Background
In San Marino, physicians, pharmacists and biologists undergo practical training at the Institute of Social Security (2 years for physicians and 6 months for pharmacists and biologists), but there is no certification process in place. It is foreseen that a law will be passed in the near future requiring 3 years’
postgraduate training for physicians. In addition, it will be compulsory for physicians wishing to work in general practice to have worked for at least 3 years in the San Marino Hospital and the Primary Care Unit. Most health professionals in San Marino need to go abroad for specialist training. For the last 15 years, a course leading to a university degree in nursing has been available in the country.
Delivery
San Marino does not have a postgraduate-training programme and is reliant on collaboration with Italian universities regarding the participation of San Marinese health professionals (except for general practitioners) in their programmes.
San Marino could improve access to postgraduate training through the University. Currently, the establishment of a postgraduate course for general practitioners is underway.
Not being a member of European Union (EU), it is difficult for San Marino to recognize postgraduate degrees obtained in EU countries.
Initiatives
Accreditation is a useful tool for improving the quality and safety of services and promoting more efficiency and effectiveness. However, it would be important also to have international certification or EU recognition. This would facilitate agreements with Italy and other countries, or private companies, on increasing the number of cases to be treated in San Marino hospitals. Currently, San Marino – together with Andorra and Monaco – is in the process of establishing an Association Agreement with the EU.
Data
San Marino only has health-professional-related data on medical doctors.
Postgraduate training in San Marino
Role of postgraduate training in reducing brain drain
Postgraduate-training agreements with the University and enhanced conditions for medical doctors (for example, financial conditions) could help avert brain drain in San Marino. San Marino would like to improve the retention of medical doctors in the future with structured pathways, clinical networks and agreements on seeking second opinions from specialists.
Agreements are being sought with Italian hospitals on exchanging services and medical staff.
Challenges and enablers
It would be important to create a network that links with the University, and to facilitate postgraduate speciality training in certain areas (such as, oncology or pain) at the San Marino Hospital. San Marino is working to have institutional accreditation in line with the national regulations, which are similar to those in Italy.
Cross-country collaboration
San Marino values cross-country collaboration highly.
Postgraduate training in clinics outside San Marino enables medical doctors to continuously upgrade their competences and skills and strengthens collaboration between the
University and the clinics involved. It also ensures future links between medical doctors in San Marino and experts in specific branches of medicine in other countries.
Organizing postgraduate training courses in San Marino (in collaboration with other countries) would facilitate the participation of medical doctors working in San Marino.
WHO support needed
It would be useful if WHO could facilitate networking among small countries and other countries on this important topic.
In addition, WHO could act as a bridge between the different countries, for example, by organizing a workshop on how countries could help each other in guaranteeing the quality of services offered.
© WHO
Postgraduate training in San Marino
Advice/how to improve postgraduate training
San Marino would welcome links with countries that have established postgraduate-training programmes, as well as information about numbers of training places available to San Marino citizens in universities in these countries.
© World Health Organization 2020. Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO license.
WHO/EURO:2020-1308-41058-55738
