Special article
Predicted change in the number of permanent medical teachers from 2017 to 2026. The training of future physicians in critical condition
Evolución previsible en el número de profesores permanentes de Medicina del 2017 al 2026. La formación de los futuros médicos en situación crítica
J.P. Laraa,
, A. Compañb, J.A. Vargas-Núñezc, F. Cardellachd, S. Fernández-Gonzáleze, A. López-Muñizf, J.L. Álvarez-Salag, On behalf of the Conferencia Nacional de Decanos de Facultades de Medicina de España ◊
Corresponding author
a Decano de la Facultad de Medicina, Universidad de Málaga, Málaga, Spain
b Decano de la Facultad de Medicina, Universidad Miguel Hernández, Elche, Alicante, Spain
c Decano de la Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, Spain
d Decano de la Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain
e Decano de la Facultad de Medicina, Universidad de Navarra, Pamplona, Navarra, Spain
f Decano de la Facultad de Medicina, Universidad de Oviedo, Oviedo, Asturias, Spain
g Presidente de la Conferencia Nacional de Decanos de Facultades de Medicina de España, Decano de la Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
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A: profesores permanentes de áreas básicas; B: profesores permanentes no vinculados de áreas clínicas; C: profesores permanentes vinculados de áreas clínicas, y D: número total de profesores permanentes.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J.P. Lara, A. Compañ, J.A. Vargas-Núñez, F. Cardellach, S. Fernández-González, A. López-Muñiz, J.L. Álvarez-Sala" "autores" => array:8 [ 0 => array:2 [ "nombre" => "J.P." "apellidos" => "Lara" ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Compañ" ] 2 => array:2 [ "nombre" => "J.A." "apellidos" => "Vargas-Núñez" ] 3 => array:2 [ "nombre" => "F." "apellidos" => "Cardellach" ] 4 => array:2 [ "nombre" => "S." "apellidos" => "Fernández-González" ] 5 => array:2 [ "nombre" => "A." "apellidos" => "López-Muñiz" ] 6 => array:2 [ "nombre" => "J.L." 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La formación de los futuros médicos en situación crítica" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1388 "Ancho" => 2566 "Tamanyo" => 232906 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Number of permanent professors by clinical knowledge area; the current total number (adjunct professors appear in blue, and staff professors appear in orange) and the number of retirements within the next 10 years are shown (both for staff and adjunct professors).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Over the past decade, Spanish medical schools have implemented the new degree in medicine in accordance with the directives resulting from the European Higher Education Area.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> The new syllabus focuses on acquiring general, transversal and specific competencies that are considered necessary for exercising the medical profession.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1,2</span></a> What is taught is not as important as what the future physician learns. The development of these plans has entailed greater teaching dedication by having to organize various types of face-to-face and other kinds of activities, including the implementation of activities for small groups, attention to tutorials and individualized practical training and the implementation of continuous assessment systems that are more complex than before. The time required of teaching staff has obviously increased significantly, as has the collaboration of healthcare institutions. Properly training future physicians deserves this effort.</p><p id="par0010" class="elsevierStylePara elsevierViewall">One might think that, in the past 10 years, there has been a parallel proportional increase in the number of professors teaching courses in medicine. Nothing could be further from the truth. Instead, a substantial reduction in their number has occurred recently, to the point where permanent professors (professors, associate professors and physician professors), upon whom the teaching organization depends, have reduced in number by an average of more than 20%. These reductions have reached 20% and 26% in the faculties of medicine of the Universidad Complutense of Madrid and the University of Malaga, respectively. The situation is so severe that there are already areas of knowledge, especially clinical, in numerous faculties that have no professors with an “adjunct position” on the subject, which are those who belong to the university's teaching staff and have the rights and responsibilities inherent in that position. This also includes the statutory employees of the regimen corresponding to social security or to the concerted institution who perform their assigned teaching, research and healthcare duties.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The current situation is of enormous concern to the National Conference of Medical School Deans of Spain (CNDFME) due to its shortcomings and the excessive effort it entails in daily practice, which is difficult to maintain over time. The outlook for the coming years is, however, even worse. For this reason, we conducted the present study, which defines the current situation in public Spanish medical schools and predicts the change in the next 10 years (period 2017–2026) if the current approaches for the replenishment of professors, especially clinicians, does not change substantially. We believe that this study reveals, clearly and obviously, the pressing need to adopt urgent measures to alleviate the current situation and prevent greater problems.</p><p id="par0020" class="elsevierStylePara elsevierViewall">In short, the objectives for this study are as follows:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1.</span><p id="par0025" class="elsevierStylePara elsevierViewall">To provide accurate information on the current number of permanent professors in the areas of basic and clinical knowledge (differentiating between staff and adjunct professors), as well as the predicted change in the coming decade.</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2.</span><p id="par0030" class="elsevierStylePara elsevierViewall">To offer objective data to facilitate decision making and establish the needs, which we believe are mandatory, and strategic actions by competent authorities.</p></li></ul></p><p id="par0035" class="elsevierStylePara elsevierViewall">The main results (based on 30 of the 32 current public Spanish medical schools) are as follows:<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">1.</span><p id="par0040" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Information regarding the number of permanent professors.</span> Based on the collection of faculties, we obtained a mean value that is representative of the situation of an average Spanish faculty (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). This faculty has 173 newly incorporated students for each course and has 87 permanent professors, 40% of whom are ascribed to 15 areas of basic knowledge and the remaining 60% to 18 areas of clinical knowledge (in which all clinical specialties are grouped). Among the latter (clinical professors), we can differentiate between those who have a staff position with the healthcare institution (45%) and those who have an adjunct position (15%). Consider as well that these same professors also teach other degrees in health sciences and other branches of knowledge. These professors also participate in postgraduate teaching, conduct essential research activities, and many of them perform quality healthcare work in their institutions.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">2.</span><p id="par0045" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Information regarding permanent professors who will retire each year over the next 10 years.</span> The information assumes that this retirement will occur at 70 years, although there is a growing number of professors who retire earlier. Thus, the number of retirements regarding the average situation of Spanish public medical schools is as follows: 87 permanent professors will become 52. In this period (2017–2026), 43% of all permanent professors will retire, the largest percentage (55%) corresponding to staff faculty of clinical areas, 34% to adjunct faculty of clinical areas and 32% to faculty of basic areas (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). In other words, the deficit is known to be significant at this time, and it is clear that in only a few years the situation will be unsustainable.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">3.</span><p id="par0050" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Information regarding the number of permanent teachers by knowledge area.</span> We independently considered the basic (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>) and clinical areas (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>), as well as their predicted change in the next 10 years. In this case, we reviewed all of the 30 faculties included in this study and not the average value, as was done in the 2 previous points.</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia></li></ul></p><p id="par0055" class="elsevierStylePara elsevierViewall">Moreover, the CNDFME wants to restate its considerable concern about the proposed new accreditation criteria for the figure of tenured professor and university professor of the ACADEMIC program of the National Agency for the Assessment of Quality and Accreditation (ANECA).<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">4,5</span></a> This concern arises from the following considerations:<ul class="elsevierStyleList" id="lis0015"><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">1.</span><p id="par0060" class="elsevierStylePara elsevierViewall">The report published by ANECA regarding the results obtained with the criteria previously in effect during 2008–2016 indicated that the “health sciences branch” achieved the lowest rate of favorable reports in the accreditation for full professor (53%, 12 points below the mean), which has prevented its renewal, even if the actual replacement rate for teacher retirements had not occurred. As indicated in this report, the lower rate of favorable reports coincides with the higher mean age of the candidates (51 years, 7 years above the mean), which indicates that the difficulty in accreditation in the “health sciences branch” is greater than that in other branches of knowledge.</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">2.</span><p id="par0065" class="elsevierStylePara elsevierViewall">The low systemic replenishment rates have, over several consecutive years, significantly aggravated the situation due to the scarce number of offered posts and the added difficulties for healthcare practitioners certified for permanent teaching positions to access these posts, by the collective agreements of universities in which these posts are not considered preferential.</p></li><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">3.</span><p id="par0070" class="elsevierStylePara elsevierViewall">The new criteria,<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> proposed by the specific committees, have been rejected by practically all university sectors due to the significant difficulty in compliance for a professor of clinical areas and because as a whole they excessively prioritize research activity, without adequately assessing the dedication to teaching, management work and healthcare work, which is often immense and performed by teachers in Spanish medical schools.</p></li><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">4.</span><p id="par0075" class="elsevierStylePara elsevierViewall">These difficulties make an academic career unattractive for practitioners.</p></li></ul></p><p id="par0080" class="elsevierStylePara elsevierViewall">Based on the previously mentioned facts and circumstances, the main conclusions are as follows:<ul class="elsevierStyleList" id="lis0020"><li class="elsevierStyleListItem" id="lsti0050"><span class="elsevierStyleLabel">1.</span><p id="par0085" class="elsevierStylePara elsevierViewall">There has been a significant reduction in the number of permanent professors, especially in the areas of clinical knowledge, above all in staff faculty, and in basic areas, in which the number of physicians has declined significantly (data not shown in this study, but in the possession of CNDFME since 2014).</p></li><li class="elsevierStyleListItem" id="lsti0055"><span class="elsevierStyleLabel">2.</span><p id="par0090" class="elsevierStylePara elsevierViewall">The reduction in the number of permanent medical professors will further intensify in the coming decade. The sizeable generational change appears to be inevitable without specific measures to deal with the severe and imminent situation. There is an urgent need to have a stable staff of permanent medical professors. Measures to prevent this considerable problem from increasing should therefore be decided upon quickly.</p></li><li class="elsevierStyleListItem" id="lsti0060"><span class="elsevierStyleLabel">3.</span><p id="par0095" class="elsevierStylePara elsevierViewall">Data regarding the retirement of staff professors fully coincide with the high number of retirements that will occur in the public healthcare system. In this respect, the demographic facts, which are available to the public administration, are unquestionable and well-known, if they really wanted to access them. Extraordinary measures will also be required to alleviate this situation, adopting urgent measures to provide stable positions for staff faculty for teaching medicine.</p></li></ul></p><p id="par0100" class="elsevierStylePara elsevierViewall">The situation and its solutions are complex. We need to consider, among other proposals, completely eliminating the replenishment and bidding of posts according to each university's actual needs, depending on their budgetary situation. We also need to consider changing the accreditation criteria for permanent professors, assigning an appropriate value to the work of teaching, healthcare and management and designing a strategy that makes the university track attractive for young physicians in hospitals and health centers. To define these solutions, this information has been sent to the Ministry of Education, Culture and Sports, the Ministry of Health, Social Services and Equality, the Conference of Rectors of Spanish Universities, ANECA, the Committees of the Health Sciences Branch of the Academic Program of ANECA, the Medical Profession Forum and the Ministries of Health and Universities. CNDFME offers their collaboration to all of these institutions.</p><p id="par0105" class="elsevierStylePara elsevierViewall">The training of future physicians, who are immediately responsible for the health of the Spanish society and the treatment of diseases, depends largely on the theoretical and clinical training taught in medical schools, with the essential collaboration of healthcare institutions. Therefore, CNDFME wants to express and indicate, so that there is no doubt, that the current situation regarding permanent professors is critical. This situation will be even worse within the near future. At present, the faculties’ current teaching system, which has provided so much quality to the Spanish healthcare system, is at risk. Furthermore, its very survival is at risk, an ominous situation considering the constant, disproportionate and seemingly unstoppable increase in the number of medical schools and in the number of students who are admitted every year, undoubtedly a paradox of paradoxes.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conflicts of interest</span><p id="par0110" class="elsevierStylePara elsevierViewall">The study was developed by the CNDFME, whose main objectives are to promote activities aimed at the scientific, technical, healthcare and cultural progress of medicine and the training (as complete possible) of Spanish physicians, as well as the study, reflection and analysis of problems in the medical education setting in Spain, within the framework defined by the Spanish constitution and laws (Art. 3 of the Statutes of Association).</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:7 [ 0 => array:3 [ "identificador" => "xres1156250" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1083491" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1156251" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1083492" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of interest" ] 5 => array:2 [ "identificador" => "xack394595" "titulo" => "Acknowledgements" ] 6 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2018-03-05" "fechaAceptado" => "2018-04-24" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1083491" "palabras" => array:3 [ 0 => "Medical schools" 1 => "Permanent teachers" 2 => "Change" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1083492" "palabras" => array:3 [ 0 => "Facultades de Medicina" 1 => "Profesores permanentes" 2 => "Evolución" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The significant and progressive reduction in the number of permanent teachers in medical schools (professor, associate professor and assistant professor) is a reason for concern for the National Conference of Deans. This reduction will intensify in the coming decade (2017–2026). Forty-three percent of the permanent faculty will retire, as will 55% of the faculty linked to clinical areas, 34% of the faculty not linked to clinical areas and 32% of the faculty of basic areas. This deficit is significant now, and, in a few years, the situation will be unsustainable, especially in the clinical areas. This report reveals the pressing need to adopt urgent measures to alleviate the present situation and prevent a greater problem. The training of future physicians, immediately responsible for the health of our society, depends largely on the theoretical and practical training taught in medical schools, with the essential collaboration of healthcare institutions. Paradoxically, while the number of teachers decreases substantially, there is an exponential increase in the number of medical schools and students who are admitted every year without academic or healthcare justification.</p></span>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">La disminución significativa y progresiva en el número de profesores permanentes en las facultades de Medicina (catedrático, profesor titular y profesor contratado doctor) es motivo de preocupación para la Conferencia Nacional de Decanos. Esta disminución se intensificará en la próxima década (2017–2026). Se jubilará el 43% del profesorado permanente: un 55% del profesorado vinculado de áreas clínicas, un 34% del profesorado no vinculado de áreas clínicas y un 32% del profesorado de áreas básicas. Este déficit es importante en el momento actual y en pocos años la situación será insostenible, especialmente en áreas clínicas. Este informe pone de manifiesto la necesidad inaplazable de adoptar medidas urgentes que palíen la situación actual y que prevengan un mal mayor. La formación de los futuros médicos, responsables inmediatos de salud de nuestra sociedad, depende en gran parte de la enseñanza teórica y práctica que se imparte en las facultades de Medicina, con la colaboración esencial de las instituciones sanitarias. Paradójicamente, a la vez que disminuye sustancialmente el número de profesores, aumenta exponencialmente el número de facultades de Medicina y el número de alumnos que se admiten cada año sin justificación académica ni sanitaria.</p></span>" ] ] "NotaPie" => array:2 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Lara JP, Compañ A, Vargas-Núñez JA, Cardellach F, Fernández-González S, López-Muñiz A, et al. Evolución previsible en el número de profesores permanentes de Medicina del 2017 al 2026. La formación de los futuros médicos en situación crítica. Rev Clín Esp. 2019;219:84–89.</p>" ] 1 => array:3 [ "etiqueta" => "◊" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">In the annex all the names of the components of the National Conference of Deans of Faculties of Medicine of Spain are detailed.</p>" "identificador" => "fn0005" ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "<p id="par0120" class="elsevierStylePara elsevierViewall">List of Deans of the National Conference of Medical School Deans of Spain</p> <p id="par0125" class="elsevierStylePara elsevierViewall">M. Rodríguez Zapata (Alcalá de Henares), J. A. Arias Navalón (Alfonso X el Sabio), Vicenç Fonollosa Pla (Autónoma de Barcelona), J. A. Vargas Núñez (Autónoma de Madrid), Francesc Cardellach López (Barcelona), A. Lorenzo Peñuelas (Cádiz), J. C. Villegas Sordo (Cantabria). A. Martínez Marcos (Castilla-La Mancha, Ciudad Real), J. Martínez Pérez (Castilla-La Mancha, Albacete), J. Lajara Blesa (Católica de Murcia, San Antonio), G. Cerdá Olmedo (Católica de Valencia, San Vicente Mártir), A. López Castellano (CEU Cardenal Herrera), T. Chivato Pérez (CEU San Pablo), J. L. Álvarez-Sala Walther (Complutense, Madrid), L. Jiménez Reina (Córdoba), E. Gazapo Carretero (Europea de Madrid), F. Vaz Leal (Extremadura), F. Caballero Martínez (Francisco de Vitoria), J. Sam Molina (Girona), A. Valenzuela Garach (Granada), A. Balaguer Santamaría (Internacional de Cataluña), M. Roca Bennasar (Balearic Islands), R. Ballester Arnal (Jaime I, Castellón), A. Castañeyra Perdomo (La Laguna), M. P. Santana Delgada (Las Palmas of Gran Canaria), R. M. Soler Tatché (Lleida), J. P. Lara Muñoz (Málaga), A. F. Compañ Rosique (Miguel Hernández), M. García Salom (Murcia), S. Fernández González (Navarra), A. López Muñiz (Oviedo), J. G. Pineda Guiral (Basque Country), J. Gea Guiral (Pompeu Fabra), C. Gallardo Pino (Rey Juan Carlos), A. Castro Salomó (Rovirá i Virgili), F. J. García Criado (Salamanca), J. Álvarez Escudero (Santiago de Compostela), L. C. Capitán Morales (Seville), F. J. Chorro Gascó (Valencia), J. M. F. Fernández Gómez (Valladolid), J. Castillo García (Zaragoza).</p>" "etiqueta" => "Appendix A" "titulo" => "Addendum" "identificador" => "sec0010" ] ] ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1073 "Ancho" => 1488 "Tamanyo" => 75214 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Average situation of public medical schools in terms of the number of permanent professors and the number of first-year students admitted. (A) Permanent professors of basic areas; (B) Permanent adjunct professors of clinical areas; (C) Permanent staff professors of clinical areas; and (D) Total number of permanent professors.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1471 "Ancho" => 2172 "Tamanyo" => 126894 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Change in the number of permanent professors, considering the average situation of public medical schools; the current number is shown for each group of professors, (2017), as well as the predicted number in 10 years (2026) and the number and percentage of retirements (RET). (A) Permanent professors of basic areas; (B) Permanent adjunct professors of clinical areas; (C) Permanent staff professors of clinical areas; and (D) Total number of permanent professors.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1355 "Ancho" => 2527 "Tamanyo" => 211205 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Number of permanent professors by basic knowledge area; the current total number and the number of retirements within the next 10 years are shown.</p>" ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1388 "Ancho" => 2566 "Tamanyo" => 232906 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Number of permanent professors by clinical knowledge area; the current total number (adjunct professors appear in blue, and staff professors appear in orange) and the number of retirements within the next 10 years are shown (both for staff and adjunct professors).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "Available from: <a class="elsevierStyleInterRef" target="_blank" id="intr0010" href="https://www.boe.es/buscar/act.php?id=BOE-A-2007-18770">https://www.boe.es/buscar/act.php?id=BOE-A-2007-18770</a> [accessed 04.04.18]" "contribucion" => array:1 [ 0 => array:1 [ "titulo" => "Real Decreto 1393/2007, de 29 de octubre, por el que se establece la ordenación de las enseñanzas universitarias oficiales" ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "BOE" "fecha" => "2007" "volumen" => "260" "paginaInicial" => "44037" "paginaFinal" => "44048" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0035" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "Available from: <a class="elsevierStyleInterRef" target="_blank" id="intr0015" href="https://www.boe.es/buscar/doc.php?id=BOE-A-2008-2674">https://www.boe.es/buscar/doc.php?id=BOE-A-2008-2674</a> [accessed 04.04.18]" "contribucion" => array:1 [ 0 => array:1 [ "titulo" => "ORDEN ECI/332/2008, de 13 de Feb, por la que se establecen los requisitos para la verificación de los títulos universitarios oficiales que habiliten para el ejercicio de la profesión de Médico" ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "BOE" "fecha" => "2008" "volumen" => "40" "paginaInicial" => "8351" "paginaFinal" => "8355" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0040" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "Available from: <a class="elsevierStyleInterRef" target="_blank" id="intr0020" href="https://www.boe.es/buscar/doc.php?id=BOE-A-1986-20584">https://www.boe.es/buscar/doc.php?id=BOE-A-1986-20584</a> [accessed 04.04.18]" "contribucion" => array:1 [ 0 => array:1 [ "titulo" => "Real Decreto 1558/1986, de 28 de junio, por el que se establecen las bases generales del régimen de conciertos entre las Universidades y las Instituciones sanitarias" ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "BOE" "fecha" => "1986" "volumen" => "182" "paginaInicial" => "27235" "paginaFinal" => "27239" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0045" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "Available from: <a class="elsevierStyleInterRef" target="_blank" id="intr0025" href="https://www.boe.es/buscar/doc.php?id=BOE-A-2015-6705">https://www.boe.es/buscar/doc.php?id=BOE-A-2015-6705</a> [accessed 04.04.18]" "contribucion" => array:1 [ 0 => array:1 [ "titulo" => "Real Decreto 415/2015, de 29 de mayo, por el que se modifica el Real Decreto 1312/2007, de 5 de octubre, por el que se establece la acreditación nacional para el acceso a los cuerpos docentes universitarios" ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "BOE" "fecha" => "2015" "volumen" => "144" "paginaInicial" => "50319" "paginaFinal" => "50337" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "Available from: <a class="elsevierStyleInterRef" target="_blank" id="intr0030" href="http://www.aneca.es/Programas-de-evaluacion/ACADEMIA/Criterios-de-evaluacion-noviembre-2017">http://www.aneca.es/Programas-de-evaluacion/ACADEMIA/Criterios-de-evaluacion-noviembre-2017</a> [accessed 26.02.18]" "contribucion" => array:1 [ 0 => array:1 [ "titulo" => "Agencia Nacional de Evaluación de la Calidad y Acreditación (ANECA). Criterios de evaluación" ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:1 [ "fecha" => "2017" ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack394595" "titulo" => "Acknowledgements" "texto" => "<p id="par0115" class="elsevierStylePara elsevierViewall">We would like to thank Mercedes de Blas for her invaluable and competent work as the Technical Secretariat of CNDFME. We would also like to thank Prof. Miguel A. Barbancho for his invaluable collaboration in processing the results.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/22548874/0000021900000002/v1_201902270625/S2254887418301024/v1_201902270625/en/main.assets" "Apartado" => array:4 [ "identificador" => "3982" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Special Article" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/22548874/0000021900000002/v1_201902270625/S2254887418301024/v1_201902270625/en/main.pdf?idApp=WRCEE&text.app=https://revclinesp.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887418301024?idApp=WRCEE" ]
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