Undergraduate and postgraduate training in Endocrinology and Nutrition

Acquiring the skills required to practise the speciality of Endocrinology and Nutrition (E&N) is based on a four-year training plan¹ open to residents in the speciality who obtain their place through the specialised medical training exams organised annually by the Spanish Ministry of Health.² However, E&N training has a much broader spectrum, starting in medical schools and continuing throughout the specialist's life. In fact, we can distinguish three major blocks in this training process for which we have interesting data for analysis: undergraduate teaching; specialised training; and continuing medical education.

With regard to undergraduate teaching, the Sociedad Española de Endocrinología y Nutrición (SEEN) [Spanish Society of Endocrinology and Nutrition] conducted a study during the 2020–2021 academic year to learn more about its implementation in Spain.³ The study showed that there was a good representation of E&N specialists in Spanish medical schools, with 34.1% having a university professor and 48.8% having at least one full university lecturer. This positioning should serve to ensure that undergraduate teaching is fit for purpose. The subject was mostly taught in 5τη year and was worth between four and seven European Credit Transfer and Accumulation System (ECTS) credits, although there was wide variability in both aspects. There was a certain unanimity in the time devoted to the teaching of hypothalamic-pituitary, thyroid and adrenal disease, but significant differences in the time devoted to diabetes and nutrition. Last of all, the major obstacle identified was that in 37.5% of the faculties, students were not obliged to complete practical placements in E&N, which could affect the image of our speciality among these students.

Specialised training (ST) has also been the subject of a specific study by the SEEN which, with the support of the international training organisation Grupo CTO-Medicina, set out to determine how the speciality is perceived by students preparing for their ST entrance exam.⁴ The study showed that there was a higher demand for the speciality than the number of places offered. These students were positive about the logical pathophysiological basis and the dynamic and varied work, the most negative aspect being the fact that there are few interventional techniques. Moreover, 37.9% of students who considered E&N as their first choice for ST indicated that the teaching of the subject had had a very positive influence on their choice. The growing interest in the speciality was demonstrated during the last recruitment process using the objective parameter of "speciality rating score".⁵

In this case, we have to understand that ST is formal and structured training with an incremental system of accountability to enable the necessary skills to be acquired.⁶ In Spain, the Comisión Nacional de la Especialidad (CNE) [National Commission for the Speciality] developed the training programme in 2006, and it was then verified by the Consejo Nacional de Especialidades Médicas [National Council of Medical Specialities].¹ In the last ST selective exam session, 103 E&N places were offered, representing an increase of 41% compared to the number of places offered 10 years ago and 98% compared to the number offered 20 years ago. These places are distributed across all of Spain's autonomous communities, except La Rioja. Although the training programme guarantees the acquisition of new skills, there are various activities organised by the SEEN and the Sociedad Española de Diabetes (SED) [Spanish Society of Diabetes] aimed at complementing the training of E&N residents.

Finally, continuing medical education (CME) is an active and permanent teaching-learning process to which healthcare professionals have the right and obligation, intended to update and improve knowledge, skills and attitudes in response to advances in science and technology and the demands and needs of both society and the healthcare system itself.⁶ Although public health systems provide hospitals with a budget for CME, most of this budget is allocated to cross-curricular or multidisciplinary, and therefore not very specific, training. In 2020, the Federación de Asociaciones Científico Médicas Españolas (FACME) [Federation of Spanish Scientific Medical Associations] performed an analysis with data from more than 1,600 CME activities carried out in 2018 and 2019.⁷ The study found that 80% of the activities carried out by the learned societies were aimed at improving clinical practice, and more than 80% of the activities had the support of one of the official accreditation schemes. At present, the most important work in CME is being done by the learned societies, either directly or through their different working groups, which organise activities taking account of the training needs of healthcare professionals with a source of funding that comes almost entirely from the pharmaceutical and technological sector. This organisational model through learned societies allows for maximum efficiency of organisational costs with maximum independence and transparency, and should be the reference model.

One aspect related to CME which may become very important in the future is "recertification". There are two directives of the European Parliament⁸ and the European Council⁹ that affect the recognition of qualifications for certain professions, including doctors, which have not been implemented here in Spain. In December 2021, the Spanish Ministry of Finance and Public Administration published a call for tenders for training in international recertification models for the Ministry of Health and the autonomous communities¹⁰ that was awarded, but for which no further information has been released. Following this publication, both FACME¹¹ and the Organización Médica Colegial (OMC) [Organisation of Official Medical Colleges]¹² made their proposals for recertification models based on the definition of key skills and the evaluation of healthcare activity (60%) and training, teaching and research (40%). Our speciality should maintain a certain alignment with the skills defined in the training plan and, although adapted to our own idiosyncrasies, with the skills defined by the European Society of Endocrinology in its Recommended Curriculum of Specialisation in Clinical Endocrinology, Diabetes and Metabolism.¹³

Funding

This paper received no funding.

Conflicts of interest

There is no conflict of interest in relation to this paper.

Acknowledgements

We would like to thank all the Endocrinology and Nutrition residents who have been keeping and will continue to keep the flame of our speciality alive.