Dissemination of continuing medical education: the EuroTransMed experience

H. Young (Cardiff, United Kingdom)

Introduction

The need for rapid dissemination of medical education has become paramount in the environment in which doctors practice. Traditional methods have relied upon the printed word or attendance at conferences or symposia. The time for research and clinical papers to reach print can vary enormously, and may result in considerable delays in dissemination. Likewise while participating in a conference may enable earlier dissemination, the ability to identify the appropriate meeting and have the time to attend it may be difficult.

In 1989, the European Space Agency (E.S.A.) invited a group of doctors to have access to the experimental OLYMPUS satellite to test a medical education project. Due to technical reasons this satellite failed, and the group was forced to look to the commercial satellite sector for transponder time. To undertake the project, the EuroTransMed Foundation was established as a non-profit foundation, initially based in the University of Leiden, The Netherlands. The remit of the Foundation was to develop high quality programmes for postgraduate and continuing medical education, which could be distributed by satellite to receive sites throughout Europe. At all times the Foundation, in its non-profit role, was to ensure its independence and integrity.

To facilitate these objectives, a defined organisational structure was developed, consisting of the Foundation, an Editorial Board and the contracting of a production company to produce and market the programmes. The Foundation holds the copyright of programmes, maintains its European Union (E.U.) links and has an evaluation and research role. The Editorial Board defines programme subject areas in a strategic role, has medical speciality representation, and has links with key European Societies including the EORTC, European Society of Cardiology and the European School of Oncology. The Board acts in a similar fashion to that of a journal.

The contracting of the production and marketing to a dedicated company was considered essential. By having a production team, familiar with terrestrial broadcasting standards, the highest quality of output could be obtained and to facilitate the interaction between doctors and broadcast professionals, a medical commissioning editor has been employed. The production company is also responsible for marketing and liaison with existing and potential sponsors. Sponsorship of programmes is undertaken by means of unrestricted educational grants to ensure that editorial issues are not compromised

Programmes

EuroTransMed (E.T.M.) programmes are available to over 250 sites throughout Western and Central Europe, reaching from Portugal in the west to Lebanon in the east, from Finland in the North to Algeria in the South. Each programme is broadcasted live and consists of short presentations by opinion leaders, including the results of latest research, followed by an interactive component. Initially interaction was undertaken using phone and/or faxed questions to the studios, supplemented occasionally by the use of ISDN/videophone where such equipment was available. Occasionally pre-recorded conference reports are broadcast, instead of a live programme.

Each programme has to address the defined educational needs of its end-user/viewer. The use of interaction has been a key part of each broadcast. However individual sites are able to record programmes and a considerable secondary use of the material takes place in a self directed learning fashion. In some instances the material has been used for personal development of medical English language skills; while in some countries medical teachers incorporate some or all of the material in medical curricula for undergraduates.

E.T.M. programmes fulfil a role in the provision of continuing medical education (C.M.E.), and in the United Kingdom they are approved for formal external C.M.E. accreditation. Where C.M.E. is being introduced in Europe, approval of E.T.M. programmes is being pursued. However, the content of programmes is applicable to both training and career grade doctors. For trainees it provides high quality, evidence based material suitable for incorporation into training curricula.

Oncology Programmes
E.T.M. is the project leader of the Multimedia Educational Databases in Clinical Oncology (MEDICO) group. This project funded under the E.U. Fourth Framework Telematics Programme brings together diverse groups involved in clinical oncology. E.T.M.'s role is to ensure the dissemination of new knowledge in oncology, using a variety of sources including the EORTC and the European School of Oncology. Up to six oncology programmes are to be broadcast each year across the network, but are being formally evaluated in 10 sites in the UK, Belgium, Italy and Germany. A separate oncology editorial board has been established with the remit to cover all major cancer areas in a three year period. Programmes broadcast to date have covered locally advanced breast cancer, prostate cancer, melanoma, lung cancer, the variability of outcomes, and the role of the information superhighway in oncology.

Each programme is evaluated locally, involving self assessment, and the use of internet returns back to the EuroTransMed web page. Delayed assessment takes place three to six months after oncology programmes to determine if initial perceptions and possible changes of practice have been maintained.

EuroTransMed and Telematics

The increasing role of telematics has been identified by EuroTransMed as an important development tool. The introduction of the ETM web site (www.eurotransmed.nl) has been supplemented by the recent addition of an audio server. The web site provides details of previous and forthcoming programmes, along with the content of the regular newsletter sent to all receiving sites.

The audio server has been developed to enable the internet users access to ETM programmes, consisting of the audio component of each programme supplemented with the graphics. Provided a fast modem (28.8bps or higher) is used, acceptable quality and minimal time delay occurs. Using the index of speakers and the content of the programme, it is possible to access those parts of a programme which an individual health care professional requires. In excess of 1000 user sessions (as opposed to 'hits') are now recorded per month. Programmes are usually available on the audio server within one week of their broadcast; it is anticipated that this delay can be minimised in the future.

Also available on the web site are evaluation forms for programmes and links to other sites (including The Lancet and Telescan). The facility to ask questions during the live programme using the e-mail facility has also overcome difficulties in some countries in accessing outside telephone lines. Using e-mail enables the PC user to ask a question to an opinion leader for the price of a local phone call.

Conclusion

The ability to disseminate high quality education to health care professionals throughout Europe now exists. EuroTransMed programmes are of the highest quality and integrity, bringing opinion leaders into the work place. The live interactive nature of the programmes fulfils the educational needs of the audience, while recording of the programmes can enable self directed learning to take place. Regular feedback and evaluation are used in the planning of future programmes. Incorporation into medical curricula in some countries has widened the potential audience.

No distinction is made between postgraduate medical education and CME. Both groups can use the material according to their needs, and it also helps to ensure that the development of best practice can take place. The long term aims must be to ensure that there is faster flow from research into clinical practice, earlier rejection of ineffective or inappropriate treatments, resulting in increased harmonisation of outcomes.

The use of telematics has focused on how ETM programmes are delivered now and in the future. While satellite delivery is cost-effective at present, as the internet develops on demand access to programmes through work based PCs or integrated learning centres becomes feasible. To develop this it is important that the provider has control of the technology. By working in EU and other research projects in the telematics field and ensuring that at all times one is responsible to the educational needs of the audience, this goal is achievable.

In the last five years, EuroTransMed has shown that the dissemination of continuing medical education can be achieved in a timely fashion across Europe. The changing nature of the environment in which health care takes place means that the need to develop best practice based upon appraisal of the evidence is a key area for all health care professionals. EuroTransMed programmes complement other educational activities and sources in helping the individual to attain these goals.

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