Clinical/Medical Microbiology in the UEMS &throughout Europe

Prof. dr. John E. Degener, University Medical Center Groningen, University ofGroningen

Nothing tops Groningen !

Aim of this presentation

• 1. To define the common profile of ClinicalMicrobiology practice as defined in Helsinki 1996

• 2. To define the present status of the specialty in EUcountries and representation in the UEMS

• 3. To discuss which knowledge, skills and attitudesshould be requested and/or trained to be regarded asa 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. To define the common profile of ClinicalMicrobiology practice as defined in Helsinki 1996

• 2. To define the present status of the specialty in EUcountries and representation in the UEMS

• 3. To discuss which knowledge, skills and attitudesshould be requested and/or trained to be regarded asa 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: Whatmakes a good clinical microbiologist?

Aim: to define the basic pillars of a moderntraining programme for residents to make

them fit for specialist tasks

8 MAIN TASKS defined by UEMSSection Med. Path. Microbiology Commission

HELSINKI 1996

• ADVICE ON DIAGNOSIS, TREATMENT &PREVENTION

• PROVIDE SCIENTIFIC BASIS FOR LABORATORYDIAGNOSIS

• UNDERTAKE MANAGEMENT RESPONSIBILITIES• TAKE CHARGE OF INFECTION CONTROL• ANTIBIOTIC POLICY• PROVIDE SURVEILLANCE DATA• PARTICIPATE IN TRAINING FOR MED.

MICROBIOLOGISTS, INFECTION CONTROLPRACTIONERS & OTHER EXPERTS

• UNDERTAKE R & D

• ADVICE ON DIAGNOSIS, TREATMENT &PREVENTION

• PROVIDE SCIENTIFIC BASIS FOR LABORATORYDIAGNOSIS

• UNDERTAKE MANAGEMENT RESPONSIBILITIES• TAKE CHARGE OF INFECTION CONTROL• ANTIBIOTIC POLICY• PROVIDE SURVEILLANCE DATA• PARTICIPATE IN TRAINING FOR MED.

MICROBIOLOGISTS, INFECTION CONTROLPRACTIONERS & OTHER EXPERTS

• UNDERTAKE R & D

Stage 1: Themes in Microbiology

microbiology

bacteriology virology mycology parasitology

HospitalHygiene &InfectionControl

Clinicalliaison &

consultancy

Laboratorydiagnosis

Publichealth

ScientificDevelopment& education

Management

2nd stage: specialty specificcompetences (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

• 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

Blueprint of the profession of Medical/ClinicalMicrobiology

ESCMID: ClinicalUEMS: Medical

2. Present status in the EU and UEMS:The harmonisation of Clinical Microbiology as a

monospecialty: A challenge and debate

Ilja Repin: “The Cossacks are writing a letter to the Sultan of Turkey”.1880, Tretjakow State Galery, Moscow.

• 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 MédecinsSpécialistes/ European Union of MedicalSpecialists

• 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

1957, Treaty of Rome

Organisation of medical specialties in the EU

19586 members

200427 members

Status of ClinicalMicrobiology as a

medical specialty inEurope in 2007(ESCMID information)

Clinical Microbiology as Medical Specialty in Europe

Country Member to UEMS Member to EU CM is Recognised asa Full Specialty

Albania no no noArmenia no no yesAustria full yes yesAzerbaijan associate no yesBelarus no no noBelgium full yes noBosnia no no yesBulgaria associate yes yesCroatia associate no yesCyprus full yes yesCzech Republic full yes yesDenmark full yes yesEstonia full yes noFinland full yes yesFrance full yes yesGeorgia associate no yesGermany full yes yesGreece full yes noHungary full yes yesIceland full no yesIreland full yes yesIsrael associate no yesItaly full yes yesLatvia full yes noLithuania no yes noLuxembourg full yes noMacedonia no no yesMalta full yes noMoldavia no no noNetherlands full yes yesNorway full no yesPoland full yes yesPortugal full yes noRomania associate yes noRussia no no yesSerbia-Montenegro no no noSlovakia full yes yesSlovenia full yes yesSpain full yes yesSweden full yes yesSwitzerland full no yesTurkey associate no yesUkraine no no yesUnited Kingdom full yes yes44 countries(without mini-states)

27 UEMSmembers 27 EU countries EU: 18 yes

UEMS : 20 yes

Status ofClinical Microbiologyas a medical specialty

In Europe(ESCMID 2007)

Clinical Microbiology as Medical Specialty in Europe

Country Member to UEMS Member to EU CM is Recognised asa Full Specialty

Albania no no noArmenia no no yesAustria full yes yesAzerbaijan associate no yesBelarus no no noBelgium full yes noBosnia no no yesBulgaria associate yes yesCroatia associate no yesCyprus full yes yesCzech Republic full yes yesDenmark full yes yesEstonia full yes noFinland full yes yesFrance full yes yesGeorgia associate no yesGermany full yes yesGreece full yes noHungary full yes yesIceland full no yesIreland full yes yesIsrael associate no yesItaly full yes yesLatvia full yes noLithuania no yes noLuxembourg full yes noMacedonia no no yesMalta full yes noMoldavia no no noNetherlands full yes yesNorway full no yesPoland full yes yesPortugal full yes noRomania associate yes noRussia no no yesSerbia-Montenegro no no noSlovakia full yes yesSlovenia full yes yesSpain full yes yesSweden full yes yesSwitzerland full no yesTurkey associate no yesUkraine no no yesUnited Kingdom full yes yes44 countries(without mini-states)

27 UEMSmembers 27 EU countries EU: 18 yes

UEMS : 20 yes

Status ofClinical Microbiologyas a medical specialty

In Europe(ESCMID 2007)

Clinical Microbiology as a medical speciality inEurope (2007)

All 44countries

27 ECcountries

Full speciality 31 18Full speciality 31 18

No speciailtyorsubspeciality

13 9

DelegatesAustria 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 (boardmember) / 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. OstermanGermany f.m. Sweden f.m.

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. vanBurgel

Liaison officer LM S. Chatzipanagiotou

3. Of knowledge, skills and attitude.

New Concepts: The 7 competencesof the Medical Specialist

2003

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

• knowledge and insight• practical expertise

• professional conduct/behaviour

• knowledge and insight• practical expertise

• professional conduct/behaviour

Applies to any medical specialist

• Medical Proficiency: having the knowledge and skillsessential to the profession.

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

• Knowledge & Science: having knowledge of evidence-based medicine, providing education, informing thegeneral public, performing scientific study.

• Co-operation: co-operating with colleagues andhealth care employees inside and outside the clinic.

• Organization: working with others in a purposefulmanner; optimizing health care logistics.

• Social Interaction: infection prevention, knowledge,and the application of the legal framework, riskmanagement, coping with errors.

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

General Core Competencies

• Medical Proficiency: having the knowledge and skillsessential to the profession.

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

• Knowledge & Science: having knowledge of evidence-based medicine, providing education, informing thegeneral public, performing scientific study.

• Co-operation: co-operating with colleagues andhealth care employees inside and outside the clinic.

• Organization: working with others in a purposefulmanner; optimizing health care logistics.

• Social Interaction: infection prevention, knowledge,and the application of the legal framework, riskmanagement, coping with errors.

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

8 MAIN TASKS defined by UEMSSection Med. Path. Microbiology Commission

HELSINKI 1996

• DIAGNOSIS, TREATMENT & PREVENTION• SCIENTIFIC BASIS• MANAGEMENT• INFECTION CONTROL• ANTIBIOTIC POLICY• SURVEILLANCE• TRAINING• R & D

• DIAGNOSIS, TREATMENT & PREVENTION• SCIENTIFIC BASIS• MANAGEMENT• INFECTION CONTROL• ANTIBIOTIC POLICY• SURVEILLANCE• TRAINING• R & D

How to fit the specialist specific tasks ofmicrobiology into the general CanMeds concept?

• Define main themes• Define main tasks• Create matrix of themes and

competences

• Define main themes• Define main tasks• Create matrix of themes and

competences

4. Contents of a curriculumfor clinical microbiology training

Competency based

Competencies and themes in microbiology in amatrix model

Training program may contain theme based charts,adapted for your local institute.

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 relationshipsin the laboratory *organize and steer progress discussions

consult his or her supervisor sufficiently and in good time

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

Example 1

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

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

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

Example 2

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

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

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, Milano 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 basicthemes by residents in different EU countries,with the aim to set minimum requirements for

training.

Survey of the UEMS Section of MM in 2010 :Define the time, spent on training in the basicthemes 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: achallenge in de EU

Albania

Andorra

Armenia

Azerbaijan

Belarus

Bosnia and Herzegovina

Georgia

Liechtenstein

Moldova

Monaco

Montenegro

Croatia

Former Yugoslav Republic of Macedonia

Iceland

Turkey

Austria

Belgium

Bulgaria

Cyprus

Czech Republic

Denmark

Estonia

Finland

France

Germany

Greece

Hungary

Ireland

EU member states Candidate states Other states

Questionnairesend to 21delegates

Montenegro

Norway

Russia

San Marino

Serbia

Switzerland

Ukraine

Vatican City State

Ireland

Italy

Latvia

Lithuania

Luxembourg

Malta

Netherlands

Poland

Portugal

Romania

Slovakia

Slovenia

Spain

Sweden

United Kingdom

Questionnairesend to 21delegates

Albania

Andorra

Armenia

Azerbaijan

Belarus

Bosnia and Herzegovina

Georgia

Liechtenstein

Moldova

Monaco

Montenegro

Croatia

Former Yugoslav Republic of Macedonia

Iceland

Turkey

Austria

Belgium

Bulgaria

Cyprus

Czech Republic

Denmark

Estonia

Finland

France

Germany

Greece

Hungary

Ireland

EU member states Candidate states Other states

13 delegatesresponding

Montenegro

Norway

Russia

San Marino

Serbia

Switzerland

Ukraine

Vatican City State

Ireland

Italy

Latvia

Lithuania

Luxembourg

Malta

Netherlands

Poland

Portugal

Romania

Slovakia

Slovenia

Spain

Sweden

United Kingdom

13 delegatesresponding

Time (months) spent in different fields ofmicrobiology

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 0-1-3surgery 0-1-3

ICU 0-3-1-4

total clinical not mandatory (Fr.)- 3-6-12-14-24-48 (UK)

Scientific training

Optional or variable- 1-3-6-12 months

Total duration of training

60 months 11 countries

24 months(+ 12 months science, notmandatory)

France24 months(+ 12 months science, notmandatory)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.

• 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. Adriana VinceLiaison officer ID

Prof. dr. StylianaosCatzipanagiotou

Liaison officer Lab. Medicine,division of Microbiology

Prof. dr. Elisabeth NagyESCMID ex. officer

Evolution and diversity: “ I think…”Can we get back to the trunk?

Final conclusion: Harmonisation in the EU: fromplugs to professionals: It can be as diverse as it is,

but it should work!

Website: U.E.M.S. Section of Medical Microbiology

EU ProfessionalCard