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Frederick, F.J. Bonilla-Escobar, A. Acosta, P.C. Candelo, A. Castro" "autores" => array:5 [ 0 => array:2 [ "nombre" => "G.A." "apellidos" => "Frederick" ] 1 => array:2 [ "nombre" => "F.J." "apellidos" => "Bonilla-Escobar" ] 2 => array:2 [ "nombre" => "A." "apellidos" => "Acosta" ] 3 => array:2 [ "nombre" => "P.C." "apellidos" => "Candelo" ] 4 => array:2 [ "nombre" => "A." 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Muñoz-Negrete, M.P. Villegas-Pérez" "autores" => array:2 [ 0 => array:4 [ "nombre" => "F.J." "apellidos" => "Muñoz-Negrete" "email" => array:1 [ 0 => "franciscojmunoz@telefonica.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" => "M.P." "apellidos" => "Villegas-Pérez" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Servicio de Oftalmología, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, IRYCIS, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Presidente de la Comisión Nacional, especialidad Oftalmología, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Hospital General Universitario Reina Sofía, Universidad de Murcia, Murcia, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Vicepresidente de la Comisión Nacional, especialidad Oftalmología, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Áreas de capacitación específica (ACE): por fin título de subespecialista en España" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The growing and rapid scientific and technological evolution of Ophthalmology is prompting professionals to specialise in specific fields in order to be able to reasonably cover an area of ophthalmological knowledge and offer better quality care.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The most appropriate denomination for training in specific fields of a speciality is much debated, although the term <span class="elsevierStyleItalic">subspecialty</span> is often used. Professor Juan Murube published a very interesting editorial on the subject,<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> indicating that the term <span class="elsevierStyleItalic">subspecialty</span>, the most commonly used term, is somewhat disparaging as it undervalues the knowledge acquired in a field. On the other hand, the term <span class="elsevierStyleItalic">super-specialty</span>, proposed by some, could be presumptuous and pompous, which is why it was not adopted. As an expert linguist, I suggested speaking of <span class="elsevierStyleItalic">proto-speciality</span> for a complete speciality such as ophthalmology, <span class="elsevierStyleItalic">deuterospeciality</span> for specialisation in the classic sections of the latter (glaucoma, cornea, retina, strabismus, etc.) and <span class="elsevierStyleItalic">tritospeciality</span> for specialisation within a <span class="elsevierStyleItalic">deuterospeciality</span>, such as dacryology within cornea or strabismus within pediatric ophthalmology.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Obviously, this terminology is much more precise, but it has not taken hold as of yet.</p><p id="par0015" class="elsevierStylePara elsevierViewall">In Spain, the Law on the Organisation of Health Professions published in 2003 distinguished “Areas of Specific Training” to refer to specialisation “within one or several Health Science Specialities”. Subsequent developments of this law suggested that these Areas were created to designate the cross-cutting knowledge of several specialties such as, for example, Neuro-ophthalmology.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Of recent publication, Royal Decree (RD) 589/2022 dated 19 July regulates the transversal training of specialities in Health Sciences, the procedure and criteria for the proposal of a new title of specialist in Health Sciences or diploma of specific training area, and the revision of the established ones.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> The changes introduced by this RD determine that what until now were called <span class="elsevierStyleItalic">subspecialties</span> in our country are now called <span class="elsevierStyleItalic">areas of specific training</span> (AST).</p><p id="par0025" class="elsevierStylePara elsevierViewall">The purpose of the ASTs is, according to this RD, the deepening of the body of competences of one or several specialities, due to the growing increase in complexity and depth of the aforementioned competences, which could not be fully satisfied by the existing specialities or ASTs. These competences cannot be based exclusively on one technique, diagnostic or therapeutic procedure or on a single disease or health problem. Therefore, it would not be possible to create an AST for diabetic retinopathy but it would be possible to create an AST for Vitreous and Retina, which involves multiple diseases, or Neuro-ophthalmology, which involves two specialities.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Access to training in an AST will require at least two years of professional practice in the speciality involved, which will be a disadvantage for our young final-year residents, who would probably prefer to begin <span class="elsevierStyleItalic">subspecialisation</span> immediately after their residency. On the other hand, the system of training in an AST will be that of Residency, although exceptions will be made for professionals with a long and recognised track record. The period of residency required to acquire the qualification will be between 20%–40% of the duration of the original speciality, so it is foreseeable that the majority will comprise 2 years.</p><p id="par0035" class="elsevierStylePara elsevierViewall">This opens up a new path for specialised training in our country, but there are a number of potential difficulties:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">–</span><p id="par0040" class="elsevierStylePara elsevierViewall">The need for the creation of an AST must be endorsed by at least 7 Health Departments, requiring signed reports endorsing the proposal and also indicating the care needs and budget. It does not seem an easy task to get more than 7 regional ministries to agree.</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">–</span><p id="par0045" class="elsevierStylePara elsevierViewall">The ASTs must be adapted to European regulations, so the existence of the <span class="elsevierStyleItalic">superspeciality</span> (the term used in the RD) must be accredited in the 26 countries of the European Union.</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">–</span><p id="par0050" class="elsevierStylePara elsevierViewall">The creation of ASTs involving more than one speciality will require the agreement of the National Commissions of the different specialities involved. Thus, Neuro-ophthalmology would require the agreement of the National Commissions of Ophthalmology and Neurology. It seems clear that in this AST the training itinerary cannot be the same for a Neurologist, who will require more training in Ophthalmology, as for an Ophthalmologist, who will require more intense training in the field of Neurology.</p></li></ul></p><p id="par0055" class="elsevierStylePara elsevierViewall">Therefore National Commissions, scientific societies and the Autonomous Communities will now have to decide which ASTs are requested, taking into account the healthcare needs and the current reality.</p><p id="par0060" class="elsevierStylePara elsevierViewall">ASTs could be requested based exclusively on the speciality of Ophthalmology, such as Cataract and Refractive Surgery, Cornea and Ocular Surface, Glaucoma, Vitreous and Retina, Uveitis. ASTs could also be requested that include content and are developed from several specialties such as Ocular Oncology, Paediatric Ophthalmology and Strabismus, Neuro-ophthalmology and Oculoplastics, Tear Ducts and Orbit (the latter is subdivided in a highly variable ways in different countries and centres).</p><p id="par0065" class="elsevierStylePara elsevierViewall">In short, we are facing an exciting challenge for the development of <span class="elsevierStyleItalic">subspecialties</span> in Spain, to which the members of the National Ophthalmology Commission, which is the body that must propose the development of the AST, will have to respond, with the essential collaboration of the Spanish Ophthalmology Society, the ophthalmological societies of the different subspecialties and the autonomous communities. However, given that the creation of ASTs requires the agreement of at least 7 Autonomous Communities and requires significant funding and administrative work, it is possible that the first ASTs will not be approved as soon as we would like.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0070" class="elsevierStylePara elsevierViewall">None of the authors have declared any conflict of interests in relation to this paper.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:2 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Evolution of medicine and proto-, deutero- and trito-specialities" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J. Murube" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jtos.2015.01.003" "Revista" => array:6 [ "tituloSerie" => "Ocul Surf" "fecha" => "2015" "volumen" => "13" "paginaInicial" => "95" "paginaFinal" => "102" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25881993" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Real Decreto 589/2022, de 19 de Julio. Boletín Oficial del Estado n (173, Sec. I, Pág. 102998-103025 [Accessed 7 September 2022]. Available from: <a target="_blank" href="https://www.boe.es/buscar/doc.php?id=BOE-A-2022-12015">https://www.boe.es/buscar/doc.php?id=BOE-A-2022-12015</a>." ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735794/0000009700000012/v1_202212030745/S2173579422001542/v1_202212030745/en/main.assets" "Apartado" => array:4 [ "identificador" => "5814" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Editorial" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735794/0000009700000012/v1_202212030745/S2173579422001542/v1_202212030745/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173579422001542?idApp=UINPBA00004N" ]
