Transcript of Episode 54 – European CME/CPD With Eugene Pozniak

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Transcript

Eugene Pozniak: So, when it comes to collaborating with organizations or people in Europe, make sure you've got someone from that country who understands that system and match it with the learners. There's no sort of pan-European, one-size-fits-all.

Alliance Podcast Editor: Welcome back to the Alliance Podcast. On this episode, Don Harding of the Alliance PEERS section, sits down with Eugene Pozniak, founder of the European CME forum and CEO of an accredited medical education company with operations in Europe to discuss issues related to healthcare CME and CPD in Europe. Take it away. Don

Don Harting, MA, MS, ELS, CHCP: Well, we'd like to welcome our listeners to this CME/CPD podcast, a special episode of the Alliance podcast where we'll be delving into issues related to continuing medical education and continuing professional development on the subcontinent of Europe, and our special guest for this episode is Eugene Pozniak. One reason why I'm so pleased to have Eugene with us is his perspective as a founder of the European CME forum and at the same time being the Chief Executive Officer of an accredited medical education company with operations in Europe. Eugene.

EP: Hello, Don. Thank you very much for the invitation. It's great to be here with you today.

DH: So Eugene, thank you so much for joining us. It's great to see you again, and I'm really looking forward to this conversation where I'm hoping that we can cover a wide range of topics about European CME/CPD, but first, let's try to get to know you a little bit better. Could you please just introduce yourself a little bit, how you come into the CME space and what you're doing right now in your day job.

EP: I wear two hats when it comes to working in CME. Firstly, as Managing Director and CEO of CME Learning, so this is an education company that's been running for 18 years now, I started off as a single-handed consultant working in the fledgling European CME fields in the early 2000s or 2010, we're now a fully-fledged medical education company. We're accredited by the ACCME. So about 10 years ago, we became the first organization outside of the US to achieve this. And we're also accredited by EBAC in Europe and so we work as a traditional medical education company based out of the UK in Manchester, but I'm also leader of European CME Forum. So soon after I set up CME Learning, actually, I identified that there was a need to get people together to talk about CME issues on European and now we meet up each year. We've just come back from Madrid, where we had our 17th Annual European CME Forum, and we talk about European and global CME/CPD.

DH: Great, Thank you. So one of the things that excites me so much about this podcast, Eugene, is the fact that you are, as you mentioned, the first hat that you wear is you're the CEO of an accredited medical education company. Did I get that right?

EP: That's right, yes.

DH: Okay. And during the question development portion of this podcast, I consulted specifically with a number of executives at medical education companies who are members of the Alliance, and asked them, “What questions would you like Eugene to respond to during this podcast?” And so I'm happy that some of these questions that we're going to be asking you, we're relaying questions on behalf of accredited medical education company executives in the United States who are curious about what the CME/CPD world is like in Europe, and hopefully, in a future episode of this podcast, we'll be interviewing other people to talk about what CME is like in other parts of the world. And as you know, because you've seen our questions, you know that our questions are divided up into various categories of topics, and over the course of this podcast, we hope to cover at least one question on each of the following topics: accreditation, content development, commercial support, regional variations from country to country or region to region, interprofessional education, program development, current events and other topics that are hot as well as the future. The future as you see it. So without further ado, let's jump into the topic of accreditation, which is a big topic from your perspective. How do European accreditation frameworks, such as those by EACME, if I'm pronouncing that right, how do they differ from North American models?

EP: Just generally in Europe, the accreditation model is activity-based, so medical education companies, hospitals, whoever, the education providers, create their education, or at least create the framework and submit it to an authority for them to review and come back with their accreditation decision. And of course, in the US, the primary route is the ACCME. A provider accreditation-based model. But of course, there are those of activity accreditation models, whether it's for the primary care physicians in the US or the Canadian systems. But that's really the main differences, is that in Europe, 99% of accredited CME is based on activity accreditation.

DH: Okay, and how does that affect international collaboration?

EP: Directly there, that's actually down to the education providers to work out the international collaborations, the accreditors, I think, quite neutral about it, they neither sort of promote it or discourage it. You can have a collaboration and submit for approvals, as long as, you know, the education is developed with the end user, the learners, in mind, and it's relevant to a European audience, then collaborations are welcomed, and it's great to have additional expertise brought to the educational programs.

DH: What is the perceived value of accreditation to the physician audience in European countries?

EP: This is question that I hear quite often, especially by, as you say, leaders in the US CME environment, the requirements and the attitudes of accredited CME in Europe is not as strong as in the US. In the US, it's heavily regulated, it's very clear how the accredited activity work, a lot to do with those credit points. In Europe, it's much more disparate. it's less formal. So the actual, even the knowledge, of what accredited CME is, is much lower than in the US.

DH: And what about for other healthcare professionals, such as nurses and pharmacists?

EP: So they do have their own systems. Note that I use the word “they”, they're sort of outside of our CME bubble in Europe, especially when it comes to, yeah, the formal kind of CME that we talk about at the Alliance, for example, is really just the physician education in Europe. So, while the nurses have their systems, and it's very much driven country by country, pharmacists and other allied health professionals have their systems, it's usually outside of the industry supported education and outside of the scope of EACME and others, even though I should say EBAC does accredit education for other healthcare professionals, but on the whole, we're just talking about physician only. So coming back to that, the concept of IPC, the interprofessional continuing education, is much stronger in the US because of the collaborations, you know, led by ACCME and the ANCC, etc. So that's really helping the IPC environment to take off. But we don't have an equivalent in Europe.

DH: While we're talking about how things are done in Europe, we're using some initialisms and anachronisms that might not be familiar to some of our listeners. So can we just be clear what we mean when we say EACME and EBAC?

EP: So those are two organizations that accredit activities for physicians across Europe. So EACME is the European Accreditation Council for CME notes that it's not a European ACCME. They just happen to have similar acronyms. This is the accreditation body of the UEMS, the European Union of Medical Specialists. It's based in Brussels, but it's got nothing to do with the European Union. EBAC is another pan-European accreditation body. Oh, you should say EACME has an agreement with the AMA on the mutual recognition of credits.

DH: So that's important, sure, okay.

EP: Yeah, EBAC started off as the European Board of Accreditation in Cardiology, but I think it was just before COVID. They expanded their remit, so it's the European Board of Accreditation of Continuing Education for Health Professionals, so they'll accredit in any disease area and for any health specialty as well. And they're based in Cologne, Germany, and they also run a provider accreditation system. And actually there's some US organizations that are accredited provider under the EBAC umbrella as well. They have mutual agreements with the AMA as well for the mutual recognition of credits. And they also have additionally recognition by the ACCME of substantive equivalency of systems.

DH: Okay.

EP: And there are others, and usually it starts with EBA-something, European Board of Accreditation in … there's hematology, pulmonology, etc. There are few other smaller accreditation systems that are disease area specific.

DH: Is it true that private med-ed companies do not have standing to confer CE credit in Europe the way they do in this country?

EP: When I saw this question, I thought this was not quite a strange one, but there's quite a lot to unpick here. But in general, med-ed companies have standing like they'd have in the US. We say med-ed company, so it's a company that doesn't do promotional education.

DH: A private medical education company that is accredited by the ACCME in the United States may not, according to my understanding of the person who asked who was encouraging me to ask this question, may not have standing to confer continuing education credits in Europe, and my guess. My question is, is that true? Or is that a misunderstanding?

EP: Right. That might be true in certain circumstance. Each accreditor has their own rules, and you know, like some of them might say something has to be multiple supported, or that they need to be a provider based in Europe or etc., but I think out of EACME and EBAC, that's not true. Maybe your colleague has had an experience with another accreditor who has some kind of strange rule that says not.

DH: I got the impression that the restriction was more on the idea that their company is organized on a for-profit basis, as opposed to a not-for-profit or academic university type organization.

EP: Yeah, that's strange. It shouldn't make a difference for-profit or not-for-profit. The accreditation fee might be different whether it's for-profit or not-for-profits, this kind of thing. But that would be strange, and it would be interesting to understand more and unpick this a bit.

DH: What steps should CME/CPD providers take to ensure that they are in good compliance and maintain their educational independence? Especially with increased scrutiny these days on industry collaboration.

EP: In Europe, I mean, quite frankly, the accreditation standards haven't moved forward that much in the past 20 years or so, those original principles are still held now, and what we're finding is the compliance side of things is actually compliance with industry standards, which is becoming more important, because over the years, industry has been hammered by the authorities so much. They're saying, “well, this is just disguised promotion,” or “the CME is not truly independent.” They've actually taken a lot of especially in Europe, they've taken a lot of steps to actually come up with a framework where they can demonstrate that where they're funding independent medical education, that it is truly independent. I've been interviewed by medical directors, European medical director of drug companies who are picking through the details, and I've asked them, “so what happens if, let's say that person had contact with someone in my office?” and they said, “Well, this would be a disciplinary issue for them.” So, people's jobs are actually on the line if they do not uphold the independent standard within the drug companies, but the accreditors still on the whole struggle to identify the difference between independent medical education and company-led education. This keeps bubbling up time and time again in Europe that if we do not have that separation, we're going to have mudded waters when it comes to independent education and the integrity and the independence of continuing education in Europe, you know, until the accreditors actually encompass this and reflect within their own standards, what industry have spent the past seven or eight years actually putting into place. This is how I'm seeing things.

DH: That’s why we're doing this podcast, to get your perspective, Eugene, and it's very valuable, and we really do appreciate it. And it actually reminds me my next question, that was a great segue, and that is, is it possible for a provider to cross a line and lose their accreditation status due to receiving industry support? Has this ever happened? And if so, could you give us an example?

EP: The CME isn't strictly enforced in Europe, as it is, sort of by the ACCME, or the system that that exists in the US. But the accreditors are doing their best to try and pick up where providers are, let's say misbehaving. But usually this comes about when a med comms agency, you know, a promotional agency of pharma, starts supplying for CME accreditation, those people should be excluded in the first place, and the accreditors are starting to understand, “Oh, those are actually the kind of organizations we should not be accrediting their activities. And it should be, you know, the bona fide a medical education companies that work in IME.”

DH: So Eugene, you told us at the top of the podcast that the 17th Annual European CME Forum in Madrid, Spain had just concluded, which is great. Congratulations. Could you tell us what were some of the major developments or issues that accredited education providers and supporters and content developers were talking about during the forum?

EP: So, a lot of the meeting was about AI. So, Gen AI was the topic of the special collection that we had this year in the Journal of CME. And so, the first part of the conference was looking at AI in different ways, from the perspective of the providers, from the educators, how healthcare professionals are interacting with it. So that was that was an interesting follow-up to developments that are really ongoing at the moment.

DH: The Alliance in New Orleans, everybody was talking about Gen AI, and it looks like that it will be very high profile issue in Orlando as well.

EP: No, absolutely, yeah, it's just not going away. It's just growing hugely. And of course, I love the three-part podcast that the alliance did, so that's that you led earlier this year, just getting the experience for people to actually just get familiar with AI. So, a lot of people talk about it, and they can imagine the potential of it, but it's getting down to actually, you know, putting information into the prompts how to use that, and using it, where you actually can speak knowledgeably, basically.

DH: Or even deciding which platform to use, because there are so many now, between ChatGPT and Claude and Perplexity and Anthrop, you know, so many others. What about the patient voice? Did that come up very much in Madrid?

EP: It did absolutely. We had a special focus on that. We had a bit of a challenge about are we serious about including the patient voice in our planning, design, delivery of our educational activities. So this caused a little bit of a stir in the meeting, while people really had to reflect on, how is it that we are including the patient? And it's not just having a patient with a condition on stage saying, “Oh yes, I'm having a terrible time of this,” but actually getting them involved in the planning, looking at PRO looking at work of the patient advocacy groups and things so that that was really, really handy. And also looking at the sort of voice of the learner, you know, just how are our learners engaging with the education that we produce as well? And we're going to be having more of a focus on that for next year's meeting.

DH: That's really interesting, the voice of the learner. Okay, I just jotted that down because that is so important. It's different. It's not the same thing as the voice of the patient. It's the voice of the learner. And in so many ways, in the CME/CPD space, that is who we're trying to serve, the learner. That's our direct person that we're trying to serve. You know, ultimately, the patient. We're trying to improve patient outcomes, but the direct audience that we try to speak to is the are the learners. So that's really interesting. Thank you, Eugene. Can we return just a little bit to an issue that we were addressing earlier in this podcast, and that is changes in accreditation standards and policies? Can you discuss what is happening in the UK with regard to industry oversight and case law?

EP: Something that's just coming out over the past couple of years. There's a real problem in the UK that we see in that European and global/international CME space. Folks in the US, no doubt, are seeing this and hence this question coming up, is that UK healthcare professionals are being excluded from internationally funded CME. And providers, especially European providers, are finding that they're being instructed by the grantor to geo-block UK learners or not invite them or exclude them, as in, they're not allowed to enter the room of a meeting. Maybe there's an accredited satellite symposium going on or something, and they're saying the UK healthcare professionals are not allowed into the room. If your US audience aren't aware of this going on, they may have seen an RFPs being issued, and there are several large pharma companies they're issuing RFPs that you know the geographic scope is anywhere in the world, except for the UK.

DH: Wow. Okay, well, that's why we're having this podcast, because we're learning what's really happening.

EP: A couple of years ago, it was the regulators in the UK deemed that if a drug company hands over any money at all for any purpose under any conditions to an organization to develop medical education, that company must control it in some way. And of course, this breaks ACCME standards, and actually most European CME standards as well. So, it's easier now for the pharma company just to say, “Look, exclude the UK, because we can't be found breaking the rules there.” So that's the shortcut that's happening. But the problem in the UK is that the regulators here do not distinguish between company led education and truly independent medical education. And the accreditors in the UK accredit junk company education, okay, where there's all this cloudiness, it's just easier for the pharma, the global pharma company, the global offices, to say, right, let's just exclude the UK, until the UK works it out. We'll be talking about it the Alliance in January. There’ll be a session where we'll touch on this as well.

DH: Super. Well, I look forward to learning more about it. Then that's great, shifting gears just a little bit to a topic that's near and dear to my heart as a medical writer, the issue of content development. And just briefly, I'm curious, is the needs assessment considered a foundational document for accredited programs in Europe, the same way as it is in the United States?

EP: Yeah, absolutely, it's just as important, and it's approached in in the same serious way. It's a formal process that European providers go through. Though, if it's for industry funded education.

DH: Who develops the needs assessment?

EP: Typically, it's done in house. So by the medical writer. It's a skill set now that's an expectation of medical writers to have working in CME providers.

DH: Shifting now to commercially supported instructional content. Do medical writers and editors collaborate with expert faculty in Spain or France or Germany, for example, the same way they might work with faculty in New York or Illinois?

EP: Yeah. I mean, there's quite a bit of variation here. But I think in the US, from what I understand, there's quite a bit of variation there as well. So, you'll have the whole spectrum of something, maybe where the medical writer develops most of the education and has it reviewed and approved by the faculty member, all the way to the faculty member developing absolutely everything themselves. They're clear about the learning objectives, they've understood the needs assessments that the education provider has come up with, and they control everything. So, this is quite normal. But what's really important, however things go, is to have the faculty member clearly involved in the education. Because when it comes to delivering content, you know, it's all about the learner, really, it's got to be as relevant as possible to the learner. So that is a critical piece.

DH: Okay, moving on to a deeper exploration of commercial support. How do perceptions of industry support vary by country around Europe or by region?

EP: From an IME perspective, from medical education perspective, it really varies hugely, so like we've talked about the UK. So in the UK, there is an expectation, I'm sure, if you ask most healthcare professionals, or let's say, most physicians, about education that is supported by a drug company. They're actually much closer to the drug company. They expect a level of control there. The countries further to the east of Europe and southern Europe, industry is more present, but countries like France and Germany, there is much more separation between industry.

DH: When I ask, “How do perceptions of industry support vary by country?” I guess I should make it a little bit more specific and say, “How do perceptions of industry support for independent medical education vary by country around Europe?”

EP: So this does vary country by country. Quite a few countries don't actually have that concept of independent medical education that's understood by the learners. To them, they're just going to a medical education activity that may or may not be supported by a pharma company, but generally, it's welcomed. It's a positive thing. Some are wary of being promoted to, because there's an approach in the company led education, they may may look like independent medical education, because, like, 80% of the educational activity is or looks independent. They're talking about management of a patient with the condition, the holistic approach to the condition. But the actual promotion bit will be in the last 20% the final presentation or something, then the learner will know that they're in a promotional meeting. But they don't have that vocabulary. They don't understand the difference between the independent medical education and company led education. But on the whole, it's, I think, more positive and less suspicious than in the US. One outlier is, is France, where the French really do not allow for company led education and even the CME activities there are so separated from the supporting company. It's funded by the Ministry of Health that if they see anything that's got an industry label there, then then they will be looking at it with much more suspicion. But on the whole, I think, around Europe, it is, it is noticed, and on the whole, I think seen positively.

DH: How do healthcare practice environments differ region to region within Europe, and how should CME CPD providers tailor their educational offerings to align with these differences?

EP: This is a hugely important point. You know, Europe, yeah, it may look like a collection of states like the United States or something, but there's no federal authority. Every country has a different healthcare system, different structures. Yes, the medical schools educate the undergraduates to the same level. But once you're in the healthcare system, it is, it is different, and this also is reflected in the accreditation standards, country by country, and the response of the learners. As a medical writer, you'll appreciate you know that whole needs assessment process and identifying the gaps and the needs of the learner, look at the learner, listen to the learner. You know. What are they expecting? What is their starting point? So, some of them will be trained in depth in a particular area, and would expect education to address their needs. Their gaps will be different than ones from the neighboring country. So, when it comes to collaborating with organizations or people in Europe, make sure you've got someone from that country who understands that system and match it with the learners. There's no sort of pan-European, one-size-fits-all way of doing things. And it's certainly a mistake to think, “Oh, we'll take a US program, run it through Google Translate 15 times and launch in 70 countries.” That just will not work.

DH: Fair enough. Moving a little bit deeper into program development, how do the delivery formats that we consider very common in the United States, such as a grand round series in hospitals, translate into Western European countries like Spain, France or Germany?

EP: Sure, sure. Yeah. So actually, this is a nice illustration. So some traditional formats in the US, like the Grand Rounds, the concept of, you know, the RSS is very us specific, yeah, in any European country, I mean, case review sessions take place, different type of team meetings take place. But it's unusual for it to be accredited CME activity, and it's even less usual for a pharma company to support that as well. And maybe an illustration of this is most, if not quite all, but most, the vast majority of hospitals in Europe do not have a CME department or a CME person, or someone responsible for needs based medical education.

DH: Now there's a very specific, tangible difference. Most European hospitals do not have a person in charge of CME for staff.

EP: Absolutely.

DH: Whereas in this country, that's clearly a job description in almost every hospital or healthcare system. I know from my previous experience in program development that if you're going to run a grand round series in 20 different hospitals, the person you work with is the CME coordinator in each hospital. You know the boots on the ground to make you know the Grand Rounds happen on site. So if there's no CME person in each hospital here, you're not going to be able to execute a series of Grand Rounds throughout Spain or France or Germany. Okay, I recall during our conversation, prior to this podcast, you brought up the issue of direct-to-consumer advertising, and how the United States direct-to-consumer advertising is a thing, and we've had it for quite a while. It is not a thing in Europe. And how does that affect CME/CPD between the two countries? From your perspective.

EP: Looking at this from a similar even a society level, you have patients who are more informed about newer products. There'll be the promotional messages that they see on TV and in print in the US. So, we don't have that happening so much in Europe. There are certain drugs, actually, let's say the fashionable drugs. There's this huge discussion about the use of Ozempic. You know, members of parliament have been taking it, you know, and various famous people, and they're writing about it in the press. But if a drug company touches a story, or is seen to have any link, they're the ones who are going to be in a huge amount of trouble. It just feels like it's sort of inappropriate, and usually members of the public are just not exposed to brand names and things, so there isn't that knock-on effect to the physicians in the clinic dealing with informed patients, whether well informed or mal informed. And when it comes to the CME activities, really the education, the traditional, normal way of approaching things in Europe is using generic names and looking at best practice and the guidelines rather than what patient may or may not have seen on TV or in some commercial somewhere.

DH: Shifting now to the topic of the future, Eugene, when you gaze into your crystal ball, what do you envision as being the future of CME, CPD in Europe? Are there any emerging trends or changes or regulatory shifts underway that you think will shape the next decade?

EP: Yeah, for Europe, that's actually some very interesting because there's no pan-European authority. And you know, we've already talked about how the pharmaceutical industry have come up with common standards that are being implemented across Europe and mostly internationally as well. So, we've seen that it's really down to the accreditation side of things over the years. I mean, there's still over 200 ways of getting a program accredited in Europe. So many countries have got multiple systems. They are pan-European, specialty-driven. It really is a huge soup of different ways of doing things. Something we've seen in recent years is the International Academy for CPD Accreditation is making some really interesting headway in Europe. It's a global organization anyway, and it was set up by the leading three organizations were the ACCME, the Royal College in Canada, and EBAC, but it's quickly expanded to a core of like, 15 or 20 accreditors, you know, from Kuwait, Bahrain, South Africa, Vietnam, Hong Kong, and they're looking at common standards for Accredited CME, and it's just gaining traction there. And I think there's this, like, core of 15 of them that are looking at this, publishing their standards, and they're now also looking to adopt standards of substantive equivalency between the accreditation systems. I'm finding this really exciting, because finally, we will have the accreditors streamlined. The pharma industry will be able to align their expectations with this, providers will know how to act. There'll be clear separation between independent medical education, company-led education. I'm holding out great hope for this, for European and the global CME environment in general.

DH: And where can people go for more information to continue this conversation?

EP: Well, of course, the Alliance. In January, I’m involved in like two sessions, and I know that there are several other European sessions, so there’ll be several discussions there. And, of course, the European CME forum. We’re planning on meeting now in November 2025, which will take place in Manchester in the UK, in my hometown.

DH: Ah, in your backyard! How handy, great! And I think the other major meeting you mentioned was the ACCME, right, wasn’t it one of the other ones?

EP: The ACCME is great for global CME as well. And there’s also the Cologne Consensus Conference, so if people are really interested in the accreditation side of things, that’s actually the meeting of the International Academy for CPD Accreditation. That rotates between Europe and North America. So the meeting just took place in Chicago this year, next year it’ll be in Cologne itself.

DH: Well, Eugene, I think that about wraps it up for this episode of this podcast. Thank you so much for joining us. And for listeners who enjoyed this topic, we would encourage you to join us at the Alliance meeting in Orlando, where Eugene will be speaking at greater length on many of the topics that we’ve touched on today. Eugene, have any final words for our listeners?

EP: Oh no, that’s great. Thank you so much, Don. I’ve really enjoyed our conversation today, it’s really been a pleasure to go through this, and I look forward to seeing you and others in Orlando!