Talking about the core curriculum of the MIR system in Spain means going back to the second half of the eighties when Luis Hernando, then president of the National Council of Specialties, and I, his fortunate secretary, drew up a first draft of the core curriculum decree that was to soon end up gathering dust in some drawer at the Ministry without ever seeing the light of day. Subsequently, from time to time, many of us have dared to speak and write about the matter without anyone reading or listening to us. It was in the middle of the first decade of this century when the issue came to the attention of ministerial officials and the National Council of Specialties and finally accomplished the goal of being published in the form of a decree in the Official State Gazette (in 2014!) after many years of more or less judicious debates. After its publication, the decree was the object of a great deal of, to some extent justified, criticism, some clearly tinged with corporatist interests that come out in the use of the much-hackneyed line of defence focused on ‘and what about me?' Many of us, including myself, told those who wanted to listen that the conceptual and structural approach to the core curriculum project was too rigid, among other things because it established a set of contents and a training period that were the same for all the specialties, regardless of the nature and needs of each one, and some were even left out of this dynamic altogether. If, in addition to this evident rigidity, we add the attacks from various scientific societies and national specialty commissions, there are no prizes for guessing the result: the core curriculum project was doomed to fail and, as in the 1980s, to become part of that forgotten list of unsuccessful ministerial initiatives.

Five years after the failed attempt to implement the core curriculum, the new government, which came to power towards the end of 2018, proposed the drafting of a specialties decree which, apparently, contemplated a more flexible structure of training and the intention of maintaining common cross-cutting skills that all specialists have to acquire. This can offer us some hope, as it would seem that the current heads of the Ministry and of the National Council for Specialities have performed a proper analysis of the mistakes made in the past and are prepared to correct them. We therefore enter what we could call the ‘wait and see' stage.

The core curriculum makes sense insofar as it determines sets of competencies that should be shared, possessed and practised by professionals from different specialities, thereby endowing them with greater cross-cutting potential, balancing an exaggerated tendency towards super-specialisation and making the labour market more flexible. In order to ensure health specialists go about their practice with the highest possible degree of effectiveness and efficiency, their competencies must belong to three perfectly balanced categories: those associated with the profession, those associated with the specialty and those associated with the context.

The first are competencies that could also be called ‘cross-cutting', since they are common to all the branches of the profession, although with different degrees and contents depending on each speciality. To give an exaggerated example, the cross-cutting skills that a pathologist must possess cannot be the same as those of a family doctor. Many – if not all – of the competencies in this group should be acquired during graduate training, whereas certain aspects that can be assimilated more easily and coherently by coming into direct contact with professional practice itself should be left for the postgraduate phase. A much closer integration of the different phases of the training continuum than currently exists could be a valuable aid in this area.

The competencies associated with the specialty are those that form part of its body of doctrine and practice and, therefore, refer directly to the content of the autonomous performance of the profession. Specialties can be classified from numerous perspectives (clinical, laboratory, imaging, medical, surgical, mixed, age and gender, public health, etc.), but a taxonomy capable of encompassing a greater number of them could be based on three essential groups:

Competencies associated with the context must provide the professional with the means to adapt as far as possible to characteristics of that context, whether it is the health system as a whole, its organisation and levels, the type of hospital (high technology, regional, etc.), the population (urban, rural, etc.), demographic, epidemiological, sociocultural and economic characteristics, technological availability and other resources, and so forth. The better the adaptation of competencies to the context is, the easier it will be to optimise the actions carried out by the professional in terms of effectiveness and efficiency.

In my opinion, an ideal design for specialised training should include all the elements outlined above in its construction and, in the case of both cross-cutting and specialty skills, enhance the versatility and adaptability of the professional to the different types of context indicated. That should be the final aim of training, whether it is called the core curriculum or by any other name.

The answer to the question posed in the title of this editorial must be given, from a legal perspective and then in the training programmes, by the heads of the Ministries and of the National Council for Specialities after listening to the opinions of the institutions, centres and experts involved. The mistakes made when designing the core curriculum should not be repeated, although this cannot be completely ruled out. Likewise, we must not neglect the risk of entering a new stage of stagnation and absence of decision making that is as long or longer than the one that preceded and followed the core curriculum decree.