There is a worrying shortage of teaching staff, which has an impact on other health sciences degrees.7 This was highlighted in the study “Predicted change in the number of permanent medical teachers from 2017 to 2026. The training of future physicians in critical condition,”8 which showed that 43% of the permanent teaching staff will retire in this decade (55% for those linked to health centers). This highlights the need to adopt urgent measures.

Very few people applied for accreditation and even fewer obtained it. In 2019, the criteria were modified without addressing the proposals made.9 That year, only 40 individuals were accredited as PTU for all the faculties that offer undergraduate medical degrees (then 43), involving up to 25 knowledge areas. Only 102 applications were submitted and the favorable report rate was only 40%, demonstrating the excessive difficulty of the current criteria. Potential candidates did not even try, a situation that reflects disaffection for collaborating with university education.

Since 2015, the CNDFME has made numerous proposals to ANECA requesting a higher valuation of teaching activity, including clinical tutoring and honorary collaborations; healthcare activity, which should be as important as teaching and research; and adequate research activity.

The willingness shown by the General Secretariat of the Ministry of Universities and the ANECA Management from 2020 to the present to seek solutions to such a serious situation is very much appreciated. In fact, in 2021, the CNDFME presented the “Study of the academic half-life of permanent professors with teaching in the degree of medicine. Estimation of the need for professors,”10 agreed on by both institutions. For public universities, the deficit of Permanent Professors and Assistant Lecturers (PAD) amounted to 2654 adjunct and 1163 non-adjunct professors. The average age for a PTU position was 54 years; for adjunct CU positions, it was 65 years. Another review of the accreditation criteria was insisted upon, as well as the priority of extending the figure of Adjunct Hired Lecturer (now in the LOSU, adjunct PPL) to the national level and implementing the figure of an adjunct PAD.8

The increase in the number of accreditations has a real impact on teaching quality. First, among many other considerations, permanent teaching staff bear the major responsibilities regarding the coordination, organization, and quality of the teaching provided. A dearth in this type professor means responsibilities must be assumed—and this happens frequently—by non-permanent teaching staff with less availability. It also requires additional dedication, which highlights their commitment to teaching. On the other hand, the increase in permanent faculty entails an improvement in the student/faculty ratio in the health sciences branch. As has been noted,10 this ratio should be similar to that of the sciences, since both branches share similar teaching needs in terms of the small number of students that must make up the internship groups, especially in healthcare centers. However, according to information from the Ministry of Universities, the current ratio is similar to that of the social and legal sciences branch. It would be necessary to hire three times the current faculty to have a ratio similar to that of the sciences. With the increase in the number of accreditations, this imbalance is beginning to be corrected.

ANECA, in agreement with the General Secretariat of the Ministry of Universities, immediately set up a commission to review these criteria (in accordance with RD 415/2015), in which members of the CNDFME and other colleagues participated. The commission worked for 18 months, leading to a significant modification of the criteria for the health sciences branch in 2022.11

Pursuant to RD 415/2015, the criteria prioritized research and teaching; a positive evaluation in these two dimensions was sufficient to obtain accreditation. In the event that the minimum level required was not reached, it could be compensated by virtue of relevant merits in the remaining dimensions: knowledge transfer and professional activity, management, and training. ANECA and the committees were responsible for approving these criteria. They were collected in a 122-page document of tables with an exhaustive list of the curricular merits that could be provided. Research activity in the health sciences branch had to be accredited by a high number of publications with a very high impact factor—which was almost exclusively within the reach of very consolidated research groups—and neither teaching collaboration nor the healthcare and transfer activity of professionals at healthcare institutions was adequately recognized.

Regarding research, following the modifications to the criteria for the health sciences branch in 2022,11 the range of publications evaluated was expanded and the required impact factor was adapted. In teaching, difficulties were resolved, such as the appropriate certification of years and hours of teaching, the justification of teaching quality, the number of hours required, and the teaching of honorary positions. In transfer and professional activity, the number of merits was increased to compensate for a deficit in research or teaching (present, above all, in health professional profiles).

Changes in the accreditations of Tenured University Lecturers and University Professors in the Health Sciences Branch by the evaluating committees: Committee of Biomedical Sciences and Related Clinical Specialties (B6), Committee of Clinical Medicine and Clinical Specialties (B7), and Committee of Health Specialties I and II (B8 and B9). The graphs have been prepared by the CNDFME based on the annual reports published by ANECA.

There has been a significant increase in the number of accreditations (Fig. 1A and B). In the case of PTU, compared to 2019, there was a 1,064% increase (149 accreditations) in Committee B6, 635% increase (165 accreditations) in Committee B7, and 479% increase (378 accreditations) in Committees B8 and B9 by 2024. In the case of CU, compared to 2020, there was a 73% increase (33 accreditations) in Committee B6, 780% increase (78 accreditations) in Committee B7, and 972% increase (107 accreditations) in Committees B8 and B9 by 2024. Just as remarkable as the increase in the number of accreditations was the increase in the number of applications and the percentage of accreditations out of the total number of applications. This shows that there is now indeed a greater interest in becoming involved with university education. Although these changes are very significant, their number is still insufficient to make up for the existing professor shortage, which began in 2010.

Figure 1.

A. Accreditations to Tenured University Lecturers in the Health Sciences Branch in the period 2019–2024 (ANECA Academy Program). B. Accreditations to University Professor in the Health Sciences Branch in the period 2020–2024 (ANECA ACADEMIA Program).

B6: Committee on Biomedical Sciences and Related Clinical Specialties; B7: Committee on Clinical Medicine and Clinical Specialties; B8 AND B9: Committee on Health Specialties I and II. Each column shows the number of favorable accreditation reports. It also indicates the number of applications and the percentage of favorable reports for those applications. Graphs prepared by the authors based on data published by ANECA.

ANECA also has the Teacher Evaluation Program for Recruitment4 (PEP), in which the evaluation for hired teaching positions is carried out. In the case of public universities, the law requires a favorable evaluation for PPL figures. With the LOSU,3 accreditation prior to PAD is not required (art. 78); quality agencies no longer perform this accreditation, although it will be considered meritorious until 2027. In the case of private universities, the LOSU3 establishes that 60% of the total number of doctoral professors must have obtained a positive evaluation from ANECA for the position of PUP (art. 99).

It also shows changes in the number of accredited faculty hired in the PEP Program (period 2020/2024) by ANECA, which has seen no significant changes during this period (Fig. 2). They are the group of people accredited in the health sciences branch, which includes 12 undergraduate degrees, medicine among them. In addition to this teaching staff are those accredited by the autonomous community quality agencies (partial data available in their annual reports), where, in general, no significant changes have been observed. The diversity of teaching figures included in AQU Catalunya12 and Unibasq-Agency for Quality of the Basque University System13 should also be considered (Table 1).

Figure 2.

Accreditations to Hired Permanent Lecturer (previously Hired Lecturer), Professors at Private Universities, and Assistant Lecturers in the Health Sciences Branch in the 2020–2024 period (ANECA’s PEP Program).

PPL: Hired Permanent Lecturer, PUP: Private University Professor, PAD: Assistant Lecturer. Each column shows the number of favorable accreditation reports. It also indicates the number of applications and the percentage of favorable reports for those applications. Graphs prepared by the authors based on data published by ANECA.

It is also noteworthy that at least the ACCUA14 Agency of Andalusia and the ACPUA15 Agency of Aragon have specific accreditation procedures for the accreditation of PPL with clinical agreements in which the health quality agencies also participate, with a specific assessment of the healthcare activity. It is surprising that some autonomous communities have not yet implemented the figure of the adjunct PPL (formerly Adjunct Hired Lecturer), since it is one of the effective measures to alleviate the deficit of clinical faculty,16 which is the most pressing.

In regard to the accreditation model of countries in this setting, the European Association for Quality Assurance in Higher Education provides general criteria and guidelines on everything related to university teaching. Although there is no single accreditation at the European level, a parallel can be drawn between Spain’s system of university teaching staff accreditation and that of other European Union countries such as Italy, France, Germany, and Portugal. This is provided for in Spain in RD 678/2023, which regulates accreditation for access to university teaching bodies5 so that the accreditation procedure does not constitute a barrier to internationalization. This decree stipulates that ANECA must have procedures in place to recognize the permanent teaching staff of universities in European Union member states as accredited. It also stipulates that the teaching staff of universities in other European Union member states who have attained a position at least comparable to that of PTU may apply for accreditation as CU.

RD 678/2023,5 which regulates state accreditation for access to university teaching bodies, unifies the accreditation and competitive examinations for access in a single regulation and expounds upon the innovations included in the LOSU.

The LOSU3 introduces the analogous consideration of teaching and research experience, including transfer, in the accreditation process (art. 51). It provides for its simplification and the inclusion of a greater variety of methods, criteria, and contributions evaluated (art. 69). The evaluation is based on the selection of a limited number of contributions and the narrative on their quality, relevance, and impact.5,6 It guarantees a “qualitative as well as quantitative” evaluation of merits, with a wide range of indicators of scientific relevance and social impact (previously based mainly on the Journal Citation Report impact factor).3,5,6. It integrates feedback from the international movement for reform of research evaluation,5,6which have also been incorporated into the evaluation of merits for ANECA accreditation of the six-year research and transfer periods.17

For sufficient teaching accreditation, the number of full-time equivalent hours/year has been reduced6 (e.g., a minimum of four years is required for PTU accreditation).

It also includes a repeated request for adequate recognition of the teaching activity carried out by PAs and clinical tutors/honorary collaborators (called “specialists with teaching commitment” by ANECA).6 “Associate professor and temporary substitute professor contracts shall be considered full-time when they reach 6h of class time per week (180h of annual teaching capacity). The rest of the contracts for associate professors and temporary substitute professors shall be considered part-time. In the case of contracts for adjunct faculty (health sciences), each 1.5 years of clinical activity as a specialist with a teaching commitment with a university (clinical professor or similar figure) will be considered 1year of full-time dedication.”

For CU accreditation, it is necessary to demonstrate leadership skills,6 including leadership of teaching and research teams, university and scientific direction and management, doctoral theses and Master’s theses, and responsibility in scientific organizations and scientific-technical committees. These merits are not required for PTU accreditation.

From the CNDFME, we requested that the Ministry of Universities consider professional healthcare activity to be as important as teaching and research for health sciences clinical areas. For the accreditation of university teaching bodies, the LOSU3 stipulates that professional healthcare activity must be evaluated (art. 69): “(…) An evaluation based on the specificity of the area or field of knowledge taking professional experience into account, among other criteria, especially when it concerns, among others, regulated professions in the health field (…).”

RD 678/2023,5 which regulates state accreditation for access to university teaching bodies (art. 21), does as well, including merits related to professional activity: “(…) after hearing the corresponding committees, ANECA will establish the merits and competencies to be considered in the assessment of applicants’ professional experience, especially in the case of regulated professions and artistic education." In fact, ANECA indicates in its evaluation criteria document,6"For accreditation to PTU and CU in the health sciences clinical areas, it will be necessary to justify five years of professional experience in clinical activity, public or private, with the period of Specialized Health Training able to be included.” These criteria must be specified by ANECA and the specific health sciences committees.

The LOSU3 includes another of the CNDFME’s requests in its second final provision, modifying art. 105 of Law 14/1986, the General Health Law: “Within the framework of the healthcare and teaching planning of the public administrations, the system of agreements between universities and healthcare institutions may establish a connection between certain healthcare and public health positions of the healthcare institution with any type of university teaching position (…) A health sciences specialist degree will be essential in the case of individuals with a university degree in medicine (…).”

The accreditation of adjunct PPL and the possibility of initiating the implementation of the figure of PAD are provided for, defining a professional promotion pathway—both at the university and healthcare institution—for young specialists with special interest in research and teaching. In fact, some autonomous communities are approving regulations for this new teaching figure (the most advanced projects are in Murcia, Aragon, and Andalusia). It is also important to promote support programs that allow the hiring of young specialists, facilitating their accreditation as PPL. This is the case of the María Castellano Arroyo Program18 in Andalusia, where the first positions have been announced.19

The first evaluations under the new model and accreditation criteria are being conducted. It may lead to a significant increase in the number of individuals accredited as permanent faculty in medical schools.