Editorial
The Core Curriculum
Troncalidad
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class="elsevierStyleTextfn">Editorial</span>" "titulo" => "The Core Curriculum" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "663" "paginaFinal" => "664" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Jaume Ferrer, Júlia Sampol" "autores" => array:2 [ 0 => array:4 [ "nombre" => "Jaume" "apellidos" => "Ferrer" "email" => array:1 [ 0 => "jjferrer@vhebron.net" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Júlia" "apellidos" => "Sampol" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servei de Pneumologia, Hospital Universitari Vall d’Hebron, Barcelona, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "CIBER Enfermedades Respiratorias (CIBERES), Barcelona, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Troncalidad" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The introduction of the core curriculum model has been presented as the most significant change in specialized medical training in Spain since the launch of the MIR system.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">1</span></a> The core curriculum was based on directives from the European Higher Education Area and had the commendable goal of improving the general training of medical specialists. It first came into law in 2003,<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">2</span></a> and this Act was followed in 2014 by a Royal Decree.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">3</span></a> Five core specialties (medical, surgical, laboratory, clinical imaging, and psychiatry) were defined, pulmonology being one of the 21 medical sub-specialties. Briefly, doctors would choose a core curriculum teaching unit according to marks obtained in a single MIR examination, similar to the one already in place. They would then complete a 2-year core training period based on an educational program prepared by a core committee. They would be supervised by core tutors and assessed by their corresponding teaching committee. If their assessment was positive, they could then choose the teaching unit where they would study one of the specialties on offer that year. Places would be awarded in descending order, according to the marks obtained in the test determining access to that core specialty.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">3</span></a> However, as a result of an appeal submitted by the Spanish Society of Immunology, in December 2016 the Supreme Court repealed the Royal Decree of 2014, due to the unavailability of an appropriate analysis of the economic impact that the core curriculum would have on the autonomous communities.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">In the case of pulmonology, we would like to consider the repercussions of switching from the training program currently in place to a core curriculum system. Our specialty is expanding, due to both advances in the knowledge of respiratory diseases and the technological innovations being introduced. We believe that for some time now, the competencies and skills covered in the training program are disproportionate to the 4 years assigned to acquire them. Indeed, this period has not changed in the last 30 years. During this time, we have witnessed substantial changes, with the introduction of non-invasive ventilation, sleep study units, semicritical care, lung transplantation and smoking, day hospitals, and the implementation of new techniques, such as chest ultrasound, endobronchial ultrasound, pleuroscopy, interventional bronchoscopy, hemodynamics, and other new skills that the respiratory medicine specialist must master, as specified in the HERMES European program.<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">5,6</span></a> Many of these advances were included in the official training program set down in the Official State Bulletin of 2008, although the training period was not extended.<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">7,8</span></a> The bulletin even set out competencies in lung cancer chemotherapy, analysis of respiratory samples for cytological, microbiological and mineralogical study, presentation of scientific communications, publication of scientific studies, and presentation of projects for obtaining a doctorate. This is clearly an ambitious program, but a closer look at the rotation program reveals how difficult it is to attain the required competences and skills within the current framework. It may be illustrative to compare the official programs for pulmonology and cardiology. Both specialties share a similar structure, based on clinical experience and technical aspects, but while the pulmonologist has 4 years for training, the cardiologist has 5.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">9</span></a> Both programs include a generic rotation and a similar amount of time in the clinic. With respect to technical skills specific to the specialty, cardiology includes 4 rotations: echocardiography (6 months), exertion testing (3 months), hemodynamics (6 months), and arrhythmias (4 months), 19 months in total. Pulmonology, in contrast, only covers 2: bronchoscopy (6 months), and lung function and sleep studies, grouped together (6 months), 12 months in total. This is a clear underestimation of the training required both in lung function testing, which in our case also includes exertion ergometrics, and in sleep disorders, and does not provide for any rotation in right heart hemodynamics. The extra year enables cardiologists to receive training in pediatrics and cardiac rehabilitation, and offers an optional period of 4–6 months, during which the trainee specialist can acquire the programmed competencies, with sufficient flexibility to adapt their training to the different characteristics of hospitals with specialist units. In the case of pulmonology, this would include lung transplantation or cystic fibrosis units, etc. Finally, a review of pulmonology training programs in Europe reveals that Spain is one of the four countries with the shortest training periods.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">10</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The core curriculum law is, in short, focused on one single aspect of resident doctor training, namely the generic phase. This was in effect extended, albeit without making explicit mention of any improvement in the actual specialization phase. Quite the contrary, in pulmonology in particular, the specific training period was to be reduced even further, from 30 to 24 months.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">11</span></a> While it is true that the act did consider the function of the National Pulmonology Council when redefining the training program, there was no guarantee that the total training time would eventually be extended: as we have pointed out, this period should be 5 years.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Of course, other questions have also fueled the debate. Indeed, while each national specialty council determined the competencies to be acquired in the specialist training phase, the national specialty council had to define the generic competencies, and the role of the pulmonology tutor was not defined by the core specialty committees. The assessment system of the core specialty phase was yet another bone of contention. For example, the introduction of a subjective assessment at the end of the core speciality phase is questionable in a system which has always based its impartiality on the objectivity of the MIR examination.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Considering the foregoing, we believe that the debate on the suitability of the core curriculum model as it affects pulmonology cannot be resolved unless we can be certain that specific pulmonology training will not be affected by the change. Improving the overall training of pulmonologists is clearly a reasonable objective. We believe that a model such as the UK system, which includes core training for at least 2 years and a minimum of 4 years in specialist pulmonology could be a good starting point. The Spanish proposal for the core curriculum, in our opinion, only affects the core training period, to the detriment of specialist training in pulmonology.</p><p id="par0030" class="elsevierStylePara elsevierViewall">In view of all this, and without going into the economic reasons on which the repeal of the project was based, saying we are in favor of the core curriculum model provided the total time of training is increased, is the same as saying we are against it unless such an extension is guaranteed.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Ferrer J, Sampol J. Troncalidad. Arch Bronconeumol. 2017;53:663–664.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:11 [ 0 => array:3 [ "identificador" => "bib0060" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Formación especializada en España: del internado rotatorio a la troncalidad" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J. Fernández Pardo" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Educ Med" "fecha" => "2015" "volumen" => "16" "paginaInicial" => "57" "paginaFinal" => "67" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0065" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Ley 44/2003, de 21 de noviembre, de ordenación de las profesiones sanitarias. 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| 2022 August | 40 | 43 | 83 |
| 2022 July | 28 | 42 | 70 |
| 2022 June | 31 | 33 | 64 |
| 2022 May | 32 | 38 | 70 |
| 2022 April | 29 | 30 | 59 |
| 2022 March | 31 | 35 | 66 |
| 2022 February | 22 | 23 | 45 |
| 2022 January | 40 | 40 | 80 |
| 2021 December | 39 | 46 | 85 |
| 2021 November | 37 | 42 | 79 |
| 2021 October | 39 | 47 | 86 |
| 2021 September | 21 | 45 | 66 |
| 2021 August | 33 | 31 | 64 |
| 2021 July | 28 | 24 | 52 |
| 2021 June | 32 | 38 | 70 |
| 2021 May | 37 | 31 | 68 |
| 2021 April | 113 | 126 | 239 |
| 2021 March | 37 | 22 | 59 |
| 2021 February | 31 | 23 | 54 |
| 2021 January | 26 | 13 | 39 |
| 2020 December | 33 | 19 | 52 |
| 2020 November | 29 | 20 | 49 |
| 2020 October | 25 | 19 | 44 |
| 2020 September | 19 | 10 | 29 |
| 2020 August | 23 | 11 | 34 |
| 2020 July | 28 | 28 | 56 |
| 2020 June | 14 | 6 | 20 |
| 2020 May | 28 | 13 | 41 |
| 2020 April | 33 | 19 | 52 |
| 2020 March | 16 | 10 | 26 |
| 2020 February | 52 | 18 | 70 |
| 2020 January | 66 | 12 | 78 |
| 2019 December | 39 | 14 | 53 |
| 2019 November | 23 | 24 | 47 |
| 2019 October | 21 | 22 | 43 |
| 2019 September | 26 | 6 | 32 |
| 2019 August | 29 | 16 | 45 |
| 2019 July | 18 | 20 | 38 |
| 2019 June | 19 | 12 | 31 |
| 2019 May | 32 | 34 | 66 |
| 2019 April | 31 | 36 | 67 |
| 2019 March | 29 | 18 | 47 |
| 2019 February | 36 | 15 | 51 |
| 2019 January | 28 | 26 | 54 |
| 2018 December | 34 | 19 | 53 |
| 2018 November | 90 | 39 | 129 |
| 2018 October | 151 | 27 | 178 |
| 2018 September | 45 | 10 | 55 |
| 2018 May | 5 | 0 | 5 |
| 2018 April | 41 | 19 | 60 |
| 2018 March | 57 | 14 | 71 |
| 2018 January | 1 | 0 | 1 |
| 2017 December | 0 | 1 | 1 |
Show all
