The European Society’s HERMES The European Society’s HERMES Project, a Model to EmulateProject, a Model to Emulate

Francesco BlasiDepartment Pathophysiology and Transplantation,

University of Milan, Italy

Disclosures

• I have accepted grants, speaking and conference invitations from Almirall, Angelini, AstraZeneca, Bayer, Chiesi, GSK, Guidotti-Malesci, Menarini, Novartis, Pfizer, and Zambon

• I have had recent or ongoing consultancy with Almirall, Angelini, AstraZeneca, GSK, Menarini, Mundipharma and Novartis

What is HERMES?

Harmonised Education in

Respiratory Medicine for

European Specialists

Mission of the HERMES Initiative

EU CONTEXT: Free access and mobility

• EU mutual recognition of diplomas and certificates of qualification in medicine in all member countries

• EU parliament 2013 modernised the 2005 directive (Directive 2013/55/EU)– Modernisation of the definition for harmonised minimum training

requirements for professions which benefit from automatic recognition

– For example for doctors, modernised directive clarifies that the basic medical education ought to be based on 5’500 training hours done within a minimum of 5 years

European Professional qualifications landscape and players

HERMES Task Forces 2005-2014

Preliminary Phase

Phase 4Phase 3 Phase 2Phase 1

Core Syllabus Completed Sept 06

Standards for Training Centres (not started)

European ExamFirst Oct 08

Core Curriculum Completed Sept 08

HERMES Project

Preliminary Phase

Phase 4Phase 3 Phase 2Phase 1

Core Syllabus Completed Sept 06

Standards for Training Centres (not started)

European ExamFirst Oct 08

Core Curriculum Completed Sept 08

HERMES Project

What does the What does the Examination look like?Examination look like?

• Knowledge-based only• Paper-based multiple-choice questionnaire (MCQ) in

English; 90 questions; 3 hrs • Blueprint for the content of the examination is the

consensus-based European syllabus (Breathe 2006; 3: 59-70) available in 24 languages at: http://hermes.ersnet.org/452-syllabus-dissemination.htm

What does the What does the Examination look like?Examination look like?

Why take a European Why take a European Examination?Examination?

• Proof of Excellence: to demonstrate to patients and colleagues your commitment to high-quality life-long learning

• Mobility: if moving to another country, the European Diploma will certainly be known and recognised within the profession

• Self-assessment: you may wish to find out where you stand against the current European standard

• Tangible recognition: European Diploma and membership of ERS School Diplomate Club

Advantages for the individual:

The European Diploma The European Diploma in Adult Respiratory in Adult Respiratory

MedicineMedicine

Re-validation:

To comply with European Curriculum recommendations (Breathe Sept 2008; volume 5, number 1), candidates are advised to voluntarily re-sit the European Examination every 5 years to demonstrate that their knowledge is up-to-date.

It is mandatory to re-sit the Examination every 10 years or the right to hold the Diploma will lapse.

SIMER INTERNATIONAL SIMER INTERNATIONAL SCHOOLSCHOOL

- Lectures Review of current guidelines

- Interactive sessions MCQ Clinical Cases

SIMER INTERNATIONAL SIMER INTERNATIONAL SCHOOLSCHOOL

A 24-year-old woman has had a long-standing mild, persistent asthma for which she has been using approximately four puffs (44 mcg/puff) per day od inhaled fluticasone and approximately two to four puffs of albuterol per week with good results. However, approximately 6 months ago, she and her husband bought and moved into a new house, which they are living in and slowly renovating. Although the main triggers to her asthma are believed to be cats and ragweed, she has noted a deterioration in her asthma since they moved in, despite multiple steps to limit her potential exposure to dust and mold during renovations. She has continued her fluticasone at the same dose but is now using two puffs of albuterol four to six times per day. She awakens because of asthma symptoms approximately once per week, and although she has not curtailed her regular activities, she reports feeling “more winded than usual”.Physical examination results are notable only for rare scattered wheezes on exhalation. FEV1 is 2.99 L (74% predicted), and FVC is 4.69 (98% predicted): the flow-volume loop shows mild expiratory coving.Assuming that no additional opportunities for trigger avoidance are identified, what is the most appropriate next step in her pharmacologic management?

A.Add a long-acting B-agonist to her current dose of inhaled fluticasone

B.Add montelukast to her current dose of inhaled fluticasone

C.Add omalizumab therapy to her current dose of inhaled fluticasone

D.Change her dose of inhaled fluticasone to four puffs bid of the 220 mcg/puff

SIMER INTERNATIONAL SIMER INTERNATIONAL SCHOOLSCHOOL

12-15 December 2011

Existing country collaborations

ADULT

•Switzerland

•Netherlands

•Russia

•Spain

•Portugal

•Austria

•Ireland

PAEDIATRIC

•UK

accreditation

Feedback collated from centres The opportunity to be part of a Pan-European network of centres To benchmark trainee facilities and educational opportunities To receive recommendations on how to improve To present to the national ministry of health (for example) any basic standards

not met which will justify requests for additional budget for training and facilities

From an ers perspective

Bridge the gap between European criteria and local implementation

Accreditation steps

Educational resources

Ers handbooks

• ERS Handbook Series– 2nd edition Respiratory Medicine

– Respiratory Sleep Medicine

– Self-Assessment in Respiratory Medicine

– Paediatric Respiratory Medicine

HERMES Publications

HERMES Adult Booklet HERMES Paediatric Booklet

Accreditation of Training Centres

Assessments

Preliminary Phase

Syllabus

HERMES Project Phases

Continuous Professional Development and

accreditation

Continuous Professional Development and

accreditation

Curriculum

Anal

ysis

of t

rain

ing

&

certi

ficati

on

Anal

ysis

of t

rain

ing

gap

Educational ResourcesEducational ResourcesPublished OutputsPublished Outputs

Phase 1 & 2Phase 1 & 2 Phase 3, 4 and 5Phase 3, 4 and 5Phase 3, 4 and 5Phase 3, 4 and 5

Standardsand

Frameworks

Adult Respiratory Medicine, Paediatric Respiratory Medicine. Multidisciplinary groups eg Respiratory Critical Care, Respiratory Sleep medicine, Thoracic Oncology, incorporation of skills assessment in addition to knowledge based assessment (HERMES Exam + portfolio), involvement of AHPs, scientists and trained staff

Applicability and acceptability of standardsApplicability and acceptability of standards

Continuous processes considered

Consolidation

Unifying processes and ensure robust methodology

Investigation of outcomes on how standards are used

Strategies of implementation Value of criteria and how they impact training and the healthcare system

Linkages

CME/CPD opportunities Based on HERMES standards (syllabi, curricula, accreditation criteria etc)

UEMS and other EU entities Other ERS committees (guidelines, scientific etc)

EBAP Other professional associations

Training centres/networks Other local/national authorities

challenges

• Promoting state-of-the-art medical education (curriculum development, assessments, teaching and learning etc)

• Differences in acceptability and applicability of the recommendations in different countries

Finding the balance

HERMES challenges

• Translation (different languages) of educational standards and assessments

• Different lengths of training across EU countries

• Different organisation of training across EU countries

• Legal aspects of practice in various fields

• Availability of resources in different countries for training

• Legal adoption of educational standards and assessments

• Models of collaboration for accreditation (individuals, centres and

networks)

priorities

Hermes priorities

Consolidation of HERMES projects

Development of processes for implementation of educational standards

Scientific approach with the processes involved (including Delphi technique and measurements)

Development of the HERMES initiative as a European/regional approach

Developing CME/CPD standards for trained specialists

Exploration of legal aspects

Rigorous validation and commitment

in formulating the educational standards

through robust methodologies in medical

education.

The transnational nature of the hermes initiative highlights and addresses the current trend of

mobility among specialists and patients within Europe.

THANK YOU FOR YOUR ATTENTION !