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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.22 no.6 Barcelona dic. 2019  Epub 09-Mar-2020 


16 años de la LOPS y de formación especializada en España: reflexiones sobre el trabajo realizado y los cambios pendientes

16 years of the LOPS and specialised training in Spain: reflections on the work carried out and the changes pending

16 years of the LOPS and specialised training in Spain: reflections on the work carried out and the changes pending

Arcadi Gual1  , Amando Martín-Zurro1  2 

1Patrón de la Fundación Educación Médica

2Vicepresidente de la Fundación Educación Médica

The Health Professions Regulation Act (LOPS) that was passed 16 years ago, in 2003, is the highest ranking legal framework governing specialised health training in Spain. Many proposals for change in this field emerge from its articles, some of which have not yet been implemented or have seen their application thwarted. Royal Decree 639/2014 regulated the core curriculum of specialised training, which is possibly the most important change in the system of resident physicians since its inception, but its effectiveness was cut short in 2016 by the Ruling of 12 December 2016, of the Third Chamber of the Supreme Court, which invalidated it in the absence of the indispensable economic memorandum that must accompany a reform of such depth but could not be drawn up without a specific allocation of resources. This legal decision resulted in all the vast amount of work carried out before and after 2014 by numerous institutions, scientific organisations, professionals and experts being shelved, perhaps forever. It should be remembered that the gestation of the core curriculum decree itself was long and laborious and that an agreement was only reached regarding its content after more than ten years of discussions. As is often the case, nobody was fully satisfied, but this is not a defect: this dissatisfaction is the result of a long negotiation involving the Spanish National Health Specialties Advisory Board (CNECS), the general councils of the health professions, the scientific societies, the Federation of Spanish Scientific Societies of Medical Specialities (FACME), student representatives, trade unions and God knows who else. In a negotiation, all the parties make concessions and it is always better to move forward, albeit only a little, than to expect the long-awaited utopian perfection to be reached. This is not the time or place to defend or criticise whether the royal decree on the core curriculum was the most appropriate. It is quite possible that proposing a universal two-year core curriculum for all specialties might not be the best idea and that the number, composition and competencies of the core blocks which were defined could be questioned. We could also discuss whether too many or too few common or core competencies were proposed or the total length of certain specialty training programmes.

Apart from the previous considerations, we believe that there some obvious facts, of which we would like to highlight two aspects:

First, since the passing of the LOPS in 2003, the health sector as a whole has demanded a more centralised organisation of specialised, which endows the training system with greater simplicity and plasticity, among other things, in order to make it better adapted to a complex labour market that is undergoing rapid organisational and technological transformation.

Second, a huge amount of top quality work has been carried out by experts, led mostly by the CNECS, for more than ten years. Can so much work be allowed to go to waste? Is it possible to even think of starting from scratch? Should we be afraid of reluctance to change after the efforts of so many professionals? As we see it, the answers to the three questions are no, no and no.

From what has been said so far, it should in no way be inferred that we nostalgically calling for a return to days gone by. Our intention is to draw the attention of all parties involved (health and educational authorities, scientific societies, organisations and professionals) to the positive aspects of the efforts made over a period of 16 years to improve specialised training. All this amounts to a set of contributions that are always the fruit of expert knowledge that must be supported and facilitated by the political structures.

Our specialised training is good or very good, but the dizzying changes in epidemiology, therapeutics and care organisations require - demand - changes in training. The question is: when? The specialised training system needs to be changed as soon as possible. We shouldn’t start from scratch with all the knowledge that has been accumulated over so many years. It is a good time both to take advantage of the accumulated information and to avoid making the same mistakes again. We need a legislative decree that makes it possible to improve the LOPS and update skills, that renews programmes and that facilitates the management of specialised training in health sciences. Professionals deserve it and citizens demand it.

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