1 RECOGNITION OF MEDICAL SPECIALTIES UNDER THE MEDICAL PRACTITIONERS ACT 2007 QUESTIONNAIRE AND GUIDANCE FOR ASPIRANT SPECIALTIES NAME, POSITION, AND CONTACT DETAILS OF PERSON COMPLETING THE QUESTIONNAIRE TITLE OF PROPOSED SPECIALTY
2 INTRODUCTION The Medical Council s primary statutory responsibility, under the Medical Practitioners Act 2007 (MPA 2007), is to protect the interests of the public. As part of this role, it sets standards for undergraduate and postgraduate education and training and monitors compliance with those standards. Its remit includes responsibility for determining, with the consent of the Minister for Health, the medical specialties that it recognises under the MPA 1. It should be noted that the medical specialties recognised shall include such medical specialties as may be designated as applying to the State in any directive adopted by the Council of the European Communities relating to specialist medicine. 2 The following questionnaire should only be completed by an aspirant speciality once the Medical Council has asked the aspirant speciality to do so as part of a process of determination under the Act. To facilitate aspirant specialties in deciding whether to apply for formal recognition and to inform them of the methodology which will be used to evaluate any application, a document entitled Recognition of Medical Specialties under the Medical Practitioners Act 2007: Guidance for Aspirant Specialties has been included as an appendix. The completed questionnaire can be returned by post to: Specialties Medical Council (Education & Training) Kingram House, Kingram Place, Dublin 2 Alternatively, it can be sent by to If you have any queries about the application process, please contact the Education and Training Section of the Medical Council at Please note we cannot advise about the current status of applications. A M Keane Head of Education and Training 1 Medical Practitioners Act 2007 (MPA 2007) Section 89 (1) 2 MPA 2007, Section 89 (5)
3 EVIDENCE REQUIRED FOR RECOGNITION OF SPECIALTY An application for the recognition of a medical specialty will be assessed against the indicators set out in I-IV below. The completed questionnaire should be a maximum of 20 pages long. Please address each subsection individually. The term assessor(s) means any person or group of people, whether Council members or otherwise, mandated by Council to evaluate an application. I: That the proposed specialty is a well-defined, distinct and legitimate area of medical practice with a sustainable base in the medical profession Please describe (using examples) how the proposed specialty: I (a) is sufficiently distinct from other specialties, based on substantiated and major new concepts in medical science and health care delivery such that it is not feasible to include it within the current specialty structure; I (b) represents a new well-defined and widely accepted field of medical practice (e.g. as demonstrated by a comprehensive and developing body of international research and scholarly literature to support evidence-based clinical practice; significant representation within academic medicine; number of meetings held annually; the existence of a national and / or international society with a principal interest in the proposed specialty; formal recognition as a medical specialty (or other relevant category) in comparable countries; I (c) has a demonstrable and sustainable base in the medical profession (e.g. as demonstrated by a sufficient number of practitioners with the capacity to meet existing clinical need, who possess the knowledge and skills to practise in the specialty, and who practice predominantly in the specialty); I (d) can sustain activities such as vocational training and assessment and continuing professional development. Please note: Information regarding current numbers practicing; the rate of increase over the past decade; and projections of the future need for specialist-level skills and knowledge in this area of medicine is required.
4 II: That specialisation in this area of medicine is demonstrably contributing to substantial improvements in the quality and safety of healthcare Please describe (using examples): II (a) Whether the proposed specialty has improved the quality of healthcare in Ireland (by increased effectiveness of health care as defined by improved health outcomes; increased appropriateness of health care as defined by providing care relevant to patients needs and based on established standards; increased safety of care and / or significant reduction of harm experienced as a result of receiving healthcare); II (b) That specialisation is not and will not adversely affecting the quality of healthcare in Ireland by promoting the unnecessary fragmentation of medical knowledge and skills and / or medical care, including that it should be broadly available nationally; the unnecessary deskilling of other medical practitioners (e.g. GPs and other primary health care providers); inequitable access to health care as defined by socioeconomic status, geography or culture; II (c) That where the specialist medical services are already provided or could be provided by practitioners in a recognised specialty or a combination of recognised specialty groupings, provision of these services by this new specialty enhances the quality and/or efficiency of healthcare.
5 III: That specialisation in this area of medicine is demonstrably contributing to substantial improvements in the standards of medical practice Please describe whether / how: III (a) There is a professional body that is responsible for setting the requirements and standards for training, assessment and certification in the specialty; that is capable of defining, promoting, maintaining and improving standards of medical practice to ensure high quality health care, and capable of engaging stakeholders, including health consumers, in setting standards; that has guidelines and procedures for determining who will be Fellows/Members of the body; that has appropriate processes for determining the standard of education, training and experience of medical practitioners trained in the discipline overseas; III (b) The specific body of knowledge and skills is sufficiently complex or extensive to require a comprehensive and distinct training programme; III (c) There is or will be a programme of education, training and assessment that will enable practitioners to: undertake unsupervised, comprehensive, safe and high quality medical practice in the relevant specialty, including in the general roles and competencies that apply to all professional medical practice; demonstrate the requisite knowledge, skills and professional attributes through exposure to a broad range of clinical experience and training in the relevant specialty; contribute to providing high standards of medical education; provide leadership in the complex health care environment, working collaboratively with patients and their families and a range of health professionals and administrators; demonstrate a knowledge and understanding of the issues associated with the delivery of safe, high quality and cost-effective health care within the Irish health system. III (d) There is or will be a programme of continuing professional development that assists participants to maintain and develop knowledge, skills and attitudes essential for meeting the changing needs of patients and the health care delivery system, and for responding to scientific developments in medicine
6 III (e) The professional body can demonstrate experience in all or some of the following: health policy development health promotion and advocacy research activity and facilitation the development and dissemination of the discipline s evidence base the education of other medical and health professionals engagement with health consumers.
7 IV: That recognition of the specialty would be a wise use of resources Please demonstrate: IV (a) That recognition of the proposed specialty is of significance to health as defined by a significant burden of disease, incidence, prevalence or impact on the community which is relevant to the proposed specialty; IV (b) That this significance is coupled with a demonstrated capacity of members of the proposed specialty to influence it; IV (c) That there is significant professional and consumer support for the recognition of the medical specialty; IV (d) That the resource implications for health care providers and consumers are justified on the basis of benefit to the community inherent in the recognition of the specialty.
8 APPENDIX 1 RECOGNITION OF MEDICAL SPECIALTIES UNDER THE MEDICAL PRACTITIONERS ACT 2007 GUIDANCE FOR ASPIRANT SPECIALTIES
9 PROCESS FOR RECOGNITION OF MEDICAL SPECIALTIES A. Summary of process The process for recognition for medical specialties is a two-stage process and has been developed on the grounds of effective use of resources, both of the Medical Council and of the applicant. In determining whether an application should be successful, and whether an aspirant specialty should be recognised or otherwise, the Medical Council places a high value on the views of the Health Service Executive (HSE), as it does on the views of all relevant stakeholders. Council is committed to ensuring that decisions made under Section 89(1) of the Medical Practitioners Act 2007 (MPA) take account of as broad a range of inputs as possible. 1. Stage One (detailed in Part B) of the recognition process is an initial evaluation of an application for recognition as a specialty. This evaluation will be undertaken by the Professional Development Committee (incorporating Education and Training) of the Medical Council (PDC) or other equivalent committee of Council. 2. The PDC will then make its recommendation to the Medical Council. 3. The Medical Council will make its decision on whether the application should proceed to Stage Two, or otherwise. 4. If Council s decision is that the application should proceed to Stage Two (detailed in Part C), the applicant will be notified and the full accreditation process will then be undertaken; the schedule for this full accreditation will be drawn up by the Medical Council. If Council s decision is that the application should not proceed to Stage Two, the applicant will be notified and given an opportunity to request a review of the decision via a Medical Council internal review mechanism. Applicants will be asked to specify the grounds on which an unsuccessful application should be reassessed. 5. Following completion of Stage Two, the PDC will then make its recommendation to the Medical Council. 6. The Medical Council will make its decision to recognise, or otherwise, the aspirant specialty. 7. The Council will seek Ministerial consent to its decision before recognition is finally determined, as per the requirements of Section 89(1) of the MPA
10 8. The applicant speciality will be notified of the outcome of the process and provided with a report. 9. In the event of an adverse decision, a review of the decision can be requested by the applicant specialty via a Medical Council internal review mechanism. As above, applicants will be asked to specify the grounds on which a reassessment should be considered. A flow chart of the process is appended. More details about some aspects of the process are provided below. B. Details of Stage One The purpose of Stage One is to give the applicant the opportunity to establish a case for full assessment. The extent to which the applicant specialty meets the required threshold for full assessment will be determined on the basis of a self-evaluation - a questionnaire completed by the applicant - and an evaluation by the PDC and Council. Council will make this assessment after reviewing the responses to indicators (I-IV) as per the questionnaire. An application is unlikely to be successful in reaching Stage Two if it: a) Is in an area of practice limited to a specific geographic area or narrow demographic group; b) Is in an area of practice limited to the treatment of a single disease, or based on a limited number of techniques; c) Is in an area of practice based on a single modality of treatment; d) Is already recognised (fully or partly) under a different name. An application cannot proceed to Stage Two if it: e) Is presented without evidence of support from a Postgraduate Training Body. For this reason, a formal letter from a Training Body in support of the application should be provided with the application. f) Is presented without confirmation from the HSE that there has been engagement with the HSE by the applicant, and that the HSE is broadly supportive of the application being assessed in further detail by the Medical Council.
11 An area of practice not directly involved in clinical care will have to provide evidence that specialisation is providing substantial benefits to the health status of the broader community if it is to proceed to Stage Two. Based on its assessment of the preliminary application, the PDC will make one of the following recommendations to Council: a) That an initial case for recognition has been made and that the applicant body be invited to submit a full application for specialty recognition; or b) That an initial case has not been made, but that the applicant body be invited to submit additional information for further consideration at a future date; or c) That an initial case has not been made and that the preliminary application should be rejected. The Medical Council will determine a), b) or c). The applicant will subsequently be informed of the outcome and may be given advice on re-submission. C. Details of Stage Two If the Medical Council decide that an initial case for recognition has been demonstrated, applicants will proceed to Stage Two. This is the full recognition process which will be undertaken under the aegis of the PDC. The indicators that will be used to assess the application in Stage Two are the same indicators as are used for Stage One. However, Stage Two will be a more in-depth assessment in which more supporting evidence may be sought from the aspirant specialty and in which the views of external assessors will be sought. At its discretion, the PDC will use assessors from inside and outside the State who have the necessary knowledge to provide feedback on the aspirant specialty. The nature of the additional supporting evidence required for Stage Two will be discussed with each applicant specialty, and may vary depending on the depth of information already submitted by the applicant. The application will be placed on the Council s website so that interested parties can contribute their views, and these will also be taken into consideration. At the PDC s discretion, there may be a meeting(s) between the applicant and the assessors / PDC members, and / or assessors / PDC members may choose to visit training site(s).
12 The Medical Council may seek additional information from the applicant in relation to the proposed training pathway for practitioners wishing to pursue specialist training in the proposed discipline. Additional engagement with the applicant, the HSE and the proposing training body may be necessary to clarify intentions and support in this area. After evaluation of the application, the PDC will recommend and Council will approve one of the following: a) That Council recognise the specialty; or b) That Council defer recognition until all necessary clarifications have been received; or c) That Council refuse recognition. If the decision is (a), the Medical Council will then seek Ministerial consent. The applicant will subsequently be informed of the outcome and if necessary may be given advice on resubmission. In the event of an adverse decision, a review of the decision can be requested by the applicant specialty via a Medical Council internal review mechanism. D. Fees The Medical Council will charge a fee to cover the costs of the necessary administration associated with the recognition process. This fee will be in two parts; an initial fee will be charged in advance for Stage One and a further fee will be charged if the aspirant specialty proceeds to Stage Two. Please refer to the Medical Council s current schedule of fees for further information; the current schedule of fees is available on the Medical Council s website or on request from the Education and Training Section at E. Queries If you have any queries about the process, please contact the Education and Training Section of the Medical Council at Please note we cannot advise about the content or current status of applications. Approved by the Medical Council 9 th September 2010 and Revised by the Education, Training and Professional Development Committee 23 rd October 2013
13 Flow Chart for Recognition of Medical Specialties under the MPA Declaration of Intent The aspirant specialty formally request recognition. 2. Stage One Self-Evaluation The aspirant specialty completes and returns self evaluation documentation within an agreed timescale. 3. Stage One- Medical Council Evaluation PDC assesses if the aspirant specialty has an initial case for recognition. 6. Stage Two- Self-Evaluation The aspirant specialty provides any requested additional evidence to support its case for recognition. 5. End of Stage One The aspirant specialty proceeds or does not proceed to Stage Two. 4. Medical Council s Decision The Medical Council determines whether the aspirant specialty s application proceeds to Stage Two. 7. Medical Council Evaluation The PDC and external assessors evaluate the application, conducting meetings / site visits as necessary. 8. Medical Council Decision The Medical Council makes its decision on recognition or otherwise. 9. After the Decision Consent of the Minister sought and the aspirant specialty informed of outcome and any follow-up action.
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