Postgraduate training in Malta

Background In Malta, a variety of postgraduate training programmes is currently available for health professionals, including: 30 on medical specialities; 12 on medical subspecialities (offered by a fully-fledged postgraduate training centre); 11 on surgical subspecialties; and 5 on paediatric medicine. Nursing and midwifery currently have 18 and 6 specialities, respectively, that are recognized by law. Postgraduate courses for nurses, midwives and allied health professionals at the post-qualification-diploma and master’s- degree levels are available at the University of Malta. Postgraduate training in dentistry mirrors that for medicine and surgery in terms of career pathways and accreditation. Currently, dentistry in Malta has 2 recognized specialities – orthodontics and oral surgery – both of which are regulated by the Medical Specialist Accreditation Committee, the Medical Council and the Malta Postgraduate Training Centre. There are plans to expand the number of specialities for dentists and introduce specialities for pharmacists. Plans for future postgraduate training in Malta include the establishment of a postgraduate training centre for nurses, midwives and allied health professionals. A postgraduate- training framework for the latter is under development. Delivery Malta delivers postgraduate training for doctors locally. For several specialities, a period of training in centres abroad (ranging from 3 to 24 months) is recommended. Specialization programmes are being set up for allied health professionals. Postgraduate courses that do not lead to specialization are also available. Postgraduate training in dentistry is currently conducted in collaboration with the Royal Colleges of Surgeons in the United Kingdom for specialist examination purposes. For doctors, better workforce planning to ensure sufficient coverage of all specialities, and better-structured cross- country exchange programmes (such as, Erasmus +) to facilitate and streamline training possibilities abroad, would improve the organization and delivery of postgraduate training in Malta. With respect to nurses, a specialist accreditation committee is being set up and venues for collaboration with foreign institutions are being sought. Currently, there are 2 recognized dental specialities (orthodontics and oral surgery); it is envisaged that restorative dentistry, dental public health, and head and neck pathology will also be recognized as specialities within the next calender year. Postgraduate training in Malta Postgraduate specialist training committees are being set up for allied professionals; these will be tasked with deciding on specializations per profession and the development of relevant training programmes. The most urgent considerations in Malta at present are the introduction of a specialist framework for nurses/midwives and allied professionals, and the creation of additional dental specialities. Improvements in postgraduate training for pharmacists are still in the initial stages. Initiatives Malta is involved in a European Structural Fund project aimed at developing a specialist training framework for 7 professions registered in Schedule 4 of the Health Professions Act (1) (physiotherapy, occupational therapy, speech and language pathology, podiatry, radiography, dental hygiene and dental technology). These professions belong to an association listed in Schedule 4 (Article 30) of the Act (1). Specialist training committees have also been established to finalize the lists of specializations to be recognized (per profession). Once these specializations have been approved and listed in Schedule 5 (Article 31) of the Act (1), each will require a dedicated training programme. Malta has set up bilateral agreements with several institutions abroad (mostly in the United Kingdom). Regarding nursing and midwifery, Malta is in the process of negotiating supervised training placements in the United Kingdom with the aim of facilitating and improving knowledge exchange and training. Malta would also like to enhance postgraduate training in the country by improving access to simulation training (already available to the medical profession) and has plans to set up a fully-fledged training centre for nurses, midwives and allied health professionals to this end. A framework for specialization in allied health is currently under development. The centre will follow provided funding is available. Data In Malta, data are available on the start and completion of doctors’ postgraduate training and data on their professional progress are collected through the e-portfolio system. It would be very useful to have similar data for other professions, such as nursing, midwifery and allied health. © W H O Postgraduate training in Malta Role of postgraduate training in reducing brain drain The availability of speciality training in Malta would encourage professionals not to seek it abroad. Due to the small size of the country, however, there may not be enough demand to merit specialization in certain areas. Postgraduate training contributes to innovation and improved performance in Malta. It keeps health professionals abreast of developments, putting them in a better position to provide patients with specialized medical services locally rather than having to send them abroad for treatment. Challenges and enablers Challenges for Malta lie in the limitations of specialized human resources in delivering training in certain areas, and in the reduced number of generalists on the ground in view of severe staff shortages in many categories. Enablers in the country are political commitment to specialization and support of employee representatives (unions). Cross-country collaboration Local specialization in Malta already depends on other countries. Most postgraduate training in medical specialities can be carried out locally, which provides the opportunity for knowledge exchange and the sharing of different types of expertise. References 1. Chapter 464. Health Care Professions Act. In: Health Care Professions. Valletta: Government of Malta; 2003 (http:// justiceservices.gov.mt/DownloadDocument.aspx?app=lom&itemid=8930&l=1, accessed 28 February 2020). 2. Small Countries Initiative. In: WHO Regional Office for Europe [website]. Copenhagen: WHO Regional Office for Europe; 2020 (http://www.euro.who.int/en/about-us/networks/small-countries-initiative, accessed 24 March 2020). WHO support needed Although Malta is well on track in developing specialist frameworks for several categories of staff and can demonstrate good medical practice as a result, WHO assistance in sharing knowledge gained and establishing collaboration with other countries on organizing study visits would be welcome. The Small Countries Initiative (2) is an important platform for this type of exchange. Advice/how to improve postgraduate training Malta’s advice to other countries would be to identify a postgraduate training model applicable specifically to their own contexts and commit to implementing it in collaboration with all stakeholders, including educational facilities, bodies dealing with finances, human resources and regulation, and employers. Ministries of health can engage stakeholders and garner their support prior to introducing the specialization programmes. For the process to run smoothly, established timeframes would need to be respected. © World Health Organization 2020. Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO license. WHO/EURO:2020-1306-41056-55736