Jorge Valdez
Dean
TecSalud (Medicine and Health Sciences Faculty of the Monterrey Institute of Technology)
/
Expert Contributor

Medical Specialist Training: Challenges and Opportunities

By Jorge Valdéz | Mon, 01/10/2022 - 17:11

Providing the population with quality healthcare is a complex process that involves different actors but mainly proficient, skillful, and highly specialized physicians. The goal of graduate medical education is to ensure that enough physicians-in-training become competent to practice in their field of medicine. In Mexico, medical residency is defined as a set of academic, care, and research activities that are endorsed by universities and the surgical programs implemented by the clinical training sites. Each residency program must be registered with the National Medical Residence System of the Interinstitutional Commission for the Training of Human Resources in Health.

Training in residency programs is highly competitive; it requires the formation of competent physicians that achieve the performance standards that were declared for their technical skills, attitudes, and interpersonal abilities. The goals of any residency program describe three needs: best care for the patient, social pertinence and accountability, and personal accomplishment. In this type of training, learning takes place in the clinical settings that are highly influenced by several changes to clinical care, such as the diminution of patients, cost optimization, and a reduction of the length of stay in hospitals. Medical specialties should adapt to those changes, and they would still have to reorient their efforts to prepare the physicians in their residency.

In our country, the number of specialists is lower than the average in other countries (178 versus 119 per 100,000 population) of the Organization for Economic Co-operation and Development. Regarding geographical distribution, 54.2 percent of medical specialists are concentrated in Mexico City, State of Mexico, Jalisco, and Nuevo Leon; the remaining 45.8 percent are distributed in the other 28 states. Mexico City had the highest rate of medical specialists (505.7/100 000 population), followed by Nuevo Leon (185.3/100 000 population) and Jalisco (172/100 000 population). On average, there are 1.7 male specialists per female specialist.

Access

Training programs are concentrated in a few cities; the cities with the highest concentration are Mexico City, Monterrey, and Guadalajara. To obtain a spot in a residency program, the graduate physician must pass the highly selective National Examination of Medical Residency Applicants. In the country, 54 institutions in the public and private spheres offer places for specialized medical training. Candidates annually compete for 17,940 spots (17,520 for Mexicans and 420 for foreigners) in the different academic programs. In 2016, of the 46 institutions that offered places for resident doctors, 18 (39 percent) were public and 28 (61 percent) private institutions. The largest number of training opportunities 9,040 (52 percent) are in the clinical facilities of the Mexican Institute of Social Security. Another 4,251 slots (24 percent) are available from the Ministry of Health. Approximately 366 (2 percent) of training opportunities are available through nongovernmental organizations; one of them, Tecnológico de Monterrey, has an innovative public-private (nonprofit) approach.

The specialties with the highest offer in descending order were: 1) Family Medicine, 2) Internal Medicine, 3) Pediatrics, 4) Anesthesiology, 5) Gynecology and Obstetrics, 6) General Surgery, 7) Emergency Medicine, 8) Traumatology and Orthopedics, 9) Diagnostic and Therapeutic Imaging and 10) Ophthalmology. The trend of increase in supply indicates that 88.3 percent of specialized training positions are concentrated in these 10 specialties and of these, 22 percent correspond to family medicine positions. In contrast, the 10 specialized training positions least requested by general practitioners in Mexico in 2016 were: Radio-oncology; Occupational and environmental medicine; Epidemiology, Audiology, Otoneurology and Phoniatrics; Medical Genetics, Nuclear Medicine and Molecular Imaging, Preventive Medicine, Quality of Clinical Care, Physical Activity Medicine and Legal Medicine, representing 2.7 percent of the total offer of specialized training places.

Certification

After completing a three- to five-year training period, residents graduate with a university degree of medical specialist. To practice their specialty, graduates must obtain a professional license, which requires passing their specialty Board of Certification examination. This is a practical and theoretical examination. Of the total of 147,910 specialists; 69 percent had current specialty certification by the medical council of the respective specialty. With some specialties obtaining rates above 95 percent of valid certification, while others occupational with percentages below 20 percent

Accreditation

Excellence in clinical care demands quality medical education. This principle has prompted initiatives for evaluation and accreditation in Mexico’s residency programs. The National Council of Science and Technology has established an accreditation system for medical residencies: the List of the National Graduate Quality Program. According to the National Council of Science and Technology (CONACyT), 250 medical specialty programs were incorporated into the PNPC in 2021. The states that have the most accredited medical specialty programs are Mexico City (85), Nuevo Leon (56), Jalisco (55) San Luis Potosi (18), and Sinaloa (10). These federal entities encompass 90 percent of all the accredited programs. Only 24 (9.6 percent) clinical training sites (endorsed by five universities: UANL, UNAM, UdeG, UASLP, and Tecnologico de Monterrrey) are accredited at international competence level, 12 in Nuevo Leon, six in Jalisco, five in Mexico City and one in San Luis Potosi.

At present time, the need for medical specialists is a hot topic of debate. Gaps in what is needed and what is offered are pointed out. There is an inertial thinking to make decisions based on the force of custom, but it is imperative to ensure the strategic planning of human resources in health in Mexico, considering the needs of the population, the quality of the training and its pertinence. We need the right number of medical specialists educated to the highest international standard to obtain the proper certifications and adequately distributed geographically.

 

Information sources:

Brechas en la Disponibilidad de Recursos Humanos para la Salud. http://www.cifrhs.salud.gob.mx/site1/residencias/brechas_medico_enf_esp.pdf

Padrón nacional de Posgrados de Calidad (CONACYT) http://svrtmp.main.conacyt.mx/ConsultasPNPC/padron-pnpc.php

Educación médica en México Ricardo León-Bórquez, Víctor M. Lara-Vélez, Luis F. Abreu-Hernández. FEM 2018; 21 (3): 119-128

Medical specialists in Mexico. Gerhard Heinze-Martin, Víctor Hugo Olmedo-Canchola, Germán Bazán-Miranda, Napoléon Andrés Bernard-Fuentes, Diana Patricia Guízar-Sánchez. Gac Med Mex 2018;154(3):342-351. doi: 10.24875/GMM.1800377

Photo by:   Jorge Valdez