Health promotion and disease
prevention including lifestyle
medicine in health and
educational settings
Mapping results and analysis to be presented at the
International Conference “Promoting healthy lifestyles
in Europe: from education to practice”, September 24th
2020
Written by ECORYS Nederland B.V.
June 2020
Third
EU Health
Programme
EUROPEAN COMMISSION
Directorate-General for Health and Food Safety
Directorate C — Public health, country knowledge, crisis management
Unit C4 — Health determinants and international relations
E-mail:
sante-consult-c4@ec.europa.eu
European Commission
L-2920 Luxembourg
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Health promotion and disease prevention including lifestyle medicine in health and
educational settings
Table of Contents
Preface ................................................................................................................ 5
Executive summary ............................................................................................. 7
1.
Introduction ................................................................................................ 11
1.1.
2.
3.
Theoretical background ............................................................................... 15
2.1.
Societal needs for health promotion and disease prevention .......................... 15
2.2.
Health profession competencies ................................................................. 16
2.3.
Educational systems for health professions in Europe .................................... 19
2.4.
Relevant educational settings for health promotion ....................................... 19
2.5.
Theoretical framework for this study ........................................................... 21
Methodology ................................................................................................ 22
3.1.
Online survey .................................................................................... 22
3.1.2.
Desk research .................................................................................... 26
Overview of educational programmes in the EU ............................................ 29
4.1.1.
Summary of the main findings in the survey .......................................... 29
4.1.2.
Detailed results of the survey .............................................................. 29
4.2.
6.
Long list of good practices ......................................................................... 27
Mapping of the current situation IN health promotion training in the EU .... 29
4.1.
5.
Mapping of health educational programmes in the EU ................................... 22
3.1.1.
3.2.
4.
Research questions ................................................................................... 14
Overview of competency profiles of health professionals in the EU .................. 44
Long list of good practices ........................................................................... 45
5.1.
Results.................................................................................................... 45
5.2.
Analysis of good practices ......................................................................... 48
Conclusions ................................................................................................. 53
Annex 1 Survey results by country .................................................................... 57
Annex 2 Competency profiles per professions ................................................... 71
Annex 3 Online survey ....................................................................................... 89
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Health promotion and disease prevention including lifestyle medicine in health and
educational settings
PREFACE
ECORYS Nederland B.V. is pleased to present the reader to support Member States in
mainstreaming health promotion and disease prevention including lifestyle medicine in
education of health professionals. The reader gives a general overview of professional
training initiatives in the European Union (EU).
The study comes at a time when it is well known that lifestyle factors are important
determinants for most non-communicable diseases. These diseases have a major impact
on the health of European citizens. At the same time, an increasing proportion of aged
population poses demands on health systems and stresses the need to sustain the work abilities of the working age population. Therefore, health promotion, disease prevention
and a healthy lifestyle are essential for patients and the general population. Health
professionals play an essential role here. This is not an easy task as dealing with lifestyle
factors requires different strategies at a population level or for targeted patient groups with
e.g. type II diabetes or cardiovascular risks. Health professionals need to be prepared for
this task in their education, either during their study period or as part of continuous
professional development. Though widely acknowledged, it remained unclear to what
extent and how Member States address this challenge.
In the context of this project, we collected practices how EU Member States include health
promotion, disease prevention and lifestyle medicine in health professional education. This
report presents a mapping of the current situation across different countries and health
professions. Without pretending to be complete, it provides a unique baseline of the way
professionals are currently prepared to implement health promotion, disease prevention
and lifestyle medicine in EU countries. With this baseline, Chafea created an important
starting point for the exchange of experiences and mutual learning. Hope is that this will
boost developments in the near future so as to prepare health professionals to adequately
address the challenges that healthcare systems in the EU face and implement the paradigm
shift from treatment of diseases among patients to promotion of health among the entire
population.
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Health promotion and disease prevention including lifestyle medicine in health and
educational settings
EXECUTIVE SUMMARY
Background
By 2020, the World Health Organization (WHO) predicts that two-thirds of all diseases
worldwide will be the result of lifestyle choices and unhealthy diets. Tobacco use, harmful
use of alcohol and physical inactivity have been identified as the top risk factors for noncommunicable diseases (NCDs) in the European Union. In recognition of this important
public health challenge, investing in effective health promotion and disease prevention of
NCDs is critical to improve the quality of life and well-being of European citizens.
Healthcare professionals such as doctors (especially general practitioners), nurses, social
workers, physiotherapists, dentists and pharmacists are uniquely positioned to make
immediate and meaningful improvements in preventing and treating NCDs. However, while
many policy statements and NCDs practice guidelines call for behavioural change as the
first line of prevention and management, professionals often do not include behavioural
change counselling in their care yet. While most health professionals acknowledge the need
for lifestyle advice, there seems to be a mismatch between the roles and competencies for
which health professionals are trained and the action required. This underscores the need
to develop and strengthen lifestyle medicine as a component of health professionals’
education, defined as: ‘the integration of lifestyle practices into the modern practice of
medicine both to lower risk factors for chronic disease and/or, if diseases are already
present, to serve as an adjunct in therapy. Lifestyle medicine brings together sound,
scientific evidence in diverse health related fields to assist the clinician in the process of not
only treating disease, but also promoting good health’
Objective of the study
This study seeks to provide a mapping of the current situation how health professionals are
trained in health promotion in the EU. To that end, this study aims to answer the following
research questions:
1. How are health professionals in the EU countries being trained in health promotion,
prevention and lifestyle medicine in graduate, post-graduate and continuous
professional education?
2. What are good practices on knowledge, capacity and competency building and
advocacy of health professionals on health promotion and disease prevention
including the potential of lifestyle medicine?
Scope of the study
Classically, public health targets at activity levels can be described in operational models
like the Frieden´s pyramid model. It is operationalized into the fundamental composition,
organization and operation of society from the underpinnings of the determinants of health,
like socioeconomic status. We use this model as a substructure to investigate health
professionals’ education as they contribute to public health at all these levels.
Methodology
In order to provide a general overview on how health professionals are trained in health
promotion and disease prevention and lifestyle medicine in the EU, we conducted an online
survey. We identified potential organisations in the EU to take part in the survey and asked
those organisations to spread the survey among other organisations or stakeholders in their
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Health promotion and disease prevention including lifestyle medicine in health and
educational settings
network. We contacted 24 EU associations that represent entire professions or part of the
professions (like post-graduates) in all EU countries and have major networks in the fields
of graduate, post-graduate and continuous professional development, for their support. We
aimed to cover all professions within the scope of this study: physicians, physiotherapists,
occupational therapists, psychologists, nurses, social workers, dentists, pharmacies,
dietitians. Also, national health associations and national educational organisations were
approached to fill in the survey. Among other topics, the survey contained questions on the
training programme, type of health professional targeted, implementation in the
curriculum, description of the health promotion component, funding, accreditation and
partnerships.
In addition to the online survey, a desk research was conducted, including both scientific
and grey literature, to establish an overview of the competency profiles of health
professionals in the field of health promotion and disease prevention. Based on the
identified literature, we described the competency profiles for each of the following
healthcare professions: (undergraduate) medicine; medical specialists; dentists; nurses;
nurse specialists; occupational therapists; pharmacists; physiotherapists; psychologists;
and social workers.
Results were tabulated and described. Good practices were selected on the basis of four
pre-established criteria. These practices were analysed more in-depth with an analytical
tool aligning Frieden’s pyramid of public health needs and Kraiger’s Learning Typology. This
in-depth analysis was used to define a short list of 10 good practices, representing a variety
of professions and countries.
Results
Health promotion, disease prevention and lifestyle medicine are to some extent present in
the competency profiles for most EU health professions included in this study: medical
doctors, medical specialists, physiotherapists, occupational therapists, psychologists,
nurses, social workers, dentists, pharmacies and dietitians. This finding means that
important progress has been made in past decades 1:there is a growing and diverse health
promotion workforce in Europe; public health has made its entrance in the education of
every health professional. However, there is room for improvement: many competency
profiles leave room for interpretation, the described competences are not ranked in order
of importance and it is often not explained how the competences should be applied in
practice, i.e., in a pro-active, preventive way (always assessing lifestyle within the
treatment) or a more curative, reactive way (only included in the treatment when there is
a clear lifestyle component related to the disease).
As for the inclusion in educational programmes, a high percentage (93%) of respondents
(n=197) indicate that health promotion and disease prevention is implemented in their
educational programmes or modules. The high share may reflect a selection bias as those
who have implemented health promotion within the education may have been more inclined
to fill in the questionnaire. In the survey, we explored how health promotion and disease
prevention is implemented in the educational setting. In summary, this provided the
following results:
1
Morales Arantxa Santa-María, Barbara Battel-Kirk, Margaret M Barry, Louisa Bosker, Anu Kasmel, Jenny Griffiths
(2009) Perspectives on health promotion competencies and accreditation in Europe. Glob Health Promot.
2009 Jun;16(2):21-31.
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Health promotion and disease prevention including lifestyle medicine in health and
educational settings
•
•
•
•
•
•
•
More than half of the respondents indicated that they filled in the questionnaire for
practices in undergraduate educational settings. Throughout Europe, these
numbers were relatively similar;
Physiotherapists are the professional group most actively involved in health
promotion training activities. The vast majority applies multidisciplinary
approaches and thus, brings other professions on board too;
Overall, traditional teaching methods (lectures and assignments) are most often
used within training programmes. In continuous professional development, on the
other hand, e-Learning is most frequently used (67%);
Educational programmes on health promotion especially target knowledge, skills
and behaviour of students;
Health behaviour, human cognition and behaviour and population health are the
theories covered in most education programmes. On a more detailed level,
communications skills, ethics and methods of evidence-based medicine are
covered most within the education. Digital health coaching, digitalisation, health
economics receive less attention;
Targeted funding was most often obtained for continuous professional
development (33%) compared to undergraduate and postgraduate education
where the topic is covered in most modules (15% and 6%). Funding was more
often obtained in Northern and Southern Europe;
The ratio health promotion covered in all modules of the educational programme
vs. one full module primarily dedicated to health promotion was 63% (all
modules)/37% (full module). Regarding full modules, high percentages indicated
that this is mandatory and that there is an exam at the end of the module (81%,
70% respectively).
Conclusions
The present study provides an overview of current practice on health promotion, disease
prevention and lifestyle medicine in the education of health professionals in EU countries.
This is an important need-assessment for the exchange of knowledge and expertise among
EU countries. All professions have versatile competency profiles in health promotion giving
a good ground for further development. As the study results reveal some unbalance in
competencies addressed and methods used, a next step could be to support further
development of educational practices in lifestyle medicine and adoption of new
technologies. There is room for improvement as well as encouraging volition to share
expertise across professions, professional associations, universities and countries in the EU.
The body of knowledge generated in this study can serve as a basis for further analysis and
contribute to the enhance effectiveness of educational practices of health promotion,
disease prevention and lifestyle medicine.
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Health promotion and disease prevention including lifestyle medicine in health and
educational settings
1. INTRODUCTION
By 2020, the World Health Organization (WHO) predicts that two-thirds of all diseases
worldwide will be the result of lifestyle choices2. In Europe, such chronic diseases, as
cancer, cardiovascular diseases, diabetes and chronic respiratory diseases are giving the
greatest disease burden3. The Global Burden of Disease (GBD) 2016 study estimates that
over 91% of deaths and over 87% of DALYs in the European Union (EU) are the result of
non-communicable diseases (NCDs), of which 61% and 43% respectively can be attributed
to modifiable risk factors4. To a large extent, lifestyle factors: unhealthy diets, tobacco use,
harmful use of alcohol and physical inactivity have been identified as the top risk factors
for NCDs in the EU5. The last non-communicable diseases progress monitor 2017 of the
WHO, underlines that: “NCDs share key modifiable behavioural risk factors like tobacco
use, unhealthy diet, lack of physical activity, and the harmful use of alcohol, which in turn
lead to overweight and obesity, raised blood pressure, raised cholesterol, and ultimately
disease”6. Since NCDs share many related modifiable risk factors and often do not occur in
isolation7, prevention must be integrated into population approaches to combat NCDs as a
group8. In recognition of this important public health challenge, investing in effective health
promotion and disease prevention is critical to improve the quality of life and well- being of
European citizens9,10 as well as their productivity, and NCD’s burden on health systems and
economy of European societies11.
Strengthening the investments in health promotion and disease prevention is key to delay
the onset and reduce the burden of NCDs in Europe12. As there is a great need for chronic
disease management, the healthcare setting is crucial for health promotion in both primary
and secondary prevention of NCDs13. For example, obesity is a major modifiable risk factor
2
3
4
5
6
7
8
9
10
11
12
13
Chopra, M. et al. (2002) A global response to a global problem: the epidemic of overnutrition
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2567699/pdf/12571723.pdf
WHO (2006) Gaining Health, The European strategy for the prevention and control of noncommunicable
diseases http://www.euro.who.int/__data/assets/pdf_file/0008/76526/E89306.pdf
EU burden from non-communicable diseases and key risk factors https://ec.europa.eu/jrc/en/healthknowledge-gateway/societal-impacts/burden
WHO (2014) Prevention and control of noncommunicable diseases in the European Region: a progress report
http://www.euro.who.int/__data/assets/pdf_file/0004/235975/Prevention-and-control-ofnoncommunicable-diseases-in-the-European-Region-A-progress-report-Eng.pdf
WHO (2017) Noncommunicable diseases progress monitor 2017 http://apps.who.int/iris/bitstream/
handle/10665/258940/9789241513029eng.pdf;jsessionid=0613BF26D66A7DA9D1C91AD325E0A75D?sequence=1
https://ac.els-cdn.com/S0091743515002832/1-s2.0-S0091743515002832-main.pdf?_tid=88fea2bf-946a44c2-be59-0edbabc2c2e8&acdnat=1541511066_feedfb33968e2ac2f5b47a3452254a9f
Integrated approach to prevent noncommunicable diseases http://www.euro.who.int/en/healthtopics/noncommunicable-diseases/cancer/activities/integrated-approach-to-prevent-noncommunicablediseases
WHO (2006) Gaining Health, The European Strategy for the prevention and control of noncommunicable
diseases http://www.euro.who.int/__data/assets/pdf_file/0008/76526/E89306.pdf
Scriven A. (2017) Promoting Health a Practical Guide Seventh Edition https://books.google.nl/
books?hl=nl&lr=&id=fJwqDwAAQBAJ&oi=fnd&pg=PP1&dq=importance+health+
promotion+and+disease+prevention+European+Commission&ots=jcXZvCYJIQ&sig=8D8Yqa9wKa_DlaaYUk
y_EtUxd_g#v=onepage&q=importance%20health%20promotion%20and%20disease%20prevention%20Eur
opean%20Commission&f=false
Tender.
Chrodis (2015) Health promotion and primary prevention in 14 European countries: a comparative overview
of key policies, approaches, gaps and needs http://chrodis.eu/wp-content/uploads/ 2015/07/
FinalFinalSummaryofWP5CountryReports.pdf
WHO (2018) Promoting physical activity in the health sector: Current status and success stories from the
European
Union
Member
States
of
the
WHO
European
Region
http://www.euro.who.int
/data/assets/pdf_file/0008/382337/fs-health-eng.pdf
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Health promotion and disease prevention including lifestyle medicine in health and
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for type II diabetes (DM II) and thus efficacy of the intervention matters. In economic
modelling for eight European countries, a body-mass index reduction in the adult population
of 5% compared to 1% resulted a three-fold reduction in the incidence of DM II14. Apart
from the health losses caused directly by NCDs, underlying conditions may also increase
susceptibility for other diseases. Patients with diabetes and serious heart conditions, e.g.,
were identified as risk populations for COVID-1915. New health threats like climate crisis
will have an impact on healthcare systems and need for adaptation options including
training of health care workers, integrated heatwave early warning systems, especially for
the most vulnerable populations and supporting lifestyle changes toward healthy choices
that are at the same time climate and health friendly.16
Healthcare providers such as doctors, especially general practitioners (GPs), nurses, social
workers, physiotherapists, dentists and pharmacists are uniquely positioned to make
immediate and meaningful improvements in preventing and treating NCDs 17. Health
promotion is collaborative work where professionals strengthen the message and help
patients to choose and implement healthier behaviours. Counselling on and prescription of
a healthy lifestyle is particularly important to socioeconomically vulnerable and
disadvantaged population groups, which are disproportionally affected by unhealthy
lifestyles, and are more difficult to reach 18. Secondary and tertiary prevention in chronic
diseases is embedded into good quality care, since good nutrition status decreases the risk
of reinfarction as does smoking cessation. For these reasons, health promotion was
explicitly recognized as an integral part of the professional role of the GP in several policy
statements at both the European and the national level 19. While many policy statements
and NCDs practice guidelines include a call for behavioural change as the first line of
prevention and management, providers often do not provide behavioural change
counselling in their care20.
A recently published report by the European Commission and WHO Europe (2018) identified
barriers for prescribing and counselling on exercise schemes and on promoting physical
activity in the health sector. These were the lack of confidence and knowledge and skills by
health professionals on providing effective counselling21. For example, Koutoukidis, et al
(2017) performed a qualitative study on the perspective of healthcare professionals on
lifestyle advice to cancer survivors. Health professional-centred barriers to provision of
lifestyle advice were a lack of knowledge on healthy lifestyle guidelines, the feeling that
14
15
16
17
18
19
20
21
Webber L, Divajeva D, Marsh T, McPherson K, Brown M, Galea G, et al. The future burden of obesity-related
diseases in the 53 WHO European-Region countries and the impact of effective interventions: A modelling
study. BMJ Open. 2014.
Centre for Disease Control and Prevention (2020). Coronavirus disease 2019. Groups at higher risk for severe
illness. https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/groups-at-higher-risk.html.
Drummond P, Ekins P, Grubb M, Lott MSEng M, Byass P, Nilsson M, et al. The Lancet Commissions Institute
for Sustainable Resources (P Health and climate change: policy responses to protect public health.
thelancet.com. 2015.
Catapano A.L. et al. (2007) Averting a pandemic health crisis in Europeby 2020: what physicians need to
know regarding cholesterol management https://www.ncbi.nlm.nih.gov/pubmed/17446817
WHO (2018) Promoting physical activity in the health sector: Current status and success stories from the
European
Union
Member
States
of
the
WHO
European
Region
http://www.euro.who.int/__data/assets/pdf_file/0008/382337/fs-health-eng.pdf
http://www.woncaeurope.org/sites/default/files/033%20%E2%80%93%20Health%20Promotion%20In%20
European%20General%20Practice.pdf.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4561845/pdf/10.1177_1559827615580307.pdf.
WHO (2018) Promoting physical activity in the health sector: Current status and success stories from the
European
Union
Member
States
of
the
WHO
European
Region
http://www.euro.who.int
/data/assets/pdf_file/0008/382337/fs-health-eng.pdf.
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Health promotion and disease prevention including lifestyle medicine in health and
educational settings
they were not the right person to provide advice, and lack of time and resources 22.
Additional barriers mentioned in the World Book of Family Medicine – European Edition
2015 are perceived as lack of time or competing work load, insufficient reimbursement,
doubts about patients’ acceptance and willingness to receive lifestyle counselling, low selfefficacy, insufficient skills and training, doubts about effectiveness of interventions and
health promotion perceived as outside professional role23,24. Therefore, while most health
professionals seem to acknowledge the need for lifestyle advice, there seems to be a
mismatch between roles, competencies, training and possibilities among health
professionals and action25. Factors causing this mismatch differ from individual and
organizational context, wherefore strategies to address these barriers will also vary 26.
These findings underline the need for developing and strengthening lifestyle medicine in
health professionals’ education27, defined as: ‘the integration of lifestyle practices into the
modern practice of medicine both to lower the risk factors for chronic disease and/or, if
disease already present, serve as an adjunct in its therapy. Lifestyle medicine brings
together sound, scientific evidence in diverse health-related fields to assist the clinician in
the process of not only treating disease, but also promoting good health’ 28. Hence, lifestyle
medicine covers the systematised approach for prevention and management of chronic
disease, addressing e.g. diet, physical activity, behaviour change, stress and coping, and
tobacco/substance abuse29. Health professionals need to learn how to overcome the
identified barriers mentioned above30 and how to effectively and efficiently counsel their
patients towards adopting and sustaining healthier behaviours 31.
Moreover, digitalization is changing the scenery for lifestyle medicine and chronic disease
management. Patient engagement can be enhanced with applications, self-monitoring or
self-management tools. To successfully embed these new forms of care, professionals must
develop new skills32. However, studies have shown that medical students are not formally
trained in major concepts known to influence health33. Philips et al. (2014) states that
including lifestyle medicine in undergraduate medical curricula would have important public
health implications by efficiently promoting the prevention and treatment of NCDs34. A
study by Dacey et al. (2012) states that face-to-face continuing medical education formats
22
23
24
25
26
27
28
29
30
31
32
33
34
Koutoukidis, D.A., Lopes, S., Fisher A., Williams K., Croker H., & Beeken R.J. (2017) Lifestyle advice to cancer
survivors: a qualitative study on the perspective of health professionals. BMJ open 2018;8.
http://www.woncaeurope.org/sites/default/files/033%20%E2%80%93%20Health%20Promotion%20In%20
European%20General%20Practice.pdf.
Geense WW, van de Glind IM, Visscher TL, van Achterberg T. Barriers, facilitators and attitudes influencing
health promotion activities in general practice: an explorative pilot study. BMC-family practice. 2013; 14:20.
Koutoukidis, D.A., Lopes, S., Fisher A., Williams K., Croker H., & Beeken R.J. (2017) Lifestyle advice to cancer
survivors: a qualitative study on the perspective of health professionals. BMJ open 2018;8.
http://www.woncaeurope.org/sites/default/files/033%20%E2%80%93%20Health%20Promotion%20In%20
European%20General%20Practice.pdf.
Polak, R. et al. (2015) Lifestyle Medicine Education https://www.ncbi.nlm.nih.gov/ pmc/articles/
PMC4561845/
Rippe, J.M. (2019). Lifestyle Medicine. Third Edition. CRC Press.
Kushner, R.F. and Webb Sorensen, K. (2013) Lifestyle medicine: the future of chronic disease management.
Obesity and nutrition. 2013;20.
Koutoukidis, D.A., Lopes, S., Fisher A., Williams K., Croker H., & Beeken R.J. (2017) Lifestyle advice to cancer
survivors: a qualitative study on the perspective of health professionals. BMJ open 2018;8.
Dacey, M., Arnstein, F., Kennedy, M.A., Wolfe, J., & Philips, E.M. (2012) The impact of lifestyle medicine
continuing education on provider knowledge, attitudes, and counselling behaviours. Medical teacher.
E.g. Richard, A. A., & Shea, K. (2011). Delineation of Self-Care and Associated Concepts. Journal of Nursing
Scholarship, 43(3), no-no. http://doi.org/10.1111/j.1547-5069.2011.01404.x.
https://cdn.ymaws.com/www.acpm.org/resource/resmgr/lifestylemedicine-files/ajpm-lmcommentary.pdf.
Philips, E., Pojednic, R., Polak, R., Bush, J & Trilk, J. (2014) including lifestyle medicine in undergraduate
medical curricula. Medical education online.
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Health promotion and disease prevention including lifestyle medicine in health and
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have a positive impact on physician behaviour toward health promotion and disease
prevention by increasing their knowledge, confidence and practices that help patients to
adopt healthy behaviours35. Similar results can be expected among other health
professionals as well.
The World Book of Family Medicine – European Edition 2015 states that the shared aim to
integrate health promotion, disease prevention and lifestyle medicine has not been fully
achieved. Future activities as to how lifestyle interventions can be better integrated need
collaborative approaches36. As a starting point for more collaborative action, this study
seeks to provide a mapping of the current situation on health professionals training in health
promotion in the EU.
1.1.
Research questions
To that end, this study seeks to answers to the following research questions:
35
36
1.
How are health professionals in the EU being trained in health promotion,
prevention and lifestyle medicine in undergraduate, post-graduate and continuous
professional education?
2.
What are good practices on knowledge training, capacity and competency building
and advocacy of health professionals on health promotion and disease prevention
including the potential of lifestyle medicine?
Dacey, M., Arnstein, F., Kennedy, M.A., Wolfe, J., & Philips, E.M. (2012) the impact of lifestyle medicine
continuing education on provider knowledge, attitudes, and counselling behaviours. Medical teacher.
http://www.woncaeurope.org/sites/default/files/033%20%E2%80%93%20Health%20Promotion%20In%20
European%20General%20Practice.pdf.
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Health promotion and disease prevention including lifestyle medicine in health and
educational settings
2. THEORETICAL BACKGROUND
2.1.
Societal needs for health promotion and disease prevention
Classically public health targets at activity levels can be described in operational models
like Frieden´s pyramid model 37. It is operationalized into the fundamental composition,
organization, and operation of society from the underpinnings of the determinants of
health, like socioeconomic status6. We use this model as a substructure in looking into
health professionals’ education as they contribute to public health in these levels (Figure
2.1). Society needs to evaluate cost-effectiveness of public health efforts and find a balance
between the levels of actions at each level. We use this framework to enable us to present
the needs of societies in general for different health professionals and their roles and
competencies in public health.
Figure 2.1 Frieden Pyramid of health impact of health professional activities at the different
levels of society (T. Frieden, 2010 CDC)
Healthcare services can contribute in mitigating the burden of disease by socioeconomic
disadvantages. Health professionals have a key role in developing health services, so their
competency to take account of differences in abilities of people to benefit from health
services is vital. But more is needed. Traditionally health professionals have been managing
the individual risk factors and provision of services. That is not enough. For example, in
cardiovascular diseases the “perfect treatment approach” fails to prevent almost half of the
disease burden37. In cancer diseases, individual health behaviours like smoking contribute
in more direct manner. Therefore we need to develop educational systems that support
health professionals to take part in new public health approaches by planning interventions
that change the environmental context to make healthy options the default choice,
37
Frieden TR. A framework for public health action: The health impact pyramid. American Journal of Public
Health. 2010.
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Health promotion and disease prevention including lifestyle medicine in health and
educational settings
regardless of education, income, service provision or other societal factors37. These are
equally needed in out-of-health contexts like climate change, where socio-economic
inequalities and (health) behavioural choices are among major drivers of climate changes. 38
Policies can influence environments to support healthier choices and we need health
professionals in policy development and execution. Still, health behaviour changes happen
at the individual level. We need more efficient skills in personalized health coaching of
individuals to increase the cost-effectiveness of treatment of NCDs39. An ageing population
and increasing rates of chronic disease, as well as advances in medical science and health
information technology to make care safer and more efficient, require a rethinking of how
care is delivered. Digitalization of services will challenge healthcare professionals and
collaborative care models have become more common 40. Instead of requiring compliance
from patients, patient-centred approaches are required from professionals. This means that
clinical interventions need to be complemented by counselling and education to achieve
long-lasting protective measures. Health coaching is aiming to empower patients in comanagement of their disease41 and emphasize and support patients’ autonomy instead of
merely compliance. It is based on shared decision-making and collaborative goal setting
facilitated by motivational interviewing42. Health coaching is already happening in digital
environments. This paradigm shift requires new skills and attitudes from health
professionals too.
New approaches to public health on societal level, the paradigm shift to health coaching on
patient level and new forms of healthcare delivery pose a big challenge to the educational
system of health professionals. It needs to prepare new professionals and train health
professionals already working in the healthcare system to master a wider scope of
knowledge and develop new skills and attitudes to implement these new approaches in a
safe, effective and efficient way.
2.2.
Health profession competencies
Healthcare service is a complex and interconnected network of professionals. There are
common professional competencies needed in health care and health promotion
(communication, collaboration), but they are applied to meet the learning aims of each
profession or level of education. If we want to increase the implementation of lifestyle
counselling or systemwide changes, we need to evaluate knowledge, skills and attitudes
required for the changes and to define the competencies needed to support this change.
Professional competencies sum the elements of abilities (knowledge, skills, attitudes and
behaviours) that enable a professional to accomplish the activities described in a task
statement that outlines what the professional is expected to do43.
38
39
40
41
42
43
Watts, Nick, Amann, Markus, Arnell, Nigel et al. (66 more authors) (2019) Report of The Lancet Countdown
on Health and Climate Change. The Lancet. ISSN 0140-6736 https://doi.org/10.1016/S01406736(19)32596-6).
Hale R, Giese J. Cost-Effectiveness of Health Coaching. Prof Case Manag. 2017.
Falconer E, Kho D, Docherty JP. Use of technology for care coordination initiatives for patients with mental
health issues: A systematic literature review. Neuropsychiatric Disease and Treatment. 2018.
Hayes E, McCahon C, Panahi MR, Hamre T, Pohlman K. Alliance not compliance: Coaching strategies to
improve type 2 diabetes outcomes. J Am Acad Nurse Pract. 2008.
Olsen JM. Health Coaching: A Concept Analysis. Nurs Forum. 2014.
Kraiger et.al. 1993 Application of cognitive, skill-based and affective theories of learning outcomes to new
methods of training evaluation.
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Health promotion and disease prevention including lifestyle medicine in health and
educational settings
Learning Outcome Typology by Kraiger is a widely used descriptive model for setting targets
and learning outcomes in education43. It comprises cognitive (knowledge), psychomotor
(skill-based), affective and behavioural (attitudes) components. This classification scheme
for learning outcomes is based on Bloom’s work (1956) of three learning domains, including
cognitive domain, the affective domain and psychomotor44 45.Knowledge can be factual and
declarative knowledge, information and concepts, or processes and organizations, or
metacognitive strategies like allocation and regulation of professional performance. Skills
include simple routine development and procedures needed at work and more complex
skills needed for the ability to monitor the performance along other tasks. Attitudes are
linked with professionals’ perceptions on learning, self-efficacy at work, perception about
ability to perform and ability to goal setting. It has domains on professionalism. Knowledge
can be obtained in reading or e-Learning modules, skills require active teaching methods
and attitudes develop over time. Behaviours then are complex situations where knowledge,
skills and attitudes are utilised in professional manners. In education planning, outcomes
are defined by these elements.
Competency frameworks are an effective method for achieving outcome-based education46.
They provide a tool for capturing the elements and abilities (knowledge, skills, attitudes
and behaviours) needed in effective and safe patient work 47.They can serve in evaluating
the components of different specialities or societal needs like in this report public health
needs. Competencies define an acceptable and feasible description of professional
behaviours used in relation to health promotion. Competency building is at the basis in
developing similar programmes in the US 48,49. Meaningful assessment of competencies
developed is critical for the implementation of effective competency-based medical
education (CBME)50.
The International Union for Health Promotion and Education (IUHPE) published an
extensive list of core competencies and professional standards for health promotion in
201651. It defines ´Health Promotion action’ in the context of these competencies and
standards to describe programmes, policies and other organised Health Promotion
interventions that are empowering, participatory, holistic, inter-sectoral, equitable,
sustainable and multi-strategy in nature and aim to improve health and reduce health
inequities51.
44
45
46
47
48
49
50
51
Bloom, B.S. (1956). Taxonomy of educational objectives: The classification of educational goals. New York, NY:
Longmans, Green.
Cruz-Cunha M.M. (2012) Handbook of Research on Serious Games as Educational, Business and Research Tools
Frank JR, Danoff D. The CanMEDS initiative: Implementing an outcomes-based framework of physician
competencies. Med Teach. 2007;29(7):642–7.
Cooke M, Irby DM, Sullivan W, Ludmerer KM. Medical education: American medical education 100 years after
the flexner report. N Engl J Med [Internet]. 2006;355(13):1339-1344+1306. Available from: http://www.
scopus.com/inward/record.url?eid=2-s2.0-33749062559&partnerID=40&md5=d949feb 758c984c732a419
cada174c85.
Alaranta A, Alaranta H, Patja K, Palmu P, Prättälä R, Martelin T, et al.Snuff use and smoking in Finnish Olympic
athletes. Int J Sports Med. 2006;27(7).
Van Horn L, Lenders CM, Pratt CA, Beech B, Carney PA, Dietz W, et al. Advancing Nutrition Education, Training,
and Research for Medical Students, Residents, Fellows, Attending Physicians, and Other Clinicians: Building
Competencies and Interdisciplinary Coordination. Adv Nutr. 2019.
Lockyer J, Carraccio C, Chan MK, Hart D, Smee S, Touchie C, et al. Core principles of assessment in
competency-based medical education. Med Teach. 2017;39(6):609–16.
IUHPE (2016) Core competencies and professional standards for health promotion full version
http://www.ukphr.org/wp-content/uploads/2017/02/Core_Competencies_Standards_linkE.pdf ).
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Health promotion and disease prevention including lifestyle medicine in health and
educational settings
We present CanMEDS as an example of a framework that includes content-specific
competencies (Table 2.1). CanMEDS was developed for medical experts, but most
competencies are applicable to all health professionals.
Table 2.1 CanMEDS in short form52 original version53
Competency
Medical Expert
Short description
Apply clinical skills and knowledge of the biomedical sciences to fulfil your scope
of practice
Collaborate with patients and families for patient-centred care and management
Contribute to health care quality and patient safety
Communicator
Build rapport and empathy in all interactions with patients, and include families
(with the patient’s consent)
Understand the patient’s perspectives, expectations, and socio-economic issues
Use active listening, patient-centred interviewing skills, and culturally safe
communication
Share information in plain language to promote patients’ understanding
Clearly document and share information with patients and others on the care
team
Collaborator
Collaborate by sharing knowledge and perspectives, sharing responsibilities,
learning together
Collaborate in care, education, advocacy, administration, and scholarship
Leader
Take responsibility for the ongoing operation, evolution, and continuous
improvement of the healthcare system
Expand beyond a clinical or technical role to take on administrative, teaching,
and scholarly roles and responsibilities
Exercise efficient use of resources to achieve cost-effective care
Contribute to improvements in personal practice, team, organization, and
system
Health
Advocate
Understand and address the determinants of health that affect patients and
support patients to navigate through the health care system
Collaborate with communities and populations to influence change in the health
care system
Contribute to health promotion and disease prevention Understand determinants
and needs, speak on behalf of others, increase awareness
Scholar
Plan for and engage in life-long learning
Teach others
Evaluate and apply evidence to day-to-day practice
Contribute to research, including creation, dissemination, and translation into
practice
Professional
Commit to patients, society, profession and “self”:
Patients – maintain clinical competency and adhere to ethical standard
Society – demonstrate social accountability by responding to societal needs and
expectations
Profession – peer assessment, mentorship, supporting others, setting standards
Self – participate in self-assessment and reflection, build self-awareness, and
manage own well-being
52
53
Michener Institute. No Title CanMEDS framework in short [Internet]. Available from: https://michener.ca/wpcontent/uploads/2018/05/CanMEDS-Framework-Summary.pdf.
Frank JR, Snell L, Sherbino J E. CanMEDs 2015 Physician Competency Framework [Internet]. CanMEDS 2015
Physician Competency Framework. Ottawa: Royal College of Physicians and Surgeons of Canada. 2015. p. 1–
30. Available from: http://www.royalcollege.ca/portal/page/portal/rc/canmeds/resources/publications.
18
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
2.3.
Educational systems for health professions in Europe
According to the EU Treaty, European citizens have a virtue of rights of free movement as
workers, freedom of establishment and freedom of service providers 54. Directives on the
requirements of professional qualifications in EU, their recognition and Regulation55.
facilitate the mobility of health personnel. Each member state will apply this directive in
the national legislation on health professional qualifications. There is a system of automatic
recognition based on harmonised minimum training requirements. This system depends on
the timely notification of new or changed evidence of formal qualifications by MS and their
publication by the Commission. Otherwise, holders of such qualifications have no
guarantees that they can benefit from automatic recognition.
The undergraduate education in Europe is coordinated through the Bologna Process, which
is an intergovernmental cooperation of 48 European countries in the field of higher
education. It guides the collective effort of public authorities, universities, teachers, and
students, together with stakeholder associations, employers, quality assurance agencies,
international organizations, and institutions, including the EC, to bring more coherence to
higher education systems across Europe56. Under the Bologna Process, all 48 participating
European countries agreed to ensure mutual recognition of qualifications and learning
periods abroad completed at other universities. Nonetheless, it should be noted that across
Europe healthcare systems and educations may still significantly differ.
While professional activity is regulated by national law in individual member states57,
faculties and other academic institutions have collaborated in the establishment of a
framework of competencies based on the scientific advances and new methodologies in
education. In fact, EU Directives of the European Parliament and Council on the recognition
of professional qualifications have consolidated a system of mutual recognition between
MS58. Examples include the PHARMINE for pharmacists and MEDINE for medical doctors59.
This collaboration is in line with the Bologna Process.
2.4.
Relevant educational settings for health promotion
Inclusion of health promotion and lifestyle medicine in undergraduate medical curricula is
expected to have important public health implications. However, in current medical
education this subject is minimal to nonexistent60. This is a global problem. In 2016, the
American associations around NCDs launched a joint programme called ‘The Lifestyle
54
55
56
57
58
59
60
Treaty on the Functioning of the European Union (TFEU), Articles 45, 49-62
European Parliament C of the EU. Directive 2005/36/EC on the recognition of professional qualifications and
Regulation [Internet]. 2013. Available from: https://eur-lex.europa.eu/legalcontent/EN/ALL/?uri=celex%3A32013L0055.
The Bologna process and the European Higher Education Area https://ec.europa.eu/ education/ policies
/higher-education/bologna-process-and-european-higher-education-area_en.
UEMS (2017) Charter on training of medical specialists in the EU https://www.uems.eu/
data/assets/pdf_file/0019/43561/ETR-Psychiatry-201703.pdf
Sanchez-Pozo, A. (2016) A comparison of competences for Healthcare professions in Europe
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5419388/pdf/pharmacy-05-00008.pdf
Sanchez-Pozo, A. (2016) A comparison of competences for Healthcare professions in Europe
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5419388/pdf/pharmacy-05-00008.pdf
Trilk J, Nelson L, Briggs A, Muscato D. Including Lifestyle Medicine in Medical Education: Rationale for
American College of Preventive Medicine/American Medical Association Resolution 959. Am J Prev Med. 2019.
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Health promotion and disease prevention including lifestyle medicine in health and
educational settings
Medicine Education Collaborative” for improvement of health promotion education among
health professionals and in medical schools61. This initiative will a) work for high-quality
curricular material on an easily navigable website, b) provide support for medical schools
to advocate for and implement lifestyle medicine curricula into their own institutions, c)
aim to increase awareness and legislative initiatives that encourage adoption of lifestyle
medicine into medical school education, d) develop and conduct assessment in the
following areas: Student Health, Student Knowledge, and Programme Effectiveness, and
e) train and support medical students as effective champions of lifestyle medicine whose
engagement with the curriculum lead to increased adoption within medical schools and
enhanced collaboration nationallyError! Bookmark not defined.. This need has been acknowledged
in Europe as well62.
Besides education in medical schools, continuous professional development (CPD) is an
essential component in health education to ensure that professionals graduated in past
decades, keep their competencies up to date and acquire new competencies needed for
health promotion, disease prevention and lifestyle medicine. It is important to encourage
further strengthening of CPD for those professions that benefit from automatic recognition
of their professional qualifications. Member states should, in particular, encourage CPD for
physicians, medical specialists, general practitioners, nurses responsible for general are,
dental practitioners, specialized dental practitioners, veterinary surgeons, midwives,
pharmacists and architects.63 Given the rapid developments in societal needs and
approaches towards health promotion and disease prevention and spectacular increase in
technological support facilities, lifelong learning is imperative for health professionals and
should be oriented towards the competencies required to best serve their population and
society.
Figure 2.2 Lifelong learning is an iterative process where learners build knowledge, skills,
attitudes and behaviours on top of their current professional competency
61
62
63
Trilk J, Nelson L, Briggs A, Muscato D. Including Lifestyle Medicine in Medical Education: Rationale for
American College of Preventive Medicine/American Medical Association Resolution 959. Am J Prev Med. 2019
European Lifestyle Medicine organisation https://www.eulm.org/
Lim SS, Vos T, Flaxman AD, Danaei G, Shibuya K, Adair-Rohani H, et al. A comparative risk assessment of
burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990-2010:
A systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012.
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Health promotion and disease prevention including lifestyle medicine in health and
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2.5.
Theoretical framework for this study
In this study, we touch upon the existing levels of health promotion, disease prevention
and lifestyle medicine in health and educational settings in the EU and make a preliminary
assessment of its relevance.
As right now, health professional competencies seem more practical, we approached the
mapping of competencies in health education through professions rather than with an
overall theoretical framework. Thus, we aim to create a general picture for different health
professions at different levels of education.
For the assessment of relevance of the existing levels of health promotion in education, we
aligned the competency framework of Kraiger with Frieden’s public health framework. We
used three components64 of Kraiger’s Learning Typology:
•
•
•
Knowledge: cognitive and mental abilities;
Skills: psychomotor, manual and physical abilities to perform tasks;
Attitude (or self): perceptions, growth in feelings or emotional areas
We used the integrated framework as an analytical tool to classify content areas covered
and their weight in educational programmes, learning objectives, learning typology and
educational methodologies applied. Thus, health promotion education in its present form is
pictured against health needs for the near future.
This study is an important first step, as we know little about present practices. However,
more detailed research will obviously be needed.
64
Given the limitations of the study, behaviour – the fourth component – is not included. Behaviour refers to
practices to utilise knowledge, skills and attitude in work environment.
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Health promotion and disease prevention including lifestyle medicine in health and
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3. METHODOLOGY
3.1.
Mapping of health educational programmes in the EU
The first aim was to provide a general overview on how health professionals are trained in
health promotion and disease prevention and lifestyle medicine in the EU. To that end, we
conducted an online survey to map the educational programmes of health professionals in
the EU. In addition to the proposed methodology, we also conducted desk research to
create an overview of competency profiles of health professionals in the EU.
3.1.1.
Online survey
This study looks at undergraduate education, postgraduate education and CPD courses in
all healthcare professions across the EU. Within the EU, different organisations are
responsible for the education of healthcare professionals:
•
•
•
The undergraduate education programmes are organised by universities in each
country;
The post-graduate education programmes are organised differently in each
country. This includes a set of European organisations that run the guidelines
and portfolio´s for each profession or specialty within this profession (like in
medicine);
CPD programmes are even more diverse between countries and can be accredited
both by European organisations and universities.
Due to the wide scope of the study and the different levels of healthcare educational
programmes, no country correspondents could be found with a full overview of educational
programmes addressing health promotion and disease prevention in their country.
Therefore, we chose for a snowball methodology to obtain information on all levels of health
professional education. The snowball methodology consists of two steps. First, we identified
potential organisations in the EU to take part in the survey. Second, we asked those
organisations to recruit other organisations or stakeholders in their national and/or
international network of colleagues and spread the survey among those. This method
required more effort and time in the beginning, but once the ‘ball’ was rolling, it provided
us with a growing dataset including the perspectives from healthcare educators, healthcare
professional associations and healthcare students and residents. The snowball method
implies a risk of selection bias, as educational institutions that have implemented health
promotion within their programmes, i.e., the front-runners, may have been more inclined
to respond than those who have not.
In addition, this recruitment process served as a communication and dissemination vehicle
and increased the engagement to the mapping. Many organisations expressed their interest
to join the workshop as well as willingness to disseminate the results to their members and
collaborators. Because of the growing interest, we decided to extend the deadline after the
workshop organised on 13 February, so attendees could spread the survey among their
national and/or international networks.
Our original workplan included an Excel worksheet to be sent to the national health
coordinators in each EU country, but as we chose a different strategy, it was necessary to
develop a more user-friendly and flexible method. Therefore, an online survey was
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Health promotion and disease prevention including lifestyle medicine in health and
educational settings
developed. This enabled refinement of questions to each level of education with core sets
of questions. Survey links proved to be easy to use and shared within educational facilities
or associations, which led to higher response.
In this section, we discuss in more detail how the survey was developed and how relevant
international organisations were recruited.
Development of an online survey
First, we developed a mapping tool (stand-alone Excel document) to map the current
situation of professionals trained in health promotion. This mapping tool was validated by
both Chafea and DG SANTE and by the external experts in the core research team. After a
pilot phase, an online survey was developed for all healthcare professions, based on the
content of the mapping tool. This was a necessary step to boost response, as the online
survey proved to be more user-friendly and easier to share among educational facilities or
associations than the mapping tool in Excel.
Among other topics, the survey contained questions on the:
•
•
•
•
•
•
•
•
Training programme for which the respondent is filling in the survey (which
(educational) institute and health profession portfolio etc.);
Type of training programme (undergraduate education, postgraduate education or
continues professional’s development;
Type of health professional targeted (e.g. GP’s, physiotherapists, etc.);
Implementation in the curriculum;
Description of the health promotion component in the programme (e.g., teaching
methods, monodisciplinary approach or multidisciplinary approach, expected
outcomes in knowledge, skills and attitude);
Targeted funding;
Accreditation;
Partnerships.
The questions in the survey correspond with the information requested in the Tender
Specifications. Note that the survey maps the educational offer; effectiveness of education
is outside the scope of this study. The complete questionnaire used in the survey can be
found in Annex 3.
Recruitment of relevant international organisations, EU and national medical and
non-medical associations, medical faculties, national and international institutes,
networks and organisations
As we used a snowball method, it is not possible to provide the exact number of persons
who received the survey and response rates. Instead, we present each of the steps taken
to approach respondents and final response obtained.
Recruitment of European associations
First, we connected with major networks in the fields of graduate, post-graduate and
continuous professional development for their support, as these organisations have an
overview of the three levels of health professional education. These associations represent
entire professions or part of the professions (like post-graduates) in all European countries.
National professional organisations are members of these umbrella organisations. For
example, the Union of Medical Specialists (UEMS) represents 1,6 million medical specialists.
It has 40 full member associations (Member States of the EU & Member States of the
European Economic Area), associate member associations (Member States of the Council
of Europe) and observer member associations (other countries, e.g. the United States).
23
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
The UEMS represents more than 50 medical disciplines through various bodies
and structures. The most important ones are the 43 Specialist Sections, which represent
independently recognised specialties. All health professionals, health professional students
and post-graduates are organised in a similar manner. These organisations are in a good
position to provide information and disseminate it across EU countries.
Overall, 24 EU associations were approached by email to spread the survey among their
networks (see Table 3.1 for a complete overview). We aimed to cover all professions within
the scope of this study, i.e., physicians, physiotherapists, occupational therapists,
psychologists, nurses, social workers, dentists, pharmacies, dietitians throughout Europe.
Therefore, European associations with focus on educational programmes for these specific
professions were approached.
Table 3.1 Approached European Associations
No
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
European Associations
European Medical Association (EMANET)
The European Union of General Practitioners (UEMO)
European Union of medical specialists (UEMS)
European Medical Students' Association EMSA)
European Forum of Medical associations (EFMA)
European Federation of Nurses Associations (EFN)
European Association of schools of social work
European Network of Physiotherapy in Higher Education
European Region – World Confederation of Physical Therapy (ER-WCPT)
European Network of Occupational Therapy in Higher Education (ENOTHE).
Council of Occupational therapists of European Countries (COTEC), part of the World
Federation of Occupational Therapists (WFOT).
Federation of National Psychologists Associations
European federation of nurse educators (FINE) association
Association for Dental Education in Europe
Council of European Dentists
Association for Medical Education in Europe (AMEE)
Pharmaceutical group of the European Union (PGEU)
European Pharmacists Forum (EPF)
European Association of faculties of pharmacy (EAFP)
European network of medical residents in Public health
The Association of Medical Schools Europe (AMSE)
The European Society of Preventive Medicine (ESPREV)
The European Lifestyle Medicine Organisation (ELMO)
Recruitment of national associations
Second, national health associations for all Member States and all professions were
approached to fill in the survey. This step was crucial to increase the response. National
health associations were selected using the member list of European organisations. Table
3.2 shows the European organisations used to identify national health associations that
were invited to participate in the survey.
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Health promotion and disease prevention including lifestyle medicine in health and
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Table 3.2 Examples of the approached national associations
Profession
European Association
Medical doctors
Standing committee of
European Doctors (CPME)
World confederation for
physical therapy (WCPT)
International federation of
social workers
European Federation of
psychologists’ association
(EFPA)
Council of occupational
therapists for the European
Countries (COTEC)
The European Federation of
the associations of dieticians
(EFAD)
Council of European Dentists
European Federation of Nurses
Association (EFN)
Pharmaceutical group of
European Union (PGEU)
Physiotherapists
Social workers
Psychologists
Occupational therapists
Dietitians
Dentists
Nurses
Pharmacists
Examples of approached
national associations
(1 out of 28)
Czech Medical Chamber
Swedish Association of
Physiotherapists
German professional
association for social work
Croatian psychological
association
Association of Bulgarian
Ergotherapists
French Association of
Nutritionist Dietitians
Irish dental association
Polish Nurse Association
Malta Chamber of Pharmacists
Recruitment of national educational organisations
Last, the list of the selected associations was used to identify relevant national educational
organisations. These national educational organisations (e.g. University of Maastricht,
Faculty of Health, Medicine and Life Sciences, Kaunas University Medical School, Lifestyle
Medicine, University of Helsinki, Faculty of Medicine) were approached individually and
asked to fill in the survey and spread it throughout their network.
Table 3.3 Number of national educational organisations approached
Profession
Medical schools
Schools of physiotherapy
School of social work
School of dietitians
School of Occupational therapists
School of dentists
School of pharmacists
Number of approached national education organisations
298
29
31
40
45
85
56
Response obtained
In total, we received information on 176 educational practices till mid-February. The
workshop organized in Luxembourg 65 gave an additional boost and resulted in 32 more
practices reported in the survey. In total, this mapping exercise is based on information on
208 practices of health promotion in educational settings.
65
Workshop “Promoting lifestyle medicine: competencies and education of health professionals in the EU today”,
13th February 2020, Luxembourg. Organized by Chafea and DG SANTE
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Health promotion and disease prevention including lifestyle medicine in health and
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3.1.2.
Desk research
Desk research was conducted on both scientific and grey literature with the main purpose
to establish an overview of the competency profiles of health professionals in the field of
health promotion and disease prevention. This overview was created to gain insight to what
extent competency profiles related to health promotion and disease prevention are covered
in the educational standards of different health professions in the EU. We have made use
of reports published online and scientific articles on competency profiles or educational
standards set at EU level (e.g. European standards in medical training (UEMS), as the EU
Directives of the European Parliament and Council on the recognition of professional
qualifications have consolidated a system of mutual recognition between Member States 3.
When reports on EU level could not be identified, we selected articles on global standards,
such as for the profession of social work (i.e. global standards for the education and training
of the social work profession).
Based on the identified literature, we have described the competency profiles for each of
the following healthcare professions:
•
•
•
•
•
•
•
•
•
•
(undergraduate) Medicine;
Medical specialists:
- sports medicine specialists;
- public health specialists;
- internists;
- cardiologists;
- psychiatrists;
- general practitioners.
Dentists;
Nurses;
Nurse specialists;
Occupational therapists;
Pharmacists;
Physiotherapists;
Psychologists;
Social workers.
The selection of healthcare professions included in the desk research was made in
consultation with Chafea, DG SANTE and the experts.
The assessment of the competency profiles was based on the three Domains of Learning
KSAs as described in Chapter 2:
•
•
•
Cognitive: mental skills (knowledge);
Psychomotor: manual or physical skills (skills);
Affective: growth in feelings or emotional areas (attitude or self).
This method was chosen, as especially “lack of confidence and knowledge and skills by
health professionals on providing effective counselling” was identified as a barrier for
prescribing and counselling on promoting physical activity in the healthcare sector66. In
Chapter 4 the results are described in detail.
66
http://www.euro.who.int/__data/assets/pdf_file/0008/382337/fs-health-eng.pdf.
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Health promotion and disease prevention including lifestyle medicine in health and
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3.2.
Long list of good practices
From the survey results, we have drawn a long list of good practices. As agreed with Chafea
and DG SANTE these good practices were selected using the following four selection criteria:
•
•
•
•
The programme contains a multidisciplinary approach;
The education is mandatory (including an exam);
The education covers the following topics: digitalisation in health, eHealth and
digital health coaching;
The expected outcome includes change in skills and or behaviour.
Several variables were included in the longlist: country, name of the programme, name of
the institute, whether there is a focus on knowledge, skills, and behaviour, the type of
professionals who are being trained, the theories that are covered by the education (e.g.,
human cognition and behaviour, health behaviour change techniques, communication skills
etc.), education methods used, year since the education is provided, the time spend in the
modules in hours and lastly, in case of one full module, the duration of this module. To
enable comparison between good practices based on different variables, the preliminary
longlist can be found in a separate Excel document. Chapter 5 includes an overview of the
coverage and content of the long list of good practices.
After closing of the online survey, we analysed the longlist of good practices along the
following research questions:
•
•
•
•
What content items of health promotion, disease prevention and lifestyle
counseling do programmes consist of?
What kinds of learning aims do they have?
How do they distribute in Friedens model of levels of health promotion?
Are there differences between professional groups?
First, we analysed the distribution of the learning skills separately by the levels of education
(undergraduate, postgraduate and CPD). We expected that adult learning will be more
directed towards skills (learning by doing), than the undergraduate and postgraduate
programmes. Secondly, we analysed the educational methods and tools used in the good
practices.
Good practices can be submitted to the European Commission’s Best Practice Portal to be
assessed by external evaluators against criteria adopted by the Steering Group on Health
Promotion, Disease Prevention and Management of NCDs. Practices rated as "best" against
these criteria will be published on the European Commission’s Best Practice Portal 67.
67
https://webgate.ec.europa.eu/dyna/bp-portal/.
27
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
28
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
4. MAPPING OF THE CURRENT SITUATION IN HEALTH PROMOTION
TRAINING IN THE EU
4.1.
4.1.1.
Overview of educational programmes in the EU
Summary of the main findings in the survey
A high percentage (93%) of respondents (n=197) indicated that health promotion and
disease prevention are implemented in their educational programmes or modules. For
undergraduate education, postgraduate education and CPD, these percentages were 95%,
93% and 83%, respectively. Other results include:
•
•
•
•
•
•
•
4.1.2.
More than half of the respondents indicated that they filled in the questionnaire
based on undergraduate educational settings. Throughout Europe, these numbers
were relatively similar;
Physiotherapists seem to be the professional group most actively involved in
health promotion training activities. The vast majority applies multidisciplinary
approaches and thus, bring other professions on board too;
Overall, traditional teaching methods (lectures and assignments) are most often
used within the undergraduate and postgraduate programmes. In CPD, on the
other hand, e-Learning is most frequently used (67%);
Educational programmes on health promotion target knowledge, skills and
attitudes of students;
Health behaviour, human cognition and behaviour and population health are the
theories covered in most education programmes. On a more detailed level,
communications skills, ethics and methods of evidence-based medicine are
covered most within the education. Digital health coaching, digitalisation, health
economics receive less attention;
Targeted funding was most often obtained for CPD (33%) compared to
undergraduate and postgraduate education (15% and 6%) when the topic is
covered in most modules. Funding was more often obtained in Northern and
Southern Europe;
The ratio health promotion covered in all modules of the educational programme
vs. one full module primarily dedicated to health promotion was 63% (all
modules)/37% (full module). With regard to full modules, high percentages
indicated that these are mandatory and that there is an exam at the end of the
module (81%, 70% respectively).
Detailed results of the survey
Respondents
In the following section we provide a detailed description of the survey results. The survey
targeted undergraduate education, postgraduate education and CPD programmes in all
Member States. Overall 208 respondents filled in the questionnaire about their educational
practice. Note, the results presented in the remainder of this report are exclusively based
on the answers respondents provided in the survey.
29
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
Table 4.1 and Figure 4.1 provide an overview of the number of practices reported per
European countries. A detailed overview of the educational programmes collected
throughout Europe can be found in Annex 1.
Figure 4.1 Practices collected in the survey by European countries (n=208)
Table 4.1 Number of respondents per European Member State, 2019-2020 (n=208)
Abbreviations
AT
BE
BG
CY
CZ
DE
DK
EE
ES
FI
FR
GB
GR
HR
HU
IE
IT
LT
LU
LV
MT
EU Member State
Austria
Belgium
Bulgaria
Cyprus
Czech Republic
Germany
Denmark
Estonia
Spain
Finland
France
United Kingdom*
Greece
Croatia
Hungary
Ireland
Italy
Lithuania
Luxembourg
Latvia
Malta
Number of respondents
12
23
4
1
7
1
8
2
22
6
15
6
10
0
3
8
10
1
0
5
6
30
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
Abbreviations
NL
PO
PT
RO
SE
SI
SK
Additional countries
TOT
EU Member State
Netherlands
Poland
Portugal
Romania
Sweden
Slovenia
Slovakia
Number of respondents
2
0
14
3
4
14
2
19
208
*the UK is included as a Member State in this study as the results were obtained before Brexit.
For mapping purposes, we made a breakdown of results by region, i.e., Northern Europe,
Eastern, Southern and Western Europe (based on United Nations Regional Groups).
Furthermore, we compare results of individual countries for which at least 10 practices have
been reported in the survey. These are Austria, Belgium, France, Greece, Italy, Portugal,
Slovenia, and Spain.
Table 4.2 European countries per region
Region
West
North
East
South
European countries
Austria, Belgium, France, Ireland, Germany,
Luxembourg, Netherlands, United Kingdom,
Switzerland
Denmark, Sweden, Estonia, Finland, Lithuania,
Latvia, Norway
Bulgaria, Czech Republic, Hungary, Romania,
Slovakia, Poland, Georgia, Kazakhstan
Italy, Spain, Cyprus, Portugal, Greece, Malta,
Slovenia, Croatia, Bosnia, Kosovo, Serbia
Type of education
We asked the respondents to indicate the type of educational setting. As shown in Figure
4.2 more than half of the practices (60%) refer to undergraduate educational settings and
approximately one third to postgraduate educational settings. Only twelve percent of the
reported educational settings is related to CPD.
31
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
Figure 4.2 Practices by educational level (n=199; in percentages)
12
29
60
Undergraduate education
Postgraduate education
Continuous professional development
Figure 4.3 and Figure 4.4 show the distribution in type of education per region and on
country level, respectively. For Western, Southern and Northern Europe, distribution is in
line with the overall results. In Eastern Europe, practices reported are more evenly
distributed over undergraduate and postgraduate education. Also, the share of CPD
practices is high in comparison with other regions and overall results.
Figure 4.3 Practices by type of education per region (n=204; in percentages)
Western Europe
60
Southern Europe
30
62
Eastern Europe
27
42
Northern Europe
Undergraduate education
20%
12
37
64
0%
10
21
29
40%
Postgraduate education
60%
80%
7
100%
Continuous professional development
32
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
Figure 4.4 Practices by type of education per country (in percentages)
Spain
71
Slovenia
71
Portugal
19
14
62
Italy
15
60
Greece
50
10
30
27
20
60
Belgium
13
70
Austria
22
83
0%
14
23
30
France
10
20%
8
40%
Undergraduate education
9
60%
Postgraduate education
80%
8
100%
Continuous professional development
Type of health professions
An overview of the type of health professional trained in the educational practices, is
provided in figure 4.5. Remarkably, over one third (35%) of the educational practices
reported are oriented to physical therapists. Note that multiple answers could be provided.
Figure 4.5 Type of health professional being trained (n=208; in percentages)
50
40
35
30
29
20
15
10
11
0
6
14
17
7
8
5
*Medical specialists refer to doctors with an extra expertise in one type of medicine, e.g., including sports
medicine, public health, internal medicine, cardiology, psychiatry and the general practitioner68. General
practitioners refers to doctors working within General Practice or Family Medicine (GP/FM)69. Medical doctors refers
to doctors without any specialization.
68
69
https://www.uems.eu/areas-of-expertise/postgraduate-training/european-standards-in-medical-training.
https://euract.woncaeurope.org/sites/euractdev/files/documents/publications/official-documents/europeantraining-requirements-gp-fm-specialist-training-euract-2018.pdf.
33
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
Health professionals involved as educators in health promotion and disease prevention are
shown in Figure 4.6. Physical therapists are most often active as teachers of health
promotion (36%), which coincides with the high share of practices oriented to this
profession. Some professions, like medical specialists, nurses and psychologists, are
represented more often as teacher then as trainee of the educational practices. This implies
they are involved in programmes oriented towards other health professions and is in line
with a multidisciplinary approach that is applied by the vast majority of practices ( 81%;
n=148).
Figure 4.6 Health professionals teaching contents of health promotion (n=90; in
percentages)
50
40
37
36
30
27
20
26
24
10
23
14
8
7
6
0
Methods of education
Survey results show that traditional methods, i.e. lectures and assignments, are most often
used (Figure 4.7). Assignment refers to home school projects such as writing papers. In
CPD, eLearning methods are more often used (67%) compared to undergraduate (45%)
and post graduate education (39%). The use of field training is relatively similar for the
different levels of education.
Figure 4.7 Teaching methods applied (n=145; in percentages)
eLearning modules
46
Field training in real environments
74
Assignments
81
Lectures
97
0
10
20
30
40
50
60
70
80
90
100
34
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
Knowledge, skills, and behaviour
As for the outcome of the education, respectively 99%, 94%, and 89% of all practices
indicate knowledge, skills, and behaviour as expected outcomes (Figure 4.8). There are no
significant differences between types of education
Figure 4.8 Knowledge, skills, and behaviour (n=142; in percentages)
100
99
94
89
80
60
40
20
0
1
No
Unknown
4
2
No
Unknown
6
4
No
Unknown
0
Yes
Knowledge
Yes
Skills
Yes
Behavior
Accreditation
Overall, 39% of the educational practices is accredited on European or international level,
53% is accredited at a national level, and only 5% lacks accreditation (n=179). Comparing
the different levels of education, the rate of accreditation at a European or nation level
varies. At a European level, these are 46%, 33%, 22%, at the national level 47%, 58%,
67% for undergraduate education, postgraduate education, and CPD respectively.
Throughout Europe, the level of accreditation of education is high: in Northern, Eastern,
Southern and Western countries the share of practices without accreditation is 11%, 0%,
5%, and 3% respectively (n=197). Eastern European countries have regulated their
accreditation more often on a national level, compared to the other countries.
Theories covered
Figure 4.9 shows that health behaviour, human cognition and behaviour, and population
health are covered in most educational practices to a high or at least limited extent.
35
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
Figure 4.9 Theories covered by the education (n=137; (in percentages)
Health behaviour
65
Human cognition and behavior
32
54
Population health
42
66
0%
20%
Yes, very much
13
31
40%
Yes, but limited
60%
No
11
80%
2
100%
Unknown
Figure 4.10 provides a more detailed overview of contents covered in the educational
programmes and shows that communications skills, ethics and methods of evidence-based
medicine are mostly covered within the education. Contents least covered are digital health
coaching, digitalisation, health economics.
Funding and partnerships
Figure 4.11 provides an overview of the practices that a) obtained targeted funding to
incorporate health promotion and disease prevention in the curriculum, b) for which a
partnership is set up for execution of teaching activities on health promotion or c) built on
existing partnerships to incorporate health promotion in the curriculum of the whole
educational programme. This overview only includes educational practices where health
promotion and disease is incorporated in most modules.
Funding differed between level of education: 15%, 6%, and 33% of the undergraduate
education, postgraduate education and CPD received targeted funding to incorporate health
promotion in the curriculum. Hence, funding seems to play a more important role for CPD
than for undergraduate and postgraduate education.
36
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
Figure 4.10 Theories that are included within education on health promotion (n=137; in
percentages)
Digital health coaching
9
43
Communication skills
42
6
64
Health behavior change techniques
31
49
Health literacy
42
41
Disease prevention in teams
48
34
Digitalisation in health promotion
50
20
5
31
4 1
55
Methods of evidence-based medicine
41
69
24
48
20%
Yes, very much
5
41
51
40
0%
5
42
16
Epidemiology and bio-statistics (research capacity)
9
47
54
Health policies and regulation
6
25
48
Ethics
9
25
50
Health care systems
Health economics
5 4
44
37
Health inequalities
23
Yes, but limited
44
40%
No
60%
6 1
7 1
80%
100%
Unknown
Figure 4.11 Funding and partnerships when health promotion is covered in most modules
of the educational programme (n=123; in percentages)
Funding to incorporate health promotion in curriculum
15
Partnerships for execution of teaching activities
61
Partnerships in incorporating it in the curriculum of the
whole educational programme
52
0
20
40
60
80
100
Figure 4.12 provides a comparison of funding obtained by European region. Remarkably,
in Western Europe, the share of practices with targeted funding to incorporate health
promotion is much lower than in the other EU regions.
37
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
Figure 4.12 Funding to incorporate health promotion for programmes covering health
promotion in most modules, by region (n=119; in percentages)
Western Europe
3
85
Southern Europe
13
21
Eastern Europe
70
12
Northern Europe
9
82
6
20
80
0%
20%
40%
Yes
No
60%
80%
100%
Unknown
Comparing individual countries, figure 4.13 shows that funding is obtained for the
educational programmes reported in Slovenia, Italy and France, while this is not the case
or unknown in Portugal, Belgium, and Austria.
Figure 4.13 Funding to incorporate health promotion, when health promotion is covered in
most modules of the educational programme, by country (n=71; in percentages)
Spain
30
Slovenia
70
9
73
Portugal 0
18
100
Italy
40
Greece
29
France
71
13
38
50
Belgium
100
Austria
89
0%
20%
40%
Yes
11
60%
No
80%
100%
Unknown
Dedicated modules to health promotion
In a majority of practices (63%), health promotion, disease prevention and lifestyle
medicine are covered in all modules of the educational programme, as opposed to coverage
in one module primarily dedicated to health promotion (37%). Undergraduate and
postgraduate education show a similar pattern, while in CPD programmes, full modules
primarily dedicated to health promotion are relatively restricted, namely 15% (Figure 4.14).
Both options have the potential to be effective, depending on context, implementation and
other factors. The data gathered in this study do not allow any statement on effectiveness
of each option.
38
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
Figure 4.14 Share of practices with one full module primarily dedicated to health promotion
(n=140; in percentages)
100
80
60
40
40
35
20
15
0
Undergraduate education
Postgraduate education
Continuous professional development
Visibility of health promotion in CPD
In CPD, health promotion is often integrated into disease-oriented or risk behaviourbased contents, making it harder to identify the subject in events available. The
Union of European Medical Specialists (UEMS) has an electronic database for
accrediting continuous medical education. This data set contains keywords. Using
health promotion, public health or lifestyle as keywords 37 educational events were
found in the years 2017-19 (Table 4.15). There were 6 events in year 2017, 3 in
year 2018 and 8 in year 2019. Average number of credits (1 ECMEC equals 1 hour,
maximum 6 per day) was 29,6, average length of events 4,5 days. This illustrates
availability of international training on health promotion and public health for
medical professions. In other events, these themes may have been touched upon
as well but are not the main subject. So, there might be a need to make health
promotion more visible in CPD events. Competency-based education could provide
a solution if health promotion, disease prevention and lifestyle medicine are defined
as competencies.
Table 4.15 CPD events with health promotion, public health or lifestyle as keyword, 20172019 (n=37)70
Title
ECMEC
Year
Location
Website
Control of multidrugresistant micro-organisms
in health care settings
Epidemiology and public
health microbiology for
facilitators
Fellowship (EPIET &
EUPHEM) introductory
course
International Society for
Quality in Health Care 34th
International Conference
DOHaD 2017, 10th World
Congress DEVELOPMENTAL
ORIGINS OF HEALTH AND
DISEASE
20
2017
Stockholm,
Sweden
http://www.ecdc.europa.eu
30
2017
Spetses,
Greece
http://www.ecdc.europa.eu
86
2017
Spetses,
Greece
http://www.ecdc.europa.eu
23
2017
http://isqua.org/Events/londo
n-2017
25
2017
London,
United
Kingdom
Rotterdam,
Netherlands
70
http://www.dohad2017.org
Source: UEMS database of accredited events 2017-2019
39
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
Title
ECMEC
Year
Location
Website
10th European Public
Health Conference
Methods and tools for
evidence-based practice
and decision-making in
Public Health with special
emphasis on communicable
disease
ESCMID Workshop on
Migrants Health
Control of multidrugresistant micro-organisms
in health care settings
23
2017
https://ephconference.eu
22
2018
Stockholm,
Sweden
Stockholm,
Sweden
15
2018
17
2018
Muscat,
Oman
Stockholm,
Sweden
ECDC Summer School 2018
23
2018
Stockholm,
Sweden
3rd International
Conference of the European
Network for Smoking and
Tobacco Prevention
European Observatory
Venice Summer School
2018
Let’s talk about nutrition
(NESG)
Epidemiology and public
health microbiology for
facilitators
International Society for
Quality in Health Care 35th
International Conference
Fellowship (EPIET &
EUPHEM) introductory
course
EGEA 2018 – “Nutrition and
health: from science to
practice”
1st EUROPEAN LIFESTYLE
MEDICINE CONGRESS
11th European Public
Health Conference:
Fellowship Multivariable
Analysis
Rapid Assessment and
Survey methods (RAS)
module
ECDC Summer School 2019
15
2018
Madrid,
Spain
https://escmid.pulselinks.co
m/event/14833
https://ecdc.europa.eu/en/ne
ws-events/course-controlmultidrug-resistant-microorganisms-mdros-healthcare-settings
https://ecdc.europa.eu/en/ne
ws-events/ecdc-summerschool-2018
https://enspconference.org/
25
2018
San Servolo,
Italy
www.theobservatorysummers
chool.org
4
2018
28
2018
Madrid,
Spain
Spetses,
Greece
http://espencongress.com/pr
ogramme/lll-courses/
https://ecdc.europa.eu/en/ep
iet-euphem/about/intro
22
2018
https://isqua.org/Events/mal
aysia-2018/
93
2018
Kuala
Lumpur,
Malaysia
Spetses,
Greece
16
2018
Lyon, France
https://www.egeaconference.
com/
13
2018
www.elmocongress.com
24
2018
25
2019
35
2019
Geneva,
Switzerland
Ljubljana,
Slovenia
Madrid,
Spain
Zagreb,
Croatia
28
2019
Stockholm,
Sweden
https://www.ecdc.europa.eu/
en/news-events/ecdcsummer-school-2019
Fellowship Vaccinology
Module
Programme Planning and
Implementation” Training
Program for Resolve to
Prevent Epidemics Initiative
29
2019
Rome, Italy
39
2019
Butaro,
Rwanda
http://www.ecdc.europa.eu/
www.ecdc.europa.eu
www.ephconference.eu
40
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
Title
ECMEC
Year
Location
Website
Skill-mix innovation in
primary and chronic care:
mobilizing the health
workforce
Evolutionary Medicine
Conference 2019: 5th
international meeting of the
International Society for
Evolution Medicine and
Public Health
Fellowship (EPIET &
EUPHEM) introductory
course
28
2019
Venice, Italy
www.theobservatorysummers
chool.org
15
2019
Zurich,
Switzerland
https://isemph.org/2019Meeting
85
2019
Spetses,
Greece
Project Management for
Emergency Preparedness:
Budget and Finance
Management
Autumn School on Medical
Education
Project Management for
Emergency Preparedness:
Practical Leadership Skills
International Society for
Quality in Health Care 36th
International Conference,
Cape Town, 20/10/2019 23/10/2019
Public Health Genomics: an
introduction
20
2019
Butaro,
Rwanda
19
2019
https://www.facebook.com/e
vents/531981117209981/
24
2019
Chernivtsi,
Ukraine
Butaro,
Rwanda
18
2019
Cape Town,
South Africa
https://www.isqua.org/event
s/cp2019.html
11
2019
Stockholm,
Sweden
ENSP Tobacco treatment
specialists’ training
World Health Summit 2019
5
2019
Paris, France
https://ecdc.europa.eu/en/ne
ws-events/public-healthgenomics-introduction
http://ensp.network/
16
2019
Time Series Analysis
28
2019
12th European Public
Health Conference
Outbreak Investigation
Module
16
2019
30
2019
Berlin,
Germany
Bilthoven,
Netherlands
Marseille,
France
Nicosia,
Cyprus
www.worldhealthsummit.org
https://ecdc.europa.eu/en/ep
iet-euphem/about/experience
www.ephconference.eu
https://www.ecdc.europa.eu/
en/epieteuphem/about/experience
Source: UEMS database of accredited events 2017-2019
Looking at the regional level, we found that in most regions, a majority of practices cover
the topic in all (or most) modules of the educational programme (Figure 4.16). In Northern
Europe, this is most pronounced with as much as 76% of the practices reported covering
health promotion in all modules, whereas in Eastern Europe, this applies for 55% of
practices. A similar analysis for individual countries shows that only in Spain, health
promotion is covered in a dedicated module in the majority (62%) of educational practices
reported while in all other countries the topic is mostly covered in all (or most) modules of
the programme. Percentages vary from 56% (Austria) to 86% (Greece. Figure 4.17).
41
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
Figure 4.16 How is health promotion implemented in education, by region (n=148; in
percentages)
100
76
80
63
58
55
60
45
42
37
40
24
20
0
Northern Europe
Eastern Europe
Southern Europe
Western Europe
One full module is primarily dedicated to health promotion
Topic is covered in all (or most) modules of the educational
Figure 4.17 How is health promotion implemented in education, by country (n=120; in
percentages)
100
86
82
78
80
64
61
63
62
56
60
44
39
40
22
18
14
20
38
38
36
0
Austria
Belgium
France
Greece
Italy
Portugal
Slovenia
Spain
One full module is primarily dedicated to health promotion
Topic is covered in all (or most) modules of the educational
55 participants answered specific questions on the full module dedicated to health
promotion, 81% of them indicated that the education is mandatory. As figure 4.18 shows,
in Northern and Eastern Europe, all dedicated module on health promotion form part of
mandatory education. In Western Europe, one out of three modules is optional for students.
42
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
Figure 4.18 Full modules on health promotion that are part of mandatory education, by
region (n=47; in percentages)
100
100
100
80
82
60
67
40
22
20
12
11
6
0
Northern Europe
Eastern Europe
Yes
Southern Europe
No
Western Europe
Unknown
An exam is taken at the end of the module in 70% of the cases. Between regions,
percentages do not differ much (Figure 4.19). Please note that results are based on a
limited number of practices as response for this question was low.
Figure 4.19 Exam at the end of dedicated module, by region (n=47; in percentages)
100
75
80
75
71
67
60
40
25
25
18
20
22
12
11
Southern Europe
Western Europe
0
Northern Europe
Eastern Europe
No
Unknown
Yes
When asked whether the module on health promotion and disease prevention was
accredited separately, 15% indicate that this is the case. 30% report that the module is
provided at multiple locations.
Figure 4.20 provides an overview of respondents who indicate that funding was obtained
to set up the module, as well as the use of partnerships for implementation of teaching
activities on health promotion or in setting up the module. Lastly, it was indicated that
mostly ‘other’ professionals are teaching these modules.
43
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
Figure 4.20 Funding and partnerships for dedicated modules (n=47; in percentages)
Funding to set up module
11
Partnerships for execution of teaching
activities
53
Partnerships in setting up module
43
0
4.2.
20
40
60
80
100
Overview of competency profiles of health professionals in the EU
A detailed description of the competency profiles per healthcare profession, as obtained
from the desk research, can be found in Annex 2 Competency profiles per professions.
These profiles provide a solid basis for health promotion and disease prevention.
Most competency profiles mention health promotion and/or disease prevention. Overall,
the competencies of medical specialists are most comprehensively described, including the
competencies for health promotion. Although there are many similarities between the
different competency profiles, we have identified differences in the coverage of domains of
learning i.e., knowledge, skills and attitudes (see chapter 2.3). Knowledge refers to
cognitive or mental competencies, skills to competencies to perform tasks or activities and
attitudes to competencies related to beliefs or values. An example of an attitude
competency is “exemplify appropriate lifestyle in personal behaviour”. In professions that
are less physically oriented, emphasis is on knowledge and attitude rather than on skills
related to health promotion/disease prevention. This mainly holds for psychiatry and social
workers. For professions in which lifestyle is an essential component, i.e. sports medicine
and public health, emphasis is on skills rather than attitudes.Only for cardiology, nurses,
nurse specialists and pharmacists, competency profiles describe competences in all
domains of learning, i.e.knowledge, skills and attitudes.
Many competency profiles leave room for interpretation and competencies described are
not ranked in order of importance. In addition, profiles do not state whether competencies
should be practised in a pro-active (within every treatment) or reactive way (only when
treating diseases with a clear lifestyle component
44
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
5. LONG LIST OF GOOD PRACTICES
In this chapter we present the coverage and content of the long list of good practices. The
list is also available in an Excel-file that provides the opportunity to easily make selections
by different variables, such as country, type of programme (undergraduate, postgraduate,
CPD), or the characteristics of the education programme.
We also provide an analysis of content areas covered and their weight in educational
programmes, learning objectives, learning typology and educational methodology using
Kraiger’s typology and Frieden’s pyramid as analytical tools.
5.1.
Results
From the survey results, we have drawn a long list of good practices. In agreement with
Chafea and DG SANTE, good practices were selected based on four criteria:
1. The programme contains a multidisciplinary approach;
2. The education is mandatory (including an exam);
3. The education covers the following topics: digitalisation in health, eHealth and digital
health coaching;
4. The expected outcome includes change in skills and/or behaviour.
This resulted in a long list of 70 good practices that meet all criteria. Educational practices
cover all regions of Europe and originate from 20 Member States (Figure 5.1 and Table
5.1).
45
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
Figure 5.1 Number of good practices selected for long list by country , 2019-2020
Table 5.1 Number of good practices selected based on the four selection criteria per
European Member State, 2019-2020
Abbreviations
EU Member State
Number of good
practices
AT
BE
BG
CY
CZ
DE
DK
EE
ES
FI
FR
GR
HR
HU
IE
IT
Austria
Belgium
Bulgaria
Cyprus
Czech Republic
Germany
Denmark
Estonia
Spain
Finland
France
Greece
Croatia
Hungary
Ireland
Italy
6
11
2
1
2
0
5
1
7
2
6
7
0
1
3
2
46
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
Abbreviations
EU Member State
Number of good
practices
LT
LU
LV
MT
NL
PO
PT
RO
SE
SI
SK
TOT
Lithuania
Luxembourg
Latvia
Malta
Netherlands
Poland
Portugal
Romania
Sweden
Slovenia
Slovakia
1
0
1
0
0
0
2
1
2
7
0
70
Of all selected good practices of healthcare educational programmes, 16 practices (23%)
cover health promotion and disease prevention in one full module primarily dedicated to
the subject. In 54 good practices (77%), the educational programmes incorporate the topic
of health promotion and disease prevention in all or most modules (Figure 5.2).
Figure 5.2 How is health promotion covered in selected good practices (n=70; in
percentages)
77%
23%
All modules
One module
When dividing good practices by type of education programme, we see that all types
educational programmes are represented (Figure 5.3). The highest share of good practices
is focused on undergraduate education (60%, n=42). Two practices are focused on both
undergraduate and postgraduate education.
Figure 5.3 Type of education (%) represented by selected good practices (n=70)
11%
3%
Undergraduate education
Post graduate education
26%
60%
Continuous professional
development
47
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
Figure 5.4 presents the absolute number of selected good practices by type of profession
trained. The absolute number sums up till 128, as multiple professions can be trained within
one programme. This shows a good variation of health professionals. Most good practices
focus on nurses (17%; n=22) and medical doctors (13%; n=17).
Figure 5.4 Good practices by profession being trained (n=70; in absolute numbers)
Physical therapists
10
Nurses
22
Psychologists
15
Medical specialists
15
Medical doctors
17
Occupational therapists
11
Dentists
4
Social workers
4
Other
30
In addition to those described above, other variables are included in the separate Excel file
mentioned above. These include the name of the programme and the institute, focus on
knowledge, skills and behaviour, type of professionals being trained, theories covered in
the education (e.g., human cognition and behaviour, health behaviour change techniques,
communication skills, etc.), education methods used, when the education started, time
spent on the modules in study hours (ECDEC) and, in case of one full module, the duration
of this module. This Excel file allows to make cross comparisons between different variables.
5.2.
Analysis of good practices
In this section, good practices are analysed more in detail. Figure 5.5 presents the
distribution of content areas in health promotion and their weight in educational
programmes. Methodological training like evidence-based methods (EBM) varies in
programmes but has a strong position. Lifestyle intervention skills are widely taught,
however new technologies are still on their way in becoming part of health promotion
education. Interestingly, health economics rate less in these practices in spite of its close
link with health promotion, as part of public health policies.
48
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
Figure 5.5 Results for good practices(n=70): “Does the education of the initiative include..”
*Numbers refer to Frieden model in levels of health promotion with exception of methodological contents marked
as tools: (1) counselling and education; (2) clinical interventions; (4) changing the context to make individual’s
default decisions healthy; (5) socioeconomic factors; (6) methods in studying and evaluating health promotion
and public health.
We used Frieden’s pyramid of levels of health promotion (Frieden, 2010) and Kraiger’s
typology of learning (Kraiger et al., 1993) to describe the abilities that professionals are
expected to acquire. Based on their description, learning objectives move in a knowledge
level, skill building or into attitudinal objectives. Figure 5.6 gives a graphical visualization
of the results of our analysis. The dark blue, green and light blue rectangles represent the
49
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
Figure 5.6 Learning objectives categorised into Frieden’s levels and learning typology
(knowledge, skills, attitudes) of good practices (n=70)
different domains of learning: knowledge, skills and attitudes. The size of the rectangles is
proportional to their share in all domains in the educational practice.
Within each domain of learning, contents are categorized. Their vertical order reflects the
order of impact levels of Frieden (from individual patient to society level) and again, size
corresponds to share in the curriculums content.
This analysis provides a general picture of educational practices in health promotion,
disease prevention and lifestyle medicine. The graph shows that practices are
predominantly oriented towards knowledge-based competencies (around 60% of the
curriculum). Roughly one third of the programme has skills-oriented learning objectives,
while competencies regarding attitudes are addressed in around 10 percent of the
programme’s content.
Looking into knowledge-based competencies, the broad spectrum of individual to societal
levels of impact is addressed. On a societal level, social and medical aspects are widely
represented, while the economic angle is scarcely present. Technological developments like
digitalisation are present to a modest extent.
Skill-oriented learning objectives focus in communicative competences like communication
skills, behaviour change techniques and teamwork. Health coaching is covered in a small
number of practices. Interestingly, in methodological contents the aim of skills-oriented
50
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
education is to provide mainly knowledge like in EBM. Few practices include practical skills
for communication and coaching in their objectives.
Competence-building in the domain of attitudes form a minimal part of educational
practices. They are reflected in e.g. health literacy and ethics. However, these are also
taught in a hidden curriculum as well.
Educational methodologies in the survey include lectures, assignments, e-Learning and
real-world field assignments. As these are the selected good practices, it was to be expected
that multiple methods are used in most of these programmes (given selection criterium 3).
In 37 programmes, all methods are in use. E-Learning is used in 41 programmes.
Figure 5.7 Educational methods used in good practices (n=70; in percentages) (%)
51
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
6. CONCLUSIONS
The competency profiles as well as information on a large number of educational practices
in health promotion, disease prevention and lifestyle medicine for health professionals in
the EU, allow us to formulate answers to the research questions that guided this study.
1.
How are health professionals in the EU being trained in health promotion,
prevention and lifestyle medicine in undergraduate, post-graduate and
continuous professional education?
Health promotion, disease prevention and lifestyle medicine are to some extent present in
the competency profiles for most EU health professions included in this study: medical
doctors, medical specialists, physiotherapists, occupational therapists, psychologists,
nurses, social workers, dentists, pharmacies and dietitians. This finding means that
important progress has been made in past decades 71:there is a growing and diverse health
promotion workforce in Europe; public health has made its entrance in the education of
every health professional. The educational practices collected show that this is true for all
regions of the EU. However, there is no overall body that has responsibility for quality
assuring standards of training and professional practice at the European level.
The information on around 200 practices from 25 EU Member States (including UK) shows
that the majority of educational practices take place in undergraduate settings while
training events on health promotion for health professionals active in the field are relatively
scarce: in continuous professional development (CPD), a limited number of practices on
health promotion are reported and indeed, few courses or training events on health
promotion are available in the CPD calendar of the UEMS database of accredited events.
Education on health promotion aims at developing competencies in knowledge, skills and
attitude and most often has a multidisciplinary character. Especially medical doctors, nurses
and psychologists are often involved in educating other disciplines on health promotion.
Health behaviour, human cognition and behaviour as well as population health are part of
educational practices for all professions. A majority also include communication skills,
methods of EBM and ethics.
The most common way to teach health professionals on health promotion, disease
prevention and lifestyle medicine is the integration of the subject in most of all modules of
the curriculum. Dedicated modules on health promotion are developed in undergraduate
and postgraduate education but are scarce in CPD. This may contribute to the invisibility of
the subject in training for professionals active in the field.
Four out of ten educational practices on health promotion are accredited on the European
(or international) level, half of them have national accreditation.
71
Morales Arantxa Santa-María, Barbara Battel-Kirk, Margaret M Barry, Louisa Bosker, Anu Kasmel, Jenny Griffiths
(2009) Perspectives on health promotion competencies and accreditation in Europe. Glob Health Promot.
2009 Jun;16(2):21-31.
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Health promotion and disease prevention including lifestyle medicine in health and
educational settings
2.
What are good practices on knowledge training, capacity and competency building
and advocacy of health professionals on health promotion and disease prevention
including the potential of lifestyle medicine?
Based on in-depth analysis of a selection of 70 good practices, knowledge proves to be the
predominant domain of learning. Theories covered relate to different levels of impact of
Frieden’s pyramid, but emphasis is on the individual patient level with a predominant
position for evidence-based medicine. Health economics receive remarkably little attention.
This may be disadvantageous for advocacy of health promotion, which requires influencing
decision-making on public funding.
Around one third of educational contents are dedicated to competencies in the domain of
skills and mainly target communicative skills. Interestingly, they provide mainly knowledge
rather than practical training. Competencies in the domain of attitude are addressed least.
Ethics and health literacy are theories are the most common examples of attitude-oriented
contents. When looking at the competencies defined by health professionals, advocacy has
a solid role in all of them with defined skills. It was represented in only few domains like
health economics, so it may well be that educating advocacy skills are more common than
found in this study.
Good practices use a mix of educational methods, including lectures, assignments, realworld practices and digital study methods.
In conclusion, this study is a first step in gaining knowledge and insights in the state of
affairs of health professionals’ education in health promotion, disease prevention and
lifestyle medicine in the EU. It is an important step, as we know little about present
practices. However, more detailed research will obviously be needed.
The results of our in-depth analysis of good practices provide qualitative information. We
used the integrated framework as an analytical tool to classify content areas covered and
their weight in educational programmes, learning objectives, learning typology and
educational methodologies applied. Thus, health promotion education in its present form is
pictured against health needs for the near future. The information supplied by the
respondents show the culture of describing health promotion and education objectives.
Therefore, no ‘hard’ conclusions can be drawn. However, some cautious notions are
worthwhile to mention as they flag opportunities for learning and improving by collaborative
action.
First, it is worthwhile to stress the progress made. While 20 years ago, health professionals
were hardly trained in health promotion and lifestyle medicine and at best received some
instruction on specific disease-related unhealthy habits (like smoking for lung diseases), it
is now part of standard education for most health professionals. That is an important
development and essential for collaboration across professions.
However, more can be done. Health promotion education should respond to society’s needs
and therefore, educational needs are constantly changing, and providers of education need
to follow needs in the field. Increasing recognition of societal impact on health inequalities,
the paradigm shift from treating to coaching patients, changes in the way care is delivered,
the digital revolution and the need to contain the cost of our healthcare systems, represent
a multitude of challenges and relentless educational efforts in health promotion, disease
prevention and lifestyle medicine.
54
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
To name a few: the balance between domains of learning in curricula will have to redefined
as in health coaching, skills, attitudes and knowledge are equally important. Health
professionals will have to manage health economics to speak the language of policy makers.
Teaching methodologies have gained from the technological revolution and there is
potential in utilising them even more. Also, there is a necessity to do so in order to provide
for effective health promotion. Health literacy has got alongside data literacy. Therefore,
education needs to respond to in using more technologies as well as teaching adaptation of
technologies into care. This is not common practice yet. The constant development in needs
also stresses the need for continuous professional development in health promotion,
disease prevention and lifestyle medicine. To date, CPD seems to be underrepresented in
educational practices on health promotion and more heavily dependent on external funding
than in undergraduate and postgraduate courses.
The experience developed in the good practices collected in the survey, represents a
valuable body of knowledge, skills and attitudes among health educators. With collaborative
efforts, this can serve as an important capital to promote continuous development and
improvement of educational practices in health promotion, disease prevention and lifestyle
medicine in all European countries.
55
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
ANNEX 1 SURVEY RESULTS BY COUNTRY
In this annex we provide the names of all educational programmes by country filled in in
the survey. In addition, the following variables of the educational programmes are
provided: the name of the educational institution, type of education and type of health
professionals being trained. This information is based on the information provided by the
respondents from each country. If certain boxes are not filled in, this means that only
partial information of this educational programme is provided.
Austria
Name of educational
programme
Name of educational
institution
Type of
education
Bachelorstudiengang
Physiotherapie
Dietetics
FH JOANEUM GmbH
Undergraduate
education
Undergraduate
education
Undergraduate
education
Undergraduate
education
Undergraduate
education
Physiotherapy
Bachelor’s Degree
Programme Physiotherapy
Dietetics and Nutrition
Health University of
Applied Sciences
University of Applied
Sciences St. Polten
FH Campus Wien
FH Joanneum
Bachelor Programme
Physiotherapy
Degree Programme Dietetics
(Bachelor of Science)
University of Applied
Sciences Upper Austria
University of Applied
Sciences Upper Austria
Undergraduate
education
Undergraduate
education
Bachelor in Health Studies
Physiotherapy
Nursing Science
FH Kaernten
Undergraduate
education
Postgraduate
education
Continuous
professional
development
Public Health
Medical University of
Graz
Medical University of
Vienna
Type of health
professionals
being trained
Physical therapists
Dieticians
Physical therapists
Physical therapists
Medical Doctors,
Non-specialized
dietitians
Physical therapists
Dietitians,
Midwifes,
Speak and
language
therapists,
Biomedical
scientists,
Radiological
technologists,
Physical therapists,
Occupational
therapists, Nurses
Physical therapists
Nurses
Medical doctors
Belgium
Name of educational
programme
Name of educational
institution
Type of education
Master of Drug Development
KU Leuven
Bachelor and master
Rehabilitation Sciences and
Physiotherapy
University of Antwerp
Undergraduate
education
Undergraduate
education
Type of health
professionals
being trained
Pharmacists
Physical
therapists
57
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
Name of educational
programme
Name of educational
institution
Type of education
Motor Sciences,
Physiotherapy
Nutrition & Dietetics
Université Libre de
Bruxelles
Thomas More University
College
Adad
Undergraduate
education
Undergraduate
education
Undergraduate
education
Postgraduate
education
Undergraduate
education
Postgraduate
education
Postgraduate
education
Adad
Master Physiotherapy and
Rehabilitation Science
Occupational therapist
KU Leuven
Master in Physical therapy
and Rehabilitation
Master in Physical therapy
Université Libre de
Bruxelles
Université Libre de
Bruxelles
Nutrition and dietetics
Thomas More University
College
Information not provided
Information not
provided
The European Lifestyle
medicine organisation
(ELMO) together with
the Belgian Lifestyle
Medicine Organisation
(BELMO)
The European Certificate in
Lifestyle Medicine
Nutrition and Dietetics
Master in Nursing and
Midwifery
Bachelor & Master
Rehabilitation Sciences &
Physiotherapy
Bachelor Nursing
Professional Bachelor in
Nutrition and Dietetics
Nutrition and Dietetics
Bachelor in Applied Health
Science
Physiotherapist
Bachelor in Medicine
HE Vinci Parnasse ISEI
Erasmus Hogeschool
Brussels
University of Antwerp
KU Leuven
Continuous
professional
education
Undergraduate
education
Continuous
professional
education
Undergraduate
education
Postgraduate
education
Undergraduate
education
University of Applied
Sciences Gent, HOGENT
University colleges
Leuven Limburg
University College
Ghent
Howest University
College
Université Libre de
Bruxelles
Undergraduate
education
Undergraduate
education
Undergraduate
education
Undergraduate
education
Postgraduate
education
Hasselt University
Undergraduate
education
Type of health
professionals
being trained
Physical
therapists
Dietitians
Physical
therapists
Physical
therapists
Occupational
therapists
Physical
therapists
Medical
specialists,
Physical
therapists
(Sport
medicine)
Medical doctors,
Dieticians,
psychologists
Pharmacists
Medical doctors,
Medical
specialists
(lifestyle
medicine),
Physical
therapists,
Occupational
therapists,
Nurses,
Psychologists,
General
practitioners
Dieticians
Nurses
Physical
therapists
Nurses
Dieticians
Dieticians
Lifestyle
coaches
Osteopathy,
Physical
therapists
Medical doctors
58
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
Name of educational
programme
Name of educational
institution
Type of education
Bachelor of Nutrition and
Dietetics
University of Applied
Sciences of Gent
Undergraduate
education
Name of educational
programme
Name of educational
institution
Type of education
Bachelor programme in
Social Work
Plovdiv University,
Department of Social
work
Bulgarian Rhinologic
Society
Medical University
Undergraduate
education
Type of health
professionals
being trained
Dieticians
Bulgaria
Rhinology
Kinesitherapy
TRS rehabilitator
Medical College,
Medical University
Type of health
professionals
being trained
Social workers
Postgraduate
education
Undergraduate
education
Continuous
professional
education
ENT doctors
Type of
health
professionals
being trained
Physical
therapists
Physical
therapists
Medical
specialists
Cyprus
Name of educational
programme
Name of
educational
institution
Type of
education
Physiotherapy
programme
Nicosia University
Undergraduate
education
Name of educational
programme
Name of educational
institution
Type of education
Physiotherapy
Universities
Physiotherapy
Charles University, first
faculty of Medicine
Faculty of Medicine,
Masaryk University,
Brno
Palacký University,
Faculty of Physical
Culture, Department of
Physiotherapy
Masaryk University
Undergraduate
education
Undergraduate
education
Undergraduate
education
Type of health
professionals
being trained
Physical
therapists
Physical
therapists
Physical
therapists
Postgraduate
education
Physical
therapists
Undergraduate
education
Continuous
professional
education
Continuous
professional
education
Nurses
Czech Republic
Physiotherapy
Physiotherapy
General Nursing
Prakticky zubni lekar
(Practical Dentist)
Czech Dental Chamber
Health Promotion
Ministry of Health,
Czech Republic
Medical
specialists
Medical
specialists
59
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
Denmark
Name of educational
programme
Name of educational
institution
Type of education
Musculoskeletal
physiotherapy
Master in Physiotherapy
Aalborg University
Postgraduate
education
Postgraduate
education
Continuous
professional
education
The Fairstart Foundation
University of Southern
Denmark
The Fairstart
Foundation
Type of health
professionals
being trained
Physical
therapists
Physical
therapists
Orphanage staff
(each
orphanage has
professional
staff, such as
psychologists,
social workers
and/or
therapists.
These staff
members are
responsible to
work with each
child on an
individual
basis), School
teachers,
Psychologists,
Social workers
Occupational
therapists,
Nurses
Physical
therapists
Bachelor in Physiotherapy
University College
North Denmark
Undergraduate
education
Bachelor’s degree
Programme of
Physiotherapy
Master of Public Health
VIA University college
Postgraduate
education
Aalborg University
Undergraduate
education
Midwives,
Nurses,
Therapists,
Psychologists,
Medical
Specialists
Name of educational
programme
Name of educational
institution
Type of education
Nursing (general nursing)
Tartu Health Care
College
University of Tarty,
Institute of Psychology
Undergraduate
education
Undergraduate
education
Type of health
professionals
being trained
Nurses
Name of educational
programme
Name of educational
institution
Type of education
Nutrition/Nutrition therapy
University of Eastern
Finland
Postgraduate
education
Estonia
Psychology
Psychologists
Finland
Type of health
professionals
being trained
Clinical
nutriontinists
60
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
Master’s programme of
Human Nutrition and foodrelated behaviour
University of Helsinki
Undergraduate
education
Master of Healthcare,
advanced practice –
supporting self-care and
care of non-communicable
diseases
Public Health Nursing
Savonia University of
Applied Sciences
Postgraduate
education
Metropolia University of
Applied Sciences
University of Helsinki,
medical faculty
Postgraduate
education
Undergraduate
education
University of Helsinki,
Faculty of Medicine,
Department of Oral and
Maxillofacial Diseases
Undergraduate
education
Name of educational
programme
Name of educational
institution
Type of
education
Occupational therapy school
Croix Rouge Françoise
Institut Régional de
Formation en Ergothérapie
Occupational therapy
Occupational therapy
Association Saint
François d'Assise
Institut de formation en
Ergothérapie de Bercksur-Mer site de Loos
IFE Assas
Postgraduate
education
Postgraduate
education
Postgraduate
education
Type of health
professionals
being trained
Occupational
therapists
Occupational
therapists
Occupational
therapists
Arrêté du 5 juillet 2010
relatif au diplôme d’État
d’ergothérapeute
Occupational therapy school
Institut de Formation
en Ergothérapie du CHU
Rouen Normandie
Croix Rouge Francaise
Undergraduate
education
Undergraduate
education
Occupational
therapists
Occupational
therapists
Occupational therapy
UPEC
Diplôme de Diététicien
IUT biologie ou BTS
diététique
CoDEPS 13
Postgraduate
education
Postgraduate
education
Postgraduate
education
Continuous
professional
education
Occupational
therapists
Occupational
therapists
Dietitians
Medical doctors training
programme
Dental education
Nutrition
experts who
work in e.g.
community
health
promotion
Physical
therapists,
Occupational
therapists,
Nurses
Public Health
nurse
Medical doctors,
Nursing,
Master degree
in Health
Management,
Psychologists,
Dentists
Dentists
France
Programme d'éducation et
de promotion à la santé
Public health
Public health
Public health residency
Université de
Bourgogne
Lyon University
Faculty of medicine,
University of Nantes
Postgraduate
education
Undergraduate
education
Undergraduate
education
Nurses,
Psychologists,
Dentists,
Social workers
Medical doctors
Medical specialists
Medical specialists
61
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
Name of educational
programme
Name of educational
institution
Type of
education
Master in Public Health
Karolinska Institute
Postgraduate
education
Public health and social
medicine
Université Versailles
Saint Quentin en
Yveline
UFR sciences de santé Université de
Bourgogne
Continuous
professional
education
Postgraduate
education
Name of educational
programme
Name of educational
institution
Type of education
Visceral Surgery
Augsburg University
Continuous
professional
education
Human Medicine – The
cologne model study course
(human medicine)
University of Cologne,
Medical faculty
Undergraduate
education
Name of educational
programme
Name of educational
institution
Type of education
Physiotherapy
University of Thessaly
Oral education programme
for children via experiential
learning
Hellenic Dental
Association-Dental
School of AthensHellenic Society of
Paediatric Dentistry
International Hellenic
University
National and
kapodistrian University
of Athens, school of
dentistry
International Hellenic
University
Undergraduate
education
Continuous
professional
education
Public health
Type of health
professionals
being trained
Occupational
therapists,
Social Workers
Medical doctors
Medical doctors,
Medical
specialists,
Midwives,
Physical
therapists,
Nurses,
General
practitioners
Germany
Type of health
professionals
being trained
Medical
specialist,
Physical
therapists,
Occupational
therapists,
Nurses,
Social workers
Medical
specialists
Greece
Sports Nutrition
Preventive Dentistry
Nutrition & Dietetics
Type of health
professionals
being trained
Physical
therapists
Psychologists,
Dentists
Postgraduate
education
Undergraduate
education
Dieticians
Postgraduate
education
Medical
specialists
Undergraduate
students
62
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
Name of educational
programme
Name of educational
institution
Type of education
Medicine – under and post
graduate studies
School of health
sciences, University of
Patras
Aristotle University of
Thessaloniki
Undergraduate
education
Undergraduate
education
Pharmacists
Name of educational
programme
Name of educational
institution
Type of education
Public Health and Preventive
Medicine
Semmelweis University,
Budapest, Faculty of
Medicine, Department
of Public Health
Semmelweis University,
Faculty of Medicine
Semmelweis University
Undergraduate
education
Type of health
professionals
being trained
Medical doctors
Undergraduate
education
Postgraduate
education
Medical doctors
Name of educational
programme
Name of educational
institution
Type of education
Master of Social Science in
Social Work
Postgraduate
education
Bachelor Physiotherapy
Maynooth University
(national University of
Ireland Maynooth)
Information not
provided
University College
Dublin
University College
Dublin
RCSI
Type of health
professionals
being trained
Social workers
Irish Dental Association
Irish dental association
Public Health Medicine
Royal College of
Physicians in Ireland
Royal College of
Physicians in Ireland
Pharmacy diploma
Type of health
professionals
being trained
Medical doctors
Hungary
Academic programme of
Medicine
Residency in Preventive
Medicine and Public Health
Medical
specialists
Ireland
Information not provided
Professional Master of
Physiotherapy
Bachelor Physiotherapy
Higher specialist training in
Public Health Medicine
Undergraduate
education
Postgraduate
education
Undergraduate
education
Undergraduate
education
Continuous
professional
development
Postgraduate
education
Postgraduate
education
Physical
therapists
Physical
therapists
Physical
therapists
Physical
therapists
Dentists
Medical
specialists
Medical doctors,
Medical
specialists,
General
practitioners
63
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
Italy
Name of educational
programme
Name of educational
institution
Type of education
Healthy Lifestyles
CNAI – Italian Nurses
association
Management for Health
Professionals
University of Rome
Continuous
professional
education
Postgraduate
education
Corso di laurea in Terapia
occupazionale (Bachelor in
Occupational therapy)
Life Sciences
Università degli Studi di
Milano (State University
of Milan)
University of Catania,
School of Medicine
Undergraduate
education
Health promotion
University of pavia
Corso di Laurea Magistrale
in Odontoiatria e Protesi
Dentaria
Hygiene, preventive
medicine and public health
Università di Parma
Undergraduate
education
Undergraduate
education
Università Cattolica del
Sacro Cuore
Postgraduate
education
Igiene e Medicina Preventiva
Università degli Studi
dell’Aquila
University of Sienna
Postgraduate
education
Postgraduate
education
Postgraduate
education
Postgraduate
education
Post graduate school of
Public Health
Hygiene and Public Health
School of specialization in
Hygiene and Preventive
Medicine
University of Bari 'Aldo
Moro'
University of Milan
Continuous
professional
education
Type of health
professionals
being trained
Nurses
Midwifes,
Physical
therapists,
Nurses
Occupational
therapists
Medical doctors,
Medical
specialists,
Physical
therapists,
Occupational
therapists,
Nurses,
Dentists
Nurses
Dentists
Medical doctors,
Medical
specialists,
general
practicioners
Medical doctors,
non-specialized
Medical doctors
Medical doctors
Medical doctors
Lithuania
Name of educational
programme
Name of educational
institution
Type of education
Health Education and
Promotion
Klaipeda State
University of Applied
sciences
Undergraduate
education
Type of health
professionals
being trained
Dietitians,
Physical
therapists,
Nurses,
Dentists,
Social workers
64
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
Latvia
Name of educational
programme
Name of educational
institution
Type of education
Dentistry
Riga Stradins University
Undergraduate
education
Professional Bachelor
programme Physiotherapy
Physiotherapy
LASE
Postgraduate
education
Undergraduate
education
Riga Stradins University
Type of health
professionals
being trained
Dentists,
General
practicioners
Physical
therapists
Physical
therapists
Malta
Name of educational
programme
Name of educational
institution
Type of education
Bachelor in Nursing Studies
University of Malta,
Faculty of Health
Sciences, department
of Nursing
University of Malta
Undergraduate
education
Undergraduate
education
General
practitioners
Name of educational
programme
Name of educational
institution
Type of education
Occupational Therapy
Information not
provided
Amsterdam University
Medical Centre
Undergraduate
education
Undergraduate
education
Type of health
professionals
being trained
Occupational
therapists
Medical
students
Name of educational
programme
Name of educational
institution
Type of education
PhD in Social Work
ISCTE University
Institute of Lisbon
Escola Superior de
Saúde de Santa Maria
IPC ESTeSC Coimbra
Health school
Escola Superior de
Saúde - Instituto
Politécnico do Porto
Instituto Piaget – Vila
Nova de Gaia
ESSATLA
Postgraduate
education
Undergraduate
education
Undergraduate
education
Undergraduate
education
FHs
Type of health
professionals
being trained
Nurses
Netherlands
Lifestyle and Healthcare
Portugal
Bachelor degree in
Physiotherapy
Physiotherapy
Licenciatura em Fisioterapia
Degree in Physical therapy
Degree in Physical therapy
Curso Licenciatura em
Fisioterapia
Instituto Politécnico de
Saúde do Norte, Escola
Superior de Saúde do
Vale do Ave, CESPU
Undergraduate
education
Continuous
professional
development
Undergraduate
education
Type of health
professionals
being trained
Social workers
Physical
therapists
Physical
therapists
Physical
therapists
Physical
therapists
Physical
therapists
Physical
therapists
65
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
Name of educational
programme
Name of educational
institution
Type of education
Clinical Education
University Fernando
Pessoa- Faculty of
Health Sciences
School of healthypolytechnic institute of
Setubal
Escola Superior De
Saúde Do Vale Do
Sousa do Instituto
Politécnico De Saúde
Do Norte
ARSLVT
Continuous
professional
development
Undergraduate
education
Physiotherapy (Bachelor)
Physiotherapy
Public Health
Information not provided
Information not provided
Information not
provided
Information not
provided
Undergraduate
education
Postgraduate
education
Postgraduate
education
Undergraduate
education
Type of health
professionals
being trained
Workers factory
Physical
therapists
Physical
therapists,
Nurses,
Psychologists,
Dentists
Medical
specialists
Physical
therapists
General
practicioners
Romania
Name of educational
programme
Name of educational
institution
Type of education
Nursing Education
University Lucian Blaga
Medicine/Pharmacy - Health
University of Oradea,
Faculty of medicine and
pharmacy, Oradea
Postgraduate
education
Postgraduation
education
Type of health
professionals
being trained
Nurses
Medical doctors,
Medical
specialists,
Pharmacists,
Physical
therapists,
Nurses,
Dentists,
General
practicioners
Slovakia
Name of educational
programme
Name of educational
institution
Type of education
Social Work
Constantine the
philosopher University
in Nitra
Comenius University in
Bratislava, Faculty of
Arts
Postgraduate
education
Name of educational
programme
Name of educational
institution
Type of
education
Physiotherapy
Alma Mater Europaea
Undergraduate
education
Specialisation study in
Clinical Psychology
Continuous
professional
development
Type of health
professionals
being trained
Social workers
Medical
specialists,
psychologists
Slovenia
Type of health
professionals
being trained
Physical therapists
66
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
Physiotherapy
University of Novo
mesto Faculty of Health
sciences
University of Primorska
Undergraduate
education
Physical therapists
Continuous
professional
education
Nursing Applied Kinesiology,
Physiotherapy and
Nutritional counselling –
dietetics
University of Primorska,
Faculty of Health
Sciences, Slovenia
Undergraduate
education
Professional higher
education study programme
1st cycle degree occupational
therapy
Applied Kinesiology
University of Ljubljana,
faculty of health
sciences
Undergraduate
education
Dietetics, Physical
therapists,
Occupational
therapists, Nurses
Nutrional
counselling,
Kinesiologists,
Physical therapists,
Nurses
Occupational
therapists
UP FVZ
Kinesiology
Physiotherapy
Alma mater Europaea –
Evropski center,
Maribor
University of Ljubliana,
Faculty of health
sciences
Angela Boskin Faculty
of healthcare
Undergraduate
education
Undergraduate
education
Undergraduate
education
Physical therapists
Postgraduate
education
Physical therapists,
Occupational
therapists, nurses
Physical therapists
Faculty of health sciences
Bachelor in Physiotherapy
Health Promotion
1st Bologna cycle study
programme Physiotherapy
Public Health Medical
Residency
Angela Boskin Faculty
of healthcare
Medical chamber of
Slovenia
Public Health
National institute of
public health of the
Republic of Slovenia
Faculty of arts,
University of Maribor
Psychology
Undergraduate
education
Continuous
professional
development
Postgraduate
education
Postgraduate
education
Physical therapists
Medical doctors
Medical doctors
Psychologists
Spain
Name of educational
programme
Name of educational
institution
Type of education
Human Nutrition and
Dietetics
/
University of Zaragoza
Physiotherapy
University of Coruna
EHEA Degree in Human
Nutrition and Dietetics
Bachelor in Pharmacy
Blanquerna School of
Health Sciences –
Universitad Ramon
Lull
Universidad de Sevilla
Undergraduate
education
Continuous
professional
education
Undergraduate
education
Undergraduate
education
Continuous professional
development
Spanish General
Council of Social Work
/
Undergraduate
education
Continuous
professional
education
Type of health
professionals
being trained
Dieticians
Nurses
Physical therapists
Dietitians
Pharmacists
Social workers
67
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
Bachelor in Pharmacy
Universidad de Alcala
Bachelor in Medicine
Faculty of medicine,
University of Cadiz,
Spain
Hospital Clinic de
Barcelona
Information not
provided
University of Navarra
Residency in Preventive
Medicine and Public Health
Bachelor in Medicine
Master/Bachelor in
Pharmacy
Human Nutrition and
Dietetics
Pharmacy
Pharmacy
Master in Advanced
Therapies and Innovation
in Biotechnology
Pharmacy
Undergraduate
education
Undergraduate
education
Universidad de
Francisco de Vitoria
Postgraduate
education
Undergraduate
education
Undergraduate
education,
Postgraduate
education
Undergraduate
education
Undergraduate
education
Undergraduate
education
Postgraduate
education
Universidad of the
Basque County
Undergraduate
education
Univeristy of Navarra
Universitad Ramon
Lull
IQS – FCSB
Pharmacists
Medical doctors,
General
practitioners
Nurses
Medical doctors
Pharmacists
Nutritionists &
Dietitians
Pharmacists
Pharmacists
Pharmacists
Pharmacists
Sweden
Name of educational
programme
Name of educational
institution
Type of education
Master programme in Public
Health
Karolinska institute
Postgraduate
education
Dietetics programme
Department of food and
Nutrition
Department of food
studies, dietetics and
nutrition
University of
Gothenburg,
Sahlgrenska Academy
Department of public
health and caring
sciences, Uppsala
University
Undergraduate
education
Undergraduate
education
Name of educational
programme
Bachelor (Hons)
Occupational Therapy/
Dietetics programme
Programme in Dietetics
Master of Public Health
Type of health
professionals
being trained
Occupational
therapists,
Social workers
Dietician
Dietician
Undergraduate
education
Dietician
Postgraduate
education
Medical doctors,
Bachelor of
science,
Physical
therapists,
Nurses,
Psychologists,
Dentists,
Social workers
Name of educational
institution
Type of education
Northumbria University
Undergraduate
education
Type of health
professionals
being trained
Occupational
therapists
United Kingdom
68
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
Name of educational
programme
Name of educational
institution
Type of education
Type of health
professionals
being trained
Master (pre reg)
Occupational Therapy
Master in Occupational
Therapy
Bachelor (Hons)
Occupational Therapy
Leeds Beckett
University
St George’s University
of London
Postgraduate
education
Undergraduate
education
Bachelor (Hons)
Occupational Therapy
Bachelor (Hons)
Occupational Therapy,
Master in (pre-reg)
Occupation Therapy,
Occupational Therapy
degree apprenticeship
Public Health speciality
training
Caterburry Christ
Church University
University of Brighton
Undergraduate
education
Undergraduate
education
Occupational
therapists
Medical doctors,
Medical
specialists,
Physical
therapists,
Occupational
therapists
Occupational
therapists
Occupational
therapists
Health education
England -north west
Postgraduate
education
Bachelor in (Hons)
Occupational Therapy,
Master in (Pre-reg)
Occupational Therapy,
Occupational Therapy
Degree apprenticeship
University of Brighton
Undergraduate
education
Name of educational
programme
Name of educational
institution
Type of education
Bachelor of Physiotherapy
University of Prishtina,
Kosovo, Albania
Faculty of health
studies, University of
Sarajevo, BosniaHerzegovina
NTNU, Norway
Postgraduate
education
Undergraduate
education
Type of health
professionals
being trained
Physical
therapists
Physical
therapists
Undergraduate
education
Undergraduate
education
Physical
therapists
Physical
therapists
Undergraduate
education
Physical
therapists
Undergraduate
education
Physical
therapists
Undergraduate
education
Medical doctors
Medical doctors,
Medical
specialists,
Researchers,
Nurses
Occupational
therapists
Additional countries
Physiotherapy
Fysioterapeututdanning
Bachelor of science in
Physiotherapy, BFH
Bachelor of science in
Physiotherapy
Physical Therapy Sciences
Medicine
Berner Fachhochschule
BFH Bern University of
Applied Sciences, Swiss
ZHAW Zurich University
of applied sciences,
Swiss
University of Iceland,
School of Health
Sciences
International school of
medicine, Kazachstan
69
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
Name of educational
programme
Name of educational
institution
Medicine/single-cycle degree
programme
University of Georgia,
Republic of Georgia
Medicine
Akaki tsereteli state
University, Republic of
Georgia
Postgraduate
education
Public Health and
Epidemiology
David tvildiani medical
University, Republic of
Georgia
David tvildiani medical
University, Republic of
Georgia
Postgraduate
education
Medicine/single-cyle degree
programme
Public Health
University of Georgia,
Republic of Georgie
Tbilisi State Medical
University (TSMU),
Republic of Georgia
Undergraduate
education
Undergraduate
education
David tvildiani Medical
University
David tvildiani Medical
University, Republic of
Georgia
Undergraduate
education
Biomedical and Healthcare
Science, doctoral
programme
Type of education
Postgraduate
education
Type of health
professionals
being trained
Medical doctors,
Psychologists,
General
practicioners
Medical doctors,
Medical
specialists,
Physical
therapists,
Psychologists,
Dentists,
General
practicioners
Medical doctors
Medical doctors,
Biomedical
Science master
degree holders
Medical doctors
Medical doctors
and public
health
specialists
Medical doctors
70
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
ANNEX 2 COMPETENCY PROFILES PER PROFESSIONS
Undergraduate medicine
The CanMEDS framework is worldwide the most commonly used and adapted model that
identifies and describes the abilities physicians require in order to effectively meet the
health care needs of the people they serve72. Within European Member States modifications
of this model are used within health and educational settings (for example in the
Netherlands and Finland) for undergraduate medicine and medical specialisations. The
CanMEDS model defines seven roles of the physician, namely: (1) medical expert (the
integrating role); (2) communicator; (3) collaborator; (4) leader; (5) health advocate; (6)
scholar and (7) professional73. The role of health advocate is defined as physicians
contributing their expertise and influence as they work with communities or patient
populations to improve health: “improving health is not limited to mitigating illness or
trauma, but also involves disease prevention, health promotion, and health protection.
Improving health also includes promoting health equity, whereby individuals and
populations reach their full health potential without being disadvantaged by, for example,
race, ethnicity, religion, gender, sexual orientation, age, social class, economic status, or
level of education”. Within this role two key competencies are defined 74:
1. Respond to an individual patient’s health needs by advocating with the patient within
and beyond the clinical environment:
a. Work with patients to address determinants of health that affect them and their access
to needed health services or resources;
b. Work with patients and their families to increase opportunities to adopt healthy
behaviours;
c. Incorporate disease prevention, health promotion, and health surveillance into
interactions with individual patients.
2. Respond to the needs of the communities or populations they serve by advocating with
them for system-level change in a socially accountable manner:
d. Work with a community or population to identify the determinants of health that affect
them;
e. Improve clinical practice by applying a process of continuous quality improvement to
disease prevention, health promotion and health surveillance activities;
f. Contribute to a process to improve health in the community or population they serve.
In addition, the European Thematic Network project MEDINE (2004-2007) and Tuning
Project (Medicine) under its auspice (MEDINE) have generated and gained widespread
consensus on a set of competences for primary medical degree qualifications in Europe
(i.e., undergraduate medicine)75. Within this project, it is stated that graduates in medicine
72
73
74
75
http://www.royalcollege.ca/rcsite/canmeds/canmeds-framework-e.
http://www.royalcollege.ca/rcsite/canmeds/about-canmeds-e.
http://www.royalcollege.ca/rcsite/canmeds/framework/canmeds-role-scholar-e.
http://tuningacademy.org/medine-medicine/?lang=en.
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Health promotion and disease prevention including lifestyle medicine in health and
educational settings
would need the ability to: “promote health, engage with population health issues and work
effectively in a health care system”76. The following points define health promotion:
•
•
•
•
•
•
•
provide patient care which minimises the risk of harm to patients;
apply measures to prevent the spread of infection;
recognise own health needs and ensure own health does not interfere with
professional responsibilities;
conform with professional regulation and certification to practise;
receive and provide professional appraisal;
make informed career choices;
engage in health promotion at individual and population levels.
Medical specialist
The European Union of Medical Specialists (UEMS) contributed significantly to the
improvement of post-graduate training through the development of a European Curriculum
in each medical speciality as well as the elaboration of training standards. 77 Within this
section we provide a detailed description of the European training requirements for a
selection of medical specialists, including sports medicine, public health, internal medicine,
cardiology, psychiatry and the general practitioner. 78 This selection was based on the fact
that within these specialities lifestyle might be an essential component or important part of
the treatment of chronically ill patients.
1) Medical specialist sports medicine
Sports medicine is defined by the European Commission as a “multidisciplinary clinical and
academic speciality of medicine dealing with health promotion for the general population
by stimulating a physically active lifestyle and diagnosis, treatment, prevention and
rehabilitation following injuries or illnesses from participation to physical activities,
exercises and sport at all levels”.79 As health promotion and prevention are both
incorporated in the definition of sports medicine these topics are included throughout the
whole curriculum of sports medicine. The curriculum of sports medicine aimed to provide
theoretical understanding and practical skills to provide first line clinical services.80 Within
the training requirements for the speciality of sports medicine, it is stated that sports
medicine does not solely take care for sporting elite athletes, but as well for its important
role to promote exercise as a medical tool, meant for patients with chronic diseases.81
• Theoretical knowledge: aims to provide theoretical understanding and practical skills to
provide first line clinical services:
-
Clinical: To provide pre-participation clinical screening and examination before
exercise and competition as well as medical assistance to the athletes engaged in all
sports;
76
77
78
79
80
81
http://www.unideusto.org/tuningeu/images/stories/Summary_of_outcomes_TN/Learning_Outcomes_Compe
tences_for_Undergraduate_Medical_Education_in_Europe.pdf
https://www.uems.eu/__data/assets/pdf_file/0011/1415/906.pdf.
https://www.uems.eu/areas-of-expertise/postgraduate-training/european-standards-in-medical-training.
https://www.uems.eu/__data/assets/pdf_file/0009/111798/UEMS-2019.47-European-TrainingRequirements-in-Sports-Medicine.pdf.
https://www.uems.eu/__data/assets/pdf_file/0009/111798/UEMS-2019.47-European-TrainingRequirements-in-Sports-Medicine.pdf.
https://www.uems.eu/__data/assets/pdf_file/0009/111798/UEMS-2019.47-European-TrainingRequirements-in-Sports-Medicine.pdf.
72
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
-
Public health:
• As part of a multi-disciplinary team to encourage and promote physical activity as
a lever for healthy living;
• To identify impediments to an active lifestyle and work within a multi-disciplinary
framework to remove those impediments or minimize their impact;
• To work alongside local health authorities/public health clinicians developing
exercise opportunities for the general public for health gain;
• To liaise with public (local authorities/education/voluntary) and private sector to
advise on the health aspects of exercise programmes for physical activity of special
groups like women, children, adolescents and aging population.
• Practical and clinical skills:
• To foster the integration of knowledge and practical skills acquired during the
cardiology, orthopaedics, physical & rehabilitation medicine, general practice
medicine and physiology internships;
• To learn to put into practice information gained in the relevant course work;
• To extend and deepen their knowledge in the assessment of fitness, such as
isokinetic and functional muscle performance, cycle ergometry and treadmill
ergometry;
• To gain experience in the use of such test results in the decision making with regard
to diagnosis, recommendations and therapy for people of both gender and in
different age groups and performance levels;
• With regard to elite sport, trainees will learn how to diagnose, treat and prevent
overtraining and overexertion;
• To become proficient in activities related to, for example, hygiene and nutrition,
and will work closely with trainers, athletes, physiotherapists, officials, etc.
• Competencies:
• Clinical and instrumental assessment to determine the pathophysiology
mechanisms and the underlying diagnosis of the patient’s condition;
• Trainees are expected to complete evidence of reflective practice through case
reports and other experiences in their training record;
• Other self-directed work will be planning, data collection, analysis and presentation
of audit and research work;
• The mandatory training record (hand written diary or preferably electronic
logbook) will contain evidence of academic pursuits and should be checked and
documented regularly by the Supervisor;
• Trainees will take part and be able to lead in teaching and will be expected to
develop skills to teach undergraduates, postgraduates and non-medical staff in
small groups and formal lectures making personal presentations using a variety of
audiovisual methods;
73
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
• They will be expected to present at journal clubs, and make case presentations at
grand rounds or similar settings;
• They will be expected to undertake personal audit and research and make
presentations of their findings at clinical meetings;
• Prescription, as much evidence-based as possible, of medical and physical
treatments (including drug treatment, physical modalities, innovative
technologies, natural factors and others), as well as of technical aids;
• Prevention and management of complications;
• Skill to perform and participate in research.
2) Medical specialist public health
The European Commission defines public health “as the science and art of preventing
disease, prolonging life and promoting mental and physical health and efficiency through
organized community effort. Public health may be considered as structures and processes
by which the Health of the population is understood, safeguarded and promoted through
the organized efforts of society.” 82 Public health specialists aim to improve population’s
health by using the following skills and competencies.
• Theoretical knowledge on a range of fields including epidemiology, prevention, health
promotion, public health research, behavioural sciences, health programme evaluations,
health need assessments and quality and safety in healthcare;
• Practical and clinical skills:
82
-
Surveillance and evaluation of the health of the population (trained in epidemiology);
-
Planning and evaluation of health services and public health control;
-
Analysing the health of the population (analysing determinants on individual and
community levels);
-
Plan, participate in or evaluate preventive and control programmes (public health
assessments);
-
Participate in multidisciplinary health impact assessment;
-
Inform decision-makers about potential impacts and to identify appropriate and
sustainable actions to manage those effects (including environmental determinants
of health);
-
Organisational issues in healthcare (participating in policy and strategic development,
quality and safety management);
-
Generate and share new evidence on the ways in which social determinants influence
population health and health equity;
-
Sufficient linguistic ability to communicate with his/her public health colleagues;
https://www.uems.eu/__data/assets/pdf_file/0011/98435/UEMS-2019.24-European-TrainingRequirements-for-Public-Health.pdf.
74
Health promotion and disease prevention including lifestyle medicine in health and
educational settings
-
Develop high professional ethical standard, including respect towards human rights,
participants in public health programmes, colleges and other professionals in the
team.
• Competencies:
-
Establish the expertise role as a Public Health Physician:
• Function as public health leaders and consultants to health services and other
organizations and institutions in order to provide safe, appropriate, cost effective
and equal health care to groups, communities and populations;
• Establish and maintain medical knowledge, skills and attitudes appropriate to their
practice, including the organization and financing of health care, public health
control and public health law.
-
Perform expertise analyses of the health of the population:
• Apply and combine medical and epidemiological competencies for the surveillance
and evaluation of the health of the population;
• Identify the determinants of health of populations and risks for public health, and
implications for interventions and policy;
• Evaluate health problems, biopsychosocial mechanisms and/or health care issues
for different population groups, and their implications for the community;
• Critically evaluate epidemiological, demographic, health statistical and
environmental pollution data and their sources, and apply them appropriately to
public health issues;
• Identify community health needs and advise about their implications for public
health and medical care services.
-
Lead and supervise public health interventions:
• Select, develop, implement and monitor public health surveillance and
interventions, namely in the areas of human behaviour, social and physical
environment, food safety and nutrition, health care associated risks and working
life related health;
• Promote the health of individuals, communities and populations through health
programming;
• Contribute to the organization and evaluation of societal and health care
programmes aiming to promote health and social functioning among individuals
with long-term diseases and disabilities;
• Contribute to the planning, organization, supervision of and evaluation of societal
and health care programmes promoting the health of specific target groups, such
as children, elderly, and vulnerable and underserved groups in society;
• Contribute to the organization of and evaluate primary and secondary medical
prevention programmes;
• Contribute to strengthening regulatory frameworks for protecting and improving
health.
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Health promotion and disease prevention including lifestyle medicine in health and
educational settings
-
Function as expertise in planning and evaluation of Public Health and Medical Care:
• Evaluate Public Health and other service programmes concerning processes and
outputs from the different perspectives of care seekers, professional health care
workers, and health managers;
• Analyse and differentiate between need, demand and supply, and assess the health
of a defined population and identify areas for improvement, including the allocation
of health care resources delivery;
• Evaluate the outcome, quality and safety of care and promote quality development
systems based on evidence and public health principles;
• Apply health economic principles and methods such as cost-effectiveness, costutility, and cost-benefits considering the strengths and weaknesses of different
methods;
• Use methods to determine priorities and their strengths and weaknesses and
promote awareness of the competing and conflicting influences on public and
political perceptions of the need for health care and the resulting constraints on
action;
• Promote and evaluate collaboration between health services and other welfare
organizations in society;
• Evaluate and contribute to the policy and strategic development in health care
planning;
• Contribute to the planning and evaluation of different sectors of society by health
impact assessments and public health medical reports and consultations.
-
Communicate and develop public health medical expertise:
• Lead, supervise and participate in an interprofessional health care team;
• Consult other (health) professionals and policymakers, and recognise the
advantages and limits of their expertise;
• Effectively convey oral and written information about public health issues, including
adequate public health reporting and effective interaction with media;
• Stimulate and motivate others so that they recognise the importance of the public
health population perspective;
• Maintain and enhance professional activities through ongoing learning and
research and contribute appropriately to the generation, dissemination, application
and translation of new public health knowledge and practices.
3) Medical specialist internal medicine
The UEMS defines an internist as “a physician trained in the scientific basis of medicine,
who specialises in the assessment, diagnosis and management of general medical
problems, atypical presentations, multiple problems and consequential complex health
issues, and system disorders (Professional). The physician is skilled in the management of
acute unselected medical emergencies and the management of patients in a holistic and
ethical way, considering all psychosocial as well as medical factors for enhancing quality of
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life. The physician values the continuing care of all patients irrespective of the nature of the
patient's complaint, and is committed to lifelong continued professional development
(Scholar). The physician practices clinical audit and evidence-based medicine. The
physician functions in a number of roles, including clinical counselling, educating, leading
and managing.”83
Internists have a fundamental role in modern healthcare systems. Within the definition of
the internist the shift towards a preventive strategy focusing on health promotion is
highlighted, by the acknowledgement of the high prevalence of chronic and complex
diseases that are associated with the lifestyle of ageing western societies. The role of
healthcare advocate (a role defined in the CanMED framework) is an important part of the
internist’s function, and forms the generic competencies of an internist (see section 1.1).
However, lifestyle promotion and disease prevention is not a specific area of expertise.
Specific areas of the internist include multi-morbidity and ageing, acute care, medical
consultation, shared-decision-making, collaborative care, transition in care, vulnerable
adult, patient safety and quality of care and medical leadership.
4) Medical specialist cardiology
According to the training requirements for the speciality of cardiology 84, training in
cardiology should be based on the syllabus of the ESC core Curriculum for the general
cardiologist, part 2: “the core curriculum per topic”. 85 The necessary core cardiology
competencies are set out as cardiology learning objectives with the knowledge, skills,
attitudes and competencies needed to fulfil the objectives. One of the core cardiology
competences is cardiovascular prevention aiming to:
•
•
•
•
•
Assess and manage patients with risk factors for cardiovascular disease;
Understand the mode of action of different prevention methods;
Describe cardiovascular disease and risk factors in the local community;
Contribute to the global efforts in reducing cardiovascular morbidity and mortality
by communicating the prevention message to the public;
To approach prevention in a holistic way, understanding the potentiation of
cardiovascular risk by clustering of risk factors.
•
Knowledge:
•
•
83
84
85
Epidemiology of cardiovascular disease in the local community: incidence,
prevalence, survival;
Risk factors in the local community;
https://www.uems.eu/__data/assets/pdf_file/0017/44450/UEMS-2016.13-European-TrainingRequirements-Internal-Medicine.pdf.
https://www.uems.eu/__data/assets/pdf_file/0011/19577/UEMS-2013.24-SECTIONS-AND-BOARDSCardiology-European-Training-Requirements-2013.10.19.pdf.
https://watermark.silverchair.com/eht234.pdf?token=AQECAHi208BE49Ooan9kkhW_Ercy7Dm3ZL_
9Cf3qfKAc485ysgAAAmkwggJlBgkqhkiG9w0BBwagggJWMIICUgIBADCCAksGCSqGSIb3DQEHATAeBglghkgBZ
QMEAS4wEQQMIJSHrbGr7Y7hFz2aAgEQgIICHCh4gCx3eV1BIjo5nRvP4BKeYP3IF0fUmW6i-U53mVVCik8lZxvaon00fsKuoRup61059Rk_pcr7iAWd4klDM4wR8Hnz6IWN0qAFLvZaG_L3VuAjpfOPo4fQ_Un4H
7KU5nHwnMt5NZ0-izF_LCuXEt22m1tP8Ql3WQQv9eqHTggRZMa5_AAtM4eTL1d8e6YKPfJxTo6oUQAt4NVqsT9vX67QiMs0FKTlhZv7qo5gNO9HC74dbF6m9HLIpw3MPe7_V02qrWIzPxZDDNbEi_5O-ZQRocvO4SFbuEqABpBa8PGjqhHoO49pfeCDTEIeSuPwks5v9So90qgyH1shzE4d5LoaiFjqU39tnDM1envuBk51JSSLWQEUL
dcEt_84qO_VOhQhZ8LqRPSFnR9MpYLpqe4_CHS0G5Q5vZGaYphQrudKcqX_J1TZL8NVMwyX9LyJPDxqTruZlCcEzp2A5fw3wZJHfXPRBWXupydarXO2VLD97DNjJYEl1XW7M86flpULCAzJw9auu4_XlU5HPktMU0BdaaPjNsSkItkKzwkH2sgraBosrkE2b8ey_m37VJfG_4WQ9pVZD1H9NMbSZu8Awwy3yprUIAtvWFwatsmKccO51DlEUq2-sD5n0BTVUNzxSQFZoadyImMS0PzudcmCwYmqL-NX7LJIRgXVdiwtSfLLveLODh_BL0nZFdgZBfivhLh5hgemA.
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Health promotion and disease prevention including lifestyle medicine in health and
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•
•
•
•
•
•
•
Risk assessment in primary prevention: multifactorial risk interaction and use of
risk scoring charts;
The impact of lifestyle on people at risk of, and patients with, cardiovascular
disease;
The potential of lifestyle changes to prevent and ameliorate cardiovascular
disease: diet and nutrition, toxic habits (smoking, alcohol and others), physical
activity;
Emerging risk factors (social, economic, stress, depression, and personality type);
Treatment/prevention strategies for major risk factors and changes in lifestyle,
including corresponding pharmacologic therapies;
The comprehensive approach required for multiple risk factors;
Patient compliance.
In addition, the main objectives and knowledge competence are further specified by
hypertension, dyslipidaemia, diabetes and lifestyle.
Skills:
•
•
•
•
•
•
•
•
•
•
obtain a relevant history and perform an appropriate clinical examination;
evaluate cardiovascular risk and assess global cardiovascular risk at the individual
level;
evaluate cardiovascular risk at population level (mortality, morbidity, disability);
evaluate the benefit of prevention at individual and population levels;
manage risk factors appropriately, including pharmacological and nonpharmacological therapies;
communicate their importance to patients, their families, and the wider
community, including smoking cessation, diet, and exercise;
communicate the importance of patient compliance and behaviour;
motivate patients and families to change lifestyles and be compliant with
prescriptions/recommendations;
monitor patient compliance and behaviour;
evaluate the benefit of risk factor intervention for the individual patient.
Behaviours and attitudes:
•
•
•
•
Non-judgemental attitude to patients regarding their lifestyle (e.g. smoking, diet,
etc.);
Exemplify appropriate lifestyle in personal behaviour;
Team working with other physicians, including general practitioners,
diabetologists, nephrologists, and elderly care physicians for the management of
specific risk factors;
Team working with all professionals with a role in primary and secondary
prevention (nurses, dieticians, teachers, and politicians).
Another core competency is the physical activity and sport in primary and secondary
prevention. Further defined in sports cardiology and cardiac rehabilitation:
Sports cardiology, aiming86:
86
https://watermark.silverchair.com/eht234.pdf?token=AQECAHi208BE49Ooan9kkhW_Ercy7Dm3ZL_9Cf3qfK
Ac485ysgAAAmkwggJlBgkqhkiG9w0BBwagggJWMIICUgIBADCCAksGCSqGSIb3DQEHATAeBglghkgBZQMEAS4
wEQQMIJSHrbGr7Y7hFz2aAgEQgIICHCh4gCx3eV1BIjo5nRvP4BKeYP3IF0fUmW6i-U53mVVCik8lZxvaon00fsKuoRup61059Rk_pcr7iAWd4klDM4wR8Hnz6IWN0qAFLvZaG_L3VuAjpfOPo4fQ_Un4H
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Health promotion and disease prevention including lifestyle medicine in health and
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•
•
•
•
To conduct strategies to implement healthy lifestyle, in particular physical and
sports activities in the general population (primary prevention);
To evaluate cardiovascular risk and exercise capacity (see Chapters 2.2 and
2.7.1);
To recognize the characteristics of the athlete’s heart;
To appropriately detect contraindications to exercise/competition, and
appropriately provide non-contraindication certificates.
Knowledge:
•
•
•
•
•
•
•
•
•
Exercise and sports physiology;
Benefits of exercise training;
Safety issues in exercise and sport;
Diagnostic criteria and appropriate investigations in athletes with cardiovascular
disease;
Risk factors for and mechanisms of sudden cardiac death (SCD) during and after
strenuous exercise;
Specific population challenges and exercise programmes in appropriate settings;
Recommendations for professional and recreational sports participation;
SCD in patients, athletes, and in the population at large; and
Mechanisms of action of illicit drugs.
Skills:
•
•
•
perform an individual CVD risk assessment using appropriate information from
history, laboratory assessment including full lipid profile and clinical data;
recognize pathological cardiovascular changes and differentiate them from the
characteristic features of ‘athlete’s heart’; and
use prevailing recommendations for eligibility for participation in competitive
sports.
Behaviours and attitudes:
•
Recognition of the role of active lifestyle, exercise, and sport in the promotion of
health and in the prevention of the most threatening diseases including
cardiovascular diseases.
Cardiac rehabilitation aiming:
•
•
•
To evaluate and manage cardiovascular risk;
To evaluate exercise capacity and causes of exercise intolerance;
To provide appropriate rehabilitation and secondary prevention to patients with
cardiovascular diseases.
7KU5nHwnMt5NZ0-izF_LCuXEt22m1tP8Ql3WQQv9eqHTggRZMa5_AAtM4eTL1d8e6YKPfJxTo6oUQAt4NVqsT9vX67QiMs0FKTlhZv7qo5gNO9HC74dbF6m9HLIpw3MPe7_V02qrWIzPxZDDNbEi_5O-ZQRocvO4SFbuEqABpBa8PGjqhHoO49pfeCDTEIeSuPwks5v9So90qgyH1shzE4d5LoaiFjqU39tnDM1envuBk51JSSLWQEUL
dcEt_84qO_VOhQhZ8LqRPSFnR9MpYLpqe4_CHS0G5Q5vZGaYphQrudKcqX_J1TZL8NVMwyX9LyJPDxqTruZlCcEzp2A5fw3wZJHfXPRBWXupydarXO2VLD97DNjJYEl1XW7M86flpULCAzJw9auu4_XlU5HPktMU0BdaaPjNsSkItkKzwkH2sgraBosrkE2b8ey_m37VJfG_4WQ9pVZD1H9NMbSZu8Awwy3yprUIAtvWFwatsmKccO51DlEUq2-sD5n0BTVUNzxSQFZoadyImMS0PzudcmCwYmqL-NX7LJIRgXVdiwtSfLLveLODh_BL0nZFdgZBfivhLh5hgemA.
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Health promotion and disease prevention including lifestyle medicine in health and
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Knowledge:
•
•
•
•
•
•
Multi-disciplinary risk factor intervention;
Definition of comprehensive cardiovascular prevention and rehabilitation;
Effects of behavioural change, including physical activity, nutrition, education and
psychosocial risk factors on quality of life, cardiovascular risk, and outcome;
Rehabilitation as a component of cardiac care and a promoter of secondary
prevention;
Target populations and risk stratification of patients;
Psychological aspects of rehabilitation and exercise practice.
Skills:
•
•
•
•
•
take a relevant history and perform an appropriate clinical examination including
the specific evaluation of the elderly patient;
perform and interpret risk stratification using indicated tests;
interpret a cardiopulmonary exercise test and distinguish different causes of
exercise limitation;
prescribe exercise-based rehabilitation programmes and other lifestyle
interventions according to the patient’s condition, in collaboration with other
specialists when necessary; and
motivate the patient to ensure long-term adherence to lifestyle changes and
continuing exercise programmes.
Behaviours and attitudes:
•
•
•
•
•
rehabilitation as a component of cardiac care;
the importance of rehabilitation and secondary prevention for professional,
personal and social life among patients with heart disease;
the interplay of physical and psychological aspects of heart disease and the
positive influence of exercise on cardiovascular risk factors;
the role of other professionals including nurse specialists, physiotherapists, ergo
physiologists, psychologists, dieticians, and general practitioners in rehabilitation
and secondary prevention; and;
the importance of patient and family education, and the role of other professionals
in rehabilitation.
5) Medical specialist psychiatry
The UEMS has issued a charter of requirements for the training in psychiatry in 2000 with
an additional European Framework for Competencies in Psychiatry in 2009. The learning
outcomes in the European Framework for Competencies in Psychiatry (EFCP) are arranged
under the seven physician roles, derived from the CanMEDS framework.87 Within the EFCP
it is stated that: “psychiatrists recognise the importance of advocacy and health promotion
in responding to the challenges represented by those social, environmental and biological
factors that determine the mental health and well-being of patients and society. They
recognise advocacy as an essential and fundamental component of mental health promotion
that occurs at the level of the individual patient, the practice population and the broader
community”.
Competencies:
87
http://uemspsychiatry.org/wp-content/uploads/2013/09/2009-Oct-EFCP.pdf.
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•
•
identify the determinants of mental disorder as well as the factors that may
contribute to positive mental health so as to be able to prevent disorder and
promote mental health:
- recognise the determinants of mental health of populations and how public
policy including legislation impacts on mental health;
- promote positive mental and physical health in patients particularly in those
with severe mental disorder based on best evidence;
- recognise the impact of mental disorder on families and carers, and take
remedial measures;
- collaborate with other community sectors to promote mental health and
prevent mental disorder at all levels focusing particularly on family, school and
workplace;
- identify and address barriers and inequity in access to care, particularly for
vulnerable or marginalised populations.
Identify and address issues and circumstances when advocacy on behalf of
patients, professions, or society is necessary:
- respect and promote the human rights of people with mental disorders and
collaborate with user and carer associations and advocacy groups;
- empower people with mental disorders and their carers;
- recognise and address prejudice, stigma and discrimination associated with
mental disorder and its treatment;
- use strategies to enhance patient’s self-management and autonomy;
- actively oppose the use of psychiatry for political repression;
- recognise the possibility of conflict inherent in their role as a health advocate
for a patient or community with that of manager or gatekeeper.
6) General practitioner
The European training requirements for General Practice/Family Medicine (GP/FM) specialist
training88 defined twelve central characteristics of the practice, before determining the core
competences. Related to health promotion and disease prevention, two of these
characteristics are as following: “promotes health and well-being both by appropriate and
effective intervention” and “has a specific responsibility for the health of the community”.
The twelve characteristics are clustered into six core competences: primary care
management; person-centred care; specific problem solving skills; comprehensive
approach; community orientation; holistic modelling. Under comprehensive approach, the
following abilities relate to health promotion and disease prevention:
•
•
to promote health and wellbeing by applying health promotion and disease
prevention strategies appropriately;
to manage and co-ordinate health promotion, prevention, cure, care and palliation
and rehabilitation.
Furthermore, community orientation includes the ability:
•
88
to reconcile the health needs of individual patients and the health needs of the
community in which they live in balance with available resources.
https://euract.woncaeurope.org/sites/euractdev/files/documents/publications/official-documents/europeantraining-requirements-gp-fm-specialist-training-euract-2018.pdf.
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In the more comprehensive assessment of GP’s performance in daily practice by the
European Academy of Teachers in General Practice/Family Medicine (EURACT) 89, these
abilities are further defined as following:
•
•
To promote health and wellbeing by applying health promotion and disease
prevention strategies appropriate:
- Identifies opportunity for health promotion intervention;
- Makes use of structured medical record as reminder of preventive activities;
- Makes use of teamwork;
- Uses communication skills;
- Is aware of any personal prejudices which might influence negatively
preventive advice;
- Makes recommendations which are feasible in the context of patient’s lifestyle
and home situation;
- Acts as suitable role model.
To manage and co-ordinate health promotion, prevention, cure, care and palliation
and rehabilitation:
- Provides appropriate medical management;
- Involves members of practice team, e.g. through case conference;
- Performs/arranges home visit (consider relevant team members) – needs
assessment, e.g. cause of falls;
- Involves relatives;
- Facilitates communication (two-way) with hospital;
- Involves external community resources (e.g. home help, etc.).
Dentist
According to the profile and competences for the graduating European dentist one of the
major competences for dentists is to improve oral health of individuals, families and groups
in the community. On graduation a dentist must be competent at promoting and improving
the oral health of individuals, families and groups in the community90. Furthermore, with
regard to health promotion and disease prevention, a dentist:
•
•
Must be competent at:
- Applying the principles of health promotion and disease prevention via
comprehensive preventive measures to individuals and the community
according to their risk assessment status;
- Understanding the complex interactions between oral health, nutrition, general
health, drugs and diseases that can have an impact on oral health care and
oral diseases;
- Providing appropriate dietary advice.
Have knowledge of:
- The organisation and provision of health care in the community and in the
specialist hospital service in the country of training;
- The prevalence of the common dental conditions in the country of
training/practice;
- The social, cultural and environmental factors which contribute to health or
illness;
- The strategies to overcome barriers to dental care for disabled, elderly,
socially deprived and ethnic minority groups;
- Training auxiliaries in basic skills of oral health promotion.
https://euract.woncaeurope.org/sites/euractdev/files/documents/publications/officialdocuments/euractperformanceagendad%C3%BCsseldorf2014-openaccessebookversion.pdf.
90
http://www.dent.uoa.gr/fileadmin/dent.uoa.gr/uploads/usefull_files/ADEE-competences-2009_en.pdf.
89
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Health promotion and disease prevention including lifestyle medicine in health and
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In 2017 a new updated framework was published for undergraduate education for dentists
including a revised structure of the educational domains and their areas of competence. In
the revised framework, health promotion and disease prevention compromises one of the
areas of competence in the domain “dentistry in society” in the educational strategy of a
dentist91. Note: Dentists can also specialise in public health in a similar programme as
physicians.
Nurses
The training for nurses responsible for general care shall, following the Directive
2013/55/EU include a set of eight competences. 92 The training for nurses should provide
assurance that the ability of the following knowledge and skills:
1. comprehensive knowledge of the sciences on which general nursing is based, including
sufficient understanding of the structure, physiological functions and behaviour of
healthy and sick persons, and of the relationship between the state of health and the
physical and social environment of the human being;
2. sufficient knowledge of the nature and ethics of the profession and of the general
principles of health and nursing;
3. adequate clinical experience; such experience, should be gained under the supervision
of qualified nursing staff and in places where the number of qualified staff and equipment
are appropriate for the nursing care of the patient;
4. the ability to participate in the practical training of health personnel and experience of
working with such personnel;
5. experience of working with members of other professions in the health sector.
Competencies: 93
6. Competency to independently diagnose the nursing care required using current
theoretical and clinical knowledge as well as to plan, organise and implement nursing
care when treating patients on the basis of page the knowledge and skills acquired in
accordance with points (1), (2) and (3) in order to improve professional practice;
7. Competency to work together effectively with other players in the health sector including
participation in the practical training of health personnel on the basis of the knowledge
and skills acquired in accordance with points (4) and (5);
8. Competency to empower individuals, families and groups towards healthy lifestyles and
self-care on the basis of the knowledge and skills acquired in accordance with points (1)
and (2);
9. Competency to independently initiate immediate measures to pre- serve life and to carry
out measures in crisis and disaster situations;
9191
92
93
Field JC, Cowpe JG, Walmsley AD. The Graduating European Dentist: A New Undergraduate Curriculum
Framework. Eur J Dent Educ. 2017;21(Suppl. 1):2-10. https://doi.org/10.1111/eje.12307
http://www.efnweb.be/wp-content/uploads/EFN-Competency-Framework-19-05-2015.pdf.
http://www.efnweb.be/wp-content/uploads/EFN-Competency-Framework-19-05-2015.pdf.
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10.
Competency to independently advise, instruct and support individuals needing care
and their attachment figures;
11.
Competency to independently ensure the quality of nursing care and assess it;
12.
Competency to communicate comprehensively and professionally and to cooperate
with members of other professions in the health sector;
13.
Competency to analyse the quality of care in order to improve their own professional
practice as general care nurses.
The competences included in Directive 2013/55/EU are different from the competences
contained in the EFN Competency Framework. These competences contain the following
competences on health promotion and disease prevention, guidance and teaching:
•
•
•
To promote healthy lifestyles, preventive measures and self-care by strengthening
empowerment, promoting health and enhancing behaviours and therapeutic
compliance;
To independently protect the health and well-being of individuals, families or
groups being cared for, ensuring their safety and promoting their autonomy;
To integrate, promote and apply theoretical, methodological and practical
knowledge. This enables the promotion and the development of nursing care in
long term care, co-morbidity and in situations of dependency in order to maintain
an individual’s personal autonomy and his/her relationships with the environment
in every moment of the health/illness process.
Nurse specialist
The European Specialist Nurses Organisation (ESNO) defines the nurse specialist as follows:
“The Nurse Specialist (NS) is an advanced practice Nurse prepared as a specialist within a
clinical specialty at the master’s, post master’s or doctoral level”94. Following the ESNO, the
competencies should be considered as a reference, template and guidelines for the different
specialities, in which each speciality can define its own knowledge, skills and attitudes.
Generic competencies are the clinical role, patient relationship, patient teaching/coaching,
mentoring, research, organisation and management, communication and teamwork, ethic
and decision making, leadership and policy making and prevention. The competency of
prevention is based on the case for investing in public health from the World Health
Organization95. The competency of prevention is based on the ability of promoting health
and prevent disease, by the capacity to develop and put in place intervention in:
•
•
•
•
•
•
•
94
95
96
Surveillance of population health and wellbeing;
Disease prevention at the 3 levels of prevention (primary, secondary);
Ability to promote health and prevent disease;
Monitoring and response to health hazards and emergencies;
Health promotion including actions to address social determinants and healthy
inequities;
Advocacy, communication and social mobilization for health advancing public
health;
Research to inform policy and practice96.
https://www.esno.org/assets/harmonise-common_training_framework.pdf.
http://www.euro.who.int/__data/assets/pdf_file/0009/278073/Case-Investing-Public-Health.pdf?ua=1.
https://www.esno.org/assets/harmonise-common_training_framework.pdf.
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Occupational therapist
The World Federation of Occupational Therapists (WFOT), provided minimum standards for
the education of occupational therapists.97 One of the settings in which occupational
therapists work is defined as following: “Community or group approaches such as health
promotion, community development, community based rehabilitation, injury prevention,
environmental design, disaster preparation and recovery”. Furthermore, under essential
knowledge, skills & attitudes for competent practice, the following (could) relate to health
promotion and disease prevention:
•
•
Knowledge about:
- The relationship between occupation and human development over the life
course, including healthy ageing;
- The relationship between psychological social and economic factors and
occupation (e.g., stress, adjustment to life changes including disability,
societal disruption, natural or man-made disaster, displacement);
- Early identification and functional interventions focusing on somatosensory
stimulation and performance mechanisms mitigating early developmental and
environmental factors impacting negatively on behaviour and learning;
- How activity limitations and participation in occupation affect health. This
includes the ability to maintain a healthy environment and personal factors
such as adjustment, interpersonal relationships and social networks;
- How health conditions and threats to health affect participation in work.
Skills in:
- Inter-sectoral collaboration in public health initiatives;
- Assessing health in relation to occupation.
In addition, the Tuning programme described the reference points for the design and
delivery degree programmes in occupational therapy98, in which they first ranked subject
specific competency. One of the highest ranked included:
•
Enable individuals/groups/organisations/communities to be engaged in occupation
through health promotion, prevention, rehabilitation, treatment and
coaching/training.
In the final set of subject specific competences, however, this is mentioned less explicitly
and only the following are related to health promotion and disease prevention:
•
97
98
Knowledge, the occupational therapist is able to:
- Work in partnership with individuals and groups, using occupation in
prevention, rehabilitation, and treatment in order to promote participation,
health and well-being;
- Explain the relationship between occupational performance, health and wellbeing;
- Collaborate with communities to promote and develop the health and wellbeing of their members through their participation in occupation;
- Develop new knowledge of occupation and occupational therapy practice,
particularly in relation to local and/or emerging health and social challenges.
https://www.wfot.org/assets/resources/COPYRIGHTED-World-Federation-of-Occupational-TherapistsMinimum-Standards-for-the-Education-of-Occupational-Therapists-2016a.pdf.
http://tuningacademy.org/wp-content/uploads/2014/02/RefOccupationalTherapy_EU_EN.pdf.
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Pharmacists
In a two-stage large-scale Delphi process, fifty competences of pharmacy practice were
ranked and the Quality Assurance in European Pharmacy Education and Training (PHARQA) framework was harmonized and validated.99 Of these fifty competences the following
relate to health promotion and disease prevention:
•
•
•
•
Ability to promote public health in collaboration with other professionals within the
healthcare system;
Ability to provide appropriate lifestyle advice to improve patient outcomes;
(e.g., advice on smoking, obesity, etc.);
Ability to use pharmaceutical knowledge and provide evidence-based advice on
public health issues involving medicines.
Physiotherapists
According to the World Confederation for Physical Therapy (WCPT), the scope of physical
therapists practices includes (among others): public health strategies and advocating for
patients/clients and for health.100 Furthermore, it is described that physical therapists may
have the following purposes:
•
•
promoting the health and wellbeing of individuals and the general public/society,
emphasising the importance of physical activity and exercise;
preventing impairments, activity limitations, participatory restrictions and
disabilities in individuals at risk of altered movement behaviours due to health
factors, socio-economic stressors, environmental factors and lifestyle factors.
The European Network of Physiotherapy in Higher Education (ENPHE) also described
professional competencies of physiotherapists. 101 According to the ENPHE, one of the roles
of a physiotherapist is to be a:
•
Health care promotor:
- Advocate on health and wellbeing promotion and disease or injury prevention
on behalf of patient/clients and the profession to enhance individual,
community and public health;
- Promote adherence to local, regional, national and EU health and safety
policies, guidelines and protocols.
Psychologist
The European Federation of Psychologists’ Associations, developed the European Certificate
in Psychology – the EuroPsy.102 The Tuning programme also published ‘Reference points for
the design and delivery of degree programmes in Psychology’, 103 in which they state that
the Tuning programme and the EuroPsy programme have experienced a parallel
development over the last ten years. In fact, the Tuning document presents a reference
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5419365/.
https://www.wcpt.org/policy/ps-descriptionPT.
101
http://www.enphe.org/wpcontent/uploads/2019/10/ESCO_report_ENPHE_recommendations_April_2017.pdf.
102
http://www.inpa-europsy.it/moduli/EuroPsy%20Regulations%20July%202011.pdf.
103
http://www.unideusto.org/tuningeu/images/stories/Summary_of_outcomes_TN/Psychology_reference_points.
pdf.
99
100
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Health promotion and disease prevention including lifestyle medicine in health and
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point for the design and delivery of degree programmes in psychology on the basis of the
EuroPsy programme.
Based on the definition of the key role of the professional psychologist, health promotion
and disease prevention could be part of the profession, as this has been described as
follows: "to develop and apply psychological principles, knowledge, models and methods in
an ethical and scientific way in order to promote the development, well-being and
effectiveness of individuals, groups, organisations and society". However, no specific
competences related to health promotion and disease prevention are now described in the
documents. It is plausible though, that psychologist do act to promote health, as the core
of their profession is to help others to understand behaviour, to improve performance and
well-being, or to alleviate problems and distress. As these emergent specialisms develop in
response to new demands, there is a tendency to develop education and training
programmes, thus increasing the specialisation, and the requirement for specialist skills of
professional psychology.
Social worker
Global standards for the education and training of the social work profession are developed
by the International Association of Schools of Social Work (IASSW). 104 The IASSW
worldwide association of schools of social work, other tertiary level social work educational
programmes, and social work educators. These global standards include, for example,
standards regarding the school’s core purpose or mission statement; standards regarding
programme objectives and outcomes; standards with regard to programme curricula
including field education. The standards with regard to the core curricula are organised into
four conceptual components: domain of the social work profession, domain of the social
work professional, methods of social work practice and paradigm of the social work
profession, under which several sub-domains are described, which mainly relate to aspects
such as inadequacies, discrimination, tradition and culture, social stability and ethical
principles. The following touch upon the field of health promotion and disease prevention:
•
•
•
•
104
Knowledge of human behaviour and development and of the social environment,
with particular emphasis on the person-in-environment transaction, life-span
development and the interaction among biological, psychological, socio-structural,
economic, political, cultural and spiritual factors in shaping human development
and behaviour (domain of the social work profession);
Sufficient practice skills in, and knowledge of, assessment, relationship building
and helping processes to achieve the identified goals of the programme for the
purposes of social support, and developmental, protective, preventive and/or
therapeutic intervention – depending on the particular focus of the programme or
professional practice orientation (methods of social work practice);
The application of social work values, ethical principles, knowledge and skills to
promote care, mutual respect and mutual responsibility amongst members of a
society (methods of social work practice);
Problem-solving and anticipatory socialisation through an understanding of the
normative developmental life cycle, and expected life tasks and crises in relation
to age-related influences, with due consideration to socio-cultural expectations
(paradigm of the social work profession).
https://www.iassw-aiets.org/wp-content/uploads/2018/08/Global-standards-for-the-education-and-trainingof-the-social-work-profession.pdf.
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Health promotion and disease prevention including lifestyle medicine in health and
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The European Social Network (ESN) investigated the social services workforce throughout
Europe and provided an overview of qualifications and skills in different Member States in
their research report, showing that qualification and skills for social care workers differ per
country.105 In fact, in some countries there are specific training routes for social care
workers including specialised training courses or apprenticeships and the content of these
trainings depends on the service user group and is generally defined at a local or authority
level. A questionnaire was set out in which essential components of social care workers
were identified, which showed that health and safety is seen as an important component
of social work.
105
https://www.esn-eu.org/sites/default/files/publications/Investing_in_the_social_service_workforce_WEB.pdf.
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Health promotion and disease prevention including lifestyle medicine in health and
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ANNEX 3 ONLINE SURVEY
Survey: Health promotion and disease prevention in health and educational
settings
Health promotion and disease prevention in health and educational settings medical schools. The European Union has commissioned Ecorys, an international
research and consultancy agency, to conduct a project on health promotion and
disease prevention in health and educational settings. In order to provide an EU
wide overview and to better support national governments, we would like to ask
for your cooperation. The project will develop an EU wide overview of the
education/training programmes for basic education, postgraduate education, as
well as continuous professional development with regard to education on health
promotion. Your help will therefore be key in the collection of information and
data on public health initiatives in medical and non-medical education. The survey
will take approximately 20 minutes of your time. You do not need to complete this
survey at once. You may leave the survey and continue at a later moment in
time. Questions can be saved by clicking on the 'pauze' button (below the
questionnaire). When doing so, a new URL link will be provided. We would be
pleased if you could provide this information by means of an online questionnaire
to Ecorys, who is also available in case you have questions or you would like
additional information: • Ms. Emalie Hurkmans (Project Coordinator); tel: +31
(0)6 280 579 21; email: emalie.hurkmans@ecorys.com • Ms. Tessa Huis in ‘t
Veld; tel: +31 6 29 22 10 58; email: tessa.huisintveld@ecorys.com
*
What is the name of your education?
*
What are the website details of the education?Please, enter the link of the website
with information of the education
Can you give a brief description of the education?
*
What type of health professionals are trained in the education?
Medical doctors
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Health promotion and disease prevention including lifestyle medicine in health and
educational settings
Medical specialists
Physical therapists
Occupational therapists
Nurses
Psychologists
Dentists
Social workers
Other, please specify
............................................................
What type of medical specialist?
*
Is the education:
Undergraduate education
Postgraduate education
Continuous professional development
*
Is the course accreditated?
Yes
No
Unknown
*
Does the course cover the topic health promotion and disease prevention?
Yes
No
*
Is the education accreditated?
Yes
No
Unknown
*
Does the education cover the topic health promotion and disease prevention?
Yes
No
*
How is the topic health promotion and disease prevention incorporated in the
curriculum?
In a seperate module
Topic incorporated into curriculum
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Health promotion and disease prevention including lifestyle medicine in health and
educational settings
Who is (are) the contact person(s) of the module health promotion and disease
prevention? Enter the name(s) and mailaddres(ses) of the contact person(s) who
has/have the authority to require consultation
*
Was there any partnerships in setting up the module health promotion and disease
prevention? For example other universities
Yes
No
Unknown
*
Are there any partnerships with regard to the execution of the teaching activities
on health promotion and disease prevention? If there are any partnerships (e.g.
businesses, NGOs, individual citizens, governmental agencies who have a role) fill
in yes, and replace namely (..) by the partnership in place.
Yes
No
Unknown
*
*
Has the education obtained any funding to set up the module on health promotion
and disease prevention? EU funding, national public funding, local public funding
or commercial private funding (e.g. pharmaceutical companies)
Yes
No
Unknown
Which health professionals are teaching health promotion and disease prevention?
Medical doctors
Medical specialists
Physical therapists
Occupational therapists
Nurses
Psychologists
Dentists
Social workers
Other, please specify
............................................................
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Health promotion and disease prevention including lifestyle medicine in health and
educational settings
Since when is the module on health promotion and disease prevention provided?
e.g. since September 2017
What is the timescale of the module? E.g. is it a two weeks, one month or one
year programme?
What is the typical quantity in hours spend at health promotion and disease
prevention by participants? The amount of hours spent on attendence and
homework
*
Is the module health promotion and disease prevention accreditated separately?
No
Unknown
Yes, please specify how many points are given
............................................................
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Health promotion and disease prevention including lifestyle medicine in health and
educational settings
*
Is it mandatory education?
Yes
No
Unknown
*
Is there an exam at the end of the module?
No
Unknown
Yes, please specify what type of exam
............................................................
*
Is the module also provided at other locations? For example at other universities
Yes
No
Unknown
Is there a contact person(s)/expert for the topic health promotion and disease
prevention?
*
Was there any partnerships in incorporating it in the curriculum?
Yes
No
Unknown
*
Are there any partnerships with regard to the execution of the teaching activities
on health promotion and disease prevention? If there are any partnerships (e.g.
businesses, NGOs, individual citizens, governmental agencies who have a role) fill
in yes, and replace namely (...) by the partnership in place.
Yes
No
Unknown
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Health promotion and disease prevention including lifestyle medicine in health and
educational settings
*
Has the education obtained funding to incorporate health promotion and disease
prevention into the curriculum? EU funding, national public funding, local public
funding or commercial private funding (e.g. pharmaceutical companies)
Yes
No
Unknown
*
Which health professionals are teaching health promotion and disease prevention?
Medical doctors
Medical specialists
Physical therapists
Occupational therapists
Nurses
Psychologists
Dentists
Social workers
Other, please specify
............................................................
Since when is health promotion and disease prevention incorporated into the whole
curriculum? e.g. since September 2017
What is the typical quantity in hours (approximately) spend at health promotion
and disease prevention by participants? The amount of hours spent on attendence
and homework
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Health promotion and disease prevention including lifestyle medicine in health and
educational settings
In what way are knowledge and skills with regard to health promotion and disease
prevention tested in the curriculum? For example incorporated into a written exam
Who is (are) the contact person(s) of the course on health promotion and disease
prevention? Enter the name(s) and mailaddres(ses) of the contact person(s) who
has/have the authority to require consultation
*
Were there any partnerships in setting up the course on health promotion and
disease prevention? For example other universities
Yes
No
Unknown
*
Are there any partnerships with regard to the execution of the teaching activities
on health promotion and disease prevention? If there are any partnerships (e.g.
business, NGO's, individual citizens, governmental agencies who have a role fill in
yes, and add by the partnership in place
No
Yes, please specify
............................................................
*
Has the education obtained any funding to set up the course on health promotion
and disease prevention?
Yes
No
Unknown
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Health promotion and disease prevention including lifestyle medicine in health and
educational settings
*
Which health professionals are teaching health promotion and disease prevention?
Medical doctors
Medical specialists
Physical therapists
Occupational therapists
Nurses
Psychologists
Dentists
Social workers
Other, please specify
............................................................
Since when is the course on health promotion and disease prevention provided?
e.g. since September 2017
What is the timescale of the course? e.g. two weeks, one month or one year
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Health promotion and disease prevention including lifestyle medicine in health and
educational settings
What is typical quantity in hours spend at health promotion and disease prevention
by participants? The amount of hours spent on attendence and homework
*
Is the course on health promotion and disease prevention accreditated separately?
No
Unknown
Yes, how many points are given?
............................................................
*
Is it mandatory education?
Yes
No
Unknown
*
Is there an exam at the end of the course?
No
Unknown
Yes, what type of exam?
............................................................
*
Is the course provided at multiple locations? For example at other universities
Yes
No
Unknown
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Health promotion and disease prevention including lifestyle medicine in health and
educational settings
What are the general objectives of the teaching activities on health promotion and
disease prevention? e.g. arise awareness among Medical Doctors on the
importance of physical activity within the elderly population with a high risk of
heart failure
Which stakeholders were involved in developing the teaching activities on health
promotion and disease prevention?
*
Is there made use of a mono- or multidisciplinary approach?
Monodisciplinairy approach
Multidisciplinary approach
Unknown
*
Does the education include theories of
1
Yes
2
No
3
Unknown
Population health
Human cognition
and behaviour
Health behaviour
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Health promotion and disease prevention including lifestyle medicine in health and
educational settings
*
Does the education include:
1
Yes
2
No
3
Unknown
Epidemiology and
bio-statistics
(research
capacity)
Methods
of
evidence-based
medicine
Health
policies
and regulation
Health economics
Ethics
Health
systems
care
Digitalisation
in
health promotion
Health inequalities
Disease
prevention
teams
in
Health literacy
Health behaviour
change
techniques
Communication
skills
Digital
health
coaching
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Health promotion and disease prevention including lifestyle medicine in health and
educational settings
*
Concerning teaching methods of health promotion and disease prevention, which
methods are used:
1
2
3
Yes
No
Unknown
Lectures
Assignments
Field training in real environments
eLearning modules
Other, please specify
............................................................
Concerning covered competencys or capacities of health promotion and disease
prevention, the main focus is on:
*
What are the expected outcomes:
1
Yes
2
No
3
Unknown
Knowledge
Skills
Behaviour/
attitudes
Relevant output (if available) e.g. number of students following the module
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Health promotion and disease prevention including lifestyle medicine in health and
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Do you think it is likely you will apply the learned knowledge and skills (on health
promotion and disease prevention) in daily practice after completion of this
education
Yes, please specify
No, please specify
Not sure, please specify
Is there a reason why this education might be a good example for other
educational settings with regard to the way that health promotion and disease
prevention is covered in the education?
Are there any remarks? Please feel free to give overall remarks or initiative-specific
remarks
Your responses have been registered! Thank you for taking the time to complete
the survey, your input is valuable to us.
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Health promotion and disease prevention including lifestyle medicine in health and
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HOW TO OBTAIN EU PUBLICATIONS
Free publications:
• one copy:
via EU Bookshop (http://bookshop.europa.eu);
• more than one copy or posters/maps:
from the European Union’s representations (http://ec.europa.eu/represent_en.htm);
from the delegations in non-EU countries (http://eeas.europa.eu/delegations/index_en.htm);
by contacting the Europe Direct service (http://europa.eu/europedirect/index_en.htm) or
calling 00 800 6 7 8 9 10 11 (freephone number from anywhere in the EU) (*).
(*)
The information given is free, as are most calls (though some operators, phone boxes or hotels may charge you).
Priced publications:
• via EU Bookshop (http://bookshop.europa.eu).
102