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The ESMO programme of certification and training for medical oncology
Annals of Oncology 9: 585-587. 1998. S1 1998 Kluwer Academic Publishers. Printed in the Netherlands.
Special article The ESMO programme of certification and training for medical oncology D. J.Th.Wagener,1 J. B.Vermorken,2 H. H. Hansen3 & D. K. Hossfeld4 'University Hospital Nijmegen, Nijmegen, The Netherlands; 2University Hospital Antwerp. Antwerp, Belgium; 3University Hospital, Finseneenter, Copenhagen, Denmark: 4 University of Hamburg, Hamburg, Germany
Summary
ESMO has designed a programme of certification and training in medical oncology. In this paper the background of these programmes is given, and the programme of graduate education is described in greater detail. The standard requirements are a total training period of six years, beginning with a common internship in internal medi-
Introduction
In 1995 the frontiers between the various member states of the European Union disappeared, after which medical specialists were no longer prohibited to practice in countries other than their own. However, the various countries have different systems of medical training. Reviews of the curricula in radiation oncology and medical oncology have recently been published [1, 2], and these indicate that training programmes in the various countries are in fact rather diverse. Programmes for medical oncology are even more heterogeneous than those for radiation oncology, and the duration of these programmes in the various countries has a broad range from two to six years with the total number of years from graduation to achievement of the title of specialist ranging from four to nine years [2]. The international exchange of specialists will only be successful if there is a more or less uniform system for training and if there is a guarantee that the level of knowledge after such training will be maintained. In the USA such a uniform system for training in medical oncology was formulated by the American Board of Internal Medicine, and a system for continuing medical education (the physician's recognition award) was designed by the American Medical Association [3, 4]. In Europe the ESMO has recognized the need for such a system for its members. To obtain insight into the level of knowledge and skills of medical oncologists in the different countries, ESMO has started with the introduction of an examination in 1989. Candidates who pass the examination and are actively working as medical oncologists at the time of application will become certified member.
cine of at least two years, followed by a training programme in oncology for three to four years, which must include at least one year of full-time clinical training in the diagnosis and management of neoplastic diseases, accompanied by one year of experience in an ambulatory care setting. Key words: certification, ESMO-MORA, medical oncology, training programme
To guarantee maintenance of the levels of knowledge, skills and attitudes essential to the provision of excellent care, a programme of continuing medical educational in medical oncology, the ESMO-MORA (Medical Oncology Recertification Award) was introduced in 1994. It consists of a system of credit points, 50 (equivalent to 50 postgraduate training hours) of which are required each year for obtaining this recertification approval. The main objectives of these certification systems are to improve the quality of patient care, set standards of clinical competence for the practice of medical oncology and encourage the continuing scholarship required for professional excellence over a lifetime of practice. Certification by ESMO thus recognizes excellence in the discipline of medical oncology. Certification is not a requirement to practice medical oncology, and the certification does not confer the right to practice. Moreover, ESMO does not intend to interfere with or to restrict the professional activities of any licensed physicians who are not certified. ESMO recently developed a programme of training in medical oncology which was accepted by its General Assembly in Hamburg in 1997. The standard programme is formulated in accordance with the requirements imposed by the UEMS (Union Europeenne des Medicins Specialistes) for recognition of medical oncology as an independent discipline. The ESMO feels that the accepted programme is the ideal one and hopes that its introduction will be promoted in every European country. It is not an immutable programme: every two years prior to the biannual ESMO meeting it will be critically reviewed to determine whether adaptations are necessary. The following is a comprehensive description of the programme.
586 Standard requirements for training in medical oncology The standard requirements are a total training period of six years, beginning with a common internship in internal medicine of at least two years, followed by a training programme in oncology for three to four years. The three to four-year training programme must include at least one year of full-time clinical training in the diagnosis and management of a broad spectrum of neoplastic diseases, accompanied by one year of experience in an ambulatory-care setting, during which the candidate attends at least one out-patient clinic for a minimum of one half-day per week and is responsible for providing continuous care to a defined cohort of patients being treated for neoplastic disorders. Full-time clinical training means that at least 80% of the trainee's professional time and effort during a standard work week is dedicated to clinical (patient care or educational) activities. These may include the primary care of cancer patients, supervision of cancer patients on the general medical service or in designated medical oncology in-patient units, oncological consultations and consultation rounds, oncology and general medicine ambulatory care, scheduled clinical conferences, performance of procedures on patients, review of imaging, pathology and other diagnostic materials, other direct patient care, attending national scientific meetings and reading clinical literature. Clinical activities may also include research involving patient contact, care and treatment.
Special requirements General information Medical oncology training is a component in the continuum of the educational process; such training should take place upon satisfactory completion of an accredited programme in internal medicine or after at least two years of training in internal medicine. To be eligible for accreditation medical oncology programmes should function in association with an accredited residency programme in internal medicine. Programmes of graduate education in medical oncology should preferably be carried out in institutions which sponsor a residency programme in internal medicine. These institutions should have extensive educational, patient care and research resources essential to the learning environment for medical oncology trainees. Faculty Programme leader The medical oncology programme leader must be qualified to supervise and to educate trainees in medical oncology. Thus, the leader must either be certified in medical oncology or possess equivalent qualifications.
The leader will have a major commitment to the training programme and related activities and must be based at the primary training site of the medical oncology programme. Faculty 1. The medical oncology programme faculty must include a minimum of three full-time qualified teaching faculty members, including the programme leader. All of the faculty members must be certified in medical oncology by the National Board of Internal Medicine or possess equivalent qualifications and each of them must devote substantial time (at least 20 hours per week) to teaching, research, administration and/or the critical evaluation of the performance, progress and competence of the trainees. For programmes with more than two trainees enrolled, a ratio of faculty to trainees of at least 1:1.5 must be maintained. 2. The teaching staff must demonstrate an interest in teaching, and set an example for trainees by documented engagement in the following pursuits: a) actively sharing in a medical oncology clinical practice, b) continuing his/her own medical education, c) active membership in regional and national scientific societies, d) active participation in research, and e) presentation and publication of scientific studies. Educational programme The educational programme in oncology must be organized to provide training and experience at a level high enough for the trainee to acquire the competency of a specialist in the field. The programme must emphasize scholarship, self-instruction, development of critical analysis of clinical problems, and the ability to take appropriate decisions. Appropriate supervision of the trainees must be provided for the duration of their educational experience. The following principles require special emphasis. Educational environment Medical oncology training programmes must provide an intellectual environment for acquisition of the knowledge, skills, clinical judgment, and attitudes essential to the practice of medical oncology. This objective can only be achieved when appropriate resources and facilities are available. Service commitments must not compromise the achievement of educational goals and objectives. Professionalism Professionalism must be fostered during medical oncology training. In addition to mastering the comprehensive clinical and technical skills of the consultant medical oncologist, trainees are expected to maintain the values of professionalism. These values include placing the needs of one's patients ahead of one's self-interest, being
587 responsive to the needs of society, and maintaining a commitment to scholarship and to high standards of related research. Trainees, therefore, should be encouraged to participate in professional organizations, community programmes, and institutional committees. Responsibility Lines of responsibility must be clearly delineated for trainees in medical oncology. Medical oncology programmes must contribute to the general internal medicine programme without diluting the overall experience of the internal medicine resident. Clinical setting a. Clinical experience must include opportunities to observe and manage patients with a wide variety of neoplastic diseases on in-patient and out-patient bases. The trainee must be given the opportunity to assume the continuing responsibility for both acute and chronically ill patients in order to learn the natural history of cancer, the extent of the effectiveness of the various therapeutic programmes, and how to impart bad news. b. Modern in-patient, ambulatory care and laboratory facilities necessary for the overall educational programme must be available and functioning. Specifically, at the primary site there must be adequate pathology services, modern diagnostic radiology services, resources for nuclear medicine imaging, blood banking and blood therapy facilities, radiation oncology facilities, and facilities for clinical pharmacology and tumour immunology. A general surgical service and its support must be available. The programme must also include attendance at a multidisciplinary tumour conference, and clinical cancer protocol studies applied according to guidelines for good clinical practice. c. It is also essential to have the support of oncology nursing, rehabilitation medicine, palliative care medicine, dietetic and psychosocial services so that the trainee can perceive the role of other specialties in the total care of the cancer patient. Responsibilities of the ESMO Educational Committee and the Committee of National Representatives The Education Committee of ESMO and the Committee of National Representatives play an essential role in the organisation of the certification and the training programme. The primary function of the Education Committee is to administer the certification process. This is done by developing and conducting examina-
tions for certification, establishing postdoctoral training requirements (ESMO-labeled courses), and providing certification for ESMO-MORA.1 The primary function of the Committee of National Representatives is to promote and supervise medical oncology in the various European countries. It does this by assessing the credentials of candidates, obtaining substantiation from appropriate authorities of the clinical skills and professional standing of candidates, and ensuring the development of a structured higher specialist training programme in medical oncology in each country, which is in accord with the aims formulated by ESMO, approved by UEMS, and accepted by the respective national bodies responsible for specialist training in internal medicine. Acknowledgements The authors thank P. Daly, Dublin; H. J. Illiger, Oldenburg; E. Kumpulainen, Kuopio; N. Pavlidis, Joannina, Greece; M. Tonato, Perugia; P. Alberto, Geneve; R. Rosell Costa, Badalona-Barcelona; J. M. A. Whitehouse, Southampton and H. F. P. Hillen, Maastricht for their contributions.
Note 1. Information to be obtained from: Prof. Dr. J. B. Vermorken, Chairman, ESMO Education Committee, University Hospital Antwerpen, Wilnjkstraat 10. B-2650 Edegem, Belgium, or from: the ESMO Head Office, Via Soldino 22, 6900 Lugano, Switzerland.
References 1. Leer JWH. Davelaar J, Overgaard J, Heeren G. Education in radiation oncology in Europe. J Radiat Oncol Biol Phys 1992, 23: 819-23. 2. Aschele C, Sobrero A, Lombardo C, Santi L. How uniform are post-graduate training programs in medical oncology in the European Union? Ann Oncol 1995; 6: 441-3. 3. American Board of Internal Medicine. Requirements for Dual Cerification in Hematology and Medical Oncology, 1989. 4. American Medical Association. The Physicians's Recognition Award, 1993. Received 10 April 1998; accepted 15 April 1998. Correspondence to: Prof. Dr. D. J. Th. Wagener Dept. Medical Oncology (550) P.O. Box 9101 6500HBNijmegen The Netherlands E-mail: d.wagenerfa onco.azn.nl
Special article The ESMO programme of certification and training for medical oncology D. J.Th.Wagener,1 J. B.Vermorken,2 H. H. Hansen3 & D. K. Hossfeld4 'University Hospital Nijmegen, Nijmegen, The Netherlands; 2University Hospital Antwerp. Antwerp, Belgium; 3University Hospital, Finseneenter, Copenhagen, Denmark: 4 University of Hamburg, Hamburg, Germany
Summary
ESMO has designed a programme of certification and training in medical oncology. In this paper the background of these programmes is given, and the programme of graduate education is described in greater detail. The standard requirements are a total training period of six years, beginning with a common internship in internal medi-
Introduction
In 1995 the frontiers between the various member states of the European Union disappeared, after which medical specialists were no longer prohibited to practice in countries other than their own. However, the various countries have different systems of medical training. Reviews of the curricula in radiation oncology and medical oncology have recently been published [1, 2], and these indicate that training programmes in the various countries are in fact rather diverse. Programmes for medical oncology are even more heterogeneous than those for radiation oncology, and the duration of these programmes in the various countries has a broad range from two to six years with the total number of years from graduation to achievement of the title of specialist ranging from four to nine years [2]. The international exchange of specialists will only be successful if there is a more or less uniform system for training and if there is a guarantee that the level of knowledge after such training will be maintained. In the USA such a uniform system for training in medical oncology was formulated by the American Board of Internal Medicine, and a system for continuing medical education (the physician's recognition award) was designed by the American Medical Association [3, 4]. In Europe the ESMO has recognized the need for such a system for its members. To obtain insight into the level of knowledge and skills of medical oncologists in the different countries, ESMO has started with the introduction of an examination in 1989. Candidates who pass the examination and are actively working as medical oncologists at the time of application will become certified member.
cine of at least two years, followed by a training programme in oncology for three to four years, which must include at least one year of full-time clinical training in the diagnosis and management of neoplastic diseases, accompanied by one year of experience in an ambulatory care setting. Key words: certification, ESMO-MORA, medical oncology, training programme
To guarantee maintenance of the levels of knowledge, skills and attitudes essential to the provision of excellent care, a programme of continuing medical educational in medical oncology, the ESMO-MORA (Medical Oncology Recertification Award) was introduced in 1994. It consists of a system of credit points, 50 (equivalent to 50 postgraduate training hours) of which are required each year for obtaining this recertification approval. The main objectives of these certification systems are to improve the quality of patient care, set standards of clinical competence for the practice of medical oncology and encourage the continuing scholarship required for professional excellence over a lifetime of practice. Certification by ESMO thus recognizes excellence in the discipline of medical oncology. Certification is not a requirement to practice medical oncology, and the certification does not confer the right to practice. Moreover, ESMO does not intend to interfere with or to restrict the professional activities of any licensed physicians who are not certified. ESMO recently developed a programme of training in medical oncology which was accepted by its General Assembly in Hamburg in 1997. The standard programme is formulated in accordance with the requirements imposed by the UEMS (Union Europeenne des Medicins Specialistes) for recognition of medical oncology as an independent discipline. The ESMO feels that the accepted programme is the ideal one and hopes that its introduction will be promoted in every European country. It is not an immutable programme: every two years prior to the biannual ESMO meeting it will be critically reviewed to determine whether adaptations are necessary. The following is a comprehensive description of the programme.
586 Standard requirements for training in medical oncology The standard requirements are a total training period of six years, beginning with a common internship in internal medicine of at least two years, followed by a training programme in oncology for three to four years. The three to four-year training programme must include at least one year of full-time clinical training in the diagnosis and management of a broad spectrum of neoplastic diseases, accompanied by one year of experience in an ambulatory-care setting, during which the candidate attends at least one out-patient clinic for a minimum of one half-day per week and is responsible for providing continuous care to a defined cohort of patients being treated for neoplastic disorders. Full-time clinical training means that at least 80% of the trainee's professional time and effort during a standard work week is dedicated to clinical (patient care or educational) activities. These may include the primary care of cancer patients, supervision of cancer patients on the general medical service or in designated medical oncology in-patient units, oncological consultations and consultation rounds, oncology and general medicine ambulatory care, scheduled clinical conferences, performance of procedures on patients, review of imaging, pathology and other diagnostic materials, other direct patient care, attending national scientific meetings and reading clinical literature. Clinical activities may also include research involving patient contact, care and treatment.
Special requirements General information Medical oncology training is a component in the continuum of the educational process; such training should take place upon satisfactory completion of an accredited programme in internal medicine or after at least two years of training in internal medicine. To be eligible for accreditation medical oncology programmes should function in association with an accredited residency programme in internal medicine. Programmes of graduate education in medical oncology should preferably be carried out in institutions which sponsor a residency programme in internal medicine. These institutions should have extensive educational, patient care and research resources essential to the learning environment for medical oncology trainees. Faculty Programme leader The medical oncology programme leader must be qualified to supervise and to educate trainees in medical oncology. Thus, the leader must either be certified in medical oncology or possess equivalent qualifications.
The leader will have a major commitment to the training programme and related activities and must be based at the primary training site of the medical oncology programme. Faculty 1. The medical oncology programme faculty must include a minimum of three full-time qualified teaching faculty members, including the programme leader. All of the faculty members must be certified in medical oncology by the National Board of Internal Medicine or possess equivalent qualifications and each of them must devote substantial time (at least 20 hours per week) to teaching, research, administration and/or the critical evaluation of the performance, progress and competence of the trainees. For programmes with more than two trainees enrolled, a ratio of faculty to trainees of at least 1:1.5 must be maintained. 2. The teaching staff must demonstrate an interest in teaching, and set an example for trainees by documented engagement in the following pursuits: a) actively sharing in a medical oncology clinical practice, b) continuing his/her own medical education, c) active membership in regional and national scientific societies, d) active participation in research, and e) presentation and publication of scientific studies. Educational programme The educational programme in oncology must be organized to provide training and experience at a level high enough for the trainee to acquire the competency of a specialist in the field. The programme must emphasize scholarship, self-instruction, development of critical analysis of clinical problems, and the ability to take appropriate decisions. Appropriate supervision of the trainees must be provided for the duration of their educational experience. The following principles require special emphasis. Educational environment Medical oncology training programmes must provide an intellectual environment for acquisition of the knowledge, skills, clinical judgment, and attitudes essential to the practice of medical oncology. This objective can only be achieved when appropriate resources and facilities are available. Service commitments must not compromise the achievement of educational goals and objectives. Professionalism Professionalism must be fostered during medical oncology training. In addition to mastering the comprehensive clinical and technical skills of the consultant medical oncologist, trainees are expected to maintain the values of professionalism. These values include placing the needs of one's patients ahead of one's self-interest, being
587 responsive to the needs of society, and maintaining a commitment to scholarship and to high standards of related research. Trainees, therefore, should be encouraged to participate in professional organizations, community programmes, and institutional committees. Responsibility Lines of responsibility must be clearly delineated for trainees in medical oncology. Medical oncology programmes must contribute to the general internal medicine programme without diluting the overall experience of the internal medicine resident. Clinical setting a. Clinical experience must include opportunities to observe and manage patients with a wide variety of neoplastic diseases on in-patient and out-patient bases. The trainee must be given the opportunity to assume the continuing responsibility for both acute and chronically ill patients in order to learn the natural history of cancer, the extent of the effectiveness of the various therapeutic programmes, and how to impart bad news. b. Modern in-patient, ambulatory care and laboratory facilities necessary for the overall educational programme must be available and functioning. Specifically, at the primary site there must be adequate pathology services, modern diagnostic radiology services, resources for nuclear medicine imaging, blood banking and blood therapy facilities, radiation oncology facilities, and facilities for clinical pharmacology and tumour immunology. A general surgical service and its support must be available. The programme must also include attendance at a multidisciplinary tumour conference, and clinical cancer protocol studies applied according to guidelines for good clinical practice. c. It is also essential to have the support of oncology nursing, rehabilitation medicine, palliative care medicine, dietetic and psychosocial services so that the trainee can perceive the role of other specialties in the total care of the cancer patient. Responsibilities of the ESMO Educational Committee and the Committee of National Representatives The Education Committee of ESMO and the Committee of National Representatives play an essential role in the organisation of the certification and the training programme. The primary function of the Education Committee is to administer the certification process. This is done by developing and conducting examina-
tions for certification, establishing postdoctoral training requirements (ESMO-labeled courses), and providing certification for ESMO-MORA.1 The primary function of the Committee of National Representatives is to promote and supervise medical oncology in the various European countries. It does this by assessing the credentials of candidates, obtaining substantiation from appropriate authorities of the clinical skills and professional standing of candidates, and ensuring the development of a structured higher specialist training programme in medical oncology in each country, which is in accord with the aims formulated by ESMO, approved by UEMS, and accepted by the respective national bodies responsible for specialist training in internal medicine. Acknowledgements The authors thank P. Daly, Dublin; H. J. Illiger, Oldenburg; E. Kumpulainen, Kuopio; N. Pavlidis, Joannina, Greece; M. Tonato, Perugia; P. Alberto, Geneve; R. Rosell Costa, Badalona-Barcelona; J. M. A. Whitehouse, Southampton and H. F. P. Hillen, Maastricht for their contributions.
Note 1. Information to be obtained from: Prof. Dr. J. B. Vermorken, Chairman, ESMO Education Committee, University Hospital Antwerpen, Wilnjkstraat 10. B-2650 Edegem, Belgium, or from: the ESMO Head Office, Via Soldino 22, 6900 Lugano, Switzerland.
References 1. Leer JWH. Davelaar J, Overgaard J, Heeren G. Education in radiation oncology in Europe. J Radiat Oncol Biol Phys 1992, 23: 819-23. 2. Aschele C, Sobrero A, Lombardo C, Santi L. How uniform are post-graduate training programs in medical oncology in the European Union? Ann Oncol 1995; 6: 441-3. 3. American Board of Internal Medicine. Requirements for Dual Cerification in Hematology and Medical Oncology, 1989. 4. American Medical Association. The Physicians's Recognition Award, 1993. Received 10 April 1998; accepted 15 April 1998. Correspondence to: Prof. Dr. D. J. Th. Wagener Dept. Medical Oncology (550) P.O. Box 9101 6500HBNijmegen The Netherlands E-mail: d.wagenerfa onco.azn.nl