The recent publication of a nationwide study on the working hours and rest periods of resident physicians in Spain as a whole [¹] has revealed a disturbing reality. The vast majority of respondents (80.49%) exceed the limit set by national and European regulations for the maximum number of working hours per week (48 hours). In addition, 13% do not rest after a 24-hour on-call shift and almost half of them do not have a day off after a weekend shift.

Previous studies [²] have revealed that the majority of resident physicians do not take breaks after on-call duty due to either an overload of clinical work or a tradition inherited from the department where they are training. Some residents, however, particularly in surgical specialties, consider that an essential reason explaining this overload is the need to acquire clinical and procedural experience within the limited time-frame of residency. This raises an important question: if the current residency time is insufficient to acquire the necessary skills and competencies, should we consider extending it? Nevertheless, it is vital to understand that simply extending training should not result in the perpetuation of inappropriate working conditions.

In recent decades, the specialised healthcare training system in Spain has theoretically been moving towards a competency-based model [³]. An example of this is the publication of programmes providing training in forensic medicine [⁴] or psychiatry [⁵] in which a generic model of training programme is being adopted. In this model a distinction is made between cross-curricular competencies (the same for all specialties) and competencies that are specific to each speciality. However, the change of model has not been as smooth as might have been expected, and there are some notable barriers that have prevented its full implementation.

Firstly, the lack of adequate resources for training has been a constant obstacle [⁶]. Competency-based training requires investment in technology, materials and, most importantly, specialised human resources. Secondly, the role of the tutor – a crucial figure in any competency-based training programme – has not received the necessary recognition and development [⁷]. A well-trained and motivated tutor should guarantee the acquisition of competencies thanks to a process of continuous feedback and supervision. But the same dynamics that promote work overload in residents [⁸] may in fact reduce the tutors' capacity and the time they have available [⁹]. These supervisory and teaching functions are often overshadowed by the pressure and demand of their healthcare duties. Last but not least, there are also cultural dynamics rooted in the system that resist change [²]. We cannot ignore the negative experience of many specialists resulting from the excessive strain imposed upon them during the time they were in training. Unfortunately, some internalise the pernicious system in which they were trained and, instead of seeking to transform it, tend to perpetuate it with the new generations. It is absolutely essential that these generations are afforded justice and redress, which consists in acknowledging the damage done and striving to avoid repeating the same mistakes.

Faced with this multifaceted reality, it is clear that the mere transition to a competency-based training system is not sufficient without addressing the context in which this training takes place. It is vital to recognise that working conditions are not just an add-on: they are the foundation on which the quality of training and, by extension, the quality of healthcare rest. The voices of resident physicians and specialists cannot be ignored. Serious commitment is needed from all the stakeholders in order to undertake meaningful reforms. It is time to begin sincere, in-depth discussions about the training system, in which the well-being of professionals is prioritised, excellence in training is guaranteed, and the times set for training are flexible and suited to the needs of resident physicians.