of accreditation and no re-certification. Type of Credit:Points  Number of Credits: • The number of credits required amounts to 200 per year (20 hours of which 3 hours must be Ethics, and 4 hours in group peer review). National Accreditor: • CME in Belgium is regulated by an organization within the INAMI-RIZIV (State Institution for Insurance against Disease and Invalidity) and hence, is monitored by the profession, the universities and scientific organizations and the (mostly politically linked) insurance organizations.

9. BULGARIA Mandatory CME Agreement with UEMS

10. CROATIA Mandatory or Voluntary CME?Mandatory.Voluntary up to 1995, since then all physicians have had to join the Croatian Medical Chamber. An Institute of Licensure and Re-licensure was established. All physicians with state examinations, already practicing medicine, were granted a license for independent practice, renewed after six years following the obtaining of 120 points of CME. Type of Credit: 1 hour = 1 credit National Accreditor: Specialists Societies and Hospitals (1996)

11. CZECH REPUBLIC Mandatory or Voluntary CME? • Mandatory, similar to Croatian system Type of Credit: Credits system Number of Credits: Credits obtained over 5 years National Accreditor: Specialist Societies and Hospitals Online CME? Yes

12. HUNGARY Mandatory or Voluntary CME? Mandatory with sanctions Type of Credit: Points Number of Credits: 250 points over 5 years National Accreditor: • Four Medical Schools under control of aSupervisory Steering Committee Other: Incentive to comply,Doctors pay to register and are punished if they do not. Also important is the Hungarian Physicians Chamber (HPC). Other: • Pharma companies (local and international), from both a financial point of view as well as giving scientific information, are playing keyrole in the continuous medical education. Every activity concerning the creditpoint system should be in close cooperation with the HPC and the entire Doctors Collegium (Neurology, Gynecology etc.)

13. POLAND Mandatory or Voluntary CME? • A law exists but doesn't work in practice. Voluntary National Accreditor: • Polish Chamber of Physicians and Dentists Other: • The Head of Polish Gynecological Society Prof. WieslawSzymanski can be interested in the introduction of CME system and give assistance.

14. ROMANIA Mandatory or Voluntary CME? Mandatory  Type of Credit: Credits per type of activity  Number of Credits: • 50-200 credits every 5 years (depending upon specialty). A scale of crediting has been established according to the difference between courses with and without a final evaluation as well as taking part in conferences and congresses. National Accreditor: Romanian College of Physicians Accreditation of providers: • Providers are accredited with help of Scientific Societies and the Professional Organizations – rules include experience and no commercial links.

15. SLOVAKIA CME is about to be established.

16. SLOVENIA Mandatory or Voluntary CME? Mandatory. Type of Credit: Credit Points. Number of Credits: 75 points over 7 years for re-certification National Accreditor: Slovenian Medical Chamber Online CME? Coming up

17. TURKEY Voluntary CME with sanctions in certain areas

19. UNITED STATES Mandatory or Voluntary CME? Mandatory in 40 states. Type of Credit: Credit hours, move to credits Number of Credits: 150 credit hours over three years National Accreditor: • The Accreditation Council for Continuing Medical Education (ACCME) Online CME • ACCME released policy 2002-A-11 stating eight points regarding online CME program. In summary, they say that CME activities delivered via the internet are expected to be in compliance with ACCME Essential Areas, Elements and Policies. Other • Reciprocity agreement between AMA and the EACCME

20. 1998 2003 USD 302 millions 971 millions N.E.J.M. february 10,2005

21. N.E.J.M. february 10,2005

22. CANADA Mandatory CME As in the United States Reciprocity agreement with USA

23. MEXICO Mandatory since 2002 Bylateral agreement with the USA

25. ARGENTINA Mandatory or Voluntary CME? • Voluntary but there are plans to make itmandatory in the future. National Accreditor: • NationalCommissionfor BoardCertification and Re-certification

26. BRAZIL • Not a formal system in place. Brazilian federal health council has no rules for CME. • Medical societies like: anesthesia, cardiology and gynecology are playing a major role in establishing standards for certifying and updating their members. • There is a trend leaded by the major schools of medicine to reduce the number of new physicians, due to saturation of the market (9,000 new doctors every year), the goal is to have better training and CME for future board certification.

27. CHILE Mandatory or Voluntary CME?Voluntary National Accreditor: • National Council for Medical Specialties Certification (CONACEM) established in 1985. certification is provided through a diploma of CME issued by this council. Online CME? Yes Other: • Government health authorities, “CONACEM” and Chilean Academy of Medicine are now considering implementation of CME and board certification standards for all specialists. • Pharmaceutical industry is playing a major role in education by delivering CME enduring programs (print and online).

28. COSTA RICA Mandatory or Voluntary CME? • Voluntary for almost all medical specialties, but mandatory for public health employees. National Accreditor: • Board certification and re-certification is ruled by the committee for medical certification of the Costa Rica’s national medical college. Re-certification required now by 6 specialties every 3 years.  Other: • Mexican influence in Costa Rica’s and Central America due many opinion leaders from the region have graduated or postgraduated in Mexico.

29. PERU • In 1998 the National system for board certification andre-certification under the rule of the Peruvian college of medicine) was established. Implementation process is starting. • There are many CME activities and programs sponsored by pharmaceutical companies.

31. KUWAIT Mandatory or Voluntary CME? Looks voluntary. Type of Credit: Points Number of Credits: • Health professionals who acquire a total of 250 credit points during a period of five years receive a Certificate of Satisfactory Completion of CME from KIMS. Category 1 Educational activities entitle the participants to claim 1 credit point of CME for one contact hour of educational activity (Lectures, symposia, group learning, seminars etc. that are structured and formal). Practical/clinical training sessions yield 0.5 credit point per hour.Category 2 activities earn 0.5 credit point of CME for every hour. National Accreditor: Kuwait Institute for Medical Specialization (KIMS) Online CME? Yes Other • Category 1 comprises formal learning opportunities provided by recognized educational institutions or professional bodies, and accredited by the CME Council of KIMS. Educational activities that are less structured from a learning viewpoint than those under Category 1 are included under Category 2.

32. SAUDI ARABIA MANDATORY CME 80 different nationalities practising medicine CME as standard practice 30 Hours

33. IRAN Mandatory CME 25 Credits a year Loss of licence

34. SOUTH AFRICA Mandatory or Voluntary CME? Mandatory. Type of Credit:Credit Points (1 point = 1 hour of CME activity) Number of Credits: 50 points National Accreditor: • Medical and Dental Professional Board under the jurisdiction of the Health Professions Council of South Africa (HPCSA).

36. SINGAPORE Mandatory system for Specialists

38. AUSTRALIA Voluntary for Specialists

39. NEW ZEALAND Voluntary for Specialists

40. COUNTRIES with MANDATORY CME North America: Canada, USA (40 States) Central America : Mexico Europe: Austria, Ireland, Italy, Netherlands, Norway (only GPs.), Switzerland, U.K. (CPD) Eastern Europe: Bulgaria,Croatia, Check Republic, Romania, Slovenia Africa: South Africa Asia: Iran, South Korea, Singapore, Saudi Arabia, Arabian Emirates

41. CME ITALY usa CME USA CME EUROPE CME WORLD

42. RECIPROCITY EACCME --ACCMECME Credits till 2006

43. UNMET NEED & ABSOLUTE REQUIREMENT Harmonization of CME Systems throughout Europe

44. Euro Currency CME Italian CME Credit System European CME Credit System EACCME German CME Credit System French CME Credit System

45. A harmonized system of CME throughout Europe is inevitable in the next few years

46. “USA-EU: Sharing the educational effort” Milan - March 2003 Rome - October 2003 Rome - April 2004 G. Walter Canonica, Chairman, European Academy of Allergology & Clinical Immunology Accreditation Council, Secretary General, World Allergy Organization, Secretary, Italian Federation of Scientific Medical Societies, Genoa Italy Murray Kopelow, Chief Executive, Accr Council for Continuing Medical Education, Chicago, IL, Bernard Maillet, Secretary General, European Union of Medical Specialists, Brussels, Belgium Herve Maisonneuve, Task force on Health Care Professionals' Competencies, Paris, France Alfonso Negri, Secretary General, Italian Council for Accreditation in Pneumology, Milan, Italy Helios Pardell, Director, Spanish Accr Council for Continuing Medical Education Madrid, Spain Teodor Popov, European Academy of Allergology and Clinical Immunology, Sofia Bulgaria Barbara Schneidman, Vice President for Education, American Medical Association, Chicago, IL Pasquale Spinelli, Vice President, Italian Federation of Scientific Medical Societies Milan, Italy Riccardo Vigneri, Chairman, Long Distance Learning Sub-Committee, Italian Continuing Medical Education Commission of the Ministry, Catania, Italy Kate Lancey, Royal College CPD London UK Next Meeting : Rome May 16, 2005

47. ROME, April 25 - 26 , 2004

48. B.M.J. May 2004

49. Consensus on Basic Values and Responsibilities Underlying the Substantial Equivalency of CME and CPD Systems Values CME/ CPD systems should be based on the following enduring values Continuing medical education and life-long learning: 1.That enhances physician performance and thereby improves the health of people. 2.That is based on information concerning the educational needs of physicians with the ultimate aim of helping them improve health. A process for the accreditation of providers/organizers of CME/CPD activities that includes: 1.Fairness, validity, innovation, honesty and consistency in accreditation practices. 2.Reasonable standards and criteria for CME providers/organizers. 3.Accountability, responsiveness, and leadership of accreditation bodies. 4.The promotion of continuous quality improvement of the accreditation process as well as the education systems it supports. 5.Collaboration and partnership between and among accreditation bodies, and between accreditation bodies and providers/organizers Allergy 2005 in press

50. Responsibilities of the provider/organizer of CME/CPD activitiesto be fulfilled in order to grant credit • 1.  Any commercial sponsorship or interests of the programme planner, presenters, or facilitators must be disclosed to the provider / organizer and the learners. • 2.Any support, sponsorship or funding by commercial health care organisations must not influence the structure or content of the educational programme. • Ensure there are outcome measures of education effectiveness expressed in terms of meeting the knowledge, competence or performance objectives of the activity. • Be able to make available a confirmation of participation, at a frequency and nature appropriate to regulatory requirements. • Ensure that the teaching methods used are appropriate to the stated learning objectives. • Be able to show that they have evaluated the quality of any previous education activities and have made improvements, where necessary The provider / organizer must: Allergy 2005 in press