Clinical/Medical Microbiology in the UEMS & throughout Europe Prof. dr. John E. Degener, University Medical Center Groningen, University of Groningen
Nothing tops Groningen!
Aim of this presentation 1. To define the common profile of Clinical Microbiology practice as defined in Helsinki 1996 2. To define the present status of the specialty in EU countries and representation in the UEMS 3. To discuss which kwledge, skills and attitudes should be requested and/or trained to be regarded as a professional clinical microbiologist 4. To discuss the contents of a curriculum 5. To discuss endqualifications of training in order to enable free movement of professionals in Europe 6. Debate with other stakeholders in our field
1. the profile of the specialty in the EU: What makes a good clinical microbiologist? Aim: to define the basic pillars of a modern training programme for residents to make them fit for specialist tasks
8 MAIN TASKS defined by UEMS Section Med. Path. Microbiology Commission HELSINKI 1996 ADVICE ON DIAGNOSIS, TREATMENT & PREVENTION PROVIDE SCIENTIFIC BASIS FOR LABORATORY DIAGNOSIS UNDERTAKE MANAGEMENT RESPONSIBILITIES TAKE CHARGE OF INFECTION CONTROL ANTIBIOTIC POLICY PROVIDE SURVEILLANCE DATA PARTICIPATE IN TRAINING FOR MED. MICROBIOLOGISTS, INFECTION CONTROL PRACTIONERS & OTHER EXPERTS UNDERTAKE R & D
Stage 1: Themes in Microbiology microbiology bacteriology Hospital Hygiene & Infection Control virology Clinical liaison & consultancy Laboratory diagsis mycology Public health parasitology Scientific Management Development & education
2nd stage: specialty specific competences (UEMS 2005) Scientific basis of clinical microbiology Laboratory safety Sterilisation and Disinfection Handling of specimens Microscopy Culture methods Further processing of cultures Antimicrobial investigations Molecular microbiology and emerging techlogies Typing techniques Data handling Clinical experience Antimicrobial usage Results reporting Quality control Audit and clinical governance Accreditation 3rd stage: logbook Kwledge Skills Attitude
Blueprint of the profession of Medical/Clinical Microbiology ESCMID: Clinical UEMS: Medical
2. Present status in the EU and UEMS: The harmonisation of Clinical Microbiology as a mospecialty: A challenge and debate Ilja Repin: The Cossacks are writing a letter to the Sultan of Turkey. 1880,Tretjakow State Galery, Moscow.
UEMS: : Union Européenne des Médecins Spécialistes/ European Union of Medical Specialists Founded in 1958, a year after the Treaty of Rome Oldest of the European Medical Organisations Represents currently around 1,4 million specialist doctors 27 members, 5 associated members Non-governmental organisation UEMS registered under Belgian law Secretariat in Brussels 1957, Treaty of Rome
Organisation of medical specialties in the EU 1958 6 members 2004 27 members
Clinical Microbiology as Medical Specialty in Europe Country Status of Clinical Microbiology as a medical specialty in Statusif2007 Europe (ESCMID information) Clinical Microbiology as a medical specialty In Europe (ESCMID 2007) Albania Armenia Austria Azerbaijan Belarus Belgium Bosnia Bulgaria Croatia Cyprus Czech Republic Denmark Estonia Finland France Georgia Germany Greece Hungary Iceland Ireland Israel Italy Latvia Lithuania Luxembourg Macedonia Malta Moldavia Netherlands Norway Poland Portugal Romania Russia Serbia-Montenegro Slovakia Slovenia Spain Sweden Switzerland Turkey Ukraine United Kingdom 44 countries (without mini-states) Member to UEMS associate associate associate associate associate associate associate 27 UEMS members CM is Recognised as a Full Specialty EU: 18 27 EU countries UEMS : 20 Member to EU
Clinical Microbiology as a medical speciality in Europe (2007) All 44 countries 27 EC countries Full speciality 31 18 No speciailty or subspeciality 13 9
Delegates Austria f.m. P. Apfalter, A. Franz Netherlands f.m. J. Degener (president) / G. Ruijs Belgium o.m. K. Magerman Norway f.m. T. Leegaard Croatia a.m. V.Tripković / S. Kalenić Poland f.m. P. Heczko / E. Lewczyk Denmark f.m. J.Prag (board member) / S. Kristian Romania f.m. I. Codita / A. Rafila Finland f.m. U.Jaakko Slovenia f.m. K. Seme (secretary) / M. Poljak Germany f.m. G. Mauff / A. Friedrich Sweden f.m. H. Rautelin / A. Osterman Hungary f.m. J. Konya Switzerland f.m. R. Zbinden / D. Burki Italy f.m. D. Marchetti (treasurer) Turkey a.m. Y. Akgun / Z. Gulay / D. Gür Latvia f.m. A. Balode UK f.m. M. Hastings /A. Mifsud Macedonia o.m. M. Petrovska / K. Ana ESCMID ex. board E. Nagy Liaison officer ID A.Vince ESCMID t.a. F. Schaumburg / N. van Burgel Liaison officer LM S. Chatzipanagiotou
3. Of kwledge, skills and attitude. New Concepts: The 7 competences of the Medical Specialist 2003
A competence is defined as A set of kwledge, skills and attitudes kwledge and insight practical expertise professional conduct/behaviour Applies to any medical specialist
General Core Competencies Medical Proficiency: having the kwledge and skills essential to the profession. Communication: being able to communicate well with the patient, family, professionals and colleagues. Kwledge & Science: having kwledge of evidencebased medicine, providing education, informing the general public, performing scientific study. Co-operation: co-operating with colleagues and health care employees inside and outside the clinic. Organization: working with others in a purposeful manner; optimizing health care logistics. Social Interaction: infection prevention, kwledge, and the application of the legal framework, risk management, coping with errors. Professional Conduct: ethics, reflection, being aware of one s own limitations.
8 MAIN TASKS defined by UEMS Section Med. Path. Microbiology Commission HELSINKI 1996 DIAGNOSIS, TREATMENT & PREVENTION SCIENTIFIC BASIS MANAGEMENT INFECTION CONTROL ANTIBIOTIC POLICY SURVEILLANCE TRAINING R&D
How to fit the specialist specific tasks of microbiology into the general CanMeds concept? Define main themes Define main tasks Create matrix of themes and competences
4. Contents of a curriculum for clinical microbiology training Competency based Competencies and themes in microbiology in a matrix model Training program may contain theme based charts, adapted for your local institute.
Medical Proficiency Theme Chart Virology Chapter 2 of the Logbook Duration of the internship: 1 year * refers to the Assessment Criteria list Example 1 display insight into the anatomy, physiology and resistance mechanisms of viruses apply general laboratory logistics A1-A6 Theme-related final attainment levels: at the end of formal training, the resident will be able to: apply direct detection techniques / microscopy B1-B2 Communication apply cultivation techniques C1 communicate with colleagues, medical analysts and laboratory managers: content-related, team-oriented with understanding of the mutual relationships apply serological techniques D1-D2 * apply molecular diagstics E1- E2 * in the laboratory * * organize and steer progress discussions critically appraise the clinical relevance of laboratory diagstics consult his or her supervisor sufficiently and in good time Organization manage the various duties and responsibilities motivate and stimulate the analysts understand the laboratory information system Kwledge & Science critically appraise the relevant literature with regard to laboratory methods and techniques Understand the hospital organization Professional Conduct Reliability of diagstics Social Interaction recognize the importance of quality apply the Occupational Health and Safety Act and of Environmental Regulations Co-operation liaise with colleagues Work in a cost-efficient manner Work in a team-oriented setting
Theme Chart Medical Proficiency: Infection Prevention and Hospital Hygiene apply Infection Prevention and Hospital Infection A1 A5 Chapter 5 of the Logbook Duration of the internship: 3 months * refers to Assessment Criteria list apply Isolation Procedures B1 B2 Example 2 apply Sterilization, Disinfection and Waste Processing D1 D4 Theme-related final attainment levels at the end of formal training the resident will be able to: apply Safety and Hygiene in the Hospital E1 E2 Communication understand the relevant legal stipulations, (inter)national guidelines, and the relevant committees communicate with colleagues, hospital hygienists and, in the hospital, with doctors and nursing staff, among others: content-related, with understanding of the mutual relationships * assume an interactive role in multi-disciplinary discussion understand when and how the GGD (Municipal Health Service), the IGZ (Netherlands Health Care Inspectorate), the Board of the institution, employees of the institution, patients and visitors should be informed of any incidents formulate a compact and concise report for internal and external use Organization motivate and stimulate hygienists, doctors, managers and nursing staff manage responsibilities various duties and Kwledge & Science understand the registration system of infection prevention and patient data systems understand the hospital organization understand and cope with epidemiological methods and evidence-based medicine * understand and cope with outbreak management understand the mechanisms of spreading and the relevant prevention measures that ought to be applied to these mechanisms understand the relevant reservoirs, lines of transmission, and the subsequently derived containment measures Social Interaction comprehend (variations prevention department in) the organizational structure of an infection understand the interaction between infection prevention and the laboratory for microbiology Professional Conduct deal with the reliability of diagstics, outbreaks and socomial infections understand when external advice ought to be sought (informal and formal) Co-operation provide guidance and co-operate with hygienists co-operate with various sections in the hospital weigh up various interests when reviewing the containment measures to be taken co-operate with the GGD and other parties in public health care
5. What should the endqualifications look like? Framework of common European requirements for specialist training in medical microbiology Inquiry in 21 countries, Turkey included UEMS Section of Medical Microbiology, Mila meeting May 6th 2011
Harmonising the profile of the specialty Survey of the UEMS Section of MM in 2010 : Define the time, spent on training in the basic themes by residents in different EU countries, with the aim to set minimum requirements for training. 2011Release of the Green Paper by the European Commission: Introduction of the European Professional Card
Harmonisation: from plugs and professionals: a challenge in de EU
EU member states Candidate states Other states Austria Croatia Albania Belgium Former Yugoslav Republic of Macedonia Andorra Bulgaria Iceland Cyprus Turkey Armenia Azerbaijan Czech Republic Belarus Denmark Estonia Bosnia and Herzegovina Finland Georgia France Liechtenstein Germany Moldova Greece Hungary Ireland Italy Latvia Lithuania Luxembourg Questionnaire send to 21 delegates Monaco Montenegro Norway Russia San Mari Serbia Malta Netherlands Switzerland Poland Ukraine Portugal Vatican City State Romania Slovakia Slovenia Spain Sweden United Kingdom
EU member states Candidate states Other states Austria Croatia Albania Belgium Former Yugoslav Republic of Macedonia Andorra Bulgaria Iceland Cyprus Turkey Armenia Azerbaijan Czech Republic Belarus Denmark Estonia Bosnia and Herzegovina Finland Georgia France Liechtenstein Germany Greece Hungary Ireland Italy Latvia Lithuania Moldova 13 delegates responding Monaco Montenegro Norway Russia San Mari Luxembourg Serbia Malta Netherlands Switzerland Poland Ukraine Portugal Vatican City State Romania Slovakia Slovenia Spain Sweden United Kingdom
Time (months) spent in different fields of microbiology bacteriology 8-12-18-23-24-26-36-54 mycology 1-2-3 parasitology 1-2-3 virology 2-4-6-10-12-18
Time (months) spent infection control 1-2-3-5 public health 0-1-2-3-6-7-12
Time (months) spent on clinical training internal medicine 0-2-3-5-12(ID) paediatrics 0-1-4-5 surgery 0-1-3 ICU 0-3-1-4 total clinical t mandatory (Fr.)- 3-612-14-24-48 (UK)
Scientific training Optional or variable- 1-3-6-12 months
Total duration of training 60 months 11 countries 24 months France (+ 12 months science, t mandatory) 48 months Turkey Examination and logbook in all countries
Conclusion General familiarity with the major themes. Variety in attention paid to the major themes. Confusing variety in clinical training period. Scientific training optional?
How to proceed? Main framework, Chapter 6: 5 yr. training period. Training programme: obtain balance between major themes of the professional training. Amount of attention to be paid to the major themes. Draft proposal: UEMS Section of Medical Microbiology.
Accepted UEMS Council October 8, 2011, Naples
6. Debate with other stakeholders: ESCMID & EU recognized Specialities in the field of microbes and microbial diseases Infectious diseases Laboratory Medicine, division or subdiscipline of microbiology Prof. dr. Stylianaos Catzipanagiotou Liaison officer Lab. Medicine, division of Microbiology Prof. dr. Adriana Vince Liaison officer ID Prof. dr. Elisabeth Nagy ESCMID ex. officer
Evolution and diversity: I think Can we get back to the trunk?
Final conclusion: Harmonisation in the EU: from plugs to professionals: It can be as diverse as it is, but it should work! Website: U.E.M.S. Section of Medical Microbiology EU Professional Card