The European Society’s HERMES
Project, a Model to Emulate
Francesco Blasi
Department Pathophysiology and Transplantation,
University of Milan, Italy
Disclosures
• I have accepted grants, speaking and conference
invitations from
Almirall, Angelini, AstraZeneca,
Bayer, Chiesi, GSK, Guidotti-Malesci, Menarini,
Novartis,
Pfizer,
and
Zambon
• I have had recent or ongoing consultancy with Almirall,
Angelini, AstraZeneca, GSK, Menarini, Mundipharma
and Novartis
What is HERMES?
Harmonised Education in
Respiratory Medicine for
European Specialists
MISSION OF THE HERMES INITIATIVE
Harmonised
Training
standards
across the
European Union
Recognition of
diplomas and
certificates of
qualification in
medicine in EU
Free access and
mobility for
European
medical
specialists
EU CONTEXT: FREE ACCESS AND MOBILITY
• EU mutual recognition of diplomas and certificates of
qualification in medicine in all member countries
• EU parliament 2013 modernised the 2005 directive (Directive
2013/55/EU)
– Modernisation of the definition for harmonised minimum training
requirements for professions which benefit from automatic recognition
– For example for doctors, modernised directive clarifies that the basic
medical education ought to be based on 5’500 training hours done
within a minimum of 5 years
EUROPEAN PROFESSIONAL QUALIFICATIONS
LANDSCAPE AND PLAYERS
Postgraduate
Specialist
Training
• Universities
• Training
Centres
• Training
Centre
Networks
Certification
• National
authorities
• HERMES
• UEMS central
• UEMS section of
pneumology
• EAP/Section of
Paediatrics
• Other sections
(ICM, Thoracic
Surgery, Oncology)
Continuing
Medical
Education
• National
authorities/
regulatory
boards
• EBAP
• EACCME
Adult
Respiratory
Medicine
(2005)
HERMES
Task Forces
2005-2014
Paediatric
Respiratory
Medicine
(2008)
Respiratory
Infections
(2014)
Thoracic
Surgery (2014)
Spirometry
(2009)
Respiratory
Sleep
Medicine
(2009)
Physiotherapy
(2012)
Thoracic
Oncology
(2011)
Respiratory
Critical Care
(2010)
HERMES Project
Preliminary
Phase
Phase 1
Phase 2
Phase 3
Phase 4
Core Syllabus
Completed Sept 06
Core Curriculum
Completed Sept 08
European Exam
First Oct 08
Standards for Training
Centres (not started)
HERMES Project
Preliminary
Phase
Phase 1
Phase 2
Phase 3
Phase 4
Core Syllabus
Completed Sept 06
Core Curriculum
Completed Sept 08
European Exam
First Oct 08
Standards for Training
Centres (not started)
What does the
Examination look like?
• Knowledge-based only
• Paper-based multiple-choice questionnaire (MCQ) in
English; 90 questions; 3 hrs
• Blueprint for the content of the examination is the
consensus-based European syllabus (Breathe 2006; 3:
59-70) available in 24 languages at:
http://hermes.ersnet.org/452-syllabus-dissemination.htm
What does the
Examination look like?
Why take a European
Examination?
Advantages for the individual:
• Proof of Excellence: to demonstrate to patients
and colleagues your commitment to high-quality
life-long learning
• Mobility: if moving to another country, the
European Diploma will certainly be known and
recognised within the profession
• Self-assessment: you may wish to find out where
you stand against the current European standard
• Tangible recognition: European Diploma and
membership of ERS School Diplomate Club
The European Diploma
in Adult Respiratory
Medicine
Re-validation:
To comply with European Curriculum
recommendations (Breathe Sept 2008; volume 5,
number 1), candidates are advised to voluntarily
re-sit the European Examination every 5 years to
demonstrate that their knowledge is up-to-date.
It is mandatory to re-sit the Examination every
10 years or the right to hold the Diploma will
lapse.
SIMER INTERNATIONAL
SCHOOL
-
Lectures
Review of current guidelines
-
Interactive sessions
MCQ Clinical Cases
SIMER INTERNATIONAL
SCHOOL
A 24-year-old woman has had a long-standing mild, persistent asthma for which she
has been using approximately four puffs (44 mcg/puff) per day od inhaled fluticasone
and approximately two to four puffs of albuterol per week with good results. However,
approximately 6 months ago, she and her husband bought and moved into a new
house, which they are living in and slowly renovating. Although the main triggers to her
asthma are believed to be cats and ragweed, she has noted a deterioration in her
asthma since they moved in, despite multiple steps to limit her potential exposure to
dust and mold during renovations. She has continued her fluticasone at the same dose
but is now using two puffs of albuterol four to six times per day. She awakens because
of asthma symptoms approximately once per week, and although she has not curtailed
her regular activities, she reports feeling “more winded than usual”.
Physical examination results are notable only for rare scattered wheezes on exhalation.
FEV1 is 2.99 L (74% predicted), and FVC is 4.69 (98% predicted): the flow-volume
loop shows mild expiratory coving.
Assuming that no additional opportunities for trigger avoidance are identified, what is
the most appropriate next step in her pharmacologic management?
A.Add a long-acting B-agonist to her current dose of inhaled fluticasone
B.Add montelukast to her current dose of inhaled fluticasone
C.Add omalizumab therapy to her current dose of inhaled fluticasone
D.Change her dose of inhaled fluticasone to four puffs bid of the 220 mcg/puff
SIMER INTERNATIONAL
SCHOOL
12-15 December 2011
Existing country
collaborations
ADULT
• Switzerland
• Netherlands
• Russia
• Spain
• Portugal
• Austria
• Ireland
PAEDIATRIC
• UK
ACCREDITATION
Feedback collated from centres
 The opportunity to be part of a Pan-European network of
centres
 To benchmark trainee facilities and educational
opportunities
 To receive recommendations on how to improve
 To present to the national ministry of health (for
example) any basic standards not met which will justify
requests for additional budget for training and facilities
FROM AN ERS PERSPECTIVE
 Bridge the gap between European criteria and local
implementation
Qualification
for
Accreditation
Qualification
based on ERS
Criteria for
Accreditation
Document
Step 2
Step 1
ACCREDITATION STEPS
Site Visit and
Accreditation
Accreditation
based on
monitoring and
implementation
of ERS criteria
for
accreditation
EDUCATIONAL RESOURCES
ERS HANDBOOKS
• ERS Handbook Series
–
–
–
–
2nd edition Respiratory Medicine
Respiratory Sleep Medicine
Self-Assessment in Respiratory Medicine
Paediatric Respiratory Medicine
HERMES Publications
HERMES Adult Booklet
HERMES Paediatric Booklet
HERMES Project Phases
Preliminar Syllabus
y Phase
Curriculum
Published Outputs
Phase 3, 4 and 5
Standards
and
Frameworks
Analysis of training &
certification
Analysis of training gap
Phase 1 & 2
Assessments
Accreditation of Training
Centres
Continuous Professional
Development and
accreditation
Educational Resources
Applicability and acceptability of standards
Adult Respiratory Medicine, Paediatric Respiratory Medicine. Multidisciplinary groups eg Respiratory
Critical Care, Respiratory Sleep medicine, Thoracic Oncology, incorporation of skills assessment in
addition to knowledge based assessment (HERMES Exam + portfolio), involvement of AHPs,
scientists and trained staff
CONTINUOUS PROCESSES
CONSIDERED
 Unifying processes and ensure
robust methodology
 Investigation of outcomes on
how standards are used
Consolidation
 Strategies of implementation
 Value of criteria and how they
impact training and the
healthcare system
CME/CPD
opportunities
Based on HERMES standards (syllabi, curricula, accreditation criteria etc)
Linkages
 UEMS and other EU entities
 Other ERS committees
(guidelines, scientific etc)
 EBAP
 Other professional associations
 Training centres/networks
 Other local/national authorities
CHALLENGES
• Promoting state-of-the-art medical education
(curriculum development, assessments,
teaching and learning etc)
• Differences in acceptability and applicability
of the recommendations in different
countries
Applicability
Finding the
balance 
Acceptability
HERMES CHALLENGES
• Translation (different languages) of educational
standards and assessments
• Different lengths of training across EU countries
• Different organisation of training across EU countries
• Legal aspects of practice in various fields
• Availability of resources in different countries for
training
• Legal adoption of educational standards and
assessments
• Models of collaboration for accreditation (individuals,
centres and networks)
PRIORITIES
HERMES PRIORITIES
 Consolidation of HERMES projects
 Development of processes for implementation of educational
standards
 Scientific approach with the processes involved (including
Delphi technique and measurements)
 Development of the HERMES initiative as a European/regional
approach
 Developing CME/CPD standards for trained specialists
 Exploration of legal aspects
RIGOROUS VALIDATION and COMMITMENT
in formulating the educational standards
through robust methodologies in medical
education.
THE TRANSNATIONAL NATURE OF THE HERMES
INITIATIVE HIGHLIGHTS AND ADDRESSES THE
CURRENT TREND OF MOBILITY AMONG
SPECIALISTS AND PATIENTS WITHIN EUROPE.
THANK YOU FOR YOUR ATTENTION !