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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.26 no.5 Barcelona oct. 2023  Epub 04-Mar-2024 


Desafiando el binomio tiempo-competencias: las condiciones laborales como piedra angular en la formación sanitaria especializada

Challenging the time-competency tradeoff: working conditions as a cornerstone of specialised healthcare training

Challenging the time-competency tradeoff: working conditions as a cornerstone of specialised healthcare training

Álvaro Cerame1  , Juan P Carrasco3  , Domingo A Sánchez2  4 

1Plan de Atención Integral al Profesional Sanitario Enfermo. Servicio Madrileño de Salud

2Consejo General de Colegios Oficiales de Médicos de España. Madrid

3Servicio de Psiquiatría. Consorcio Hospitalario Provincial de Castellón. Castellón

4Servicio de Oncología Médica. IMIB-Arrixaca. Murcia, España

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.

Bibliografía / References

1. Sanchez-Martínez DA, Carrasco-Picazo J, Estrella-Porter PD, Ruiz-Montero R, Aginagalde-Llorente AH, et al. Resident physician duty hours, resting times and European Working Time Directive compliance in Spain:a cross-sectional study. Hum Resour Health 2023;21: 70. [ Links ]

2. Carrasco JP, Ferrando M, Jiménez M, Martín J, Martínez E, Martínez LC, et al. ¿Se sobrecarga a los médicos residentes? Estudio descriptivo sobre la falta de libranza de guardias de los médicos residentes y análisis de sus consecuencias docentes en la provincia de Valencia. Educación Médica 2021;22:98-105. [ Links ]

3. Etxeandia-Pradera JI, Martinez-Uribe D, Bellver-Pradas F, Gonzalez-Piqueras JC, Aguilar EJ. The challenge of introducing competency-based psychiatry training in Spain. Acad Psychiatry 2020;44:770-4. [ Links ]

4. Orden PCM/997/2022, de 18 de octubre, por la que se aprueba y publica el programa formativo de la especialidad de Medicina Legal y Forense, los criterios de evaluación de los especialistas en formación y los requisitos de acreditación de las unidades docentes. BOE núm. 254, de 22 de octubre de 2022, páginas 144793 a 144827. Madrid: Ministerio de la Presidencia, Relaciones con las Cortes y Memoria Democrática;2022. [ Links ]

5. Orden PCM/205/2023, de 2 de marzo, por la que se aprueban y publican los programas formativos de las especialidades de Psiquiatría y Psiquiatría Infantil y de la Adolescencia, los criterios de evaluación de los especialistas en formación y los requisitos de acreditación de las Unidades Docentes Multiprofesionales de salud mental. BOE núm. 54, de 4 de marzo de 2023, páginas 32231 a 32291. Madrid: Ministerio de la Presidencia, Relaciones con las Cortes y Memoria Democrática;2023. [ Links ]

6. García-Iglesias JJ, Gómez-Salgado J, Fagundo-Rivera J, Romero-Martín M, Ortega-Moreno M, Navarro-Abal Y. Factores predictores de los niveles de burnout y work engagement en médicos y enfermeras:una revisión sistemática. Rev Esp Salud Publica 2021;95:e202104046. [ Links ]

7. Martín-Zurro A. Acreditación y reconocimiento de la acción tutorial en España: hacia una propuesta estatal. FEM 2018;21:57-9. [ Links ]

8. Cerame-del Campo A, Maiques-Gámez M, Coucheiro P, Cayuela RL. Estudio descriptivo sobre libranza de guardias de médicos residentes de Madrid: efecto de la huelga de 2020 en el cumplimiento de los descansos obligatorios. Rev Esp Educ Med 2021;2:86-96. [ Links ]

9. Galcerá-Tomás J, Botella-Martínez C, Saura-Llamas J, Navarro-Mateu F;Chiefs of Study Forum of Murcia Region (CSFMR). New regulations regarding postgraduate medical training in Spain: perception of the tutor's role in the Murcia Region. BMC Med Educ 2010;10:44. [ Links ]

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