ENT-HNS in Spain Eduardo Raboso, MD, PhD.

M.I.R Médico Interno Residente. Current official medical training program in Spain. Since 1976.

M.I.R. In order to be allowed to train residents, clinical departments must apply for certification. Requirements are very stringent. Certifications are reviewed periodically and can be removed. Most are public hospitals. Only two private hospitals are certified for ENT resident training.

M.I.R. Graduate students are not allowed to practise medicine unless they complete a minimum of two years clinical training in a hospital. In practice, that means that every graduate student in Spain must undergo the MIR training syllabus in order to be able to practise medicine.

MIR Access to the MIR training program is granted via an examination. It is considered one of the most difficult exams in Spain. Over 14.000 students apply for over 6.000 posts.

MIR EU students are granted exactly the same rights as the spanish students. South american students also enjoy a very easy access but they can apply to a limited percentage of posts (4%). Non EU applicants must get the medical degree accepted and certified by the Health Ministry and demonstrate a certain level of spanish language.

MIR The exam: 225 multiple choice questions. 10 more in reserve. 35 are based on anatomical and radiological imaging. Many clinical cases. Extremely up to date. Only 3 ENT questions.

MIR The exam means the 90% of the final qualification. The remainder 10% depends of the career marks.

MIR The final qualification provides an order number. Number one chooses first, number two chooses second and so on. The choosing procedure takes two weeks and is followed with the utmost interest by the health community.

MIR Residents start spending some months in general surgery. The training syllabus must follow the guidelines stipulated by the Ministry. All services must have at least one tutor in charge of the residents. Department heads are not allowed to be tutors. Most services have a rotation program inside and outside the department. Residents are allowed to make clinical rotations in other centers, even in the foreign. All the training procedure is closely monitored by the training commision of the hospital. Residents are evaluated every year. The department is also valuated by the residents.

MIR Residents can be forced to repeat one year. They can also be dismissed. The department can also deny the certification. There is no national board examination after resident training…yet. Residents assume the first call of the ward. They must always have a member of the staff overviewing their work. Residents start surgery very early. They are never allowed to operate alone. All the residents activities must be surveyed by the staff members.

ENT-MIR ENT resident appointment is for 4 years. There are 81 ENT certified posts for residents available each year.

Registered number of ENT specialists. (SEORL-CCC) Active specialists:1780 Residents: 344 Retired: 330 Total number can be close to 4000. 46.500.000 inhab. 1 ENT /11.500 people.

Public/private activity Most of the ENT staff have private practice in Spain. Residents are not allowed to have private practice. In some areas of Spain, Heads of Departments are not allowed private practice.

Non EU specialists They need a Permission to Work. If the ENT certification has not been achieved in the EU, it must be validated by the Health Ministry with an examination. The Ministry is quite reluctant to validate non EU certifications.

Academic degree. PhD is required for any academic activity. It is extremely difficult to certify as professor or chairman of a University Department because of the very low impact factor of the ENT magazines.