Traditionally, continuing medical education (CME) activities were delivered on a country-by-country basis with very little expansion across borders. With a strong belief in the globalisation of medicine 1 , the expansion of educational activities to other countries or regions has become of great interest for medical education providers, associations and pharmaceutical companies. While language barriers and accreditation requirements are widely respected 2 , with several publications accessible 3,4 , very little attention has been paid to diff erences in the medical education pathways and underlying national health care systems-potentially leading to diff erent learning styles and learning needs. In order to address this question, the following research project was documented and analysed based on a structured questionnaire on three main aspects of under-and postgraduate education and continuing medical education (CME) in 12 European countries: 1. Terminology: Increased understanding of terminology applied beyond language barriers, for example, do we mean the same when using the same term? 2. CME systems: Detailed documentation on national CME requirements, including review of impact for physicians, for example, the implications of stated requirements as well as roles and responsibilities. 3. Medical education pathways: Documentation of the medical education pathway from undergraduate to postgraduate and life-long learning, including how CME is embedded in this pathway as well as underlying structures. Field research was performed from October 2010 till October 2011 by native speakers with a medical or pharmaceutical background. It revealed signifi cant diff erences in all areas analysed with subsets of countries following similar models. Bearing in mind the objective of off ering best quality in response to learners' needs, this research project may serve as a relevant source for providers of medical education and medical societies when developing educational programmes for their members as well as for the set-up of global projects and collaboration. In addition, the information gathered and analysed may serve as an interesting resource for CME professionals in various positions. The next step will be to analyse the impact of integrating this knowledge into the educational planning process for national and international projects and to assess if this will prove to be an additional quality factor for educational programmes and will improve outcomes.
We have previously published the results of a comprehensive research project which was conducted in 11 European countries in 2010/2011 to establish a detailed database on the implementation of CME in these countries, including underlying structures, roles and responsibilities, and funding models. Special attention was given to the role of the various stakeholders such as Ministry of Health/government, physician associations/societies/chambers, and universities in addition to the positioning of CME within the medical education pathway from undergraduate through postgraduate to life-long learning. We showed that there were three models for the implementation and accreditation of CME: physiciancentric model, politician-centric model and university-centric model. In this paper we describe a more detailed analysis of these systems. The three diff erent types are characterised by diff erent leaderships (physician representations, Ministry of Health and universities), diff erent drivers and diff erent means of access to CME. There was no relationship between the accreditation system implemented in the respective country and the identifi ed CME implementation model. In addition, diff erent approaches to funding were identifi ed for the diff erent models, from purely governmental funding to predominantly third party sponsoring, revealing diff erent risks for bias in the diff erent models. We conclude that knowledge of the underlying model may be crucial for providers of medical education and medical societies when executing international educational programmes for their members or setting up international collaborations. It is hoped that these new fi ndings may also stimulate an interesting discussion amongst the leaders in CME on what may be the future model for CME in Europe: Is there one compelling model other countries may want to follow?
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