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FEM: Revista de la Fundación Educación Médica

versión On-line ISSN 2014-9840versión impresa ISSN 2014-9832

FEM (Ed. impresa) vol.20 no.1 Barcelona feb. 2017  Epub 16-Ago-2021 


What do the experts in medical education think about the ruling on the core curriculum?

Arcadi Gual1  , Jordi Palés-Argullós2  , Felipe Rodríguez de Castro3 

1Secretario de SEDEM

2Director de FEM

3Presidente de SEDEM

For some years now – our memory goes back to the 80s and 90s – there have been an endless number of calls justifying the need to modify the system of specialised training to make it more flexible and better adapted to the requirements of the Spanish National Health System (SNS). Little by little this universally desired reform has gradually taken shape with proposals for the need to define common spaces among the different specialties with the idea of not only improving training but also optimising the SNS’s resources. It is not easy to remember when or by whom the term ‘core curriculum’ was first used to refer to all this process, but it was then, in its early stages, when those desired common spaces among specialties became what are now known as ‘core blocks’ (troncos). The term ‘core curriculum’ was officially christened as such in Article 19, section 2 of the Health Professions Regulation Act (LOPS), which states: ‘The specialties in health sciences shall be grouped, whenever appropriate, taking into account a mandatory core curriculum. The specialties within the same core block shall have a common training period with a duration of two years.’

Core blocks lasting two years! How perceptive the lawmaker was to know exactly how long the common spaces among specialties have to be (there are currently 59 of them) without having previously defined their competencies or their training programmes! First mistake.

But let us continue with the sociological thread of the process of the core curriculum. After the first phase, in which those theoretical common spaces were viewed by nearly everyone with a fair amount of enthusiasm, we move on into a second phase in which, following the publication of the LOPS, these common spaces would have to stop being theoretical compositions and become real structures. The general attitude, only made explicit in certain spheres but internalised in the vast majority of them, was clearly transformed and the idea of a core curriculum began to be viewed as a problem and even as a danger. We would dare to say that, in the first decade of this century, the general opinion about the core curriculum in this country could be summed up by the following sentence: ‘a core curriculum is fine for most specialities, but it is not the best thing for my specialty’. That more or less apparent murmur did not go beyond being a rumour during the long period that elapsed between the publication of the LOPS (in 2003) and the Core Curriculum Royal Decree (in 2014). Even if we admit the complexity of the process, eleven years – over a decade! – to launch the core curriculum seems to be an excessive amount of time, in which it is easy to revive rumours and kindle the spurious defence of interests. Second mistake.

But along comes a new decree, RD 639/2014, and it’s time to get down to work. Doing two things at the same time is no easy matter, but juggling with three or more has to be even more difficult. This is exactly the overwhelming task we have been faced with in the last two years: defining the cross-curricular, core and specific competencies; specifying assessment methodologies and making the level of competencies in the specialties comparable to those of our European partners; structuring new teaching units (stress on the word ‘new’) in which not only is it possible to acquire the established competencies but where professionals from different degrees are grouped and will pursue different specialties; training tutors for the core blocks and for the specialties; and many other tasks and modifications that are required by the core curriculum and whose details lie beyond the scope of this editorial.

From the Sociedad Española de Educación Médica (SEDEM) and from the Fundación Educación Médica (FEM) we have already said on a number of different occasions, including the Escuela de Salud Pública in Menorca in the year 2015, that the mandatory core curriculum would transform the SNS. At that time, not only were we told that we were exaggerating, we were even called scaremongers. Today, however, we are more convinced than ever that a change in the training of healthcare professionals that includes the use of new spaces, where the aim is to establish meeting points among specialties and among professions, and in which the patient is seen as the axis of the system, will undoubtedly entail a transformation of the SNS. And now we come to the third and greatest mistake: how is possible that such a substantial change, with direct effects on professionals, the 17 autonomic health systems, scientific societies, professional associations, students and many other social stakeholders, failed to be worked, detailed and agreed in a suitable fashion? The easiest thing would be to point to the Administration as being solely responsible, but it would also be unfair. All the stakeholders are, to a greater or lesser extent, responsible and, consequently, they must all guarantee the success of the project or be held accountable for its failure.

It is surprising, even amusing, that the Administrative Chamber of the Supreme Court (Ruling 2569/ 2016) has declared the RD 639/2014 null due to ‘clear insufficiency’ of the impact analysis report as regards the economic and budgetary impact that that regulation entailed; note, however, that the ruling in no way questions the technical content of the RD. From our point of view the fact that the RD did not include an adequate economic report is irrelevant – although in any case we assume it is necessary. What is clearly cause for concern is the inconsistency of the two parties, who only seem to remember things when it’s already too late. We will not accuse the Central Government, which has enough on its plate with having to deal with the complex situation in which the ruling has left the whole process. And the reason we will not do so is because it would be the easiest and least appropriate thing to do. Nevertheless, we will denounce the fact that an important number of the stakeholders involved have waited to see what happens, irresponsibly placing their trust in ‘luck’. And indeed, for some, the Supreme Court ruling has been ‘luck’, for others ‘relief’ from a problem that was lurking over the horizon, and for many it has meant the opportunity to go on doing the same as usual, because, after all, why should we change something that works?

Scientific societies and professional associations, healthcare authorities (both central and autonomic), public and private healthcare institutions, patients’ associations, faculties of medicine and of health sciences, students… can we not all agree on how to train better professionals? Wasn’t the need to find common spaces for training there staring us in the face? What does our civil society prefer: to help the Administration to solve problems or to put spokes in the wheels?

We will not, of course, claim to be in possession of the truth but a sense of responsibility urges us to assume the voice of experts in medical education. Both the SEDEM and the FEM, in their role as qualified experts, have contributed with all their know-how, they have been at the service of the different parties when required to do so, and they have worked alongside them on specific aspects like defining competencies. But reviewing the training of the professionals working in the health sciences, and consequently the SNS itself, is such a complex task that it requires solid foundations that can only be provided by a multidisciplinary team of experts with responsibilities in different areas of the healthcare sector.

Not everything has been done badly, but the issue does not lie in the training programmes based on competencies, or in the moment when the specialty is chosen, or in how long it lasts, or in the number of core blocks there must be, or in whether the last year of the degree course is the appropriate link with which to accomplish the educational continuum, or whether there are non-core curriculum specialties or not. The problem lies in the foundations of the building. The work needs to be carried out by experts (actively practising professionals, healthcare managers, specialised training tutors, students, healthcare authorities, people from university management and experts in medical education) who are independent, free of any conflicting interests, capable of designing a consistent, solid and balanced project that allows the healthcare authorities to follow a better direction and lay better foundations for the building. It is time to construct and make up for the time lost in this process of reform. Failing to see it in this way and seeking an easy way out of the situation created by the ruling is, as we, specialists in medical education, see it, cause for concern

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