2009-The Physician of the Future English and Catalan

F UNDACIÓN E DUCACIÓN M ÉDICA (FEM) 80 3.2. Postgraduate specialist training providers $e postgraduate cycle is the main component in conforming professional attitudes although, nowadays, we are only concerned with special knowledge and skills to be acquired by residents. All the agents involved in this educational cycle – the Department of Health, the National Council of Medical Specialties, the accredited health care organisations and the accredited educational programmes – should be aware of the changes required and take measures to implement them. Firstly, criteria and procedures for selection and distribution of candidates should take into account the complete pro"le of the candidate, exceeding current limitations that only take into consideration theoretical knowledge. Specialist training should change from the present “comb” model , with forty or so individualised specialties to the “tree” model with two-three levels of specialisation originating from fewer (4-6) trunks. Di'erent kinds of medical specialist are needed in the health care system. Some may be of a more technical pro"le then others but basic common traits acquired on a basic level should not be lost in the process of acquiring more speci"c ones at higher levels of specialisation. Training curricula cannot further neglect ethical development in professionalism values of trainees nor general skills such as information management or the workings of the health care system. $e selection and assessment of tutors-mentors should be better handled given the relevant role they play in the “hidden curriculum” as “role models” in shaping attitudes of future specialists. $e formative and summative assessment of trainees, on a credible basis, has yet to be developed, almost out of nothing, if the system wants to know how it is really performing and be accountable for the quality of what it produces. $e postgraduate specialist training system should avoid further advancing in its fragmentation with an increase in the number of “independent” specialties without a reorganisation of the system, since this trend distorts the medical profession into a cloud of highly skilled technicians with a very limited scope of expertise.