Medicina Intensiva  (English Edition) Medicina Intensiva  (English Edition)
Med Intensiva 2018;42:65-8 - Vol. 42 Num.1 DOI: 10.1016/j.medine.2017.12.004
Letter to the Editor
Choice of critical care medicine: Analysis of the last 10 years
La elección de la especialidad medicina intensiva: análisis de los últimos 10 años
J. Curbeloa,, , A. Fernández-Somoanob,c, J.M. Romerod, T. Villacampae, F. Sánchez-Lasherasf, J. Baladróng
a Servicio de Medicina Interna, Hospital Universitario La Princesa, Madrid, Spain
b Departamento de Medicina, IUOPA-Área de Medicina Preventiva y Salud Pública, Universidad de Oviedo, Oviedo, Spain
c CIBER de Epidemiología y Salud Pública-CIBERESP, Instituto de Salud Carlos III, Madrid, Spain
d Blog MIRentrelazados, Spain
e Curso Atención Primaria Asturias, Oviedo, Spain
f Departamento de Construcción e Ingeniería de Fabricación, Universidad de Oviedo, Gijón, Spain
g Curso Intensivo MIR Asturias, Oviedo, Spain
Received 23 January 2017, Accepted 06 February 2017
Dear Editor:

In Spain, practicing the medical profession requires a Degree in Medicine. Furthermore, access to specialized training requires passing a State examination called on an annual basis by the Spanish Ministry of Health, Social Services and Equality (Ministerio de Sanidad, Servicios Sociales e Igualdad [MSSSI]), and known as the Internal Resident in Training (Médico Interno Residente [MIR]) exam.1 Those candidates that reach an examination grade above the minimum cutoff point are listed from higher to lower total score and are assigned an order number with which they become potential choosers of one of the offered specialized training posts.2,3 The higher the total score, the lower the order number: number one corresponds to the candidate with the maximum note, and this individual is the first to choose a specialized training post. The choice and designation of posts is called by the MSSSI, and the data are public.

The present communication analyzes the offer and demand referred to the specialty of Intensive Care Medicine in recent years, and presents the map of Spanish Autonomous Communities and chosen centers with the best order numbers. The analysis has been based on the official MIR posts designated by the MSSSI covering the annual examinations from 2006 to 2015–the latter corresponding to the post designation act of 2016. The data obtained from the different analyses are reported as the mean, maximum and minimum, median and percentiles 25 and 75 of the order number of the candidates that chose such training posts. We studied the association between the number of posts in Intensive Care Medicine and the total posts offered annually, based on the Pearson correlation coefficient.

In the period covering the years 2006 to 2015, the number of training posts in Intensive Care Medicine ranged from a minimum of 139 in 2006 to a maximum of 168 in the years 2009 and 2010. The number of posts offered gradually increased up until 2010, coinciding with a total of 6874 hospital training posts offered that same year. Since then the mentioned figure has decreased slightly, in parallel to the drop in total number of posts. The correlation between the offered number of posts in Intensive Care Medicine and the total number of training posts was 0.92 (p<0.005).

In the period between 2006 and 2015, the minimum order number for choosing the specialty of Intensive Care Medicine was 7 and the maximum 5441–the latter being the post chosen as last option in the considered time period.

The median order number for choosing Intensive Care Medicine in that period was 3677, with a mean of 3317. On limiting the analysis to the period covering the last 5 years, the median order number was 3621.5 and the mean 3196.1. Fig. 1 shows the annual evolution of the median and percentiles 25 and 75 from the year 2006 to the last examination call (2015). Slight variations are observed, influenced in part by the number of posts in Intensive Care Medicine offered each year. The maximum or highest median corresponded to the year 2009, with a value of 3960, and in that same year a total of 168 posts in Intensive Care Medicine were offered (the highest offered posts value). In contrast, the lowest median corresponded to the year 2006, with 3363, and with 139 offered posts (the lowest value in the period 2006–2015). Therefore, the median choice of each year for Intensive Care Medicine has varied little, and has done so in relation to the total resident training posts offered.

Figure 1.
(0.09MB).

Distribution of order numbers in the choice of Intensive Care Medicine according to year of examination call.

In relation to the choice of Intensive Care Medicine with respect to other specialties, based on pooled data covering the period from 2006 to 2010, the median for Intensive Care Medicine stood in position 28 of the ranking by specialties, while in the period 2011–2015 it stood in position 29. In the isolated analysis of the year 2015, the specialty remained in position 29 out of a total of 44 offered specialties. Fig. 2 shows the ranking of the different medical specialties by median order number corresponding to the choice in the examination of the year 2015.

Figure 2.
(0.44MB).

Representation of the medical specialties offered, listed by median order number of choice corresponding to the examination call of the year 2015.

In the analysis according to Autonomous Communities, Madrid was the Community offering the largest number of training posts in Intensive Care Medicine during the period 2011–2015, with a total of 130 (17.3% of the global offer). This Community was followed by Andalusia with 123 posts (16.4%) and Catalonia with 109 (14.5%). In contrast, the Communities with the fewest posts in Intensive Care Medicine during the period were La Rioja, Navarre and Asturias, with 5, 8 and 12 posts, respectively. In the ranking by Autonomous Communities during the period 2011–2015, Madrid was the Community with the lowest median order number, with a value of 2225, followed by Cantabria with 2410 and the Basque Country with 2743. Table 1 shows the Autonomous Communities listed from best to worst median order number. Likewise, for each Community, the table shows the hospital with the lowest order number for that period and region. In the Communities of La Rioja, Cantabria and Navarre the Community and hospital data coincide, since these Communities have a single center offering training posts in Intensive Care Medicine.

Table 1.

Ranking of the Spanish Autonomous Communities according to median order number with the data corresponding to the period 2011–2015. The hospital with the lowest median in that period is shown for each Community.

Ranking by Autonomous Communities and hospitals in each Community in the period 2011–2015
  No.  Mean  Minimum  Maximum  p25  Median  p75 
Madrid  130  2257  4102  1226  2225  3439 
H. U. 12 de Octubre  15  621.7  1475  237  428  1039 
Cantabria  15  2521.8  443  4075  1744  2410  3567 
H. U. Marqués de Valdecilla  15  2521.8  443  4075  1744  2410  3567 
Basque country  29  2881  371  4378  2101  2743  3972 
H. U. de Donostia  10  2129.2  371  3972  1605  1939.5  2675 
Aragon  26  2753.3  336  4837  1388  2827.5  3982 
H. U. Miguel Servet  11  1612.4  336  2893  1001  1388  2310 
Catalonia  109  2964.1  110  4523  2361  3281  3860 
H. U. Germans Trias i Pujol  13  1563.1  110  2784  361  1974  2930 
Valencian Community  85  3201.8  235  4839  2569  3556  3934 
H. U. i Politècnic La Fe  15  1665.9  235  3073  1153  1517  2323 
Asturias  12  3587.1  923  4676  3350.5  3665  4161 
H. U. Central de Asturias  3159  923  4104  3055  3437  3823 
Navarre  3374.5  1898  4422  2512  3642.5  4183.5 
C. H. de Navarra  3374.5  1898  4422  2512  3642.5  4183.5 
Andalusia  123  3415.1  331  4581  3218  3754  4000 
H. Regional U. de Málaga  12  2464  331  3673  1658.5  2778  3236 
Murcia  32  3589.8  642  4763  3541  3829  4105.5 
H. Clinico. U. Virgen de la Arrixaca  14  2983.7  642  3922  2586  3541  3755 
Balearic Islands  16  3355.6  1011  4265  3007  3838.5  4018.5 
H. U. Son Espases  11  3216.1  1011  4054  3002  3791  3986 
Castilla La Mancha  26  3946.7  3221  4725  3594  3952  4310 
C. H. de Toledo  3628.2  3475  4000  3538  3576  3604 
Galicia  25  3899.8  2155  4536  3771  4041  4346 
C. H. U. A Coruña  11  3658.1  2155  4467  3621  3905  4025 
La Rioja  4126.4  3804  4498  3949  4123  4258 
H. San Pedro  4126.4  3804  4498  3949  4123  4258 
Canary Islands  41  4087.5  1796  4982  3946  4207  4470 
H. U. de Canarias  3827  2485  4525  3557  3972.5  4273.5 
Castilla y León  48  3857.6  466  5156  3596.5  4248.5  4433.5 
H. U. Rio Hortega  2904.4  1820  4349  2245  2886  3222 
Extremadura  20  4159.9  2165  4695  4115.2  4252.5  4484.5 
C. H. U. de Badajoz  10  4143  3382  4597  4009  4167.5  4253 

C.H.U.: university hospital complex (complejo hospitalario universitario); H.: hospital; No.: total number of posts offered in the period; p25: percentile 25; p75: percentile 75; U.: university.

Table 2 shows the pooled data since 2011, corresponding to the 15 best ranking hospitals in term of Intensive Care Medicine throughout the country. The list is headed by Hospital Universitario Doce de Octubre, Hospital Clínico San Carlos and Hospital Miguel Servet. Their median order numbers were 428, 762 and 1388, respectively.

Table 2.

Ranking of the 15 hospitals with the lowest median order number in the choice of Intensive Care Medicine with the pooled data corresponding to the period 2011–2015.

Ranking of hospitals at national level in the period 2011–2015
  No.  Mean  Minimum  Maximum  p25  Median  p75 
H. U. 12 de Octubre  15  621.7  1475  237  428  1039 
H. U. Clínico San Carlos  14  833.6  109  1522  614  762  1118 
H. U. Miguel Servet  11  1612.4  336  2893  1001  1388  2310 
H. U. Puerta de Hierro  10  1574.4  686  2968  915  1488  2018 
H. U. i Politècnic La Fe  15  1665.9  235  3073  1153  1517  2323 
H. U. de Donostia  10  2129.2  371  3972  1605  1939.5  2675 
H. U. Germans Trias i Pujol  13  1563.1  110  2784  361  1974  2930 
H. U. La Paz  15  1983.5  525  3368  1636  2034  2321 
H. U. de Getafe  10  2275  822  3625  1619  2046.5  3094 
H. U. Fundación Jiménez Díaz  2416.8  874  3647  2044  2059  3460 
H. U. Vall d’Hebron  15  2023.9  237  3588  1549  2174  2536 
H. General U. Gregorio Marañón  10  2312.7  1489  3468  1924  2222.5  2550 
H. U. Marqués de Valdecilla  15  2521.8  443  4075  1744  2410  3567 
H. U. Cruces  2542  1458  3290  2577  2660  2725 
H. Regional U. de Málaga  12  2464  331  3673  1658.5  2778  3236 

C.H.U.: university hospital complex (complejo hospitalario universitario); H.: hospital; No.: total number of posts offered in the period; p25: percentile 25; p75: percentile 75; U.: university.

The data presented in this study are the result of an objective analysis of the choice of training posts in Intensive Care Medicine, based on official information from the MSSSI. The study does not intend to afford an analysis of healthcare or training quality of the teaching hospital centers. The choice of training post is conditioned by many individual variables of the candidate that have not been considered in this study. The analysis is no less interesting as a result of this, however, since the data reflect a constant demand for the specialty over the years and highlight the trends in terms of geographical setting and training hospitals.

Conflicts of interest

The authors declare that they have no conflicts of interest.

References
1
Real Decreto 127/1984, de 11 de enero, por el que se regula la formación médica especializada y la obtención del título de médico especialista. BOE núm. 26, de 31 de enero de 1984. p. 2524–8.
2
Real Decreto 183/2008, de 8 de febrero, por el que se determinan y clasifican las especialidades en Ciencias de la Salud y se desarrollan determinados aspectos del sistema de formación sanitaria especializada. Available at: http://www.boe.es/boe/dias/2008/02/21/pdfs/A10020-10035.pdf [accessed 08.01.17].
3
Real Decreto 639/2014, de 25 de julio, por el que se regula la troncalidad, la reespecialización troncal y las áreas de capacitación específica, se establecen las normas aplicables a las pruebas anuales de acceso a plazas de formación y otros aspectos del sistema de formación sanitaria especializada en Ciencias de la Salud y se crean y modifican determinados títulos de especialista. Available at: http://www.boe.es/boe/dias/2014/08/06/pdfs/BOE-A-2014-8497.pdf [accessed 08.01.17].

Please cite this article as: Curbelo J, Fernández-Somoano A, Romero JM, Villacampa T, Sánchez-Lasheras F, Baladrón J. La elección de la especialidad medicina intensiva: análisis de los últimos 10 años. Med Intensiva. 2018;42:65–68.

Corresponding author. (J. Curbelo curbelo1984@gmail.com)
Copyright © 2017. Elsevier España, S.L.U. and SEMICYUC
Med Intensiva 2018;42:65-8 - Vol. 42 Num.1 DOI: 10.1016/j.medine.2017.12.004