Continuing medical education (CME) refers to the set of (structured or regulated) educational activities aimed at the acquisition, maintenance or improvement of professional competencies. In general terms, CME is usually defined as a set of educational activities that physicians undertake once they have completed their period of undergraduate and specialisation studies in order to keep their skills up to date and which do not involve the awarding of any additional qualification ¹.

Any doctor, after six years’ undergraduate studies and a further five years of specialisation, has at least 35 years before them in which to practise their profession. We know that over the course of those 35 years knowledge in the field will advance exponentially and physicians will update their competencies through CME. It is no wild claim to say that all doctors update their know-how by means of the different resources made available by CME.

Having established the need for and the universal use of CME, we now ask ourselves about the need to accredit it. Even the briefest reflection on the matter enables us to put forward several arguments that support that necessity, but here we will focus on just two of them. First, faced with the wide range of training courses on offer, the quality and quantity of which are growing in crescendo, it is useful for the physician to know the opinion that experts have regarding the different training activities. This experts’ opinion, which is reflected in a certain number of credits, allows the doctor to choose the activity whose quality and duration best match his or her needs as regards the updating of knowledge. Let us consider, for example, two activities of the same length addressing the same topic, but one of them has been rated with more credits than the other. It is obvious that the one with the higher number of credits, in the experts’ opinion, will be an activity of greater interest. In other words, accreditation enables the physician to make a correct choice from among an increasingly wider offer.

There is also a second key argument for accrediting CME. In addition to enabling the doctor to make better-informed choices, accrediting the training activities on offer helps direct CME towards fields, areas, knowledge, therapies and methodologies that the professional would never choose because he or she is unaware of their existence. Since the evaluation is carried out by experts, as is to be expected, they will grant an especially high value (number of credits) to the most relevant activities in processes of change, new discoveries and novel advances in medicine. Thus, accreditation not only makes things easier for the professional but must also be understood as an instrument for the management of healthcare that will help the physician to be prepared to fulfil his or her professional duties and thereby ensure that the medical act carried out in any given place and at any given time is the best possible.

In today’s world, the accreditation of CME is in the hands of the professionals involved. Yet, the ’management’ of the accreditation of CME can be performed by different agents, who may be from the professional sphere, the healthcare authorities or even from the world of business. In the United States, both accreditation and management are the responsibility of the professionals through the American Medical Association (AMA), and the same occurs in Europe, where both the accreditation and the management of CME are essentially undertaken by the Union Européenne des Médecins Spécialistes (UEMS).

In Spain, we have two ways by which CME can be accredited. The first, which has a long history and recognised prestige, is the one that is managed by the 17 autonomous regions, under the coordination of the Continuing Education Committee of the Spanish National Health Service. This accreditation system has gained prestige over the years thanks to its methodological rigour and its good management. In some regions, however, it is slower than would be desirable, although this does not mean it is of lower quality. Since the credits in this system are those of the different healthcare authorities (Spanish Ministry of Health and autonomous regions), they are not questioned in any process of selecting or assessing professionals, as may be the case of calls to fill public sector job vacancies.

Another CME accreditation system is the one the professional organisations set up before the healthcare authorities themselves did the same, this latter system in fact being a copy of the first from start to finish. At the beginning of the year 2000, the Official Medical Association of Barcelona (COMB) implemented a process for the accreditation of CME that was quickly adopted by the General Council of Official Medical Associations (CGCOM). With the aim of avoiding a situation in which it was seen as both judge and jury, the CGCOM set up, together with the main professional representatives, what was known as the Spanish Medical Professional Accreditation Council for CPD/CME (SEAFORMEC)². Initially, SEAFORMEC managed its own credits, but some years later, when the Spanish National Health Service (SNS) implemented the National System for the Accreditation of Continuing Education, it also administered the SNS credits in parallel to the offices within each autonomous region. Nevertheless, a court ruling in the year 2011 withdrew the Ministry of Health’s power to accredit CME, arguing that powers regarding healthcare matters had already been transferred to the autonomous regions; consequently, SEAFORMEC lost its accreditation capacity because it had been granted this power by delegation by the Ministry of Health. Today, with regard to the SNS credits, SEAFORMEC only manages the CME credits of the autonomous regions in which they have specifically been delegated again³.

In any event, SEAFORMEC has continued to accredit CME with its own credits, the Spanish Professional Credit for CPD/CME (CEP-DPC). These credits have also gained increased prestige as a result of their methodological rigour and the good management they enjoy, although they have not always been recognised by the healthcare institutions of the SNS. Yet, the SEAFORMEC credits have been recognised by the UEMS, so that, by means of a cooperation agreement between the two institutions, SEAFORMEC has gained the capacity to accredit Spanish local activities with European credits from the UEMS, the so-called European Continuous Medical Education Credits (ECMEC). In sum, it can be said that SEAFORMEC currently issues three types of credits: those of the SEAFORMEC itself (CEP-DPC), the SNS credits of the autonomous regions that have had the management of accreditation transferred to them, and the UEMS credits (ECMEC) for local activities with a maximum participation of 400 professionals (for a better understanding, please see the figure).

Finally, attention should be drawn to another relevant activity for professionals carried out with the aim of providing access to CME credits. More particularly we are referring to international credits and their conversion into SNS credits. This is a very convenient process for professionals who carry out international activities that have UEMS credits (ECMEC) or credits from the United States or Canada issued by the AMA (AMA-Pra 1 credits). It could be the case that CME activities undertaken in Europe or the United States do not count in selection processes or public offers for employment in SNS institutions. In order to solve this matter, in 2015 the Spanish Ministry of Health entered into a tripartite agreement involving UEMS-EACCME-SEAFORMEC in order to undertake the official recognition of international credits. This process is managed through a computer platform which can be accessed from the SEAFORMEC website (www.seaformec.es). Once a professional has requested recognition of international CME credits, the platform issues two communications: one, to the Spanish Ministry of Health, indicating that the activity has been recognised, and another to the professional by means of a credential that indicates the international credits obtained and their equivalence in SNS credits.

In short, in Spain there are three complementary paths or procedures by which a promoter of CME activities can accredit them according to their own and the professional’s interests. Moreover, there is also a specific path for recognising international credits, whether they are from the UEMS or the AMA.