Introduction

In 2004 the EAU and EBU have joined forces to promote Continuing Medical Education amongst all urologists in Europe by creating a new committee: the EU-ACME. Both organizations have equal representation in this committee under the chairmanship of Prof Dr Helmuth Madersbacher.

The EBU will be responsible for all regulatory matters, such as determining the rules for accreditation of educational activities in accordance with the guidelines of the UEMS. The partnership with EAU makes a truly European wide system possible, with its promotional and administrative possibilities.

Urologists already participating in the EBU-CME system will continue to benefit from the present system but will experience the advantages of a much more sophisticated system currently being under development.

The constant demands of modern medicine make Continuing Medical Education (CME) and Continuing Professional Development (CPD) an absolute necessity.

Continuing Medical Education

CME activities are almost always geared toward practicing physicians and are designed to provide information that is both relevant and essential to medical practice. To achieve these aims, successful CME programs are based on effective educational principles that promote the acquisition of knowledge while promoting efficiency, professional integrity and high ethical standards.

Continuing Professional Development

Continuing Professional Development can be defined as the systematic maintenance, improvement and broadening of knowledge and skill, and the development of personal qualities necessary for the execution of professional and echnical duties throughout the practitioner’s working life (Continuing Professional Development. A practical approach. John Lorriman. The Institution of Electrical Engineers. p 1. 1997)

To be granted Credits, institutions and especially educational activities, should be accredited by a special body: the EBU Accreditation Committee, constituted by members of the European Board of Urology. The EU-ACME Committee is constituted by EBU members and representatives of the European Association of Urology and deals with EAU issues concerning CME, but has recently also included international and national educational activities.

The real key to successful CPD is the doctor as an individual. The achievement of excellence is inevitably an individual task and a difficult one, if the developmental goals the doctor sets are high, as indeed they should be in order to attain optimum results.

Institutions should guarantee that all professionals are teaching, training and learning throughout their careers
Continuing Professional Development, as a system, targets individuals, organizations, providers and professional institutions, all of whom must be involved in the process together and work toward mutually sustaining it.

Promoting a Culture of Continuing Professional Development
Continuing Professional Development is the ultimate challenge we can take on. It tests our capacity to achieve, maximizes the learning process, updates our knowledge, translates theory into practice, sharpens our skills, and puts us at the cutting edge of our field.

Continuing Medical Education and Continuing Professional Development are fundamental tools in ongoing development
CME and CPD help doctors maintain and upgrade their knowledge in the chosen medical field and broaden their personal and professional experience after obtaining the post-graduate degree and becoming specialists. Above all, CME-CPD enhances the quality of patient’s care by constantly improving the physician's skills, broadening the physician's professional outlook and helping him/her to keep up with the vast amount of scientific information constantly being generated.

The entities that stand to benefit most from the doctor’s upgraded knowledge and resulting improved health care are the institutions that employ physicians and the public at l arge who need to be assured that their country's practicing physicians are abreast of the latest techniques and theories. It is therefore imperative that all institutions interested in maintaining high standards of medical practice give their unrelenting commitment to Continuing Medical Education and Continuing Professional Development. Universities, hospitals, scientific associations/societies, colleges of specialists and scientific, pedagogical and professional institutes as well as such international institutions as the boards should take an active role in promoting this form of ongoing professional development.
Serious commitment means that professionals must be given time off to participate in scientific meetings, or engage in selfstudy if educational goals are to be achieved. Professional leave should be guaranteed by employers.
Hospital departments should at least partially reimburse expenses incurred by CME-CPD activities. Continuing Medical Education and Continuing Professional Development are a joint process that should continue throughout the physician's professional life. A review of CME-CPD activities in which the doctor is engaged and an evaluation of his/her skills and knowledge should be maintained.

A Credit System for monitoring and promoting Continuing Medical Education and Continuing Professional Development
The Union Européenne des Médecins Spécialistes (UEMS) recommends that the institutions that sponsor / provide CME-CPD activities on a regional, national and international level, as well as the activities themselves, should be accredited in the European Union. The EBU and EAU are aware that a new vision of Continuing Medical Education should be conveyed and, in the future, it will be forced to move from a credit accumulation system to a system based on confidence and reliance on people.

In order to achieve the above-mentioned goals, the EBU first instituted a credit system to control CME-CPD activities of specialists. The system, applied to CME, was inaugurated in July 1998, at a European School of Urology (ESU) Course in Lisbon, as a pilot study.

The Accreditation Committee of the EBU is responsible for the accreditation of activities and institutions to be granted EBU Credits.
The European Association of Urology (EAU) is the main provider of pan-European CME activities in urology.

In 2004 both the EAU and EBU have joined forces to improve the system and to make it into a truly European System (EU-ACME system), to be used by all urologists in Europe, to help them to keep track of their educational activities, irrespective of the country they practice in or where they have participated in CME and/or CPD activities. For the system to become successful close co-operation between national as well as international associations is essential.

In the EU-ACME System Credits are grouped into five categories. Within each category, a number of units, commonly called Credits, are applied to all approved CME-CPD activities.

The number of credits attributed to the activities depends on the kind of activity. The number of credits considered the minimum necessary for an adequate training/experience as a specialist, for a period of five years is defined by the EBU Accreditation Committee.

The EAU offers automatic registration for its active members for EAU Membership in the system is strictly voluntary. The information recorded can be used both by the specialist for personal record-keeping and curricular purposes and/or by health authorities for informational purposes.

National, International and EAU activities can be accredited by the EBU Accreditation Committee. The mentioned activities are subject to a regular review.

The EU-ACME will act as a central ‘institution’ where all information forwarded by the European Association of Urology and the National Associations is kept and where the credits registered are harmonized for the European Union. The EUACME Credit System has been designed to ensure uniform standards, while taking into account each country's present organizational structure. National credits can easily be converted to EU-ACM or EBU credits and vice versa.

Organizing and providing institutions may only announce credit-bearing activities after approval has been granted by (national) credit-granting authorities.

The names of organizing/providing institutions should appear on all material published, especially on activity programs.

All of the above-mentioned services will be supervised by the Accreditation Committee of EBU, which will base its action on the information provided by the European Association of Urology, by the National Delegates to the EBU and by non-EAU International institutions.

CREDIT SYSTEM

Data management
When the National Association has adopted the EU-ACME System, registered specialists can send records of their CME-CPD accredited activities directly to the EBU Office.

All organizers of accredited activities must submit lists of participants (including their CME number) in an electronic format or attendance lists, controlled and validated by the organizer, to the EBU Office, so credits can be attributed automatically. Attendance control is the responsibility of the organizer. Special scanning machines can be supplied by the EU-ACME.

The National Association may opt for the possibility to organize its own Credit System and send credit records to the EU-ACME office, which will convert the national Credits into EU-ACME Credits. This latter arrangement means there is a local and central database that contains data on European specialists that is both uniform and standardized.

A computerized record of all doctors is kept in the central EU-ACME / EBU Credit System Database. The doctors will be informed of their credit status, annually or upon request, whenever they need a report.

Distribution of credits per active type Continuing Medical Education (CME)
Category 1 - EAU Activities

ESU Courses, Workshops EAU Congress	1,5 Credits per hour (No maximum)
EAU Section Meetings EAU Symposia (Program approved by the Scientific Committee) Regional meetings, Winter Forum, Winter Escape meeting	Hours of attendance = Number of Credits (Maximum of 6 Credits per day and 18 per meeting)

Category 2 - National and Non-EAU International Activities

Congresses, Seminars, Symposia, Courses Workshops or other scientific meetings run independently or included in national or international Congresses Company sponsored Symposia are eligible for accreditation. Company organized Symposia are excluded (Previous accreditation of the organization and program is compulsory)	Hours of attendance = Number of Credits (Maximum of 6 Credits per day and 18 per meeting)
Study visits Training periods in national or foreign hospitals (Requires confirmation by the institution where the training or visit took place. Final report is obligatory)	6 Credits per day (Maximum of 50 Credits in 5 years)
Individual study Reading urological journals (minimum recommended is 2 journals per urologist per year); the reader will be required to answer a set of MCQ's Online courses confirmed by a test	2 Credits per issue (Maximum 10 Credits per year)

To qualify as a Category 2 credit, the activity must be evaluated and accredited beforehand. Medical colleges, scientific associations/societies and university departments specialised in medical education are examples of institutions that may grant sponsorship and accreditation for Category 2 Credits to organizations and programs.
To be accepted under Category 2, activities must:

• Meet requirements as CME
• Clearly state educational objectives
• Fulfil a recognised professional need in the field, as defined in the statement of objectives
• Present subject matter that attains the stated objectives
• Make use of current teaching and learning techniques
• Indicate selection criteria for presenters
• Award certificates of attendance and course completion

Activities will not be granted Category 2 status post facto; prior approval is required.
The application for Credits should include the name and address of the accredited organization, a description of the event and the dates the event initiated and ended. A program including the themes, speakers and other pertinent information should be sent for appraisal.

Continuing Professional Development (CPD)
Cateory 3 - National and Non-EAU International Activities

Teaching activities Undergraduate, post-graduate, post-specialization and other teaching activities	1 Credit per activity/lecture
ESU courses (faculty)	1,5 Credits per hour
Development of clinical and/or technical skills Professional clinical and therapeutic acts of relevance (Documental proof required)	1-10 Credits per year
Sub-specialization or building-up of a special competence	25 Credits
EBU In-Service-Assessment Master's Degree Doctoral Degree Fellowship of the EBU Hospital Competitions	2 Credits 25 Credits 50 Credits 50 Credits 50 Credits

Category 4

Papers, Posters or other type of Presentations (Documental proof required)	5 Credits per act All authors receive Credits
Participation in Debates, Lecturers, Speeches or Interviews	5 Credits per participation
Scientific publications	5 Credits per publication All authors receive Credits

Category 4 Credits will be granted to scientific works published in medical journals, magazines or books; presentations, educational material, and videos or posters presented. Credits are granted only once per subject matter, regardless of the number of times presented.

Category 5

Research Projects (Documental proof required)	Participation = 5 Credits Publication of the results = 5 Credits
Organizing Symposia, Seminars, Courses or similar activities (Number of Credits varies depending on the importance of the event)	5 Credits per event
Participation in Councils, Committees, Study Groups of a scientific, professional or medical/administrative nature (Number of Credits varies depending on the importance of the event)	10 Credits per participation per year
Cultural activities in the Humanities, Social Sciences or Non-Medical Scientific areas	Number of Credits to be decided on a case-by-case basis (maximum of 10 Credits per year)

Activities not included in any of the categories mentioned above may be eligible for Category 5 Credits.

Application for credit attribution under category 5 must come with a letter stating:

• CPD objectives achieved by the activity
• Proof that the activity undertaken is necessary in the field 13 of CPD
• Program of activities and techniques to be used
• Level of knowledge and/or technical skills to be achieved
• Names of instructors and /or institutions involved in the planning, administration and evaluation of the activity
• Final evaluation criteria
• Duration, venue and dates the activity initiated and ended.

Minimum of credits recommended per category per 5 years

CONTINUING MEDICAL EDUCATION
Activity	Credits	Categories
ESU Courses / EAU Congress EAU Section Meetings / EAU Symposia Regional Meetings, Winter Forum, Winter Escape meeting	250	Category 1
Congresses, Seminars, Symposia, Courses. Workshops or other scientific meetings run independently or included in national or international Congresses. Study visits Reading urological journals Online courses confirmed by a test		Category 2
CONTINUING PROFESSIONAL DEVELOPMENT
Activity	Credits	Categories
Teaching activities	50	Category 3
Development of clinical and/or technical skills
Sub-specialization or building-up of a special competence
EBU In-Service Assessment Master's Degree Doctoral Degree Fellowship of the EBU Hospital Competitions
Papers, Posters presentations		Category 4
Participation in Debates, Lectures etc.
Scientific publications
Research projects		Category 5
Organizing Symposia, Courses etc.
Participation in scientific / professional committees.
Cultural activities in the Humanities, Social Sciences or Non-Medical Scientific areas

MINIMUM NUMBER OF CREDITS, RECOMMENDED FOR 5 YEARS

It is recommended that, in 5 years, a minimum of 300 Credits should be obtained, with the following distribution:

250 Credits	Category 1 Category 2
50 Credits	Category 3 Category 4 Category 5

Credits from category 1 and 2 are granted to CME activities and Credits from categories 3, 4 and 5 to CPD activities

Very important note:
Credits from one category or group of categories cannot be added to credits of the other group of categories to make up for the total number required.

Acknowledgments

We are deeply grateful for the priceless contribution that all the members of the Accreditation Committee have made in creating this brochure. Special thanks go to Linda van de Paal whose invaluable comments have made her a virtual co-author of this work. We would also like to acknowledge the important help given by Paula Fassman in editing the text and by Fátima Mascarenhas and Isabel Morais.

References

1. Continuing Medical Education: a quality control system. Matos-Ferreira, A. British Journal of Urology 82: 467-475; 1998
2. Continuing Medical Education and Continuing Professional Development: a credit system for monitoring and promoting excellence. Matos-Ferreira, A. British Journal of Urology 87: 1-12; 2001
3. Continuing Professional Development. A practical approach. John Lorriman. The Institution of Electrical Engineers. p 1.1997

Authors

Prof Dr Helmuth Madersbacher

Prof Dr Alberto Matos Ferreira

Prof Dr Rien JM Nijman