The EU Family Tree ofClinical Microbiology

ESCMID Council meeting

October 9th, 2008, Rome

Prof. dr. John E. DegenerUniversity Medical Center Groningen UMCG

Why a family tree of Clinical Microbiology?

• To know the common background of the profession (the history of microbiology, our predecessors): Where did we start?

• To know how we grew up and understand: Who we are now ?

• To know what is expected of us: How to train our offspring / residents to make them fit for society?

General aim of this introduction

• To define the common trunk of Clinical Microbiology

• To discuss which competences are needed to be a professional in Europe

• To discuss end qualifications in order to enable free movement of professionals in Europe

Common trunk

Start of the art

Development of medical specialities in the field of microbes and

microbial diseases

• Basic sciences: Chemistry, anatomo-pathology,physiology, biology, immunology

• Practical medicine: Veterinary medicine, general internal medicine, general surgery,general practice

obstetrician Chemist/physiciansurgeon chemist physician surgeon

Start of Pathology & Laboratory Medicine

• 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 full members, 5 associated members

• Non-governmental organisation

• UEMS registered under Belgian law

• Secretariat in Brussels

UEMS: : Union Européenne des Médecins Spécialistes/ European Union of Medical Specialists. Birth of European Specialties

1957, Treaty of Rome

Organisation of medical specialties in the EU

19586 members

Medical Biopathology

200427 members

Medical Biopathology

UEMS SECTION OF MEDICAL BIOPATHOLOGY: HISTORY AND

AIMS (1).

• 1962: SECTION LABORATORY MEDICINE UNDER UMBRELLA OF UEMS (Be, De, Fr, It, Lu, Ne)

• 1988: SPLIT OFF ANATOMO-PATHOLOGY• 1992: 5 non-official SUB-DISCIPLINES:

- MEDICAL MICROBIOLOGY- CLINICAL CHEMISTRY- HAEMATOLOGY- IMMUNOLOGY- POLYVALENT MEDICAL BIOPATHOLGY

UEMS SECTION OF MEDICAL BIOPATHOLOGY: HISTORY AND

AIMS (2).

• STANDARDS FOR TRAINING: STRUCTURE• QUALITY AND CONTENT OF TRAINING

PROGRAMMES• CRITERIA FOR TRAINING CENTRES• EXAMINATION OF QUALITY OF TRAINING

CENTRES IN E.U.• EXCHANGE OF TRAINEES THROUGHOUT

E.U.• ESTABLISHING OF FELLOWSHIP OF THE

EUROPEAN BOARD OF MEDICAL BIOPATHOLOGY F.E.B.M.B.

• FREE MOVEMENT THROUGHOUT E.U.

ACTIVITIES UEMS SECTION MEDICAL BIOPATHOLOGY-Commission of Microbiology

• CORE TRAINING PROGRAMME

• TRAINING RECORD / portfolio

• FELLOWSHIP EUROPEAN BOARD MEDICAL BIOPATHOLOGY / F.E.B.M.B. Medical Microbiology CONTINUOUS MEDICAL EDUCATION CME/CPD, EACCME / EBACM

Present status of Medical Microbiology in the extended EU

Giuseppe Cornaglia

Medical Microbiology in all Eu in 2002

Medical Microbiology inEU member countries

in 2002

Duration of training in Clinical Microbiology: 3, 4 or 5 years

4 yr

5 yr

3

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

UEMS CouncilBrussels April 19th 2008

• The official name assigned to medical specialities is laid down in the European directives and official documents

• The speciality is named “Medical Microbiology”

• Voting on the creation of a new Section of Medical Microbiology

• UEMS Council meeting in Copenhagen, October 10-11th: continuing discussion on the feasibility of a Federation of Laboratory Medicine

UEMS Council vote on the new Section of Medical Microbiology

• In favour: 22

• Against: 4

• Abstentions: 2

• Birth of the UEMS Section of Medical Microbiology

Why a Federation of Medical Specialties in Laboratory Medicine?

• Support for colleagues in countries without full recognition of Clinical Microbiology

• Mutual interests with other laboratory orientated specialties: logistics, automation, management

• Overlap of professional and scientific-content related activities

• What is the future of Laboratory Medicine in Europe?

EU recognised specialties in the field of diagnosis, prevention and treatment of microbial diseases,

since 2008

• Infectious Diseases

• Medical (Clinical) Microbiology

• Medical Biopathology/Laboratory Medicine, subdiscipline Microbiology

Scientific cohesion of specialities in ESCMID,Same goal, many ways to achieve…

Gallery of presidents (ESCMID News 2008)

Blueprint of the profession of Medical/Clinical Microbiology

ESCMID: Clinical

UEMS: Medical

8 MAIN TASKS defined by UEMSSection 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

Harmonizing the profile of the specialty in the EU

Define the elements of a modern training programme for residents to

make them fit for specialist tasks

1st Stage: Themes in Microbiology

microbiology

bacteriology virology mycology parasitology

Hospital Hygiene &Infection Control

Clinical liaison &

consultancy

Laboratorydiagnosis

Publichealth

ScientificDevelopment& education

Management

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 technologies• Typing techniques• Data handling• Clinical experience• Antimicrobial usage• Results reporting• Quality control• Audit and clinical governance• Accreditation

KnowledgeSkills

Attitude

3rd stage: logbook

New Concepts: The 7 competencesof the Medical Specialist

2003

A competence is defined as “A set of knowledge, skills and attitudes”

• knowledge and insight

• practical expertise

• professional conduct/behaviour

Applying to any medical specialist

• Medical Proficiency: having the knowledge and skills essential to the profession.

• Communication: being able to communicate well with the patient, family, professionals and colleagues.

• Knowledge & Science: having knowledge of evidence-based 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, knowledge, and the application of the legal framework, risk management, coping with errors.

• Professional Conduct: ethics, reflection, being aware of one’s own limitations.

General Core competencies

How to fit the specialist specific tasks of microbiology into the general

CanMeds concept?

• Define main tasks

• Create main themes

• Create matrix of themes and competences

Competencies and themes in microbiology in a matrix model

Theme based training charts to become a professional in the

specialty of Medical Microbiology

Theme ChartVirologyChapter 2 of the LogbookDuration of the internship: 1 year* refers to the Assessment Criteria list

Theme-related final attainment levels: at the end of formal training, the residentwill be able to:

Communication

communicate with colleagues, medical analysts and laboratory managers:content-related, team-oriented with understanding of the mutual relationships

in the laboratory *

organize and steer progress discussions

consult his or her supervisor sufficiently and in good time

motivate and stimulate the analysts

Knowledge & Science

critically appraise the relevant literature with regard to laboratory methods andtechniques

Social Interaction

apply the Occupational Health and Safety Act and of EnvironmentalRegulations

Work in a cost-efficient manner

Medical Proficiency

display insight into the anatomy, physiology and resistance mechanisms of viruses

apply general laboratory logistics A1-A6

apply direct detection techniques / microscopy B1-B2

apply cultivation techniques C1 *

apply serological techniques D1-D2 *

apply molecular diagnostics E1- E2 *

critically appraise the clinical relevance of laboratory diagnostics

Organization

manage the various duties and responsibilities

understand the laboratory information system

Understand the hospital organization

Professional Conduct

Reliability of diagnostics

recognize the importance of quality

Co-operation

liaise with colleagues

Work in a team-oriented setting

Theme ChartInfection Prevention and Hospital HygieneChapter 5 of the LogbookDuration of the internship: 3 months* refers to Assessment Criteria list

Theme-related final attainment levels –at the end of formal training the resident willbe able to:

Communication

communicate with colleagues, hospital hygienists and, in the hospital, with doctorsand nursing staff, among others: content-related, with understanding of the mutualrelationships*

assume an interactive role in multi-disciplinary discussion

motivate and stimulate hygienists, doctors, managers and nursing staff

Knowledge & Science

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 thatought to be applied to these mechanisms

understand the relevant reservoirs, lines of transmission, and the subsequentlyderived containment measures

Social Interaction

weigh up various interests when reviewing the containment measures to be taken

Medical Proficiency:

apply Infection Prevention and Hospital Infection A1 –A5

apply Isolation Procedures B1 –B2

apply Sterilization, Disinfection and Waste Processing D1 –D4

apply Safety and Hygiene in the Hospital E1 –E2

understand the relevant legal stipulations, (inter)national guidelines, and therelevant committees

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 anyincidents

formulate a compact and concise report for internal and external use

Organization

manage various duties andresponsibilities

understand the registration system of infection prevention and patient datasystems

understand the hospital organization

comprehend (variations in) the organizational structure of an infectionprevention department

understand the interaction between infection prevention and the laboratory formicrobiology

Professional Conduct

deal with the reliability of diagnostics, outbreaks and nosocomial 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

co-operate with the GGD and other parties in public health care

Assessment methods during resident training

Theme: Bacteriology Assessment Criteria list

Typical Professional Situation

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Communication with colleagues, medical analysts and laboratory managers: content-related, team-oriented with understanding of the mutual relationships in the laboratory

SPA1 SPA1

Direct detection methods / microscopy SPA2

Cultivation, determination and verification of resistance SPA3

Critical appraisal of the clinical relevance of laboratory diagnostics SPA4

Keeping up to date with quality systems and accreditation SPA5 SPA5

Duration of the internship: 1 yearTest moments:

Number of SPAs: at least 115 types of SPA, use each SPA at least once

Annual progress assessmentSPA: Short Practice-Oriented Assessment

How to proceed, Chpt. 6

• Central Monitoring Authority (UEMS/ESCMID) lay down and monitor general standards for specialty recognition and QA

• Rules for access to, duration of and common trunk of training

• Implementation of training and logbook

• QC and assessment of training

• Manpower planning policy

• Requirements for institutions, teachers, trainees

A family tree of Clinical Microbiology