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.

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

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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.

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

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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 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.

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.