ALLERGOL. ET IMMUNOPATHOL., 1998;26(3):79-80
EDITORIAL
CURRENT STATUS OF THE SUBSPECIALTY OF CLINICAL IMMUNOLOGY AND PEDIATRIC ALLERGY
The Medical Specialties Act currently in effect in Spain defines the pediatrics specialty as Pediatrics and its Specific Areas. The most recent update of its training program was made in 1996 (1). The designation of the pediatrics specialty indicates specific areas of pediatric specialization that are not regulated with regard to training requirements and the diploma awarded. There is a general conviction that pediatric subspecialties should be developed. In countries such as the United States, where subspecialties have been developed for the last 25 years, the advantages of subspecialization include improvements in research, quality of care, the image of the specialty and training of undergraduates, residents, and doctoral candidates.
The potential disadvantages of subspecialization included the following:
Fractioning of the specialty.
Loss of interest among residents in common aspects that are fundamental for general department activities, such as being on call, outpatient clinics, etc., which should be carried out by all department members.
Prolongation of physician training.
The two former problems can be remedied by not allowing early subspecialization and stimulating competition and demanding a high specialist level as an entrance requirement for subspecialization.
The latter point has a fundamental connotation: increased economic cost if subspecialization requires prolonging resident training (2).
In the face of the growing need for subspecialized training, in 1995 a committee named by the Ministry of Health and Consumption and the Ministry of Education and Science addressed the topic of subspecialties for the first time (3). This Committee for Areas of Specific Training elaborated a report in which an Area of Specific Training was defined as: "The combination of knowledge, skills, and attitudes that enhance the depth and/or extension of those acquired during the training period as a specialist and are developed within the context of one or more specialties, in which there is sufficient interest in care and scientific aspects and significant dedication by a group of specialists.
This combination of scientific knowledge and skills as applied to care should meet the following conditions:
1. A knowledge and skill content of sufficient entity as to be an addition to existing specialties.
2. An adequate number of specialists who are professionally dedicated to this area of specific training.
3. Immediate or future need for health care efforts in this area and a social interest.
4. A field not based solely on the existence of an instrument or technique.
5. Access to the Area of Specific Training should be possible from one or more specialties.
6. Program development should be carried out in teaching units which are suitably accredited.
7. Training should be based on the principle of assigning progressively greater responsibility and exercising supervision as in specialized training.
8. The teaching units, duly accredited for specialized training and the Specific Training Areas, should guarantee adequate training without neglecting any aspect.
9. The catalog of Areas of Specific Training will be approved and updated by the National Council of Medical Specialties.
10. The National Commissions involved will report to the National Council of Medical Specialties regarding the accreditation and control of the Areas of Special Training.
11. Official recognition of specific training in an area can be obtained by:
Duly accredited practice.
Regulated training in an accredited unit.
12. The number of specialists admitted to training will be regulated in accordance with national health needs.
At present there is a bill for a Statute of Specialties that has been studied and corrected by the national commissions for the recognized medical specialties. This bill recognizes subspecialties of the pediatrics specialty. Pediatrics is considered to be a «non-trunk» specialty which require four years of training. The following pediatric subspecialties are recognized: Digestive System, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Nephrology, Neonatology, Pediatric Pneumology, Neuropediatrics, Intensive Medicine, Child Psychiatry, Pediatric Allergology, and Pediatric Oncology, all with 2 years of training, in addition to 4 years of Pediatrics training, in the general specialty. A diploma is awarded for Pediatrics and the subspecialty (Table I).
Table I | ||
| Pediatric subspecialties | Years of training | Pediatric diploma |
| Digestive system | 2 | Digestive system and Pediatrics |
| Pediatric cardiology | 2 | Cardiology and Pediatrics |
| Pediatric endocrinology | 2 | Endocrinology and Pediatrics |
| Pediatric nephrology | 2 | Nephrology and Pediatrics |
| Neonatology | 2 | Pediatrics |
| Pediatric pneumology | 2 | Pneumology and Pediatrics |
| Neuropediatrics | 2 | Neurology and Pediatrics |
| Intensive medicine | 2 | Intensive medicine and Pediatrics |
| Child psychiatry | 2 | Psychiatry and Pediatrics |
| Pediatric allergology | 2 | Allergology and Pediatrics |
| Oncology | 2 | Oncology and Pediatrics |
The project mentioned contemplates the possibility of obtaining a pediatric subspecialty in two ways: 1) as mentioned, through 4 years of training in the specialty of pediatrics and 2 years of training in the subspecialty, and 2) through 4 years of training in the adult specialty and 2 years of training in general pediatrics.
At present, the Spanish Association of Pediatrics, in view of the growing need to defend the field of pediatrics, has developed an accreditation protocol for pediatric subspecialties, and the corresponding sections or associations for the different specialties that have appeared in recent years. This protocol has a double mission: 1) to accredit existing pediatrics specialists, and 2) to establish a training program for pediatricians who wish to become superspecialists. A coherent orientation in this second case would be to take advantage of doctoral training, as the maximum university level, to develop Master Courses.
Mª Anunciación Martín Mateos
President of S.E.I.C.A.P.
REFERENCES
1. Pediatría y sus Areas Específicas. Guía de formación de especialistas. Ministerio de Sanidad y Consumo. Consejo Nacional de Especialidades Médicas. 1996.
2. Martín Mateos, Mª A. « Proyecto Docente». Barcelona, Marzo 1997.
3. Ministerio de Sanidad y Consumo. Comité de Areas de Capacitación Específica. Actas de 16 de febrero, 4 de abril y 13 de junio de 1995.
