Variations in CME Management in Europe: Insights for CE Providers and Healthcare Professionals

Variations in CME Systems in Europe were outlined at the Global Alliance for Medical Education (GAME) which were discussed in a presentation  based on a recently published paper in the Journal of European CME.  The presentation by Madeline Schaffer of the European Institute for Medical & Scientific Education (EIMSED) titled:  “Variations in CME management in Europe: Insights for CE providers and healthcare professionals” was insightful on how CME systems in various countries are lead by very different influences.  

EIMSE, in cooperation with White Cube Health Care, recently completed a Scientific study on Medical Education and Continuing Medical Education (CME) in Europe.  The study assessed 11 European countries (Austria, Belarus, Czech Republic, France, Germany, Great Britain, Italy, Hungary, Spain, Switzerland, Ukraine).  The study was based on a structured questionnaire as well as online research and interviews. 

In their analysis, EIMSED gathered data on Medical education systems (pre-/post-graduate); CME & accreditation systems; and Health care systems & cultural aspects.  The authors looked at terminology, meaning/understanding, and language.  They then assessed their roles as another quality factor in CME for individual programs as well as cross-boarder programs and collaborations 

The presentation noted how “Harmonization of CME systems across Europe seems to be on its way.”  Out of 11 countries analyzed: 10 countries have implemented a credit-based CME system, and 10 countries have made participation in certified CME activities mandatory. 

The authors tested the following hypothesis: Integrating the background of medical education systems and linking areas between physicians and the health care system will prove to be an additional quality factor for educational programs…

…and will substantially improve.  Countries were clustered based on the following criteria: 

  • Roles & responsibilities
    • Who is in the driver seat for CME?
    • Who takes decisions?
    • Who provides the regulatory framework?
    • Position of CME within the medical education path
    • Funding models 

The presentation then discussed three main CME Models 

  1. Physician-centric model
  2. Politician-centric model
  3. University-centric model 

Physician-centric model 

Responsibility for CME is given to the official physician representations (Medical chamber / association) of the respective countries.  The physician representatives  

  • Develop the regulatory framework for CME; and
  • Approve educational activities 

Typical representatives of this model are Germany, Austria, Italy and the Czech Republic. UK and Switzerland follow this model as well but with some significant differences.  The strengths and opportunities of this model is that it provides 1) freedom of choice for the learner; flexibility; and continuing development of CME due to numerous providers. 

The weaknesses/risks of this model is the lack of curriculum; strong dependency from commercial sponsors; high risk for commercial bias; low involvement of universities as experts in education; unstructured approach; and the self-management of the education. 

Politician-centric model 

The Ministry of health is centrally responsible for the legal framework and is involved in the organization and management of CME through an executive body.  Typical representatives of this model are Spain, France and partially Italy.  The strengths of this model are its independent funding and more structured approach.  The weaknesses, however, are the lack of a continuum, no structural involvement of universities as experts in education, and slower development due to lower numbers of CME providers. 

University-centric model 

The Universities are the central body responsible for management and implementation of CME. Universities are the single or dominant provider of CME. The legal framework

is provided by the Ministry of health.  This model is characterized by a centralized, clear structured CME system, closely embedded in the medical education path from pre-graduate to post-graduate.  Typical representatives for this model are Ukraine and Belarus.  Also Hungary can be allocated to this cluster with a clear structured educational system. 

This model is strong because it offers a structured, curriculum based approach, and a continuum of learning from pre-graduate to post-graduate.  However, there is a high risk for governmental bias and a lack of funds. 


Ultimately, customized medical education will lead to improved outcomes and improved patient care.  The authors concluded that CME providers need to fully understand structural and systematic differences even between systems which look similar at first (from medical school till life-long learning) in order to provide education across borders that adds value for the learners.  This conclusion was supported by EIMSED outcome data (not part of this study) clearly showing that learning outcomes are improved by integrating this in-depth background information into the whole educational planning process.

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