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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">It has been clear for years that in clinical specialties with a very wide area of activity&#44; such as respiratory medicine&#44; highly specific areas of knowledge and sophisticated techniques will emerge over time<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>&#46; This calls for formal recognition of this specialization to ensure that the positions offered in National Health System hospitals cover the specific developmental needs of each respiratory subspecialty&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The Spanish Ministry of Health&#44; mindful of the evidence and necessities&#44; has been working to regulate specific subspecialization areas &#40;<span class="elsevierStyleItalic">&#193;reas de Capacitaci&#243;n Espec&#237;fica</span> &#91;ACE&#93; in Spanish&#41;&#46; In this respect&#44; there are plans to approve a decree-law on subspecialization&#44; to regulate this&#44; currently unrecognized specialties&#44; and to make a new attempt to establish or strengthen the core syllabus in general-internal medicine<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>&#44; now known as &#8220;transversality&#8221;&#46; Although the latter is equally controversial and probably calls for a SEPAR position statement&#44; this editorial focuses only on ACEs and how they should be implemented&#46; It appears that the initial plan was to include subspecialization in the already tightly packed 4-year residence period&#44; although&#44; paradoxically&#44; the subspecialization period is specified as 1&#8211;2 years&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">It is obviously impossible to train a pulmonologist in general respiratory medicine and in a subspecialization at the same time&#44; as basic specialist training would be already reduced to a scant year and a half &#40;and this time includes duty rosters and vacations&#41;&#44; leaving it squeezed in between the core syllabus &#40;18 months&#41; and the proposed subspecialization&#46; As things stand&#44; then&#44; it is impossible complete the current general specialist training program<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;4</span></a>&#46; In fact&#44; SEPAR has been calling for years for a 5-year residency in basic specialist training in respiratory diseases<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;6</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">To contemplate a period of subspecialization during the current 4 years of residency&#44; of which almost 3 are dedicated to other topics&#44; is not simply difficult and problematic&#44; it is clearly impossible and foolhardy&#46; The logical approach would be to subspecialize separately after the period of residency for the basic specialization in respiratory medicine&#44; that would last 5 years&#44; as is already the case in other European countries and in North America&#44; and often demanded here<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#8211;8</span></a>&#46; Furthermore&#44; training in both the general specialty and subspecialties &#40;ACE&#41; should be harmonized with our neighboring countries&#44; and this probably calls for regulatory convergence and a drive for initiatives such as HERMES<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Another bone of contention is what scientific and&#47;or technological area would be a suitable ACE and who should put forward the proposal&#46; On the one hand&#44; certain areas of expertise often have dedicated hospital units and might aspire to be considered a subspecialization or specific area of respiratory expertise&#46; These include&#44; for example&#44; severe asthma&#44; interstitial pathology&#44; smoking cessation&#44; lung vascular disorders&#44; lung transplantation&#44; and semicritical patients&#46; On the other hand&#44; some areas of expertise require specific training in both theoretical aspects and in instrumentation skills&#46; This is true not only for some of the aforementioned areas&#44; but also for interventional pulmonology&#44; highly specialized respiratory function units that perform both standard and exercise tolerance testing&#44; and units that study respiratory sleep disorders&#46; We believe that both approaches may be correct&#44; and that the National Health System and scientific societies must clearly define their needs in order to facilitate prioritization&#46; The system must also be flexible enough to adapt to unexpected situations&#44; such as the Covid-19 pandemic and the implementation in Spain of numerous intermediate respiratory care units&#46; However&#44; for the time being&#44; the order in which the ACEs should be established&#44; their requirements&#44; and who should propose them all remain unclear&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">A third important issue is to determine where the subspecialization should be available&#44; and what the training program should consist of&#46; Will it be offered in all units that are accredited for resident training&#63; Or only in tertiary centers with previously accredited specialist units led by renowned professionals&#63; In the latter case&#44; who will accredit them&#63; Moreover&#44; will all respiratory medicine residents be able to subspecialize&#44; or only those working in suitably accredited centers&#63; The ideal training program&#44; we believe&#44; should be based on the acquisition of skills&#44; possibly inspired by the SEPAR Continuous Professional Development &#40;CPD&#41; program&#46; This also means that the criteria for acquiring ACE skills and qualifications must be clearly defined&#44; and it should not simply be a matter of following the training program as is currently the case with obtaining qualifications in medical specialties&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">A fourth controversial issue is to decide when a resident can choose to be either a general pulmonologist or a subspecialist in one or more ACE&#46; The initial idea behind the proposed decree is that the resident makes this decision at the time of selecting their internship&#44; although at that time the applicant &#40;usually a recent graduate in medicine&#41; obviously cannot know what area of the specialty they are going to find most attractive&#44; or if they want to practice as a general specialist or acquire a subspecialty&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Finally&#44; another aspect that can also cause controversy is the possibility of accessing a specific ACE from different medical specialties&#46; This may be admissible in some cases&#58; for example&#44; general training in sleep disorder studies may be accessible to both pulmonologists and neurophysiologists&#44; while pulmonary hemodynamic training could be made available to cardiologists and pulmonologists&#44; but in many other cases it could lead to encroachment into specific areas of a specialty&#46; Whose decision will this be&#63; Who will make the proposal&#63; It seems clear that scientific societies&#44; such as SEPAR&#44; should lead the debate&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Despite the importance of this topic for the future of both respiratory medicine and thoracic surgery&#44; the authorities seem intent not only on rushing through legislation to resolve these uncertainties&#44; but on arriving at a &#8220;low cost&#8221; solution without giving scientific societies the chance to calmly debate with the regulatory authorities the issues in question&#46; SEPAR needs to state its position and try to ensure that such a laudable and necessary goal as the accreditation of subspecialties is implemented following a methodology that encourages excellence in subsequent professional practice&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">The aim of this editorial is to put some of the key questions for the future of respiratory medicine in the spotlight and to generate the much-needed debate&#46; The National Health System requires a solution to the subspecialization issue as soon possible&#44; but this must be a quality solution that has been evaluated and debated by all the sectors concerned&#44; and as far as possible&#44; it should be the fruit of consensus&#46;</p></span>"
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Editorial
Areas of Specific Subspecialization (ACE) in pulmonology
Áreas de Capacitación Específica (ACE) en neumología
Joaquim Geaa,
Corresponding author
jgea@parcdesalutmar.cat

Corresponding author.
, Miguel Barruecob, Cristina Martínezc, Carlos Jiménez-Ruízd
a Comité de Grados de SEPAR, Ex-miembrodel Management Council del European Board for Accreditation inPneumology(EBAP,2015-19), Servicio de Neumología, Hospital del Mar-IMIM, DCEXS, Universidad Pompeu Fabra, CIBERES, ISCIII, Barcelona, Spain
b Servicio de Neumología, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Departamento de Medicina, Universidad de Salamanca, Salamanca, Spain
c Comisión Nacional de la Especialidad de Neumología, Hospital Universitario Central de Asturias, Facultad de Medicina, Instituto de Investigación Sanitaria del principado de Asturias (ISPA), Oviedo, Spain
d Presidente de SEPAR, Unidad Especializada de Tabaquismo de la Comunidad de Madrid, Servicio de Neumología, Madrid, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">It has been clear for years that in clinical specialties with a very wide area of activity&#44; such as respiratory medicine&#44; highly specific areas of knowledge and sophisticated techniques will emerge over time<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>&#46; This calls for formal recognition of this specialization to ensure that the positions offered in National Health System hospitals cover the specific developmental needs of each respiratory subspecialty&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The Spanish Ministry of Health&#44; mindful of the evidence and necessities&#44; has been working to regulate specific subspecialization areas &#40;<span class="elsevierStyleItalic">&#193;reas de Capacitaci&#243;n Espec&#237;fica</span> &#91;ACE&#93; in Spanish&#41;&#46; In this respect&#44; there are plans to approve a decree-law on subspecialization&#44; to regulate this&#44; currently unrecognized specialties&#44; and to make a new attempt to establish or strengthen the core syllabus in general-internal medicine<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>&#44; now known as &#8220;transversality&#8221;&#46; Although the latter is equally controversial and probably calls for a SEPAR position statement&#44; this editorial focuses only on ACEs and how they should be implemented&#46; It appears that the initial plan was to include subspecialization in the already tightly packed 4-year residence period&#44; although&#44; paradoxically&#44; the subspecialization period is specified as 1&#8211;2 years&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">It is obviously impossible to train a pulmonologist in general respiratory medicine and in a subspecialization at the same time&#44; as basic specialist training would be already reduced to a scant year and a half &#40;and this time includes duty rosters and vacations&#41;&#44; leaving it squeezed in between the core syllabus &#40;18 months&#41; and the proposed subspecialization&#46; As things stand&#44; then&#44; it is impossible complete the current general specialist training program<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;4</span></a>&#46; In fact&#44; SEPAR has been calling for years for a 5-year residency in basic specialist training in respiratory diseases<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;6</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">To contemplate a period of subspecialization during the current 4 years of residency&#44; of which almost 3 are dedicated to other topics&#44; is not simply difficult and problematic&#44; it is clearly impossible and foolhardy&#46; The logical approach would be to subspecialize separately after the period of residency for the basic specialization in respiratory medicine&#44; that would last 5 years&#44; as is already the case in other European countries and in North America&#44; and often demanded here<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#8211;8</span></a>&#46; Furthermore&#44; training in both the general specialty and subspecialties &#40;ACE&#41; should be harmonized with our neighboring countries&#44; and this probably calls for regulatory convergence and a drive for initiatives such as HERMES<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Another bone of contention is what scientific and&#47;or technological area would be a suitable ACE and who should put forward the proposal&#46; On the one hand&#44; certain areas of expertise often have dedicated hospital units and might aspire to be considered a subspecialization or specific area of respiratory expertise&#46; These include&#44; for example&#44; severe asthma&#44; interstitial pathology&#44; smoking cessation&#44; lung vascular disorders&#44; lung transplantation&#44; and semicritical patients&#46; On the other hand&#44; some areas of expertise require specific training in both theoretical aspects and in instrumentation skills&#46; This is true not only for some of the aforementioned areas&#44; but also for interventional pulmonology&#44; highly specialized respiratory function units that perform both standard and exercise tolerance testing&#44; and units that study respiratory sleep disorders&#46; We believe that both approaches may be correct&#44; and that the National Health System and scientific societies must clearly define their needs in order to facilitate prioritization&#46; The system must also be flexible enough to adapt to unexpected situations&#44; such as the Covid-19 pandemic and the implementation in Spain of numerous intermediate respiratory care units&#46; However&#44; for the time being&#44; the order in which the ACEs should be established&#44; their requirements&#44; and who should propose them all remain unclear&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">A third important issue is to determine where the subspecialization should be available&#44; and what the training program should consist of&#46; Will it be offered in all units that are accredited for resident training&#63; Or only in tertiary centers with previously accredited specialist units led by renowned professionals&#63; In the latter case&#44; who will accredit them&#63; Moreover&#44; will all respiratory medicine residents be able to subspecialize&#44; or only those working in suitably accredited centers&#63; The ideal training program&#44; we believe&#44; should be based on the acquisition of skills&#44; possibly inspired by the SEPAR Continuous Professional Development &#40;CPD&#41; program&#46; This also means that the criteria for acquiring ACE skills and qualifications must be clearly defined&#44; and it should not simply be a matter of following the training program as is currently the case with obtaining qualifications in medical specialties&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">A fourth controversial issue is to decide when a resident can choose to be either a general pulmonologist or a subspecialist in one or more ACE&#46; The initial idea behind the proposed decree is that the resident makes this decision at the time of selecting their internship&#44; although at that time the applicant &#40;usually a recent graduate in medicine&#41; obviously cannot know what area of the specialty they are going to find most attractive&#44; or if they want to practice as a general specialist or acquire a subspecialty&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Finally&#44; another aspect that can also cause controversy is the possibility of accessing a specific ACE from different medical specialties&#46; This may be admissible in some cases&#58; for example&#44; general training in sleep disorder studies may be accessible to both pulmonologists and neurophysiologists&#44; while pulmonary hemodynamic training could be made available to cardiologists and pulmonologists&#44; but in many other cases it could lead to encroachment into specific areas of a specialty&#46; Whose decision will this be&#63; Who will make the proposal&#63; It seems clear that scientific societies&#44; such as SEPAR&#44; should lead the debate&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Despite the importance of this topic for the future of both respiratory medicine and thoracic surgery&#44; the authorities seem intent not only on rushing through legislation to resolve these uncertainties&#44; but on arriving at a &#8220;low cost&#8221; solution without giving scientific societies the chance to calmly debate with the regulatory authorities the issues in question&#46; SEPAR needs to state its position and try to ensure that such a laudable and necessary goal as the accreditation of subspecialties is implemented following a methodology that encourages excellence in subsequent professional practice&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">The aim of this editorial is to put some of the key questions for the future of respiratory medicine in the spotlight and to generate the much-needed debate&#46; The National Health System requires a solution to the subspecialization issue as soon possible&#44; but this must be a quality solution that has been evaluated and debated by all the sectors concerned&#44; and as far as possible&#44; it should be the fruit of consensus&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Gea J&#44; Barrueco M&#44; Mart&#237;nez C&#44; Jim&#233;nez-Ru&#237;z C&#46; &#193;reas de Capacitaci&#243;n Espec&#237;fica &#40;ACE&#41; en neumolog&#237;a&#46; Arch Bronconeumol&#46; 2021&#59;57&#58;733&#8211;734&#46;</p>"
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Article information
ISSN: 15792129
Original language: English
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