Preventive Medicine and Public Health It is, for better or worse, a unique specialty. Far from the ‘classic’ healthcare field of the medical profession, the vast majority of residents who choose it in each MIR call do so from a very vocational point of view, and that is why it never usually appears among those that are exhausted before (in fact , in the last call it was the only one that, together with Family and Community Medicine and Occupational Medicine, did not cover all their places in the ordinary call). This is also why it has a radically different training to all other specialties, and its residents have been demanding for some time that this be reflected in the next updating your teaching program.
“Our training is divided into three stages: the first is the master’s degree in public health that we must take compulsorily; the second is carried out in primary and specialized care centers; and the third and last is in public care centers, research centers and administrative units. In addition to all this, the training program of Preventive Medicine and Public Health mark the transversal and specific skills that we must acquire in each of these blocks,” he explains to ConSalud.es Antonio Pujol de Castromember of the National Commission of the specialty representing residents.
First of all, indicate the R3 of the San Carlos Clinical Hospital of Madrid, from ARES (Association of Residents of Preventive Medicine and Public Health) what they seek is precisely to better differentiate the areas where these levels are developed, since the current program only indicates the five professional areas that specialists cover: epidemiology, administration health, preventive medicine, environmental and occupational health and health promotion. “It is not the same to do it in a hospital or a research center as in a health department or in a public administration,” says the resident.
“Training in a hospital or a research center is not the same as training in a Ministry of Health or in a public administration”
Also, within these dimensions, and independently of the theoretical and practical contents that the new program includes, they ask to introduce into it a part of “rights” of residents that appear regulated. And, remembers the future preventivist, his has a series of peculiarities that make it “very different” from the rest of specialties. “For example, we do not do Preventive Medicine guards, but rather we have continuing care modulesand that is why we have appreciated that we are not regulated by days, like other residents. In the end, each hospital has different hours, which in essence is an extended day,” explains Pujol de Castro.
In fact, they ask that this module directly change its name, from ‘continuous care’ to ‘continuous or extended day‘, and instead of having a maximum or minimum number of days, what is taken into account are the hours: “In one hospital they stay until nine, in another until ten… you have to regulate minimum hoursbecause the maximums should be, in principle, the same as those of the rest of the guards, according to the labor legislation of that moment.
Also, the possibility of making maximums by objectives. “That is to say, that it is no longer just presence that counts, but that, depending on the rotation you are in At all times, you can achieve objectives regardless of whether they are done during work hours or not. In fact, in many places they already work like this,” says the former ARES coordinator, who also asks that the emergency guards for Preventive Medicine residents: “In some hospitals the R1s do them, in others they don’t… and, of course, in the rest of their professional life as preventive specialists they will not have guards. We don’t see that it makes sense beyond carry one more person to train during the guards.”
“It doesn’t make any sense that a rotation that has to be done no matter what counts as external”
Likewise, unlike in the rest of specialties, many of those skills that the training program establishes can only be acquired in state agenciesas external health. Thus, Pujol de Castro criticizes, it also makes no sense that a rotation that they have to do “yes or yes” to acquire these skills counts in the file as an external rotation. “We ask that all rotations in the Ministry of Health count as internalbecause our scope is very broad, it is not limited only to the hospital,” he requests. Regarding this, he reports, they have already had meetings with Health, “who say they agree,” but meetings with each teaching unit are missing to be able to carry it out.
WAITING FOR A LONG TIME TO CHANGE THE CONDITIONS
The last time the Preventive Medicine and Public Health training program was modified was almost 20 years ago. Specifically in the 2005so, if the Ministry of Health meets its forecasts, it will be updated after 1998: Thoracic Surgery, Anesthesiology, Cardiovascular Surgery, Nuclear Medicine and Intensive Medicine. “Already in 2021, the National Commission of the specialty made a first draft of the new programwhich he sent to the Ministry. However, they have not paid much attention to us since then, and the president of the Commission, Inmaculada Salcedo, has asked to meet with them on several occasions. They have never received it,” Pujol de Castro laments about a specialty that, as mentioned at the beginning of the article, requires taking a master’s degree during the first year of residency.
Said master’s degree, however, It is only available in some cities in Spainforcing many future specialists to move. The young resident talks about “surviving” with a base salary of around 1,300 euros. “We see an economic grievance with other specialties, and even with residents who are from the same city where they study the master’s degree. For example, many of us from Madrid were able to do guard duty in first class, while those who come from elsewhere do not have that time. We ask that you can do continued tele-face-to-face care modules, which in our specialty is possible,” requests Pujol de Castro. “We also came to raise the specialty name changeto bring it more in line with current events, but the Ministry told us that this was a different procedure, and that it was not advisable to delay all the updates,” he says.