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Medical training programs: comparisons between family and community medicine, internal medicine, intensive care medicine, anesthesiology and critical care, and emergency medicine

Diéguez S, Krompiewski VA, Serrano L, Pardo S, Llorens P

Servicio de Urgencias, Hospital del Vinalopó, Elche, Alicante, Spain. Servicio de Urgencias, Hospital Clínico Universitario de Sant Joan d´Alacant, Alicante, Spain. Servicio de Urgencias, Hospital Universitario y Politécnico La Fe, Valencia, Spain. Servicio de Urgencias, Hospital General Universitario de Elche, Alicante, Spain. Servicio de Urgencias, Unidad Corta Estancia y Unidad de Hospitalización a Domicilio, Hospital General Universitario de Alicante, ISABIAL, Alicante, Spain.

Objective. To analyze whether current medical residency training programs in Spain foster the acquisition of knowledge and skills that enable specialists to provide emergency and urgent medical care.
Methods. We studied documents related to the content of residency programs for the following 4 specialties in effect in June 2021: internal medicine, intensive care medicine, anesthesiology and critical care, and family and community medicine. Program descriptions were obtained from the website of the Spanish Ministry of Health and the professional associations for each specialty. The associations’ unofficial drafts and proposed updates were also studied. For emergency and urgent medicine, we studied drafts and updates of proposals presented to the Ministry of Health by the Spanish Society of Emergency Medicine (SEMES) in 2010 and an updated version presented in 2021. The proposals were drafted by the SEMES committee to promote specialization in emergency medicine.
Results. Existing residency programs treat the management of urgent events from diverse points of view related to hospital settings (internal medicine focusing on admitted patients, anesthesiology on patients in perioperative settings, and intensive care on those in their specialized units) or to primary care centers (family medicine), where they are an extension of routine care. The residents’ rotations in emergency medicine vary. In anesthesiology,
intensive care medicine, and family medicine, training occurs while residents are on call — in the first year for trainees in anesthesiology and intensive care medicine but throughout the 4-year residency (with time decreasing each year) for trainees in family medicine. Internal medicine offers an initial 3-month rotation in emergency medicine in the early
phase and then assigns on-call shifts, without specifying a number. The proposed program submitted by SEMES includes wide-ranging contact with emergencies in various hospital settings (observation ward, trauma care, and pediatric care). Training in out-of-hospital emergencies and emergency and urgent care resource coordination centers are also included.
Conclusions. Currently available residency training in Spain does not provide appropriate preparation for practicing emergency medicine. Emergency medicine has its own body of theory and settings for practice that differ from those of other specialties. Therefore, at present there is a training gap in Spain that should be filled by creating a specialization in emergency medicine.

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