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Cardiology Training in Europe: Assessing Standards
Dr Jim Hall Vice-President Training UEMS-Cardiac Section
Middlesbrough UK
CONFLICTS ON INTEREST
1. Honoraria for lectures – None for >5 years
2. Honoraria for advisory board activities – None for >5 years
3. Participation in clinical trials – No current CI or PI roles
4. Research funding – No current personal grants – No institutional grants relevant to this topic
2 low financial conflicts
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Cardiology Training in Europe: Assessing Standards
➢Background – my background ➢Topic background - mobility of physicians ➢Links to political strategy – EU directives ➢What is UEMS ➢Training Requirements for the Specialty of
Cardiology ➢Assessment strategy
➢EEGC European Examination in General Cardiology
➢EDGC European Diploma in General Cardiology
MIDDLESBROUGH
Health professional mobility in a changing Europe Buchan et al European Observatory on Health Services and Policies 2014
EXAMPLE OF MOBILITY OF PHYSICIANS IN EUROPE
GERMANY 1995 – 2012
DOCTORS REGISTERED WHO QUALIFIED OUTSIDE GERMANY
MOBILITY OF PHYSICIANS IN EUROPE – POLITICAL STRATEGY
The European Union has 28 member states total population of 505 million people
• EU Directives 2005/36/EC and 2013/55/EU on the Recognition of Professional Qualifications
– Aim to facilitate the free movement of EU citizens by making it easier for professionals qualified in one Member State to practise their profession in another
MOBILITY OF PHYSICIANS IN EUROPE – POLITICAL STRATEGY
The European Union has 28 member states total population of 505 million people
• EU Directives 2005/36/EC and 2013/55/EU on the Recognition of Professional Qualifications
– Aim to facilitate the free movement of EU citizens by making it easier for professionals qualified in one Member State to practise their profession in another
“CARDIOLOGIST = 4 years training”
UEMS
The European Union of Medical Specialists (UEMS) - formed in 1958
✓ representative organisation for National Associations of Medical Specialists in Europe - over 1.6 million medical specialists
✓ aims to promote harmonization of postgraduate specialty training to common high standards
✓ works through 43 Specialist Sections - each addressing training in their respective Specialty
Cardiac Section – cardiologists delegated through their NMA - Training Requirements for the Specialty of Cardiology - Assessment of training – EDGC, EEGC - CME accreditation – EBAC and CCC - journal - Continuing Cardiology Education
UEMS
The European Union of Medical Specialists (UEMS) - formed in 1958
✓ representative organisation for National Associations of Medical Specialists in Europe - over 1.6 million medical specialists
✓ aims to promote harmonization of postgraduate specialty training to common high standards
✓ works through 43 Specialist Sections - each addressing training in their respective Specialty
Cardiac Section – Training Requirements for the Specialty of Cardiology “CARDIOLOGIST = 4 years training that is …….…..”
http://www.uems-cardio.eu
UEMS 2012/29: Training Requirements for the Speciality of Cardiology
Defines: • Training
– Expectations of training environment – Expectations of trainers – Expectations of trainees
• Competences to be achieved
• Assessment strategy
MILLER’S TRIANGLE
MILLER’S PRISM
European Diploma General Cardiology
In addition to a National Licence as a Cardiologist
European Diploma in General Cardiology (EDGC) will provide confidence to a patient or regulator or employer that training was to a satisfactory level of competence
EDGC requires assessment of
✓ knowledge ✓ skills ✓ professionalism
European Diploma General Cardiology
In addition to a National Licence as a Cardiologist
European Diploma in General Cardiology (EDGC) will provide confidence to a patient or regulator or employer that training was to a satisfactory level of competence
EDGC requires assessment of
✓ knowledge – European Examination in General Cardiology ✓ skills ✓ professionalism
EEGC - ASSESSMENT OF LEARNING
• What are we wanting to determine? – Knowledge and its use in clinical reasoning
• Pass/fail or ranking? – Pass/fail
• Utility – a composite function of Validity, Reliability,
Educational Impact, Acceptability, Cost and Defensibility
• REMEMBER - Assessment drives learning
EEGC
• An assessment of knowledge • Mapped to the curriculum • MCQs • Clinical scenarios • Interpretation -aimed at understanding
and use of knowledge • Pass/fail (expectation 85-95% pass rate)
Multiple Choice Question
a clinical stem + possibly an image still image (approx 16%) or video loop (approx 8%)
followed by a single question
then a series of five choices (single correct)
Collaborative venture
EEGC
National Cardiac
SocietiesESC
University of
Cologne
UEMS Cardiac Section
Delivery in testing centres
• 120 MCQs in 3 hours
• Individual computers
• Invigilated sitting at exam centre
How it fits in with cardiology training
Common Trunk Internal
Medicine
CARDIOLOGY TRAINING CORE ADVANCED
EEGC
Integrating with subsidiarity principle
Medical School
Certification Completion of
trainingNat
ion
al
lev
el
How to Prepare
Advice:
Cardiology training prepares trainees for a career in cardiology and hence an aptitude for lifelong learning is essential. No limited list of appropriate sources of information. Trainees are encouraged to read widely and use whatever means they prefer for keeping up-to-date.
How to Prepare
Advice:
Cardiology training prepares trainees for a career in cardiology and hence an aptitude for lifelong learning is essential. No limited list of appropriate sources of information. Trainees are encouraged to read widely and use whatever means they prefer for keeping up-to-date.
Examples of good sources of knowledge include: ✓ Textbooks e.g. ESC textbook of Cardiovascular Medicine ✓ Guidelines e.g. ESC clinical practice guidelines ✓ Educational articles e.g. Education in Heart ✓ On-line reviews e.g. Uptodate ✓ On-line educational material e.g. Continuing Cardiology Education ✓ Academic journals e.g. NEJM, EHJ, Lancet, Heart
Running the EEGC
Question Writing Group
Meet twice a year 3-5 nominated writers per country ~ 25 MCQs submitted/writer/year Peer review groups (4-6 reviewers / group)
Editing / accept / return to sender / reject ~ 10 accepted to the MCQ bank/writer
Question Selection Group
Meets once a year 1 member per country
Focus on a category of MCQs from the bank Selects 36 MCQs
Selection template 50% new 25% used 2 yrs 25% used 3 yrs quarter of questions should have image(s) still (16%) or video (8%) avoid repetition of topic
Standard Setting Group
Meets once a year 1-2 members per country ➔ 8-10 strong
Group not all are Question Writing Group members trainees included cannot be a Question Selector
Each reviews and scores all 150 MCQs what % of ‘just-passing’ candidates would get this right?
Exam Board
• Exam performance review
• ‘examinology’ – psychometric analysis – review of item performance – review of candidate performance – passmark adjudication – independent scrutiny of high stakes exam
by University of Cologne
How it is developing
Pilot phase
First pilot in the UK 2009
– 60 candidates – 22 ST3, 31 ST4 – Mean score ST3 or below 61.4 (n=23) – Mean score ST4 or above 65.5 (n=37) – Validation of exam template
→ mandatory annual exam since 2010 ~100 candidates/year
European Pilot in 2012
Spain, Portugal, UK, Netherlands and Ireland
80 candidates Pearson Vue centres in 5 countries
Raw Score out of 117 Min, Max and Interquartile Range
7 Countries had exam candidates in 2016 – Greece – Ireland – Netherlands – Spain – Portugal – United Kingdom – Malta
Current status
EEGC candidates/year
0
100
200
300
400
2012 2013 2014 2015 2016
EEGC
• New countries - candidates 2017 – Switzerland, Cyprus
• New countries at QWG – candidates 2018 – Finland, Sweden, Germany
EDGC – skills assessment
Skills • the Eucardia logbook will document - the type and
numbers of procedures performed during training; the procedural and/or disease variables; the results of Directly Observed Procedural Skills assessments
• a final statement of the trainer(s) regarding the level of competence achieved
Methods of Assessment
EEGC knowledge based assessment
DOPS directly observed procedural skills
Mini-CEX mini clinical evaluation exercise
CBD case based discussion
Multi-rater feedback of behaviour & attitudes
EDGC - assessment of professionalism
Proof of valid licence
• 360° appraisal using relevant documents online
• If not feasible: courses in communication skills etc
• document additional qualifications/research activities/educational activities/participation in quality assurance activities etc
The management platform for the EUROPEAN DIPLOMA GENERAL CARDIOLOGY
Training in Cardiology in Europe: assessing standards
Dr Jim Hall Vice-President Training UEMS-Cardiac Section
THANK YOU FOR YOUR ATTENTION - ANY QUESTIONS?