Needs for PRM and Allied Health Professional Education at the European and National Levels Maria Gabriella Ceravolo

May 13th 2019

Needs for PRM and allied health professional education at the European and National Levels Maria Gabriella Ceravolo

President of the UEMS PRM Board

Neurorehabilitation Clinic, United Hospitals of Ancona, Dept of Experimental and Clinical Medicine Faculty of Medicine, Politecnica delle Marche University, ITALY- [email protected]

R2S2 2nd Edition – Porto Potenza Picena (MC) ITALY - May 13-18, 2019 Needs for PRM and allied health professional education at the European and National Levels Maria Gabriella Ceravolo DISCLOSURE

I HAVE NO CONFLICTS OF INTERESTS TO DISCLOSE

R2S2 2nd Edition – Porto Potenza Picena (MC) ITALY - May 13-18, 2019 Needs for PRM and allied health professional education at the European and National Levels Maria Gabriella Ceravolo R2S2 2nd Edition – Porto Potenza Picena (MC) ITALY - May 13-18, 2019 Needs for PRM and allied health professional education at the European and National Levels Maria Gabriella Ceravolo R2S2 2nd Edition – Porto Potenza Picena (MC) ITALY - May 13-18, 2019 Needs for PRM and allied health professional education at the European and National Levels Maria Gabriella Ceravolo The need to scale up rehabilitation

R2S2 2nd Edition – Porto Potenza Picena (MC) ITALY - May 13-18, 2019 Needs for PRM and allied health professional education at the European and National Levels Maria Gabriella Ceravolo R2S2 2nd Edition – Porto Potenza Picena (MC) ITALY - May 13-18, 2019 Needs for PRM and allied health professional education at the European and National Levels Maria Gabriella Ceravolo R2S2 2nd Edition – Porto Potenza Picena (MC) ITALY - May 13-18, 2019 Needs for PRM and allied health professional education at the European and National Levels Maria Gabriella Ceravolo N. HOSPITAL BED S/1000 people.

ITALY 70 /100000 people

Italy Poland Spain Russia Czech Republic Romania Netherlands Belgium Portugal Slovakia Republic Bulgaria Georgia Croatia Hungary Norway Greece United Kingdom Israel FYROM Latvia Slovenia Luxembourg Ireland Cyprus Malta Ukraine 0 500 1000 1500 2000 2500 3000

R2S2 2nd Edition – Porto Potenza Picena (MC) ITALY - May 13-18, 2019 Needs for PRM and allied health professional education at the European and National Levels Maria Gabriella Ceravolo R2S2 2nd Edition – Porto Potenza Picena (MC) ITALY - May 13-18, 2019 Needs for PRM and allied health professional education at the European and National Levels Maria Gabriella Ceravolo Many countries, especially in western Europe, have well-developed tertiary care services of a high quality, although not always available to all sections of society. In many cases disease registries, risk factor survey instruments and surveillance systems are lacking or not fit for purpose, with only limited disaggregation of data by sex, age or social strata. This presents problems for comparative analysis and benchmarking between and within countries, and means that monitoring of trends and the impacts of interventions is limited. R2S2 2nd Edition – Porto Potenza Picena (MC) ITALY - May 13-18, 2019 Needs for PRM and allied health professional education at the European and National Levels Maria Gabriella Ceravolo SWOT ANALYSIS OF MAJOR STRENGTHS, WEAKNESSES OPPORTUNITIES AND THREADS OF HEALTH SYSTEMS IN THE EU COUNTRIES

R2S2 2nd Edition – Porto Potenza Picena (MC) ITALY - May 13-18, 2019 Needs for PRM and allied health professional education at the European and National Levels Maria Gabriella Ceravolo R2S2 2nd Edition – Porto Potenza Picena (MC) ITALY - May 13-18, 2019 Needs for PRM and allied health professional education at the European and National Levels Maria Gabriella Ceravolo 10 CORE ESSENTIAL PUBLIC HEALTH OPERATIONS

1. Surveillance Of Population Health And Well-being; 2. Monitoring And Response To Health Hazards And Emergencies; 3. Health Protection, Including Environmental, Occupational And Food Safety And Others; 4. Health Promotion, Including Action To Address Social Determinants And Health Inequi-y; 5. Disease Prevention, Including Early Detection Of Illness; 6. Assuring Governance For Health; 7. Assuring A Competent Public Health Workforce; 8. Assuring Organizational Structures And Financing; 9. Information, Communication And Social Mobilization For Health; 10. Advancing Public Health Research To Inform Policy And Practice.

R2S2 2nd Edition – Porto Potenza Picena (MC) ITALY - May 13-18, 2019 Needs for PRM and allied health professional education at the European and National Levels Maria Gabriella Ceravolo EPHO REQUISITES 1. Surveillance Of Population Health statistics system, health-related surveys, the health management And Well-being information system and existing disease registries 2. Monitoring And Response To Health identification and monitoring of health hazards (natural, human-caused and Hazards And Emergencies; technological) 3. Health Protection, Including protection of environmental, occupational health; food safety, patient Environmental, Occupational And Food Safety And Others; safety, road safety and consumer product safety 4. Health Promotion, Including Action To government and health system responses to the main risk factors and Address Social Determinants And Health Inequity determinants of health; promotion of changes in lifestyle, practices and environmental and social conditions 5. Disease Prevention, Including Early Vaccination; maternal and neonatal health programmes, smoking cessation Detection Of Illness; services ; secondary prevention ; services in place to foster good quality of life (tertiary and quaternary prevention), support for patient groups and rehabilitation, survivorship and disease management programmes. social support systems that create a supportive environment for behaviour change and assist caregivers at a psychosocial level. 6. Assuring Governance For Health; capacity of the ministry of health to lead public health efforts both within and outside the health system; effectiveness of the health policy cycle 7. Assuring A Competent Public Health capacities to plan for, manage, educate and govern the public health Workforce; workforce. 8. Assuring Organizational Structures financing public health services; describe the decision-making criteria used And Financing; to allocate resources. 9. Information, Communication And public health communication campaigns; use of ICT in the health system Social Mobilization For Health; 10. Advancing Public Health Research To setting a national research agenda ; capacity-building for public health Inform Policy And Practice. research; integration of research in educational activities and public health

R2S2 2nd Edition – Porto Potenza Picena (MC) ITALY - Maypractice, 13-18, 2019 Needs dissemination for PRM and allied health professionalof evidence education at and the European knowledge and National Levels-brokering; Maria Gabriella Ceravolo Needs for PRM and allied health professional education at the European and National Levels

❑ greater strength through mutual co-operation;

❑ a unified voice in the international representation of medical specialists;

❑ international excellence in key areas of relevance to the medical profession;

❑ effective interaction and support between NMAs and the UEMS, and between individual specialties and the UEMS;

❑ addressing interdisciplinary issues in emerging areas of specialist medical practice;

❑ setting the basis for the robust accreditation of the educational meetings attended by our colleagues;

❑ the development of new, harmonized models for the training of the next generation of medical specialists, and of high standards of clinical practice, hence improved care for patients throughout Europe.

IS a Working Group of Physical and Rehabilitation Medicine Section of the Union Européenne des Médecins Specialistes (U.E.M.S., European Union of Medical Specialists).

was founded by a separate statute in 1991.

IS INTERESTED in defining in clear terms "European Standards", i.e. the basic elements for a European training programme, the opportunities and conditions for training rotation, attachments, exchanges and the average level of required knowledge and technical competence.

aims to harmonize the training in E.U. so as to ensure optimal rehabilitative care for patients in the countries of European Union.

WILL PURSUE the objectives of UEMS in so far as they apply to Physical and Rehabilitation Medicine.

Certification of PRM specialists (by examination and equivalence

Certification of PRM trainers

Certification/Recertification of PRM training centres

Continuing Medical Education and Recertification of PRM Specialists

Accreditation of European congresses and Teaching Programmes

This goal is currently pursued

- Delivering documents, position papers on standards of PRM education

- Delivering educational material published on the Board educational platform

- Offering a graduate educational programme, accessible by trainees at European Congresses accredited by the Board , Board organized Teaching Programmes (ESM, EMRSS, RSS) Board organized Teaching Sessions during European Congresses

White Book of PRM in Europe. Chapter 9 – Education and continuous professional development: shaping the future of PRM

R2S2 2nd Edition – Porto Potenza Picena (MC) ITALY - May 13-18, 2019 Needs for PRM and allied health professional education at the European and National Levels Maria Gabriella Ceravolo - Documents, position papers on standards of PRM education White Book of PRM in Europe. Chapter 9 – Education and continuous professional development: shaping the future of PRM

R2S2 2nd Edition – Porto Potenza Picena (MC) ITALY - May 13-18, 2019 Needs for PRM and allied health professional education at the European and National Levels Maria Gabriella Ceravolo - Documents, position papers on standards of PRM education White Book of PRM in Europe. Chapter 9 – Education and continuous professional development: shaping the

This Chapter answers the following MAIN question: future of PRM

WHAT is needed to a physician to become (and remain) a Specialist in PRM ? (education and training requirements, core curriculum of theoretical knowledge and main competencies, skills and attitudes)

It develops through dealing with the following issues TABLE OF CONTENTS

WHAT is the state of art of education in PRM across European countries EDUCATION AND TRAINING

WHAT is the recommended standard in the Education and Standards in education and training of PRM training of PRM specialists across Europe physicians • Training duration • Directors of Training, Trainers and training units WHAT is needed to any physician to understand the role of PRM • Assessment of learning /training outcomes physicians and rehabilitation? (undergraduate PRM training) • Certification procedures Undergraduate Training

HOW are knowledge and competencies maintained as the PRM physicians grow older and the contextual factors change CONTINUING PROFESSIONAL DEVELOPMENT (CPD) AND MEDICAL EDUCATION (CME) WHAT competencies should any PRM physician achieve, based on the epidemiology of diseases and the main concept of the CURRICULUM IN PRM: MAIN PRINCIPLES highest efficacyR2S2 and 2nd Editionsoundness – Porto Potenza of Picenaa patient(MC) ITALY-centered - May 13-18, 2019approach Needs for PRM and allied health professional education at the European and National Levels Maria Gabriella Ceravolo TRAINING REQUIREMENTS IN PHYSICAL AND REHABILITATION MEDICINE

1. Content of training and learning outcome

…the trainee should become familiar with the theoretical knowledge about the full spectrum of Body a. Theoretical knowledge structure/Body function impairments, the mechanisms of tissue damage and repair, the principles of motor learning, the epidemiology and natural history of diseases, the tools for clinical, functional and instrumental diagnosis, the effects of pharmacological, surgical and complementary treatments, as well as of specific rehabilitation interventions. b. Practical and clinical skills • clinical and instrumental assessment to determine the pathophysiology mechanisms and the underlying diagnosis of the patient’s condition. • functional assessment in the frame of ICF, including assessment of body function/structure impairment, assessment of activity limitation and participation restriction and discrimination between capacity and performance, based on the detection of contextual (personal characteristics) and environmental barriers/facilitators • implementation of clinical and instrumental assessment tools to explore motor, cognitive, behavioural and autonomic functions. • prognosis of disease/disability course, detection of adverse/favourable factors of functional recovery and definition of the means (ways) of recovery, compensation and adaptation; • devising and conducting a rehabilitation plan, through a team-based approach that consists of setting achievable short, medium and long-term goals, agreed with the patient and carers, and eventually leading to patient’s reintegration in the community and improved quality of life; • 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 (orthotics, prosthetics, wheelchairs and others), effective to achieve the goals of the rehabilitation plan; • prevention and management of complications c. Professionalism PRM practice is uniquely characterized by a team-based, patient-centred, goal-directed approach aimed to optimize patient function and quality of life, prevent complications and increase community participation. Therefore, PRM specialists are required to develop not only medical knowledge, competence in patient care and specific procedural skills, but also attitudes towards interpersonal relationship and communication, profound understanding of the main principles of medical ethics and public health, ability to apply policies of care and prevention for disabled people, capacity to master strategies for reintegration of disabled people into society, apply principles of quality assurance and promote a practice-based continuous professional development. As leaders of the multi- professional rehabilitation teams involved in the continuum of care delivery from hospital to the community, they must also exhibit managerial competences, know and apply the principles of evidence-based medicine, incorporate considerations of cost awareness and risk-benefit analysis in patient and/or population- based care as appropriate

2. Organization of training a. Schedule of training the PRM educational program in Europe is usually configured in 48-month format, rising up to 72 months in some countries, including a minimum 36 months of clinical training (of which 24 months spent in a PRM department). However, considering the tremendous increase in life expectancy all over Europe, and the consequent increase in age-related disabling illnesses with acute onset and chronic course, the frequency and complexity of comorbidities in rehabilitation wards have markedly increased. Patients are admitted to wards much earlier after the onset of acute illness or injury and the complexity of the disabilities is also rising. For this reason the UEMS PRM Section and Board requires a duration of training of 60 months including 12 months rotations in external departments (like internal medicine, neurology, intensive care and others).

A written Training Curriculum must be designed to provide a diversified and balanced quality (theoretical and practical) of b. Curriculum of training PRM education describing the contents and aims in each year of training. There should be established rotation periods covering all main areas of PRM practice. There should be a documented, continuous Education Programme which should include seminars, conferences and meetings at a regular basis (weekly, monthly, yearly).

Logbook Each trainee must keep an authorized Logbook for documentation of professional experience c. Support of trainees (not only, functional assessments, rehabilitation plans, active participation in team meetings, procedural skills; but also, multisource feedback from other members of the rehabilitation team)Patient feedback) The minimal numbers per year of each of these items should be determined nationally d. Assessment and evaluation E-Portfolio (.including an up-to-date curriculum vitae - EUROPASS style)i

Exit examination The Training Director certifies the attainment of adequate competency level for each training outcome. The final year examination must verify that the trainee has demonstrated sufficient competence to enter practice e. Governance without direct supervision and has achieved the standard level of entrustable professional activity. The minimum levels of applied clinical knowledge and applied clinical skills that a trainee must exhibit at the exit examination are reported for each single item of the whole Curriculum of Studies in PRM.

R2S2 2nd Edition – Porto Potenza Picena (MC) ITALY - May 13-18, 2019 Needs for PRM and allied health professional education at the European and National Levels Maria Gabriella Ceravolo II. TRAINING REQUIREMENTS FOR TRAINERS 1. Process for recognition as trainer To be recognized as a trainer, a physician should: a. Requested qualification and experience • Be certified as a specialist in PRM by the responsible national authority in his or her country. • Be recognized as a trainer in PRM by the responsible national authority in his or her country. • Demonstrate his or her clinical activity as being within this discipline. • Practice in the specialty for at least 80% of his or her time in an establishment recognized as a training centre by the national responsible authority over 5 years. • Practice within a defined rehabilitation team. Actively participate in training and research in PRM with regular publications b. Core competencies for trainers 2. Quality management for trainers

III. TRAINING REQUIREMENTS FOR TRAINING INSTITUTIONS 1. Process for recognition as training center a. Requirement on staff and clinical activities

To be recognized as a PRM training unit of European level, an institution/department must: • Be recognized as a training facility in PRM by the responsible national authority in its Country. • Be directed by a doctor, who is: - a specialist in PRM, recognized as a trainer by the European Board, - responsible for a team comprising: one more Board certified specialist in PRM, professionals allied to medicine, including physiotherapists and occupational therapists as well as a group of other personnel (speech therapists, psychologists, social workers). • Have all the necessary infrastructure to provide the training in PRM as defined in the curriculum (i.e. the facilities to perform diagnostic assessments, functional investigation and measurement, and treatments relevant to the discipline of PRM) • Have adequate teaching staff • Provide the trainee with space and opportunities for practical and theoretical study and access to adequate national and international professional literature • Have a structured training program, which includes theoretical teaching sessions, training duties for each trainer and adequate numbers of practical procedures per trainee • Undergo monitoring in a structured way by the national authorities including visits and appraisal of their standards as training centres on a regular basis • Have an internal system of medical audit or quality assurance including features such as reporting of accidents in accordance with a structured procedures • Maintain a network of contacts among clinical colleagues and professionals allied to medicine in hospital settings and services assisting the discharge of patients into the community. R2S2 2nd Edition – Porto Potenza Picena (MC) ITALY - May 13-18, 2019 Needs for PRM and allied health professional education at the European and National Levels Maria Gabriella Ceravolo III. TRAINING REQUIREMENTS FOR TRAINING INSTITUTIONS 2. Quality Management within Training institutions

Training centers must be recognized as a training facility in PRM by the responsible national authority. It is expected that training a. Accreditation centers undergo regular audit within their country with respect to their clinical, scientific and educational activity; therefore the audit would include data relating to the progress of trainees and their acquisition of specialist accreditation. The UEMS-PRM Board will recognize a PRM department/center as a European training center after successful completion of their procedure of a European appraisal, according to the rules published at http://www.euro-prm.org/index.php?option=com_content&view=article&id=22&Itemid=300&lang=en

Training centers should undertake internal audits of their performance as part of the requirements for continuing national accreditation. b. Clinical Governance Any national evaluation of a training center’s performance is expected to include the demonstration that it is: - providing care for patients with a wide range of disabling health conditions - providing educational and training support for trainees - part of a healthcare system that provides immediate access to relevant laboratory and other investigations as well as providing when necessary immediate access to other clinical specialties that maybe required by their patients - ensure the continuum of care Training centers should keep records of the progress of their trainees.

There are currently around 20000 PRM-specialists in Europe and 3000 PRM trainees, with a median ratio of c. Manpower planning 4 PRM physicians and 0,5 PRM trainees/100000 inhabitants, across different countries; the median number of hospital beds for intensive rehabilitation is around 100/100000 inhabitants. These figures account for a prospective increase of the total number of PRM specialists, in line with the increasing demand for rehabilitation provision and adequately staffed rehabilitation facilities

d. Regular report

PHYSICAL AND REHABILITATION MEDICINE

Standard minimum levels to be achieved on completion of postgraduate course Content /Learning Unit Applied clinical knowledge Applied clinical skill CHAPTER 1. THE FUNDAMENTALS OF PRM

CHAPTER 2. Human anatomy, physiology, applied physics, biochemistry, BODY STRUCTURES AND BODY biomechanics FUNCTIONS CHAPTER 3. Use (indications, application and Ability to administer selective clinical measures , CLINICAL DIAGNOSIS AND FUNCTIONAL interpretation) of selective clinical interpreting the results and exploiting them for clinical and instrumental measures. ASSESSMENT IN PRM decision making ; Indications and prescription/referral for intervention by Indications and evidence-based allied health professionals based on the expected outcome CHAPTER 4. INTERVENTIONS IN PRM cost-to-benefit ratio and within the framework of the individual rehabilitaton project/plan Direct administration of the intervention . CHAPTER 5. REHABILITATION APPROACHES TO Functional diagnosis and prognosis of functional recovery DISEASE –SPECIFIC DISABILITIES in the affected subject, planning the individual rehabilitation project, team work coordination, monitoring of intervention delivery and assessment of outcome, CHAPTER 6. throughout the continuum of care in the inpatient and PRM APPROACH TO DISABLING Epidemiology, pathogenesis, outpatient setting, with special attention to the early PRM CONDITIONS IN THE ELDERLY clinical assessment, rehabilitation intervention in the acute hospital stay, the involvement of techniques, prognostic factors of family carers and social workers , the development of recovery, for each health condition community rehabilitation projects aimed at preventing CHAPTER 7. functional decline and complications; the adaptation of PRM APPROACH TO DISABLING rehabilitation goals to the changing needs of disabled individuals during growth, also through the active CONDITIONS IN CHILDREN. involvement of parents, caregivers, school teachers and other education professionals

CHAPTER 8. Ability to develop the different components of the research RESEARCH IN REHABILITATION Theoretical bases of each studies thematic area and their relevance CHAPTER 9. to clinical practice and research Ability to transfer theoretical knowledge to clinical practice INTEGRATIVE AND CLINICAL in PRM REHABILITATION SCIENCES

R2S2 2nd Edition – Porto Potenza Picena (MC) ITALY - May 13-18, 2019 Needs for PRM and allied health professional education at the European and National Levels Maria Gabriella Ceravolo Standard minimum levels to be achieved on completion of CURRICULUM OF STUDIES IN Content /Learning Unit postgraduate course PHYSICAL AND REHABILITATION MEDICINE Applied clinical knowledge Applied clinical skill CHAPTER 1. For applied clinical knowledge the following THE FUNDAMENTALS OF PRM levels are used: 1. The trainee masters a thematic area on a basic level CHAPTER 2. Human anatomy, physiology, applied physics, 2. The trainee has partially mastered a BODY STRUCTURES AND BODY biochemistry, biomechanics thematic area FUNCTIONS 3. The trainee has fully mastered the Use (indications, thematic area and is familiar with CHAPTER 3. application and Ability to administer selective clinical measures , CLINICAL DIAGNOSIS AND interpretation) of selective interpreting the results and exploiting them for relevant literature FUNCTIONAL ASSESSMENT IN PRM clinical and instrumental clinical decision making ; measures. Indications and prescription/referral for For applied clinical skills the following levels intervention by allied health professionals based Indications and evidence- are used: CHAPTER 4. on the expected outcome and within the INTERVENTIONS IN PRM based cost-to-benefit ratio 1. The trainee has experience of selecting framework of the individual rehabilitaton the procedure appropriately and project/plan interpreting the results but not Direct administration of the intervention . CHAPTER 5. necessarily experience of performing the REHABILITATION APPROACHES Functional diagnosis and prognosis of functional procedure. 2. The trainee is able to go beyond level 1 TO DISEASE –SPECIFIC recovery in the affected subject, planning the individual rehabilitation project, team work and perform the procedure with limited DISABILITIES coordination, monitoring of intervention delivery supervision/assistance in routine cases. and assessment of outcome, throughout the 3. The trainee independently is able to CHAPTER 6. continuum of care in the inpatient and outpatient Epidemiology, pathogenesis, recognise the indication for, perform and PRM APPROACH TO DISABLING setting, with special attention to the early PRM clinical assessment, interpret the results of the procedure CONDITIONS IN THE ELDERLY intervention in the acute hospital stay, the rehabilitation techniques, and manage any complications arising. involvement of family carers and social workers , prognostic factors of the development of community rehabilitation recovery, for each health projects aimed at preventing functional decline condition For core competencies the following levels CHAPTER 7. and complications; the adaptation of rehabilitation goals to the changing needs of are used PRM APPROACH TO DISABLING disabled individuals during growth, also through 1. The trainee needs help and supervision CONDITIONS IN CHILDREN. the active involvement of parents, caregivers, to work and solve the problems of the school teachers and other education thematic area professionals 2. The trainee needs partial professional supervision to work and solve the CHAPTER 8. Ability to develop the different components of the problems of the thematic area RESEARCH IN REHABILITATION Theoretical bases of each research studies thematic area and their 3. The trainee is able to work relevance to clinical independently and solve the problems of CHAPTER 9. practice and research in Ability to transfer theoretical knowledge to the thematic area, has knowledge of INTEGRATIVE AND CLINICAL PRM clinical practice own capacities and limitations, is ready REHABILITATION SCIENCES for referral to other specialists R2S2 2nd Edition – Porto Potenza Picena (MC) ITALY - May 13-18, 2019 Needs for PRM and allied health professional education at the European and National Levels Maria Gabriella Ceravolo THEMATIC AREA LEVEL OF ADVANCEMENT 1 2 3 GENERAL COMPETENCIES Date and mentor’s signature 1 The trainee has Knowing and applying the mastered a thematic principles of medical ethics and deontology area on a basic level Possessing professionalism, humanity and he needs help and and ethics with the obligation to protect the privacy and dignity of the patient supervision to work Knowing the art of dealing with and solve the problems patients, colleagues and other experts - communication skills of the thematic area Being able to convey relevant information and explanations in a 2 The trainee has comprehensible and appropriate partially mastered a manner to the patient (verbally and in writing) and his family and to thematic area and with colleagues and other experts with the partial professional goal of joint participation in planning and implementation of health care supervision is able to BASIC KNOWLEDGE OF THE Date and mentor’s work and solve the SPECIALIZATION signature problems of the Anatomy and physiology of the musculoskeletal system thematic area Pathophysiology of the musculoskeletal system 3 The trainee has fully Pathophysiology of pain, the interaction of mastered the thematic pain and movement General and Applied Biomechanics area, is familiar with Kinesiology relevant literature and ELECTRODIAGNOSTICS: Date and mentor’s is able to work ELECTROMYOGRAPHY, signature independently and CONDUCTIVITY STUDY OF NERVES AND EVOKEND POTENTIALS solve the problems of Electromyography

the R2S2thematic 2nd Edition – Porto area. Potenza Picena (MC) ITALY - May 13-18, 2019 Needs forElectroneurography PRM and allied health professionaland education evoked at the European potentials and National Levels Maria Gabriella Ceravolo THANKS TO……

R2S2 2nd Edition – Porto Potenza Picena (MC) ITALY - May 13-18, 2019 Needs for PRM and allied health professional education at the European and National Levels Maria Gabriella Ceravolo