[Reinventing specialty training of physicians? Principles and challenges]

In a world undergoing constant change, in the era of globalisation, the training of medical professionals should be under constant review so that it can be tailored to meet the needs of this society in transition. This is all the more true at times of economic uncertainty, such as the current conditions, which have a direct impact on health services. Professionals need new Competencies for new times. Over the last decade initiatives have emerged in various Anglo-Saxon countries which have defined a framework of basic Competencies that all medical specialists should demonstrate in their professional practice. In addition to this, we must respond to the creation of the European Higher Education Area which has implications for specialised training. In Spain, training for medical specialists was in need of an overhaul and the recently passed law (Real Decreto 183/2008) will allow us to move forward and implement, in medical education, initiatives and innovations required in our medical centres, to respond to the new society and bring us in line with international professional education and practice. The way forward is a Competency-based model for medical education with assessment of these Competencies using simple instruments, validated and accepted by all the stakeholders. The institutions involved (hospitals, medical centres and other health care services) should trial different approaches within the general framework established by the current legislation and be conscious of the duty they have to society as accredited training organisations. Accordingly, they should consolidate their teaching and learning structures and the various different educational roles (Director of Studies, Tutors, and other teaching positions), showing the leadership necessary to allow proper implementation of their training programmes. For this, the Spanish Autonomous Regions must develop their own legislation regulating Medical Specialty Training. So, medical professionals should receive training, based on ethical values, behaviours and attitudes that considers humanistic, scientific and technical factors, developing an understanding of the scientific method; ability to put it into practice; skills to manage complexity and uncertainty; a command of scientific, technical and IT terminology to facilitate independent learning; and a capacity for initiative and teamwork, as well as skills for dealing with people and for making an effective, democratic contribution both within health organisations and in the wider society.