Carlos Perdigão
Professor of Cardiology at the FMUL
Coordinator of the IFA Office of Continuous TrainingContinuous Medical Training
Continuous medical training, understood as lifelong training, is a need that doctors feel for permanent updating of the knowledge and skills they acquired as undergraduates and that they will apply in their clinical activity, research or even as new teachers. This updating has an obvious reflection on the community, given that it allows an improvement of health care provided to the population. For this reason, in the report by the Permanent Committee of European Doctors, continuous medical training is considered to be an ethical obligation and also a fundamental right.Training Actions
The forms that this updating might take on and the methods used are very diversified. From courses to symposia, from workshops to conferences, all forms are valid as long as they have very clearly defined aims and are organized and carried out by those who have the competence and necessary training to do so. It will be up to the doctors to orientate their needs and choose the training actions that they deem most adequate to these needs.The Training Entities
Among the entities that can carry out this continuous training – the Ministry of Health, Scientific Societies, the Medical Association, Faculties of Medicine – the last of these may take on a relevant role, given that in themselves they contain an excellent human potential covering all the medical areas. Indeed, in all medical schools there has been an increasing concern for providing post-graduate training, which nowadays is an integral part of medical teaching and an essential complement to undergraduate training.Certification and Accreditation
One concern that training actions have brought to educators and to trainees alike is that of the method of certification and accreditation of the different training actions. The Ministry of Education and the Ministry of Science, Innovation and Higher Education, the Chancelleries of the Universities and the governing bodies of the Faculties of Medicine have sought to regulate the certification and accreditation of the training. The different formats that the training actions have, with differing aims and frameworks, a greatly variable workload and different forms of assessment, has meant some difficulty in standardising this accreditation. If for the training courses there is a definition in terms of timetable hours and ECTS (European Credit Transfer System) accreditation according to this clearly regulated number of hours set by the ministries involved, for the actions formatted as symposia or workshops, their accreditation is not considered in the legislation produced by the ministry. Thus the accreditation presented by the European Union of Specialist Doctors (UEMS) was proposed and accepted, granting a credit unit to each hour of training.The IFA Office of Continuous Training In the Faculty of Medicine of the University of Lisbon (FMUL) post-graduate training has been taken on by the Institute of Advanced Training, and we have been responsible for the coordination of its Office of Continuous Training.
The IFA Office of Continuous Training is a structure aimed at supporting FMUL teachers in the training actions that they carry out in their different areas of work. This has been active for about five years, and has been responsible for supporting the programmes leading to different modalities of certification that do not grant an academic degree.
The training actions and programmes that are presented to the IFA Office vary greatly in their formats and aims, ranging from post-graduation courses to symposia, conferences and workshops.

Post-Graduation Courses In order to adapt these programmes to the Deliberation nº 961/2003 by the Chancellor’s Office of the University of Lisbon, approved by the Scientific Committee of the Senate at the meeting of the 2nd of June 2003 and published in the Journal of the Republic, Series II, nº 153, 5th of July 2003, it considers:

a – Post-graduate Refresher Course, lasting a maximum of a semester.

b – Post-graduate Improvement Courses, lasting a maximum of one year.

c – Post-graduate Specialisation Course, lasting a maximum of one year.

The specialization courses, when they are followed by a period of preparing an original dissertation, may constitute a Masters programme.
The creating of the above-mentioned courses is the responsibility of the Scientific Council, and the respective regulation must be sent to the Scientific Commission of the Senate for information purposes.

Seminars, Symposia and Workshops
Many of the training actions proposed to the Office of Continuous Training and supported by it do not meet the required format and aim of the post-graduate courses, but rather take on the form of seminars, symposia or workshops. These are often monothematic, and their numbers of effective hours has varied between 4 and 32 hours. Although these training actions are not foreseen nor regulated in the directives from the ministry or from the chancellor’s office, their interest in continuous training is clearly shown in the great number of actions that take place each year, in the considerable number of enrolments that many actions have and in the different editions that many of them involve, sometimes with annual editions.

In Charts I and II we present the training actions held or foreseen for 2007 and 2008, with the respective hourly workload and the number of enrolments. Although the majority is presented under the overall designation of the courses, many of these actions do not fit into the structure of the course as we have described them above.

Applied Accreditation The accreditation that is referred to by the Deliberation nº 961/2003 and revised in the Deliberation nº 1506/2006 by the Chancellor’s Office of the University of Lisbon, covered by the Decree-Law nº 42/2005 of the 22nd of February, expressed in ECTS, may reach 30 credits in the Refresher Courses, 60 credits ECTS in the Improvement Courses, and 60 credits in the Specialisation Courses.
The recent Decree–Law nº 107/2008 of the 25th of June, in its Article 6, states that “The number of credits to be attributed to the dissertation of the study cycles leading to the degree of masters (…) as well as other works of the same nature foreseen for the obtaining of diplomas for cycles that do not lead to a degree, is fixed taking into account the average time estimated as necessary for its preparation and assessment, measured in academic years or fraction thereof, with the work of an academic year corresponding 60 credits.”
As the majority of the actions proposed to the Office of Continuous Training do not conform to this typology, accreditation was adopted on the basis of 1 hour = 1 credit, in accordance with the UEMS, which was ratified by the Internal Norm nº 30/2002 by the Dean of the FMUL.

Regulation of the Courses and other training Actions The courses and other training actions that do not lead to an academic degree may be proposed by a teacher at the FMUL and organized through the IFA Office of Continuous Training.
All the training actions, once they are accepted by the Office, will have to have the approval of the Director of the IFA. The courses will have to have the approval of the Scientific Council of the Lisbon Faculty of Medicine.
For a better organization and management of the activities of each training action, the office will promote its articulation with the faculty of Medicine Association for Research and Development (AIDFM), as a co-organizer within the scope of the protocol celebrated with the FMUL.
Those proposing training actions should present the Office of Continuous Training with a proposal including the name and qualifications of those responsible for the training action, its aims, the detailed programme, the intended logistics and an economic study.
The coordinator of the Office of Continuous Training will collaborate with those responsible for the training action in order to guarantee the logistics and appreciate the economic study, drawing up an opinion report in the space of a fortnight.