The orthopaedic industry continues to evolve in its approaches to innovation and safety. So, do we need continuing medical education (CME) for physicians, medical staff and healthcare professionals in the 21st century? In this article, we look at the current state of CME in Europe and what the future could bring as the tracking and analysis of outcomes becomes more prevalent in today’s performance-payment system.
First, when did medical education start?
Continuing medical education isn’t a new concept. The earliest organized CME in Europe occurred around 1300 in the city of Venice, where a minimum standard of professional competence was ensured by requiring specialty certification for initial medical licensure. Annual refresher courses were also a requirement for practitioners wishing to keep their licenses. The first public autopsy took place in 1537 in the city of Leuven, near Brussels. In 1811, Massachusetts General Hospital was founded as an academic teaching hospital.
Where are we today?
Clinical outcomes vary widely across hospitals and surgeons. Opinions on CME in Europe depend upon location. In Netherlands, there’s a mandatory CME system. Spain has no mandatory requirements and no sanctions if you don’t participate. In Albania, most are unfamiliar with the CME concept.
No central body upholds the standards of CME accreditation across Europe, much like the Accreditation Council for Continuing Medical Education does in the U.S. Progress is being made to develop a more coherent approach to CME in Europe; however, there is currently no unified approach.
Quality management and audits have taught all stakeholders that when CME is a required process, it improves quality assurance in medicine and healthcare. Likewise, CME is a pathway to enhancing knowledge, competency and career advancement.
What are the challenges to CME?
Patient safety is paramount in medicine. Preventable adverse events significantly contribute to morbidity and mortality during a patient’s hospital stay. Manufacturers are held to regulations and expectations in terms of product quality and safety. Companies are investing the utmost effort to receive the CE Mark and FDA approval or clearance for their innovations. These existing regulations stipulate processes starting with product launch via postmarket surveillance studies and customer device complaint through to recall action. Hospitals have started implementing and integrating quality management systems and auditing processes.
These stakeholders are satisfied with a 98 percent excellent outcome rate. But to put it in different terms, would you take a seat in a plane for which the airline reports a two percent annual failure rate?
Product recalls and infection rates are increasing in numbers, today. The underlying errors cannot be explained solely by medical technical inadequacies, but are more often attributed to difficulties in the transition of theoretical knowledge into tasks under the conditions of clinical reality.
It seems that we need to change our handling of information, and take the opportunity to establish a new safety culture and adjust medical education. Key to this is the understanding that the learning curve is more a circle than a bending line.
Advances in medical technology with ever-faster and shorter innovation cycles, as well as professional challenges associated with modern healthcare and clinical research, signal that all stakeholders should be required to constantly update their medical and technical knowledge and skills. The causes for errors do not lie purely in medical/technical deficit, but in difficulties in the practical implementation of knowledge under conditions of reality. Crew resource management and human factors, which determine the safety and performance of humans in complex situations, can help to eliminate these causes.
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