international emergency education

Education and Education and International International Emergency Emergency MedicineMedicine

Joe Lex, MD, FACEP, FAAEM, MAAEMTemple University School of Medicine

Philadelphia, PA USA

DisclosureDisclosure

NOTHING NOTHING TO TO

DISCLOSEDISCLOSE

A Point to PonderA Point to Ponder

““Naturally conservative, we are Naturally conservative, we are bewildered by the rapidity of a bewildered by the rapidity of a forced progress and change…We forced progress and change…We have outrun an educational system have outrun an educational system framed in simpler days and for framed in simpler days and for simpler conditions…”simpler conditions…”

A Point to PonderA Point to Ponder

“…“…The pressure comes hard The pressure comes hard enough upon the teacher but far enough upon the teacher but far harder upon the taught, who suffer harder upon the taught, who suffer in a hundred different ways.”in a hundred different ways.”

Sir William OslerSir William OslerLecture at St. George’s HospitalLecture at St. George’s Hospital

London – 1913 London – 1913

““Prediction Is Hard, Especially Prediction Is Hard, Especially About the Future”About the Future”

Famed philosopher Famed philosopher Lawrence BerraLawrence Berra

Prediction Is Hard…Prediction Is Hard…

““predicting the future is neither a predicting the future is neither a science nor an art: predicting the science nor an art: predicting the future is a sport and as in all sports future is a sport and as in all sports activities the players are subject to activities the players are subject to spectators’ criticism and second-spectators’ criticism and second-guessing.”guessing.”

Stephen AbrahamsonStephen AbrahamsonEssays on Medical EducationEssays on Medical Education

We’ve Known ThisWe’ve Known This

“…“…the educational sequence from the educational sequence from pre-medical education to retirement pre-medical education to retirement from practice should be looked upon from practice should be looked upon broadly as a single problem, not a broadly as a single problem, not a succession of isolated and unrelated succession of isolated and unrelated experiences.”experiences.”Commission on Medical EducationCommission on Medical Education – –

1932 1932

Something to RememberSomething to Remember The primary difference The primary difference

between reality and fiction is between reality and fiction is that fiction has to make sensethat fiction has to make sense

20 years ago…20 years ago…

……would you have predicted the would you have predicted the impact made byimpact made by

The internetThe internet Smart phones Smart phones Electronic medical recordsElectronic medical records Compact imaging toolsCompact imaging tools Changes in education methodsChanges in education methods

Our patients…Our patients…

……are more complicated are more complicated ……are more sophisticated about their are more sophisticated about their

conditionsconditions……sometimes have implanted sometimes have implanted

devices and continuous infusionsdevices and continuous infusions……live with conditions thought not live with conditions thought not

survivable just decades agosurvivable just decades ago

Emergency Medicine…Emergency Medicine…

……is in a perfect position to make is in a perfect position to make changes in the house of medicine changes in the house of medicine come aboutcome about

……sees the booming opportunities sees the booming opportunities and looming problems on a daily and looming problems on a daily basisbasis


……is available to deliver expert is available to deliver expert evaluation and treatment 24 hours evaluation and treatment 24 hours a day, 7 days a week a day, 7 days a week

……has not only changed the has not only changed the traditional face of medicine, but traditional face of medicine, but has also changed patients’ and has also changed patients’ and consultants’ expectations for what consultants’ expectations for what medicine should bemedicine should be


……is establishing accelerated is establishing accelerated pathways for chest pain, TIA, pathways for chest pain, TIA, minor head injury, asthma, etc.minor head injury, asthma, etc.– Allows safe, early discharge and Allows safe, early discharge and

maximal use of inpatient bedsmaximal use of inpatient beds

……is establishing protocols for is establishing protocols for resuscitation and post-resuscitation and post-resuscitation care resuscitation care

The rest of medicine must catch The rest of medicine must catch up with usup with us

Nonavailability of medical Nonavailability of medical imaging, subspecialty consultation imaging, subspecialty consultation services, and in-house 24 hour services, and in-house 24 hour critical care will no longer be critical care will no longer be acceptable to patients or those acceptable to patients or those who pay their billswho pay their bills

ProceduralistsProceduralists We will become proceduralists by We will become proceduralists by

defaultdefault Additional shift or two: inpatient Additional shift or two: inpatient

proceduresprocedures– Abdominal paracentesis, arterial Abdominal paracentesis, arterial

line placement, arthrocentesis, line placement, arthrocentesis, central venous line placement, central venous line placement, lumbar puncture, thoracentesislumbar puncture, thoracentesis

New Areas of ExpertiseNew Areas of Expertise Resuscitation: ours by defaultResuscitation: ours by default Geriatric emergency medicine: Geriatric emergency medicine:

graying of the populationgraying of the population Each specialty will need experts in Each specialty will need experts in

managing complicated patients on managing complicated patients on an accelerated pathway over an accelerated pathway over hours, rather than dayshours, rather than days

New Areas of ExpertiseNew Areas of Expertise Pediatric Emergency Medicine: Pediatric Emergency Medicine:

“The last thing a sick kid needs is “The last thing a sick kid needs is a pediatrician.”a pediatrician.”

Emergency Radiology: coming Emergency Radiology: coming from which direction?from which direction?

Palliative Care: because death is Palliative Care: because death is inevitableinevitable

Better ToolsBetter Tools Universal charting: access all Universal charting: access all

medical and pertinent social medical and pertinent social information on patients, no matter information on patients, no matter where treatedwhere treated

Better ToolsBetter Tools Medical recordsMedical records

– Identification photos of patientsIdentification photos of patients– Allow photo upload photos from Allow photo upload photos from

portable cameras and smart phonesportable cameras and smart phones

Prehospital & EMPrehospital & EM Information from crash scene: Information from crash scene:

plug directly into vehicle’s plug directly into vehicle’s computer for crash speed, use of computer for crash speed, use of restraints, forces, intrusion, etc. restraints, forces, intrusion, etc.

Evaluate outpatients through Evaluate outpatients through ambulance telemetry systems to ambulance telemetry systems to determine need for transportation determine need for transportation to emergency departmentto emergency department

Currently in DevelopmentCurrently in Development Synthetic oxygen carriersSynthetic oxygen carriers Reperfusion “cocktails” Reperfusion “cocktails” Mitochondrial stabilizersMitochondrial stabilizers Free radical scavengersFree radical scavengers Caspase (“executioner” protein) Caspase (“executioner” protein)

inhibitorsinhibitors

Currently in DevelopmentCurrently in Development Mechanical organs and artificial Mechanical organs and artificial

tissues: pumps, tubes (vessels), tissues: pumps, tubes (vessels), muscles, bones, jointsmuscles, bones, joints

Neuroimaging may demonstrate Neuroimaging may demonstrate different patterns of neural different patterns of neural activation to help us distinguish activation to help us distinguish between chronic or recurrent pain between chronic or recurrent pain and addictionand addiction

EducationEducation Large medical meetings will never Large medical meetings will never

go away: excellent tool for go away: excellent tool for networking and sharing ideas or networking and sharing ideas or researchresearch

Credentialing organizations must Credentialing organizations must eventually recognize that eventually recognize that emergency practitioners learn “on emergency practitioners learn “on the fly”the fly”

EducationEducation We see a patient with an We see a patient with an

unfamiliar disease or taking a unfamiliar disease or taking a vaguely-remembered medication vaguely-remembered medication book or on-line resource…and book or on-line resource…and we learnwe learn

EducationEducation This learning results in better This learning results in better

patient outcomes, but patient outcomes, but unrecognized in favor of unrecognized in favor of “organized” learning at “organized” learning at conferences or journalsconferences or journals

US Perspective on CMEUS Perspective on CME

““Educational activities that serve Educational activities that serve to maintain, develop, or increase to maintain, develop, or increase the knowledge, skills, and the knowledge, skills, and professional performance and professional performance and relationships a physician uses to relationships a physician uses to provide services for patients, the provide services for patients, the public, or the profession.”public, or the profession.”

In other words…In other words…

CME helps medical CME helps medical practitioners learn practitioners learn

information and acquire information and acquire skills that helps them take skills that helps them take better care of their patientsbetter care of their patients

In better words…In better words…

Continuing Professional Continuing Professional DevelopmentDevelopment (CPD) asserts (CPD) asserts not just that physicians will not just that physicians will continue learning, but that continue learning, but that they will learn how to keep they will learn how to keep

learning.learning.

4 Questions4 Questions Will ACCME model work for the Will ACCME model work for the

rest of the world?rest of the world? Should there be specialty-specific Should there be specialty-specific

CPD?CPD? Should there be different Should there be different

categories of CPD?categories of CPD? Did Internet change everything?Did Internet change everything?

Question 1Question 1 Will ACCME model work for the Will ACCME model work for the

rest of the world?rest of the world? Should there be specialty-specific Should there be specialty-specific

CPD?CPD? Should there be different Should there be different

categories of CPD?categories of CPD? Did Internet change everything?Did Internet change everything?

The ACCMEThe ACCME The The AAccreditation ccreditation CCouncil for ouncil for

CContinuing ontinuing MMedical edical EEducation ducation was formed in 1981 to monitor was formed in 1981 to monitor providers of CME in the USAproviders of CME in the USA

Ensures CME activities are of Ensures CME activities are of scientific merit and appropriate for scientific merit and appropriate for the people who participatethe people who participate

The ACCME OrganizationsThe ACCME Organizations1.1. ABMSABMS: American Board of Medical : American Board of Medical

SpecialtiesSpecialties2.2. AHAAHA: American Hospital Association: American Hospital Association3.3. AMAAMA: American Medical Association: American Medical Association4.4. AAMCAAMC: Association of American Medical : Association of American Medical

CollegesColleges5.5. AHMEAHME: Association for Hospital Medical : Association for Hospital Medical

EducationEducation6.6. CMSSCMSS: Council of Medical Specialty : Council of Medical Specialty

SocietiesSocieties7.7. FSMBFSMB: Federation of State Medical Boards: Federation of State Medical Boards

US PerspectiveUS Perspective CME mandatory in 40 / 50 states CME mandatory in 40 / 50 states

to maintain medical licenseto maintain medical license Most hospitals require physicians Most hospitals require physicians

to obtain CME credits for hospital to obtain CME credits for hospital credentialing (appointment and credentialing (appointment and re-appointment)re-appointment)

US PerspectiveUS Perspective Most specialty boards Most specialty boards

require CME for continued require CME for continued certificationcertification

Quality activities play vital role in Quality activities play vital role in the life-time learning of physicians the life-time learning of physicians and other healthcare providersand other healthcare providers

US PerspectiveUS Perspective 150 credit hours over 3 years 150 credit hours over 3 years 1 hour equals 1 credit 1 hour equals 1 credit Future: replace credit hours by Future: replace credit hours by

determining in advance the determining in advance the number of hours needed for number of hours needed for comprehension, based on contentcomprehension, based on content

CME in the USA: 3 WaysCME in the USA: 3 Ways

1. The AMA Physician Recognition 1. The AMA Physician Recognition Award (PRA) Category 1 and 2 Award (PRA) Category 1 and 2 credit systemcredit system

Live activities, enduring materials, Live activities, enduring materials, journal-based CME, test item journal-based CME, test item writing, manuscript review, writing, manuscript review, performance improvement (PI) performance improvement (PI) CME and Internet point of careCME and Internet point of care


2. American Osteopathic 2. American Osteopathic Association (AOA) credit systemAssociation (AOA) credit system

AOA approves individual activities AOA approves individual activities and accredits organizationsand accredits organizations


3. American Academy of Family 3. American Academy of Family Physicians (AAFP) Prescribed Physicians (AAFP) Prescribed and Elective credit systemand Elective credit system

Approves individual activitiesApproves individual activities Largest of the 3 systemsLargest of the 3 systems Note: precedent exists for Note: precedent exists for

specialty-specific CPDspecialty-specific CPD

Category 1Category 1 Live / attendance-based activitiesLive / attendance-based activities

– National conferences, local National conferences, local workshops, seminars, grand roundsworkshops, seminars, grand rounds

Enduring materialsEnduring materials– Printed, recorded, audio, video, and Printed, recorded, audio, video, and

electronic activities that may be electronic activities that may be used over time at various locationsused over time at various locations

Medical ConferencesMedical Conferences 2011: more than 2000 health-2011: more than 2000 health-

related conferencesrelated conferences– 259 were on-line webinars259 were on-line webinars

Probably underestimatedProbably underestimated Real number may be ~100,000Real number may be ~100,000 Monetary cost?? UnfathomableMonetary cost?? Unfathomablewww.clocate.comwww.clocate.com

http://www.clocate.com/

Medical ConferencesMedical Conferences Disseminate / advance researchDisseminate / advance research TrainTrain EducateEducate Set evidence-based policySet evidence-based policy There is no evidence that they do There is no evidence that they do

ANY of these thingsANY of these things

Medical ConferencesMedical Conferences Estimated environmental effect to Estimated environmental effect to

attend midsized international attend midsized international conference: 10,000 tons of carbonconference: 10,000 tons of carbon

Peer-review: what can you tell Peer-review: what can you tell from a 250 word abstractfrom a 250 word abstract

Most are never published in a Most are never published in a peer-review journalpeer-review journal

Medical ConferencesMedical Conferences Create a “branding system” that Create a “branding system” that

promotes herding after elevated promotes herding after elevated prestigious opinion leadersprestigious opinion leaders

Dynamics of large professional Dynamics of large professional societies: leadership frequently societies: leadership frequently judged on ability to navigate judged on ability to navigate power circles, not on teachingpower circles, not on teaching

Category 2 CPDCategory 2 CPD All educational activities not All educational activities not

designated Category 1designated Category 1 Improve care for patientsImprove care for patients Many on a day-to-day basisMany on a day-to-day basis Consultation with peers and Consultation with peers and

medical expertsmedical experts Small group discussionsSmall group discussions

Category 2: ExamplesCategory 2: Examples Developing and reviewing quality Developing and reviewing quality

assessment data: Morbidity and assessment data: Morbidity and MortalityMortality

Use of electronic databases in Use of electronic databases in patient carepatient care

Journal club activities not Journal club activities not designated Category 1designated Category 1

Category 2: ExamplesCategory 2: Examples Self-assessment activitiesSelf-assessment activities Reading enduring materials: Reading enduring materials:

reading medical books, web sites, reading medical books, web sites, periodicalsperiodicals

Medical writing: abstracts, journal Medical writing: abstracts, journal articles, book chaptersarticles, book chapters

TeleconferencesTeleconferences

Category 2: ExamplesCategory 2: Examples Teaching health professionals: Teaching health professionals:

medical students, residents, medical students, residents, physicians, nurses, allied healthphysicians, nurses, allied health

Lectures, seminars, and Lectures, seminars, and workshops not designated workshops not designated Category 1, such as poster Category 1, such as poster viewing at society meetingsviewing at society meetings

If you want to know medicine…If you want to know medicine…

……5 years ago 5 years ago read a textbook read a textbook……2 years ago 2 years ago read a journal read a journal

articlearticle……now now go to a go to a goodgood conference conference……in the future in the future

……listen in the hallwayslisten in the hallways……use FOAMuse FOAM

FOAMFOAM

FFree ree OOpen pen AAccess ccess MMeducationeducation

State: CaliforniaState: California 100 Category 1 credits over 4 100 Category 1 credits over 4

yearsyears One-time requirement of 12 hours One-time requirement of 12 hours

pain management and end-of-life pain management and end-of-life carecare

If >20% of patients are over 65, If >20% of patients are over 65, 20 hours in geriatric medicine20 hours in geriatric medicine

State: PennsylvaniaState: Pennsylvania 100 credits over 2 years100 credits over 2 years 20 hours must be Category 120 hours must be Category 1 12 hours of patient safety or risk 12 hours of patient safety or risk

managementmanagement If work at Trauma Center: 16 If work at Trauma Center: 16

hours traumahours trauma– 8 hours from outside own hospital8 hours from outside own hospital

States Requiring States Requiring NoneNone ColoradoColorado IndianaIndiana MontanaMontana New YorkNew York South DakotaSouth Dakota VermontVermont Hawaii (none for osteopaths)Hawaii (none for osteopaths)

Where Do US Docs Get CME?Where Do US Docs Get CME?

3.993.993.643.643.603.603.533.53

3.323.322.532.53

2.202.202.142.14

1.771.77

1 2 3 4 5

TeleconferencesIndividually arranged retrainingAudio or visual tapes

Computer-based CMEGrand rounds

Short in-depth one topic courseJournalsUpdate or review courses

Medical association meetings

ACCME Requires…ACCME Requires… Accreditation application formAccreditation application form Conflict of interest disclosureConflict of interest disclosure Full program / agenda for eventFull program / agenda for event Course evaluationCourse evaluation Program objectivesProgram objectives Learning objectivesLearning objectives

ACCME Requires…ACCME Requires… List of proposed presentersList of proposed presenters Presenter qualificationPresenter qualification Description of course formatDescription of course format Needs assessmentNeeds assessment Finalized course contentFinalized course content Outcomes measurementOutcomes measurement

System of AccountabilitySystem of Accountability

CME must be…CME must be………based on valid contentbased on valid content……effective in improving practiceeffective in improving practice……linked to quality and safetylinked to quality and safety……independent of commercial independent of commercial

interestsinterests

Do We Follow ACCME?Do We Follow ACCME?

Checklist for CPD CreditsChecklist for CPD Credits TimelineTimeline1. Verify that the activity is 1. Verify that the activity is developed from a professional developed from a professional practice gap connected to your practice gap connected to your own learnersown learners

9 months 9 months prior to prior to activityactivity

2. Verify that the educational 2. Verify that the educational needs (knowledge, competence, needs (knowledge, competence, or performance) were derived or performance) were derived from the professional practice gapfrom the professional practice gap



Checklist for CPD CreditsChecklist for CPD Credits TimelineTimeline3. Verify that the need(s) was 3. Verify that the need(s) was incorporated into the activityincorporated into the activity


4. Verify the expression of the 4. Verify the expression of the expected change, in terms of expected change, in terms of competence, performance or competence, performance or patient outcomes (e.g. goals or patient outcomes (e.g. goals or objectives)objectives)



Checklist for CPD CreditsChecklist for CPD Credits TimelineTimeline5. Verify the match between the 5. Verify the match between the content and the scope of your content and the scope of your learners’ current or potential learners’ current or potential scope of professional activitiesscope of professional activities


6. Verify the implementation of a 6. Verify the implementation of a process to ensure format is process to ensure format is appropriate to objectives and appropriate to objectives and desired resultsdesired results



Checklist for CPD CreditsChecklist for CPD Credits TimelineTimeline7. Verify that a desirable physician 7. Verify that a desirable physician attribute was incorporated into the attribute was incorporated into the planning processplanning process


9. Verify that all individuals in a 9. Verify that all individuals in a position to control the content position to control the content disclosed relevant financial disclosed relevant financial relationships to the providerrelationships to the provider



Checklist for CPD CreditsChecklist for CPD Credits TimelineTimeline11. Verify implementation of a 11. Verify implementation of a mechanism to mechanism to identifyidentify conflicts of conflicts of interest prior to start of an activityinterest prior to start of an activity


12. Verify implementation of a 12. Verify implementation of a mechanism to mechanism to resolveresolve conflicts of conflicts of interest prior to start of an activityinterest prior to start of an activity



Checklist for CPD CreditsChecklist for CPD Credits TimelineTimeline15. Attach a list of all commercial 15. Attach a list of all commercial supporters for the activity, if supporters for the activity, if applicableapplicable

1 month 1 month prior to prior to activityactivity

16. Attach all signed agreements, 16. Attach all signed agreements, if applicableif applicable

1 month 1 month prior to prior to activityactivity


Checklist for CPD CreditsChecklist for CPD Credits TimelineTimeline19. Verify 19. Verify evaluationevaluation of changes in of changes in learners’ competence learners’ competence oror performance performance oror changes in patient changes in patient outcomeoutcome

1 month 1 month after after activityactivity

21. Verify any changes made in 21. Verify any changes made in your activities that results from your activities that results from your overall CME program your overall CME program evaluation and analysisevaluation and analysis

1 month 1 month after after activityactivity


Checklist for CPD CreditsChecklist for CPD Credits TimelineTimeline23. Verify that non-educational 23. Verify that non-educational strategies were used to enahnce strategies were used to enahnce change as adjuncts to the CME change as adjuncts to the CME activityactivity

None None notednoted

24. Verify that factors outside the 24. Verify that factors outside the provider’s control that impact on provider’s control that impact on patient outcomes were identifiedpatient outcomes were identified



Checklist for CPD CreditsChecklist for CPD Credits TimelineTimeline25. Verify that educational 25. Verify that educational strategies to remove, overcome, strategies to remove, overcome, or address barriers to physician or address barriers to physician change were implementedchange were implemented


26. Verify efforts to build bridges 26. Verify efforts to build bridges with other stakeholders through with other stakeholders through collaboration and cooperationcollaboration and cooperation


In other words…In other words…

……by the time that the criteria are by the time that the criteria are met, the information may be out of met, the information may be out of datedate

International CME / CPDInternational CME / CPD

International CME / CPDInternational CME / CPD Union Européenne Des Médecins Union Européenne Des Médecins

SpécialistesSpécialistes: UEMS: UEMS European Accreditation Council European Accreditation Council

for Continuing Medical Education: for Continuing Medical Education: EACCMEEACCME

Global Alliance for Medical Global Alliance for Medical Education: GAMEEducation: GAME

http://www.uems.net/http://www.uems.net/

http://www.uems.net/

http://www.eaccme.euhttp://www.eaccme.eu

http://www.eaccme.eu/

http://www.game-cme.orghttp://www.game-cme.org

http://www.game-cme.org/

http://www.sacme.org/http://www.sacme.org/

http://www.sacme.org/

CME in SpainCME in Spain VoluntaryVoluntary Salary incentive: CME credits Salary incentive: CME credits

used for professional career used for professional career purposes in regional public health purposes in regional public health services (which employ most services (which employ most physicians)physicians)

CME in SpainCME in Spain Spanish Medical Association has Spanish Medical Association has

CME accreditation system under CME accreditation system under the Spanish Accreditation Council the Spanish Accreditation Council for CME (SACCME)for CME (SACCME)

Regional commissions accredit Regional commissions accredit events for all health professionalsevents for all health professionals

SACCME only for physiciansSACCME only for physicians

CME in SpainCME in Spain Highly decentralized: 51 Spanish Highly decentralized: 51 Spanish

Autonomous Regions have put Autonomous Regions have put into practice their Regional into practice their Regional Commission of CE AccreditationCommission of CE Accreditation

It is expected that accredited It is expected that accredited providers be introduced in the providers be introduced in the near futurenear future

CME in SpainCME in Spain Full day program of CME: 6Full day program of CME: 6 1-hour face-to-face CME 1-hour face-to-face CME

symposium: 1symposium: 1 1-hour e-CME: 11-hour e-CME: 1

http://www.uems.net/http://www.uems.net/

http://www.uems.net/

UEMSUEMS Established in 1958Established in 1958 Headquarters in BelgiumHeadquarters in Belgium 17 national associations from 17 national associations from

countries of European Unioncountries of European Union 37 specialist organizations37 specialist organizations Standardizing CME for physicians Standardizing CME for physicians

migrating around EUmigrating around EU

http://www.eaccme.euhttp://www.eaccme.eu

http://www.eaccme.eu/

EACCMEEACCME Established in 1999Established in 1999 Governed by UEMSGoverned by UEMS

– Similar to ACCME & AMASimilar to ACCME & AMA Clearing house for CME Clearing house for CME

certification in Europecertification in Europe Does not directly accredit CME Does not directly accredit CME

activitiesactivities

EACCMEEACCME Established basic requirements Established basic requirements

for defining quality CMEfor defining quality CME European physicians assured of European physicians assured of

quality from approved programsquality from approved programs European physicians can gain European physicians can gain

CME from other European CME from other European countries and from AMA PRAcountries and from AMA PRA

EACCME / AMA ICRPEACCME / AMA ICRP

EACCME / AMA ICRPEACCME / AMA ICRP If the organization offering CME If the organization offering CME

activity is accredited by ACCME activity is accredited by ACCME or recognized state medical or recognized state medical society, it can designate the society, it can designate the activity for Category 1 Creditactivity for Category 1 Credit

The location of the activity has no The location of the activity has no effect on accredited organizations effect on accredited organizations that provide CMEthat provide CME

EACCME / AMA ICRPEACCME / AMA ICRP International conferences International conferences

sponsored by non-accredited sponsored by non-accredited organizations may be able to organizations may be able to receive AMA PRA Category 1 receive AMA PRA Category 1 Credit™ if the conference has Credit™ if the conference has been approved by the AMA’s been approved by the AMA’s International Conference International Conference Recognition (ICR) ProgramRecognition (ICR) Program

EACCME / AMA ICRPEACCME / AMA ICRP Physicians attending live activities Physicians attending live activities

approved for EACCME credit can approved for EACCME credit can earn AMA PRA Cat 1 Credit™earn AMA PRA Cat 1 Credit™

Submit a copy of EACCME credit Submit a copy of EACCME credit certificate with completed certificate with completed application and fee to the AMA to application and fee to the AMA to receive AMA PRA Cat 1 Credit™receive AMA PRA Cat 1 Credit™

EACCME / AMA ICRPEACCME / AMA ICRP Physicians attending international Physicians attending international

CME activities sponsored by CME activities sponsored by nonaccredited organizations nonaccredited organizations which are not approved by the which are not approved by the ICR Program or the EACCME ICR Program or the EACCME Reciprocity Agreement, may claim Reciprocity Agreement, may claim AMA PRA Category 2 Credit™ for AMA PRA Category 2 Credit™ for their participation…their participation…

http://www.ifem.cc/http://www.ifem.cc/

http://www.ifem.cc/

IFEMIFEM Founded in 1989Founded in 1989 Purpose: promote at an Purpose: promote at an

international level, interchange, international level, interchange, understanding and co-operation understanding and co-operation among physicians who practice among physicians who practice emergency medicineemergency medicine

>30 member organizations>30 member organizations

Goals of IFEMGoals of IFEM

1.1. Exchange information on topics of Exchange information on topics of international interest international interest

2.2. Provide a mechanism for Provide a mechanism for international collaborative research international collaborative research

3.3. Provide a mechanism for Provide a mechanism for international elective opportunities for international elective opportunities for trainees in EM programs trainees in EM programs


4.4. Provide avenue for international Provide avenue for international sabbatical and exchange sabbatical and exchange opportunities for practitioners of opportunities for practitioners of emergency medicineemergency medicine

5.5. Act as forum for common problems Act as forum for common problems and approaches to solving problems and approaches to solving problems specific to emergency medicine specific to emergency medicine


6.6. Offer advice and guidance to Offer advice and guidance to emergency medicine practitioners emergency medicine practitioners worldwide in the formation of national worldwide in the formation of national associations and associations and training and training and certification programscertification programs

7.7. Provide a network system of centers Provide a network system of centers to facilitate international cooperation to facilitate international cooperation in the event of national or manmade in the event of national or manmade disasters disasters


8.8. Organize an international conference Organize an international conference on topics of interest in emergency on topics of interest in emergency medicine every 2 yearsmedicine every 2 years

9.9. Act as a resource in the development Act as a resource in the development of emergency medical services (out-of emergency medical services (out-of-hospital care)of-hospital care)

10.10. Provide support for public education Provide support for public education programs related to emergency programs related to emergency medicine or manmade disasters medicine or manmade disasters


11.11. Provide policy recommendations on Provide policy recommendations on international, public and international, public and governmental issues related to governmental issues related to emergency medicineemergency medicine

12.12. ??? Serve as a clearing house ??? Serve as a clearing house and certifier of quality CPD / CME and certifier of quality CPD / CME for the international emergency for the international emergency medicine community ???medicine community ???

Should IFEM Approve CPD?Should IFEM Approve CPD? ““Experienced” physicians…Experienced” physicians…

……possess possess lessless factual knowledge factual knowledge……are are lessless likely to adhere to likely to adhere to appropriate standards of careappropriate standards of care……may have may have poorerpoorer patient patient outcomesoutcomes

Choudhry NK, et al. Systematic Review: The relationship between clinical experience and quality of health care. Ann Intern Med. 2005;142~4!:260–273.

Should IFEM Approve CPD?Should IFEM Approve CPD?

First thought: NOFirst thought: NO Incredible administrative burdenIncredible administrative burden No business model to do soNo business model to do so Limit to English-language Limit to English-language

programs?programs? No control over in-flow: may be No control over in-flow: may be

feast or faminefeast or famine

Should IFEM Approve CPD?Should IFEM Approve CPD?

But…But… IFEM presently forming committee IFEM presently forming committee

to “certify” or approve educational to “certify” or approve educational offeringsofferings

ConsideringConsidering CPD approval, but CPD approval, but recognizing barriers & limitsrecognizing barriers & limits

Who Can Apply?Who Can Apply? Professional societies only? (e.g. Professional societies only? (e.g.

SAE, SEMES, SAMU)SAE, SEMES, SAMU) Universities only?Universities only? Pharmaceutical and device Pharmaceutical and device

manufacturers?manufacturers? Individual educational Individual educational

entrepreneurs?entrepreneurs?

Other questionsOther questions Different categories?Different categories?

– Live activities vs Internet vs printLive activities vs Internet vs print How do we charge for service?How do we charge for service?

– € € per attendee?per attendee?– Flat fee per program?Flat fee per program?

Should we be part of the planning Should we be part of the planning process?process?

Where Should IFEM Look?Where Should IFEM Look?

3.993.993.643.643.603.603.533.53

3.323.322.532.53

2.202.202.142.14

1.771.77

1 2 3 4 5

TeleconferencesIndividually arranged retrainingAudio or visual tapes

Computer-based CMEGrand rounds

Short in-depth one topic courseJournalsUpdate or review courses

Medical association meetings