Annals of Medicine and Surgery

<!DOCTYPE html> <html dir="ltr" lang="en-US"> <head> <script type='text/javascript' data-ot-ignore>const otAllowScripts = ['/init.js']; new MutationObserver(function (d) { Array.prototype.forEach.call(d, function (g) { Array.prototype.forEach.call(g.addedNodes, function (e) { try { if ('script' === e.tagName?.toLowerCase() && otAllowScripts.some(s => e.src?.includes(s))) { e.setAttribute('data-ot-ignore', ''); } } catch (err) { console.error(err); } }) }) }).observe(document.documentElement, { childList: !0, subtree: !0, attributes: !0, attributeFilter: ['src'] });</script>  <script type="text/javascript" src="https://cdn.cookielaw.org/consent/7537629c-faa0-40ce-a837-f7b14c0d4e70/OtAutoBlock.js"></script> <script src="https://cdn.cookielaw.org/scripttemplates/otSDKStub.js" type="text/javascript" charset="UTF-8" data-domain-script="7537629c-faa0-40ce-a837-f7b14c0d4e70"></script> <script type="text/javascript" src="https://lww.com/_layouts/15/oaks.journals/core/lww-cookiepro.js?v=05.24.00.023"> </script> <title> Annals of Medicine and Surgery </title>   <script>(function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.setAttributeNode(d.createAttribute('data-ot-ignore'));j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-NLR6H6W');</script>  <meta name="GENERATOR" content="Microsoft SharePoint" /><meta http-equiv="Content-type" content="text/html; charset=utf-8" /><meta http-equiv="X-UA-Compatible" content="IE=edge" /><script type="text/javascript">window.NREUM||(NREUM={});NREUM.info = {"beacon":"bam.nr-data.net","errorBeacon":"bam.nr-data.net","licenseKey":"NRJS-310e337bbb542715b7f","applicationID":"1029107228","transactionName":"ZgdWMRZUVkVSBUBbCl9NdTY0GllYXQdYQUheBBkIAVFRVVoIUR8EXwYZFhFHX1NBHxttBlAWVQkLUksZXgdHRgBDElUCARpKU0AWW1wWWBRRFQVSXVpSH1tHER8DRxUc","queueTime":0,"applicationTime":406,"agent":"","atts":""}</script><script type="text/javascript">(window.NREUM||(NREUM={})).init={privacy:{cookies_enabled:true},ajax:{deny_list:["bam.nr-data.net"]},distributed_tracing:{enabled:true}};(window.NREUM||(NREUM={})).loader_config={agentID:"1103305545",accountID:"2792772",trustKey:"1191223",xpid:"VgEOU1FUChABVFNbBgEAVFYJ",licenseKey:"NRJS-310e337bbb542715b7f",applicationID:"1029107228"};;/*! For license information please see nr-loader-spa-1.281.0.min.js.LICENSE.txt */ (()=>{var e,t,r={8122:(e,t,r)=>{"use strict";r.d(t,{a:()=>i});var n=r(944);function i(e,t){try{if(!e||"object"!=typeof e)return(0,n.R)(3);if(!t||"object"!=typeof t)return(0,n.R)(4);const r=Object.create(Object.getPrototypeOf(t),Object.getOwnPropertyDescriptors(t)),o=0===Object.keys(r).length?e:r;for(let a in o)if(void 0!==e[a])try{if(null===e[a]){r[a]=null;continue}Array.isArray(e[a])&&Array.isArray(t[a])?r[a]=Array.from(new Set([...e[a],...t[a]])):"object"==typeof e[a]&&"object"==typeof t[a]?r[a]=i(e[a],t[a]):r[a]=e[a]}catch(e){(0,n.R)(1,e)}return r}catch(e){(0,n.R)(2,e)}}},2555:(e,t,r)=>{"use strict";r.d(t,{Vp:()=>c,fn:()=>s,x1:()=>u});var n=r(384),i=r(8122);const o={beacon:n.NT.beacon,errorBeacon:n.NT.errorBeacon,licenseKey:void 0,applicationID:void 0,sa:void 0,queueTime:void 0,applicationTime:void 0,ttGuid:void 0,user:void 0,account:void 0,product:void 0,extra:void 0,jsAttributes:{},userAttributes:void 0,atts:void 0,transactionName:void 0,tNamePlain:void 0},a={};function s(e){try{const t=c(e);return!!t.licenseKey&&!!t.errorBeacon&&!!t.applicationID}catch(e){return!1}}function c(e){if(!e)throw new Error("All info objects require an agent identifier!");if(!a[e])throw new Error("Info for ".concat(e," was never set"));return a[e]}function u(e,t){if(!e)throw new Error("All info objects require an agent identifier!");a[e]=(0,i.a)(t,o);const r=(0,n.nY)(e);r&&(r.info=a[e])}},9417:(e,t,r)=>{"use strict";r.d(t,{D0:()=>p,gD:()=>m,xN:()=>g});var n=r(3333),i=r(993);const o=e=>{if(!e||"string"!=typeof e)return!1;try{document.createDocumentFragment().querySelector(e)}catch{return!1}return!0};var a=r(2614),s=r(944),c=r(384),u=r(8122);const d="[data-nr-mask]",l=()=>{const e={feature_flags:[],experimental:{marks:!1,measures:!1,resources:!1},mask_selector:"*",block_selector:"[data-nr-block]",mask_input_options:{color:!1,date:!1,"datetime-local":!1,email:!1,month:!1,number:!1,range:!1,search:!1,tel:!1,text:!1,time:!1,url:!1,week:!1,textarea:!1,select:!1,password:!0}};return{ajax:{deny_list:void 0,block_internal:!0,enabled:!0,autoStart:!0},distributed_tracing:{enabled:void 0,exclude_newrelic_header:void 0,cors_use_newrelic_header:void 0,cors_use_tracecontext_headers:void 0,allowed_origins:void 0},get feature_flags(){return e.feature_flags},set feature_flags(t){e.feature_flags=t},generic_events:{enabled:!0,autoStart:!0},harvest:{interval:30},jserrors:{enabled:!0,autoStart:!0},logging:{enabled:!0,autoStart:!0,level:i.p_.INFO},metrics:{enabled:!0,autoStart:!0},obfuscate:void 0,page_action:{enabled:!0},page_view_event:{enabled:!0,autoStart:!0},page_view_timing:{enabled:!0,autoStart:!0},performance:{get capture_marks(){return e.feature_flags.includes(n.$v.MARKS)||e.experimental.marks},set capture_marks(t){e.experimental.marks=t},get capture_measures(){return e.feature_flags.includes(n.$v.MEASURES)||e.experimental.measures},set capture_measures(t){e.experimental.measures=t},capture_detail:!0,resources:{get enabled(){return e.feature_flags.includes(n.$v.RESOURCES)||e.experimental.resources},set enabled(t){e.experimental.resources=t},asset_types:[],first_party_domains:[],ignore_newrelic:!0}},privacy:{cookies_enabled:!0},proxy:{assets:void 0,beacon:void 0},session:{expiresMs:a.wk,inactiveMs:a.BB},session_replay:{autoStart:!0,enabled:!1,preload:!1,sampling_rate:10,error_sampling_rate:100,collect_fonts:!1,inline_images:!1,fix_stylesheets:!0,mask_all_inputs:!0,get mask_text_selector(){return e.mask_selector},set mask_text_selector(t){o(t)?e.mask_selector="".concat(t,",").concat(d):""===t||null===t?e.mask_selector=d:(0,s.R)(5,t)},get block_class(){return"nr-block"},get ignore_class(){return"nr-ignore"},get mask_text_class(){return"nr-mask"},get block_selector(){return e.block_selector},set block_selector(t){o(t)?e.block_selector+=",".concat(t):""!==t&&(0,s.R)(6,t)},get mask_input_options(){return e.mask_input_options},set mask_input_options(t){t&&"object"==typeof t?e.mask_input_options={...t,password:!0}:(0,s.R)(7,t)}},session_trace:{enabled:!0,autoStart:!0},soft_navigations:{enabled:!0,autoStart:!0},spa:{enabled:!0,autoStart:!0},ssl:void 0,user_actions:{enabled:!0,elementAttributes:["id","className","tagName","type"]}}},f={},h="All configuration objects require an agent identifier!";function p(e){if(!e)throw new Error(h);if(!f[e])throw new Error("Configuration for ".concat(e," was never set"));return f[e]}function g(e,t){if(!e)throw new Error(h);f[e]=(0,u.a)(t,l());const r=(0,c.nY)(e);r&&(r.init=f[e])}function m(e,t){if(!e)throw new Error(h);var r=p(e);if(r){for(var n=t.split("."),i=0;i<n.length-1;i++)if("object"!=typeof(r=r[n[i]]))return;r=r[n[n.length-1]]}return r}},5603:(e,t,r)=>{"use strict";r.d(t,{a:()=>c,o:()=>s});var n=r(384),i=r(8122);const o={accountID:void 0,trustKey:void 0,agentID:void 0,licenseKey:void 0,applicationID:void 0,xpid:void 0},a={};function s(e){if(!e)throw new Error("All loader-config objects require an agent identifier!");if(!a[e])throw new Error("LoaderConfig for ".concat(e," was never set"));return a[e]}function c(e,t){if(!e)throw new Error("All loader-config objects require an agent identifier!");a[e]=(0,i.a)(t,o);const r=(0,n.nY)(e);r&&(r.loader_config=a[e])}},3371:(e,t,r)=>{"use strict";r.d(t,{V:()=>f,f:()=>l});var n=r(8122),i=r(384),o=r(6154),a=r(9324);let s=0;const c={buildEnv:a.F3,distMethod:a.Xs,version:a.xv,originTime:o.WN},u={customTransaction:void 0,disabled:!1,isolatedBacklog:!1,loaderType:void 0,maxBytes:3e4,onerror:void 0,ptid:void 0,releaseIds:{},appMetadata:{},session:void 0,denyList:void 0,timeKeeper:void 0,obfuscator:void 0,harvester:void 0},d={};function l(e){if(!e)throw new Error("All runtime objects require an agent identifier!");if(!d[e])throw new Error("Runtime for ".concat(e," was never set"));return d[e]}function f(e,t){if(!e)throw new Error("All runtime objects require an agent identifier!");d[e]={...(0,n.a)(t,u),...c},Object.hasOwnProperty.call(d[e],"harvestCount")||Object.defineProperty(d[e],"harvestCount",{get:()=>++s});const r=(0,i.nY)(e);r&&(r.runtime=d[e])}},9324:(e,t,r)=>{"use strict";r.d(t,{F3:()=>i,Xs:()=>o,Yq:()=>a,xv:()=>n});const n="1.281.0",i="PROD",o="CDN",a="^2.0.0-alpha.17"},6154:(e,t,r)=>{"use strict";r.d(t,{A4:()=>s,OF:()=>d,RI:()=>i,WN:()=>h,bv:()=>o,gm:()=>a,lR:()=>f,m:()=>u,mw:()=>c,sb:()=>l});var n=r(1863);const i="undefined"!=typeof window&&!!window.document,o="undefined"!=typeof WorkerGlobalScope&&("undefined"!=typeof self&&self instanceof WorkerGlobalScope&&self.navigator instanceof WorkerNavigator||"undefined"!=typeof globalThis&&globalThis instanceof WorkerGlobalScope&&globalThis.navigator instanceof WorkerNavigator),a=i?window:"undefined"!=typeof WorkerGlobalScope&&("undefined"!=typeof self&&self instanceof WorkerGlobalScope&&self||"undefined"!=typeof globalThis&&globalThis instanceof WorkerGlobalScope&&globalThis),s="complete"===a?.document?.readyState,c=Boolean("hidden"===a?.document?.visibilityState),u=""+a?.location,d=/iPad|iPhone|iPod/.test(a.navigator?.userAgent),l=d&&"undefined"==typeof SharedWorker,f=(()=>{const e=a.navigator?.userAgent?.match(/Firefox[/\s](\d+\.\d+)/);return Array.isArray(e)&&e.length>=2?+e[1]:0})(),h=Date.now()-(0,n.t)()},7295:(e,t,r)=>{"use strict";r.d(t,{Xv:()=>a,gX:()=>i,iW:()=>o});var n=[];function i(e){if(!e||o(e))return!1;if(0===n.length)return!0;for(var t=0;t<n.length;t++){var r=n[t];if("*"===r.hostname)return!1;if(s(r.hostname,e.hostname)&&c(r.pathname,e.pathname))return!1}return!0}function o(e){return void 0===e.hostname}function a(e){if(n=[],e&&e.length)for(var t=0;t<e.length;t++){let r=e[t];if(!r)continue;0===r.indexOf("http://")?r=r.substring(7):0===r.indexOf("https://")&&(r=r.substring(8));const i=r.indexOf("/");let o,a;i>0?(o=r.substring(0,i),a=r.substring(i)):(o=r,a="");let[s]=o.split(":");n.push({hostname:s,pathname:a})}}function s(e,t){return!(e.length>t.length)&&t.indexOf(e)===t.length-e.length}function c(e,t){return 0===e.indexOf("/")&&(e=e.substring(1)),0===t.indexOf("/")&&(t=t.substring(1)),""===e||e===t}},1687:(e,t,r)=>{"use strict";r.d(t,{Ak:()=>c,Ze:()=>l,x3:()=>u});var n=r(7836),i=r(3606),o=r(860),a=r(2646);const s={};function c(e,t){const r={staged:!1,priority:o.P3[t]||0};d(e),s[e].get(t)||s[e].set(t,r)}function u(e,t){e&&s[e]&&(s[e].get(t)&&s[e].delete(t),h(e,t,!1),s[e].size&&f(e))}function d(e){if(!e)throw new Error("agentIdentifier required");s[e]||(s[e]=new Map)}function l(e="",t="feature",r=!1){if(d(e),!e||!s[e].get(t)||r)return h(e,t);s[e].get(t).staged=!0,f(e)}function f(e){const t=Array.from(s[e]);t.every((([e,t])=>t.staged))&&(t.sort(((e,t)=>e[1].priority-t[1].priority)),t.forEach((([t])=>{s[e].delete(t),h(e,t)})))}function h(e,t,r=!0){const o=e?n.ee.get(e):n.ee,s=i.i.handlers;if(!o.aborted&&o.backlog&&s){if(r){const e=o.backlog[t],r=s[t];if(r){for(let t=0;e&&t<e.length;++t)p(e[t],r);Object.entries(r).forEach((([e,t])=>{Object.values(t||{}).forEach((t=>{t[0]?.on&&t[0]?.context()instanceof a.y&&t[0].on(e,t[1])}))}))}}o.isolatedBacklog||delete s[t],o.backlog[t]=null,o.emit("drain-"+t,[])}}function p(e,t){var r=e[1];Object.values(t[r]||{}).forEach((t=>{var r=e[0];if(t[0]===r){var n=t[1],i=e[3],o=e[2];n.apply(i,o)}}))}},7836:(e,t,r)=>{"use strict";r.d(t,{P:()=>c,ee:()=>u});var n=r(384),i=r(8990),o=r(3371),a=r(2646),s=r(5607);const c="nr@context:".concat(s.W),u=function e(t,r){var n={},s={},d={},l=!1;try{l=16===r.length&&(0,o.f)(r).isolatedBacklog}catch(e){}var f={on:p,addEventListener:p,removeEventListener:function(e,t){var r=n[e];if(!r)return;for(var i=0;i<r.length;i++)r[i]===t&&r.splice(i,1)},emit:function(e,r,n,i,o){!1!==o&&(o=!0);if(u.aborted&&!i)return;t&&o&&t.emit(e,r,n);for(var a=h(n),c=g(e),d=c.length,l=0;l<d;l++)c[l].apply(a,r);var p=v()[s[e]];p&&p.push([f,e,r,a]);return a},get:m,listeners:g,context:h,buffer:function(e,t){const r=v();if(t=t||"feature",f.aborted)return;Object.entries(e||{}).forEach((([e,n])=>{s[n]=t,t in r||(r[t]=[])}))},abort:function(){f._aborted=!0,Object.keys(f.backlog).forEach((e=>{delete f.backlog[e]}))},isBuffering:function(e){return!!v()[s[e]]},debugId:r,backlog:l?{}:t&&"object"==typeof t.backlog?t.backlog:{},isolatedBacklog:l};return Object.defineProperty(f,"aborted",{get:()=>{let e=f._aborted||!1;return e||(t&&(e=t.aborted),e)}}),f;function h(e){return e&&e instanceof a.y?e:e?(0,i.I)(e,c,(()=>new a.y(c))):new a.y(c)}function p(e,t){n[e]=g(e).concat(t)}function g(e){return n[e]||[]}function m(t){return d[t]=d[t]||e(f,t)}function v(){return f.backlog}}(void 0,"globalEE"),d=(0,n.Zm)();d.ee||(d.ee=u)},2646:(e,t,r)=>{"use strict";r.d(t,{y:()=>n});class n{constructor(e){this.contextId=e}}},9908:(e,t,r)=>{"use strict";r.d(t,{d:()=>n,p:()=>i});var n=r(7836).ee.get("handle");function i(e,t,r,i,o){o?(o.buffer([e],i),o.emit(e,t,r)):(n.buffer([e],i),n.emit(e,t,r))}},3606:(e,t,r)=>{"use strict";r.d(t,{i:()=>o});var n=r(9908);o.on=a;var i=o.handlers={};function o(e,t,r,o){a(o||n.d,i,e,t,r)}function a(e,t,r,i,o){o||(o="feature"),e||(e=n.d);var a=t[o]=t[o]||{};(a[r]=a[r]||[]).push([e,i])}},3878:(e,t,r)=>{"use strict";function n(e,t){return{capture:e,passive:!1,signal:t}}function i(e,t,r=!1,i){window.addEventListener(e,t,n(r,i))}function o(e,t,r=!1,i){document.addEventListener(e,t,n(r,i))}r.d(t,{DD:()=>o,jT:()=>n,sp:()=>i})},5607:(e,t,r)=>{"use strict";r.d(t,{W:()=>n});const n=(0,r(9566).bz)()},9566:(e,t,r)=>{"use strict";r.d(t,{LA:()=>s,ZF:()=>c,bz:()=>a,el:()=>u});var n=r(6154);const i="xxxxxxxx-xxxx-4xxx-yxxx-xxxxxxxxxxxx";function o(e,t){return e?15&e[t]:16*Math.random()|0}function a(){const e=n.gm?.crypto||n.gm?.msCrypto;let t,r=0;return e&&e.getRandomValues&&(t=e.getRandomValues(new Uint8Array(30))),i.split("").map((e=>"x"===e?o(t,r++).toString(16):"y"===e?(3&o()|8).toString(16):e)).join("")}function s(e){const t=n.gm?.crypto||n.gm?.msCrypto;let r,i=0;t&&t.getRandomValues&&(r=t.getRandomValues(new Uint8Array(e)));const a=[];for(var s=0;s<e;s++)a.push(o(r,i++).toString(16));return a.join("")}function c(){return s(16)}function u(){return s(32)}},2614:(e,t,r)=>{"use strict";r.d(t,{BB:()=>a,H3:()=>n,g:()=>u,iL:()=>c,tS:()=>s,uh:()=>i,wk:()=>o});const n="NRBA",i="SESSION",o=144e5,a=18e5,s={STARTED:"session-started",PAUSE:"session-pause",RESET:"session-reset",RESUME:"session-resume",UPDATE:"session-update"},c={SAME_TAB:"same-tab",CROSS_TAB:"cross-tab"},u={OFF:0,FULL:1,ERROR:2}},1863:(e,t,r)=>{"use strict";function n(){return Math.floor(performance.now())}r.d(t,{t:()=>n})},7485:(e,t,r)=>{"use strict";r.d(t,{D:()=>i});var n=r(6154);function i(e){if(0===(e||"").indexOf("data:"))return{protocol:"data"};try{const t=new URL(e,location.href),r={port:t.port,hostname:t.hostname,pathname:t.pathname,search:t.search,protocol:t.protocol.slice(0,t.protocol.indexOf(":")),sameOrigin:t.protocol===n.gm?.location?.protocol&&t.host===n.gm?.location?.host};return r.port&&""!==r.port||("http:"===t.protocol&&(r.port="80"),"https:"===t.protocol&&(r.port="443")),r.pathname&&""!==r.pathname?r.pathname.startsWith("/")||(r.pathname="/".concat(r.pathname)):r.pathname="/",r}catch(e){return{}}}},944:(e,t,r)=>{"use strict";function n(e,t){"function"==typeof console.debug&&console.debug("New Relic Warning: https://github.com/newrelic/newrelic-browser-agent/blob/main/docs/warning-codes.md#".concat(e),t)}r.d(t,{R:()=>n})},5284:(e,t,r)=>{"use strict";r.d(t,{t:()=>c,B:()=>s});var n=r(7836),i=r(6154);const o="newrelic";const a=new Set,s={};function c(e,t){const r=n.ee.get(t);s[t]??={},e&&"object"==typeof e&&(a.has(t)||(r.emit("rumresp",[e]),s[t]=e,a.add(t),function(e={}){try{i.gm.dispatchEvent(new CustomEvent(o,{detail:e}))}catch(e){}}({loaded:!0})))}},8990:(e,t,r)=>{"use strict";r.d(t,{I:()=>i});var n=Object.prototype.hasOwnProperty;function i(e,t,r){if(n.call(e,t))return e[t];var i=r();if(Object.defineProperty&&Object.keys)try{return Object.defineProperty(e,t,{value:i,writable:!0,enumerable:!1}),i}catch(e){}return e[t]=i,i}},6389:(e,t,r)=>{"use strict";function n(e,t=500,r={}){const n=r?.leading||!1;let i;return(...r)=>{n&&void 0===i&&(e.apply(this,r),i=setTimeout((()=>{i=clearTimeout(i)}),t)),n||(clearTimeout(i),i=setTimeout((()=>{e.apply(this,r)}),t))}}function i(e){let t=!1;return(...r)=>{t||(t=!0,e.apply(this,r))}}r.d(t,{J:()=>i,s:()=>n})},3304:(e,t,r)=>{"use strict";r.d(t,{A:()=>o});var n=r(7836);const i=()=>{const e=new WeakSet;return(t,r)=>{if("object"==typeof r&&null!==r){if(e.has(r))return;e.add(r)}return r}};function o(e){try{return JSON.stringify(e,i())??""}catch(e){try{n.ee.emit("internal-error",[e])}catch(e){}return""}}},5289:(e,t,r)=>{"use strict";r.d(t,{GG:()=>o,sB:()=>a});var n=r(3878);function i(){return"undefined"==typeof document||"complete"===document.readyState}function o(e,t){if(i())return e();(0,n.sp)("load",e,t)}function a(e){if(i())return e();(0,n.DD)("DOMContentLoaded",e)}},384:(e,t,r)=>{"use strict";r.d(t,{NT:()=>o,US:()=>d,Zm:()=>a,bQ:()=>c,dV:()=>s,nY:()=>u,pV:()=>l});var n=r(6154),i=r(1863);const o={beacon:"bam.nr-data.net",errorBeacon:"bam.nr-data.net"};function a(){return n.gm.NREUM||(n.gm.NREUM={}),void 0===n.gm.newrelic&&(n.gm.newrelic=n.gm.NREUM),n.gm.NREUM}function s(){let e=a();return e.o||(e.o={ST:n.gm.setTimeout,SI:n.gm.setImmediate,CT:n.gm.clearTimeout,XHR:n.gm.XMLHttpRequest,REQ:n.gm.Request,EV:n.gm.Event,PR:n.gm.Promise,MO:n.gm.MutationObserver,FETCH:n.gm.fetch,WS:n.gm.WebSocket}),e}function c(e,t){let r=a();r.initializedAgents??={},t.initializedAt={ms:(0,i.t)(),date:new Date},r.initializedAgents[e]=t}function u(e){let t=a();return t.initializedAgents?.[e]}function d(e,t){a()[e]=t}function l(){return function(){let e=a();const t=e.info||{};e.info={beacon:o.beacon,errorBeacon:o.errorBeacon,...t}}(),function(){let e=a();const t=e.init||{};e.init={...t}}(),s(),function(){let e=a();const t=e.loader_config||{};e.loader_config={...t}}(),a()}},2843:(e,t,r)=>{"use strict";r.d(t,{u:()=>i});var n=r(3878);function i(e,t=!1,r,i){(0,n.DD)("visibilitychange",(function(){if(t)return void("hidden"===document.visibilityState&&e());e(document.visibilityState)}),r,i)}},8139:(e,t,r)=>{"use strict";r.d(t,{u:()=>f});var n=r(7836),i=r(3434),o=r(8990),a=r(6154);const s={},c=a.gm.XMLHttpRequest,u="addEventListener",d="removeEventListener",l="nr@wrapped:".concat(n.P);function f(e){var t=function(e){return(e||n.ee).get("events")}(e);if(s[t.debugId]++)return t;s[t.debugId]=1;var r=(0,i.YM)(t,!0);function f(e){r.inPlace(e,[u,d],"-",p)}function p(e,t){return e[1]}return"getPrototypeOf"in Object&&(a.RI&&h(document,f),c&&h(c.prototype,f),h(a.gm,f)),t.on(u+"-start",(function(e,t){var n=e[1];if(null!==n&&("function"==typeof n||"object"==typeof n)){var i=(0,o.I)(n,l,(function(){var e={object:function(){if("function"!=typeof n.handleEvent)return;return n.handleEvent.apply(n,arguments)},function:n}[typeof n];return e?r(e,"fn-",null,e.name||"anonymous"):n}));this.wrapped=e[1]=i}})),t.on(d+"-start",(function(e){e[1]=this.wrapped||e[1]})),t}function h(e,t,...r){let n=e;for(;"object"==typeof n&&!Object.prototype.hasOwnProperty.call(n,u);)n=Object.getPrototypeOf(n);n&&t(n,...r)}},3434:(e,t,r)=>{"use strict";r.d(t,{Jt:()=>o,YM:()=>c});var n=r(7836),i=r(5607);const o="nr@original:".concat(i.W);var a=Object.prototype.hasOwnProperty,s=!1;function c(e,t){return e||(e=n.ee),r.inPlace=function(e,t,n,i,o){n||(n="");const a="-"===n.charAt(0);for(let s=0;s<t.length;s++){const c=t[s],u=e[c];d(u)||(e[c]=r(u,a?c+n:n,i,c,o))}},r.flag=o,r;function r(t,r,n,s,c){return d(t)?t:(r||(r=""),nrWrapper[o]=t,function(e,t,r){if(Object.defineProperty&&Object.keys)try{return Object.keys(e).forEach((function(r){Object.defineProperty(t,r,{get:function(){return e[r]},set:function(t){return e[r]=t,t}})})),t}catch(e){u([e],r)}for(var n in e)a.call(e,n)&&(t[n]=e[n])}(t,nrWrapper,e),nrWrapper);function nrWrapper(){var o,a,d,l;try{a=this,o=[...arguments],d="function"==typeof n?n(o,a):n||{}}catch(t){u([t,"",[o,a,s],d],e)}i(r+"start",[o,a,s],d,c);try{return l=t.apply(a,o)}catch(e){throw i(r+"err",[o,a,e],d,c),e}finally{i(r+"end",[o,a,l],d,c)}}}function i(r,n,i,o){if(!s||t){var a=s;s=!0;try{e.emit(r,n,i,t,o)}catch(t){u([t,r,n,i],e)}s=a}}}function u(e,t){t||(t=n.ee);try{t.emit("internal-error",e)}catch(e){}}function d(e){return!(e&&"function"==typeof e&&e.apply&&!e[o])}},9300:(e,t,r)=>{"use strict";r.d(t,{T:()=>n});const n=r(860).K7.ajax},3333:(e,t,r)=>{"use strict";r.d(t,{$v:()=>u,TZ:()=>n,Zp:()=>i,kd:()=>c,mq:()=>s,nf:()=>a,qN:()=>o});const n=r(860).K7.genericEvents,i=["auxclick","click","copy","keydown","paste","scrollend"],o=["focus","blur"],a=4,s=1e3,c=["PageAction","UserAction","BrowserPerformance"],u={MARKS:"experimental.marks",MEASURES:"experimental.measures",RESOURCES:"experimental.resources"}},6774:(e,t,r)=>{"use strict";r.d(t,{T:()=>n});const n=r(860).K7.jserrors},993:(e,t,r)=>{"use strict";r.d(t,{ET:()=>o,TZ:()=>a,p_:()=>i});var n=r(860);const i={ERROR:"ERROR",WARN:"WARN",INFO:"INFO",DEBUG:"DEBUG",TRACE:"TRACE"},o="log",a=n.K7.logging},3785:(e,t,r)=>{"use strict";r.d(t,{R:()=>c,b:()=>u});var n=r(9908),i=r(1863),o=r(860),a=r(3969),s=r(993);function c(e,t,r={},c=s.p_.INFO){(0,n.p)(a.xV,["API/logging/".concat(c.toLowerCase(),"/called")],void 0,o.K7.metrics,e),(0,n.p)(s.ET,[(0,i.t)(),t,r,c],void 0,o.K7.logging,e)}function u(e){return"string"==typeof e&&Object.values(s.p_).some((t=>t===e.toUpperCase().trim()))}},3969:(e,t,r)=>{"use strict";r.d(t,{TZ:()=>n,XG:()=>s,rs:()=>i,xV:()=>a,z_:()=>o});const n=r(860).K7.metrics,i="sm",o="cm",a="storeSupportabilityMetrics",s="storeEventMetrics"},6630:(e,t,r)=>{"use strict";r.d(t,{T:()=>n});const n=r(860).K7.pageViewEvent},782:(e,t,r)=>{"use strict";r.d(t,{T:()=>n});const n=r(860).K7.pageViewTiming},6344:(e,t,r)=>{"use strict";r.d(t,{BB:()=>d,G4:()=>o,Qb:()=>l,TZ:()=>i,Ug:()=>a,_s:()=>s,bc:()=>u,yP:()=>c});var n=r(2614);const i=r(860).K7.sessionReplay,o={RECORD:"recordReplay",PAUSE:"pauseReplay",REPLAY_RUNNING:"replayRunning",ERROR_DURING_REPLAY:"errorDuringReplay"},a=.12,s={DomContentLoaded:0,Load:1,FullSnapshot:2,IncrementalSnapshot:3,Meta:4,Custom:5},c={[n.g.ERROR]:15e3,[n.g.FULL]:3e5,[n.g.OFF]:0},u={RESET:{message:"Session was reset",sm:"Reset"},IMPORT:{message:"Recorder failed to import",sm:"Import"},TOO_MANY:{message:"429: Too Many Requests",sm:"Too-Many"},TOO_BIG:{message:"Payload was too large",sm:"Too-Big"},CROSS_TAB:{message:"Session Entity was set to OFF on another tab",sm:"Cross-Tab"},ENTITLEMENTS:{message:"Session Replay is not allowed and will not be started",sm:"Entitlement"}},d=5e3,l={API:"api"}},5270:(e,t,r)=>{"use strict";r.d(t,{Aw:()=>c,CT:()=>u,SR:()=>s});var n=r(384),i=r(9417),o=r(7767),a=r(6154);function s(e){return!!(0,n.dV)().o.MO&&(0,o.V)(e)&&!0===(0,i.gD)(e,"session_trace.enabled")}function c(e){return!0===(0,i.gD)(e,"session_replay.preload")&&s(e)}function u(e,t){const r=t.correctAbsoluteTimestamp(e);return{originalTimestamp:e,correctedTimestamp:r,timestampDiff:e-r,originTime:a.WN,correctedOriginTime:t.correctedOriginTime,originTimeDiff:Math.floor(a.WN-t.correctedOriginTime)}}},3738:(e,t,r)=>{"use strict";r.d(t,{He:()=>i,Kp:()=>s,Lc:()=>u,Rz:()=>d,TZ:()=>n,bD:()=>o,d3:()=>a,jx:()=>l,uP:()=>c});const n=r(860).K7.sessionTrace,i="bstResource",o="resource",a="-start",s="-end",c="fn"+a,u="fn"+s,d="pushState",l=1e3},3962:(e,t,r)=>{"use strict";r.d(t,{AM:()=>o,O2:()=>c,Qu:()=>u,TZ:()=>s,ih:()=>d,pP:()=>a,tC:()=>i});var n=r(860);const i=["click","keydown","submit","popstate"],o="api",a="initialPageLoad",s=n.K7.softNav,c={INITIAL_PAGE_LOAD:"",ROUTE_CHANGE:1,UNSPECIFIED:2},u={INTERACTION:1,AJAX:2,CUSTOM_END:3,CUSTOM_TRACER:4},d={IP:"in progress",FIN:"finished",CAN:"cancelled"}},7378:(e,t,r)=>{"use strict";r.d(t,{$p:()=>x,BR:()=>b,Kp:()=>R,L3:()=>y,Lc:()=>c,NC:()=>o,SG:()=>d,TZ:()=>i,U6:()=>p,UT:()=>m,d3:()=>w,dT:()=>f,e5:()=>T,gx:()=>v,l9:()=>l,oW:()=>h,op:()=>g,rw:()=>u,tH:()=>A,uP:()=>s,wW:()=>E,xq:()=>a});var n=r(384);const i=r(860).K7.spa,o=["click","submit","keypress","keydown","keyup","change"],a=999,s="fn-start",c="fn-end",u="cb-start",d="api-ixn-",l="remaining",f="interaction",h="spaNode",p="jsonpNode",g="fetch-start",m="fetch-done",v="fetch-body-",b="jsonp-end",y=(0,n.dV)().o.ST,w="-start",R="-end",x="-body",E="cb"+R,T="jsTime",A="fetch"},4234:(e,t,r)=>{"use strict";r.d(t,{W:()=>o});var n=r(7836),i=r(1687);class o{constructor(e,t){this.agentIdentifier=e,this.ee=n.ee.get(e),this.featureName=t,this.blocked=!1}deregisterDrain(){(0,i.x3)(this.agentIdentifier,this.featureName)}}},7767:(e,t,r)=>{"use strict";r.d(t,{V:()=>o});var n=r(9417),i=r(6154);const o=e=>i.RI&&!0===(0,n.gD)(e,"privacy.cookies_enabled")},425:(e,t,r)=>{"use strict";r.d(t,{j:()=>j});var n=r(860),i=r(2555),o=r(3371),a=r(9908),s=r(7836),c=r(1687),u=r(5289),d=r(6154),l=r(944),f=r(3969),h=r(384),p=r(6344);const g=["setErrorHandler","finished","addToTrace","addRelease","recordCustomEvent","addPageAction","setCurrentRouteName","setPageViewName","setCustomAttribute","interaction","noticeError","setUserId","setApplicationVersion","start",p.G4.RECORD,p.G4.PAUSE,"log","wrapLogger"],m=["setErrorHandler","finished","addToTrace","addRelease"];var v=r(1863),b=r(2614),y=r(993),w=r(3785),R=r(2646),x=r(3434);const E=new Map;function T(e,t,r,n){if("object"!=typeof t||!t||"string"!=typeof r||!r||"function"!=typeof t[r])return(0,l.R)(29);const i=function(e){return(e||s.ee).get("logger")}(e),o=(0,x.YM)(i),a=new R.y(s.P);a.level=n.level,a.customAttributes=n.customAttributes;const c=t[r]?.[x.Jt]||t[r];return E.set(c,a),o.inPlace(t,[r],"wrap-logger-",(()=>E.get(c))),i}function A(){const e=(0,h.pV)();g.forEach((t=>{e[t]=(...r)=>function(t,...r){let n=[];return Object.values(e.initializedAgents).forEach((e=>{e&&e.api?e.exposed&&e.api[t]&&n.push(e.api[t](...r)):(0,l.R)(38,t)})),n.length>1?n:n[0]}(t,...r)}))}const S={};var N=r(9417),_=r(5603),O=r(5284);const I=e=>{const t=e.startsWith("http");e+="/",r.p=t?e:"https://"+e};let P=!1;function j(e,t={},g,R){let{init:x,info:E,loader_config:j,runtime:C={},exposed:k=!0}=t;C.loaderType=g;const L=(0,h.pV)();E||(x=L.init,E=L.info,j=L.loader_config),(0,N.xN)(e.agentIdentifier,x||{}),(0,_.a)(e.agentIdentifier,j||{}),E.jsAttributes??={},d.bv&&(E.jsAttributes.isWorker=!0),(0,i.x1)(e.agentIdentifier,E);const H=(0,N.D0)(e.agentIdentifier),M=[E.beacon,E.errorBeacon];P||(H.proxy.assets&&(I(H.proxy.assets),M.push(H.proxy.assets)),H.proxy.beacon&&M.push(H.proxy.beacon),A(),(0,h.US)("activatedFeatures",O.B),e.runSoftNavOverSpa&&=!0===H.soft_navigations.enabled&&H.feature_flags.includes("soft_nav")),C.denyList=[...H.ajax.deny_list||[],...H.ajax.block_internal?M:[]],C.ptid=e.agentIdentifier,(0,o.V)(e.agentIdentifier,C),e.ee=s.ee.get(e.agentIdentifier),void 0===e.api&&(e.api=function(e,t,h=!1){t||(0,c.Ak)(e,"api");const g={};var R=s.ee.get(e),x=R.get("tracer");S[e]=b.g.OFF,R.on(p.G4.REPLAY_RUNNING,(t=>{S[e]=t}));var E="api-",A=E+"ixn-";function N(t,r,n,o){const a=(0,i.Vp)(e);return null===r?delete a.jsAttributes[t]:(0,i.x1)(e,{...a,jsAttributes:{...a.jsAttributes,[t]:r}}),I(E,n,!0,o||null===r?"session":void 0)(t,r)}function _(){}g.log=function(e,{customAttributes:t={},level:r=y.p_.INFO}={}){(0,a.p)(f.xV,["API/log/called"],void 0,n.K7.metrics,R),(0,w.R)(R,e,t,r)},g.wrapLogger=(e,t,{customAttributes:r={},level:i=y.p_.INFO}={})=>{(0,a.p)(f.xV,["API/wrapLogger/called"],void 0,n.K7.metrics,R),T(R,e,t,{customAttributes:r,level:i})},m.forEach((e=>{g[e]=I(E,e,!0,"api")})),g.addPageAction=I(E,"addPageAction",!0,n.K7.genericEvents),g.recordCustomEvent=I(E,"recordCustomEvent",!0,n.K7.genericEvents),g.setPageViewName=function(t,r){if("string"==typeof t)return"/"!==t.charAt(0)&&(t="/"+t),(0,o.f)(e).customTransaction=(r||"http://custom.transaction")+t,I(E,"setPageViewName",!0)()},g.setCustomAttribute=function(e,t,r=!1){if("string"==typeof e){if(["string","number","boolean"].includes(typeof t)||null===t)return N(e,t,"setCustomAttribute",r);(0,l.R)(40,typeof t)}else(0,l.R)(39,typeof e)},g.setUserId=function(e){if("string"==typeof e||null===e)return N("enduser.id",e,"setUserId",!0);(0,l.R)(41,typeof e)},g.setApplicationVersion=function(e){if("string"==typeof e||null===e)return N("application.version",e,"setApplicationVersion",!1);(0,l.R)(42,typeof e)},g.start=()=>{try{(0,a.p)(f.xV,["API/start/called"],void 0,n.K7.metrics,R),R.emit("manual-start-all")}catch(e){(0,l.R)(23,e)}},g[p.G4.RECORD]=function(){(0,a.p)(f.xV,["API/recordReplay/called"],void 0,n.K7.metrics,R),(0,a.p)(p.G4.RECORD,[],void 0,n.K7.sessionReplay,R)},g[p.G4.PAUSE]=function(){(0,a.p)(f.xV,["API/pauseReplay/called"],void 0,n.K7.metrics,R),(0,a.p)(p.G4.PAUSE,[],void 0,n.K7.sessionReplay,R)},g.interaction=function(e){return(new _).get("object"==typeof e?e:{})};const O=_.prototype={createTracer:function(e,t){var r={},i=this,o="function"==typeof t;return(0,a.p)(f.xV,["API/createTracer/called"],void 0,n.K7.metrics,R),h||(0,a.p)(A+"tracer",[(0,v.t)(),e,r],i,n.K7.spa,R),function(){if(x.emit((o?"":"no-")+"fn-start",[(0,v.t)(),i,o],r),o)try{return t.apply(this,arguments)}catch(e){const t="string"==typeof e?new Error(e):e;throw x.emit("fn-err",[arguments,this,t],r),t}finally{x.emit("fn-end",[(0,v.t)()],r)}}}};function I(e,t,r,i){return function(){return(0,a.p)(f.xV,["API/"+t+"/called"],void 0,n.K7.metrics,R),i&&(0,a.p)(e+t,[r?(0,v.t)():performance.now(),...arguments],r?null:this,i,R),r?void 0:this}}function P(){r.e(478).then(r.bind(r,8778)).then((({setAPI:t})=>{t(e),(0,c.Ze)(e,"api")})).catch((e=>{(0,l.R)(27,e),R.abort()}))}return["actionText","setName","setAttribute","save","ignore","onEnd","getContext","end","get"].forEach((e=>{O[e]=I(A,e,void 0,h?n.K7.softNav:n.K7.spa)})),g.setCurrentRouteName=h?I(A,"routeName",void 0,n.K7.softNav):I(E,"routeName",!0,n.K7.spa),g.noticeError=function(t,r){"string"==typeof t&&(t=new Error(t)),(0,a.p)(f.xV,["API/noticeError/called"],void 0,n.K7.metrics,R),(0,a.p)("err",[t,(0,v.t)(),!1,r,!!S[e]],void 0,n.K7.jserrors,R)},d.RI?(0,u.GG)((()=>P()),!0):P(),g}(e.agentIdentifier,R,e.runSoftNavOverSpa)),void 0===e.exposed&&(e.exposed=k),P=!0}},8374:(e,t,r)=>{r.nc=(()=>{try{return document?.currentScript?.nonce}catch(e){}return""})()},860:(e,t,r)=>{"use strict";r.d(t,{$J:()=>u,K7:()=>s,P3:()=>c,XX:()=>i,qY:()=>n,v4:()=>a});const n="events",i="jserrors",o="browser/blobs",a="rum",s={ajax:"ajax",genericEvents:"generic_events",jserrors:i,logging:"logging",metrics:"metrics",pageAction:"page_action",pageViewEvent:"page_view_event",pageViewTiming:"page_view_timing",sessionReplay:"session_replay",sessionTrace:"session_trace",softNav:"soft_navigations",spa:"spa"},c={[s.pageViewEvent]:1,[s.pageViewTiming]:2,[s.metrics]:3,[s.jserrors]:4,[s.spa]:5,[s.ajax]:6,[s.sessionTrace]:7,[s.softNav]:8,[s.sessionReplay]:9,[s.logging]:10,[s.genericEvents]:11},u={[s.pageViewEvent]:a,[s.pageViewTiming]:n,[s.ajax]:n,[s.spa]:n,[s.softNav]:n,[s.metrics]:i,[s.jserrors]:i,[s.sessionTrace]:o,[s.sessionReplay]:o,[s.logging]:"browser/logs",[s.genericEvents]:"ins"}}},n={};function i(e){var t=n[e];if(void 0!==t)return t.exports;var o=n[e]={exports:{}};return r[e](o,o.exports,i),o.exports}i.m=r,i.d=(e,t)=>{for(var r in t)i.o(t,r)&&!i.o(e,r)&&Object.defineProperty(e,r,{enumerable:!0,get:t[r]})},i.f={},i.e=e=>Promise.all(Object.keys(i.f).reduce(((t,r)=>(i.f[r](e,t),t)),[])),i.u=e=>({212:"nr-spa-compressor",249:"nr-spa-recorder",478:"nr-spa"}[e]+"-1.281.0.min.js"),i.o=(e,t)=>Object.prototype.hasOwnProperty.call(e,t),e={},t="NRBA-1.281.0.PROD:",i.l=(r,n,o,a)=>{if(e[r])e[r].push(n);else{var s,c;if(void 0!==o)for(var u=document.getElementsByTagName("script"),d=0;d<u.length;d++){var l=u[d];if(l.getAttribute("src")==r||l.getAttribute("data-webpack")==t+o){s=l;break}}if(!s){c=!0;var f={478:"sha512-jmvAlmjCn64ans8tLueqHRlBI/iWekylsDWb94A77CG0ukSriVDvgD3dThx+XjUSBBBMYhFn8B1a18fViyBPEQ==",249:"sha512-ICY/ZrcytM/86t5KFy+9OAWVYmNNJy10EBtxoSUGjQWuZx53p/eLo+L8HfrGjvHuRHRnutqLTGSnvNttffJkaA==",212:"sha512-pQSn+X/RfBOvx/49HvlghaiXMLhhDQXTi13n1N2XMpDquWJgs9U0pbqE3RbAnYC9nsdaTu/RVGvneEPv1fpCxA=="};(s=document.createElement("script")).charset="utf-8",s.timeout=120,i.nc&&s.setAttribute("nonce",i.nc),s.setAttribute("data-webpack",t+o),s.src=r,0!==s.src.indexOf(window.location.origin+"/")&&(s.crossOrigin="anonymous"),f[a]&&(s.integrity=f[a])}e[r]=[n];var h=(t,n)=>{s.onerror=s.onload=null,clearTimeout(p);var i=e[r];if(delete e[r],s.parentNode&&s.parentNode.removeChild(s),i&&i.forEach((e=>e(n))),t)return t(n)},p=setTimeout(h.bind(null,void 0,{type:"timeout",target:s}),12e4);s.onerror=h.bind(null,s.onerror),s.onload=h.bind(null,s.onload),c&&document.head.appendChild(s)}},i.r=e=>{"undefined"!=typeof Symbol&&Symbol.toStringTag&&Object.defineProperty(e,Symbol.toStringTag,{value:"Module"}),Object.defineProperty(e,"__esModule",{value:!0})},i.p="https://js-agent.newrelic.com/",(()=>{var e={38:0,788:0};i.f.j=(t,r)=>{var n=i.o(e,t)?e[t]:void 0;if(0!==n)if(n)r.push(n[2]);else{var o=new Promise(((r,i)=>n=e[t]=[r,i]));r.push(n[2]=o);var a=i.p+i.u(t),s=new Error;i.l(a,(r=>{if(i.o(e,t)&&(0!==(n=e[t])&&(e[t]=void 0),n)){var o=r&&("load"===r.type?"missing":r.type),a=r&&r.target&&r.target.src;s.message="Loading chunk "+t+" failed.\n("+o+": "+a+")",s.name="ChunkLoadError",s.type=o,s.request=a,n[1](s)}}),"chunk-"+t,t)}};var t=(t,r)=>{var n,o,[a,s,c]=r,u=0;if(a.some((t=>0!==e[t]))){for(n in s)i.o(s,n)&&(i.m[n]=s[n]);if(c)c(i)}for(t&&t(r);u<a.length;u++)o=a[u],i.o(e,o)&&e[o]&&e[o][0](),e[o]=0},r=self["webpackChunk:NRBA-1.281.0.PROD"]=self["webpackChunk:NRBA-1.281.0.PROD"]||[];r.forEach(t.bind(null,0)),r.push=t.bind(null,r.push.bind(r))})(),(()=>{"use strict";i(8374);var e=i(944),t=i(6344),r=i(9566);class n{agentIdentifier;constructor(){this.agentIdentifier=(0,r.LA)(16)}#e(t,...r){if("function"==typeof this.api?.[t])return this.api[t](...r);(0,e.R)(35,t)}addPageAction(e,t){return this.#e("addPageAction",e,t)}recordCustomEvent(e,t){return this.#e("recordCustomEvent",e,t)}setPageViewName(e,t){return this.#e("setPageViewName",e,t)}setCustomAttribute(e,t,r){return this.#e("setCustomAttribute",e,t,r)}noticeError(e,t){return this.#e("noticeError",e,t)}setUserId(e){return this.#e("setUserId",e)}setApplicationVersion(e){return this.#e("setApplicationVersion",e)}setErrorHandler(e){return this.#e("setErrorHandler",e)}addRelease(e,t){return this.#e("addRelease",e,t)}log(e,t){return this.#e("log",e,t)}}class o extends n{#e(t,...r){if("function"==typeof this.api?.[t])return this.api[t](...r);(0,e.R)(35,t)}start(){return this.#e("start")}finished(e){return this.#e("finished",e)}recordReplay(){return this.#e(t.G4.RECORD)}pauseReplay(){return this.#e(t.G4.PAUSE)}addToTrace(e){return this.#e("addToTrace",e)}setCurrentRouteName(e){return this.#e("setCurrentRouteName",e)}interaction(){return this.#e("interaction")}wrapLogger(e,t,r){return this.#e("wrapLogger",e,t,r)}}var a=i(860),s=i(9417);const c=Object.values(a.K7);function u(e){const t={};return c.forEach((r=>{t[r]=function(e,t){return!0===(0,s.gD)(t,"".concat(e,".enabled"))}(r,e)})),t}var d=i(425);var l=i(1687),f=i(4234),h=i(5289),p=i(6154),g=i(5270),m=i(7767),v=i(6389);class b extends f.W{constructor(e,t,r=!0){super(e.agentIdentifier,t),this.auto=r,this.abortHandler=void 0,this.featAggregate=void 0,this.onAggregateImported=void 0,!1===e.init[this.featureName].autoStart&&(this.auto=!1),this.auto?(0,l.Ak)(e.agentIdentifier,t):this.ee.on("manual-start-all",(0,v.J)((()=>{(0,l.Ak)(e.agentIdentifier,this.featureName),this.auto=!0,this.importAggregator(e)})))}importAggregator(t,r={}){if(this.featAggregate||!this.auto)return;let n;this.onAggregateImported=new Promise((e=>{n=e}));const o=async()=>{let o;try{if((0,m.V)(this.agentIdentifier)){const{setupAgentSession:e}=await i.e(478).then(i.bind(i,6526));o=e(t)}}catch(t){(0,e.R)(20,t),this.ee.emit("internal-error",[t]),this.featureName===a.K7.sessionReplay&&this.abortHandler?.()}try{if(!this.#t(this.featureName,o))return(0,l.Ze)(this.agentIdentifier,this.featureName),void n(!1);const{lazyFeatureLoader:e}=await i.e(478).then(i.bind(i,6103)),{Aggregate:a}=await e(this.featureName,"aggregate");this.featAggregate=new a(t,r),t.runtime.harvester.initializedAggregates.push(this.featAggregate),n(!0)}catch(t){(0,e.R)(34,t),this.abortHandler?.(),(0,l.Ze)(this.agentIdentifier,this.featureName,!0),n(!1),this.ee&&this.ee.abort()}};p.RI?(0,h.GG)((()=>o()),!0):o()}#t(e,t){switch(e){case a.K7.sessionReplay:return(0,g.SR)(this.agentIdentifier)&&!!t;case a.K7.sessionTrace:return!!t;default:return!0}}}var y=i(6630);class w extends b{static featureName=y.T;constructor(e,t=!0){super(e,y.T,t),this.importAggregator(e)}}var R=i(384);var x=i(9908),E=i(2843),T=i(3878),A=i(782),S=i(1863);class N extends b{static featureName=A.T;constructor(e,t=!0){super(e,A.T,t),p.RI&&((0,E.u)((()=>(0,x.p)("docHidden",[(0,S.t)()],void 0,A.T,this.ee)),!0),(0,T.sp)("pagehide",(()=>(0,x.p)("winPagehide",[(0,S.t)()],void 0,A.T,this.ee))),this.importAggregator(e))}}var _=i(3969);class O extends b{static featureName=_.TZ;constructor(e,t=!0){super(e,_.TZ,t),this.importAggregator(e)}}var I=i(6774),P=i(3304);class j{constructor(e,t,r,n,i){this.name="UncaughtError",this.message="string"==typeof e?e:(0,P.A)(e),this.sourceURL=t,this.line=r,this.column=n,this.__newrelic=i}}function C(e){return H(e)?e:new j(void 0!==e?.message?e.message:e,e?.filename||e?.sourceURL,e?.lineno||e?.line,e?.colno||e?.col,e?.__newrelic)}function k(e){const t="Unhandled Promise Rejection";if(!e?.reason)return;if(H(e.reason))try{return e.reason.message=t+": "+e.reason.message,C(e.reason)}catch(t){return C(e.reason)}const r=C(e.reason);return r.message=t+": "+r?.message,r}function L(e){if(e.error instanceof SyntaxError&&!/:\d+$/.test(e.error.stack?.trim())){const t=new j(e.message,e.filename,e.lineno,e.colno,e.error.__newrelic);return t.name=SyntaxError.name,t}return H(e.error)?e.error:C(e)}function H(e){return e instanceof Error&&!!e.stack}class M extends b{static featureName=I.T;#r=!1;constructor(e,r=!0){super(e,I.T,r);try{this.removeOnAbort=new AbortController}catch(e){}this.ee.on("internal-error",((e,t)=>{this.abortHandler&&(0,x.p)("ierr",[C(e),(0,S.t)(),!0,{},this.#r,t],void 0,this.featureName,this.ee)})),this.ee.on(t.G4.REPLAY_RUNNING,(e=>{this.#r=e})),p.gm.addEventListener("unhandledrejection",(e=>{this.abortHandler&&(0,x.p)("err",[k(e),(0,S.t)(),!1,{unhandledPromiseRejection:1},this.#r],void 0,this.featureName,this.ee)}),(0,T.jT)(!1,this.removeOnAbort?.signal)),p.gm.addEventListener("error",(e=>{this.abortHandler&&(0,x.p)("err",[L(e),(0,S.t)(),!1,{},this.#r],void 0,this.featureName,this.ee)}),(0,T.jT)(!1,this.removeOnAbort?.signal)),this.abortHandler=this.#n,this.importAggregator(e)}#n(){this.removeOnAbort?.abort(),this.abortHandler=void 0}}var D=i(8990);let K=1;const U="nr@id";function V(e){const t=typeof e;return!e||"object"!==t&&"function"!==t?-1:e===p.gm?0:(0,D.I)(e,U,(function(){return K++}))}function G(e){if("string"==typeof e&&e.length)return e.length;if("object"==typeof e){if("undefined"!=typeof ArrayBuffer&&e instanceof ArrayBuffer&&e.byteLength)return e.byteLength;if("undefined"!=typeof Blob&&e instanceof Blob&&e.size)return e.size;if(!("undefined"!=typeof FormData&&e instanceof FormData))try{return(0,P.A)(e).length}catch(e){return}}}var F=i(8139),B=i(7836),W=i(3434);const z={},q=["open","send"];function Z(t){var r=t||B.ee;const n=function(e){return(e||B.ee).get("xhr")}(r);if(void 0===p.gm.XMLHttpRequest)return n;if(z[n.debugId]++)return n;z[n.debugId]=1,(0,F.u)(r);var i=(0,W.YM)(n),o=p.gm.XMLHttpRequest,a=p.gm.MutationObserver,s=p.gm.Promise,c=p.gm.setInterval,u="readystatechange",d=["onload","onerror","onabort","onloadstart","onloadend","onprogress","ontimeout"],l=[],f=p.gm.XMLHttpRequest=function(t){const r=new o(t),a=n.context(r);try{n.emit("new-xhr",[r],a),r.addEventListener(u,(s=a,function(){var e=this;e.readyState>3&&!s.resolved&&(s.resolved=!0,n.emit("xhr-resolved",[],e)),i.inPlace(e,d,"fn-",y)}),(0,T.jT)(!1))}catch(t){(0,e.R)(15,t);try{n.emit("internal-error",[t])}catch(e){}}var s;return r};function h(e,t){i.inPlace(t,["onreadystatechange"],"fn-",y)}if(function(e,t){for(var r in e)t[r]=e[r]}(o,f),f.prototype=o.prototype,i.inPlace(f.prototype,q,"-xhr-",y),n.on("send-xhr-start",(function(e,t){h(e,t),function(e){l.push(e),a&&(g?g.then(b):c?c(b):(m=-m,v.data=m))}(t)})),n.on("open-xhr-start",h),a){var g=s&&s.resolve();if(!c&&!s){var m=1,v=document.createTextNode(m);new a(b).observe(v,{characterData:!0})}}else r.on("fn-end",(function(e){e[0]&&e[0].type===u||b()}));function b(){for(var e=0;e<l.length;e++)h(0,l[e]);l.length&&(l=[])}function y(e,t){return t}return n}var Y="fetch-",X=Y+"body-",J=["arrayBuffer","blob","json","text","formData"],Q=p.gm.Request,ee=p.gm.Response,te="prototype";const re={};function ne(e){const t=function(e){return(e||B.ee).get("fetch")}(e);if(!(Q&&ee&&p.gm.fetch))return t;if(re[t.debugId]++)return t;function r(e,r,n){var i=e[r];"function"==typeof i&&(e[r]=function(){var e,r=[...arguments],o={};t.emit(n+"before-start",[r],o),o[B.P]&&o[B.P].dt&&(e=o[B.P].dt);var a=i.apply(this,r);return t.emit(n+"start",[r,e],a),a.then((function(e){return t.emit(n+"end",[null,e],a),e}),(function(e){throw t.emit(n+"end",[e],a),e}))})}return re[t.debugId]=1,J.forEach((e=>{r(Q[te],e,X),r(ee[te],e,X)})),r(p.gm,"fetch",Y),t.on(Y+"end",(function(e,r){var n=this;if(r){var i=r.headers.get("content-length");null!==i&&(n.rxSize=i),t.emit(Y+"done",[null,r],n)}else t.emit(Y+"done",[e],n)})),t}var ie=i(7485),oe=i(5603);class ae{constructor(e){this.agentIdentifier=e}generateTracePayload(e){if(!this.shouldGenerateTrace(e))return null;var t=(0,oe.o)(this.agentIdentifier);if(!t)return null;var n=(t.accountID||"").toString()||null,i=(t.agentID||"").toString()||null,o=(t.trustKey||"").toString()||null;if(!n||!i)return null;var a=(0,r.ZF)(),s=(0,r.el)(),c=Date.now(),u={spanId:a,traceId:s,timestamp:c};return(e.sameOrigin||this.isAllowedOrigin(e)&&this.useTraceContextHeadersForCors())&&(u.traceContextParentHeader=this.generateTraceContextParentHeader(a,s),u.traceContextStateHeader=this.generateTraceContextStateHeader(a,c,n,i,o)),(e.sameOrigin&&!this.excludeNewrelicHeader()||!e.sameOrigin&&this.isAllowedOrigin(e)&&this.useNewrelicHeaderForCors())&&(u.newrelicHeader=this.generateTraceHeader(a,s,c,n,i,o)),u}generateTraceContextParentHeader(e,t){return"00-"+t+"-"+e+"-01"}generateTraceContextStateHeader(e,t,r,n,i){return i+"@nr=0-1-"+r+"-"+n+"-"+e+"----"+t}generateTraceHeader(e,t,r,n,i,o){if(!("function"==typeof p.gm?.btoa))return null;var a={v:[0,1],d:{ty:"Browser",ac:n,ap:i,id:e,tr:t,ti:r}};return o&&n!==o&&(a.d.tk=o),btoa((0,P.A)(a))}shouldGenerateTrace(e){return this.isDtEnabled()&&this.isAllowedOrigin(e)}isAllowedOrigin(e){var t=!1,r={};if((0,s.gD)(this.agentIdentifier,"distributed_tracing")&&(r=(0,s.D0)(this.agentIdentifier).distributed_tracing),e.sameOrigin)t=!0;else if(r.allowed_origins instanceof Array)for(var n=0;n<r.allowed_origins.length;n++){var i=(0,ie.D)(r.allowed_origins[n]);if(e.hostname===i.hostname&&e.protocol===i.protocol&&e.port===i.port){t=!0;break}}return t}isDtEnabled(){var e=(0,s.gD)(this.agentIdentifier,"distributed_tracing");return!!e&&!!e.enabled}excludeNewrelicHeader(){var e=(0,s.gD)(this.agentIdentifier,"distributed_tracing");return!!e&&!!e.exclude_newrelic_header}useNewrelicHeaderForCors(){var e=(0,s.gD)(this.agentIdentifier,"distributed_tracing");return!!e&&!1!==e.cors_use_newrelic_header}useTraceContextHeadersForCors(){var e=(0,s.gD)(this.agentIdentifier,"distributed_tracing");return!!e&&!!e.cors_use_tracecontext_headers}}var se=i(9300),ce=i(7295),ue=["load","error","abort","timeout"],de=ue.length,le=(0,R.dV)().o.REQ,fe=(0,R.dV)().o.XHR;class he extends b{static featureName=se.T;constructor(e,t=!0){super(e,se.T,t),this.dt=new ae(e.agentIdentifier),this.handler=(e,t,r,n)=>(0,x.p)(e,t,r,n,this.ee);try{const e={xmlhttprequest:"xhr",fetch:"fetch",beacon:"beacon"};p.gm?.performance?.getEntriesByType("resource").forEach((t=>{if(t.initiatorType in e&&0!==t.responseStatus){const r={status:t.responseStatus},n={rxSize:t.transferSize,duration:Math.floor(t.duration),cbTime:0};pe(r,t.name),this.handler("xhr",[r,n,t.startTime,t.responseEnd,e[t.initiatorType]],void 0,a.K7.ajax)}}))}catch(e){}ne(this.ee),Z(this.ee),function(e,t,r,n){function i(e){var t=this;t.totalCbs=0,t.called=0,t.cbTime=0,t.end=R,t.ended=!1,t.xhrGuids={},t.lastSize=null,t.loadCaptureCalled=!1,t.params=this.params||{},t.metrics=this.metrics||{},e.addEventListener("load",(function(r){E(t,e)}),(0,T.jT)(!1)),p.lR||e.addEventListener("progress",(function(e){t.lastSize=e.loaded}),(0,T.jT)(!1))}function o(e){this.params={method:e[0]},pe(this,e[1]),this.metrics={}}function s(t,r){e.loader_config.xpid&&this.sameOrigin&&r.setRequestHeader("X-NewRelic-ID",e.loader_config.xpid);var i=n.generateTracePayload(this.parsedOrigin);if(i){var o=!1;i.newrelicHeader&&(r.setRequestHeader("newrelic",i.newrelicHeader),o=!0),i.traceContextParentHeader&&(r.setRequestHeader("traceparent",i.traceContextParentHeader),i.traceContextStateHeader&&r.setRequestHeader("tracestate",i.traceContextStateHeader),o=!0),o&&(this.dt=i)}}function c(e,r){var n=this.metrics,i=e[0],o=this;if(n&&i){var a=G(i);a&&(n.txSize=a)}this.startTime=(0,S.t)(),this.body=i,this.listener=function(e){try{"abort"!==e.type||o.loadCaptureCalled||(o.params.aborted=!0),("load"!==e.type||o.called===o.totalCbs&&(o.onloadCalled||"function"!=typeof r.onload)&&"function"==typeof o.end)&&o.end(r)}catch(e){try{t.emit("internal-error",[e])}catch(e){}}};for(var s=0;s<de;s++)r.addEventListener(ue[s],this.listener,(0,T.jT)(!1))}function u(e,t,r){this.cbTime+=e,t?this.onloadCalled=!0:this.called+=1,this.called!==this.totalCbs||!this.onloadCalled&&"function"==typeof r.onload||"function"!=typeof this.end||this.end(r)}function d(e,t){var r=""+V(e)+!!t;this.xhrGuids&&!this.xhrGuids[r]&&(this.xhrGuids[r]=!0,this.totalCbs+=1)}function l(e,t){var r=""+V(e)+!!t;this.xhrGuids&&this.xhrGuids[r]&&(delete this.xhrGuids[r],this.totalCbs-=1)}function f(){this.endTime=(0,S.t)()}function h(e,r){r instanceof fe&&"load"===e[0]&&t.emit("xhr-load-added",[e[1],e[2]],r)}function g(e,r){r instanceof fe&&"load"===e[0]&&t.emit("xhr-load-removed",[e[1],e[2]],r)}function m(e,t,r){t instanceof fe&&("onload"===r&&(this.onload=!0),("load"===(e[0]&&e[0].type)||this.onload)&&(this.xhrCbStart=(0,S.t)()))}function v(e,r){this.xhrCbStart&&t.emit("xhr-cb-time",[(0,S.t)()-this.xhrCbStart,this.onload,r],r)}function b(e){var t,r=e[1]||{};if("string"==typeof e[0]?0===(t=e[0]).length&&p.RI&&(t=""+p.gm.location.href):e[0]&&e[0].url?t=e[0].url:p.gm?.URL&&e[0]&&e[0]instanceof URL?t=e[0].href:"function"==typeof e[0].toString&&(t=e[0].toString()),"string"==typeof t&&0!==t.length){t&&(this.parsedOrigin=(0,ie.D)(t),this.sameOrigin=this.parsedOrigin.sameOrigin);var i=n.generateTracePayload(this.parsedOrigin);if(i&&(i.newrelicHeader||i.traceContextParentHeader))if(e[0]&&e[0].headers)s(e[0].headers,i)&&(this.dt=i);else{var o={};for(var a in r)o[a]=r[a];o.headers=new Headers(r.headers||{}),s(o.headers,i)&&(this.dt=i),e.length>1?e[1]=o:e.push(o)}}function s(e,t){var r=!1;return t.newrelicHeader&&(e.set("newrelic",t.newrelicHeader),r=!0),t.traceContextParentHeader&&(e.set("traceparent",t.traceContextParentHeader),t.traceContextStateHeader&&e.set("tracestate",t.traceContextStateHeader),r=!0),r}}function y(e,t){this.params={},this.metrics={},this.startTime=(0,S.t)(),this.dt=t,e.length>=1&&(this.target=e[0]),e.length>=2&&(this.opts=e[1]);var r,n=this.opts||{},i=this.target;"string"==typeof i?r=i:"object"==typeof i&&i instanceof le?r=i.url:p.gm?.URL&&"object"==typeof i&&i instanceof URL&&(r=i.href),pe(this,r);var o=(""+(i&&i instanceof le&&i.method||n.method||"GET")).toUpperCase();this.params.method=o,this.body=n.body,this.txSize=G(n.body)||0}function w(e,t){if(this.endTime=(0,S.t)(),this.params||(this.params={}),(0,ce.iW)(this.params))return;let n;this.params.status=t?t.status:0,"string"==typeof this.rxSize&&this.rxSize.length>0&&(n=+this.rxSize);const i={txSize:this.txSize,rxSize:n,duration:(0,S.t)()-this.startTime};r("xhr",[this.params,i,this.startTime,this.endTime,"fetch"],this,a.K7.ajax)}function R(e){const t=this.params,n=this.metrics;if(!this.ended){this.ended=!0;for(let t=0;t<de;t++)e.removeEventListener(ue[t],this.listener,!1);t.aborted||(0,ce.iW)(t)||(n.duration=(0,S.t)()-this.startTime,this.loadCaptureCalled||4!==e.readyState?null==t.status&&(t.status=0):E(this,e),n.cbTime=this.cbTime,r("xhr",[t,n,this.startTime,this.endTime,"xhr"],this,a.K7.ajax))}}function E(e,r){e.params.status=r.status;var n=function(e,t){var r=e.responseType;return"json"===r&&null!==t?t:"arraybuffer"===r||"blob"===r||"json"===r?G(e.response):"text"===r||""===r||void 0===r?G(e.responseText):void 0}(r,e.lastSize);if(n&&(e.metrics.rxSize=n),e.sameOrigin){var i=r.getResponseHeader("X-NewRelic-App-Data");i&&((0,x.p)(_.rs,["Ajax/CrossApplicationTracing/Header/Seen"],void 0,a.K7.metrics,t),e.params.cat=i.split(", ").pop())}e.loadCaptureCalled=!0}t.on("new-xhr",i),t.on("open-xhr-start",o),t.on("open-xhr-end",s),t.on("send-xhr-start",c),t.on("xhr-cb-time",u),t.on("xhr-load-added",d),t.on("xhr-load-removed",l),t.on("xhr-resolved",f),t.on("addEventListener-end",h),t.on("removeEventListener-end",g),t.on("fn-end",v),t.on("fetch-before-start",b),t.on("fetch-start",y),t.on("fn-start",m),t.on("fetch-done",w)}(e,this.ee,this.handler,this.dt),this.importAggregator(e)}}function pe(e,t){var r=(0,ie.D)(t),n=e.params||e;n.hostname=r.hostname,n.port=r.port,n.protocol=r.protocol,n.host=r.hostname+":"+r.port,n.pathname=r.pathname,e.parsedOrigin=r,e.sameOrigin=r.sameOrigin}const ge={},me=["pushState","replaceState"];function ve(e){const t=function(e){return(e||B.ee).get("history")}(e);return!p.RI||ge[t.debugId]++||(ge[t.debugId]=1,(0,W.YM)(t).inPlace(window.history,me,"-")),t}var be=i(3738);const{He:ye,bD:we,d3:Re,Kp:xe,TZ:Ee,Lc:Te,uP:Ae,Rz:Se}=be;class Ne extends b{static featureName=Ee;constructor(e,t=!0){super(e,Ee,t);if(!(0,m.V)(this.agentIdentifier))return void this.deregisterDrain();const r=this.ee;let n;ve(r),this.eventsEE=(0,F.u)(r),this.eventsEE.on(Ae,(function(e,t){this.bstStart=(0,S.t)()})),this.eventsEE.on(Te,(function(e,t){(0,x.p)("bst",[e[0],t,this.bstStart,(0,S.t)()],void 0,a.K7.sessionTrace,r)})),r.on(Se+Re,(function(e){this.time=(0,S.t)(),this.startPath=location.pathname+location.hash})),r.on(Se+xe,(function(e){(0,x.p)("bstHist",[location.pathname+location.hash,this.startPath,this.time],void 0,a.K7.sessionTrace,r)}));try{n=new PerformanceObserver((e=>{const t=e.getEntries();(0,x.p)(ye,[t],void 0,a.K7.sessionTrace,r)})),n.observe({type:we,buffered:!0})}catch(e){}this.importAggregator(e,{resourceObserver:n})}}var _e=i(2614);class Oe extends b{static featureName=t.TZ;#i;#o;constructor(e,r=!0){let n;super(e,t.TZ,r),this.replayRunning=!1,this.#o=e;try{n=JSON.parse(localStorage.getItem("".concat(_e.H3,"_").concat(_e.uh)))}catch(e){}(0,g.SR)(e.agentIdentifier)&&this.ee.on(t.G4.RECORD,(()=>this.#a())),this.#s(n)?(this.#i=n?.sessionReplayMode,this.#c()):this.importAggregator(e),this.ee.on("err",(e=>{this.replayRunning&&(this.errorNoticed=!0,(0,x.p)(t.G4.ERROR_DURING_REPLAY,[e],void 0,this.featureName,this.ee))})),this.ee.on(t.G4.REPLAY_RUNNING,(e=>{this.replayRunning=e}))}#s(e){return e&&(e.sessionReplayMode===_e.g.FULL||e.sessionReplayMode===_e.g.ERROR)||(0,g.Aw)(this.agentIdentifier)}#u=!1;async#c(e){if(!this.#u){this.#u=!0;try{const{Recorder:t}=await Promise.all([i.e(478),i.e(249)]).then(i.bind(i,8589));this.recorder??=new t({mode:this.#i,agentIdentifier:this.agentIdentifier,trigger:e,ee:this.ee,agentRef:this.#o}),this.recorder.startRecording(),this.abortHandler=this.recorder.stopRecording}catch(e){}this.importAggregator(this.#o,{recorder:this.recorder,errorNoticed:this.errorNoticed})}}#a(){this.featAggregate?this.featAggregate.mode!==_e.g.FULL&&this.featAggregate.initializeRecording(_e.g.FULL,!0):(this.#i=_e.g.FULL,this.#c(t.Qb.API),this.recorder&&this.recorder.parent.mode!==_e.g.FULL&&(this.recorder.parent.mode=_e.g.FULL,this.recorder.stopRecording(),this.recorder.startRecording(),this.abortHandler=this.recorder.stopRecording))}}var Ie=i(3962);class Pe extends b{static featureName=Ie.TZ;constructor(e,t=!0){if(super(e,Ie.TZ,t),!p.RI||!(0,R.dV)().o.MO)return;const r=ve(this.ee);Ie.tC.forEach((e=>{(0,T.sp)(e,(e=>{a(e)}),!0)}));const n=()=>(0,x.p)("newURL",[(0,S.t)(),""+window.location],void 0,this.featureName,this.ee);r.on("pushState-end",n),r.on("replaceState-end",n);try{this.removeOnAbort=new AbortController}catch(e){}(0,T.sp)("popstate",(e=>(0,x.p)("newURL",[e.timeStamp,""+window.location],void 0,this.featureName,this.ee)),!0,this.removeOnAbort?.signal);let i=!1;const o=new((0,R.dV)().o.MO)(((e,t)=>{i||(i=!0,requestAnimationFrame((()=>{(0,x.p)("newDom",[(0,S.t)()],void 0,this.featureName,this.ee),i=!1})))})),a=(0,v.s)((e=>{(0,x.p)("newUIEvent",[e],void 0,this.featureName,this.ee),o.observe(document.body,{attributes:!0,childList:!0,subtree:!0,characterData:!0})}),100,{leading:!0});this.abortHandler=function(){this.removeOnAbort?.abort(),o.disconnect(),this.abortHandler=void 0},this.importAggregator(e,{domObserver:o})}}var je=i(7378);const Ce={},ke=["appendChild","insertBefore","replaceChild"];function Le(e){const t=function(e){return(e||B.ee).get("jsonp")}(e);if(!p.RI||Ce[t.debugId])return t;Ce[t.debugId]=!0;var r=(0,W.YM)(t),n=/[?&](?:callback|cb)=([^&#]+)/,i=/(.*)\.([^.]+)/,o=/^(\w+)(\.|$)(.*)$/;function a(e,t){if(!e)return t;const r=e.match(o),n=r[1];return a(r[3],t[n])}return r.inPlace(Node.prototype,ke,"dom-"),t.on("dom-start",(function(e){!function(e){if(!e||"string"!=typeof e.nodeName||"script"!==e.nodeName.toLowerCase())return;if("function"!=typeof e.addEventListener)return;var o=(s=e.src,c=s.match(n),c?c[1]:null);var s,c;if(!o)return;var u=function(e){var t=e.match(i);if(t&&t.length>=3)return{key:t[2],parent:a(t[1],window)};return{key:e,parent:window}}(o);if("function"!=typeof u.parent[u.key])return;var d={};function l(){t.emit("jsonp-end",[],d),e.removeEventListener("load",l,(0,T.jT)(!1)),e.removeEventListener("error",f,(0,T.jT)(!1))}function f(){t.emit("jsonp-error",[],d),t.emit("jsonp-end",[],d),e.removeEventListener("load",l,(0,T.jT)(!1)),e.removeEventListener("error",f,(0,T.jT)(!1))}r.inPlace(u.parent,[u.key],"cb-",d),e.addEventListener("load",l,(0,T.jT)(!1)),e.addEventListener("error",f,(0,T.jT)(!1)),t.emit("new-jsonp",[e.src],d)}(e[0])})),t}const He={};function Me(e){const t=function(e){return(e||B.ee).get("promise")}(e);if(He[t.debugId])return t;He[t.debugId]=!0;var r=t.context,n=(0,W.YM)(t),i=p.gm.Promise;return i&&function(){function e(r){var o=t.context(),a=n(r,"executor-",o,null,!1);const s=Reflect.construct(i,[a],e);return t.context(s).getCtx=function(){return o},s}p.gm.Promise=e,Object.defineProperty(e,"name",{value:"Promise"}),e.toString=function(){return i.toString()},Object.setPrototypeOf(e,i),["all","race"].forEach((function(r){const n=i[r];e[r]=function(e){let i=!1;[...e||[]].forEach((e=>{this.resolve(e).then(a("all"===r),a(!1))}));const o=n.apply(this,arguments);return o;function a(e){return function(){t.emit("propagate",[null,!i],o,!1,!1),i=i||!e}}}})),["resolve","reject"].forEach((function(r){const n=i[r];e[r]=function(e){const r=n.apply(this,arguments);return e!==r&&t.emit("propagate",[e,!0],r,!1,!1),r}})),e.prototype=i.prototype;const o=i.prototype.then;i.prototype.then=function(...e){var i=this,a=r(i);a.promise=i,e[0]=n(e[0],"cb-",a,null,!1),e[1]=n(e[1],"cb-",a,null,!1);const s=o.apply(this,e);return a.nextPromise=s,t.emit("propagate",[i,!0],s,!1,!1),s},i.prototype.then[W.Jt]=o,t.on("executor-start",(function(e){e[0]=n(e[0],"resolve-",this,null,!1),e[1]=n(e[1],"resolve-",this,null,!1)})),t.on("executor-err",(function(e,t,r){e[1](r)})),t.on("cb-end",(function(e,r,n){t.emit("propagate",[n,!0],this.nextPromise,!1,!1)})),t.on("propagate",(function(e,r,n){this.getCtx&&!r||(this.getCtx=function(){if(e instanceof Promise)var r=t.context(e);return r&&r.getCtx?r.getCtx():this})}))}(),t}const De={},Ke="setTimeout",Ue="setInterval",Ve="clearTimeout",Ge="-start",Fe=[Ke,"setImmediate",Ue,Ve,"clearImmediate"];function Be(e){const t=function(e){return(e||B.ee).get("timer")}(e);if(De[t.debugId]++)return t;De[t.debugId]=1;var r=(0,W.YM)(t);return r.inPlace(p.gm,Fe.slice(0,2),Ke+"-"),r.inPlace(p.gm,Fe.slice(2,3),Ue+"-"),r.inPlace(p.gm,Fe.slice(3),Ve+"-"),t.on(Ue+Ge,(function(e,t,n){e[0]=r(e[0],"fn-",null,n)})),t.on(Ke+Ge,(function(e,t,n){this.method=n,this.timerDuration=isNaN(e[1])?0:+e[1],e[0]=r(e[0],"fn-",this,n)})),t}const We={};function ze(e){const t=function(e){return(e||B.ee).get("mutation")}(e);if(!p.RI||We[t.debugId])return t;We[t.debugId]=!0;var r=(0,W.YM)(t),n=p.gm.MutationObserver;return n&&(window.MutationObserver=function(e){return this instanceof n?new n(r(e,"fn-")):n.apply(this,arguments)},MutationObserver.prototype=n.prototype),t}const{TZ:qe,d3:Ze,Kp:Ye,$p:Xe,wW:$e,e5:Je,tH:Qe,uP:et,rw:tt,Lc:rt}=je;class nt extends b{static featureName=qe;constructor(e,t=!0){if(super(e,qe,t),!p.RI)return;try{this.removeOnAbort=new AbortController}catch(e){}let r,n=0;const i=this.ee.get("tracer"),o=Le(this.ee),a=Me(this.ee),s=Be(this.ee),c=Z(this.ee),u=this.ee.get("events"),d=ne(this.ee),l=ve(this.ee),f=ze(this.ee);function h(e,t){l.emit("newURL",[""+window.location,t])}function g(){n++,r=window.location.hash,this[et]=(0,S.t)()}function m(){n--,window.location.hash!==r&&h(0,!0);var e=(0,S.t)();this[Je]=~~this[Je]+e-this[et],this[rt]=e}function v(e,t){e.on(t,(function(){this[t]=(0,S.t)()}))}this.ee.on(et,g),a.on(tt,g),o.on(tt,g),this.ee.on(rt,m),a.on($e,m),o.on($e,m),this.ee.on("fn-err",((...t)=>{t[2]?.__newrelic?.[e.agentIdentifier]||(0,x.p)("function-err",[...t],void 0,this.featureName,this.ee)})),this.ee.buffer([et,rt,"xhr-resolved"],this.featureName),u.buffer([et],this.featureName),s.buffer(["setTimeout"+Ye,"clearTimeout"+Ze,et],this.featureName),c.buffer([et,"new-xhr","send-xhr"+Ze],this.featureName),d.buffer([Qe+Ze,Qe+"-done",Qe+Xe+Ze,Qe+Xe+Ye],this.featureName),l.buffer(["newURL"],this.featureName),f.buffer([et],this.featureName),a.buffer(["propagate",tt,$e,"executor-err","resolve"+Ze],this.featureName),i.buffer([et,"no-"+et],this.featureName),o.buffer(["new-jsonp","cb-start","jsonp-error","jsonp-end"],this.featureName),v(d,Qe+Ze),v(d,Qe+"-done"),v(o,"new-jsonp"),v(o,"jsonp-end"),v(o,"cb-start"),l.on("pushState-end",h),l.on("replaceState-end",h),window.addEventListener("hashchange",h,(0,T.jT)(!0,this.removeOnAbort?.signal)),window.addEventListener("load",h,(0,T.jT)(!0,this.removeOnAbort?.signal)),window.addEventListener("popstate",(function(){h(0,n>1)}),(0,T.jT)(!0,this.removeOnAbort?.signal)),this.abortHandler=this.#n,this.importAggregator(e)}#n(){this.removeOnAbort?.abort(),this.abortHandler=void 0}}var it=i(3333);class ot extends b{static featureName=it.TZ;constructor(e,t=!0){super(e,it.TZ,t);const r=[e.init.page_action.enabled,e.init.performance.capture_marks,e.init.performance.capture_measures,e.init.user_actions.enabled,e.init.performance.resources.enabled];if(p.RI&&(e.init.user_actions.enabled&&(it.Zp.forEach((e=>(0,T.sp)(e,(e=>(0,x.p)("ua",[e],void 0,this.featureName,this.ee)),!0))),it.qN.forEach((e=>{const t=(0,v.s)((e=>{(0,x.p)("ua",[e],void 0,this.featureName,this.ee)}),500,{leading:!0});(0,T.sp)(e,t)}))),e.init.performance.resources.enabled&&p.gm.PerformanceObserver?.supportedEntryTypes.includes("resource"))){new PerformanceObserver((e=>{e.getEntries().forEach((e=>{(0,x.p)("browserPerformance.resource",[e],void 0,this.featureName,this.ee)}))})).observe({type:"resource",buffered:!0})}r.some((e=>e))?this.importAggregator(e):this.deregisterDrain()}}var at=i(993),st=i(3785);class ct extends b{static featureName=at.TZ;constructor(e,t=!0){super(e,at.TZ,t);const r=this.ee;this.ee.on("wrap-logger-end",(function([e]){const{level:t,customAttributes:n}=this;(0,st.R)(r,e,n,t)})),this.importAggregator(e)}}new class extends o{constructor(t){super(),p.gm?(this.features={},(0,R.bQ)(this.agentIdentifier,this),this.desiredFeatures=new Set(t.features||[]),this.desiredFeatures.add(w),this.runSoftNavOverSpa=[...this.desiredFeatures].some((e=>e.featureName===a.K7.softNav)),(0,d.j)(this,t,t.loaderType||"agent"),this.run()):(0,e.R)(21)}get config(){return{info:this.info,init:this.init,loader_config:this.loader_config,runtime:this.runtime}}run(){try{const t=u(this.agentIdentifier),r=[...this.desiredFeatures];r.sort(((e,t)=>a.P3[e.featureName]-a.P3[t.featureName])),r.forEach((r=>{if(!t[r.featureName]&&r.featureName!==a.K7.pageViewEvent)return;if(this.runSoftNavOverSpa&&r.featureName===a.K7.spa)return;if(!this.runSoftNavOverSpa&&r.featureName===a.K7.softNav)return;const n=function(e){switch(e){case a.K7.ajax:return[a.K7.jserrors];case a.K7.sessionTrace:return[a.K7.ajax,a.K7.pageViewEvent];case a.K7.sessionReplay:return[a.K7.sessionTrace];case a.K7.pageViewTiming:return[a.K7.pageViewEvent];default:return[]}}(r.featureName).filter((e=>!(e in this.features)));n.length>0&&(0,e.R)(36,{targetFeature:r.featureName,missingDependencies:n}),this.features[r.featureName]=new r(this)}))}catch(t){(0,e.R)(22,t);for(const e in this.features)this.features[e].abortHandler?.();const r=(0,R.Zm)();delete r.initializedAgents[this.agentIdentifier]?.api,delete r.initializedAgents[this.agentIdentifier]?.features,delete this.sharedAggregator;return r.ee.get(this.agentIdentifier).abort(),!1}}}({features:[he,w,N,Ne,Oe,O,M,ot,ct,Pe,nt],loaderType:"spa"})})()})();</script><meta charset="utf-8" /><meta name="viewport" content="width=device-width, initial-scale=1" /><meta http-equiv="Expires" content="0" /><meta name="DCSext.FullHTMLview" content="1" /><meta name="WT.cg_n" content="annals-of-medicine-and-surgery" /><meta name="WT.cg_s" content="Articles,Open Access Articles" /><meta name="wkhealth_journal_title" content="Annals of Medicine and Surgery" /><meta name="wkhealth_journal_title_legacy" content="Annals of Medicine & Surgery" /><meta name="wkhealth_issue" content="2" /><meta name="wkhealth_article_publication_date" content="January 3, 2024" /><meta name="wkhealth_volume" content="86" /><meta name="wkhealth_ovid_accession_number" content="01845215-202402000-00010" /><meta name="wkhealth_issn" content="2049-0801" /><meta name="wkhealth_title" content="The UEMS experience in continuous medical education accreditation process: a ‘quo vadis’ analysis of our global database" /><meta name="wkhealth_authors" content="Sideris, Michail;Rallis, Kathrine S.;Nicolaides, Marios;Kuri, Ashvin;Schottler, Nadine;Collaborators†;Paulus, Nathalie;Haas, Orthmar;Krajewski, Romuald;Grenho, Joao;Papalois, Vassilios" /><meta name="wkhealth_doi" content="10.1097/MS9.0000000000001583" /><meta name="wkhealth_abstract_html_url" content="https://journals.lww.com/annals-of-medicine-and-surgery/abstract/2024/02000/the_uems_experience_in_continuous_medical.10.aspx" /><meta name="wkhealth_fulltext_html_url" content="https://journals.lww.com/annals-of-medicine-and-surgery/fulltext/2024/02000/the_uems_experience_in_continuous_medical.10.aspx" /><meta name="wkhealth_toc_section" content="Original Research" /><meta name="wkhealth_toc_sub_section" /><meta name="wkhealth_eJpId" content="annals-of-medicine-and-surgery:2024:02000:00010" /><meta name="wkhealth_firstpage" content="689" /><meta name="wkhealth_date" content="February 2024" /><meta name="wkhealth_pdf_url" content="https://journals.lww.com/annals-of-medicine-and-surgery/_layouts/15/oaks.journals/downloadpdf.aspx?trckng_src_pg=Other&an=01845215-202402000-00010" /><meta name="Description" content="Background: The authors systematically appraise a large database of continuous professional devel" /><meta property="og:site_name" content="LWW" /><meta property="og:type" content="article" /><meta property="og:title" content="The UEMS experience in continuous medical education... : Annals of Medicine and Surgery" /><meta property="og:description" content="ospective observational study of all CPD or CME events within the European Union of Medical Specialists (UEMS) database between 2017 and 2019, including 91 countries and 6034 events. Assessment of event design, quality and outcomes was evaluated against a validated, expert-derived accreditation framework, using thematic analysis to extract distinct themes, and subsequent quantitative analysis. Results: The authors included 5649 live educational events (LEEs) and 385 e-learning materials (ELMs). Three thousand seven hundred sixty-two [3762 (62.3%)] of the events did not report clear justification in their needs assessment process. Most accreditation applications claimed covering a single educational need [1603/2277 (70.3%)]. Needs assessments were reported to be similar across conferences, courses and other types of events (P<0.01); 5642/6034 events (93.5%) had clearly documented expected learning outcomes; only 978/6034 (16.2%) reported a single expected learning outcome while the rest report 2–10 outcomes. Providers who declared more than one educational need also declared multiple learning outcomes (ρ=0.051, P<0.01). Conclusions: Despite EACCME providing a robust framework for the CPD/CME accreditation process, reporting quality can still be improved, as more than 1 in 2 events fail to provide a clear description of their needs assessment. To the authors’ knowledge, this is the largest educational LEE/ELM database, which can be a starting to revisit the CME/CPD accreditation process...." /><meta property="og:image" content="https://images.journals.lww.com/annals-of-medicine-and-surgery/SocialThumb.01845215-202402000-00010.F1.jpeg" /><meta property="og:image:width" content="1551" /><meta property="og:image:height" content="457" /><meta property="og:url" content="https://journals.lww.com/annals-of-medicine-and-surgery/fulltext/2024/02000/the_uems_experience_in_continuous_medical.10.aspx" /><meta property="twitter:card" content="summary" /><meta name="robots" content="index, follow, noarchive" /><meta name="WT.sv" content="ZUSE1PEJPWEB06" /><meta name="Title" content="Annals of Medicine and Surgery" /><style id="SPThemeHideForms" type="text/css">body {opacity:0 !important}</style>  <link href="https://fonts.googleapis.com/css?family=Arvo:400,400i,700|Fira+Sans:300,300i,400,400i,500,500i,600,600i,700,700i&display=swap" rel="stylesheet" /> <script> // temporary workaround for Bug 316328:[Stage][Registration][Regression 05.04] - Omniture events are not displayed for article viewer page // prevents JS exception in Adobe launch.js caused by situation when wkhealth_institution_type meta tag is present while wkhealth_institution_name tag is not in the page head // see this check in Adobe launch.js: null != document.querySelector("meta[name='wkhealth_institution_name']") ... // TODO: implement proper code fix after release 05.04.00 deployment var wkhealth_institution_type = document.querySelector("meta[name='wkhealth_institution_type']"); var wkhealth_institution_name = document.querySelector("meta[name='wkhealth_institution_name']"); console.warn(wkhealth_institution_type); console.warn(wkhealth_institution_name); if (wkhealth_institution_type && !wkhealth_institution_name) { console.warn('Workaround in release 05.04.00 - removing wkhealth_institution_type meta tag if wkhealth_institution_name is not present'); wkhealth_institution_type.remove(); } </script> <link rel="shortcut icon" href="https://cdn.wolterskluwer.io/wk-logos/1.0.x/favicon.png" type="image/vnd.microsoft.icon" id="favicon" /> <link id="ctl00_ctl14_wkfavicon_linkFavIcon" rel="shortcut icon" href="/annals-of-medicine-and-surgery/PublishingImages/WKfavicon.ico" type="image/x-icon"></link> <meta name="msapplication-TileImage" content="/_layouts/15/images/SharePointMetroAppTile.png" /><meta name="msapplication-TileColor" content="#0072C6" /> <link rel="stylesheet" type="text/css" href="https://lww.com/_layouts/15/1033/styles/Themable/corev15.css?v=05.24.00.023" media="screen" /> <link rel="stylesheet" type="text/css" href="https://lww.com/_layouts/15/oaks.journals/core/bootstrap.min.css?v=05.24.00.023" media="screen" /> <link id="ctl00_ctl14_FontAwesomeStylesheet" rel="stylesheet" type="text/css" href="https://unpkg.com/font-awesome@4.4.0/css/font-awesome.min.css"></link> <link rel="stylesheet" type="text/css" href="https://lww.com/_layouts/15/1033/styles/oaks.journals/bootstrap-overwrites.css?v=05.24.00.023" media="screen" /><link rel="stylesheet" type="text/css" href="https://lww.com/_layouts/15/1033/styles/oaks.journals/tachyons.css?v=05.24.00.023" media="screen" /><link rel="stylesheet" type="text/css" href="/annals-of-medicine-and-surgery/_layouts/15/1033/styles/oaks.journals/base-main-header.css?v=05.24.00.023" media="screen" /><link rel="stylesheet" type="text/css" href="https://lww.com/_layouts/15/oaks.journals/core/lww-core.css?v=05.24.00.023" media="screen" /><link rel="stylesheet" type="text/css" href="https://lww.com/_layouts/15/oaks.journals/core/ejp.css?v=05.24.00.023" media="screen" /><link rel="stylesheet" type="text/css" href="https://lww.com/_layouts/15/oaks.journals/core/ejp-print.css?v=05.24.00.023" media="print" /><link rel="stylesheet" type="text/css" href="https://lww.com/_layouts/15/oaks.journals/core/jqueryui.css?v=05.24.00.023" media="screen" /> <link rel="stylesheet" type="text/css" href="/annals-of-medicine-and-surgery/Style%20Library/journal.css?v=05.24.00.023" media="screen" /> <link rel="stylesheet" type="text/css" href="/annals-of-medicine-and-surgery/Style%20Library/custom.journal.css?v=05.24.00.023" media="screen" /> <script>var WebContext = {"EndPoints":{"ArticleMetricsEndpoint":"//services.journals.lww.com/IntegrationServices/ArticleMetricsService.svc","ThirdPartyRSSFeedServiceEndPoint":"https://services.journals.lww.com/IntegrationServices/ThirdPartyRSSFeedService.svc","JwtTokenServiceEndpoint":"https://journals.lww.com/annals-of-medicine-and-surgery/_layouts/15/OAKS.Journals/JsonWebToken.svc"}}</script> <script type="text/javascript">// <![CDATA[ var g_SPOffSwitches={}; // ]]> </script> <script type="text/javascript" src="/_layouts/15/1033/initstrings.js?rev=EIwgcAIn5eSIF0jZ5w1WhQ%3D%3DTAG0"></script> <script type="text/javascript" src="/_layouts/15/init.js?rev=zTJw1vV9i5CJeZ52lkKJSQ%3D%3DTAG0"></script> <script type="text/javascript" src="/_layouts/15/1033/strings.js?rev=50XNF7CGsZt5Ek1YPXlC1A%3D%3DTAG0"></script> <script type="text/javascript" src="/_layouts/15/theming.js?rev=SuLUbbwTXcxFWOWLFUsOkw%3D%3DTAG0"></script> <script type="text/javascript" src="/_layouts/15/ie55up.js?rev=WNq9rt3%2F6kUumHFiQZo6Jw%3D%3DTAG0"></script> <script type="text/javascript" src="/ScriptResource.axd?d=F7rjznvAP1ZvjwmSYaDR9a3zqrnKFnNGXs7A_cRIg2rplizpOOjwg9eBfW_KxBMLRVN3lzATjzWkisQusj_Iaw7I7xHhM2EsA2p1WTk5lIh-1_uEIMq1sktVYKM3D6Gp5VSqOtDTEnrScqHWTHOzdCPnKDjm2mtJH72pNbP0u4uI_zDnfi9spPAqI_kz3qnF0&t=ffffffffaa493ab8"></script> <script type="text/javascript" src="/_layouts/15/blank.js?rev=6Epdi%2BEh0XOHrFNRcf4Cwg%3D%3DTAG0"></script> <script type="text/javascript" src="/ScriptResource.axd?d=yatK8ruofouVZAe4qMCnoohEpb3HRGGjDeZZjZ7kMmC722OeAMhxqxkQCI5Rxx8YROZ4ohEXEd-BY-UzqqqylduXIs6jc38C73kN3lT2QdlwTljpny1fYEjcvvbYSMHNq1-TT-bDa0cFUDuAr5ywhChhEELpPbB_In_xfOO6OlgjpjP86LmsgZzKkXo8aCS90&t=ffffffffaa493ab8"></script> <script type="text/javascript" src="/ScriptResource.axd?d=Fr5k7XDliwj7SPEiKSqb-V3uT_yv_Vc0LBq3yd_m1_Ea8vkvI41fPqtWB8rH7kW9D2--SObxiXOCEDDg2Tv5yxNEAylK5ZpV5j9rD03yPUcCPh8w-y9A8MWLSg0jrQ-0kisGzu4Hba8Ct3e6oiiAj5nLa8lUDGLzNSKFrT8wEzRvrGDuqa6AKloxdLDyhLNb6sYlIjtGIn7oUTXlG_HGsg2&t=596f116c"></script> <script type="text/javascript" src="/ScriptResource.axd?d=LXNyktQiaIpbp533FW-c46OHB30ylIqDlrzk7r3HlWeMLy05SwQ7ZZDsPGq7NzzDRSU0tvewepiuVrszZuoio7QLmOYibhCj6dQNfSL2hGpxpyP-E7et27fbWMHpoIuHecopwN8d_b-WR8rimwUGdbN6akitIdX32lXMez7LH7qkG1jVMDvXf2M0_6gdMpGjpPKlEhmMrNGzYuo05_KLRO4TeTkKykcR_5pPB2fyzgk1&t=596f116c"></script> <script type="text/javascript" src="/ScriptResource.axd?d=UozfgYfgcP8g118ZMoKEWz_x5V51ZaIWOeFUe49mdZ8Yy8frQahBfRlFRNNeizXxYfmbtpE1uZMOMW2QeF7QCWjREvRvpNDSCGO5YICh1GalcUtEGJaGvVObluwmGza6-lV8S-wgb9vDF6UYZlWbyLOo-d94ckB8BN1hUlnIdqL9auDE1qR-ddFC7rw_89VZWQ6uTxR6vOlq2jE0iTr3J_6_Q3a7SLOduMua_ZXDgk7k01lBMUodCwi6dm-oTxLE0&t=596f116c"></script> <script type="text/javascript" src="/ScriptResource.axd?d=ZWgxL8bxzPcm3sf7nBtjnXIE2wsAF-izuHnFdkP9YIwhY40NTQZWAMXXd5_I4JNrdCjHASB5kHO0Yp663zuk5AhL_jRl1k_SY5vnpUrSCkFxyolVdXM4FQlXIKn4Vvw31N76GuK5LU06Z_W9PLwfY2Syw-289UtPxVzBx9gVTRruCab2sQxw8wsPzWwQuzodrorJnIINUBwKL_vl4JpUyg2&t=596f116c"></script> <script type="text/javascript" src="/ScriptResource.axd?d=EBaCwkyF6v0hRUf3ae-93ssVmxQ7oIMqv_PPxkqrb9oreHGbb2-nfpYVrHcdp3m-zVM-7IejfExLCflpv83MelmvDxCP_bfWTqE6qeqNKtnJrC6U7f-VSqzDeiqxeFeQcr2gdWPsj6xuQIL9yofEjL-H9aGyCIOqWIpEBJ7whIjP5cINMF1LSl9sjJQ7m8EzvCkRy97Lv87xdtMaOwsPZQua3oe2eRAfQMy5DfH1rBU1&t=596f116c"></script> <script type="text/javascript" src="/ScriptResource.axd?d=wD8VqdUYdbEDwBKpnhKPdzJbzZckynHSZAFSwtw0pb9xBjjkE5QcyWugHeKYmmlr5VSa3nfGB1Xz7jafz_E7BWSKiwSgokhW7jiO928L_QrPFxF6EUuMyF_R_k74O2ZH3Z2j_4YTihok5YYe4jIHNbXew2ICIYicdQ6t5hTNp6rgynp1DalRocxe5znBs87HZLCu8p1QfDK38eKJRZE968HV31IWzfYmG-OLm0YY--COCDBd2W06gq-Q4GGHyVyR0&t=596f116c"></script> <script type="text/javascript" src="/ScriptResource.axd?d=-7EYqBUD5SBnN9GXen_j6q1vUCHCiGsBm9LG-6jUM7Rd46ySBRRKNEzamKwU97Ev4GNWdvuZGqjKPpTco_vaUnZotagIyWjSOr8Y_YpPpCBN41u1qvqUa_Z3KhaMpFpLnBCVAOGXsZBX0gnLdrWl7SPrwgrfSJovgJOyKQNohnCagrVGRS7D0SajjiwZiBwbRFFXzQUODi-UXS4-R3OUE9NEoYmrfX_DvTq3geTEsrQ1&t=596f116c"></script> <script type="text/javascript" src="/ScriptResource.axd?d=1Bz5XD8diaSe1jTYew43lskkqvoOQ7xUk9zYBR9yPfNI5dG64NIPCYkFSKOHNDL_QVi-dGp62xDY0jGHiOTaybK9bApxYHqJLIbzEwEQB4irPiQPiKBzzY5p7N4f-D0FpCNtiMYBBQwavF6nxBbyIVOMdRyTBQ10Hm9Zmj9z2NOmhfNxDVkOcXNQDwO54qpnA74wIl4P7kqB5Ngz9hx4kY3xEadtMKXSX7uqRVTMzso1&t=596f116c"></script> <script type="text/javascript" src="/ScriptResource.axd?d=2jUlVNSVbehJJ-Lt4PSuX3imkArDDoAUwrw500StXDnRKdoHS2np91egmJiBUG7feIOax9x-3d3eG4JYvatg-8X9LQmJU49eWww19gWY7vSdphyQrCWf_QI352TwlgZkOjBO9SLzCdnP0Rkx2chN2q3GkIbDzjCD2z0q_V19F4FLoBgT9FcKUizcWUqIzBoXhgYN9ZOMKI0YCb0cjcqnIG9l7yUe6eYzolUqVyyoo5k1&t=596f116c"></script> <script type="text/javascript">RegisterSod("require.js", "\u002f_layouts\u002f15\u002frequire.js?rev=bv3fWJhk0uFGpVwBxnZKNQ\u00253D\u00253DTAG0");</script> <script type="text/javascript">RegisterSod("core.js", "\u002f_layouts\u002f15\u002fcore.js?rev=j9a0d\u00252BPy1yQxnd9MnbVzHQ\u00253D\u00253DTAG0");</script> <script type="text/javascript">RegisterSod("menu.js", "\u002f_layouts\u002f15\u002fmenu.js?rev=wrJq19VhLDExyMJ5\u00252B8yU0Q\u00253D\u00253DTAG0");</script> <script type="text/javascript">RegisterSod("mQuery.js", "\u002f_layouts\u002f15\u002fmquery.js?rev=NDgkLecAIkz\u00252BweeQGHsFzg\u00253D\u00253DTAG0");</script> <script type="text/javascript">RegisterSod("callout.js", "\u002f_layouts\u002f15\u002fcallout.js?rev=TL9KyIcEAc\u00252BtRfD5o03AZw\u00253D\u00253DTAG0");RegisterSodDep("callout.js", "mQuery.js");RegisterSodDep("callout.js", "core.js");</script> <script type="text/javascript">RegisterSod("clienttemplates.js", "\u002f_layouts\u002f15\u002fclienttemplates.js?rev=Mfj8gPH7gaoqpkHow8ptUQ\u00253D\u00253DTAG0");</script> <script type="text/javascript">RegisterSod("sharing.js", "\u002f_layouts\u002f15\u002fsharing.js?rev=l8H6ygZ\u00252BG2\u00252BDpz6C6Y8\u00252BUg\u00253D\u00253DTAG0");RegisterSodDep("sharing.js", "mQuery.js");RegisterSodDep("sharing.js", "clienttemplates.js");RegisterSodDep("sharing.js", "core.js");</script> <script type="text/javascript">RegisterSod("suitelinks.js", "\u002f_layouts\u002f15\u002fsuitelinks.js?rev=ShSwDRp3T8g1UhgsRv9KUg\u00253D\u00253DTAG0");RegisterSodDep("suitelinks.js", "core.js");</script> <script type="text/javascript">RegisterSod("followingcommon.js", "\u002f_layouts\u002f15\u002ffollowingcommon.js?rev=QR2wCguxRV0mhBMJO0Vskw\u00253D\u00253DTAG0");RegisterSodDep("followingcommon.js", "sp.js");RegisterSodDep("followingcommon.js", "userprofile");RegisterSodDep("followingcommon.js", "core.js");RegisterSodDep("followingcommon.js", "mQuery.js");</script> <script type="text/javascript">RegisterSod("profilebrowserscriptres.resx", "\u002f_layouts\u002f15\u002f1033\u002fprofilebrowserscriptres.js?rev=qwf69WaVc1mYlJLXqmZmVA\u00253D\u00253DTAG0");</script> <script type="text/javascript">RegisterSod("inplview", "\u002f_layouts\u002f15\u002finplview.js?rev=tpT9cAwdUg7z15xrMhetGA\u00253D\u00253DTAG0");RegisterSodDep("inplview", "core.js");RegisterSodDep("inplview", "clienttemplates.js");RegisterSodDep("inplview", "sp.js");</script> <script type="text/javascript">RegisterSod("dragdrop.js", "\u002f_layouts\u002f15\u002fdragdrop.js?rev=EBYmSndveb1Mkb91tDqsDA\u00253D\u00253DTAG0");</script> <script type="text/javascript">RegisterSod("quicklaunch.js", "\u002f_layouts\u002f15\u002fquicklaunch.js?rev=py6pvqNpjt2nepYELtlKNQ\u00253D\u00253DTAG0");RegisterSodDep("quicklaunch.js", "dragdrop.js");</script> <script type="text/javascript">RegisterSod("WPAdderClass", "\u002f_layouts\u002f15\u002fwpadder.js?rev=529JQZgm\u00252BveAvynFOnp2OA\u00253D\u00253DTAG0");</script> <script type="text/javascript" src="https://lww.com/_layouts/15/oaks.journals/core/jquery.js?v=05.24.00.023"> </script> <script type="text/javascript" src="https://lww.com/_layouts/15/oaks.journals/core/bootstrap.bundle.min.js?v=05.24.00.023" defer="true"> </script> <script type="text/javascript" src="https://lww.com/_layouts/15/oaks.journals/core/jqueryui.js?v=05.24.00.023"> </script> <link type="text/xml" rel="alternate" href="/annals-of-medicine-and-surgery/_vti_bin/spsdisco.aspx" /> <link rel="canonical" href="https://journals.lww.com/annals-of-medicine-and-surgery/fulltext/2024/02000/the_uems_experience_in_continuous_medical.10.aspx" /> <noscript> <meta http-equiv="Refresh" content="3;url=/_layouts/1033/OAKS.Journals/Error/JavaScript.html" /> </noscript> <script type="text/javascript" src="https://lww.com/_layouts/15/oaks.journals/core/lww-core.js?v=05.24.00.023"> </script> <script type="text/javascript" src="https://lww.com/_layouts/15/1033/Scripts/wk/journal-navigation.min.js?v=05.24.00.023" defer="true"> </script> <script type="text/javascript" src="https://lww.com/_layouts/15/1033/Scripts/wk/journals_master.min.js?v=05.24.00.023"> </script> <script type="text/javascript" src="https://lww.com/_layouts/15/oaks.journals/core/manifest.js?v=05.24.00.023" defer="true"> </script> <script type="text/javascript" src="https://lww.com/_layouts/15/oaks.journals/core/ejp.js?v=05.24.00.023" defer="true"> </script> <script type="text/javascript" src="https://lww.com/_layouts/15/oaks.journals/core/react-redux-vendors.js?v=05.24.00.023" defer="true"> </script> <script type="text/javascript"> var scpl_time = new Date(); scpl_time = scpl_time.getTime(); window.A8AJQ = jQuery.noConflict(); window.$ = jQuery.noConflict(); </script> <script async type="text/plain" src="https://aim-tag.hcn.health/js/client.js?dl=aimDataLayer&target=ie11" class="optanon-category-C0004"></script> <script> window.aimDataLayer = window.aimDataLayer || []; function aimTag() { aimDataLayer.push(arguments); } aimTag('2429bf11-c05b-409f-b998-8acef505546e', 'pageview'); aimTag('2429bf11-c05b-409f-b998-8acef505546e', 'signal', function (err, success) { if (err) { console.log(err); } else { console.log(success); if (success.identity_type === "AUT") { } } }); </script> <meta name="citation_doi" content="10.1097/MS9.0000000000001583"><meta name="citation_fulltext_world_readable" content="" /></head> <body id="ctl00_BodyTag" class="lww-body lww-article-view"> <span class="js-custom-event" data-config="{"name":"omni:page:view","detail":{"uid":"","uid_src":"None","page_loc":"https://journals.lww.com/annals-of-medicine-and-surgery/pages/articleviewer.aspx?year=2024&issue=02000&article=00010&type=Fulltext","page_ttl":"Annals of Medicine and Surgery"},"order":2147483647,"config":{"bubbles":true,"cancelable":true,"composed":false}}"></span>  <noscript><iframe src="https://www.googletagmanager.com/ns.html?id=GTM-NLR6H6W"height="0" width="0" style="display:none;visibility:hidden"></iframe></noscript>  <div id="imgPrefetch" style="display:none"> <img src="https://cdn.wolterskluwer.io/wk-logos/1.0.x/favicon.png?rev=43" /> <img src="/_layouts/15/images/spcommon.png?rev=43" /> </div> <noscript><div class='noindex'>You may be trying to access this site from a secured browser on the server. Please enable scripts and reload this page.</div></noscript> <form method="post" action="/annals-of-medicine-and-surgery/fulltext/2024/02000/the_uems_experience_in_continuous_medical.10.aspx" onsubmit="javascript:return WebForm_OnSubmit();" id="aspnetForm"> <div class="aspNetHidden"> <input type="hidden" name="_wpcmWpid" id="_wpcmWpid" value="" /> <input type="hidden" name="wpcmVal" id="wpcmVal" value="" /> <input type="hidden" name="MSOWebPartPage_PostbackSource" id="MSOWebPartPage_PostbackSource" value="" /> <input type="hidden" name="MSOTlPn_SelectedWpId" id="MSOTlPn_SelectedWpId" value="" /> <input type="hidden" name="MSOTlPn_View" id="MSOTlPn_View" value="0" /> <input type="hidden" name="MSOTlPn_ShowSettings" id="MSOTlPn_ShowSettings" value="False" /> <input type="hidden" name="MSOGallery_SelectedLibrary" id="MSOGallery_SelectedLibrary" value="" /> <input type="hidden" name="MSOGallery_FilterString" id="MSOGallery_FilterString" value="" /> <input type="hidden" name="MSOTlPn_Button" id="MSOTlPn_Button" value="none" /> <input type="hidden" name="__EVENTTARGET" id="__EVENTTARGET" value="" /> <input type="hidden" name="__EVENTARGUMENT" id="__EVENTARGUMENT" value="" /> <input type="hidden" name="__REQUESTDIGEST" id="__REQUESTDIGEST" value="noDigest" /> <input type="hidden" name="MSOSPWebPartManager_DisplayModeName" id="MSOSPWebPartManager_DisplayModeName" value="Browse" /> <input type="hidden" name="MSOSPWebPartManager_ExitingDesignMode" id="MSOSPWebPartManager_ExitingDesignMode" value="false" /> <input type="hidden" name="MSOWebPartPage_Shared" id="MSOWebPartPage_Shared" value="" /> <input type="hidden" name="MSOLayout_LayoutChanges" id="MSOLayout_LayoutChanges" value="" /> <input type="hidden" name="MSOLayout_InDesignMode" id="MSOLayout_InDesignMode" value="" /> <input type="hidden" name="_wpSelected" id="_wpSelected" value="" /> <input type="hidden" name="_wzSelected" id="_wzSelected" value="" /> <input type="hidden" name="MSOSPWebPartManager_OldDisplayModeName" id="MSOSPWebPartManager_OldDisplayModeName" value="Browse" /> <input type="hidden" name="MSOSPWebPartManager_StartWebPartEditingName" id="MSOSPWebPartManager_StartWebPartEditingName" value="false" /> <input type="hidden" name="MSOSPWebPartManager_EndWebPartEditing" id="MSOSPWebPartManager_EndWebPartEditing" value="false" /> <input type="hidden" name="listContainerControlstate" id="listContainerControlstate" value="AAEAAAD/////AQAAAAAAAAAEAQAAAA5TeXN0ZW0uQm9vbGVhbgEAAAAHbV92YWx1ZQABAAs=" /> <input type="hidden" name="hiddenDisplayItemView" id="hiddenDisplayItemView" value="Citation" /> <input type="hidden" name="hiddenSortBy" id="hiddenSortBy" value="" /> <input type="hidden" name="__LASTFOCUS" id="__LASTFOCUS" value="" /> <input type="hidden" name="__VIEWSTATE" id="__VIEWSTATE" value="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" /> </div> <script type="text/javascript"> //<![CDATA[ var theForm = document.forms['aspnetForm']; if (!theForm) { theForm = document.aspnetForm; } function __doPostBack(eventTarget, eventArgument) { if (!theForm.onsubmit || (theForm.onsubmit() != false)) { theForm.__EVENTTARGET.value = eventTarget; theForm.__EVENTARGUMENT.value = eventArgument; theForm.submit(); } } //]]> </script> <script src="/WebResource.axd?d=dnaDAFNiQGyAS-8AAnEusSAvRcEvxsZnbowJJdr_Pi9Oz7lzs5k45FStkRo1xlEHk9NeovbY1Hwq_CwXR_md87LXDXM1L2hMpaL8ksMyAA01&t=637811513229275428" type="text/javascript"></script> <script type="text/javascript"> //<![CDATA[ var MSOWebPartPageFormName = 'aspnetForm'; var g_presenceEnabled = true; var g_wsaEnabled = false; var g_correlationId = 'ca5c82a1-621e-f0c3-dd35-8fc10057a224'; var g_wsaQoSEnabled = false; var g_wsaQoSDataPoints = []; var g_wsaRUMEnabled = false; var g_wsaLCID = 1033; var g_wsaListTemplateId = 850; var g_wsaSiteTemplateId = 'EJOURNALS#7'; var _spPageContextInfo={"webServerRelativeUrl":"/annals-of-medicine-and-surgery","webAbsoluteUrl":"https://journals.lww.com/annals-of-medicine-and-surgery","viewId":"","listId":"{874e2075-d303-498d-9acf-32c2bcdb863a}","listPermsMask":{"High":0,"Low":200769},"listUrl":"/annals-of-medicine-and-surgery/Pages","listTitle":"Pages","listBaseTemplate":850,"viewOnlyExperienceEnabled":false,"blockDownloadsExperienceEnabled":false,"idleSessionSignOutEnabled":false,"cdnPrefix":"","siteAbsoluteUrl":"https://journals.lww.com/annals-of-medicine-and-surgery","siteId":"{8f5c1437-9c95-45d2-9e9f-6889de083ffb}","showNGSCDialogForSyncOnTS":false,"supportPoundStorePath":true,"supportPercentStorePath":true,"siteSubscriptionId":null,"CustomMarkupInCalculatedFieldDisabled":true,"AllowCustomMarkupInCalculatedField":false,"isSPO":false,"farmLabel":null,"serverRequestPath":"/annals-of-medicine-and-surgery/pages/articleviewer.aspx","layoutsUrl":"_layouts/15","webId":"{3016c7a5-9550-483b-8234-b047f7de98c1}","webTitle":"Annals of Medicine and Surgery","webTemplate":"20200","webTemplateConfiguration":"EJOURNALS#7","webDescription":"","tenantAppVersion":"0","isAppWeb":false,"webLogoUrl":"_layouts/15/images/siteicon.png","webLanguage":1033,"currentLanguage":1033,"currentUICultureName":"en-US","currentCultureName":"en-US","currentCultureLCID":1033,"env":null,"nid":0,"fid":0,"serverTime":"2025-02-17T11:16:34.0502143Z","siteClientTag":"0$$16.0.10416.20026","crossDomainPhotosEnabled":false,"openInClient":false,"Has2019Era":true,"webUIVersion":15,"webPermMasks":{"High":0,"Low":196609},"pageListId":"{874e2075-d303-498d-9acf-32c2bcdb863a}","pageItemId":58,"pagePermsMask":{"High":0,"Low":200769},"pagePersonalizationScope":1,"userEmail":"","userId":0,"userLoginName":null,"userDisplayName":null,"isAnonymousUser":true,"isAnonymousGuestUser":false,"isEmailAuthenticationGuestUser":false,"isExternalGuestUser":false,"systemUserKey":null,"alertsEnabled":true,"siteServerRelativeUrl":"/annals-of-medicine-and-surgery","allowSilverlightPrompt":"True","themeCacheToken":"/annals-of-medicine-and-surgery::1:","themedCssFolderUrl":null,"themedImageFileNames":null,"modernThemingEnabled":true,"isSiteAdmin":false,"ExpFeatures":[480216468,1884350801,1158731092,62197791,538521105,335811073,4194306,34614301,268500996,-1946025984,28445328,-2147475455,134291456,65536,288,950272,1282,808326148,134217873,0,0,-1073217536,545285252,18350656,-467402752,6291457,-2147483644,1074794496,-1728053184,1845537108,622628,4102,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0],"killSwitches":{},"InternalValidAuthorities":["journals.na.lww.com","journals.lww.com","journals.na.lww.com","journals.lww.com","cloud-journals.lww.com","cloud-journals.lww.com"],"CorrelationId":"ca5c82a1-621e-f0c3-dd35-8fc10057a224","hasManageWebPermissions":false,"isNoScriptEnabled":false,"groupId":null,"groupHasHomepage":true,"groupHasQuickLaunchConversationsLink":false,"departmentId":null,"hubSiteId":null,"hasPendingWebTemplateExtension":false,"isHubSite":false,"isWebWelcomePage":false,"siteClassification":"","hideSyncButtonOnODB":false,"showNGSCDialogForSyncOnODB":false,"sitePagesEnabled":false,"sitePagesFeatureVersion":0,"DesignPackageId":"00000000-0000-0000-0000-000000000000","groupType":null,"groupColor":"#188387","siteColor":"#188387","headerEmphasis":0,"navigationInfo":null,"guestsEnabled":false,"MenuData":{"SignInUrl":"/annals-of-medicine-and-surgery/_layouts/15/Authenticate.aspx?Source=%2Fannals%2Dof%2Dmedicine%2Dand%2Dsurgery%2Ffulltext%2F2024%2F02000%2Fthe%5Fuems%5Fexperience%5Fin%5Fcontinuous%5Fmedical%2E10%2Easpx"},"RecycleBinItemCount":-1,"PublishingFeatureOn":true,"PreviewFeaturesEnabled":false,"disableAppViews":false,"disableFlows":false,"serverRedirectedUrl":null,"formDigestValue":"0xB68CD0BDE491981C56DFB0978D0804A9679B7C12A5CBEC31274C7A5CF7F54321266CEA716927CCE017C2AD563DC9852FD8ED13B1BF52DD04B4EE180C46DC24D4,17 Feb 2025 11:16:34 -0000","maximumFileSize":10240,"formDigestTimeoutSeconds":1800,"canUserCreateMicrosoftForm":false,"canUserCreateVisioDrawing":true,"readOnlyState":null,"isTenantDevSite":false,"preferUserTimeZone":false,"userTimeZoneData":null,"userTime24":false,"userFirstDayOfWeek":null,"webTimeZoneData":null,"webTime24":false,"webFirstDayOfWeek":null,"isSelfServiceSiteCreationEnabled":null,"alternateWebAppHost":"","aadTenantId":"","aadUserId":"","aadInstanceUrl":"","msGraphEndpointUrl":"https://","allowInfectedDownload":true};_spPageContextInfo.updateFormDigestPageLoaded=new Date();_spPageContextInfo.clientServerTimeDelta=new Date(_spPageContextInfo.serverTime)-new Date();if(typeof(define)=='function'){define('SPPageContextInfo',[],function(){return _spPageContextInfo;});}var L_Menu_BaseUrl="/annals-of-medicine-and-surgery"; var L_Menu_LCID="1033"; var L_Menu_SiteTheme="null"; document.onreadystatechange=fnRemoveAllStatus; function fnRemoveAllStatus(){removeAllStatus(true)};//]]> </script> <script src="https://lww.com/_layouts/15/1033/Scripts/wk/alerts-subscription.min.js?v=05.24.00.023" type="text/javascript"></script> <script type="text/javascript"> //<![CDATA[ Flighting.ExpFeatures = [480216468,1884350801,1158731092,62197791,538521105,335811073,4194306,34614301,268500996,-1946025984,28445328,-2147475455,134291456,65536,288,950272,1282,808326148,134217873,0,0,-1073217536,545285252,18350656,-467402752,6291457,-2147483644,1074794496,-1728053184,1845537108,622628,4102,0,0,0,0,0,0,0,0,0,0,0,0,0,0,0]; (function() { if(typeof(window.SP) == "undefined") window.SP = {}; if(typeof(window.SP.YammerSwitch) == "undefined") window.SP.YammerSwitch = {}; var ysObj = window.SP.YammerSwitch; ysObj.IsEnabled = false; ysObj.TargetYammerHostName = "www.yammer.com"; } )(); var _spWebPartComponents = new Object();function openEmtcIfAuthenticated(resourceId){logCounterDataEmailToColleagueByAN('01845215-202402000-00010', false); window.location.assign('https://journals.lww.com/annals-of-medicine-and-surgery/pages/login.aspx?ReturnUrl=%2fannals-of-medicine-and-surgery%2ffulltext%2f2024%2f02000%2fthe_uems_experience_in_continuous_medical.10.aspx');}function slideShow_NavigateToUrl(urlToNavigate) { $('#ArticleImageModal').modal('hide'); logCounterDataImageGalleryByAN('01845215-202402000-00010'); window.location = urlToNavigate; }function HideSlideShow() { $('#ArticleImageModal').modal('hide'); }//]]> </script> <script src="https://lww.com/_layouts/15/1033/Scripts/wk/ListContainerControlBase.js?v=05.24.00.023" type="text/javascript"></script> <script type="text/javascript"> //<![CDATA[ function getSelectedItemsField() { return $get("selectedItems"); }function getCheckBoxListContainer() { return $get("checkBoxListContainer"); }function getListActionsContainerTop() { return $get("listActionsContainerTop"); }function getListActionsContainerBottom() { return $get("listActionsContainerBottom"); }function getSelectedItemsCount() {{ return getSelectedItemsField().value.split(';').length - 1; }}function article_AddSelectedItem(){ addToMyCollectionsLinkClicked('00010'); }function getEmailRegularExpression() { return /^(([a-zA-Z0-9_\-\.]+)@([a-zA-Z0-9_\-\.]+)\.([a-zA-Z]{2,5}){1,25})$/; }function getMultipleEmailsRegularExpression() { return /^(([a-zA-Z0-9_\-\.]+)@([a-zA-Z0-9_\-\.]+)\.([a-zA-Z]{2,5}){1,25})+([;.](([a-zA-Z0-9_\-\.]+)@([a-zA-Z0-9_\-\.]+)\.([a-zA-Z]{2,5}){1,25})+)*$/; }function getMailMessage() { return 'Thought you might appreciate this item(s) I saw in Annals of Medicine and Surgery.'; }function getImageCountStatus() { return $get("ctl00_ctl29_g_a3e22abe_1c71_45a4_806e_a91a83e1cfae_ctl00_slideShowUserControl_imageCountStatus"); }function getCallshowImage() { return $get("ctl00_ctl29_g_a3e22abe_1c71_45a4_806e_a91a83e1cfae_ctl00_slideShowUserControl_callShowImage"); }function getImageUrl() { return $get("ctl00_ctl29_g_a3e22abe_1c71_45a4_806e_a91a83e1cfae_ctl00_slideShowUserControl_image_url"); }function getDescription() { return $get("ctl00_ctl29_g_a3e22abe_1c71_45a4_806e_a91a83e1cfae_ctl00_slideShowUserControl_image_description"); }function getImageSourceTitle() { return $get("ctl00_ctl29_g_a3e22abe_1c71_45a4_806e_a91a83e1cfae_ctl00_slideShowUserControl_image_sourceTitle"); }function getImageSourceUrl() { return $get("ctl00_ctl29_g_a3e22abe_1c71_45a4_806e_a91a83e1cfae_ctl00_slideShowUserControl_image_sourceUrl"); }function getImageSourceInfo() { return $get("ctl00_ctl29_g_a3e22abe_1c71_45a4_806e_a91a83e1cfae_ctl00_slideShowUserControl_image_sourceInfo"); }function getImageKey() { return $get("ctl00_ctl29_g_a3e22abe_1c71_45a4_806e_a91a83e1cfae_ctl00_slideShowUserControl_image_key"); }function getImageFullSizeUrl() { return $get("ctl00_ctl29_g_a3e22abe_1c71_45a4_806e_a91a83e1cfae_ctl00_slideShowUserControl_image_fullSizeUrl"); }function getImageGalleryUrl() { return $get("ctl00_ctl29_g_a3e22abe_1c71_45a4_806e_a91a83e1cfae_ctl00_slideShowUserControl_image_imageGalleryUrl"); }function getEmailTOColleaguePopupID() { return "ctl00_ctl29_g_a3e22abe_1c71_45a4_806e_a91a83e1cfae_ctl00_emailToColleague"; }function image(id, nextImageId, previousImageId, title, description, rolloverUrl, popupUrl, fullSizeUrl, originalUrl, imageGalleryUrl, windowId){this.id = id;this.title = title;this.description = description;this.rolloverUrl = rolloverUrl;this.popupUrl = popupUrl;this.nextImageId = nextImageId;this.previousImageId = previousImageId; this.fullsizeUrl = fullSizeUrl; this.originalUrl = originalUrl;this.imageGalleryUrl = imageGalleryUrl; this.windowId=windowId}function Global_GetImagesCollection(){var images = new Object();images["F1"]=new image("F1","F2","","Figure 1","Coded themes (light grey boxes) under each axis (dark grey boxes).","https://images.journals.lww.com/annals-of-medicine-and-surgery/Rollover.01845215-202402000-00010.F1.jpeg","https://images.journals.lww.com/annals-of-medicine-and-surgery/Gallery.01845215-202402000-00010.F1.jpeg","https://journals.lww.com/annals-of-medicine-and-surgery/_layouts/oaks.journals/ImageView.aspx?k=annals-of-medicine-and-surgery:2024:02000:00010&i=F1&year=2024&issue=02000&article=00010&type=Fulltext","https://images.journals.lww.com/annals-of-medicine-and-surgery/Original.01845215-202402000-00010.F1.jpeg","/annals-of-medicine-and-surgery/pages/imagegallery.aspx?year=2024&issue=02000&article=00010", "annals-of-medicine-and-surgery_2024_02000_00010_F1");images["F2"]=new image("F2","F3","F1","Figure 2","Events summary diagrams depicting the scope of educational event applications.","https://images.journals.lww.com/annals-of-medicine-and-surgery/Rollover.01845215-202402000-00010.F2.jpeg","https://images.journals.lww.com/annals-of-medicine-and-surgery/Gallery.01845215-202402000-00010.F2.jpeg","https://journals.lww.com/annals-of-medicine-and-surgery/_layouts/oaks.journals/ImageView.aspx?k=annals-of-medicine-and-surgery:2024:02000:00010&i=F2&year=2024&issue=02000&article=00010&type=Fulltext","https://images.journals.lww.com/annals-of-medicine-and-surgery/Original.01845215-202402000-00010.F2.jpeg","/annals-of-medicine-and-surgery/pages/imagegallery.aspx?year=2024&issue=02000&article=00010", "annals-of-medicine-and-surgery_2024_02000_00010_F2");images["F3"]=new image("F3","","F2","Figure 3","Events summary diagrams depicting data relating to events quality assessment and stakeholders’ perspective.","https://images.journals.lww.com/annals-of-medicine-and-surgery/Rollover.01845215-202402000-00010.F3.jpeg","https://images.journals.lww.com/annals-of-medicine-and-surgery/Gallery.01845215-202402000-00010.F3.jpeg","https://journals.lww.com/annals-of-medicine-and-surgery/_layouts/oaks.journals/ImageView.aspx?k=annals-of-medicine-and-surgery:2024:02000:00010&i=F3&year=2024&issue=02000&article=00010&type=Fulltext","https://images.journals.lww.com/annals-of-medicine-and-surgery/Original.01845215-202402000-00010.F3.jpeg","/annals-of-medicine-and-surgery/pages/imagegallery.aspx?year=2024&issue=02000&article=00010", "annals-of-medicine-and-surgery_2024_02000_00010_F3"); return images; }function getPopupImageId() { return $get("ctl00_ctl29_g_a3e22abe_1c71_45a4_806e_a91a83e1cfae_ctl00_slideShowUserControl_popupImageId"); }function getIsExportToPPT() { return $get("ctl00_ctl29_g_a3e22abe_1c71_45a4_806e_a91a83e1cfae_ctl00_slideShowUserControl_IsExportToPPT"); }//]]> </script> <script src="/ScriptResource.axd?d=11ySqNT2t8wJXf-5ynqkHTYVaR0CZPUQDLhFk5-B61-yY4pHK9T4A-OmNoLERHX1OU2F3io32lKHXeNlvH0kpnJP6-ZQm2Ado5OlvNqUwB9TpwuIgMVQBgIz-DSVpHWqDoVFHrt69C9fSrbhF6t9QBuuAcSpa-p9_2de4EnR0aU1&t=2265eaa7" type="text/javascript"></script> <script src="/_layouts/15/blank.js?rev=6Epdi%2BEh0XOHrFNRcf4Cwg%3D%3DTAG0" type="text/javascript"></script> <script type="text/javascript"> //<![CDATA[ window.SPThemeUtils && SPThemeUtils.RegisterCssReferences([]); (function(){ if (typeof(_spBodyOnLoadFunctions) === 'undefined' || _spBodyOnLoadFunctions === null) { return; } _spBodyOnLoadFunctions.push(function() { SP.SOD.executeFunc('core.js', 'FollowingDocument', function() { FollowingDocument(); }); }); })();(function(){ if (typeof(_spBodyOnLoadFunctions) === 'undefined' || _spBodyOnLoadFunctions === null) { return; } _spBodyOnLoadFunctions.push(function() { SP.SOD.executeFunc('core.js', 'FollowingCallout', function() { FollowingCallout(); }); }); })();if (typeof(DeferWebFormInitCallback) == 'function') DeferWebFormInitCallback();//]]> </script> <script src="/WebResource.axd?d=ujR-dJ4zUHGN6jELxLVetl199sJpE_qZiBmEfUoaRM4DCmEfpBr9GGhTGo9ZJcfF6mQ45yf4Ik1RnQ9yqZG9_5EcA9R0xynU6JEfYiEh3vA1&t=637811513229275428" type="text/javascript"></script> <script type="text/javascript"> //<![CDATA[ function WebForm_OnSubmit() { UpdateFormDigest('\u002fannals-of-medicine-and-surgery', 1440000);if (typeof(ValidatorOnSubmit) == "function" && ValidatorOnSubmit() == false) return false;if (typeof(_spFormOnSubmitWrapper) != 'undefined') {return _spFormOnSubmitWrapper();} else {return true;}; return true; } //]]> </script> <div class="aspNetHidden"> <input type="hidden" name="__VIEWSTATEGENERATOR" id="__VIEWSTATEGENERATOR" value="5C44CD86" /> <input type="hidden" name="__EVENTVALIDATION" id="__EVENTVALIDATION" value="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" /> </div> <script type="text/javascript"> var submitHook = function () { return false; }; theForm._spOldSubmit = theForm.submit; theForm.submit = function () { if (!submitHook()) { this._spOldSubmit(); } }; </script> <span id="DeltaSPWebPartManager"> </span> <script type="text/javascript">$.getJSON("https://login.journals.lww.com/AuthCheck.aspx?Callback=?", null, function (data) { if(data.IsAuthenticated.toLowerCase() == "true") {window.location.replace("https://login.journals.lww.com/?wa=wsignin1.0&wtrealm=urn%3ajournals&wctx=https%3a%2f%2fjournals.lww.com%2fannals-of-medicine-and-surgery%2f_layouts%2f15%2fAuthenticate.aspx%3fSource%3d%252fannals-of-medicine-and-surgery%252ffulltext%252f2024%252f02000%252fthe_uems_experience_in_continuous_medical.10.aspx"); } }) </script> <script type="text/javascript"> //<![CDATA[ Sys.WebForms.PageRequestManager._initialize('ctl00$ScriptManager', 'aspnetForm', ['fctl00$WebPartAdderUpdatePanel',''], [], ['ctl00$WebPartAdder','','ctl00$ctl29$g_a3e22abe_1c71_45a4_806e_a91a83e1cfae$ctl00$ucArticleTools$exportToCitationManager$btnOpenExportDialog',''], 90, 'ctl00'); //]]> </script> <span id="DeltaDelegateControls"> </span>   <div id="ctl00_MicrobarContainer" class="top-microbar-container"> </div>  <a id="HiddenAnchor" href="javascript:;" style="display: none;"></a>  <div id="ctl00_TopAdvertisementContainer" class="advertisement-content_top top-banner"> <div class="top-banner__content--centered top-banner--low-opacity"> <div id="ctl00_ctl49_adContainer" class="ej-advertisement ej-advertisement-topcombo"> <div class="ej-advertisement-content"> <div> <div id="ga_2d7f4009-bf00-439e-aed9-d3f021766a6b" class="ad-slot-container ad-slot-container-ga_2d7f4009-bf00-439e-aed9-d3f021766a6b" data-sizemap="[[[730, 500], [[728, 90]]], [[0, 0], [[300, 50]]]]" data-adpath="/15726702761/Desktop/annals-of-medicine-and-surgery/Article/Top" data-autoload="yes" data-outofpage="no" data-sticky="no" data-slottargeting='' data-displayslug="yes" data-sticky-duration="5" data-name="Top"></div> </div> </div> </div> </div> </div> <div class="main-wrapper"> <div id="main-container">  <header class="header"> <div class="header__holder"> <div class="header__layout-top wk-grid-page-container"> <script type="text/javascript" src="https://lww.com/_layouts/15/1033/Scripts/wk/UserToolbarDropdown.js?v=05.24.00.023" defer="true"> </script> <section class="user-action-toolbar"> <ul class="user-menu user-info" role="tablist"> <li id="ctl00_ctl51_Header_UserActionTools_liLogin" class="user-menu__item user-menu__item--popup-container user-menu__item--login-popup-container dib"> <button class="user-menu__link user-menu__link--login js-ejp-login-btn" type="button" data-config="{"eventName":"login","eventDetail":{"source":"Masthead Dropdown"},"isNull":false}"> <i class="fa fa-sign-in"></i> <span>Log in</span> </button> </li> <li id="ctl00_ctl51_Header_UserActionTools_liOr" class="dib or-spacing"><span>or</span></li> <li id="ctl00_ctl51_Header_UserActionTools_liRegister2" class="user-menu__item dib"> <a id="ctl00_ctl51_Header_UserActionTools_RegisterUserPopupLnk" class="user-menu__link js-register-link" data-config="{"eventName":"Register","eventDetail":{"source":"Masthead Dropdown"},"isNull":false}" href="https://journals.lww.com/annals-of-medicine-and-surgery/pages/register.aspx?ContextUrl=%2fannals-of-medicine-and-surgery%2ffulltext%2f2024%2f02000%2fthe_uems_experience_in_continuous_medical.10.aspx">Register</a> </li> <li id="ctl00_ctl51_Header_UserActionTools_liIssueAlerts" class="user-menu__item dib"> <i class="fa fa-envelope"></i> <a rel="nofollow" title href="javascript:javascript: alerts_ShowSubscribeeTOCPopup('Annals of Medicine and Surgery','annals-of-medicine-and-surgery','eTOC', 'eTOC');;" onclick="javascript: alerts_ShowSubscribeeTOCPopup('Annals of Medicine and Surgery','annals-of-medicine-and-surgery','eTOC', 'eTOC');" class="user-menu__link"><span id="ctl00_ctl51_Header_UserActionTools_SubscribeToAlertsActionToolLink_defaultText" class="hideOnFixed">Get new issue alerts</span><span id="ctl00_ctl51_Header_UserActionTools_SubscribeToAlertsActionToolLink_stickyText" class="showOnFixed">Get alerts</span></a> </li> </ul> </section> <span id="ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_dummyTargetControl"></span> <div id="ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_pnlunSubscribeToAlerts" style="display: none;"> <div tabindex="-1" role="dialog" class="wk-modal horizontally-centered small wk-modal-with-overlay wk-modal-small ejp-modal"> <div id="ej-box-modal-style-1"> <div id="ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_pnlMain"> <div id="tocUnsubscribeModal" > <section class="wk-modal-content"> <header class="wk-modal-header ejp-modal-header"> <div class="wk-modal-title ejp-modal-title"></div> <button aria-label="close dialog" class="js-close primary-button wk-button-icon wk-modal-close ejp-modal-close "><i class="fa fa-times"></i></button> </header> <div class="wk-modal-body"> <div class="wk-field-item"> <p> <span id="ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_lblUnsubscribeMessage"></span> </p> <div class="wk-button-bar"> <div class="wk-button-group-left"> <p id="ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_pUnsubscribeButtons" Style="display: none;"> <input type="submit" name="ctl00$ctl51$Header$UserActionTools$ucUnsubscribeToAlertsUserControl$btnContinue" value="Yes" onclick="javascript:WebForm_DoPostBackWithOptions(new WebForm_PostBackOptions("ctl00$ctl51$Header$UserActionTools$ucUnsubscribeToAlertsUserControl$btnContinue", "", true, "", "", false, false))" id="ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_btnContinue" class="primary-button" /> <input type="button" value="No" id="btnCancel" aria-label="close dialog" class="js-close secondary-button" /> </p> </div> </div> </div> </div> </section> </div> </div> </div> </div> </div> <div id="ej-clear-float"> </div> <input type="hidden" name="ctl00$ctl51$Header$UserActionTools$ucUnsubscribeToAlertsUserControl$hiddenUnSubscribeAlertType" id="ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_hiddenUnSubscribeAlertType" /> <input type="hidden" name="ctl00$ctl51$Header$UserActionTools$ucUnsubscribeToAlertsUserControl$hiddenUnsubscribeJournalId" id="ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_hiddenUnsubscribeJournalId" /> <input type="hidden" name="ctl00$ctl51$Header$UserActionTools$ucUnsubscribeToAlertsUserControl$hiddenUnsubscribeMessage" id="ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_hiddenUnsubscribeMessage" /> <input type="hidden" name="ctl00$ctl51$Header$UserActionTools$ucUnsubscribeToAlertsUserControl$hiddenTopicalCollectionId" id="ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_hiddenTopicalCollectionId" /> <input type="hidden" name="ctl00$ctl51$Header$UserActionTools$ucUnsubscribeToAlertsUserControl$hiddenOvidId" id="ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_hiddenOvidId" /> <input type="hidden" name="ctl00$ctl51$Header$UserActionTools$ucUnsubscribeToAlertsUserControl$hiddenJournalId" id="ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_hiddenJournalId" /> <script type="text/javascript"> function alerts_ShowUnSubscribeeTOCPopup(title, alertType, journalId) { var unSubscribeeTocPopup = $find('unSubscribeToAlerts'); var lblUnsubscribeMessage = document.getElementById('ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_lblUnsubscribeMessage'); lblUnsubscribeMessage.innerHTML = title; document.getElementById('ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_hiddenUnSubscribeAlertType').value = alertType; document.getElementById('ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_hiddenUnsubscribeMessage').value = title; $('#' + 'ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_pUnsubscribeButtons').show(); if (document.getElementById('ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_hiddenJournalId').value == null || document.getElementById('ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_hiddenJournalId').value == '') { document.getElementById('ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_hiddenJournalId').value = journalId; } if (unSubscribeeTocPopup != null) { unSubscribeeTocPopup.show(); } } function alerts_ShowUnSubscribeeTOCPopup_Root(title, journalId, alertType) { var unSubscribeeTocPopup = $find('unSubscribeToAlerts'); var lblUnsubscribeMessage = document.getElementById('ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_lblUnsubscribeMessage'); lblUnsubscribeMessage.innerHTML = title; document.getElementById('ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_hiddenUnsubscribeMessage').value = title; document.getElementById('ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_hiddenUnSubscribeAlertType').value = alertType; document.getElementById('ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_hiddenUnsubscribeJournalId').value = journalId; $('#' + 'ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_pUnsubscribeButtons').show(); if (unSubscribeeTocPopup != null) { unSubscribeeTocPopup.show(); } } function alerts_ShowUnSubscribeeTOCPopup_Citation(title, journalId, ovidId) { var unSubscribeeTocPopup = $find('unSubscribeToAlerts'); var lblUnsubscribeMessage = document.getElementById('ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_lblUnsubscribeMessage'); lblUnsubscribeMessage.innerHTML = title; document.getElementById('ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_hiddenUnsubscribeMessage').value = title; document.getElementById('ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_hiddenUnSubscribeAlertType').value = 'Citation'; document.getElementById('ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_hiddenUnsubscribeJournalId').value = journalId; document.getElementById('ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_hiddenOvidId').value = ovidId; $('#' + 'ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_pUnsubscribeButtons').show(); if (unSubscribeeTocPopup != null) { unSubscribeeTocPopup.show(); } } function alerts_ShowUnSubscribeeTOCPopup_Topical(title, journalId, topicalCollectionId) { var unSubscribeeTocPopup = $find('unSubscribeToAlerts'); var lblUnsubscribeMessage = document.getElementById('ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_lblUnsubscribeMessage'); lblUnsubscribeMessage.innerHTML = title; document.getElementById('ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_hiddenUnsubscribeMessage').value = title; document.getElementById('ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_hiddenUnSubscribeAlertType').value = 'Topical'; document.getElementById('ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_hiddenUnsubscribeJournalId').value = journalId; document.getElementById('ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_hiddenTopicalCollectionId').value = topicalCollectionId; $('#' + 'ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_pUnsubscribeButtons').show(); if (document.getElementById('ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_hiddenJournalId').value == null || document.getElementById('ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_hiddenJournalId').value == '') { document.getElementById('ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_hiddenJournalId').value = journalId; } if (unSubscribeeTocPopup != null) { unSubscribeeTocPopup.show(); } } function alerts_ShowUnSubscribeeTOCSuccessPopup() { var unSubscribeeTocPopup = $find('unSubscribeToAlerts'); if (unSubscribeeTocPopup != null) { unSubscribeeTocPopup.show(); } } $('.js-close').on('click', function() { var unSubscribeeTocPopup = $find('unSubscribeToAlerts'); if (unSubscribeeTocPopup != null) { unSubscribeeTocPopup.hide(); } return false; }); </script> <span id="ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_dummyTargetControl"></span> <input type="hidden" name="ctl00$ctl51$Header$UserActionTools$SubscribeToEtocPopupControl$hiddenSubscribeToEtocPopupState" id="ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_hiddenSubscribeToEtocPopupState" value="showemail" /> <input type="hidden" name="ctl00$ctl51$Header$UserActionTools$SubscribeToEtocPopupControl$hiddenConfirmSubscriptionPageUrl" id="ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_hiddenConfirmSubscriptionPageUrl" /> <input type="hidden" name="ctl00$ctl51$Header$UserActionTools$SubscribeToEtocPopupControl$hiddenJournalId" id="ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_hiddenJournalId" /> <input type="hidden" name="ctl00$ctl51$Header$UserActionTools$SubscribeToEtocPopupControl$hiddenSubscriptionType" id="ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_hiddenSubscriptionType" /> <div id="divPopupOverLay" class="Popup-Overlay" style="display: none; position: fixed; left: 0; top: 0; z-index: 3800; width: 1920px; height: 4517px;"></div> <div id="ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_pnlSubscribeToEtoc" class="etoc-popup ej-box-modal-drop-shadow" style="display: none;"> <div tabindex="-1" role="dialog" class="wk-modal horizontally-centered small wk-modal-with-overlay wk-modal-small ejp-modal"> <div id="ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_pnlMain" onkeypress="javascript:return WebForm_FireDefaultButton(event, 'ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_btnContinue')"> <section class="wk-modal-content"> <header class="wk-modal-header ejp-modal-header"> <div class="wk-modal-title ejp-modal-title"> <span id="ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_lblTitle"></span> </div> <button aria-label="close dialog" class="js-close primary-button wk-button-icon wk-modal-close ejp-modal-close "> <i class="fa fa-times"></i> </button> </header> <div class="wk-modal-body"> <div class="wk-field-item"> <div class="wk-field-body"> <strong> <span id="ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_lblThankYouMessage"></span></strong> </div> <div class="wk-field-body"> <span id="ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_cvEmailError" style="color:Black;display:none;"> <div class="ej-error-message"> <p class="ej-error-message-icon error-red"> </p> </div> </span> <label for="Email input">Enter your Email address:</label> <div class="wk-field-body"> <input name="ctl00$ctl51$Header$UserActionTools$SubscribeToEtocPopupControl$txtEmailAddress" type="text" id="ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_txtEmailAddress" class="ej-box-modal-style-1-input" /> </div> </div> <div class="wk-button-bar"> <div class="wk-button-group-left"> <input type="submit" name="ctl00$ctl51$Header$UserActionTools$SubscribeToEtocPopupControl$btnContinue" value="Continue" onclick="javascript:WebForm_DoPostBackWithOptions(new WebForm_PostBackOptions("ctl00$ctl51$Header$UserActionTools$SubscribeToEtocPopupControl$btnContinue", "", true, "", "", false, false))" id="ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_btnContinue" class="primary-button" /> <input type="button" value="Cancel" id="btnCancel" class="js-close secondary-button" /> </div> </div> </div> <div class="wk-field-item"> <div class="wk-field-body"> <a id="ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_hypPrivacy" href="https://journals.lww.com/annals-of-medicine-and-surgery/_layouts/oaks.journals/privacy.aspx" target="_blank">Privacy Policy</a> </div> </div> </div> </section> </div> <div id="ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_pnlAuthenticatedUser" style="display: none;"> <section class="wk-modal-content"> <header class="wk-modal-header ejp-modal-header"> <div class="wk-modal-title ejp-modal-title"></div> <button aria-label="close dialog" class="js-close primary-button wk-button-icon wk-modal-close ejp-modal-close "><i class="fa fa-times"></i></button> </header> <div class="wk-modal-body"> <div class="wk-field-item"> <p> <strong> <span id="ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_lblAuthenticatedUserTitle"></span> </strong> </p> </div> <p id="ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_pAuthenticatedUserMessage"> </p> </div> </section> </div> </div> </div> <div id="ej-clear-float"> </div> <script type="text/javascript"> function alerts_SaveSubscriptionTypeInHiddenField(url, subscriptionType, journalId, yearId, issueId, articleId) { if (journalId && yearId && issueId && articleId) { logCounterDataAlertWhenCitedSynchronously(journalId, yearId, issueId, articleId); } $('#' + 'ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_hiddenSubscriptionType').val(subscriptionType); $('#' + 'ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_hiddenJournalId').val(journalId); if (url) window.location = url; else __doPostBack('hypSubscribeToAlerts'); return false; } function alerts_ShowSubscribeeTOCPopup(journalTitle, journalId, subscriptionType, displaySubscriptionType) { $('#' + 'ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_hiddenSubscriptionType').val(subscriptionType); var subscribeToEtocPopup = $find('subscribeToEtoc'); subscribeToEtocPopup.show(); document.getElementsByTagName( 'html' )[0].classList.add('no-scroll'); var modelPopupState = document.getElementById('ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_hiddenSubscribeToEtocPopupState'); var emailTextBox = document.getElementById('ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_txtEmailAddress'); var thanksPanel = document.getElementById('ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_pnlAuthenticatedUser'); var mainPanel = document.getElementById('ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_pnlMain'); var thankYouMessageUnAuthenticated = document.getElementById('ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_lblThankYouMessage'); var thankYouMessageAuthenticated = document.getElementById('ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_lblAuthenticatedUserTitle'); if (!displaySubscriptionType) { displaySubscriptionType = subscriptionType; } if (modelPopupState.value == 'showthanksmessage') { thanksPanel.style.display = "block"; mainPanel.style.display = "none"; thankYouMessageAuthenticated.innerHTML = "Thank you for subscribing to the " + displaySubscriptionType + " for " + journalTitle + "."; } if (modelPopupState.value == 'showemail') { thanksPanel.style.display = "none"; mainPanel.style.display = "block"; thankYouMessageUnAuthenticated.innerHTML = "Thank you for choosing to subscribe to the " + displaySubscriptionType + " for " + journalTitle + "."; } if ($('.etoc-popup') != null) { document.getElementById('ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_hiddenJournalId').value = journalId; if (modelPopupState.value == 'showemail') emailTextBox.focus(); } } $('.js-close').on('click', function () { document.getElementById('ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_txtEmailAddress').value = ""; document.getElementById('ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_cvEmailError').style.display = "none"; var pageUrl = document.getElementById('ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_hiddenConfirmSubscriptionPageUrl'); var subscribeeTocPopup = $find('subscribeToEtoc'); if (subscribeeTocPopup != null) { subscribeeTocPopup.hide(); document.getElementsByTagName( 'html' )[0].classList.remove('no-scroll'); if (pageUrl.value !== '' && pageUrl.value !== window.location.pathname) window.location = pageUrl.value; } return false; }); </script> <div id="ctl00_ctl51_Header_UserActionTools_eTocTopContainer"> <div id="eTocTop" style="display: none;"> <a rel="nofollow" title href="javascript:javascript: alerts_ShowSubscribeeTOCPopup('Annals of Medicine and Surgery','annals-of-medicine-and-surgery','eTOC', 'eTOC');;" onclick="javascript: alerts_ShowSubscribeeTOCPopup('Annals of Medicine and Surgery','annals-of-medicine-and-surgery','eTOC', 'eTOC');"><span id="ctl00_ctl51_Header_UserActionTools_alertLinkControlTop_defaultText" class="hideOnFixed">Subscribe to eTOC</span></a> </div> </div> <script> $(function () { //find recent searches link and move container var recentSearchesControl = $("a[id$='RecentSearches']"); if (recentSearchesControl.length) { recentSearchesControl.click(function (e) { e.stopPropagation(); if ($("#ResentSearchContainer").is(":hidden")) { $("#ResentSearchContainer").slideDown("slow"); recentSearchesControl.addClass('open'); } else { $("#ResentSearchContainer").hide(); recentSearchesControl.removeClass('open'); } }); } var eTocAccountLink = $("ul.js-user-action-toolbar__dropdown>li>a[id='SubscribeToEToc']"); if (eTocAccountLink.length) { eTocAccountLink.parent().html($("#eTocTop>a")); } }); </script> <a class="logo-secondary white" href="http://wolterskluwer.com/" target="_blank"> <h3 class="logo-secondary-text">Secondary Logo</h3> </a> <a href="#" class="sticky-search"><i class="fa fa-search"></i></a> </div> <div class="header__layout-bottom wk-grid-page-container"> <a id="hypJournals" class="logo-main" href="https://journals.lww.com/annals-of-medicine-and-surgery/pages/default.aspx"> <h3 class="logo-main-text">Journal Logo </h3> </a> <div class="search-v2"> <div class="search-wrapper"> <select name="ctl00$ctl51$Header$SearchTopBoxControl$ddlContentScope" id="ctl00_ctl51_Header_SearchTopBoxControl_ddlContentScope"> <option value="All">All</option> <option selected="selected" value="Articles">Articles</option> <option value="Images">Images</option> <option value="Videos">Videos</option> <option value="Podcasts">Podcasts</option> <option value="Blogs">Blogs</option> </select> <div class="input-group" id="globalSearch"> <input name="ctl00$ctl51$Header$SearchTopBoxControl$txtKeywords" type="text" value="Search" id="ctl00_ctl51_Header_SearchTopBoxControl_txtKeywords" class="form-control searchText" /> <span class="input-group-btn"> <button id="ctl00_ctl51_Header_SearchTopBoxControl_btnGlobalSearchMagnifier" type="submit" class="btn btn-default"><i class="fa fa-search"></i></button> </span> <input type="hidden" name="ctl00$ctl51$Header$SearchTopBoxControl$IsAutoCompleteEnabled" id="ctl00_ctl51_Header_SearchTopBoxControl_IsAutoCompleteEnabled" value="false" /> <input type="hidden" name="ctl00$ctl51$Header$SearchTopBoxControl$AutocompleteApiUrl" id="ctl00_ctl51_Header_SearchTopBoxControl_AutocompleteApiUrl" value="https://platformservices.wolterskluwerhealth.com/autocomplete/AMSUR/shingle/" /> </div> </div> <div class="advance-search" style=""> <a id="ctl00_ctl51_Header_SearchTopBoxControl_lnkAdvanceSearch" href="https://journals.lww.com/annals-of-medicine-and-surgery/pages/advancedsearch.aspx">Advanced Search</a> <input type="submit" name="ctl00$ctl51$Header$SearchTopBoxControl$btnGlobalSearch" value="" id="ctl00_ctl51_Header_SearchTopBoxControl_btnGlobalSearch" disabled="disabled" class="aspNetDisabled btnGlobalSearch" style="display: none;" /> <input name="ctl00$ctl51$Header$SearchTopBoxControl$hfldKeywords" type="hidden" id="ctl00_ctl51_Header_SearchTopBoxControl_hfldKeywords" class="hfldKeywords" value="disableButton" /> </div> </div> <script> $(function() { try { var objSearchBox = { btnGlobalSearchMagnifierId: 'ctl00_ctl51_Header_SearchTopBoxControl_btnGlobalSearchMagnifier', searchButtonId: 'ctl00_ctl51_Header_SearchTopBoxControl_btnGlobalSearch', txtKeywordsId: 'ctl00_ctl51_Header_SearchTopBoxControl_txtKeywords', hfldKeywordsHiddenId: 'ctl00_ctl51_Header_SearchTopBoxControl_hfldKeywords', defaultSearchText: 'Search' }; new Searchbox(objSearchBox).Init(); } catch (e) { console.error(e); } }); //autocomplete functionality for basic search //this functionality will call the SBA url and start suggesting after typing 3rd character var textKeywords = null; var hiddenAutocompleteApiUrl = null; var buttonGlobalSearch = null; $(function () { try { var objAutocomplete = { hiddenIsAutoCompleteEnabled: $('#ctl00_ctl51_Header_SearchTopBoxControl_IsAutoCompleteEnabled'), textKeywords: $('#ctl00_ctl51_Header_SearchTopBoxControl_txtKeywords'), hiddenAutocompleteApiUrl: $('#ctl00_ctl51_Header_SearchTopBoxControl_AutocompleteApiUrl'), buttonGlobalSearch: $('#ctl00_ctl51_Header_SearchTopBoxControl_btnGlobalSearch'), enableNewAutoComplete: true, newAutoCompleteUrl: 'https://dxg-search-na-prd.wkgposvc.cloud/Query.svc/Query_Expand', newAutoCompleteMaxSuggestions: '10', newAutoCompleteDictionaryIds: 'ovid_sted28_mesh22' }; autoComplete(objAutocomplete); } catch (e) { console.error(e); } }); $(function () { let searchSelect = $('select[id$="ddlContentScope"]');; if (searchSelect.length){ searchSelect.selectize(); } }); </script> </div> <div id="main-nav-container-v2"> <nav id="main-nav" class="navbar navbar-default yamm wk-grid-page-container"> <div class="navbar-header"> <button id="fatJuicy" type="button" class="navbar-hamburger-button navbar-toggle collapsed pull-left" data-bs-toggle="collapse" data-bs-target="#zz1_TopNavigationMenu" aria-expanded="false" aria-controls="navbar"> <span class="visually-hidden">Toggle navigation</span> <span class="icon-bar"></span> <span class="icon-bar"></span> <span class="icon-bar"></span> <span class="navbar-hamburger-button__text"></span> </button> </div> <div id="navActionButtons" class="btn-group navbar-hover-color" role="group" aria-label="..."> <a id="ctl00_ctl51_lnkRegister" class="btn btn-default navbar-button" href="https://journals.lww.com/annals-of-medicine-and-surgery/pages/register.aspx?ContextUrl=%2fannals-of-medicine-and-surgery%2ffulltext%2f2024%2f02000%2fthe_uems_experience_in_continuous_medical.10.aspx">Register</a> <button class="user-menu__link user-menu__link--login js-ejp-login-btn btn btn-default navbar-button" type="button" data-config="{"eventName":"login","eventDetail":{},"isNull":false}"> <span>Login</span> </button> </div> <div id="ctl00_ctl51_TopNavigationMenuConfiguration" style="display:none" class="js-top-navigation-menu-configuration" data-config="{"browsingHistory":{"isEnabled":true,"serviceUrl":"https://apim-hlrp-ejp-prod.azure-api.net/ee","pdfDownloadUrl":"/_layouts/15/oaks.journals/downloadpdf.aspx?trckng_src_pg=HistoryTab"}}"></div> <div id="zz1_TopNavigationMenu" class="navbar-collapse collapse js-top-navigation-menu noindex ms-core-listMenu-horizontalBox"> <ul id="zz2_RootAspMenu" class="root ms-core-listMenu-root static"> <li class="static selected"><a class="static selected menu-item ms-core-listMenu-item ms-displayInline ms-core-listMenu-selected ms-navedit-linkNode" href="/annals-of-medicine-and-surgery/pages/default.aspx" accesskey="1"><span class="additional-background ms-navedit-flyoutArrow"><span class="menu-item-text">Home</span><span class="ms-hidden">Currently selected</span></span></a></li><li class="static dynamic-children"><span class="static dynamic-children menu-item ms-core-listMenu-item ms-displayInline ms-navedit-linkNode"><span aria-haspopup="true" class="additional-background ms-navedit-flyoutArrow dynamic-children"><span class="menu-item-text">Articles & Issues</span></span></span><ul aria-hidden="true" class="dynamic"> <li class="dynamic"><a class="dynamic menu-item ms-core-listMenu-item ms-displayInline ms-navedit-linkNode" href="/annals-of-medicine-and-surgery/pages/currenttoc.aspx"><span class="additional-background ms-navedit-flyoutArrow"><span class="menu-item-text">Current Issue</span></span></a></li><li class="dynamic"><a class="dynamic menu-item ms-core-listMenu-item ms-displayInline ms-navedit-linkNode" href="/annals-of-medicine-and-surgery/pages/issuelist.aspx"><span class="additional-background ms-navedit-flyoutArrow"><span class="menu-item-text">Previous Issues</span></span></a></li><li class="dynamic"><a class="dynamic menu-item ms-core-listMenu-item ms-displayInline ms-navedit-linkNode" href="/annals-of-medicine-and-surgery/toc/publishahead"><span class="additional-background ms-navedit-flyoutArrow"><span class="menu-item-text">Online First</span></span></a></li> </ul></li><li class="static dynamic-children"><span class="static dynamic-children menu-item ms-core-listMenu-item ms-displayInline ms-navedit-linkNode"><span aria-haspopup="true" class="additional-background ms-navedit-flyoutArrow dynamic-children"><span class="menu-item-text">For Authors</span></span></span><ul aria-hidden="true" class="dynamic"> <li class="dynamic"><a class="dynamic menu-item ms-core-listMenu-item ms-displayInline ms-navedit-linkNode" href="https://www.editorialmanager.com/amsu/default2.aspx"><span class="additional-background ms-navedit-flyoutArrow"><span class="menu-item-text">Submit a Manuscript</span></span></a></li><li class="dynamic"><a class="dynamic menu-item ms-core-listMenu-item ms-displayInline ms-navedit-linkNode" href="/annals-of-medicine-and-surgery/Pages/Information-for-Authors.aspx"><span class="additional-background ms-navedit-flyoutArrow"><span class="menu-item-text">Information for Authors</span></span></a></li><li class="dynamic"><a class="dynamic menu-item ms-core-listMenu-item ms-displayInline ms-navedit-linkNode" href="/annals-of-medicine-and-surgery/Pages/Language-Editing-Services.aspx"><span class="additional-background ms-navedit-flyoutArrow"><span class="menu-item-text">Language Editing Services</span></span></a></li><li class="dynamic"><a class="dynamic menu-item ms-core-listMenu-item ms-displayInline ms-navedit-linkNode" href="/annals-of-medicine-and-surgery/Pages/Editorial,-Legal,-and-Ethical-Policies.aspx"><span class="additional-background ms-navedit-flyoutArrow"><span class="menu-item-text">Editorial, Legal, & Ethical Policies</span></span></a></li> </ul></li><li class="static dynamic-children"><span class="static dynamic-children menu-item ms-core-listMenu-item ms-displayInline ms-navedit-linkNode"><span aria-haspopup="true" class="additional-background ms-navedit-flyoutArrow dynamic-children"><span class="menu-item-text">Journal Info</span></span></span><ul aria-hidden="true" class="dynamic"> <li class="dynamic"><a class="dynamic menu-item ms-core-listMenu-item ms-displayInline ms-navedit-linkNode" href="/annals-of-medicine-and-surgery/pages/aboutthejournal.aspx"><span class="additional-background ms-navedit-flyoutArrow"><span class="menu-item-text">About the Journal</span></span></a></li><li class="dynamic"><a class="dynamic menu-item ms-core-listMenu-item ms-displayInline ms-navedit-linkNode" href="/annals-of-medicine-and-surgery/pages/editorialboard.aspx"><span class="additional-background ms-navedit-flyoutArrow"><span class="menu-item-text">Editorial Board</span></span></a></li><li class="dynamic"><a class="dynamic menu-item ms-core-listMenu-item ms-displayInline ms-navedit-linkNode" href="/annals-of-medicine-and-surgery/Pages/Journal-Staff-and-Contacts.aspx"><span class="additional-background ms-navedit-flyoutArrow"><span class="menu-item-text">Journal Staff & Contacts</span></span></a></li><li class="dynamic"><a class="dynamic menu-item ms-core-listMenu-item ms-displayInline ms-navedit-linkNode" href="https://www.wolterskluwer.com/en/solutions/lippincott-hcp-access/media-kits/annals-of-medicine-and-surgery"><span class="additional-background ms-navedit-flyoutArrow"><span class="menu-item-text">Advertising</span></span></a></li><li class="dynamic"><a class="dynamic menu-item ms-core-listMenu-item ms-displayInline ms-navedit-linkNode" href="/annals-of-medicine-and-surgery/Pages/Reprints.aspx"><span class="additional-background ms-navedit-flyoutArrow"><span class="menu-item-text">Reprints</span></span></a></li><li class="dynamic"><a class="dynamic menu-item ms-core-listMenu-item ms-displayInline ms-navedit-linkNode" href="/annals-of-medicine-and-surgery/Pages/Open-Access.aspx"><span class="additional-background ms-navedit-flyoutArrow"><span class="menu-item-text">Open Access</span></span></a></li><li class="dynamic"><a class="dynamic menu-item ms-core-listMenu-item ms-displayInline ms-navedit-linkNode" href="/annals-of-medicine-and-surgery/Pages/Rights-and-Permissions.aspx"><span class="additional-background ms-navedit-flyoutArrow"><span class="menu-item-text">Rights and Permissions</span></span></a></li><li class="dynamic"><a class="dynamic menu-item ms-core-listMenu-item ms-displayInline ms-navedit-linkNode" href="https://journals.lww.com/ijspg/Pages/default.aspx"><span class="additional-background ms-navedit-flyoutArrow"><span class="menu-item-text">IJSPG Portfolio</span></span></a></li> </ul></li><li class="static"><a class="static menu-item ms-core-listMenu-item ms-displayInline ms-navedit-linkNode" href="https://preflight.paperpal.com/partner/lww/annals-of-medicine-and-surgery/submit"><span class="additional-background ms-navedit-flyoutArrow"><span class="menu-item-text">Submit</span></span></a></li><li class="static dynamic-children"><span class="static dynamic-children menu-item ms-core-listMenu-item ms-displayInline ms-navedit-linkNode"><span aria-haspopup="true" class="additional-background ms-navedit-flyoutArrow dynamic-children"><span class="menu-item-text">Collections</span></span></span><ul aria-hidden="true" class="dynamic"> <li class="dynamic"><a class="dynamic menu-item ms-core-listMenu-item ms-displayInline ms-navedit-linkNode" href="/annals-of-medicine-and-surgery/Pages/high-impact-research.aspx"><span class="additional-background ms-navedit-flyoutArrow"><span class="menu-item-text">High-impact research</span></span></a></li> </ul></li> </ul> </div> <div class="search-v2"> <div class="search-wrapper"> <select name="ctl00$ctl51$SearchBox$ddlContentScope" id="ctl00_ctl51_SearchBox_ddlContentScope"> <option value="All">All</option> <option selected="selected" value="Articles">Articles</option> <option value="Images">Images</option> <option value="Videos">Videos</option> <option value="Podcasts">Podcasts</option> <option value="Blogs">Blogs</option> </select> <div class="input-group" id="globalSearch"> <input name="ctl00$ctl51$SearchBox$txtKeywords" type="text" value="Search" id="ctl00_ctl51_SearchBox_txtKeywords" class="form-control searchText" /> <span class="input-group-btn"> <button id="ctl00_ctl51_SearchBox_btnGlobalSearchMagnifier" type="submit" class="btn btn-default"><i class="fa fa-search"></i></button> </span> <input type="hidden" name="ctl00$ctl51$SearchBox$IsAutoCompleteEnabled" id="ctl00_ctl51_SearchBox_IsAutoCompleteEnabled" value="false" /> <input type="hidden" name="ctl00$ctl51$SearchBox$AutocompleteApiUrl" id="ctl00_ctl51_SearchBox_AutocompleteApiUrl" value="https://platformservices.wolterskluwerhealth.com/autocomplete/AMSUR/shingle/" /> </div> </div> <div class="advance-search" style=""> <a id="ctl00_ctl51_SearchBox_lnkAdvanceSearch" href="https://journals.lww.com/annals-of-medicine-and-surgery/pages/advancedsearch.aspx">Advanced Search</a> <input type="submit" name="ctl00$ctl51$SearchBox$btnGlobalSearch" value="" id="ctl00_ctl51_SearchBox_btnGlobalSearch" disabled="disabled" class="aspNetDisabled btnGlobalSearch" style="display: none;" /> <input name="ctl00$ctl51$SearchBox$hfldKeywords" type="hidden" id="ctl00_ctl51_SearchBox_hfldKeywords" class="hfldKeywords" value="disableButton" /> </div> </div> <script> $(function() { try { var objSearchBox = { btnGlobalSearchMagnifierId: 'ctl00_ctl51_SearchBox_btnGlobalSearchMagnifier', searchButtonId: 'ctl00_ctl51_SearchBox_btnGlobalSearch', txtKeywordsId: 'ctl00_ctl51_SearchBox_txtKeywords', hfldKeywordsHiddenId: 'ctl00_ctl51_SearchBox_hfldKeywords', defaultSearchText: 'Search' }; new Searchbox(objSearchBox).Init(); } catch (e) { console.error(e); } }); //autocomplete functionality for basic search //this functionality will call the SBA url and start suggesting after typing 3rd character var textKeywords = null; var hiddenAutocompleteApiUrl = null; var buttonGlobalSearch = null; $(function () { try { var objAutocomplete = { hiddenIsAutoCompleteEnabled: $('#ctl00_ctl51_SearchBox_IsAutoCompleteEnabled'), textKeywords: $('#ctl00_ctl51_SearchBox_txtKeywords'), hiddenAutocompleteApiUrl: $('#ctl00_ctl51_SearchBox_AutocompleteApiUrl'), buttonGlobalSearch: $('#ctl00_ctl51_SearchBox_btnGlobalSearch'), enableNewAutoComplete: true, newAutoCompleteUrl: 'https://dxg-search-na-prd.wkgposvc.cloud/Query.svc/Query_Expand', newAutoCompleteMaxSuggestions: '10', newAutoCompleteDictionaryIds: 'ovid_sted28_mesh22' }; autoComplete(objAutocomplete); } catch (e) { console.error(e); } }); $(function () { let searchSelect = $('select[id$="ddlContentScope"]');; if (searchSelect.length){ searchSelect.selectize(); } }); </script> </nav> </div> </div> </header>     <div id="main-container-content" class="wk-grid-page-container"> <div id="DeltaWebPartAdderUpdatePanelContainer" class="ms-core-webpartadder"> <div id="WebPartAdderUpdatePanelContainer"> <div id="ctl00_WebPartAdderUpdatePanel"> <span id="ctl00_WebPartAdder"></span> </div> </div> </div> <div id="notificationArea" class="ms-notif-box"></div> <div id="DeltaPageStatusBar"> <div id="pageStatusBar"></div> </div> <div id="DeltaPlaceHolderMain" class="delta-place-holder-main"> <a id="mainContent" name="mainContent" tabindex="-1"></a> <div id="ctl00_PlaceHolderMain_ResponsivePageLayoutRenderer_responsivePageLayoutContainer" class="main-content ejp-page-container"> <div class="wk-grid-container-no-margin" id="AddRowTopContainer"> </div> <div id="ctl00_PlaceHolderMain_ResponsivePageLayoutRenderer_ResponsiveLayoutRowRepeater_ctl00_ResponsiveLayoutRowContainer" class="wk-grid-container-no-margin"> <div id="ctl00_PlaceHolderMain_ResponsivePageLayoutRenderer_ResponsiveLayoutRowRepeater_ctl00_ResponsiveLayoutRow" class="wk-grid"> <div id="ctl00_PlaceHolderMain_ResponsivePageLayoutRenderer_ResponsiveLayoutRowRepeater_ctl00_ResponsiveLayoutColumnRepeater_ctl00_ResponsiveLayoutColumn" class=" wk-column-12 wk-column-12-m wk-column-12-l wk-column-12-xl wk-column-12-xxl"> <div class="ms-webpart-zone ms-fullWidth"> <div id="MSOZoneCell_WebPartctl00_ctl29_g_c59f289e_5505_46d1_bca8_4009f71c0f43" class="s4-wpcell-plain ms-webpartzone-cell ms-webpart-cell-vertical-inline-table ms-webpart-cell-vertical ms-fullWidth "> <div class="ms-webpart-chrome ms-webpart-chrome-vertical ms-webpart-chrome-fullWidth "> <div WebPartID="c59f289e-5505-46d1-bca8-4009f71c0f43" HasPers="false" id="WebPartctl00_ctl29_g_c59f289e_5505_46d1_bca8_4009f71c0f43" width="100%" class="ms-WPBody noindex " allowDelete="false" style="" ><div id="ctl00_ctl29_g_c59f289e_5505_46d1_bca8_4009f71c0f43">  <div class="ejp-article-breadcrumb"> <div class="ejp-article-breadcrumb__left"> <a title href="/annals-of-medicine-and-surgery/toc/2024/02000" class="ejp-article-nav__list-link-back">February 2024 - Volume 86 - Issue 2 </a> </div> <div class="ejp-article-breadcrumb__right"> <nav id="ctl00_ctl29_g_c59f289e_5505_46d1_bca8_4009f71c0f43__fed64fd7592441ab_ArticleNavigator"> <ul class="ejp-article-nav__list"> <li id="ctl00_ctl29_g_c59f289e_5505_46d1_bca8_4009f71c0f43__fed64fd7592441ab_liArticleNavigatorPrev"> <a title href="/annals-of-medicine-and-surgery/fulltext/2024/02000/comparison_of_indocyanine_green_angiography_vs.9.aspx" onmouseover="javascript:Tooltip_Article('Comparison of indocyanine green angiography vs intraoperative parathyroid hormone in early prediction of risk of post-thyroidectomy hypocalcemia: a prospective cohort study', 'Devgan Yuvraj MBBS MS MCh; Mayilvaganan, Sabaretnam MBBS, MS, MCh; Mishra, Anjali MBBS, MS, PDC; Chand, Gyan MBBS, MS; Agarwal, Gaurav MBBS, MS, DNB, PDC; Agarwal, Amit MBBS, MS', 'Annals of Medicine and Surgery', 'February 2024', '86', '2' , 'p 678-688')" onmouseout="javascript:Tooltip_MouseOut()" class="ejp-article-nav__list-link-prev"> <span>Previous</span> <span class="ejp-article-nav__list-link-mobile-hide">Article</span> </a> </li> <li id="ctl00_ctl29_g_c59f289e_5505_46d1_bca8_4009f71c0f43__fed64fd7592441ab_liArticleNavigatorNext"> <a title href="/annals-of-medicine-and-surgery/fulltext/2024/02000/transcatheter_aortic_valve_replacement_in_patients.11.aspx" onmouseover="javascript:Tooltip_Article('Transcatheter aortic valve replacement in patients with chronic kidney disease: a multi-centre retrospective study', 'Al Jarallah Mohammed MD; Abdulsalam, Salman MBBD; Rajan, Rajesh MD; Dashti, Raja MD; Zhanna, Kobalava D. MD; Setiya, Parul PhD; Al-Saber, Ahmad PhD; Alajmi, Mohammad MBBS; Brady, Peter A. MD; Luisa Baca, Georgiana MD; Al Balool, Joud MBBD; Tse, Gary MD', 'Annals of Medicine and Surgery', 'February 2024', '86', '2' , 'p 697-702')" onmouseout="javascript:Tooltip_MouseOut()" class="ejp-article-nav__list-link-next"> <span>Next</span> <span class="ejp-article-nav__list-link-mobile-hide">Article</span> </a> </li> </ul> </nav> </div> </div> </div><div class="ms-clear"></div></div> </div> </div> </div></div> </div> </div> <div id="ctl00_PlaceHolderMain_ResponsivePageLayoutRenderer_ResponsiveLayoutRowRepeater_ctl01_ResponsiveLayoutRowContainer" class="wk-grid-container-no-margin"> <div id="ctl00_PlaceHolderMain_ResponsivePageLayoutRenderer_ResponsiveLayoutRowRepeater_ctl01_ResponsiveLayoutRow" class="wk-grid"> <div id="ctl00_PlaceHolderMain_ResponsivePageLayoutRenderer_ResponsiveLayoutRowRepeater_ctl01_ResponsiveLayoutColumnRepeater_ctl00_ResponsiveLayoutColumn" class=" wk-column-12 wk-column-8-m wk-column-8-l wk-column-8-xl wk-column-8-xxl"> <div class="ms-webpart-zone ms-fullWidth"> <div id="MSOZoneCell_WebPartctl00_ctl29_g_a3e22abe_1c71_45a4_806e_a91a83e1cfae" class="s4-wpcell-plain ms-webpartzone-cell ms-webpart-cell-vertical-inline-table ms-webpart-cell-vertical ms-fullWidth "> <div class="ms-webpart-chrome ms-webpart-chrome-vertical ms-webpart-chrome-fullWidth "> <div WebPartID="a3e22abe-1c71-45a4-806e-a91a83e1cfae" HasPers="false" id="WebPartctl00_ctl29_g_a3e22abe_1c71_45a4_806e_a91a83e1cfae" width="100%" class="ms-WPBody noindex " allowDelete="false" style="" ><div id="ctl00_ctl29_g_a3e22abe_1c71_45a4_806e_a91a83e1cfae">  <script type="text/javascript" src="https://lww.com/_layouts/15/1033/Scripts/wk/article.min.js?v=05.24.00.023"> </script> <link rel="stylesheet" type="text/css" href="https://lww.com/_layouts/1033/OAKS.Journals/MediaElement/mediaelementplayer.css?v=05.24.00.023" media="print" /> <span class="js-custom-event" data-config="{"name":"articleView","detail":{"articleDetails":{"journalName":"Annals of Medicine and Surgery","articleTopicName":"","articleName":"The UEMS experience in continuous medical education accreditation process: a ‘quo vadis’ analysis of our global database","publicationDate":"02/01/2024","accessionNumber":"01845215-202402000-00000","doi":"10.1097/MS9.0000000000001583","authors":"Michail Sideris, MD, MDRes, PhD, MRCOG; Kathrine S. Rallis, MBBS, MSc; Marios Nicolaides, MBBS, MSc; Ashvin Kuri, MBBS; Nadine Schottler, MBBS; Collaborators†; Nathalie Paulus; Orthmar Haas, MD; Romuald Krajewski, MD, PhD; Joao Grenho, MD; Vassilios Papalois, KJSJ, MD, PhD","societyName":"","collectionName":"","abstractValues":"Background: The authors systematically appraise","sku":"2049-0801","format":"HTML","articleKeywords":"continuous medical education; continuous professional development; European Accreditation Council for Continuous Medical Education; European Union of Medical Specialists","articleMetadata":"OPENACCESS=TRUE","systemIndicators":["Open"],"meshTerms":["Accreditation","Education, Medical","Database","Needs Assessment","Specialization","European Union","Outcome Assessment, Health Care","Observational Study","Teaching","Educational Status"],"pageSource":"ArticleViewer"},"articleDisplayType":"Fulltext"},"order":2147483647,"config":{"bubbles":true,"cancelable":true,"composed":false}}"></span><span class="js-custom-event" data-config="{"name":"omni:article:view","detail":{"viewType":"Fulltext","publisher":"LWW","journalTitle":"Annals of Medicine and Surgery","issueNumber":"02000","volumeNumber":"86","accessionNumber":"01845215-202402000-00010","doi":"10.1097/MS9.0000000000001583","articleTitle":"The UEMS experience in continuous medical education accreditation process: a ‘quo vadis’ analysis of our global database","publicationDate":"02/01/2024","flags":"Open","keywords":"continuous medical education, continuous professional development, European Accreditation Council for Continuous Medical Education, European Union of Medical Specialists","tocSection":"Original Research","firstPage":"689"},"order":2147483647,"config":{"bubbles":true,"cancelable":true,"composed":false}}"></span>  <link rel="stylesheet" type="text/css" href="https://lww.com/_layouts/1033/styles/oaks.journals/print-article.css?v=05.24.00.023" media="print" /> <script type="text/javascript"> var articleContainer = document.getElementById('ArticleContainer'); function getElementReferences() { textDiv = articleContainer; // textDiv = document.getElementById('ArticleContainer'); } function getArticleContainer() { return articleContainer; } $(function () { // Change the '+', '-' icon when panels are collapsed. $('a.toggle-content').click(function () { var isExpanded = $(this).attr('aria-expanded'); var i = $(this).children('i'); if (isExpanded === 'true') { i.removeClass('fa fa-minus-square-o').addClass('fa fa-plus-square-o'); } else { i.removeClass('fa fa-plus-square-o').addClass('fa fa-minus-square-o'); } }); var articleAbstractLink = $('#article-abstract-content4>ul>li>a')[0]; if ($(articleAbstractLink).html() === 'Abstract') { $(articleAbstractLink).click($.proxy(clickAbstractLink, this)); } }); function LogArticleSubTabClickEventToCounterData(subTabType) { var dualAccessHelper = new DualAccess(); if (subTabType === "AISummary") { //handle it for other sub tab types dualAccessHelper.SendCounterDataRequestByAn(dualAccessHelper.EventTypes.Investigation, dualAccessHelper.ContentTypes.AISummary, '01845215-202402000-00010'); } else { dualAccessHelper.SendCounterDataRequestByAn(dualAccessHelper.EventTypes.Investigation, dualAccessHelper.ContentTypes.ArticleTab, '01845215-202402000-00010'); } }; function ArticleTabClickLogToCounterService() { var dualAccessHelper = new DualAccess(); dualAccessHelper.SendCounterDataRequestByAn(dualAccessHelper.EventTypes.Investigation, dualAccessHelper.ContentTypes.ArticleTab, '01845215-202402000-00010'); }; window.addEventListener("load", () => { HighlightSearchTerms(); }); document.addEventListener('DOMContentLoaded', function() { function dispatchCustomEvent(eventName, linkUrl) { document.dispatchEvent(new CustomEvent(eventName, { detail: { link_url: linkUrl } })); } var anchors = { 'omni:articleviewer:buy': document.getElementById('ctl00_ctl29_g_a3e22abe_1c71_45a4_806e_a91a83e1cfae_ctl00_hypPurchase'), 'omni:articleviewer:subscribe': document.getElementById('ctl00_ctl29_g_a3e22abe_1c71_45a4_806e_a91a83e1cfae_ctl00_hypSubscribe'), 'omni:articleviewer:permission': document.getElementById('ctl00_ctl29_g_a3e22abe_1c71_45a4_806e_a91a83e1cfae_ctl00_hypliPatentOrCaregiver'), 'omni:articleviewer:society': document.getElementById('ctl00_ctl29_g_a3e22abe_1c71_45a4_806e_a91a83e1cfae_ctl00_hypSociety') }; Object.keys(anchors).forEach(function(eventName) { var anchor = anchors[eventName]; if (anchor) { anchor.addEventListener('click', function(event) { dispatchCustomEvent(eventName, anchor.href); }); } }); }); </script> <script> function closeArticleViewerModalDialog() { $('#articleViewerDialog').hide(); return false; } </script> <div class="ejp-article-wrapper"> <div id="ctl00_ctl29_g_a3e22abe_1c71_45a4_806e_a91a83e1cfae_ctl00_ucArticleTools_container" data-article-config="{"title":"ReadAloud: The UEMS experience in continuous medical education accreditation process: a ‘quo vadis’ analysis of our global database","doi":"10.1097/MS9.0000000000001583"}" data-read-along="false" data-ppt-event-detail="{"eventName":"PPTDownload","eventDetail":{"url":"https://journals.lww.com:443/annals-of-medicine-and-surgery/fulltext/2024/02000/the_uems_experience_in_continuous_medical.10.aspx?Ppt=Article|annals-of-medicine-and-surgery:2024:02000:00010|10.1097/ms9.0000000000001583|","gating":false},"eventOptions":{"bubbles":true,"cancelable":true,"composed":false},"loginDetail":{"isLoginOptional":true,"promptLogin":false},"isNull":false}" data-has-ce="false" data-is-social-sharing-enabled="false" data-ce-cme-redirect="false" data-ppt-visible="true" data-email-to-colleague-control-id="ctl00_ctl29_g_a3e22abe_1c71_45a4_806e_a91a83e1cfae_ctl00_ucArticleTools_emailToColleagueControl" data-images-slideshow-visible="true" data-social-sharing-title="The UEMS experience in continuous medical education... : Annals of Medicine and Surgery" data-pdf-visible="true" class="js-ejp-article-tools lww-ejp-article-tools" data-ce-cme-url="" data-has-permissions="true" data-epub-enabled="true" data-article-accession-number="01845215-202402000-00010" data-epub-visible="true" data-image-gallery-url="/annals-of-medicine-and-surgery/pages/imagegallery.aspx?year=2024&issue=02000&article=00010" data-social-sharing-source="https://journals.lww.com/annals-of-medicine-and-surgery/fulltext/2024/02000/the_uems_experience_in_continuous_medical.10.aspx" data-favorites-event-detail="{"eventName":"AddToFavorites","eventDetail":{"items":["Article|annals-of-medicine-and-surgery:2024:02000:00010|10.1097/ms9.0000000000001583|"],"an":"01845215-202402000-00010"},"eventOptions":{"bubbles":true,"cancelable":true,"composed":false},"loginDetail":{"isLoginOptional":false,"promptLogin":true,"loginPromptText":"To save this item, login or register"},"isNull":false}" data-ce-cme-title="" data-is-fulltext="true" data-has-cme="false" data-pdf-enabled="true" data-images-gallery-visible="true" data-pdf-event-detail="{"eventName":"PDFDownloadInit","eventDetail":{"url":"https://journals.lww.com/annals-of-medicine-and-surgery/_layouts/15/oaks.journals/downloadpdf.aspx?trckng_src_pg=ArticleViewer&an=01845215-202402000-00010","gating":false},"eventOptions":{"bubbles":true,"cancelable":true,"composed":false},"loginDetail":{"isLoginOptional":true,"promptLogin":false},"isNull":false}" data-epub-event-detail="{"eventName":"EPUBDownload","eventDetail":{"url":"https://journals.lww.com:443/annals-of-medicine-and-surgery/fulltext/2024/02000/the_uems_experience_in_continuous_medical.10.aspx?generateEpub=Article|annals-of-medicine-and-surgery:2024:02000:00010|10.1097/ms9.0000000000001583|","gating":false},"eventOptions":{"bubbles":true,"cancelable":true,"composed":false},"loginDetail":{"isLoginOptional":true,"promptLogin":false},"isNull":false}" data-pdf-url="https://journals.lww.com/annals-of-medicine-and-surgery/_layouts/15/oaks.journals/downloadpdf.aspx?trckng_src_pg=ArticleViewer&an=01845215-202402000-00010"> </div> <div style="display: none;"> <div id="ctl00_ctl29_g_a3e22abe_1c71_45a4_806e_a91a83e1cfae_ctl00_ucArticleTools_epubContainer"> <a an="01845215-202402000-00010" rel="opener" title href="#epub-link" class="ej-art-as-epub">Article as EPUB</a> </div> <a href="/annals-of-medicine-and-surgery/fulltext/2024/02000/the_uems_experience_in_continuous_medical.10.aspx?Ppt=Article|annals-of-medicine-and-surgery:2024:02000:00010|10.1097/ms9.0000000000001583|" id="ctl00_ctl29_g_a3e22abe_1c71_45a4_806e_a91a83e1cfae_ctl00_ucArticleTools_lnkExportImagesToPPT_fileLink" rel="nofollow">Export All Images to PowerPoint File</a> <button class="user-menu__link user-menu__link--add-to-favorites js-ejp-login-btn addToMyFavoriteLink" type="button" data-config="{"eventName":"AddToFavorites","eventDetail":{"items":["Article|annals-of-medicine-and-surgery:2024:02000:00010|10.1097/ms9.0000000000001583|"],"an":"01845215-202402000-00010"},"eventOptions":{"bubbles":true,"cancelable":true,"composed":false},"loginDetail":{"isLoginOptional":false,"promptLogin":true,"loginPromptText":"To save this item, login or register"},"isNull":false}"> <span>Add to My Favorites</span> </button> </div> <script type="text/javascript" src="https://lww.com/_layouts/15/1033/Scripts/wk/EmailToColleague.js?v=05.24.00.023" defer="true"> </script> <a id="ctl00_ctl29_g_a3e22abe_1c71_45a4_806e_a91a83e1cfae_ctl00_ucArticleTools_emailToColleagueControl_hypEmailToColleague" href="javascript:" style="display:none;"></a> <div id="ctl00_ctl29_g_a3e22abe_1c71_45a4_806e_a91a83e1cfae_ctl00_ucArticleTools_emailToColleagueControl_pnlEmailToColleague" class="wk-modal-table" style="display: none"> <div class="wk-modal-cell"> <div id="ej-box-modal-drop-shadow" class="wk-modal horizontally-centered small wk-modal-with-overlay wk-modal-small ejp-modal email-to-colleague" tabindex="-1" role="dialog" style="position: static;"> <div id="ctl00_ctl29_g_a3e22abe_1c71_45a4_806e_a91a83e1cfae_ctl00_ucArticleTools_emailToColleagueControl_pnlMain" class="js-main-panel" onkeypress="javascript:return WebForm_FireDefaultButton(event, 'ctl00_ctl29_g_a3e22abe_1c71_45a4_806e_a91a83e1cfae_ctl00_ucArticleTools_emailToColleagueControl_btnSend')"> <section class="wk-modal-content"> <header class="wk-modal-header ejp-modal-header"> <div class="wk-modal-title ejp-modal-title"> <strong> <span id="ctl00_ctl29_g_a3e22abe_1c71_45a4_806e_a91a83e1cfae_ctl00_ucArticleTools_emailToColleagueControl_lblEmailToColleague">Email to Colleague</span></strong> </div> <button aria-label="close dialog" class="primary-button wk-button-icon wk-modal-close ejp-modal-close js-close "> <i class="fa fa-times"></i> </button> </header> <div class="wk-modal-body"> <div class="wk-field-item"> <div class="wk-field-header"> <div id="ctl00_ctl29_g_a3e22abe_1c71_45a4_806e_a91a83e1cfae_ctl00_ucArticleTools_emailToColleagueControl_divErrorMessage" class="js-error-message-div ej-error-message-panel" style="display: none; color: red; font-style: italic"> <p class="ej-error-message-icon"> <span id="ctl00_ctl29_g_a3e22abe_1c71_45a4_806e_a91a83e1cfae_ctl00_ucArticleTools_emailToColleagueControl_lblErrorMessage" class="js-error-message-label">Colleague's E-mail is Invalid</span> </p> </div> </div> </div> <div class="wk-field-item"> <div class="wk-field-header"> Your Name: </div> <div class="wk-field-body"> <input name="ctl00$ctl29$g_a3e22abe_1c71_45a4_806e_a91a83e1cfae$ctl00$ucArticleTools$emailToColleagueControl$txtYourName" type="text" id="ctl00_ctl29_g_a3e22abe_1c71_45a4_806e_a91a83e1cfae_ctl00_ucArticleTools_emailToColleagueControl_txtYourName" class="js-name" /> </div> </div> <div class="wk-field-item"> <div class="wk-field-header"> <span id="ctl00_ctl29_g_a3e22abe_1c71_45a4_806e_a91a83e1cfae_ctl00_ucArticleTools_emailToColleagueControl_lblColleaguesEmail" class="js-collegaues-email-lbl">Colleague's Email:</span> </div> <div class="wk-field-body no-bottom-margin"> <input name="ctl00$ctl29$g_a3e22abe_1c71_45a4_806e_a91a83e1cfae$ctl00$ucArticleTools$emailToColleagueControl$txtColleaguesEmail" type="text" id="ctl00_ctl29_g_a3e22abe_1c71_45a4_806e_a91a83e1cfae_ctl00_ucArticleTools_emailToColleagueControl_txtColleaguesEmail" class="js-collegaues-email" /> </div> <div class="wk-field-header"><span class="ej-form-comments">Separate multiple e-mails with a (;).</span></div> </div> <div class="wk-field-item"> <div class="wk-field-header"> Message: </div> <div class="wk-field-body"> <textarea name="ctl00$ctl29$g_a3e22abe_1c71_45a4_806e_a91a83e1cfae$ctl00$ucArticleTools$emailToColleagueControl$txtMessage" rows="2" cols="20" id="ctl00_ctl29_g_a3e22abe_1c71_45a4_806e_a91a83e1cfae_ctl00_ucArticleTools_emailToColleagueControl_txtMessage" class="js-message"> Thought you might appreciate this item(s) I saw in Annals of Medicine and Surgery.</textarea> </div> </div> <div class="wk-button-bar"> <div class="wk-button-group-left"> <input type="submit" name="ctl00$ctl29$g_a3e22abe_1c71_45a4_806e_a91a83e1cfae$ctl00$ucArticleTools$emailToColleagueControl$btnSend" value="Send" id="ctl00_ctl29_g_a3e22abe_1c71_45a4_806e_a91a83e1cfae_ctl00_ucArticleTools_emailToColleagueControl_btnSend" class="js-send-button primary-button grecaptcha-email-colleague-e533c678e88e43cfa6859385da28813d" /> <input type="button" value="Cancel" id="btnCancel" class="secondary-button js-close" /> </div> </div> <div class="wk-field-item wk-email-colleague-captcha-bar"> <div class="wk-field-body"> <div id="div-recaptcha-e533c678e88e43cfa6859385da28813d" class="div-recaptcha-container" data-uniqueclassidentifier="grecaptcha-email-colleague-e533c678e88e43cfa6859385da28813d" data-sitekey="6LeeoSAUAAAAACFv8yNuINPv8IWyXHJ6uN447qEK" data-callback="ctl00_ctl29_g_a3e22abe_1c71_45a4_806e_a91a83e1cfae_ctl00_ucArticleTools_emailToColleagueControl_captchaCallBack" data-badge="inline" data-size="invisible" data-type="image" > </div> </div> </div> </div> </section> </div> <div id="ctl00_ctl29_g_a3e22abe_1c71_45a4_806e_a91a83e1cfae_ctl00_ucArticleTools_emailToColleagueControl_pnlSuccessMessage" class="js-success-message-panel" style="display: none;"> <section class="wk-modal-content"> <header class="wk-modal-header ejp-modal-header"> <div class="wk-modal-title ejp-modal-title"></div> <button aria-label="close dialog" class="primary-button wk-button-icon wk-modal-close ejp-modal-close js-close "><i class="fa fa-times"></i></button> </header> <div class="wk-modal-body"> <div class="wk-field-item"> <br /> <p> <span id="ctl00_ctl29_g_a3e22abe_1c71_45a4_806e_a91a83e1cfae_ctl00_ucArticleTools_emailToColleagueControl_lblMessageSent">Your message has been successfully sent to your colleague.</span> </p> <br /> </div> <div class="wk-button-bar"> <div class="wk-button-group-left"> <input type="button" value="Close Window" id="btnClose" class="primary-button js-close" /> </div> </div> </div> </section> </div> <div id="ctl00_ctl29_g_a3e22abe_1c71_45a4_806e_a91a83e1cfae_ctl00_ucArticleTools_emailToColleagueControl_pnlErrorMessage" class="js-error-message-panel" style="display: none;"> <section class="wk-modal-content"> <header class="wk-modal-header ejp-modal-header"> <div class="wk-modal-title ejp-modal-title"></div> <button aria-label="close dialog" class="primary-button wk-button-icon wk-modal-close ejp-modal-close js-close "><i class="fa fa-times"></i></button> </header> <div class="wk-modal-body"> <br /> <div class="wk-field-item"> <span id="ctl00_ctl29_g_a3e22abe_1c71_45a4_806e_a91a83e1cfae_ctl00_ucArticleTools_emailToColleagueControl_lblInvalidEmail" style="color:Red;">Some error has occurred while processing your request. Please try after some time.</span> </div> <br /> <div class="wk-button-bar"> <div class="wk-button-group-left"> <input type="button" value="Close Window" id="btnEClose" class="primary-button js-close" /> </div> </div> </div> </section> </div> </div> <input type="hidden" name="ctl00$ctl29$g_a3e22abe_1c71_45a4_806e_a91a83e1cfae$ctl00$ucArticleTools$emailToColleagueControl$hiddenEmailToColleague" id="ctl00_ctl29_g_a3e22abe_1c71_45a4_806e_a91a83e1cfae_ctl00_ucArticleTools_emailToColleagueControl_hiddenEmailToColleague" /> <input type="hidden" name="ctl00$ctl29$g_a3e22abe_1c71_45a4_806e_a91a83e1cfae$ctl00$ucArticleTools$emailToColleagueControl$hiddenIsUser" id="ctl00_ctl29_g_a3e22abe_1c71_45a4_806e_a91a83e1cfae_ctl00_ucArticleTools_emailToColleagueControl_hiddenIsUser" /> </div> </div> <script type="text/javascript"> window.emailToColleaguePopups = window.emailToColleaguePopups || []; var ctl00_ctl29_g_a3e22abe_1c71_45a4_806e_a91a83e1cfae_ctl00_ucArticleTools_emailToColleagueControl_captchaCallBack = function () { ejpAnalytics.track('emailColleaguereCAPTCHA'); ejpAnalytics.track('emailColleagueComplete'); __doPostBack('ctl00$ctl29$g_a3e22abe_1c71_45a4_806e_a91a83e1cfae$ctl00$ucArticleTools$emailToColleagueControl$btnSend','') }; var initEmailToColleaguectl00_ctl29_g_a3e22abe_1c71_45a4_806e_a91a83e1cfae_ctl00_ucArticleTools_emailToColleagueControl = function () { window.emailToColleaguePopups['ctl00_ctl29_g_a3e22abe_1c71_45a4_806e_a91a83e1cfae_ctl00_ucArticleTools_emailToColleagueControl'] = new EmailToColleagueComponent('ctl00_ctl29_g_a3e22abe_1c71_45a4_806e_a91a83e1cfae_ctl00_ucArticleTools_emailToColleagueControl_pnlEmailToColleague', 'div-recaptcha-e533c678e88e43cfa6859385da28813d', 'grecaptcha-email-colleague-e533c678e88e43cfa6859385da28813d', 'emailToColleaguePopupExtender__76606239', 'ctl00_ctl29_g_a3e22abe_1c71_45a4_806e_a91a83e1cfae_ctl00_ucArticleTools_emailToColleagueControl_hiddenEmailToColleague', 'ctl00_ctl29_g_a3e22abe_1c71_45a4_806e_a91a83e1cfae_ctl00_ucArticleTools_emailToColleagueControl_hiddenIsUser', '01845215-202402000-00010' ); } Sys.WebForms.PageRequestManager.getInstance().add_pageLoaded(initEmailToColleaguectl00_ctl29_g_a3e22abe_1c71_45a4_806e_a91a83e1cfae_ctl00_ucArticleTools_emailToColleagueControl); </script> <script type="text/javascript" src="https://lww.com/_layouts/15/1033/Scripts/wk/ExportToCitationManager.js?v=05.24.00.023" defer="true"> </script> <a id="ctl00_ctl29_g_a3e22abe_1c71_45a4_806e_a91a83e1cfae_ctl00_ucArticleTools_exportToCitationManager_hypExportToCitationManager" href="javascript:" style="display:none;"></a> <div id="ctl00_ctl29_g_a3e22abe_1c71_45a4_806e_a91a83e1cfae_ctl00_ucArticleTools_exportToCitationManager_pnlExportTo" style="display: none"> <div id="ej-box-modal-drop-shadow"> <div id="ej-box-modal-style-1" tabindex="-1" role="dialog" class="wk-modal wk-modal-with-overlay wk-modal-small ejp-modal horizontally-centered" data-behaviorid="OpenExportToPopupExtender_292447296"> <div id="ctl00_ctl29_g_a3e22abe_1c71_45a4_806e_a91a83e1cfae_ctl00_ucArticleTools_exportToCitationManager_pnlMainExport"> <section class="wk-modal-content"> <header class="wk-modal-header ejp-modal-header"> <div class="wk-modal-title ejp-modal-title"><strong>Export to</strong></div> <button onclick="return closeExportToModalPopUp();" aria-label="close dialog" class="primary-button wk-button-icon wk-modal-close ejp-modal-close "><i class="fa fa-times"></i></button> </header> <div class="wk-modal-body"> <div class="wk-field-item"> <fieldset> <table id="ctl00_ctl29_g_a3e22abe_1c71_45a4_806e_a91a83e1cfae_ctl00_ucArticleTools_exportToCitationManager_radioBtnExportTypes"> <tr> <td><input id="ctl00_ctl29_g_a3e22abe_1c71_45a4_806e_a91a83e1cfae_ctl00_ucArticleTools_exportToCitationManager_radioBtnExportTypes_0" type="radio" name="ctl00$ctl29$g_a3e22abe_1c71_45a4_806e_a91a83e1cfae$ctl00$ucArticleTools$exportToCitationManager$radioBtnExportTypes" value="EndNote" checked="checked" /><label for="ctl00_ctl29_g_a3e22abe_1c71_45a4_806e_a91a83e1cfae_ctl00_ucArticleTools_exportToCitationManager_radioBtnExportTypes_0">End Note</label></td> </tr><tr> <td><input id="ctl00_ctl29_g_a3e22abe_1c71_45a4_806e_a91a83e1cfae_ctl00_ucArticleTools_exportToCitationManager_radioBtnExportTypes_1" type="radio" name="ctl00$ctl29$g_a3e22abe_1c71_45a4_806e_a91a83e1cfae$ctl00$ucArticleTools$exportToCitationManager$radioBtnExportTypes" value="Procite" /><label for="ctl00_ctl29_g_a3e22abe_1c71_45a4_806e_a91a83e1cfae_ctl00_ucArticleTools_exportToCitationManager_radioBtnExportTypes_1">Procite</label></td> </tr><tr> <td><input id="ctl00_ctl29_g_a3e22abe_1c71_45a4_806e_a91a83e1cfae_ctl00_ucArticleTools_exportToCitationManager_radioBtnExportTypes_2" type="radio" name="ctl00$ctl29$g_a3e22abe_1c71_45a4_806e_a91a83e1cfae$ctl00$ucArticleTools$exportToCitationManager$radioBtnExportTypes" value="ReferenceManager" /><label for="ctl00_ctl29_g_a3e22abe_1c71_45a4_806e_a91a83e1cfae_ctl00_ucArticleTools_exportToCitationManager_radioBtnExportTypes_2">Reference Manager</label></td> </tr> </table> </fieldset> <p> <label for="default"> <input id="ctl00_ctl29_g_a3e22abe_1c71_45a4_806e_a91a83e1cfae_ctl00_ucArticleTools_exportToCitationManager_checkBoxSaveMySelection" type="checkbox" name="ctl00$ctl29$g_a3e22abe_1c71_45a4_806e_a91a83e1cfae$ctl00$ucArticleTools$exportToCitationManager$checkBoxSaveMySelection" /><label for="ctl00_ctl29_g_a3e22abe_1c71_45a4_806e_a91a83e1cfae_ctl00_ucArticleTools_exportToCitationManager_checkBoxSaveMySelection">Save my selection</label> </label> </p> <div class="wk-button-bar"> <div class="wk-button-group-left"> <input type="submit" name="ctl00$ctl29$g_a3e22abe_1c71_45a4_806e_a91a83e1cfae$ctl00$ucArticleTools$exportToCitationManager$btnOpenExportDialog" value="Export" onclick="return validateExportType();WebForm_DoPostBackWithOptions(new WebForm_PostBackOptions("ctl00$ctl29$g_a3e22abe_1c71_45a4_806e_a91a83e1cfae$ctl00$ucArticleTools$exportToCitationManager$btnOpenExportDialog", "", true, "", "", false, false))" id="ctl00_ctl29_g_a3e22abe_1c71_45a4_806e_a91a83e1cfae_ctl00_ucArticleTools_exportToCitationManager_btnOpenExportDialog" class="primary-button" /> <input type="submit" name="ctl00$ctl29$g_a3e22abe_1c71_45a4_806e_a91a83e1cfae$ctl00$ucArticleTools$exportToCitationManager$btnCancelOpenExportDialog" value="Cancel" onclick="return closeExportToModalPopUp();WebForm_DoPostBackWithOptions(new WebForm_PostBackOptions("ctl00$ctl29$g_a3e22abe_1c71_45a4_806e_a91a83e1cfae$ctl00$ucArticleTools$exportToCitationManager$btnCancelOpenExportDialog", "", true, "", "", false, false))" id="ctl00_ctl29_g_a3e22abe_1c71_45a4_806e_a91a83e1cfae_ctl00_ucArticleTools_exportToCitationManager_btnCancelOpenExportDialog" class="secondary-button" /> <p id="ctl00_ctl29_g_a3e22abe_1c71_45a4_806e_a91a83e1cfae_ctl00_ucArticleTools_exportToCitationManager_pUnsubscribeButtons"> </p> </div> </div> </div> </div> </section> </div> </div> </div> <div id="ej-clear-float"></div> <input type="hidden" name="ctl00$ctl29$g_a3e22abe_1c71_45a4_806e_a91a83e1cfae$ctl00$ucArticleTools$exportToCitationManager$hiddenExportType" id="ctl00_ctl29_g_a3e22abe_1c71_45a4_806e_a91a83e1cfae_ctl00_ucArticleTools_exportToCitationManager_hiddenExportType" /> </div> <script type="text/javascript"> var hiddenExportType = $get('ctl00_ctl29_g_a3e22abe_1c71_45a4_806e_a91a83e1cfae_ctl00_ucArticleTools_exportToCitationManager_hiddenExportType'); function getExportPopup() { return $find('OpenExportToPopupExtender_292447296'); } var pnlMainExport = $get('ctl00_ctl29_g_a3e22abe_1c71_45a4_806e_a91a83e1cfae_ctl00_ucArticleTools_exportToCitationManager_pnlMainExport'); document.addEventListener('DOMContentLoaded', function () { function dispatchCustomEvent(eventName) { try { document.dispatchEvent(new CustomEvent(eventName)); } catch (error) { console.error('Error dispatching custom event:', error); } } try { var exportButton = document.getElementById('ctl00_ctl29_g_a3e22abe_1c71_45a4_806e_a91a83e1cfae_ctl00_ucArticleTools_exportToCitationManager_btnOpenExportDialog'); var radioButtons = document.querySelectorAll('#ctl00_ctl29_g_a3e22abe_1c71_45a4_806e_a91a83e1cfae_ctl00_ucArticleTools_exportToCitationManager_radioBtnExportTypes input[type=radio]'); exportButton.addEventListener('click', function (event) { var selectedRadioButton = Array.from(radioButtons).find(rb => rb.checked); if (selectedRadioButton) { var selectedValue = selectedRadioButton.value; var eventName = ''; switch (selectedValue) { case "Procite": case "ReferenceManager": eventName = 'omni:articletools:cite:ris'; break; case 'EndNote': eventName = 'omni:articletools:cite:endnote'; break; default: eventName = ''; } if (eventName) { dispatchCustomEvent(eventName); } else { console.warn('No event name matched for the selected radio button value:', selectedValue); } } else { console.warn('No radio button selected'); } }); } catch (error) { console.error('Error initializing event listeners:', error); } }); </script> <script type="text/javascript"> $(document).ready(function () { $('p').filter(function () { return this.innerHTML.trim() === "" }).remove(); }); function showPrinterFriendlyView() { open("https://journals.lww.com/annals-of-medicine-and-surgery/pages/printerfriendly.aspx?year=2024&issue=02000&article=00010&type=Fulltext", ""); } function showExportToCitationPopUp() { return "OpenExportToPopupExtender_292447296"; } function getPermissionsClick() { showRightsLinkPopUp( 'https://s100.copyright.com/AppDispatchServlet', 'WoltersKluwer', 'MS9', 'The UEMS experience in continuous medical education accreditation process: a ‘quo vadis’ analysis of our global database', '01032024', 'Michail Sideris, Kathrine S. Rallis, Marios Nicolaides, et al', '86', '2', 'Copyright \u00A9 2024 The Author(s). Published by Wolters Kluwer Health, Inc.', '01845215-202402000-00010', '', true, 'CC-BY-ND'); } </script> <div id="ArticleContainer"> <article id="ej-article-view" class="js-article-view ej-article-view" xmlns:ssr="http://ssr-eus-go-csi.cloudapp.net/v1/assets" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xhtml="http://www.w3.org/1999/xhtml"><section class="ejp-r-article-subsection"><div class="ejp-r-article-subsection__text">Original Research</div></section><header class="ejp-article-header"><h1 class="ejp-article-title">The UEMS experience in continuous medical education accreditation process: a ‘quo vadis’ analysis of our global database</h1></header><section id="ejp-article-authors"><p id="P7">Sideris, Michail MD, MDRes, PhD, MRCOG<sup xmlns:mrws="http://webservices.ovid.com/mrws/1.0">a</sup>; Rallis, Kathrine S. MBBS, MSc<sup xmlns:mrws="http://webservices.ovid.com/mrws/1.0">i</sup>; Nicolaides, Marios MBBS, MSc<sup xmlns:mrws="http://webservices.ovid.com/mrws/1.0">c</sup>; Kuri, Ashvin MBBS<sup xmlns:mrws="http://webservices.ovid.com/mrws/1.0">a</sup>; Schottler, Nadine MBBS<sup xmlns:mrws="http://webservices.ovid.com/mrws/1.0">d</sup>; Collaborators<sup xmlns:mrws="http://webservices.ovid.com/mrws/1.0">†</sup>; Paulus, Nathalie<sup xmlns:mrws="http://webservices.ovid.com/mrws/1.0">e</sup>; Haas, Orthmar MD<sup xmlns:mrws="http://webservices.ovid.com/mrws/1.0">f</sup>; Krajewski, Romuald MD, PhD<sup xmlns:mrws="http://webservices.ovid.com/mrws/1.0">g</sup>; Grenho, Joao MD<sup xmlns:mrws="http://webservices.ovid.com/mrws/1.0">h</sup>; Papalois, Vassilios KJSJ, MD, PhD<sup xmlns:mrws="http://webservices.ovid.com/mrws/1.0">b</sup></p><section><a href="#" id="ejp-article-authors-link"> Author Information <i class="wk-icon-arrow-down-r"></i></a></section></section><section id="ejp-article-authors-info" class="ejp-article-authors-info ejp-article-authors-info--hidden"><div class="ejp-article-authors-info-holder"> <p id=""><sup xmlns:mrws="http://webservices.ovid.com/mrws/1.0">a</sup>Wolfson Institute of Population Health, Queen Mary University of London</p> <p id=""><sup xmlns:mrws="http://webservices.ovid.com/mrws/1.0">b</sup>Imperial College London</p> <p id=""><sup xmlns:mrws="http://webservices.ovid.com/mrws/1.0">c</sup>Lewisham & Greenwich NHS Trust, London</p> <p id=""><sup xmlns:mrws="http://webservices.ovid.com/mrws/1.0">d</sup>Southampton General Hospital, Hampshire, England, UK</p> <p id=""><sup xmlns:mrws="http://webservices.ovid.com/mrws/1.0">e</sup>European Union of Medical Specialists (UEMS), Brussels, Belgium</p> <p id=""><sup xmlns:mrws="http://webservices.ovid.com/mrws/1.0">f</sup>Group Practice Dr. Haas/Dr. Engler, Klagenfurt, Germany</p> <p id=""><sup xmlns:mrws="http://webservices.ovid.com/mrws/1.0">g</sup>Head & Neck Cancer Department, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland</p> <p id=""><sup xmlns:mrws="http://webservices.ovid.com/mrws/1.0">h</sup>General Surgery Department, Hospital da Luz Oeiras, Oeiras, Portugal</p> <p id=""><sup xmlns:mrws="http://webservices.ovid.com/mrws/1.0">i</sup>Beth Israel Deaconess Medical Centre, Harvard Medical School, Boston, Massachusetts, USA</p> <p id="">Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.</p> <p id="">† Medical Student Collaborators equal–Rickesh Shah, Ryan Udall, Anah Mushtaq, Ryan McWilliams, Andreas Andreou, Carola M. Bigogno, Guru Amirthalingam.</p> <p id="">Published online 3 January 2024</p> <p id="cor1"><sup xmlns:mrws="http://webservices.ovid.com/mrws/1.0">*</sup>Corresponding author. Address: Wolfson Institute of Population Health, Queen Mary University of London, Charterhouse Square Campus, Barbican, London EC1M 6BQ, London, United Kingdom. Tel.: +44 020 7882 5555. E-mail: <span><a href="/cdn-cgi/l/email-protection#c7aaa6aeabb3a8fdaab4aea3a2b5aeb487a9afb4e9a9a2b3" onclick="javascript:window.open('mailto:mailto:msideris@nhs.net');return false"><span class="__cf_email__" data-cfemail="711c02181514031802311f19025f1f1405">[email protected]</span></a></span> (M. Sideris).</p> <p id="">This is an open access article distributed under the <span><a href="http://creativecommons.org/licenses/by-nd/4.0/" onclick="javascript:window.open('http://creativecommons.org/licenses/by-nd/4.0/');return false">Creative Commons Attribution-NoDerivatives License 4.0</a></span>, which allows for redistribution, commercial and non-commercial, as long as it is passed along unchanged and in whole, with credit to the author. <span><a href="http://creativecommons.org/licenses/by-nd/4.0/" onclick="javascript:window.open('http://creativecommons.org/licenses/by-nd/4.0/');return false">http://creativecommons.org/licenses/by-nd/4.0/</a></span></p> </div></section><section id="article-journal-info"><div class="ej-journal-info"><span class="ej-journal-name">Annals of Medicine & Surgery </span><span id="ej-journal-date-volume-issue-pg"><a href="/annals-of-medicine-and-surgery/toc/2024/02000">86(2):p 689-696, February 2024.</a></span><span> | </span><span class="ej-journal-doi">DOI: </span>10.1097/MS9.0000000000001583<a id="ej-article-indicators-ccl" onmouseover="javascript:Tooltip_CCL('This is an open access article distributed under the Creative Commons Attribution-NoDerivatives License 4.0, which allows for redistribution, commercial and non-commercial, as long as it is passed along unchanged and in whole, with credit to the author. http://creativecommons.org/licenses/by-nd/4.0/')" onmouseout="javascript:Tooltip_MouseOut()" href="http://creativecommons.org/licenses/by-nd/4.0/" target="_blank"><span class="ejp-article-indicators__ccl"></span></a></div></section><section id="ejp-article-indicators" class="ejp-article-indicators"><ul class="ejp-article-indicators__list"> <li id="ej-article-indicators-open" class="ejp-article-indicators__list-item" onmouseover="javascript:Tooltip_Open()" onmouseout="javascript:Tooltip_MouseOut()"><span class="ejp-indicator">Open</span></li> </ul><button id="openArticleMetricsPopupButton" type="button" class="wk-button wk-button-ghost wk-button-icon-left ejp-article-metrics-btn" data-articleMetricsEndpoint="//services.journals.lww.com/IntegrationServices/ArticleMetricsService.svc" data-articleMetricsDetailsUrl="https://wolterskluwer.altmetric.com/details/" data-doi="10.1097/MS9.0000000000001583" data-suiteId="vrs_woltere_journalsglobalvrs" data-articlePublicationDate="2024-01-03" data-articlePublicationDateString="January 3, 2024" data-receivedDate="2023-09-08" data-revisionReceivedDate="" data-acceptedDate="2023-11-23" data-crossrefRefLinkRoot="https://doi.org/" data-medlineRefLinkRoot="http://www.ncbi.nlm.nih.gov/pubmed/" data-pubMedId="38333329"><i class="wk-icon-filled-chart-r"></i><i class="wk-icon-filled-chart-white-r"></i> Metrics </button></section><section class="ejp-article-tabs" id="abstractWrap"><h2 class="ejp-article-tabs-heading">Abstract</h2> <div class="ejp-article-tabs__tabpanel" id="panel1" role="tabpanel" aria-labelledby="tab1"> <div id="article-abstract-content1"> <div class="ejp-article-text-abstract"> <h3>Background: </h3> <p>The authors systematically appraise a large database of continuous professional development (CPD) and continuous medical education (CME) events against the European Accreditation Council for Continuous Medical Education (EACCME) framework.</p> <h3>Methods: </h3> <p>The authors performed a retrospective observational study of all CPD or CME events within the European Union of Medical Specialists (UEMS) database between 2017 and 2019, including 91 countries and 6034 events. Assessment of event design, quality and outcomes was evaluated against a validated, expert-derived accreditation framework, using thematic analysis to extract distinct themes, and subsequent quantitative analysis.</p> <h3>Results: </h3> <p>The authors included 5649 live educational events (LEEs) and 385 e-learning materials (ELMs). Three thousand seven hundred sixty-two [3762 (62.3%)] of the events did not report clear justification in their needs assessment process. Most accreditation applications claimed covering a single educational need [1603/2277 (70.3%)]. Needs assessments were reported to be similar across conferences, courses and other types of events (<em xmlns:mrws="http://webservices.ovid.com/mrws/1.0">P</em><0.01); 5642/6034 events (93.5%) had clearly documented expected learning outcomes; only 978/6034 (16.2%) reported a single expected learning outcome while the rest report 2–10 outcomes. Providers who declared more than one educational need also declared multiple learning outcomes (<em xmlns:mrws="http://webservices.ovid.com/mrws/1.0">ρ</em>=0.051, <em xmlns:mrws="http://webservices.ovid.com/mrws/1.0">P</em><0.01).</p> <h3>Conclusions: </h3> <p>Despite EACCME providing a robust framework for the CPD/CME accreditation process, reporting quality can still be improved, as more than 1 in 2 events fail to provide a clear description of their needs assessment. To the authors’ knowledge, this is the largest educational LEE/ELM database, which can be a starting to revisit the CME/CPD accreditation process.</p> </div> </div> </div></section><div class="ejp-fulltext-content js-ejp-fulltext-content"><section id="ArticleBody"><h2 class="ejp-article-outline-heading" data-level="1" id="JCL4">Introduction</h2><article class="article-boxed-text"><p id="JCL-P-7">Highlights</p> <ul id="shaded-2" class="wk-article__list wk-article__list--bullet"> <li class="wk-article__list-item wk-article__list-item--bullet">Continuous professional development (CPD) is a crucial part of healthcare professionals’ careers and ensures professionals remain up-to-date with important advances in the field.</li> <li class="wk-article__list-item wk-article__list-item--bullet">There have been several attempts to standardise the accreditation process for CPD across educational providers and healthcare institutions.</li> <li class="wk-article__list-item wk-article__list-item--bullet">To date, there have been no attempts to systematically review CPD events and audit accreditation processes. The findings of this study call for the accreditation approach for CPD to shift to a more dynamic and involved process to meet the needs of a rapidly evolving educational landscape.</li> </ul></article><p id="JCL-P-11">Medicine is a rapidly evolving discipline. The technological revolution, fast-evolving basic sciences and widespread establishment of evidence-based practice necessitate a lifelong learning approach to clinical practice<sup><a class="ejp-citation-link js-ejp-citation-link" data-reference-links="R1">1</a></sup>. Practically, this has manifested as widespread adoption of ‘continuous professional development’ (CPD) and ‘continuous medical education’ (CME) amongst healthcare professionals.</p> <p id="JCL-P-12">Global trends in medical education demonstrate a huge variation in needs-to-cover, along with different delivery methods across the educational systems and<sup><a class="ejp-citation-link js-ejp-citation-link" data-reference-links="R2">2</a></sup> CPD/CME refers to a broad group of teaching modalities that aim to expand healthcare professionals’ skills and knowledge in order to keep them ‘up-to-date’ with their latest practice recommendations<sup><a class="ejp-citation-link js-ejp-citation-link" data-reference-links="R3">3</a></sup>.</p> <p id="JCL-P-13">For CPD/CME to achieve its goal, it should cover a certain need (needs assessment) and target defined aims and goals (learning outcomes), which necessitates the use of specific learning methods<sup><a class="ejp-citation-link js-ejp-citation-link" data-reference-links="R4">4</a></sup>. Although this seems conceptually simple, placed upon the background of ever-evolving learning needs’ complexity, designing and delivering a teaching intervention can be challenging and may fail to cover educational needs or achieve educational objectives. Nonetheless, robust needs assessments can theoretically improve learning outcomes, increase participant satisfaction and streamline resource allocation. Robust frameworks for creating CPD/CME events rooted in needs assessment and target aims/goals may improve the quality of events. The European Union of Medical Specialists (UEMS) has previously developed one such accreditation process for educational events, which has been adopted by hundreds of organisations and thousands of events globally<sup><a class="ejp-citation-link js-ejp-citation-link" data-reference-links="R4">4</a></sup>. However, to date, adherence to the accreditation process (study design, methods, quality assessment) has not been systematically analysed, and its potential impact has not been quantified.</p> <p id="JCL-P-14">To date, the dedicated research on global trends of needs assessment for designing and delivering educational events, and whether those needs are adequately addressed via distinct learning outcomes, is scarce<sup><a class="ejp-citation-link js-ejp-citation-link" data-reference-links="R5">5</a></sup>. Furthermore, there is hardly any high-quality evidence on the influence of needs assessment on learning outcome(s) and specific method choices for each educational event. The global evidence on participants’ views on whether and how educational events met their initial aim to cover a need is almost non-existent and is predominantly presented as fragmented evidence<sup><a class="ejp-citation-link js-ejp-citation-link" data-reference-links="R6">6</a></sup>.</p> <p id="JCL-P-15">This large, international retrospective study evaluates adherence to the accreditation process of live and e-learning CPD/CME events from the UEMS database and attempts to quantify the educational impact of events. The primary aim was to analyse needs assessment trends and how these are translated into distinct learning methods and learning outcomes. The secondary aim was to assess adherence to UEMS accreditation standards, and subsequently the quality of information available prior to the accreditation process. Through these aims, recommendations for improving the current model of accreditation process are proposed, which have global translational value. Fundamentally, our study objective was to evaluate real-world adherence to the validated UEMS accreditation process for CPD/CME events and highlight areas for improvement.</p> <h2 class="ejp-article-outline-heading" data-level="1" id="JCL5">Materials and methods</h2> <p id="JCL-P-16">UEMS receives applications for live educational events (LEEs) and e-learning materials (ELMs) globally, which are stored in a prospective Microsoft Excel file. Consecutive applications for LEEs (5649) and ELMs (385) that were submitted to UEMS for accreditation under the 2017 revised EACCME criteria were retrospectively reviewed. All applications approved between 2017 and 2019 were included, with no exclusion criteria.</p> <h3 class="ejp-article-outline-heading" data-level="2" id="JCL6">Included data</h3> <p id="JCL-P-17">Submitted applications for LEE/ELMs were exported to a Microsoft Excel spreadsheet by the UEMS IT team; the Excel file was automatically generated including all application variables. Data were extracted from each section of the applications; this included: (1) event code, (2) description of the nature of the event, (3) duration, (4) target audience, (5) international audience, (6) needs assessment process and derived educational needs, (7) expected educational outcomes, (8) methods to promote active learning, (9) learner engagement, means for learner feedback, (10) sources of feedback, (11) number of CMEs granted and (12) event report. Similarly, for ELMs, data were extracted from the following sections: (1) overall description, (2) ‘State how the ELM has been prepared to fulfil stated educational needs, and indicate how this will be achieved’, (3) expected educational outcomes, (4) target audience, (5) duration, (6) level of evidence of the content, (7) ‘Please specify how the ELM must encourage the learner to employ methods of active, (8) adult learning to achieve the educational objectives’, (9) ‘Please specify the extent to which the ELM includes a means of confirming learner engagement, and achievement of the educational objective(s)’, (10) ‘Please specify the extent to which the content is suitable for an international audience’ and (11) source of funding and number of credits.</p> <h3 class="ejp-article-outline-heading" data-level="2" id="JCL7">Pilot data extraction</h3> <p id="JCL-P-18">For a pilot data extraction exercise, 283 LEE (5%) and 20 ELM (5%) applications were selected, and each section of the application form was assessed individually to delineate the most common (>90%) information element trends in responses. Those trends were defined as ‘themes’, which were subsequently used to break down each section of the application into discrete categories. Responses were subsequently coded for each theme for ease of analysis. These themes were further grouped in domains that cover common information of similar nature, named ‘axes’. Hence, the final axes of ‘Event Characteristics’, ‘Target Audience’, ‘Needs Assessment’, ‘Learning outcomes’, ‘Methods of Learning’, ‘Engagement of participants’ and ‘Feedback methods’, ‘Educational report outcomes’ and ‘CME’ were developed. Each axis contained several themes that have discrete responses. <a href="javascript:void(0)" onclick="javascript:showSlideShowByImageID('F1', '01845215-202402000-00010');">Figure 1</a> summarises the coding themes for each section of the application grouped in the relevant axes.</p><section class="ejp-r-article-images"><figure class="ejp-r-article-images__figure"><a href="javascript:void(0)" class="ejp-r-article-images__image-link" onclick="showSlideShowByImageID('F1', '01845215-202402000-00010')"><img class="ejp-r-article-images__img js-lazy-load lazy-load" src="javascript:void(0);" data-src="https://images.journals.lww.com/annals-of-medicine-and-surgery/ArticleViewerPreview.01845215-202402000-00010.F1.jpeg" data-srcset="https://images.journals.lww.com/annals-of-medicine-and-surgery/ArticleViewerPreview@2.01845215-202402000-00010.F1.jpeg 2x" srcset="" alt="F1"></a><figcaption class="ejp-r-article-images__figcaption"><a href="javascript:void(0)" class="ejp-r-article-images__figcaption-link" onclick="showSlideShowByImageID('F1', '01845215-202402000-00010')">Figure 1: </a><div class="ejp-r-article-images__figcaption-text">Coded themes (light grey boxes) under each axis (dark grey boxes).</div></figcaption></figure></section><h3 class="ejp-article-outline-heading" data-level="2" id="JCL8">Thematic analysis of data</h3> <p id="JCL-P-19">Data for each application section were summarised using the predefined (coded) response ‘themes’, and conclusions were grouped based on the axes. For continuous variables, normality was assessed, and each section was described using mean or median where applicable.</p> <h3 class="ejp-article-outline-heading" data-level="2" id="JCL9">Primary outcomes</h3> <p id="JCL-P-20">Primary outcomes were the quality parameters included in the events report (quality of the event, relevance, suitability of the format, practice-changing potential and commercial bias).</p> <h3 class="ejp-article-outline-heading" data-level="2" id="JCL10">Data cleaning</h3> <p id="JCL-P-21">Following thematic analysis, the data were cross-checked and cleaned prior to final analysis; this included manual checks to ensure no mistaken values were imported in our analysis.</p> <h3 class="ejp-article-outline-heading" data-level="2" id="JCL11">Data analysis</h3> <p id="JCL-P-22">Since this project followed an audit design, we have opted to use univariate descriptive statistics. The normality of continuous data was assessed using the Shapiro–Wilks test to distinguish the use of parametric vs. non-parametric statistics. Associations between continuous variables were assessed with Spearman’s rho (<em xmlns:mrws="http://webservices.ovid.com/mrws/1.0">ρ</em>). Where data were proven normal, we opted for parametric statistics, and hence means (± SD) across different groups were assessed with one-way ANOVA or independent <em xmlns:mrws="http://webservices.ovid.com/mrws/1.0">t</em>-test. In the case of non-normal distribution, we opted for non-parametric statistics including median [±IQR (interquartile range)]. Level of statistical significance was set as <em xmlns:mrws="http://webservices.ovid.com/mrws/1.0">P</em><0.05. Analysis process was performed on IBM SPSS for Macintosh v.27.</p> <h3 class="ejp-article-outline-heading" data-level="2" id="JCL12">STROCCS criteria</h3> <p id="JCL-P-23">This study has been in line with STROCCS criteria (Strengthening the reporting of cohort, cross-sectional and case-control studies in surgery)<sup><a class="ejp-citation-link js-ejp-citation-link" data-reference-links="R7">7</a></sup>.</p> <h4 class="ejp-article-outline-heading" data-level="3" id="JCL13">Ethics and approvals</h4> <p id="JCL-P-24">This study was internally reviewed and approved by the Executive Board of UEMS.</p> <h2 class="ejp-article-outline-heading" data-level="1" id="JCL14">Results</h2> <h3 class="ejp-article-outline-heading" data-level="2" id="JCL15">Events summary (infographics)</h3> <p id="JCL-P-25">Six thousand and thirty-four (6034) applications from 91 countries were included in the analysis; this includes 5649 LEEs and 385 ELMs, which were submitted for accreditation between 2017 and 2019 for events that would take place up until and including 2020. In total, 931 educational events took place in 2017, 1986 in 2018, 2282 in 2019, and 507 in 2020; 5973 events were targeting an international audience, whereas 35 were nationally targeted. From those 6034 educational events, 2323 were conferences, 3239 courses, 180 hands-on workshops and 292 satellite symposia. Two thousand eight hundred forty-eight (2848) applications did not specify location or origin of the LEE or ELM; Spain and France hosted the most educational events – 331 each, followed by Italy where 271 events were hosted. <a href="javascript:void(0)" onclick="javascript:showSlideShowByImageID('F2', '01845215-202402000-00010');">Figure 2</a> (infographics) summarises the characteristics of the LEE and ELM included in the analysis.</p><section class="ejp-r-article-images"><figure class="ejp-r-article-images__figure"><a href="javascript:void(0)" class="ejp-r-article-images__image-link" onclick="showSlideShowByImageID('F2', '01845215-202402000-00010')"><img class="ejp-r-article-images__img js-lazy-load lazy-load" src="javascript:void(0);" data-src="https://images.journals.lww.com/annals-of-medicine-and-surgery/ArticleViewerPreview.01845215-202402000-00010.F2.jpeg" data-srcset="https://images.journals.lww.com/annals-of-medicine-and-surgery/ArticleViewerPreview@2.01845215-202402000-00010.F2.jpeg 2x" srcset="" alt="F2"></a><figcaption class="ejp-r-article-images__figcaption"><a href="javascript:void(0)" class="ejp-r-article-images__figcaption-link" onclick="showSlideShowByImageID('F2', '01845215-202402000-00010')">Figure 2: </a><div class="ejp-r-article-images__figcaption-text">Events summary diagrams depicting the scope of educational event applications.</div></figcaption></figure></section><h3 class="ejp-article-outline-heading" data-level="2" id="JCL16">Reporting quality</h3> <h4 class="ejp-article-outline-heading" data-level="3" id="JCL17">Needs assessments, engaging participants to achieve tailored learning</h4> <p id="JCL-P-26"><a href="#T1">Table 1</a> summarises the breakdown of needs assessment and engagement methods. Three thousand seven hundred sixty-two (3762; 62.3%) of the events did not report clear justification in their needs assessment process. From the 2271 events (37.6%) which had a clear needs assessment breakdown, almost all of them [2223 (99.3%)] justified their activity from international needs. Most events arose from a single educational need [1603 (26.6%)]. ‘Previous activity’ was reported as the most common theme for initiating an educational activity [1503 events (65.8%)], followed by ‘survey of previous participants’ [927 events (40.6%)]; 670/935 conferences (>3 in 4) justified their needs assessment based on ‘previous activity’; same applies for 757/1133 courses (>2 in 3). Only 307/935 conferences (1 in 3) reported ‘surveys of potential participants’ as the justification to set up their educational event, whereas 541/1133 courses (1 in 2) were based on ‘surveys of potential participants’.</p> <div class="wk-clearfix-article-table"></div> <div class="article-table"><a id="T1"></a><div class="article-table-title"><span>Table 1 - </span> Comparisons of needs assessment trends across different years, LEE vs. ELM, type of event and country where the event took place<em class="fa fa-arrows-alt expand-button js-expand-table-event" aria-label="expand table"></em><div class="clearfix"></div> </div> <div class="scroll-message"></div> <div class="dummy-scroll"> <div></div> </div> <div class="article-table-body"> <div class="article-table-container"> <table> <col align="left" width="1*" span="1" xmlns="http://www.w3.org/1999/xhtml" /> <col align="left" width="1*" span="1" xmlns="http://www.w3.org/1999/xhtml" /> <col align="left" width="1*" span="1" xmlns="http://www.w3.org/1999/xhtml" /> <col align="left" width="1*" span="1" xmlns="http://www.w3.org/1999/xhtml" /> <col align="left" width="1*" span="1" xmlns="http://www.w3.org/1999/xhtml" /> <col align="left" width="1*" span="1" xmlns="http://www.w3.org/1999/xhtml" /> <col align="left" width="1*" span="1" xmlns="http://www.w3.org/1999/xhtml" /> <col align="left" width="1*" span="1" xmlns="http://www.w3.org/1999/xhtml" /> <col align="left" width="1*" span="1" xmlns="http://www.w3.org/1999/xhtml" /> <col align="left" width="1*" span="1" xmlns="http://www.w3.org/1999/xhtml" /> <thead xmlns="http://www.w3.org/1999/xhtml"> <tr> <th align="left" rowspan="1" colspan="1" axis="1" /> <th align="center" rowspan="1" colspan="9" axis="1">Needs assessment/engaging participants/tailored learning</th> </tr> </thead> <tbody xmlns="http://www.w3.org/1999/xhtml"> <tr> <td align="left" rowspan="1" colspan="1" /> <td align="center" rowspan="1" colspan="9">Needs assessment breakdown</td> </tr> <tr> <td align="left" rowspan="1" colspan="1">Needs assessment (general)</td> <td align="center" rowspan="1" colspan="2">Clear justification</td> <td align="center" rowspan="1" colspan="2">Local/international needs</td> <td align="center" rowspan="1" colspan="5">Needs assessment (number of reported needs)</td> </tr> <tr> <td align="left" rowspan="1" colspan="1" /> <td align="center" rowspan="1" colspan="1">Yes</td> <td align="center" rowspan="1" colspan="1">2271 (37.6%)</td> <td align="left" rowspan="1" colspan="1">Local</td> <td align="center" rowspan="1" colspan="1">15 (0.7%)</td> <td align="center" rowspan="1" colspan="1">None</td> <td align="center" rowspan="1" colspan="1">1</td> <td align="center" rowspan="1" colspan="1">2</td> <td align="center" rowspan="1" colspan="1">3</td> <td align="center" rowspan="1" colspan="1">4</td> </tr> <tr> <td align="left" rowspan="1" colspan="1" /> <td align="center" rowspan="1" colspan="1">No</td> <td align="center" rowspan="1" colspan="1">3762 (62.3%)</td> <td align="left" rowspan="1" colspan="1">International</td> <td align="center" rowspan="1" colspan="1">2223 (99.3%)</td> <td align="center" rowspan="1" colspan="1">3750 (62.2%)</td> <td align="center" rowspan="1" colspan="1">1603 (26.6%)</td> <td align="center" rowspan="1" colspan="1">494 (8.2%)</td> <td align="center" rowspan="1" colspan="1">68 (1.1%)</td> <td align="center" rowspan="1" colspan="1">118 (2.0%)</td> </tr> <tr> <td align="left" rowspan="1" colspan="1">Needs assessment (origin)</td> <td align="center" rowspan="1" colspan="2">Previous activity</td> <td align="center" rowspan="1" colspan="2">Survey of participants</td> <td align="center" rowspan="1" colspan="2">New guidelines or research</td> <td align="center" rowspan="1" colspan="2">Legislative/regulatory changes</td> <td align="center" rowspan="1" colspan="1">Other</td> </tr> <tr> <td align="left" rowspan="1" colspan="1" /> <td align="center" rowspan="1" colspan="1">Yes</td> <td align="center" rowspan="1" colspan="1">1503 (65.8%)</td> <td align="center" rowspan="1" colspan="1">Yes</td> <td align="center" rowspan="1" colspan="1">927 (40.6%)</td> <td align="center" rowspan="1" colspan="1">Yes</td> <td align="center" rowspan="1" colspan="1">508 (22.3%)</td> <td align="center" rowspan="1" colspan="1">Yes</td> <td align="center" rowspan="1" colspan="1">145 (6.4%)</td> <td align="center" rowspan="1" colspan="1">165 (7.2%)</td> </tr> <tr> <td align="left" rowspan="1" colspan="1" /> <td align="center" rowspan="1" colspan="1">No</td> <td align="center" rowspan="1" colspan="1">34.2 (35.2%)</td> <td align="center" rowspan="1" colspan="1">No</td> <td align="center" rowspan="1" colspan="1">1356 (59.4%)</td> <td align="center" rowspan="1" colspan="1">No</td> <td align="center" rowspan="1" colspan="1">1775 (77.7%)</td> <td align="center" rowspan="1" colspan="1">No</td> <td align="center" rowspan="1" colspan="1">2138 (93.6%)</td> <td align="center" rowspan="1" colspan="1" /> </tr> <tr> <td align="left" rowspan="1" colspan="1" /> <td align="center" rowspan="1" colspan="9">Engaging participants breakdown</td> </tr> <tr> <td align="left" rowspan="1" colspan="1" /> <td align="left" rowspan="1" colspan="5">Engagement methods</td> <td align="center" rowspan="1" colspan="4">Feedback methods</td> </tr> <tr> <td align="left" rowspan="1" colspan="1">Methods</td> <td align="center" rowspan="1" colspan="1">Registration/badge</td> <td align="center" rowspan="1" colspan="1">Continuous</td> <td align="center" rowspan="1" colspan="1">None</td> <td align="center" rowspan="1" colspan="1">Other</td> <td align="center" rowspan="1" colspan="1">Attendance sheets</td> <td align="center" rowspan="1" colspan="1">Printed form</td> <td align="center" rowspan="1" colspan="1">Online form</td> <td align="center" rowspan="1" colspan="1">Mixed</td> <td align="center" rowspan="1" colspan="1">Other</td> </tr> <tr> <td align="left" rowspan="1" colspan="1" /> <td align="center" rowspan="1" colspan="1">1838 (30.6%)</td> <td align="center" rowspan="1" colspan="1">1036 (17.2%)</td> <td align="center" rowspan="1" colspan="1">1142 (18.9%)</td> <td align="center" rowspan="1" colspan="1">1046 (17.3%)</td> <td align="center" rowspan="1" colspan="1">960 (15.9%)</td> <td align="center" rowspan="1" colspan="1">3756 (62.3%)</td> <td align="center" rowspan="1" colspan="1">1524 (25.3%)</td> <td align="center" rowspan="1" colspan="1">353 (5.9%)</td> <td align="center" rowspan="1" colspan="1">399 (6.6%)</td> </tr> <tr> <td align="left" rowspan="1" colspan="1">Educational hours</td> <td align="center" rowspan="1" colspan="1">15.3±9.5</td> <td align="center" rowspan="1" colspan="1">18±8.71</td> <td align="center" rowspan="1" colspan="1">14.2±11.4</td> <td align="center" rowspan="1" colspan="1">9.4±9.9</td> <td align="center" rowspan="1" colspan="1">16.3±10.1</td> <td align="center" rowspan="1" colspan="1" /> <td align="left" rowspan="1" colspan="1" /> <td align="left" rowspan="1" colspan="1" /> <td align="left" rowspan="1" colspan="1" /> </tr> <tr> <td align="left" rowspan="1" colspan="1">Number of participants</td> <td align="center" rowspan="1" colspan="1">593±1405</td> <td align="center" rowspan="1" colspan="1">588±1986</td> <td align="center" rowspan="1" colspan="1">403±1517</td> <td align="center" rowspan="1" colspan="1">405±1338</td> <td align="center" rowspan="1" colspan="1">137±355</td> <td align="center" rowspan="1" colspan="1" /> <td align="left" rowspan="1" colspan="1" /> <td align="left" rowspan="1" colspan="1" /> <td align="left" rowspan="1" colspan="1" /> </tr> </tbody> </table> <div class="article-table-descriptions"></div> </div> </div> </div><br><p id="JCL-P-27">Conferences had a clearer justification of needs assessment compared to courses (926/2322 vs. 1131/3239, <em xmlns:mrws="http://webservices.ovid.com/mrws/1.0">P</em><0.01). Conferences, courses, hands-on workshops and satellite symposia were assigned a similar number of needs assessments (<em xmlns:mrws="http://webservices.ovid.com/mrws/1.0">P</em><0.01) and had similar overall needs assessment reporting quality (<em xmlns:mrws="http://webservices.ovid.com/mrws/1.0">P</em><0.01).</p> <p id="JCL-P-28">When comparing the trends of needs assessment reporting (clear justification, local/international, number of reported needs assessments) across several years, there were similar results in a statistically significant manner (<em xmlns:mrws="http://webservices.ovid.com/mrws/1.0">P</em><0.01). The same applied when comparing all the reporting parameters of needs assessment across different countries (<em xmlns:mrws="http://webservices.ovid.com/mrws/1.0">P</em><0.01). Minor differences were reported when comparing ELM vs. LEE, which can be attributed to the significantly smaller number of ELM vs. LEE. ELMs seem to initiate more often from ‘surveys of potential participants’ (113/385 vs. 815/4814, <em xmlns:mrws="http://webservices.ovid.com/mrws/1.0">P</em><0.01) and far less frequently from ‘evaluation of previous activity’ (57/385 vs. 1446/4202, <em xmlns:mrws="http://webservices.ovid.com/mrws/1.0">P</em><0.01). However, both ELM and LEE have a similar ‘clear justification’ of needs assessment trends (160/385 vs. 2111/5648, <em xmlns:mrws="http://webservices.ovid.com/mrws/1.0">P</em>=0.057).</p> <p id="JCL-P-29">‘Registration with or without badge’ was the most common form of engagement method (1838/6032 events, 30.8%), followed by ‘continuous sign in/out assessment’ in 1036/6032 events (17.2%). Printed feedback forms remain the most common form of feedback reporting (3756/6032 events, 62.3%).</p> <h4 class="ejp-article-outline-heading" data-level="3" id="JCL18">Learning outcomes and applied methods</h4> <p id="JCL-P-30">Five thousand six hundred forty-two (5642)/6034 events (93.5%) had clearly documented expected learning outcomes; 978/6034 (16.2%) reported a single expected learning outcome while the rest report multiple (2–10) outcomes. The most commonly reported primary learning outcomes were ‘Applied knowledge’ (1240/6034, 21%), ‘Clinical Practice’ (1275/6034, 21.6%) and ‘stay up-to-date’ (2102/6034, 35.5%). Similar trends were observed for secondary learning outcomes in the case were the events reported multiple learning outcomes.</p> <p id="JCL-P-31">Almost all events had documented methods of learning (6033/6034); the median number of methods of learning was 3. The most frequently reported primary learning method was ‘open space’ (2853/6033, 47.3%) followed by ‘discussion time’ (1024/6033, 17%) and dedicated ‘training sessions’ (576/6033, 9.5%); similar trends were observed for secondary learning method in events that employed more than one learning method.</p> <p id="JCL-P-32">The number of learning outcomes was statistically significantly correlated with the number of reported needs assessment (<em xmlns:mrws="http://webservices.ovid.com/mrws/1.0">ρ</em>=0.051, <em xmlns:mrws="http://webservices.ovid.com/mrws/1.0">P</em><0.01). As expected, the number of learning outcomes was statistically significantly associated with the number of learning methods (<em xmlns:mrws="http://webservices.ovid.com/mrws/1.0">ρ</em>=0.202, <em xmlns:mrws="http://webservices.ovid.com/mrws/1.0">P</em><0.01).</p> <h4 class="ejp-article-outline-heading" data-level="3" id="JCL19">Quality assessment, the stakeholders’ perspective</h4> <p id="JCL-P-33">Two thousand six hundred thirty-seven (2637)/6034 events submitted an event report; 1052/2637 were conferences with 968±2166 mean number of participants, 1383/2637 were courses (108±298 participants), 84/2637 hands-on workshops (70±77 participants) and 118/2637 satellite symposia with 268±206 participants. The overall median and mean number of participants were 87 (IQR: 36–280) and 457 (2–23 239), respectively (<a href="javascript:void(0)" onclick="javascript:showSlideShowByImageID('F3', '01845215-202402000-00010');">Fig. 3</a>).</p><section class="ejp-r-article-images"><figure class="ejp-r-article-images__figure"><a href="javascript:void(0)" class="ejp-r-article-images__image-link" onclick="showSlideShowByImageID('F3', '01845215-202402000-00010')"><img class="ejp-r-article-images__img js-lazy-load lazy-load" src="javascript:void(0);" data-src="https://images.journals.lww.com/annals-of-medicine-and-surgery/ArticleViewerPreview.01845215-202402000-00010.F3.jpeg" data-srcset="https://images.journals.lww.com/annals-of-medicine-and-surgery/ArticleViewerPreview@2.01845215-202402000-00010.F3.jpeg 2x" srcset="" alt="F3"></a><figcaption class="ejp-r-article-images__figcaption"><a href="javascript:void(0)" class="ejp-r-article-images__figcaption-link" onclick="showSlideShowByImageID('F3', '01845215-202402000-00010')">Figure 3: </a><div class="ejp-r-article-images__figcaption-text">Events summary diagrams depicting data relating to events quality assessment and stakeholders’ perspective.</div></figcaption></figure></section><p id="JCL-P-34">Audiences had most participants from Europe (71%), followed by the US (3.4%), Canada (0.88%) and other countries (21.8%). Similar audience distributions were observed across the different types of events (conferences vs. courses vs. hands-on workshops vs. satellite symposia, <em xmlns:mrws="http://webservices.ovid.com/mrws/1.0">P</em>>0.05).</p> <p id="JCL-P-35">The overall median events quality was unified (% scale) and reported to 90% (IQR: 84–94%); overall median relevance 89.4% (IQR: 80–95%), and overall median suitability of format 90% (IQR: 78–95%). The overall median % of delegates who thought the event was practice-changing was 90% (IQR: 80–94.1%), and 90% (median) of delegates reported that the event was commercial bias free (IQR: 80–96%).</p> <p id="JCL-P-36">Similar performance markers were observed across different types of events (<em xmlns:mrws="http://webservices.ovid.com/mrws/1.0">P</em>>0.05 for all associations). Educational events with clearly justified needs assessment reported marginally higher relevance (88.7% vs. 87.1%, <em xmlns:mrws="http://webservices.ovid.com/mrws/1.0">P</em><0.01) and had more suitable format (88.1% vs. 86.3%, <em xmlns:mrws="http://webservices.ovid.com/mrws/1.0">P</em><0.01); however, the quality of events was deemed equal by participants (88.6% vs. 88.3%, <em xmlns:mrws="http://webservices.ovid.com/mrws/1.0">P</em>>0.05).</p> <h4 class="ejp-article-outline-heading" data-level="3" id="JCL20">CMEs and educational hours</h4> <p id="JCL-P-37">The mean educational hours (duration) of events were 14.7±10.3. The mean number of CMEs awarded was 13.05±9.99. In 5426/6034 (89.9%) events, the educational hours matched the number of CMEs awarded.</p> <h2 class="ejp-article-outline-heading" data-level="1" id="JCL21">Discussion</h2> <h3 class="ejp-article-outline-heading" data-level="2" id="JCL22">Strengths of the study</h3> <p id="JCL-P-38">This is the largest educational events database ever to be analysed from the biggest educational provider in the EU (UEMS). We included 6034 events from 91 countries and employed a unique protocol to unify data reporting to come up with distinct themes and axes to analyse the data. Although retrospective in nature, our analysis of the UEMS database was approached with a prospective protocol, and data assessors underwent vigorous training, and a pilot cross-validation of a sample of their screening was undertaken to reduce bias in data reporting. We avoided overcomplicating the analysis process, as this database was not originally designed for research purposes. We noticed an acceptable number of missing data, which underlines the overall good quality of the available data. Our study is the first evidence-based approach to explore needs assessment in CME and assess its association with learning outcomes and learning methods as well as stakeholders’ perception of the relevance, suitability and educational impact of events.</p> <h3 class="ejp-article-outline-heading" data-level="2" id="JCL23">Main findings</h3> <p id="JCL-P-39">Less than 1 in 2 LEEs or ELMs initiate their activity on the grounds of robust needs assessment. We reported a similar trend of needs assessment across 2017–2019; most educational events claim they cover a single educational need, which is applicable on an international scale. Most LEEs based their needs assessment on previous activity recommendations, followed by a structured survey of their stakeholders, which seems to be the most common needs assessment justification for ELM. The needs assessment reporting quality and breakdown number were similar across conferences, courses and other types of events (<em xmlns:mrws="http://webservices.ovid.com/mrws/1.0">P</em><0.01).</p> <p id="JCL-P-40">Overall, reporting quality for learning outcomes and methods was excellent. This probably reflects the standardised framework provided by EACCME guidelines<sup><a class="ejp-citation-link js-ejp-citation-link" data-reference-links="R4">4</a></sup>. Almost 4 in 10 events focus on providing ‘up-to-date’ information to their participants, which is the primary pillar of CME. More than 2 in 10 events aimed to provide applied knowledge or clinical practice-related information. Almost all events aimed to cover composite (multiple) learning outcomes via employing mixed learning methods. One in 2 LEEs employed ‘open space’ learning methods followed by ‘discussion time’ (1 in 2) and ‘training sessions’ (1 in 10).</p> <p id="JCL-P-41">Composite needs assessment was statistically significantly associated with the presence of multiple learning outcomes (<em xmlns:mrws="http://webservices.ovid.com/mrws/1.0">ρ</em>=0.051, <em xmlns:mrws="http://webservices.ovid.com/mrws/1.0">P</em><0.01); equally, multiple learning outcomes required the employment of multiple learning methods.</p> <p id="JCL-P-42">One in 3 LEEs employ ‘Registration with badge’ as a method to monitor engagement and 1 in 5 had continuous assessment of delegates’ presence. Printed feedback was the most used form of assessing quality (>1 in 2) of LEE and ELM, followed by online forms (1 in 4).</p> <p id="JCL-P-43">More than 9 in 10 delegates perceived CME events as suitable, relevant, commercial bias free and practice-changing. This is the most promising finding, which proves the positive perception of stakeholders towards CME. Most of the audience was from the EU (7 in 10 participants); the rest were from other countries (2 in 10), the US (3 in 100) and Canada (1 in 100).</p> <p id="JCL-P-44">Finally, 9 in 10 events awarded a matching number of CMEs to their educational hours.</p> <h3 class="ejp-article-outline-heading" data-level="2" id="JCL24">Interpretation</h3> <p id="JCL-P-45">Needs assessment explores the gap between the current educational landscape and a desired situation. Although the EACCME provides a clear definition with examples of what qualifies as a sufficient needs’ assessment process, still only 50% of the events manage to provide a solid justification. This could be explained either because many organisers consider the adjacent information given in the learning outcomes or methods self-explanatory for needs assessment, or, because several events lack a solid needs foundation. The fact that there is a similar trend of needs assessment reporting across several event types leads us to conclude that the organisers fail to acknowledge the importance of this section as the founding justification for their event. Recommendations from previous activity or surveys of the stakeholders were, as expected, the most common justification reported in our study and appear to be an orthodox approach for setting up an event.</p> <p id="JCL-P-46">Compared to the American Council of Continuous Medical Education (ACCME) criteria where the accreditation process is ‘provider-centred’, EACCME operates majorly their assessment on each event individually rather than accrediting the provider. ACCME holds a slightly different framework of operation where emphasis is given on the educational framework of each provider rather than each event itself. In their recent audit<sup><a class="ejp-citation-link js-ejp-citation-link" data-reference-links="R8">8</a></sup> report, ACCME have outlined a series of strict criteria (C23-38) on commendation, commenting on main reasons for non-compliance. These were primarily summarised around the fact that providers did not address critical elements (C23-38) or lack of compliance evidence or did not submit the number of examples required for the organisation programme size. Although not identical reasoning, nevertheless, we can see some core similarities with EU-based data from EACCME, indicating some common ground elements for improvement.</p> <p id="JCL-P-47">We observed a clear reporting trend in the learning outcomes and methods, with most of the events employing a composite set-up of learning methods to cover multiple outcomes. This is to be expected, as most events aim to cover a melange of different needs – in most cases fuelled by and serving the ever-increasing demands and standards of an upgrading modern medical practice, which is the primary purpose of CME. The reporting quality of learning methods and outcomes was excellent, reflecting that organisers understand the significance of those two elements as the backbone of their educational event. This is an important quality assurance indicator of the event, which essentially organisers pay a lot of attention to deliver a successful event. This is most likely ‘perceived’ as the recipe for receiving good feedback,</p> <p id="JCL-P-48">One of the most promising findings of this study is the fact that almost 9 in 10 delegates found LEE/ELM as suitable, relevant, commercial bias free and practice-changing. This shows (a) stakeholders value highly any CME effort, (b) EACCME has a critical role and responsibility as an educational guardian and (c) UEMS has been successful in ensuring – despite the limitations discussed below – that high standards are maintained in the vast majority of educational events.</p> <h3 class="ejp-article-outline-heading" data-level="2" id="JCL25">Limitations</h3> <p id="JCL-P-49">We must acknowledge a series of limitations in our study. Firstly, EACCME database is not designed for research purposes. As a result, there was a considerable variation in data reporting, both in terms of quality but mainly in the way applicants describe their needs assessment, delivery methodology (learning methods) and learning outcomes. Occasionally, data were not self-explanatory, and a separate process had to be undertaken to clarify the intended content and appropriately code for analysis. Therefore, one of the most critical steps was harmonisation of the material provided in the application forms. This was a lengthy process, which, although undertaken meticulously and in a stepwise manner, may have introduced bias, especially when the final ‘themes’ were selected. In simple words, quantifying qualitative data was the biggest challenge; however, we consider our prospective protocol as a safe route to minimise bias. Secondly, although we used a prospective research methodology protocol, the study nature remains retrospective, which is also a limiting factor. Finally, in several sections, reporting quality was limited, which may have led to false assumptions in our interpretation process.</p> <h3 class="ejp-article-outline-heading" data-level="2" id="JCL26">Recommendations</h3> <h4 class="ejp-article-outline-heading" data-level="3" id="JCL27">Delivering high-quality evidence through research frameworks</h4> <p id="JCL-P-50">The nature of this analysis is observational, and further definitive association should be explored using a prospective, research-friendly database. Hence, designing a research-friendly database will be a stepping-stone transition to explore with confidence critical research questions on needs assessment, learning outcomes and methods for CME activities. A critical recommendation from our data harmonisation process is to consider a set of Core Outcome Sets, which will prospectively harmonise the way applicants report and structure their educational event. This has been the case with other research areas<sup><a class="ejp-citation-link js-ejp-citation-link" data-reference-links="R9">9</a></sup>; for instance, the CROWN initiative has been a great example to reduce research way and optimise trial design and evidence synthesis, which results in solid evidence.</p> <h4 class="ejp-article-outline-heading" data-level="3" id="JCL28">Accreditation should be a dynamic process</h4> <p id="JCL-P-51">Despite the EACCME accreditation involving expert reviewer recommendations, who assess and score each application prior to providing with CME credits, this should gain a more critical role in the accreditation process. That can be facilitated with either a strict ‘revise and resubmit’, which ensures each event design at least ‘fits the purpose’, meaning it has a clear needs assessment ground, which is facilitated by the selected learning outcomes and methods. The other important catalyst towards this process will be to randomly select LEE or ELM and design an assessment protocol that aims to figure out whether the actual event follows the submitted application. This will additionally allow EACCME panel to undertake an essential role in actively improving an educational event, as most of them run periodically. This is perhaps the most effective strategy to command immediate change that will confer a meaningful impact on the educational experience of stakeholders attending that event, instead of only focusing on future event improvements.</p> <h4 class="ejp-article-outline-heading" data-level="3" id="JCL29">There should be a shift from time-based to educational-impact-based CMEs</h4> <p id="JCL-P-52">Although currently CME credits directly reflect educational hours, there should be a shift for CMEs to be quantified towards educational impact. This is not going to be an easy task and will require robust prospective research to identify outcomes that subjectively quantify educational impact. An effort towards this direction has been attempted by the introduction of ‘pragmatic’ outcomes from the ESMSC course<sup><a class="ejp-citation-link js-ejp-citation-link" data-reference-links="R1 R10 R11">1,10,11</a></sup>. Those outcomes were based on a mathematic breakdown of each course module and prospectively compared with delegates perspective (feedback) as well as their objective improvement on the learning outcomes using validated practical skills assessments or exam material. A starting – and realistic – point towards this direction will be a consensus document that quantifies some objective standards matched to the number of accredited CMEs, which can be an interim transition from the purely time-based to ‘educational impact’-based CMEs.</p> <h2 class="ejp-article-outline-heading" data-level="1" id="JCL30">Conclusion</h2> <p id="JCL-P-53">Less than 1 in 2 events describe needs assessment properly. The EACCME board should consider redesigning their database to make it more research friendly, which will catalyse generation of high-quality evidence. Regular audits of this database will ensure better adherence to accreditation in the future. Given UEMS is the largest educational provider globally, this database could drive changes to shape the future educational landscape. The approach to accreditation should shift to a more dynamic and involved process to meet the needs of a rapidly evolving educational landscape.</p> <h2 class="ejp-article-outline-heading" data-level="1" id="JCL31">Ethical approval</h2> <p id="JCL-P-54">No ethical approval was required as this is an audit project commissioned by UEMS as part of their standard operational framework.</p> <h2 class="ejp-article-outline-heading" data-level="1" id="JCL32">Consent</h2> <p id="JCL-P-55">This study does not include any human participants.</p> <h2 class="ejp-article-outline-heading" data-level="1" id="JCL33">Sources of funding</h2> <p id="JCL-P-56">No funding was received for this study.</p> <h2 class="ejp-article-outline-heading" data-level="1" id="JCL34">Author contribution</h2> <p id="JCL-P-57">M.S. has conceived the protocol to approach the UEMS data and has analysed and drafted the manuscript. V.P. is the senior author and currently holding the position of president of UEMS. K.S.R. and M.N. are equal contributors, with data collection and data analysis/drafting of parts of the manuscript. A.K. and N.S. have contributed to data collection and manuscript editing. N.P., O.H., R.S.K. and J.G. have provided senior input in editing the manuscript and are part of the UEMS board. R.S., R.U., A.M., R.M., A.A., C.M.B. and G.A. have contributed to data collection. All authors have approved the final version of the manuscript.</p> <h2 class="ejp-article-outline-heading" data-level="1" id="coi-statement">Conflicts of interest disclosure</h2> <p id="JCL-P-58">No conflicts of interest reported.</p> <h2 class="ejp-article-outline-heading" data-level="1" id="JCL35">Research registration unique identifying number (UIN)</h2> <p id="JCL-P-59">Not applicable – this is an audit that does not directly or indirectly involve human participants.</p> <h2 class="ejp-article-outline-heading" data-level="1" id="JCL36">Guarantor</h2> <p id="JCL-P-60">M.S. and V.P. are the guarantors of this work.</p> <h2 class="ejp-article-outline-heading" data-level="1" id="JCL37">Data availability statement</h2> <p id="JCL-P-61">Data available upon reasonable request.</p> <h2 class="ejp-article-outline-heading" data-level="1" id="JCL38">Provenance and peer review</h2> <p id="JCL-P-62">Not commissioned, externally peer-reviewed.</p></section><section id="article-references" class="article-references js-article-references"><h2 class="ejp-article-outline-heading" data-level="1" id="JCL39">Acknowledgement</h2> <p id="JCL-P-63">None.</p> <h2 class="ejp-article-outline-heading" data-level="1" id="JCL-L-1">References</h2> <div id="R1" class="article-references__item js-article-reference">1. Sideris M, Emin EI, Hanrahan JG, et al. ABC of surgical teaching: time to consider a global blueprint for holistic education. J Invest Surg 2021;34:1355–1365.<div> <ul class="article-references__item-links"> <li class="internal-links"><a href="#JCL-P-11"> Cited Here</a> | </li> <li><a href="https://scholar.google.com/scholar_lookup?title=ABC+of+surgical+teaching%3a+time+to+consider+a+global+blueprint+for+holistic+education&publication_year=2021&author=M+Sideris&author=EI+Emin&author=JG+Hanrahan" onclick="javascript:window.open('https://scholar.google.com/scholar_lookup?title=ABC+of+surgical+teaching%3a+time+to+consider+a+global+blueprint+for+holistic+education&publication_year=2021&author=M+Sideris&author=EI+Emin&author=JG+Hanrahan');return false">Google Scholar</a></li> </ul> </div> </div> <div id="R2" class="article-references__item js-article-reference">2. Sideris M, Nicolaides M, Theodoulou I, et al. Student views on a novel holistic surgical education curriculum (iG4): a multi-national survey in a changing landscape. In Vivo 2020;34:1063–1069.<div> <ul class="article-references__item-links"> <li class="internal-links"><a href="#JCL-P-12"> Cited Here</a> | </li> <li><a href="https://scholar.google.com/scholar_lookup?title=Student+views+on+a+novel+holistic+surgical+education+curriculum+(iG4)%3a+a+multi-national+survey+in+a+changing+landscape&publication_year=2020&author=M+Sideris&author=M+Nicolaides&author=I+Theodoulou" onclick="javascript:window.open('https://scholar.google.com/scholar_lookup?title=Student+views+on+a+novel+holistic+surgical+education+curriculum+(iG4)%3a+a+multi-national+survey+in+a+changing+landscape&publication_year=2020&author=M+Sideris&author=M+Nicolaides&author=I+Theodoulou');return false">Google Scholar</a></li> </ul> </div> </div> <div id="R3" class="article-references__item js-article-reference">3. National Institutes of Health. What is CME credit? 2017. Accessed 30 July 2023. <span><a href="https://www.nih.gov/about-nih/what-cme-credit" onclick="javascript:window.open('https://www.nih.gov/about-nih/what-cme-credit');return false">https://www.nih.gov/about-nih/what-cme-credit</a></span><div> <ul class="article-references__item-links"> <li class="internal-links"><a href="#JCL-P-12"> Cited Here</a> | </li> <li><a href="https://scholar.google.com/scholar_lookup?" onclick="javascript:window.open('https://scholar.google.com/scholar_lookup?');return false">Google Scholar</a></li> </ul> </div> </div> <div id="R4" class="article-references__item js-article-reference">4. (UEMS) EUoMS. EACCME criteria for the accreditation of live educational events 2016. Accessed 30 July 2023. <span><a href="https://www.uems.eu/__data/assets/pdf_file/0009/40302/UEMS2016.20-EACCME-2-0-CRITERIA-FOR-THE-ACCREDITATION-OF-LEE.pdf" onclick="javascript:window.open('https://www.uems.eu/__data/assets/pdf_file/0009/40302/UEMS2016.20-EACCME-2-0-CRITERIA-FOR-THE-ACCREDITATION-OF-LEE.pdf');return false">https://www.uems.eu/__data/assets/pdf_file/0009/40302/UEMS2016.20-EACCME-2-0-CRITERIA-FOR-THE-ACCREDITATION-OF-LEE.pdf</a></span> [Accessed 30 July 2023].<div> <ul class="article-references__item-links"> <li class="internal-links"><a href="#JCL-P-13"> Cited Here</a> | </li> <li><a href="https://scholar.google.com/scholar_lookup?" onclick="javascript:window.open('https://scholar.google.com/scholar_lookup?');return false">Google Scholar</a></li> </ul> </div> </div> <div id="R5" class="article-references__item js-article-reference">5. Grant J. Learning needs assessment: assessing the need. BMJ 2002;324:156–159.<div> <ul class="article-references__item-links"> <li class="internal-links"><a href="#JCL-P-14"> Cited Here</a> | </li> <li><a href="https://scholar.google.com/scholar_lookup?title=Learning+needs+assessment%3a+assessing+the+need&publication_year=2002&author=J+Grant" onclick="javascript:window.open('https://scholar.google.com/scholar_lookup?title=Learning+needs+assessment%3a+assessing+the+need&publication_year=2002&author=J+Grant');return false">Google Scholar</a></li> </ul> </div> </div> <div id="R6" class="article-references__item js-article-reference">6. Hanrahan JG, Sideris M, Pasha T, et al. Postgraduate assessment approaches across surgical specialties: a systematic review of the published evidence. Acad Med 2021;96:285–295.<div> <ul class="article-references__item-links"> <li class="internal-links"><a href="#JCL-P-14"> Cited Here</a> | </li> <li><a href="https://scholar.google.com/scholar_lookup?title=Postgraduate+assessment+approaches+across+surgical+specialties%3a+a+systematic+review+of+the+published+evidence&publication_year=2021&author=JG+Hanrahan&author=M+Sideris&author=T+Pasha" onclick="javascript:window.open('https://scholar.google.com/scholar_lookup?title=Postgraduate+assessment+approaches+across+surgical+specialties%3a+a+systematic+review+of+the+published+evidence&publication_year=2021&author=JG+Hanrahan&author=M+Sideris&author=T+Pasha');return false">Google Scholar</a></li> </ul> </div> </div> <div id="R7" class="article-references__item js-article-reference">7. Mathew G, Agha R, Albrecht J, et al; for the STROCSS Group. STROCSS 2021: strengthening the reporting of cohort, cross-sectional and case-control studies in surgery. Int J Surg 2021;96:106165.<div> <ul class="article-references__item-links"> <li class="internal-links"><a href="#JCL-P-23"> Cited Here</a> | </li> <li><a href="https://scholar.google.com/scholar_lookup?title=STROCSS+2021%3a+strengthening+the+reporting+of+cohort%2c+cross-sectional+and+case-control+studies+in+surgery&publication_year=2021&author=G+Mathew&author=R+Agha&author=J+Albrecht" onclick="javascript:window.open('https://scholar.google.com/scholar_lookup?title=STROCSS+2021%3a+strengthening+the+reporting+of+cohort%2c+cross-sectional+and+case-control+studies+in+surgery&publication_year=2021&author=G+Mathew&author=R+Agha&author=J+Albrecht');return false">Google Scholar</a></li> </ul> </div> </div> <div id="R8" class="article-references__item js-article-reference">8. Accreditation Council for Continuing Medical Education (ACCME) “learn well”, Menu of criteria for Accreditation with Commendation Transition Report.<span><a href="https://www.accme.org/sites/default/files/2020-08/859_20200811_Menu_of_Criteria_for_Accreditation_with_Commendation_Transition_Report.pdf" onclick="javascript:window.open('https://www.accme.org/sites/default/files/2020-08/859_20200811_Menu_of_Criteria_for_Accreditation_with_Commendation_Transition_Report.pdf');return false">https://www.accme.org/sites/default/files/2020-08/859_20200811_Menu_of_Criteria_for_Accreditation_with_Commendation_Transition_Report.pdf</a></span><div> <ul class="article-references__item-links"> <li class="internal-links"><a href="#JCL-P-46"> Cited Here</a> | </li> <li><a href="https://scholar.google.com/scholar_lookup?" onclick="javascript:window.open('https://scholar.google.com/scholar_lookup?');return false">Google Scholar</a></li> </ul> </div> </div> <div id="R9" class="article-references__item js-article-reference">9. Oliver Daly J. Harmonisation of research outcomes for meaningful translation to practice: the role of Core Outcome Sets and the CROWN Initiative. Aust N Z J Obstet Gynaecol 2018;58:15–16.<div> <ul class="article-references__item-links"> <li class="internal-links"><a href="#JCL-P-50"> Cited Here</a> | </li> <li><a href="https://scholar.google.com/scholar_lookup?title=Harmonisation+of+research+outcomes+for+meaningful+translation+to+practice%3a+the+role+of+Core+Outcome+Sets+and+the+CROWN+Initiative&publication_year=2018&author=J+Oliver+Daly" onclick="javascript:window.open('https://scholar.google.com/scholar_lookup?title=Harmonisation+of+research+outcomes+for+meaningful+translation+to+practice%3a+the+role+of+Core+Outcome+Sets+and+the+CROWN+Initiative&publication_year=2018&author=J+Oliver+Daly');return false">Google Scholar</a></li> </ul> </div> </div> <div id="R10" class="article-references__item js-article-reference">10. Sideris M, Papalois V, Athanasiou T, et al. A novel multi-faceted course blueprint to support outcome-based holistic surgical education: the integrated generation 4 model (iG4). In Vivo 2020;34:503–509.<div> <ul class="article-references__item-links"> <li class="internal-links"><a href="#JCL-P-52"> Cited Here</a> | </li> <li><a href="https://scholar.google.com/scholar_lookup?title=A+novel+multi-faceted+course+blueprint+to+support+outcome-based+holistic+surgical+education%3a+the+integrated+generation+4+model+(iG4)&publication_year=2020&author=M+Sideris&author=V+Papalois&author=T+Athanasiou" onclick="javascript:window.open('https://scholar.google.com/scholar_lookup?title=A+novel+multi-faceted+course+blueprint+to+support+outcome-based+holistic+surgical+education%3a+the+integrated+generation+4+model+(iG4)&publication_year=2020&author=M+Sideris&author=V+Papalois&author=T+Athanasiou');return false">Google Scholar</a></li> </ul> </div> </div> <div id="R11" class="article-references__item js-article-reference">11. Theodoulou I, Sideris M, Lawal K, et al. Retrospective qualitative study evaluating the application of IG4 curriculum: an adaptable concept for holistic surgical education. BMJ Open 2020;10:e033181.<div> <ul class="article-references__item-links"> <li class="internal-links"><a href="#JCL-P-52"> Cited Here</a> | </li> <li><a href="https://scholar.google.com/scholar_lookup?title=Retrospective+qualitative+study+evaluating+the+application+of+IG4+curriculum%3a+an+adaptable+concept+for+holistic+surgical+education&publication_year=2020&author=I+Theodoulou&author=M+Sideris&author=K+Lawal" onclick="javascript:window.open('https://scholar.google.com/scholar_lookup?title=Retrospective+qualitative+study+evaluating+the+application+of+IG4+curriculum%3a+an+adaptable+concept+for+holistic+surgical+education&publication_year=2020&author=I+Theodoulou&author=M+Sideris&author=K+Lawal');return false">Google Scholar</a></li> </ul> </div> </div> <div class="article-references__button-container"></div></section><div><strong>Keywords:</strong><p id="">continuous medical education; continuous professional development; European Accreditation Council for Continuous Medical Education; European Union of Medical Specialists</p> </div><section class="ej-article-copyright">Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.</section></div><button class="ejp-toggle-fulltext-button js-ejp-toggle-fulltext-button">View full article text</button></article> </div> </div> <div id="article-metrics"> <div id="article-metrics-container"> </div> </div> <div id="ctl00_ctl29_g_a3e22abe_1c71_45a4_806e_a91a83e1cfae_ctl00_divOutlineHTML"></div> <script data-cfasync="false" src="/cdn-cgi/scripts/5c5dd728/cloudflare-static/email-decode.min.js"></script><script type="text/javascript" src="https://lww.com/_layouts/15/1033/Scripts/wk/SlideShowPopup.js?v=05.24.00.023" defer="true"> </script> <script type="text/javascript" src="https://lww.com/_layouts/15/1033/Scripts/wk/zoom.js?v=05.24.00.023" defer="true"> </script> <script> var sample = 6; var smPos = 153; var spPos = 153; var sW; var sH; var articleImageDialogModal = $('#ArticleImageDialogModal'); function setImage(imageUrl) { var $container = $("#zoom_container"); var width = $container.width(); $container.z("destroy") .css("background-image", "url(/_layouts/1033/images/oaks.journals/preloader.gif)") .z({ width: width, image_url: imageUrl, responsive: true, responsive_maintain_ratio: true, max_WIDTH: '1200', max_HEIGHT: '1200', initial_ZOOM: 100, initial_POSITION: '0,0' }); return false; } </script> <div id="ArticleImageModal" class="wk-modal wk-modal-slideshow horizontally-centered large fixed-vertical ejp-modal" role="dialog" style="display: none;"> <div class="modal-dialog"> <section class="modal-content wk-modal-content wk-modal-slideshow__content"> <header class="wk-modal-header ejp-modal-header"> <button onclick="return displaySlideShowModal(false);" aria-label="close dialog" class="wk-button-icon wk-modal-close ejp-modal-close" data-dismiss="wk-modal"><i class="fa fa-times"></i></button> </header> <div class="modal-body wk-modal-body wk-modal-slideshow__body flex flex-column"> <div id="zoom_container" class="wk-modal-slideshow__zoom-container"></div> <div id="ZoomContainerDetails" class="wk-modal-slideshow__zoom-container-details pa3"> <h3> <div class="wk-modal-slideshow__title"></div> </h3> <div class="wk-modal-slideshow__description"></div> <h4>Source</h4> <div class="wk-modal-slideshow__source-article mb4"> <a href="javascript:void(0);" id="ctl00_ctl29_g_a3e22abe_1c71_45a4_806e_a91a83e1cfae_ctl00_slideShowUserControl_sourceArticleUrl" onclick="HideSlideShow();">The UEMS experience in continuous medical education accreditation process: a ‘quo vadis’ analysis of our global database</a> </div> <div id="ctl00_ctl29_g_a3e22abe_1c71_45a4_806e_a91a83e1cfae_ctl00_slideShowUserControl_citationdiv" class="wk-modal-slideshow__source-citation mb4"> Annals of Medicine and Surgery86(2):689-696, February 2024. </div> </div> </div> <div class="modal-footer wk-modal-footer wk-modal-slideshow__footer pa2 flex flex-column flex-wrap"> <div class="wk-modal-slideshow__zoom-controls flex justify-between items-center mb2"> <div id="zoom_buttons" class="wk-modal-slideshow__zoom-buttons flex justify-between"> <a href="#" onmousedown="$('#zoom_container').z('zoomIn')" onclick="return false" title="Zoom In" class="ph3"><i class="fa fa-plus-square white"></i></a> <a href="#" onmousedown="$('#zoom_container').z('zoomOut')" onclick="return false" title="Zoom Out" class="ph3"><i class="fa fa-minus-square white"></i></a> </div> <div class="wk-modal-slideshow__list-pager flex pr3"> <a href="javascript:void(0);" onclick="MovePrevious();" id="anchorPrev" title="Previous"><i class="fa fa-arrow-circle-left white"></i></a> <span id="ctl00_ctl29_g_a3e22abe_1c71_45a4_806e_a91a83e1cfae_ctl00_slideShowUserControl_imageCountStatus" class="wk-modal-slideshow__list-pager-text mh3 tc white"></span> <a href="javascript:void(0);" onclick="MoveNext();" id="anchorNext" title="Next"><i class="fa fa-arrow-circle-right white"></i></a> </div> </div> <ul class="wk-modal-slideshow__action-controls flex justify-between"> <li class="pv2 ph3"> <a href="javascript:void(0);" onclick="ShowFullSize('01845215-202402000-00010');" class="white tc"> <i class="fa fa-arrows-alt mb2 db white"></i> <span class="wk-modal-slideshow__action-controls-text">Full-Size</span> </a> </li> <li id="ctl00_ctl29_g_a3e22abe_1c71_45a4_806e_a91a83e1cfae_ctl00_slideShowUserControl_lnkEmailToColleague" class="pv2 ph3"> <a href="javascript:void(0);" onclick="slideShow_EmailLinkClicked(imageIndex);" class="white tc"> <i class="fa fa-envelope mb2 db white"></i> <span class="wk-modal-slideshow__action-controls-text">Email</span> </a> </li> <li id="ctl00_ctl29_g_a3e22abe_1c71_45a4_806e_a91a83e1cfae_ctl00_slideShowUserControl_lnkFavorites" class="pv2 ph3"> <button class="user-menu__link user-menu__link--add-to-favorites js-ejp-login-btn white tc" type="button" data-config="{"eventName":"AddToFavoritesFromSlideShow","eventDetail":{"items":["Image|annals-of-medicine-and-surgery:2024:02000:00010|{0}|"],"an":"01845215-202402000-00010"},"eventOptions":{"bubbles":true,"cancelable":true,"composed":false},"loginDetail":{"isLoginOptional":false,"promptLogin":true,"loginPromptText":"To save this item, login or register"},"isNull":false}"> <i class="fa fa-folder mb2 db white"></i> <span class="wk-modal-slideshow__action-controls-text">+ Favorites</span> </button> </li> <li class="pv2 ph3"> <button class="user-menu__link user-menu__link--ppt-download js-ejp-login-btn" type="button" data-config="{"eventName":"PPTDownload","eventDetail":{"url":"https://journals.lww.com:443/annals-of-medicine-and-surgery/fulltext/2024/02000/the_uems_experience_in_continuous_medical.10.aspx?Ppt=Article|annals-of-medicine-and-surgery:2024:02000:00010|10.1097/ms9.0000000000001583|","gating":false},"eventOptions":{"bubbles":true,"cancelable":true,"composed":false},"loginDetail":{"isLoginOptional":true,"promptLogin":false},"isNull":false}"> <i class="fa fa-file-powerpoint-o mb2 db white"></i> <span class="wk-modal-slideshow__action-controls-text">Export</span> </button> </li> <li class="wk-modal-slideshow__view-gallery pv2 ph3"> <a href="javascript:void(0);" id="ctl00_ctl29_g_a3e22abe_1c71_45a4_806e_a91a83e1cfae_ctl00_slideShowUserControl_imageGalleryUrl" class="white tc" onclick="slideShow_NavigateToUrl('/annals-of-medicine-and-surgery/pages/imagegallery.aspx?year=2024&issue=02000&article=00010')"> <i class="fa fa-th-large mb2 db white"></i> <span class="wk-modal-slideshow__action-controls-text">View in Gallery</span> </a> </li> </ul> </div> </section> </div> </div> <input type="hidden" name="ctl00$ctl29$g_a3e22abe_1c71_45a4_806e_a91a83e1cfae$ctl00$slideShowUserControl$callShowImage" id="ctl00_ctl29_g_a3e22abe_1c71_45a4_806e_a91a83e1cfae_ctl00_slideShowUserControl_callShowImage" /> <input type="hidden" name="ctl00$ctl29$g_a3e22abe_1c71_45a4_806e_a91a83e1cfae$ctl00$slideShowUserControl$popupImageId" id="ctl00_ctl29_g_a3e22abe_1c71_45a4_806e_a91a83e1cfae_ctl00_slideShowUserControl_popupImageId" value="F1" /> <input type="hidden" name="ctl00$ctl29$g_a3e22abe_1c71_45a4_806e_a91a83e1cfae$ctl00$slideShowUserControl$IsExportToPPT" id="ctl00_ctl29_g_a3e22abe_1c71_45a4_806e_a91a83e1cfae_ctl00_slideShowUserControl_IsExportToPPT" value="false" /> <input type="hidden" name="ctl00$ctl29$g_a3e22abe_1c71_45a4_806e_a91a83e1cfae$ctl00$slideShowUserControl$keyword" id="ctl00_ctl29_g_a3e22abe_1c71_45a4_806e_a91a83e1cfae_ctl00_slideShowUserControl_keyword" /> <input type="hidden" name="ctl00$ctl29$g_a3e22abe_1c71_45a4_806e_a91a83e1cfae$ctl00$slideShowUserControl$image_url" id="ctl00_ctl29_g_a3e22abe_1c71_45a4_806e_a91a83e1cfae_ctl00_slideShowUserControl_image_url" /> <input type="hidden" name="ctl00$ctl29$g_a3e22abe_1c71_45a4_806e_a91a83e1cfae$ctl00$slideShowUserControl$image_description" id="ctl00_ctl29_g_a3e22abe_1c71_45a4_806e_a91a83e1cfae_ctl00_slideShowUserControl_image_description" /> <input type="hidden" name="ctl00$ctl29$g_a3e22abe_1c71_45a4_806e_a91a83e1cfae$ctl00$slideShowUserControl$image_sourceTitle" id="ctl00_ctl29_g_a3e22abe_1c71_45a4_806e_a91a83e1cfae_ctl00_slideShowUserControl_image_sourceTitle" /> <input type="hidden" name="ctl00$ctl29$g_a3e22abe_1c71_45a4_806e_a91a83e1cfae$ctl00$slideShowUserControl$image_sourceUrl" id="ctl00_ctl29_g_a3e22abe_1c71_45a4_806e_a91a83e1cfae_ctl00_slideShowUserControl_image_sourceUrl" /> <input type="hidden" name="ctl00$ctl29$g_a3e22abe_1c71_45a4_806e_a91a83e1cfae$ctl00$slideShowUserControl$image_sourceInfo" id="ctl00_ctl29_g_a3e22abe_1c71_45a4_806e_a91a83e1cfae_ctl00_slideShowUserControl_image_sourceInfo" /> <input type="hidden" name="ctl00$ctl29$g_a3e22abe_1c71_45a4_806e_a91a83e1cfae$ctl00$slideShowUserControl$image_key" id="ctl00_ctl29_g_a3e22abe_1c71_45a4_806e_a91a83e1cfae_ctl00_slideShowUserControl_image_key" /> <input type="hidden" name="ctl00$ctl29$g_a3e22abe_1c71_45a4_806e_a91a83e1cfae$ctl00$slideShowUserControl$image_fullSizeUrl" id="ctl00_ctl29_g_a3e22abe_1c71_45a4_806e_a91a83e1cfae_ctl00_slideShowUserControl_image_fullSizeUrl" /> <input type="hidden" name="ctl00$ctl29$g_a3e22abe_1c71_45a4_806e_a91a83e1cfae$ctl00$slideShowUserControl$image_imageGalleryUrl" id="ctl00_ctl29_g_a3e22abe_1c71_45a4_806e_a91a83e1cfae_ctl00_slideShowUserControl_image_imageGalleryUrl" /> <input type="hidden" id="NoOfImages" name="NoOfImages" value="3" /> <script type="text/javascript" src="https://lww.com/_layouts/15/1033/Scripts/wk/EmailToColleague.js?v=05.24.00.023" defer="true"> </script> <a id="ctl00_ctl29_g_a3e22abe_1c71_45a4_806e_a91a83e1cfae_ctl00_emailToColleague_hypEmailToColleague" href="javascript:" style="display:none;"></a> <div id="ctl00_ctl29_g_a3e22abe_1c71_45a4_806e_a91a83e1cfae_ctl00_emailToColleague_pnlEmailToColleague" class="wk-modal-table" style="display: none"> <div class="wk-modal-cell"> <div id="ej-box-modal-drop-shadow" class="wk-modal horizontally-centered small wk-modal-with-overlay wk-modal-small ejp-modal email-to-colleague" tabindex="-1" role="dialog" style="position: static;"> <div id="ctl00_ctl29_g_a3e22abe_1c71_45a4_806e_a91a83e1cfae_ctl00_emailToColleague_pnlMain" class="js-main-panel" onkeypress="javascript:return WebForm_FireDefaultButton(event, 'ctl00_ctl29_g_a3e22abe_1c71_45a4_806e_a91a83e1cfae_ctl00_emailToColleague_btnSend')"> <section class="wk-modal-content"> <header class="wk-modal-header ejp-modal-header"> <div class="wk-modal-title ejp-modal-title"> <strong> <span id="ctl00_ctl29_g_a3e22abe_1c71_45a4_806e_a91a83e1cfae_ctl00_emailToColleague_lblEmailToColleague">Email to Colleague</span></strong> </div> <button aria-label="close dialog" class="primary-button wk-button-icon wk-modal-close ejp-modal-close js-close "> <i class="fa fa-times"></i> </button> </header> <div class="wk-modal-body"> <div class="wk-field-item"> <div class="wk-field-header"> <div id="ctl00_ctl29_g_a3e22abe_1c71_45a4_806e_a91a83e1cfae_ctl00_emailToColleague_divErrorMessage" class="js-error-message-div ej-error-message-panel" style="display: none; color: red; font-style: italic"> <p class="ej-error-message-icon"> <span id="ctl00_ctl29_g_a3e22abe_1c71_45a4_806e_a91a83e1cfae_ctl00_emailToColleague_lblErrorMessage" class="js-error-message-label">Colleague's E-mail is Invalid</span> </p> </div> </div> </div> <div class="wk-field-item"> <div class="wk-field-header"> Your Name: </div> <div class="wk-field-body"> <input name="ctl00$ctl29$g_a3e22abe_1c71_45a4_806e_a91a83e1cfae$ctl00$emailToColleague$txtYourName" type="text" id="ctl00_ctl29_g_a3e22abe_1c71_45a4_806e_a91a83e1cfae_ctl00_emailToColleague_txtYourName" class="js-name" /> </div> </div> <div class="wk-field-item"> <div class="wk-field-header"> <span id="ctl00_ctl29_g_a3e22abe_1c71_45a4_806e_a91a83e1cfae_ctl00_emailToColleague_lblColleaguesEmail" class="js-collegaues-email-lbl">Colleague's Email:</span> </div> <div class="wk-field-body no-bottom-margin"> <input name="ctl00$ctl29$g_a3e22abe_1c71_45a4_806e_a91a83e1cfae$ctl00$emailToColleague$txtColleaguesEmail" type="text" id="ctl00_ctl29_g_a3e22abe_1c71_45a4_806e_a91a83e1cfae_ctl00_emailToColleague_txtColleaguesEmail" class="js-collegaues-email" /> </div> <div class="wk-field-header"><span class="ej-form-comments">Separate multiple e-mails with a (;).</span></div> </div> <div class="wk-field-item"> <div class="wk-field-header"> Message: </div> <div class="wk-field-body"> <textarea name="ctl00$ctl29$g_a3e22abe_1c71_45a4_806e_a91a83e1cfae$ctl00$emailToColleague$txtMessage" rows="2" cols="20" id="ctl00_ctl29_g_a3e22abe_1c71_45a4_806e_a91a83e1cfae_ctl00_emailToColleague_txtMessage" class="js-message"> Thought you might appreciate this item(s) I saw in Annals of Medicine and Surgery.</textarea> </div> </div> <div class="wk-button-bar"> <div class="wk-button-group-left"> <input type="submit" name="ctl00$ctl29$g_a3e22abe_1c71_45a4_806e_a91a83e1cfae$ctl00$emailToColleague$btnSend" value="Send" id="ctl00_ctl29_g_a3e22abe_1c71_45a4_806e_a91a83e1cfae_ctl00_emailToColleague_btnSend" class="js-send-button primary-button grecaptcha-email-colleague-a0d20e854d844ae7a4c969b49915d817" /> <input type="button" value="Cancel" id="btnCancel" class="secondary-button js-close" /> </div> </div> <div class="wk-field-item wk-email-colleague-captcha-bar"> <div class="wk-field-body"> <div id="div-recaptcha-a0d20e854d844ae7a4c969b49915d817" class="div-recaptcha-container" data-uniqueclassidentifier="grecaptcha-email-colleague-a0d20e854d844ae7a4c969b49915d817" data-sitekey="6LeeoSAUAAAAACFv8yNuINPv8IWyXHJ6uN447qEK" data-callback="ctl00_ctl29_g_a3e22abe_1c71_45a4_806e_a91a83e1cfae_ctl00_emailToColleague_captchaCallBack" data-badge="inline" data-size="invisible" data-type="image" > </div> </div> </div> </div> </section> </div> <div id="ctl00_ctl29_g_a3e22abe_1c71_45a4_806e_a91a83e1cfae_ctl00_emailToColleague_pnlSuccessMessage" class="js-success-message-panel" style="display: none;"> <section class="wk-modal-content"> <header class="wk-modal-header ejp-modal-header"> <div class="wk-modal-title ejp-modal-title"></div> <button aria-label="close dialog" class="primary-button wk-button-icon wk-modal-close ejp-modal-close js-close "><i class="fa fa-times"></i></button> </header> <div class="wk-modal-body"> <div class="wk-field-item"> <br /> <p> <span id="ctl00_ctl29_g_a3e22abe_1c71_45a4_806e_a91a83e1cfae_ctl00_emailToColleague_lblMessageSent">Your message has been successfully sent to your colleague.</span> </p> <br /> </div> <div class="wk-button-bar"> <div class="wk-button-group-left"> <input type="button" value="Close Window" id="btnClose" class="primary-button js-close" /> </div> </div> </div> </section> </div> <div id="ctl00_ctl29_g_a3e22abe_1c71_45a4_806e_a91a83e1cfae_ctl00_emailToColleague_pnlErrorMessage" class="js-error-message-panel" style="display: none;"> <section class="wk-modal-content"> <header class="wk-modal-header ejp-modal-header"> <div class="wk-modal-title ejp-modal-title"></div> <button aria-label="close dialog" class="primary-button wk-button-icon wk-modal-close ejp-modal-close js-close "><i class="fa fa-times"></i></button> </header> <div class="wk-modal-body"> <br /> <div class="wk-field-item"> <span id="ctl00_ctl29_g_a3e22abe_1c71_45a4_806e_a91a83e1cfae_ctl00_emailToColleague_lblInvalidEmail" style="color:Red;">Some error has occurred while processing your request. Please try after some time.</span> </div> <br /> <div class="wk-button-bar"> <div class="wk-button-group-left"> <input type="button" value="Close Window" id="btnEClose" class="primary-button js-close" /> </div> </div> </div> </section> </div> </div> <input type="hidden" name="ctl00$ctl29$g_a3e22abe_1c71_45a4_806e_a91a83e1cfae$ctl00$emailToColleague$hiddenEmailToColleague" id="ctl00_ctl29_g_a3e22abe_1c71_45a4_806e_a91a83e1cfae_ctl00_emailToColleague_hiddenEmailToColleague" /> <input type="hidden" name="ctl00$ctl29$g_a3e22abe_1c71_45a4_806e_a91a83e1cfae$ctl00$emailToColleague$hiddenIsUser" id="ctl00_ctl29_g_a3e22abe_1c71_45a4_806e_a91a83e1cfae_ctl00_emailToColleague_hiddenIsUser" /> </div> </div> <script type="text/javascript"> window.emailToColleaguePopups = window.emailToColleaguePopups || []; var ctl00_ctl29_g_a3e22abe_1c71_45a4_806e_a91a83e1cfae_ctl00_emailToColleague_captchaCallBack = function () { ejpAnalytics.track('emailColleaguereCAPTCHA'); ejpAnalytics.track('emailColleagueComplete'); __doPostBack('ctl00$ctl29$g_a3e22abe_1c71_45a4_806e_a91a83e1cfae$ctl00$emailToColleague$btnSend','') }; var initEmailToColleaguectl00_ctl29_g_a3e22abe_1c71_45a4_806e_a91a83e1cfae_ctl00_emailToColleague = function () { window.emailToColleaguePopups['ctl00_ctl29_g_a3e22abe_1c71_45a4_806e_a91a83e1cfae_ctl00_emailToColleague'] = new EmailToColleagueComponent('ctl00_ctl29_g_a3e22abe_1c71_45a4_806e_a91a83e1cfae_ctl00_emailToColleague_pnlEmailToColleague', 'div-recaptcha-a0d20e854d844ae7a4c969b49915d817', 'grecaptcha-email-colleague-a0d20e854d844ae7a4c969b49915d817', 'emailToColleaguePopupExtender_1175489550', 'ctl00_ctl29_g_a3e22abe_1c71_45a4_806e_a91a83e1cfae_ctl00_emailToColleague_hiddenEmailToColleague', 'ctl00_ctl29_g_a3e22abe_1c71_45a4_806e_a91a83e1cfae_ctl00_emailToColleague_hiddenIsUser', '01845215-202402000-00010' ); } Sys.WebForms.PageRequestManager.getInstance().add_pageLoaded(initEmailToColleaguectl00_ctl29_g_a3e22abe_1c71_45a4_806e_a91a83e1cfae_ctl00_emailToColleague); </script> <input type="hidden" id="selectedItems" name="selectedItems" value="" /> </div><div class="ms-clear"></div></div> </div> </div> </div></div> <div id="ctl00_PlaceHolderMain_ResponsivePageLayoutRenderer_ResponsiveLayoutRowRepeater_ctl01_ResponsiveLayoutColumnRepeater_ctl01_ResponsiveLayoutColumn" class=" wk-column-12 wk-column-4-m wk-column-4-l wk-column-4-xl wk-column-4-xxl"> <div class="ms-webpart-zone ms-fullWidth"> <div id="MSOZoneCell_WebPartWPQ1" class="s4-wpcell-plain ms-webpartzone-cell ms-webpart-cell-vertical-inline-table ms-webpart-cell-vertical ms-fullWidth "> <div class="ms-webpart-chrome ms-webpart-chrome-vertical ms-webpart-chrome-fullWidth "> <div WebPartID="9cf8dfb4-1d39-4e08-a5f3-92fb2c43a63f" HasPers="false" id="WebPartWPQ1" width="100%" class="ms-WPBody noindex " allowDelete="false" style="" ><div id="ctl00_ctl29_g_9cf8dfb4_1d39_4e08_a5f3_92fb2c43a63f"> <div id="ctl00_ctl29_g_9cf8dfb4_1d39_4e08_a5f3_92fb2c43a63f_ctl00_adContainer" class="ej-advertisement ej-advertisement-middle"> <div class="ej-advertisement-content"> <div> <div id="ga_312130b3-3105-4f18-90fc-9426a4517018" class="ad-slot-container ad-slot-container-ga_312130b3-3105-4f18-90fc-9426a4517018" data-sizemap="[[[0, 0], [[300, 250]]]]" data-adpath="/15726702761/Desktop/annals-of-medicine-and-surgery/Article/Right" data-autoload="no" data-outofpage="no" data-sticky="no" data-slottargeting='' data-displayslug="yes" data-sticky-duration="0" data-name="Right"></div> </div> </div> </div> </div><div class="ms-clear"></div></div> </div><div class="ms-PartSpacingVertical"></div> </div><div id="MSOZoneCell_WebPartWPQ2" class="s4-wpcell-plain ms-webpartzone-cell ms-webpart-cell-vertical-inline-table ms-webpart-cell-vertical ms-fullWidth "> <div class="ms-webpart-chrome ms-webpart-chrome-vertical ms-webpart-chrome-fullWidth "> <div WebPartID="350d4ae1-64e3-44f9-b007-a09380c212e3" HasPers="false" id="WebPartWPQ2" width="100%" class="ms-WPBody noindex " allowDelete="false" style="" ><div id="ctl00_ctl29_g_350d4ae1_64e3_44f9_b007_a09380c212e3"> <div class="js-advanced-recommendation-widget" data-config="{"serviceUrl":null,"displayMode":"ListView","headerText":"Related Articles","hash":"1","itemsPerPage":6,"renderOnServer":false,"showConsoleLog":false,"shouldShowSpeciality":"0","kind":"Article","title":"The UEMS experience in continuous medical education accreditation process: a ‘quo vadis’ analysis of our global database","meshTerms":["Accreditation","Education, Medical","Database","Needs Assessment","Specialization","European Union","Outcome Assessment, Health Care","Observational Study","Teaching","Educational Status"],"wkmrid":"JOURNAL/amsur/04.03/01845215-202402000-00010/root/v/2024-02-05T191112Z/r/text-xml","imageHandlerUrl":"https://images.journals.lww.com/annals-of-medicine-and-surgery","accessionNumber":"01845215-202402000-00010","fontSize":"small","displayImage":false,"showJournalTitle":false,"showPublicationDate":false}"></div> </div><div class="ms-clear"></div></div> </div><div class="ms-PartSpacingVertical"></div> </div><div id="MSOZoneCell_WebPartWPQ3" class="s4-wpcell-plain ms-webpartzone-cell ms-webpart-cell-vertical-inline-table ms-webpart-cell-vertical ms-fullWidth "> <div class="ms-webpart-chrome ms-webpart-chrome-vertical ms-webpart-chrome-fullWidth "> <div WebPartID="0fbdfe55-803c-48b7-b9c2-4a2f4b8f6435" HasPers="false" id="WebPartWPQ3" width="100%" class="ms-WPBody noindex " allowDelete="false" style="" ><div id="ctl00_ctl29_g_0fbdfe55_803c_48b7_b9c2_4a2f4b8f6435"> <div id="ctl00_ctl29_g_0fbdfe55_803c_48b7_b9c2_4a2f4b8f6435_ctl00_adContainer" class="ej-advertisement ej-advertisement-middle"> <div class="ej-advertisement-content"> <div> <div id="ga_3bd7e313-842c-4cae-97a4-91b7b7f73db5" class="ad-slot-container ad-slot-container-ga_3bd7e313-842c-4cae-97a4-91b7b7f73db5" data-sizemap="[[[0, 0], [[300, 250]]]]" data-adpath="/15726702761/Desktop/annals-of-medicine-and-surgery/Article/Right" data-autoload="no" data-outofpage="no" data-sticky="no" data-slottargeting='' data-displayslug="yes" data-sticky-duration="0" data-name="Right"></div> </div> </div> </div> </div><div class="ms-clear"></div></div> </div><div class="ms-PartSpacingVertical"></div> </div><div id="MSOZoneCell_WebPartWPQ4" class="s4-wpcell-plain ms-webpartzone-cell ms-webpart-cell-vertical-inline-table ms-webpart-cell-vertical ms-fullWidth "> <div class="ms-webpart-chrome ms-webpart-chrome-vertical ms-webpart-chrome-fullWidth "> <div WebPartID="82061bb9-7676-48cd-83d7-d8c5bd3e3945" HasPers="false" id="WebPartWPQ4" width="100%" class="ms-WPBody noindex " allowDelete="false" style="" ><div id="ctl00_ctl29_g_82061bb9_7676_48cd_83d7_d8c5bd3e3945"> <div data-config="{"serviceUrl":null,"displayMode":null,"hash":"1","itemsPerPage":40,"renderOnServer":false}"></div><section id="ctl00_ctl29_g_82061bb9_7676_48cd_83d7_d8c5bd3e3945_ctl01_divRecentActivity" class="content-box cb-collapsible"> <div class="ejp-uc--small"> <header class="ejp-heading-2"> <h2 aria-expanded="false"> Readers Of this Article Also Read </h2> </header> <div id="ej-box-01-body"> <div id="ej-articlesWithTerms"> <ul> <li class="ejp-uc__list-item"> <h3 class='ejp-uc__article-title'><a title href="https://journals.lww.com/annals-of-medicine-and-surgery/fulltext/2024/02000/unplanned_pregnancy_and_risk_of_peripartum.8.aspx" onmouseover="javascript:event.cancelBubble = true;Tooltip_Article('Unplanned pregnancy and risk of peripartum depression: a prospective cohort study in Saudi pregnant women attending antenatal care clinic', 'Alsahafi Imtinan K. MD; Alblady, Eman H. MD; Magliah, Sultan F. MD; Alahmadi, Layan S. MD; Alshareef, Reem J. MD; Binmahfoodh, Dina S. MD; Alsalem, Moayyad S. MD', 'Annals of Medicine and Surgery', 'February 2024', '86', '2' , 'p 666-677');" onmouseout="javascript:Tooltip_MouseOut()" class="ejp-uc__article-title-link">Unplanned pregnancy and risk of peripartum depression: a prospective cohort...</a></h3></li> <li class="ejp-uc__list-item"> <h3 class='ejp-uc__article-title'><a title href="https://journals.lww.com/annals-of-medicine-and-surgery/fulltext/2024/02000/paroxysmal_atrial_fibrillation_and.41.aspx" onmouseover="javascript:event.cancelBubble = true;Tooltip_Article('Paroxysmal atrial fibrillation and hemochromatosis: a narrative review', 'Ahmed Gulzar MBBS; Rathi, Sushma MBBS; Sidhu, Harmandeep K. MD; Muzaffar, Momil MBBS; Wajid, Muhammad H. MBBS; Kumari, Komal MBBS; Fakhor, Hajar MD; Attia, Nada M. MBBCh; Majumder, Koushik MBBS; Kumar, Vikash MD; Tejwaney, Usha PharmD; Ram, Nanik FCPS', 'Annals of Medicine and Surgery', 'February 2024', '86', '2' , 'p 909-919');" onmouseout="javascript:Tooltip_MouseOut()" class="ejp-uc__article-title-link">Paroxysmal atrial fibrillation and hemochromatosis: a narrative review</a></h3></li> <li class="ejp-uc__list-item"> <h3 class='ejp-uc__article-title'><a title href="https://journals.lww.com/annals-of-medicine-and-surgery/fulltext/2024/02000/spontaneous_recurrent_menstrual_pneumothorax__a.69.aspx" onmouseover="javascript:event.cancelBubble = true;Tooltip_Article('Spontaneous recurrent menstrual pneumothorax: a case report', 'Hirono Takae MBBS; Feng, Ye BD; Wang, Wenhui MD; Yu, Huan MD', 'Annals of Medicine and Surgery', 'February 2024', '86', '2' , 'p 1096-1100');" onmouseout="javascript:Tooltip_MouseOut()" class="ejp-uc__article-title-link">Spontaneous recurrent menstrual pneumothorax: a case report</a></h3></li> <li class="ejp-uc__list-item"> <h3 class='ejp-uc__article-title'><a title href="https://journals.lww.com/annals-of-medicine-and-surgery/fulltext/2024/02000/acute_generalized_peritonitis_revealing_an_ovarian.97.aspx" onmouseover="javascript:event.cancelBubble = true;Tooltip_Article('Acute generalized peritonitis revealing an ovarian pregnancy: a case report', 'Boka Tounga Yahouza MD; Soumana Diaouga, Hamidou MD; Moumouni, Soufianou MD; James Didier, Lassey PhD; Rachid, Sani PhD', 'Annals of Medicine and Surgery', 'February 2024', '86', '2' , 'p 1234-1237');" onmouseout="javascript:Tooltip_MouseOut()" class="ejp-uc__article-title-link">Acute generalized peritonitis revealing an ovarian pregnancy: a case report</a></h3></li> <li class="ejp-uc__list-item"> <h3 class='ejp-uc__article-title'><a title href="https://journals.lww.com/annals-of-medicine-and-surgery/fulltext/2024/02000/incidence,_types,_and_associated_factors_of.25.aspx" onmouseover="javascript:event.cancelBubble = true;Tooltip_Article('Incidence, types, and associated factors of external abdominal hernias among adult patients visiting the surgical outpatient department, eastern Ethiopia: a multicentre cross-sectional study', 'Miresa Fufa MD; Abdulhadi, Munewor MD; Aliye, Abdurahman MD; Beyene, Badhaasaa MD; Sileshi, Rahel MSc', 'Annals of Medicine and Surgery', 'February 2024', '86', '2' , 'p 793-799');" onmouseout="javascript:Tooltip_MouseOut()" class="ejp-uc__article-title-link">Incidence, types, and associated factors of external abdominal hernias among...</a></h3></li> </ul> </div> </div> </div> </section> </div><div class="ms-clear"></div></div> </div><div class="ms-PartSpacingVertical"></div> </div><div id="MSOZoneCell_WebPartWPQ5" class="s4-wpcell-plain ms-webpartzone-cell ms-webpart-cell-vertical-inline-table ms-webpart-cell-vertical ms-fullWidth "> <div class="ms-webpart-chrome ms-webpart-chrome-vertical ms-webpart-chrome-fullWidth "> <div WebPartID="21bf5643-bdbf-438c-a763-7bbbc2591aef" HasPers="false" id="WebPartWPQ5" width="100%" class="ms-WPBody noindex " allowDelete="false" style="" ><div id="ctl00_ctl29_g_21bf5643_bdbf_438c_a763_7bbbc2591aef"> <div id="ctl00_ctl29_g_21bf5643_bdbf_438c_a763_7bbbc2591aef_ctl00_adContainer" class="ej-advertisement ej-advertisement-bannercombo"> <div class="ej-advertisement-content"> <div> <div id="ga_510a9023-33b9-4323-be86-443063fd096c" class="ad-slot-container ad-slot-container-ga_510a9023-33b9-4323-be86-443063fd096c" data-sizemap="[[[1050, 200], [[300, 600], [300, 250], [160, 600]]], [[730, 600], [[300, 600], [300, 250]]], [ [ 0, 0 ], [ [300, 250] ] ] ]" data-adpath="/15726702761/Desktop/annals-of-medicine-and-surgery/Article/Right1" data-autoload="no" data-outofpage="no" data-sticky="no" data-slottargeting='' data-displayslug="yes" data-sticky-duration="0" data-name="Right1"></div> </div> </div> </div> </div><div class="ms-clear"></div></div> </div><div class="ms-PartSpacingVertical"></div> </div><div id="MSOZoneCell_WebPartWPQ6" class="s4-wpcell-plain ms-webpartzone-cell ms-webpart-cell-vertical-inline-table ms-webpart-cell-vertical ms-fullWidth "> <div class="ms-webpart-chrome ms-webpart-chrome-vertical ms-webpart-chrome-fullWidth "> <div WebPartID="8a5133b7-8c5c-4644-a4e1-b079af83bdf0" HasPers="false" id="WebPartWPQ6" width="100%" class="ms-WPBody noindex " allowDelete="false" style="" ><div id="ctl00_ctl29_g_8a5133b7_8c5c_4644_a4e1_b079af83bdf0"> <div class="js-ejp-universalMostPopular-webpart" data-config="{"serviceUrl":"https://services.journals.lww.com/IntegrationServices/MostPopularDataService.svc/GetMostPopularItems?timeframe=90d&journalIds=annals-of-medicine-and-surgery&publisher=LWW&results=5&numberOfSymbolsInSubtitle=275&hash=1&displayCustomIndicator=False","headerText":"Most Popular","headerUrl":null,"displayMode":"ListView","hash":"1","shouldShowImage":false,"shouldShowSpeciality":"JournalSpeciality","showArticleDescription":false,"showJournalTitle":false,"viewAllLink":null,"fontSize":"small","showSpecialitySection":false,"showPublicationDate":false,"showIndicators":false}"></div> </div><div class="ms-clear"></div></div> </div> </div> </div></div> </div> </div> <div class="wk-grid-container-no-margin" id="AddRowBottomContainer"> </div> </div> <div style='display:none' id='hidZone'><menu class="ms-hide"> <ie:menuitem id="MSOMenu_Help" iconsrc="/_layouts/15/images/HelpIcon.gif" onmenuclick="MSOWebPartPage_SetNewWindowLocation(MenuWebPart.getAttribute('helpLink'), MenuWebPart.getAttribute('helpMode'))" text="Help" type="option" style="display:none"> </ie:menuitem> </menu></div> </div> <div id="DeltaFormDigest"> <script type="text/javascript">//<![CDATA[ var formDigestElement = document.getElementsByName('__REQUESTDIGEST')[0]; if (!((formDigestElement == null) || (formDigestElement.tagName.toLowerCase() != 'input') || (formDigestElement.type.toLowerCase() != 'hidden') || (formDigestElement.value == null) || (formDigestElement.value.length <= 0))) { formDigestElement.value = '0xB68CD0BDE491981C56DFB0978D0804A9679B7C12A5CBEC31274C7A5CF7F54321266CEA716927CCE017C2AD563DC9852FD8ED13B1BF52DD04B4EE180C46DC24D4,17 Feb 2025 11:16:34 -0000';_spPageContextInfo.updateFormDigestPageLoaded = new Date(); } //]]> </script> </div> </div>  <footer class="ejp-footer"> <div class="container wk-grid-page-container"> <a class="ejp-footer__back-to-top-link"><i class="fa fa-angle-up b ejp-footer__back-to-top-link-icon"></i>Back to Top</a> <div class="ejp-footer__main-content">  <div class="ejp-footer__smart-control-section"> <section class="ejp-footer__smart-control-section-wrapper js-section-alert"> <div class="ejp-footer__smart-control-section-image-container"> <img src="https://images.journals.lww.com/annals-of-medicine-and-surgery/XLargeThumb.01845215-202501000-00000.CV.jpeg" id="ctl00_ctl56_FooterSmartControl_ctl00_imgAlertControl" alt="Current Issue Cover Image" class="" /> </div> <div class="ejp-footer__smart-control-section-text-holder"> <h4 id="ctl00_ctl56_FooterSmartControl_ctl00_headerAlertControl">Never Miss an Issue</h4> <div class="js-section-alert__content"> <span id="ctl00_ctl56_FooterSmartControl_ctl00_spanBodyAlertControl" class="ejp-footer__smart-control-section-info">Get new journal Tables of Contents sent right to your email inbox</span> <input name="ctl00$ctl56$FooterSmartControl$ctl00$userEmailAlertControl" type="text" id="ctl00_ctl56_FooterSmartControl_ctl00_userEmailAlertControl" class="js-section-alert__email" placeholder="Type your email" /> <span class="js-section-alert--error"></span> <button id="ctl00_ctl56_FooterSmartControl_ctl00_buttonAlertControl" type="button" class="js-section-alert__subscribe-button" data-alert-type="Etoc" data-subscribed-msg="You are now subscribed to receive eTOC alerts whenever new issues are published">Get New Issue Alerts</button> </div> </div> </section> <script type="text/javascript"> (function($) { $("#smartWpMostPopularLink").on('click', function() { window.location = "https://journals.lww.com/annals-of-medicine-and-surgery/pages/viewallmostpopulararticles.aspx?WT.mc_id=HPxADx20100319xMP"; }); })(jQuery); </script> </div> <div class="ejp-footer__info-holder"> <div id="ctl00_ctl56_divLeftColumn" class="ejp-footer__info-left-wrapper"> <div class="ejp-footer__info-block"> <h4 class="ejp-footer__info-block-header">Browse Journal Content</h4> <ul class="ejp-footer__info-block-two-col-list"> <li id="ctl00_ctl56_liRegister"><a id="ctl00_ctl56_lnkRegister" href="https://journals.lww.com/annals-of-medicine-and-surgery/pages/register.aspx?ContextUrl=%2fannals-of-medicine-and-surgery%2ffulltext%2f2024%2f02000%2fthe_uems_experience_in_continuous_medical.10.aspx">Register on the website</a></li> </ul> </div> </div> <div id="ctl00_ctl56_divRightColumn" class="ejp-footer__info-right-wrapper"> <div class="ejp-footer__info-block ejp-footer__info-block--custom-service"> <h4 class="ejp-footer__info-block-header">Customer Service</h4> <ul> <li><span class="ejp-footer--show-on-mobile">Contact us at:</span> <ul> <li class="ejp-footer__contacts-wrapper ejp-footer__email-settings"> <div class="ejp-footer--show-on-mobile">Support:</div> <a href="https://www.tfaforms.com/4966570" id="ctl00_ctl56_custSupport" target="_blank">Submit a Service Request</a> </li> <li class="ejp-footer__contacts-wrapper ejp-footer__phone-settings"> <div class="ejp-footer--show-on-mobile ejp-footer__phone-settings--version"> <div id="ctl00_ctl56_telMobileCustom">TEL:</div> </div> <div class="ejp-footer__phone-settings--holder"> <div>800-638-3030 (within the USA)</div> <div>301-223-2300 (outside of the USA)</div> </div> </li> </ul> </li> </ul> <ul><li> <button id="ot-sdk-btn" class="ot-sdk-show-settings ot-ejp-btn" onclick="return false;">Cookie Settings</button> </li> </ul> </div> </div> </div> <span id="ctl00_ctl56_FooterConfiguration" class="js-config-provider" data-config="{"loginConfiguration":{"serviceUrl":"https://services.journals.lww.com/IntegrationServices/AccountService.svc/Login","registerUrl":"https://journals.lww.com/annals-of-medicine-and-surgery/pages/register.aspx?ContextUrl=%2fannals-of-medicine-and-surgery%2ffulltext%2f2024%2f02000%2fthe_uems_experience_in_continuous_medical.10.aspx","forgotPasswordUrl":"https://journals.lww.com/annals-of-medicine-and-surgery/pages/forgotpassword.aspx?ContextUrl=%2fannals-of-medicine-and-surgery%2ffulltext%2f2024%2f02000%2fthe_uems_experience_in_continuous_medical.10.aspx","redirectUrl":"https://journals.lww.com/annals-of-medicine-and-surgery/pages/login.aspx?ContextUrl=%2fannals-of-medicine-and-surgery%2ffulltext%2f2024%2f02000%2fthe_uems_experience_in_continuous_medical.10.aspx","tokenKey":"AppSsoToken","ssoLoginOptions":[],"customerService":{"customerServiceUSPhone":"(800) 638-3030","customerServiceInternationalPhone":"301-223-2300","customerServiceEmail":"customerservice@lww.com"},"useAlternativeAccountLinks":false},"commonConfiguration":{"commonEndpoints":{"addToFavoritesServiceUrl":"https://journals.lww.com/annals-of-medicine-and-surgery/_layouts/15/OAKS.Journals/UserCollectionsService.svc/AddToFavorites","saveSearchServiceUrl":"https://journals.lww.com/annals-of-medicine-and-surgery/_layouts/15/OAKS.Journals/UserCollectionsService.svc/SaveSearch","counterDataServiceUrl":"https://journals.lww.com/annals-of-medicine-and-surgery/_layouts/15/OAKS.Journals/DualAccessService.svc/SendCounterDataRequestByAN"},"kaltura":{"partnerId":"1315631","playerId":"52253872","kalturaWidgetUrl":"https://cdnapisec.kaltura.com/p/1315631/embedPlaykitJs/uiconf_id/52253872"},"brightCove":{"brightCoveScriptUrl":"https://players.brightcove.net/2324982687001/HyP0JSARx_default/index.min.js","dataAccount":"2324982687001","dataPlayer":"HyP0JSARx"},"math":{"libUrl":"https://cdn.jsdelivr.net/npm/mathjax@3/es5/tex-mml-chtml.js"},"recoWidget":{"journals":[{"Id":"annals-of-medicine-and-surgery","Version":"04.03","ProductCode":"amsur"}],"pubFilter":{},"clientId":"ejp_v3","libUrl":"https://assets.ovid.com/widget/v3/widget.js"},"sciteBadge":{"libUrl":"https://cdn.scite.ai/badge/scite-badge-latest.min.js"}}}"></span> </div> <div class="ejp-footer__bottom-links"> <ul class="ejp-footer__useful-links"> <li><a id="ctl00_ctl56_hlkPrivacy" href="https://journals.lww.com/annals-of-medicine-and-surgery/_layouts/oaks.journals/privacy.aspx">Privacy Policy</a></li> <li><a id="ctl00_ctl56_hlkLegal" href="https://journals.lww.com/annals-of-medicine-and-surgery/_layouts/oaks.journals/disclaimer.aspx">Legal Disclaimer</a></li> <li><a id="ctl00_ctl56_hlkTermsOfUse" href="https://journals.lww.com/annals-of-medicine-and-surgery/_layouts/oaks.journals/terms.aspx">Terms of Use</a></li> <li><a id="ctl00_ctl56_hlkNIHPublicAccess" href="https://www.wolterskluwer.com/en/solutions/lippincott-journals/lippincott-open-access">Open Access Policy</a></li> <li><a id="ctl00_ctl56_hlkCAPrivacyChoices" href="https://privacyportal-de.onetrust.com/webform/2217e117-526b-4696-8a98-8c402f8f2b81/5b049ba3-0106-4b77-a7da-5d12238c90a4">Your California Privacy Choices</a> <img src="/_layouts/1033/IMAGES/OAKS.Journals/CAPrivacyPolicy.png" id="ctl00_ctl56_imgCAPrivacyPolicyChoices" class="wk-footer__ca-privacy-logo" alt="California Consumer Privacy Act (CCPA) Opt-Out Icon" /> </li> </ul> <ul class="ejp-footer__copyright-block"> <li><span>Copyright © 2025</span></li> <li><a href="https://www.wolterskluwer.com/en/health" target="_blank">Wolters Kluwer Health, Inc. and/or its subsidiaries. All rights reserved.</a></li> </ul> </div> </div> </footer> </div> </div>   <script> $(document).on('click', '.yamm .dropdown-menu', function (e) { e.stopPropagation(); }); </script>   <div id="ctl00_ctl59_adContainer" class="ej-advertisement ejp-advertisement-highimpact js-advertisement-highimpact"> <div class="ej-advertisement-content"> <div> <div id="ga_c5a46e75-aa84-4647-b3d9-b4628dad26ac" class="ad-slot-container ad-slot-container-ga_c5a46e75-aa84-4647-b3d9-b4628dad26ac" data-sizemap="[[[992, 500], [[300, 250]]], [[768, 180], [[728, 90]]], [[0, 0], [[300, 50]]]]" data-adpath="/15726702761/Desktop/annals-of-medicine-and-surgery/HighImpact" data-autoload="yes" data-outofpage="no" data-sticky="yes" data-slottargeting='' data-displayslug="yes" data-sticky-duration="10" data-name="HighImpact"></div> </div> </div> </div>    <script type="text/javascript"> //<![CDATA[ var Page_Validators = new Array(document.getElementById("ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_cvEmailError")); //]]> </script> <script type="text/javascript"> //<![CDATA[ var ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_cvEmailError = document.all ? document.all["ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_cvEmailError"] : document.getElementById("ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_cvEmailError"); ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_cvEmailError.display = "Dynamic"; ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_cvEmailError.validationGroup = "EmailValidationGroup"; ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_cvEmailError.evaluationfunction = "CustomValidatorEvaluateIsValid"; //]]> </script> <script type="text/javascript"> //<![CDATA[ var _spFormDigestRefreshInterval = 1440000;window.SPThemeUtils && SPThemeUtils.ApplyCurrentTheme(true); IsSPSocialSwitchEnabled = function() { return true; };var _fV4UI = true; function _RegisterWebPartPageCUI() { var initInfo = {editable: false,isEditMode: false,allowWebPartAdder: false,listId: "{874e2075-d303-498d-9acf-32c2bcdb863a}",itemId: 58,recycleBinEnabled: true,enableMinorVersioning: false,enableModeration: false,forceCheckout: false,rootFolderUrl: "\u002fannals-of-medicine-and-surgery\u002fPages",itemPermissions:{High:0,Low:200769}}; SP.Ribbon.WebPartComponent.registerWithPageManager(initInfo); var wpcomp = SP.Ribbon.WebPartComponent.get_instance(); var hid; hid = document.getElementById("_wpSelected"); if (hid != null) { var wpid = hid.value; if (wpid.length > 0) { var zc = document.getElementById(wpid); if (zc != null) wpcomp.selectWebPart(zc, false); } } hid = document.getElementById("_wzSelected"); if (hid != null) { var wzid = hid.value; if (wzid.length > 0) { wpcomp.selectWebPartZone(null, wzid); } } }; function __RegisterWebPartPageCUI() { ExecuteOrDelayUntilScriptLoaded(_RegisterWebPartPageCUI, "sp.ribbon.js");} _spBodyOnLoadFunctionNames.push("__RegisterWebPartPageCUI");var __wpmExportWarning='This Web Part Page has been personalized. As a result, one or more Web Part properties may contain confidential information. Make sure the properties contain information that is safe for others to read. After exporting this Web Part, view properties in the Web Part description file (.WebPart) by using a text editor such as Microsoft Notepad.';var __wpmCloseProviderWarning='You are about to close this Web Part. It is currently providing data to other Web Parts, and these connections will be deleted if this Web Part is closed. To close this Web Part, click OK. To keep this Web Part, click Cancel.';var __wpmDeleteWarning='You are about to permanently delete this Web Part. Are you sure you want to do this? To delete this Web Part, click OK. To keep this Web Part, click Cancel.';var lblColleaguesEmail = $get('ctl00_ctl29_g_a3e22abe_1c71_45a4_806e_a91a83e1cfae_ctl00_ucArticleTools_emailToColleagueControl_lblColleaguesEmail'); var Page_ValidationActive = false; if (typeof(ValidatorOnLoad) == "function") { ValidatorOnLoad(); } function ValidatorOnSubmit() { if (Page_ValidationActive) { return ValidatorCommonOnSubmit(); } else { return true; } } //]]> </script> <script type='text/javascript'>SP.SOD.set_prefetch(0);</script> <script type="text/javascript"> //<![CDATA[ WPSC.Init(document); var varPartWPQ1 = WPSC.WebPartPage.Parts.Register('WPQ1','9cf8dfb4-1d39-4e08-a5f3-92fb2c43a63f',document.getElementById('WebPartWPQ1')); var varPartWPQ2 = WPSC.WebPartPage.Parts.Register('WPQ2','350d4ae1-64e3-44f9-b007-a09380c212e3',document.getElementById('WebPartWPQ2')); var varPartWPQ3 = WPSC.WebPartPage.Parts.Register('WPQ3','0fbdfe55-803c-48b7-b9c2-4a2f4b8f6435',document.getElementById('WebPartWPQ3')); var varPartWPQ4 = WPSC.WebPartPage.Parts.Register('WPQ4','82061bb9-7676-48cd-83d7-d8c5bd3e3945',document.getElementById('WebPartWPQ4')); var varPartWPQ5 = WPSC.WebPartPage.Parts.Register('WPQ5','21bf5643-bdbf-438c-a763-7bbbc2591aef',document.getElementById('WebPartWPQ5')); var varPartWPQ6 = WPSC.WebPartPage.Parts.Register('WPQ6','8a5133b7-8c5c-4644-a4e1-b079af83bdf0',document.getElementById('WebPartWPQ6')); WPSC.WebPartPage.WebURL = 'https:\u002f\u002fjournals.lww.com\u002fannals-of-medicine-and-surgery'; WPSC.WebPartPage.WebServerRelativeURL = '\u002fannals-of-medicine-and-surgery'; var g_clientIdDeltaPlaceHolderMain = "DeltaPlaceHolderMain"; var g_clientIdDeltaPlaceHolderUtilityContent = "DeltaPlaceHolderUtilityContent"; WebForm_AutoFocus('ctl00_ctl29_g_a3e22abe_1c71_45a4_806e_a91a83e1cfae_ctl00_emailToColleague_txtYourName');Sys.Application.add_init(function() { $create(AjaxControlToolkit.ModalPopupBehavior, {"BackgroundCssClass":"Popup-Overlay","DropShadow":true,"PopupControlID":"ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_pnlunSubscribeToAlerts","dynamicServicePath":"/annals-of-medicine-and-surgery/pages/articleviewer.aspx","id":"unSubscribeToAlerts"}, null, null, $get("ctl00_ctl51_Header_UserActionTools_ucUnsubscribeToAlertsUserControl_dummyTargetControl")); }); Sys.Application.add_init(function() { $create(AjaxControlToolkit.ModalPopupBehavior, {"BackgroundCssClass":"Popup-Overlay","DropShadow":true,"PopupControlID":"ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_pnlSubscribeToEtoc","dynamicServicePath":"/annals-of-medicine-and-surgery/pages/articleviewer.aspx","id":"subscribeToEtoc"}, null, null, $get("ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_dummyTargetControl")); }); document.getElementById('ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_cvEmailError').dispose = function() { Array.remove(Page_Validators, document.getElementById('ctl00_ctl51_Header_UserActionTools_SubscribeToEtocPopupControl_cvEmailError')); } g_QuickLaunchControlIds.push("zz1_TopNavigationMenu");_spBodyOnLoadFunctionNames.push('QuickLaunchInitDroppable'); var g_zz1_TopNavigationMenu = null; function init_zz1_TopNavigationMenu() { if (g_zz1_TopNavigationMenu == null) g_zz1_TopNavigationMenu = $create(SP.UI.AspMenu, null, null, null, $get('zz1_TopNavigationMenu')); } if(g_spPreFetchKeys) {{ g_spPreFetchKeys.push('SP.Core.js');}}EnsureScriptFunc('SP.Core.js', 'SP.UI.AspMenu', init_zz1_TopNavigationMenu); Sys.Application.add_init(function() { $create(AjaxControlToolkit.ModalPopupBehavior, {"BackgroundCssClass":"Popup-Overlay","PopupControlID":"ctl00_ctl29_g_a3e22abe_1c71_45a4_806e_a91a83e1cfae_ctl00_ucArticleTools_emailToColleagueControl_pnlEmailToColleague","dynamicServicePath":"/annals-of-medicine-and-surgery/pages/articleviewer.aspx","id":"emailToColleaguePopupExtender__76606239"}, null, null, $get("ctl00_ctl29_g_a3e22abe_1c71_45a4_806e_a91a83e1cfae_ctl00_ucArticleTools_emailToColleagueControl_hypEmailToColleague")); }); Sys.Application.add_init(function() { $create(AjaxControlToolkit.ModalPopupBehavior, {"BackgroundCssClass":"Popup-Overlay","PopupControlID":"ctl00_ctl29_g_a3e22abe_1c71_45a4_806e_a91a83e1cfae_ctl00_ucArticleTools_exportToCitationManager_pnlExportTo","dynamicServicePath":"/annals-of-medicine-and-surgery/pages/articleviewer.aspx","id":"OpenExportToPopupExtender_292447296"}, null, null, $get("ctl00_ctl29_g_a3e22abe_1c71_45a4_806e_a91a83e1cfae_ctl00_ucArticleTools_exportToCitationManager_hypExportToCitationManager")); }); Sys.Application.add_init(function() { $create(AjaxControlToolkit.ModalPopupBehavior, {"BackgroundCssClass":"Popup-Overlay","PopupControlID":"ctl00_ctl29_g_a3e22abe_1c71_45a4_806e_a91a83e1cfae_ctl00_emailToColleague_pnlEmailToColleague","dynamicServicePath":"/annals-of-medicine-and-surgery/pages/articleviewer.aspx","id":"emailToColleaguePopupExtender_1175489550"}, null, null, $get("ctl00_ctl29_g_a3e22abe_1c71_45a4_806e_a91a83e1cfae_ctl00_emailToColleague_hypEmailToColleague")); }); //]]> </script> </form> <span id="DeltaPlaceHolderUtilityContent"> </span> <script type="text/javascript">// <![CDATA[ var g_Workspace = "s4-workspace"; // ]]> </script> <div id="ctl00_ctl64_divAdConfig" data-adconfig="{"adTitle":"Advertisement","slotClass":"ad-slot-container","topBanner":{"sticky":"false","stickyDuration":"5000"},"lazyLoadingEnabled":false,"npiHash":"","pageTargeting":{"ArticleId":"01845215-202402000-00010"}}" data-videoadconfig="{"serverURL":"https://pubads.g.doubleclick.net/gampad/ads","sizes":"320x180|640x360","overlayUnitPath":"/15726702761/Desktop/annals-of-medicine-and-surgery/Video/overlay","prerollUnitPath":"/15726702761/Desktop/annals-of-medicine-and-surgery/Video/pre-roll","postrollUnitPath":"/15726702761/Desktop/annals-of-medicine-and-surgery/Video/post-roll"}" class="js-ad-config"> </div> <div id="ctl00_ctl64_divScripts"><script type="text/plain" async="async" src="https://securepubads.g.doubleclick.net/tag/js/gpt.js" class="optanon-category-C0004"></script> <script type="text/javascript" src="https://lww.com/_layouts/15/oaks.journals/core/ads.js?v=05.24.00.023" defer="true"> </script> </div>  <script type="text/javascript"> (function($) { if (false) { $(".top-microbar-container").addClass('top-microbar-container-moved').insertAfter(".advertisement-content_top"); } $(function () { if (false) { $( '<div class="top-banner-verify-email">Be sure to check your email to verify your new user account! Thanks!</div>') .insertAfter(".top-microbar-container"); } }); })(jQuery); </script> <script type="text/javascript"> window.twttr = (function(d, s, id) { var js, fjs = d.getElementsByTagName(s)[0], t = window.twttr || {}; if (d.getElementById(id)) return t; js = d.createElement(s); js.id = id; js.src = "https://platform.twitter.com/widgets.js"; fjs.parentNode.insertBefore(js, fjs); t._e = []; t.ready = function(f) { t._e.push(f); }; return t; }(document, "script", "twitter-wjs")); </script> <script type="text/javascript" src="https://lww.com/_layouts/15/oaks.journals/core/ee.js?v=05.24.00.023" defer="true"> </script> <script type="text/javascript"> function OTScriptExecutedEventHandler(e) { if (window.WKTracker && window.TrackingSetup) { window.TrackingSetup.api = window.TrackingSetup.api || {}; window.TrackingSetup.api.baseUrl = 'https://apim-hlrp-ejp-prod.azure-api.net/ee'; window.TrackingSetup.api.log = window.TrackingSetup.api.log || {}; window.TrackingSetup.api.resolve = window.TrackingSetup.api.resolve || {}; window.TrackingSetup.gdpr = window.TrackingSetup.gdpr || {}; window.TrackingSetup.gdpr.cookieUsageConsent = window.cookieUsageConsent || false; window.WKTracker.configure(window.TrackingSetup); window.WKTracker.track(); // Remove the event listener window.removeEventListener('OTScriptExecuted', OTScriptExecutedEventHandler); } } window.addEventListener('OTScriptExecuted', OTScriptExecutedEventHandler); </script> <script>(function(){function c(){var b=a.contentDocument||a.contentWindow.document;if(b){var d=b.createElement('script');d.innerHTML="window.__CF$cv$params={r:'91355daeea62fd10',t:'MTczOTc5MDk5NC4wMDAwMDA='};var a=document.createElement('script');a.nonce='';a.src='/cdn-cgi/challenge-platform/scripts/jsd/main.js';document.getElementsByTagName('head')[0].appendChild(a);";b.getElementsByTagName('head')[0].appendChild(d)}}if(document.body){var a=document.createElement('iframe');a.height=1;a.width=1;a.style.position='absolute';a.style.top=0;a.style.left=0;a.style.border='none';a.style.visibility='hidden';document.body.appendChild(a);if('loading'!==document.readyState)c();else if(window.addEventListener)document.addEventListener('DOMContentLoaded',c);else{var e=document.onreadystatechange||function(){};document.onreadystatechange=function(b){e(b);'loading'!==document.readyState&&(document.onreadystatechange=e,c())}}}})();</script></body> </html>

CINXE.COM

Annals of Medicine and Surgery