The Federation of Spanish Scientific Medical Associations (FACME) has designed a common framework, applicable to all medical specialties, with the aim of strengthening advanced specialization and the professional development of specialist doctors.
This proposal sets out four differentiated training pathways starting from the obtaining of the specialist title, with the intention of configuring a uniform model based on scientific-technical criteria that facilitates in Spain the formal recognition of the advanced competencies of clinicians.
FACME points out that the greater complexity of pathologies, technological progress, and the demand for the utmost effectiveness and safety for patients have made it essential to structure areas of advanced specialization that are developed after MIR training and the obtaining of the specialty.
Although the country already has a legal framework formed by Law 44/2003 (LOPS) and Royal Decrees 639/2015 and 589/2022, the federation emphasizes that the absence of effective implementation is generating organizational difficulties in the National Health System (SNS), by complicating the planning of positions with profiles of high specialization.
"This situation affects both the care guarantees for patients and the professional development of specialist doctors," FACME adds.
The consensus document proposes a framework for advanced specialization and aims to serve as a guide to the Public Administrations for its recognition and implementation in the SNS. In its drafting, 46 scientific societies that group the medical specialties recognized legally in Spain have intervened, together with experts from the autonomous communities and the collaboration of the Ministry of Health.
Four differentiated pathways
The Federation’s proposal establishes four complementary routes to respond to different scenarios of updating and specialization.
The first is the periodic recertification of the specialty, conceived to check and offer public assurance that all practicing specialists retain and renew their professional competencies, with a suggested cycle of six years.
The second includes specific courses and short training placements, aimed at recognizing and accrediting specific techniques or learnings as professional merits, without them constituting a new official qualification. The document exemplifies this pathway with training in robotic surgery for general surgeons.
The third route is the Diplomas of Advanced Accreditation (DAA). FACE explains that they respond to the need to organize and recognize existing care situations in which certain professionals assume functions of higher qualification in specific functional areas.
It is proposed to resort to this route when the tasks of higher qualification exceed 50 percent of the activity of the care unit. The example used in the document is the diploma in palliative care.
The fourth route is the Areas of Specific Training (ACE): advanced training programs designed to respond to scientific and technical advances that require knowledge, competencies, and skills of very high specialization. Their creation is proposed when activities of higher qualification represent more than 80 percent of usual practice. The illustrative case included in the document is specialization in hemodynamics and interventional cardiology.
For the ACE, the proposal includes training placements of between one and two years (with at least 70 percent of the time devoted to specific training), planned jointly between the General Administration of the State and the autonomous communities based on care needs.
Likewise, an extraordinary or transitional route of access is provided for those professionals who, at the time the ACE is launched, can provide proof of sufficient experience in the corresponding functional area.
Joint work with the Ministry of Health
The document is the result of several months of work between the Ministry of Health and FACME, which began at a meeting held in early 2026 with more than 40 experts from scientific-medical societies and ministerial representatives, including the minister Mónica García and the Director General of Professional Planning, Miguel Ángel Máñez, as well as specialists designated by the autonomous communities.
The final text incorporates the subsequent contributions of all the societies integrated in the Federation. This initiative is part of the prior public consultation opened by the Ministry on July 17 to modify, by means of a royal decree, the regulation of the DAA and the ACE, a process in which FACME submitted its technical proposals on July 31.
The Federation trusts that the clear definition of these four itineraries will make it possible to harmonize the needs for continued and advanced medical training with a more efficient organization of the health system, always maintaining the highest levels of quality and safety in patient care.