Doctors’ specialist
medical training
Regulations and general guidelines
Descriptions of objectives
2008Contents
Regulations and general guidelines for doctors’ specialist medical training(SOSFS 2008:17) ______________________________________________ 7
Chapter 1 Area of application and explanation of terms ______________ 7
Chapter 2 The basis for specialist medical training __________________ 8
Chapter 3 Quality aspects in specialist medical training ______________ 8
Chapter 4 Combined specialities, etc. ____________________________ 11
Chapter 5 Branch and additional specialities ______________________ 12
Chapter 6 Crediting qualifications from doctoral studies and service
abroad _____________________________________________________ 14
Chapter 7 Application and approval procedures ___________________ 15
Description of objectives for the respective specialties ______________ 18
Specialties in surgery _________________________________________ 19
Surgery ____________________________________________________ 19
Urology ____________________________________________________ 32
Paediatric surgery____________________________________________ 42
Plastic surgery_______________________________________________ 57
Vascular surgery _____________________________________________ 72
Thoracic surgery _____________________________________________ 86
Orthopaedics________________________________________________ 99
Hand surgery ______________________________________________ 114
Anaesthesiology and intensive care ____________________________ 129
Obstetrics and gynaecology ___________________________________ 144
Otorhinolaryngology ________________________________________ 159
Audiology _________________________________________________ 174
Phoniatrics ________________________________________________ 189
Ophthalmology _____________________________________________ 204
Specialities in internal medicine _______________________________ 219
Internal medicine ___________________________________________ 219

Cardiology _________________________________________________ 234
Gastroenterology and hepatology______________________________ 250
Endocrinology and diabetology ________________________________ 265
Renal medicine (nephrology) __________________________________ 279
Respiratory medicine ________________________________________ 292
Haematology ______________________________________________ 305
Allergology ________________________________________________ 318
Geriatrics __________________________________________________ 331
Specialties in paediatrics _____________________________________ 344
Paediatrics ________________________________________________ 344
Child and adolescent allergology_______________________________ 360
Child and adolescent neurology and habilitation __________________ 375
Neonatology _______________________________________________ 390
Paediatric oncology _________________________________________ 406
Paediatric cardiology ________________________________________ 421
Psychiatric specialties________________________________________ 437
Psychiatry __________________________________________________ 437
Forensic psychiatry __________________________________________ 452
Child and adolescent psychiatry _______________________________ 466
Specialties in radiology ______________________________________ 481
Radiology _________________________________________________ 481
Neuroradiology_____________________________________________ 498
Nuclear medicine ___________________________________________ 515
Clinical physiology __________________________________________ 531
Specialties in laboratory medicine ______________________________ 548
Clinical immunology and transfusion medicine ___________________ 548
Clinical bacteriology and virology ______________________________ 565
Clinical chemistry ___________________________________________ 580
Clinical pharmacology _______________________________________ 594

Clinical pathology ___________________________________________ 608
Forensic medicine ___________________________________________ 622
Neurological specialties ______________________________________ 637
Neurology _________________________________________________ 637
Neurological surgery ________________________________________ 653
Clinical neurophysiology _____________________________________ 666
Physiotherapy and rehabilitation ______________________________ 682
Separate base specialties _____________________________________ 697
Family medicine ____________________________________________ 697
Oncology __________________________________________________ 712
Gynaecological oncology _____________________________________ 726
Infectious diseases __________________________________________ 740
Clinical genetics ____________________________________________ 754
Occupational and environmental medicine ______________________ 769
Dermatology and venereology ________________________________ 784
Rheumatology _____________________________________________ 798
Social medicine _____________________________________________ 814
Additional specialties ________________________________________ 828
Emergency medicine ________________________________________ 828
Pain management __________________________________________ 844

Regulations and general guidelines
for doctors’ specialist medical training

adopted 24 June 2008.
The National Board of Health and Welfare (Socialstyrelsen) prescribes thefollowing under the provisions of Chapter 4, Sections 1 and 3 of the Ordinance (1998:1513) on Professional Activities in the Health and Medical
Care System, and adopts the following general guidelines.
Under the provisions of the Statutes Ordinance (1976:725), Appendix 2,
the regulations on which knowledge, skills, and approaches are to apply foreach specialist competence (descriptions of objectives) will be published byother means in a special publication. Descriptions of objectives listed under
the heading ‘Training Structure’ constitute general guidelines, as do theteaching methods under the heading ‘Partial Objectives’ where the followup method is not indicated.

Chapter 1 Area of application and explanation ofterms
Section 1. These regulations are to apply to the further training of licensed
doctors in order to achieve specialist competence according to Chapter 3,
Section 9 of the Law (1998:531) on Professional Activities in the Healthand Medical Care System.
Section 2. The following concepts and terms are used in these regulations
and general guidelines:
Intended
specialist competence
Tutor

instruction

instructor

the specialist competence that the licensed doctor
undergoing specialist medical training (the ST
doctor) intends to obtain with the planned training
a person who continuously, and in dialogue form,
supports and guides as well as evaluates a staffer
regarding his or her professional development
assignment from a staffer to an ST doctor on
work-specific techniques or procedures, while notbeing responsible for the ST doctor’s professional
development
staffer who gives the ST doctor assignments on
work-specific techniques or procedures, while notbeing responsible for the ST doctor’s professional

director of studies

clinical manager
health care provider

development
doctor with specialist competence who provides anorganisational support function for a clinical manager, tutor, and ST doctor. The director’s area of
responsibility can relate to one or several training
units, all or part of a county council, region, or corresponding unit
holder of the position responsible for operations
natural person or legal entity that practices healthcare professionallyChapter 2 The basis for specialist medical
training
Section 1. In accordance with Chapter 4, Section 1, first paragraph of theOrdinance (1998:1513) on Professional Activities in the Health and Medical
Care System, the licensed doctor wishing to obtain specialist competence
must undergo further education for at least five years in order to acquire theknowledge, skills, and approaches prescribed for the specialist competence
being sought. These must be acquired through service as a doctor under tutoring and through participation in supplementary training (specialist medical training).
Section 2. Vacations and on-call compensation may be credited in specialist
medical training.
Section 3. If the specialist medical training is completed on part time, thespecialist medical training must be extended so that the service time corresponds to at least five years of full time service.

Chapter 3 Quality aspects in specialist medical
training
Section 1. The health care provider is to provide directives and see to it that
there are documented routines, so that the specialist medical training can be
carried out and regularly evaluated, in order to ensure consistently highquality in the specialist training.

Service and training programmes
Section 2. The health care provider is responsible for access to a director ofstudies, who must be a doctor with specialist competence, and who has undergone tutor training.
Section 3. The clinical manager is responsible for1. assigning a tutor for the licensed doctor undergoing specialist medical
training (the ST doctor),
2. establishing and finalising an individual training programme in accordance with the requirements in the description of objectives, in consultation
with the tutor and the ST doctor,
3. scheduling theoretical training elements and courses into the training programme in accordance with the requirements in the description of objectives, and
4. auditing the training programme regularly, and additionally as needed, in
consultation with the tutor and the ST doctor.

General guidelines
Courses during specialist medical training should be audited for quality.
An example of this is the courses announced by IPULS, the Institute forProfessional Development of Doctors in Sweden, and which are quality audited according to a clear standard.
The tasks of the director of studies should include providing an organisational support function for clinical managers, tutors, and ST doctors. The
director of studies should, among other things, participate in establishing
training programmes, drawing up orientation programmes, and see to it thatthe tutors have the relevant qualifications for the field.
The need for necessary tutor and instructor contributions should be met
by access to doctors with the relevant specialist competence and otherstaffers in the operation with specialist medical training.
Operations where specialist medical training is practised should be comprehensive enough to meet the requirements for competence in the description of objectives. There should be premises and equipment to the extent
and standard needed to achieve the requirements of the description of objectives.
All ST doctors should have access to regular, planned internal and external training, as well as the opportunity for time regularly set aside for selfstudy. The operation should also offer ST doctors the opportunity to participate in research and quality development work.

Tutoring and instruction
Section 4. In accordance with Chapter 4, Section 1 of the Ordinance(1998:1513) on Professional Activities in the Health and Medical Care System, the specialist medical training must be carried out under tutoring.

General guidelines
Tutoring should be provided regularly, with the greatest continuity possible,
and should be in agreement with and based on the individual training programme.
Outside of tutoring, the ST doctor should be continuously provided with
the necessary instructions in the service, with feedback from operations
staff.
Section 5. The tutor must have specialist competence in the intended speciality, and must have undergone tutor training.
General guidelines
Tutor training should include tutoring, pedagogy, communication, and ethics.

Documentation, evaluation, and assessment
Section 6. The clinical manager is responsible for the continuous, regular
evaluation of the ST doctor’s professional development, based on the description of objectives and the training programme, during the entire specialist medical training.
Section 7. ST doctors, with the support of their tutors, must continuously
document skills achieved and knowledge acquired.
General guidelines
The tutor should continuously support, guide, and evaluate the ST doctor’s
professional development.
The continuous evaluation of the ST doctor’s professional development
should–encompass all aspects of the specialist medical training and all theobjectives covered in the description of objectives,–
be carried out using methods known and agreed on in advance, and–as a rule, be carried out internally within the operation.
If there are deficiencies in ST doctors’ competence, it should lead to improvements in their training programmes, in the training efforts of the operation, or, where appropriate, through more explicit demands on the ST
doctors’ efforts.
The clinical manager, or the doctor with the intended specialist competence to whom the clinical manager has given the assignment, should holdregular professional development interviews, which should be documented.
Tutors should document their interviews with the ST doctors. ST doctors
should also document tutor and professional development interviews.

Section 8. The health care provider must give directives and ensure that
there are documented routines for how operations with specialist medical
training are to be regularly reviewed through external inspections.
The inspecting unit and the operation inspected must not have economic,
administrative, or organisational connections with each other.
The review must relate to the requirements set down in Sections 1
through 7, as well as those pertaining to general guidelines.
General guidelines
A review according to Section 8 may be done in accordance with the SPUR
inspection model (a model for external review developed by the training
quality foundation of the Swedish Medical Association and the Swedish
Society of Medicine).

Chapter 4 Combined specialities, etc.
Section 1. There must be two responsible clinical managers and two responsible tutors for the specialist competences in clinical immunology and transfusion medicine, clinical bacteriology and virology, and industrial and environmental medicine.
The provisions of this chapter regarding the clinical manager are also intended for the doctor with the intended specialist competence to whom theclinical manager has given the assignment.
Exceptions from the requirement for dual clinical managers may be madeif the clinical manager has dual specialist competences in accordance withthe above, or specialist competence in accordance with the speciality listing
indicated in Chapter 4, Section 1 of the Ordinance (1998:1513) on Professional Activities in the Health and Medical Care System. The same exception also applies to the requirement for the tutors.
Section 2. The clinical managers indicated in Section 1, first paragraph,must both have the indicated specialist competence for the combined speciality in question. The same requirement applies to the tutors.
This means that the clinical manager and the tutors must have specialist
competence in1.
clinical immunology and transfusion medicine respectively for the
speciality in clinical immunology and transfusion medicine,2.
bacteriology and virology respectively for the speciality in clinicalbacteriology and virology, and3.
occupational health care and occupational and environmental
medicine respectively for the speciality in industrial and environmental medicine.
Section 3. One of the clinical managers and one of the tutors must havechief responsibility for the specialist medical training.
The clinical managers must select which of them will bear chief responsibility through an agreement. The same applies to the tutors.

Section 4. The clinical manager with chief responsibility is responsible for
1. establishing a training programme for the ST doctor,
2. designating a tutor with the relevant specialist competence,
3. providing the ST doctor with tutoring, and
4. co-ordinating the certification procedure in consultation with the tutor
with chief responsibility when the ST doctor has achieved all the requirements in the description of objectives.
Section 5. The tutor with chief responsibility must
1. establish a training programme for the ST doctor in consultation
with the clinical manager with chief responsibility,
2. provide the ST doctor with tutoring, and
3. co-ordinate the certification procedure in consultation with the clinical manager with chief responsibility when the ST doctor has
achieved all the requirements in the description of objectives.

Section 6. The clinical managers and tutors are responsible within their respective medical fields for certifying that the ST doctor has achieved therequirements of the description of objectives in their parts.
Section 7. In the speciality of radiology, a specialist in medical radiology
must tutor and approve ST doctors being trained in the speciality.

Chapter 5 Branch and additional specialities
Section 1. In Chapter 4, Section 1 of the Ordinance (1998:1513) on Professional Activities in the Health and Medical Care System, the conditions under which a licensed doctor can obtain a certificate in a branch speciality
and an additional speciality respectively are indicated.
General guidelines
A licensed doctor who wishes to obtain a qualification in a branch or additional speciality can, to a limited extent, begin specializing in the intended
branch or additional speciality within the specialist medical training for thebase speciality.
Section 2. Obtaining a certificate of specialist competence in emergency
medical care requires possession of specialist competence in a base speciality belonging to any of

1.
2.
3.
4.
5.
6.

the surgical specialities,
the internal medicine specialities,
the paediatrics specialities,
the psychiatry specialities,
the neurological specialities (except clinical neurophysiology), or
the individual base specialities (except social medicine and clinical genetics).

Section 3. For those licensed as a doctor prior to 1 July 2006 who are applying for specialist competence in emergency medical care and who wish toinclude specialist competence in accordance with older regulations, the following shall apply.
Obtaining a certificate of specialist competence in emergency medical carerequires a certificate of specialist competence in a speciality belonging to
any of
1.
2.
3.
4.
5.

the operating specialities,
the internal medicine specialities,
the paediatric specialities,
the psychiatric specialities, orthe individual specialities in general practice, occupational health care,school health care, skin and sexually transmitted diseases, neurology, infectious diseases, rehabilitation medicine, oncology, and pain relief.

Section 4. Obtaining a certificate of specialist competence in pain relief
requires possession of a specialist competence certificate in a base speciality
belonging to any of
1.
2.
3.
4.
5.
6.

the surgical specialities,
the internal medicine specialities,
the paediatric specialities,
the psychiatric specialities,
the neurological specialities (except clinical neurophysiology), or
the individual base specialities (except social medicine and clinical genetics).

Section 5. For those licensed as a doctor prior to 1 July 2006 who are applying for specialist competence in pain relief and who wish to include specialist competence in accordance with older regulations, the following shallapply.
Obtaining a certificate of specialist competence in pain relief requires
possession of a certificate of specialist competence in a speciality belonging
to any of

1.
2.
3.
4.
5.

the operating specialities,
the internal medicine specialities,
the paediatric specialities,
the psychiatric specialities, or
any of the individual specialities in general practice, occupational healthcare, school health care, skin and sexually transmitted diseases, neurology, infectious diseases, rehabilitation medicine, and oncology.

Chapter 6 Crediting qualifications from doctoral
studies and service abroad
Section 1. In accordance with Chapter 4, Section 1, first paragraph of theOrdinance (1998:1513) on Professional Activities in the Health and Medical
Care System, qualifications from doctoral studies may be credited towards
specialist medical training.
On condition that the requirements in the description of objectives inquestion are fulfilled, The National Board of Health and Welfare (Socialstyrelsen) shall issue a specialist competence certificate after at least four and ahalf years of service if the ST doctor has
1. a Swedish doctorate, or
2. a foreign doctorate that is judged to correspond to a Swedish doctorate
by a Swedish university or college, or where applicable by the Swedish
National Agency for Higher Education.
Section 2. Service in a clinic or corresponding facility in a country otherthan Sweden (service abroad) may be credited towards specialist medical
training, if it
1. was included as part of an individual training programme,
2. was carried out under tutoring,
3. can be confirmed with a certificate issued by the institution’s clinicalmanager or corresponding person, and
4. has led to the fulfilment of planned partial objective competence according to the clinical manager who will certify that the requirements of thedescription of objectives is fulfilled in its entirety.
The certificate under Point 3 must contain a short description of the operations managed at the institution.
Section 3. For doctors with licenses from a third country (a state outside theEuropean Union and the European Economic Area), service may be credited
in accordance with Section 2 from the moment the license was issued.

Chapter 7 Application and approval procedures
Section 1. In accordance with Chapter 3, Section 10 of the Law (1998:531)
on Professional Activities in the Health and Medical Care System, issues of
specialist competence will be examined by The National Board of Healthand Welfare (Socialstyrelsen).
Section 2. The clinical manager, or the doctor with the intended specialist
competence to whom the clinical manager has given the assignment, and thetutor are responsible for achieving the indicated training objective in the unit
where operations within the intended speciality are managed.

Application
Section 3. An application for specialist competence in accordance with
Chapter 3, Section 9 of the Law (1998:531) on Professional Activities in the
Health and Medical Care System must be made on Form SoSB 45000 (Appendix 1). The application must be sent to The National Board of Healthand Welfare (Socialstyrelsen).
Section 4. The clinical manager, or the doctor with the intended specialist
competence to whom the clinical manager has given the assignment, and thetutor are to issue a certificate on form SoSB 45001 (Appendix 2) showingthat the ST doctor has
1. acquired the knowledge, skills, and approaches indicated in the finalised
description of objectives for the speciality being sought,
2. completed at least five years of service under tutoring, and3. made use of the teaching methods in the description of objectives to theextent they indicate teaching methods as indicated in Section 7.
If any service abroad was relevant to fulfilling an objective or partial objective in the description of objectives, this shall also be indicated on the certificate.
The certificate must be attached to the application to The National Boardof Health and Welfare (Socialstyrelsen).
Section 5. In the event the clinical manager has assigned a doctor with theintended specialist competence to issue the certificate in accordance with
Section 4, this shall be verified by the clinical manager (Appendix 2).
In the event the clinical manager has been the tutor for the ST doctor, theclinical manager must designate a doctor with the intended specialist competence who, alongside the clinical manager him- or herself, is to certify thecompetence achieved (Appendix 2).
Section 6. If the ST doctor has served in several units, the clinical manager,
or the doctor with the intended specialist competence to whom the clinicalmanager has given the assignment, in the unit within the speciality beingsought where the ST doctor last served for the certificate are responsible.

The clinical manager must then consult with the clinical managers, or the
doctor with the intended specialist competence to whom the clinical manager has given the assignment, in the units where the ST doctor served previously (Appendix 2).
Section 7. The following teaching methods in the description of objectives
is to be used and shown via certificate on forms SoSB 45002, SoSB 45003,
SoSB 45004, SoSB 45005 and SoSB 45006 (Appendices 3–7), which are to
be sent to The National Board of Health and Welfare (Socialstyrelsen) in
connection with applications for specialist competence in:
1. clinical service,
2. auscultations – only when the teaching method is indicated in the description of objectives as an alternative to clinical service,
3. courses,
4. written individual work in accordance with scientific principles, and
5. quality and development work.
General guidelines
The following may be used as supplementary teaching methods to thoseindicated in Section 7:–
instructing under supervision;–
tutoring under supervision;–
health care team work under supervision;–
seminar;–large professional assembly;–
diagnostics and treatment symposia;–
training in a simulated environment;–
sit-ins;–
intraprofessional group reflection; and–theoretical studies.

Approval
Section 8. The National Board of Health and Welfare (Socialstyrelsen) will,on the basis of the application, examine whether the requirement for service
time according to Chapter 4, Section 1 of the Ordinance (1998:1513) on
Professional Activities in the Health and Medical Care System, as well as
the requirements in the description of objectives, have been fulfilled.
Section 9. The National Board of Health and Welfare (Socialstyrelsen) willcollect statements from two external assessors for the review.
Section 10. The external assessors must

1. be selected by The National Board of Health and Welfare (Socialstyrelsen) for a period of three years, which can be renewed once,
2. be appointed according to proposals from the speciality association in
the Swedish Medical Association or the section in the Swedish Societyof Medicine, and3. have specialist competence in the intended speciality.
Section 11. The external assessment must include an examination ofwhether
1. services and certified teaching methods for the various partial objectives
in the description of objectives as regards its contents were relevant tofulfilling all of the competence requirements and partial objective requirements,
2. the certified persons had the relevant competence for the task, and3. any service abroad has been certified by persons with the relevant competence.
_____________________________________________________________
1. This statute enters into force, with reference to the requirement for tutor
training in Chapter 3,
Sections 2 and 5, on 1 September 2010, and otherwise on 1 September
2008.
2. With this statute, the following are repealed:– The National Board of Health and Welfare (Socialstyrelsen) regulations(SOSFS 1996:26) Description of objectives for specialities within specialist
medical training for doctors,– The National Board of Health and Welfare (Socialstyrelsen) regulations
and general guidelines (SOSFS 1996:27) Specialist medical training for
doctors, etc.
3. For doctors who received a licence prior to 1 July 2006, however, the oldstatutes may apply if applications regarding a certificate of specialist competence are submitted no later than 31 Dec 2013.

Description of objectives for therespective specialties

Specialties in surgery

Surgery
Introduction
Explanation of terms
General definition of competencies
Definition of area of competence
Competence requirements
Competence requirements for medical competence
Competence requirements for communicative competence, leadershipcompetence, and competence within medical science and quality work
Training structure
Special recommendations
Intermediate objectives
Medical competenceCommunicative competence
Leadership competence
Competence within medical science and quality work

Introduction

On June 24, 2008, The National Board of Health and Welfare (Socialstyrelsen) decided to issue new regulations and general guidelines for doctors’
specialist medical training (SOSFS 2008:17). The statute consists of a general part with common provisions for all specialties and a specific part withall the descriptions of objectives. The description of objectives for the respective specialties should be understood against the background of the provisions in the general part.
In each description of objectives, there is a section headed ‘Training
structure’, which constitutes general guidelines. The teaching methods under the heading ‘Intermediate objectives’ where no follow-up is indicatedalso constitute general guidelines.

Explanation of terms

current mentor
a specialist doctor whose specialist competence corresponds to the area ofcompetence indicated by the intermediate objective, and who is responsible
for ST doctors’s professional development during the teaching period or forthe method of teaching indicatedthe assignment as a mentor for an ST doctor generally encompasses the entire period of specialist training but can also encompass part or parts of it
auscultation
during mentoring, and in accordance with a pre-designed programme, tostudy the profession of a specialist doctor or other health care staff by following one or several professionals, as well as carrying out assignments in
the relevant area to a certain extent
evaluate
to form a sound opinion of a patient or similar person as a basis for further
management
masterbeing fully able to evaluate and handle the medical investigation, diagnostics, treatment, and follow-up of a patient or similar person, and being fully
able to use the techniques relevant to the area
capability
personal capacity to execute or perform a task
have understanding
having acquired knowledge and insight into an area through theoretical studies and/or practical exercise of the profession
have knowledge
having acquired some knowledge in an area through theoretical studies
and/or practical exercise of the profession
mentoring under supervision
as an ST doctor, mentor a co-worker while simultaneously being mentored
by a doctor with specialist competence
mentorcontinuously, and in dialogue form, supporting and guiding, as well as evaluating, a co-worker’s professional development
mentoringsee mentor

handleto actively carry out measures regarding investigation, diagnostics, treatment, and follow-up of a patient or similar person, and have overall responsibility for carrying out these measuresinitially handle
as the primary physician in charge, to actively carry out measures regarding
investigation, diagnostics, treatment, and follow-up of a patient or similar
person, and have overall responsibility for carrying out these measuresinitially evaluate
as the primary physician in charge, to form a sound opinion of a patient orsimilar person as a basis for further management
intraprofessional group reflection
reflection done in a group together with other doctors, chiefly for the purpose of further education and training
clinical service
health and medical care duties that ST doctors perform under their own professional liability and with the support of a mentor
courseteacher-led training with an established plan, given during a defined periodof timesitting-in
training activity involving an ST doctor observing when a specialist doctor
or other health care staff holds a consultationorassessment activity involving a specialist doctor or other health care staff
observing and evaluating ST doctors during a consultation
seminarinstruction in group form with active participation
training in a simulated environment
training carried out in an environment created to emulate reality
large professional assembly
conference, congress, symposium or similar event
health care centre
health care unit in primary carehealth care team work
work where ST doctors, under supervision, participates in and sometimes
leads a group of co-operating health care staff with various competencies
charged with responsibility for care for an individual patient or group ofpatients

General definition of competencies

Definition of area of competence
The specialty of surgery includes injuries and diseases in the organs of theabdominal cavity, in the chest, skin, hypodermis, and endocrine glands inthe throat and abdominal cavities of patients of all ages who could be considered as needing treatment involving methods employing surgical instruments in which skills in operating techniques are crucial. The evaluation ofsymptoms and understanding of pathophysiology, diagnostics and evaluation in surgical treatment and aftercare also play a central role, as does acutetreatment in the case of multitrauma. Multidisciplinary cooperation is a prerequisite for development in this area of competence.
Surgery is the base specialty for the branch specialties of urology, paediatric surgery, plastic surgery and vascular surgery.

Competence requirements
Competence requirements for medical competence
For specialist competence in surgery, it is necessary to master surgical pathophysiology, basic surgical techniques, initial trauma management, acutesurgical diseases in adults and children, basic nutrition management, basic
pain management, basic surgical intensive care and the effects of anaesthetics. This forms the common knowledge base with the branch specialties(intermediate objectives 1–4).
For specialist competence in surgery, it is also necessary to master diagnostics and operative methods for patients with hernias and to be able tohandle patients with diseases of the upper and lower gastrointestinal canals.
It also involves having an understanding of evaluation, diagnostics andtreatment of surgical conditions in the endocrine glands and chest and being
able to initially handle injuries and diseases within peripheral ducts and theurinary tract.

Competence requirements for communicative competence, leadership competence, and competence within medical scienceand quality work
Communicative competence
The equal and responsible patient
Doctors with specialist competence must be capable of dialogue and of
maintaining open contact with patients and their next of kin. Contact should
be characterised by empathy and trust, as well as respect for the patients’right to information, influence, and participation in decisions. Contact

should also be characterised by co-operation and sensitivity to the patients’needs, desires and right to self-determination, as well as providing incentives for the patients’ involvement and responsibility for their own care.
Multicultural and gender aspects
Communication with patients and their next of kin should be characterisedby understanding and respect for cross-cultural and multicultural aspects
such as age, language, ethnicity, sexual orientation, and religion, as well as
gender.
Interprofessional relations
Doctors with specialist competence must have the ability to communicate,both in writing and orally, with other doctors and co-workers showing respect for their professional knowledge and competencies. The same applies
to contact with representatives of the public and various civil authorities.
Pedagogical skills
Doctors with specialist competence must have pedagogical capability inorder to inform and instruct not only patients and their next of kin but also
other doctors and co-workers, as well as students.
Professional approach and ethics
Doctors with specialist competence must be capable of working continuously with their professional and medical ethical approaches, with the objectiveof being able to make independent decisions of a medical ethical nature.
Individual professional development
Doctors with specialist competence must be capable of continually examining and identifying their own needs for professional development, in addition to operational requirements, in order to be able to meet requirements forthe best possible patient care.

Leadership competence
Collaboration
Doctors with specialist competence must have a developed capability for
self-knowledge and understanding of their own functions and roles in theorganisation.
Mentoring skills
Doctors with specialist competence must be capable of mentoring other doctors and co-workers, as well as students.

Leadership
Doctors with specialist competence must be capable of leadership characterised by collaboration, openness, and dialogue with co-workers. Leadershipmust further be characterised by participation and activity development
aimed at improvement. The ability to lead the work of the health care teamis essential.
System knowledge
Doctors with specialist competence must have an understanding of the organisation, administration, finances, and regulatory systems of health andmedical care, as well as its governance, in order to make the best use of resources.

Competence within medical science and quality work
Medical science
Doctors with specialist competence must be capable of adopting a medicallyscientific outlook and approach, and must have knowledge of research methodology including basic epidemiological concepts as well as of methods
for evidence-based medicine and review of scientific information.
Improvement and quality work
Doctors with specialist competence must have an understanding of, andcompetence in, evidence-based improvement and quality work. The objective is to be able to initiate, participate in, and be responsible for continuous
systematic improvement work with emphasis on a holistic perspective, patient safety, patient benefit, measurability, and teaching management in order to be able to review and evaluate their own operations.
Public health and prevention
Doctors with specialist competence must have an understanding of the factors determining health, other aspects of public health, and methods forpromoting health and efforts aimed at preventing injury and illness, in order
to be able to take this understanding into account in medical scientific work.

Training structure
Early education and training in basic surgical techniques is essential andshould take place in both clinical and simulated environments during
placements within both basic and branch specialties. Training in the initialhandling of acute surgical diseases should begin at an early stage and thencontinue throughout the entire training with development of operative
treatment and aftercare.
Training in surgical pathophysiology, basic pain management, intensive
care, and anaesthetic effects should take place during the first part of the
training and form the basis for the more specialised training.

Specialised training can begin during the first part; one suggestion is toinitiate it with uninterrupted training in areas where large volumes of operative training can be offered. Training in visceral surgery is central to thisand should be given a lot of space. The main placement should be arrangedin the middle of the training, while shorter placements can be arranged at an
early stage in order to provide basic training in handling acute conditions.
It is best for placements at units treating breast, endocrine, vascular surgery and urological diseases to take place towards the end of training.
Courses, auscultations and theoretical studies should, where possible, takeplace during the placement in question. These specialised placements should
be as closely connected as possible and should only be interrupted by any
acute placement or course.
Communicative competence, leadership competence and competence
within medical science and quality work should be initiated at an early stage
and continue as a natural and integral part of the entire training.

Special recommendations
The specialty associations and sections of the medical organisations haveformulated special recommendations for their own specialties. The recommendations concern such issues as how specialist medical training should be
structured.

Intermediate objectives

Medical competenceIntermediate objective 1

Teaching methods

Follow-up

To master surgical pathophysiology, basic surgical techniques andtreatment of diseases of the skinand hypodermis that could require
surgical treatment.

Clinical service under supervision ina unit that handles these conditions

CourseCertificate of successfully completed clinical service and competence achieved, issued bycurrent mentor
Certificate of successfully completed course, issued by course
leaderTraining in a simulated environment
Theoretical studies

Intermediate objective 2

Teaching methods

Follow-up

To master evaluation, diagnostics and initial treatment of
acute abdominal diseases

Clinical service under supervision in a unit that handles these
conditions

Certificate of successfully completed clinical service andcompetence achieved, issued
by current mentor

Theoretical studies

Intermediate objective 3

Teaching methods

Follow-up

To master initial handling of major and minor traumas

Clinical service under
supervision in a unit that
handles these conditions

Certificate of successfully completed
clinical service and competenceachieved, issued by current mentor

CourseCertificate of successfully completed
course, issued by course leader

Theoretical studies

Intermediate objective 4

Teaching methods

Follow-up

To master basic pain management, surgical intensive care andanaesthetic effects

Clinical service under supervision
in a unit that handles these conditions

Certificate of successfully completed clinical service and competence achieved, issued bycurrent mentor

Theoretical studies

Intermediate objective 5

Teaching methods

To master diagnostics and opera- Clinical service under supervision
tive methods for hernias
in a unit that handles these conditions

CourseFollow-up
Certificate of successfully completed clinical service and competence achieved, issued bycurrent mentor
Certificate of successfully completed course, issued by course
leader

Theoretical studies

Intermediate objective 6

Teaching methods

Follow-up

To be able to handle patients withinjuries to and diseases of theupper gastrointestinal canalClinical service under supervision
in a unit that handles these conditions

Certificate of successfully completed clinical service and competence achieved, issued bycurrent mentor

CourseCertificate of successfully completed course, issued by course
leaderDiagnostics and treatment
symposium
Theoretical studies

Intermediate objective 7

Teaching methods

Follow-up

To be able to handle patients withinjuries to and diseases of thelower gastrointestinal canalClinical service under supervision
in a unit that handles these conditions

Certificate of successfully completed clinical service and competence achieved, issued bycurrent mentor

CourseCertificate of successfully completed course, issued by course
leaderDiagnostics and treatment
symposium
Theoretical studies

Intermediate objective 8

Teaching methods

To have an understanding of inves- Clinical service under supervisiontigation, diagnostics and treatment in a unit that handles these condiof malignant and benign diseases tionsof the breast
CourseDiagnostics and treatment
symposium
Theoretical studies

Follow-up
Certificate of successfully completed clinical service and competence achieved, issued bycurrent mentor
Certificate of successfully completed course, issued by course
leaderIntermediate objective 9

Teaching methods

Follow-up

To have an understanding of examination, diagnostics and treatment of diseases of the thyroid,parathyroid and other endocrineorgans where surgical treatment
may be an alternative

Clinical service under supervision
in a unit that handles these conditions

Certificate of successfully completed clinical service and competence achieved, issued bycurrent mentor

CourseCertificate of successfully completed course, issued by course
leader

Theoretical studies

Intermediate objective 10

Teaching methods

Follow-up

To be able to initially handle themedical investigations, diagnostics and treatment of peripheralarterial and venous diseases

Clinical service under supervision
in a unit that handles these conditions

Certificate of successfully completed clinical service and competence achieved, issued bycurrent mentor

CourseCertificate of successfully completed course, issued by course
leader

Theoretical studies

Intermediate objective 11

Teaching methods

Follow-up

To be able to initially handle acuteinjuries to and diseases of the kidneys and urinary tract

Clinical service under supervision
in a unit that handles these conditions

Certificate of successfully completed clinical service and competence achieved, issued by current
mentor

Theoretical studies

Intermediate objective 12

Teaching methods
SeminarTo have an understanding of disastermedicine work and disaster medicine
organisation

Follow-up

Communicative competenceIntermediate objective 13

Teaching methods

To be capable of dialogue andopen contact with patientsand their next of kin

Clinical service under supervision in a unit where such operations are practised

Intermediate objective 14

To be capable of communication,
both oral and written, with otherdoctors and co-workers

Follow-up

Certificate of successfully completed
clinical service and competenceachieved, issued by current mentor

Teaching methods
Clinical service under supervision
in a unit where such operations
are practised

Intermediate objective 15

Teaching methods

To be capable of informing and instructing patients, next of kin, otherdoctors, and co-workers, as well as
students

Clinical service under supervision in a unit where suchoperations are practised

Follow-up

Certificate of successfully completed clinical service and competence achieved, issued bycurrent mentor

Follow-up

Certificate of successfully completed
clinical service and competenceachieved, issued by current mentor

Instructing under supervision

Leadership competenceIntermediate objective 16

Teaching methods

To be capable of mentoring otherdoctors and co-workers as well as
students

Clinical service under supervision
in a unit where such operations
are practised

CourseMentoring under supervision

Follow-up

Certificate of successfully completed clinical service and competence achieved, issued bycurrent mentor

Certificate of successfully completed course, issued by course
leaderIntermediate objective 17

Teaching methods

To be capable of leading using
collaboration and dialogue with coworkers as well as within the healthcare team

Clinical service under supervision
in a unit where such operations
are practised

Intermediate objective 18

Follow-up

Certificate of successfully completed clinical service and competence achieved, issued bycurrent mentor

CourseCertificate of successfully completed course, issued by course
leaderTeaching methods

Follow-up

CourseCertificate of successfully completed course, issued by course
leaderTo have an understanding of theorganisation, management, andregulatory systems of health andmedical care

Competence within medical science and quality
work
Intermediate objective 19

Teaching methods

Follow-up

To be capable of a medically scientific outlook and approach

CourseCertificate of successfully completed course, issued by course
leaderWritten individual work under supervision according to scientific principles

Certificate of approved written individual work, issued by current mentor

Large professional assemblyIntermediate objective 20

Teaching methods

Follow-up

To have an understanding of, andcompetence in, evidence-based improvement and quality work

Quality and development work under Certificate of quality and developsupervision
ment work, issued by current mentor

Urology

General definition of competence
Definition of area of competence .
Competence requirements
Competence requirements for medical competenceTraining structure
Special recommendations
Intermediate objectives
Medical competenceCommunicative competence
Leadership competence
Competence within medical science and quality work

General definition of competence

Definition of area of competence
The area of competence within the specialty of urology involves knowledgeof congenital and acquired illnesses or conditions in the urinary tracts andthe male genitals, as well as injuries to these organ systems. Surgical skills
are essential for the specialty, but other treatments also take up a large partof operations. Pharmacological, minimally invasive, and paramedical treatment principles in urological tumour illnesses, symptoms in the lower urinary tract, lithiasis, sexual dysfunction and pain palliation in urological tumour illnesses are just a few examples of this important field.

Competence requirements
Competence requirements for medical competenceSpecialist competence in urology requires being able to handle acute injuries
and illnesses in the kidneys and urinary tracts, as well as knowledge of inflammation and infection in the urinary tracts and the male genitalia. Additionally, being able to evaluate and handle lithiasis in the urinary tracts, aswell as functional disorders and obstructions in the lower urinary tracts, isrequired. Furthermore, knowledge of endourological investigation andtreatment of other illnesses in the upper urinary tract is required. Urologicaltumour illness is a large illness field where knowledge of evaluation andhandling is required. Additionally, being able to evaluate and handle symptoms and illnesses in men’s genitalia, as well as knowledge of illnesses associated with male sexuality, is required. Beyond that, being able to handle
symptoms and illnesses in the urinary tracts and the genitalia of male children is required.
Specialist competence in urology further requires mastering surgicalpathophysiology, basic surgical techniques, initial trauma handling, acutesurgical illnesses in adults and children, basic nutritional treatment, basic
pain management, basic surgical intensive care, and the effects of anaesthetics. This makes up the common knowledge base with the branch specialties(intermediate objectives 1-4).

Competence requirements for communicative competence,leadership competence, and competence within medical science and quality work
Communicative competence
The equal and responsible patient
Doctors with specialist competence must be capable of dialogue and of
maintaining open contact with patients and their next of kin, which should
be characterised by empathy and trust, as well as respect for the patients’right to information, influence, and participation in decisions. Contact
should also be characterised by co-operation and sensitivity to the patients’needs, desires and right to self-determination, as well as providing incentive
for patients’ involvement in, and responsibility for, their own care.
Multicultural and gender aspects
Communication with patients and their next of kin should be characterisedby understanding and respect for cross-cultural and multicultural aspects
such as age, language, ethnicity, sexual orientation and religion, as well as
gender.
Interprofessional relations
Doctors with specialist competence must be capable of communicating,both in writing and orally, with other doctors and co-workers showing respect for their professional knowledge and competencies. The same applies
to contact with representatives of the public and various civil authorities.
Pedagogical skills
Doctors with specialist competence must have pedagogical capability inorder to inform and instruct not only patients and their next of kin, but also
other doctors and co-workers, as well as students.
Professional approach and ethics
Doctors with specialist competence must be capable of working continuously with their professional and medical ethical approaches, with the objective of being able to make independent decisions of a medical ethical nature.
Individual professional development
Doctors with specialist competence must be capable of continually examining and identifying their own needs for professional development, in addition to operational requirements, in order to be able to meet requirements forthe best possible patient care.

Leadership competence
Collaboration
Doctors with specialist competence must have a developed capability for
self-knowledge and an understanding of their own functions and roles in theorganisation.
Mentoring skills
Doctors with specialist competence must be capable of mentoring other doctors and co-workers, as well as students.
Leadership
Doctors with specialist competence must be capable of leadership characterised by collaboration, openness, and dialogue with co-workers. Leadershipmust further be characterised by participation and activity development
aimed at improvement. The ability to lead the work of the health care teamis essential.
System knowledge
Doctors with specialist competence must have an understanding of the organisation, administration, finances, and regulatory systems of health care,
as well as its governance, in order to make the best use of resources.

Competence within medical science and quality work
Medical science
Doctors with specialist competence must be capable of adopting a medicallyscientific outlook and approach, and must have knowledge of researchmethodology, including basic epidemiological concepts, as well as of methods for evidence-based medicine and review of scientific information.
Improvement and quality work
Doctors with specialist competence must have an understanding of, andcompetence in, evidence-based improvement and quality work. The objective is to be able to initiate, participate in, and be responsible for continuous
systematic improvement work with emphasis on a holistic perspective, patient safety, patient benefit, measurability, and teaching management in order to be able to review and evaluate their own operations.
Public health and prevention
Doctors with specialist competence must have an understanding of the factors determining health, other aspects of public health, and methods forpromoting health and efforts aimed at preventing injury and illness, in order
to be able to take this understanding into account in medical scientific work.

Training structure
Prior training and practise in basic surgical techniques is essential andshould take place in both a clinical and a simulated environment during
placement within both the base and the branch specialty. Practise in initialhandling of acute urological and surgical illnesses should be initiated early
and then go on during the entire training, and be followed by development
towards operative treatment and aftercare.
Training in surgical pathophysiology, basic pain management, intensive
care, and the effects of anaesthetics should be situated in the first part oftraining and make up the base for more specialised training.
The more specific training in urology should be initiated early on in thespecialist training, and it is recommended that it be started with connectedtraining in a field where large volumes of operative practise can be offered.
Training in transurethral surgery is essential and should be given broad
scope. The main placement should occur in the middle of training; shorter
placements, however, can be allocated early in order to provide basic practise in handling acute conditions.
If possible, courses, auscultations, and theoretical studies should bespread out in a way that allows integration with the ongoing placement.
Communication competence, leadership competence, and competence in
medical science and quality work should be initiated early on and should
continue as a natural and integrated part of the entire training.

Special recommendations
The specialty associations and sections of the medical organisations haveformulated special recommendations for their own specialties. The recommendations concern such issues as how specialist medical training should be
structured.

Intermediate objectives

Medical competenceIntermediate objective 1
To master surgical pathophysiology, basic surgical
techniques and treatment
of diseases of the skin anddermis requiring surgicaltreatment

Teaching methods
Clinical service under
supervision in a unit thattreats these conditions

Follow-up
Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor
Certificate of successfullycompleted course, issuedby course leader

Training in a simulated
environment
Theoretical studies
Intermediate objective 2
To master evaluation,
diagnostics, and treatment of acute abdominal
illnesses

Teaching methods
Clinical service under
supervision in a unit thattreats these conditions

Follow-up
Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

Theoretical studies
Intermediate objective 3
To master initial handlingof greater and lesser
traumaTeaching methods
Clinical service under
supervision in a unit thattreats these conditions
CourseFollow-up
Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor
Certificate of successfullycompleted course, issuedby course leader

Theoretical studies
Intermediate objective 4
To master basic pain
management, surgicalintensive care and theeffects of anaesthetics

Teaching methods
Clinical service under
supervision in a unit thattreats these conditions
Theoretical studies

Follow-up
Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

Intermediate objective 5
To be able to handle
acute injuries and illnesses in the urinary
tracts and genitals

Teaching methods
Clinical service under
supervision in a unit that
handles these conditions

Follow-up
Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

Theoretical studies
Intermediate objective 6
To be able to evaluate
and handle suspected
urological cancer

Teaching methods
Clinical service under
supervision in a unit that
handles these conditions
CourseFollow-up
Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor
Certificate of successfullycompleted course, issuedby course leader

Diagnostics and treatment conference
Theoretical studies
Intermediate objective 7
To be able to evaluate
and handle stones in theurinary tracts. To have an
understanding of endourological investigationand treatment of otherillnesses in the upper urinary tract

Teaching methods
Clinical service under
supervision in a unit thattreats these conditions
CourseFollow-up
Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor
Certificate of successfullycompleted course, issuedby course leader

Theoretical studies
Intermediate objective 8
To be able to evaluate
and handle infections andinflammatory conditions in
the urinary tracts andmale genitalia

Teaching methods
Clinical service under
supervision in a unit thattreats these conditions
CourseTheoretical studies

Follow-up
Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor
Certificate of successfullycompleted course, issuedby course leader

Intermediate objective 9
To be able to evaluate
and handle functional
disorders and obstructionsin the lower urinary tracts

Teaching methods
Clinical service under
supervision in a unit that
handles these conditions
CourseFollow-up
Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor
Certificate of successfullycompleted course, issuedby course leader

Theoretical studies
Intermediate objective 10
To be able to evaluate
and handle symptoms andillnesses in men’s genitalia

Teaching methods
Clinical service under
supervision in a unit that
handles these conditions
CourseFollow-up
Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor
Certificate of successfullycompleted course, issuedby course leader

Theoretical studies
Intermediate objective 11
To be able to evaluate
and handle symptoms andillnesses associated withmale sexuality

Teaching methods
Clinical service under
supervision in a unit that
handles these conditions
CourseFollow-up
Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor
Certificate of successfullycompleted course, issuedby course leader

Theoretical studies
Intermediate objective 12
To be able to initiallyevaluate and handle
symptoms and illnesses in
the urinary tracts andgenitalia of male children

Teaching methods
Clinical service under
supervision or auscultation in a unit that handles
these conditions
Theoretical studies

Follow-up
Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

Communicative competenceIntermediate objective 13
To be capable of dialogue
and open contact withpatients and their next ofkin, including difficult
answers

Teaching methods
Clinical service under
supervision in a unit
where such operations
are practised

Follow-up
Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

Intermediate objective 14
To be capable of communication, both oral andwritten, with other doctors
and co-workers

Teaching methods
Clinical service under
supervision in a unit
where such operations
are practised

Follow-up
Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

Intermediate objective 15
To be capable of informing and instructing patients, next of kin, otherdoctors, and co-workers,
as well as students

Teaching methods
Clinical service under
supervision in a unit
where such operations
are practised

Follow-up
Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

Instruction under supervision

Leadership competenceIntermediate objective 16
To be capable of mentoring other doctors and coworkers, as well as students

Teaching methods
Clinical service under
supervision in a unit
where such operations
are practised
CourseMentoring under supervision

Follow-up
Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor
Certificate of successfullycompleted course, issuedby course leader

Intermediate objective 17
To be capable of leading
using collaboration anddialogue with co-workers
as well as within thehealth care team

Teaching methods
Clinical service under
supervision in a unit
where such operations
are practised
CourseIntermediate objective 18
To have an understandingof the organisation, management and regulatory
systems of health andmedical care

Teaching methods
CourseFollow-up
Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor
Certificate of successfullycompleted course, issuedby course leader
Follow-up
Certificate of successfullycompleted course, issuedby course leader

Competence within medical science and quality
work
Intermediate objective 19
To be capable of a medically scientific outlook andapproach

Teaching methods
CourseWritten individual work
under supervision according to scientific principles
Large professional assemblyIntermediate objective 20
To have an understandingof, and competence in,evidence-based improvement and quality work

Teaching methods
Quality and development
work under supervision

Follow-up
Certificate of successfullycompleted course, issuedby course leader
Certificate of approved
written individual work,
issued by current mentor

Follow-up
Certificate of quality anddevelopment work, issued by current mentor

Paediatric surgery

Introduction
Explanation of terms
General definition of competencies
Definition of area of competence
Competence requirements
Competence requirements for medical competence
Competence requirements for communicative competence, leadershipcompetence, and competence within medical science and quality work
Training structure
Special recommendations
Intermediate objectives
Medical competenceCommunicative competence
Leadership competence
Competence within medical science and quality work

Introduction

On June 24, 2008, The National Board of Health and Welfare (Socialstyrelsen) decided to issue new regulations and general guidelines for doctors’
specialist medical training (SOSFS 2008:17). The statute consists of a general part with common provisions for all specialties and a specific part withall the descriptions of objectives. The description of objectives for the respective specialties should be understood against the background of the provisions in the general part.
In each description of objectives, there is a section headed ‘Training
structure’, which constitutes general guidelines. The teaching methods under the heading ‘Intermediate objectives’ where no follow-up is indicatedalso constitute general guidelines.

Explanation of terms

current mentor
a specialist doctor whose specialist competence corresponds to the area ofcompetence indicated by the intermediate objective, and who is responsible
for ST doctors’s professional development during the teaching period or forthe method of teaching indicatedthe assignment as a mentor for an ST doctor generally encompasses the entire period of specialist training but can also encompass part or parts of it
auscultation
during mentoring, and in accordance with a pre-designed programme, tostudy the profession of a specialist doctor or other health care staff by following one or several professionals, as well as carrying out assignments inthe current area
evaluate
to form a sound opinion of a patient or similar person as a basis for further
management
masterbeing fully able to evaluate and handle the medical investigation, diagnostics, treatment, and follow-up of a patient or similar person, and being fully
able to use the techniques relevant to the area
capability
personal capacity to execute or perform a task
have understanding
having acquired knowledge and insight into an area through theoretical studies and/or practical exercise of the profession
have knowledge
having acquired some knowledge in an area through theoretical studies
and/or practical exercise of the profession
mentoring under supervision
as an ST doctor, mentor a co-worker while simultaneously being mentored
by a doctor with specialist competence
mentorcontinuously, and in dialogue form, supporting and guiding, as well as evaluating, a co-worker’s professional development

mentoringsee mentor
handleto actively carry out measures regarding investigation, diagnostics, treatment, and follow-up of a patient or similar person, and have overall responsibility for carrying out these measuresinitially handle
as the primary physician in charge, to actively carry out measures regarding
investigation, diagnostics, treatment, and follow-up of a patient or similar
person, and have overall responsibility for carrying out these measuresinitially evaluate
as the primary physician in charge, to form a sound opinion of a patient orsimilar person as a basis for further management
intraprofessional group reflection
reflection done in a group together with other doctors, chiefly for the purpose of further education and training
clinical service
health and medical care duties that ST doctors perform under their own professional liability and with the support of a mentor
courseteacher-led training with an established plan, given during a defined periodof timesitting-in
training activity involving an ST doctor observing when a specialist doctor
or other health care staff holds a consultationorassessment activity involving a specialist doctor or other health care staff
observing and evaluating ST doctors during a consultation
seminarinstruction in group form with active participation
training in a simulated environment
training carried out in an environment created to emulate reality
large professional assembly
conference, congress, symposium or similar event

health care centre
health care unit in primary carehealth care team work
work where ST doctors, under supervision, participates in and sometimes
leads a group of co-operating health care staff with various competencies
charged with responsibility for care for an individual patient or group ofpatients

General definition of competencies

Definition of area of competence
The specialty of paediatric surgery covers the handling of children andyoung people with deformities, injuries and diseases that are treated using
surgical methods. Skills in operating techniques are crucial to this specialty.
Contact with children and parents is also vital in order to correctly evaluate
symptoms and pathophysiological courses of events. In addition to thecourse of events immediately prior to and after the operation, an importantelement of the specialty is the long-term follow-up of the growing individual.
Paediatric surgery is a branch specialty of the base specialty of surgery.

Competence requirements
Competence requirements for medical competence
For specialist competence in paediatric surgery, it is necessary to be able tohandle deformities and diseases of the gastrointestinal canal and urinary
tract, as well as hernias and other deformities of the abdominal wall anddiaphragm. It is also necessary to be able to initially handle common deformities and diseases of the blood vessels and lymphatic vessels, and of theorgans of the thorax. It is also important to be able to evaluate solid tumours
in children and to have an understanding of how to examine and treat them.
In practical terms, it is necessary to master basic investigation methods
and surgical operations, and to have an understanding of more advanced
surgical measures. It is also necessary to master the follow-up of paediatricsurgery conditions during the years of childhood and adolescence, and tohave an understanding of the consequences these could have for the patientas an adult. An understanding is also required of embryology, perinatal physiology, growth and development, as well as an understanding of intensive
care and anaesthesiology as regards the growing individual.
For specialist competence in paediatric surgery, it is also necessary tomaster surgical pathophysiology, basic surgical techniques, initial trauma
management, acute surgical diseases in adults and children, basic nutrition
management, basic pain management, basic surgical intensive care and theeffects of anaesthetics. This forms the common knowledge base with thebranch specialties (intermediate objectives 1–4).

Competence requirements for communicative competence,leadership competence, and competence within medical
science and quality work
Communicative competence
The equal and responsible patient
Doctors with specialist competence must be capable of dialogue and of
maintaining open contact with patients and their next of kin. Contact should
be characterised by empathy and trust, as well as respect for the patients’right to information, influence, and participation in decisions. Contact
should also be characterised by co-operation and sensitivity to the patients’needs, desires and right to self-determination, as well as providing incentives for the patients’ involvement and responsibility for their own care.
Multicultural and gender aspects
Communication with patients and their next of kin should be characterisedby understanding and respect for cross-cultural and multicultural aspects
such as age, language, ethnicity, sexual orientation, and religion, as well as
gender.
Interprofessional relations
Doctors with specialist competence must have the ability to communicate,both in writing and orally, with other doctors and co-workers showing respect for their professional knowledge and competencies. The same applies
to contact with representatives of the public and various civil authorities.
Pedagogical skills
Doctors with specialist competence must have pedagogical capability inorder to inform and instruct not only patients and their next of kin but also
other doctors and co-workers, as well as students.
Professional approach and ethics
Doctors with specialist competence must be capable of working continuously with their professional and medical ethical approaches, with the objectiveof being able to make independent decisions of a medical ethical nature.
Individual professional development
Doctors with specialist competence must be capable of continually examining and identifying their own needs for professional development, in addition to operational requirements, in order to be able to meet requirements forthe best possible patient care.

Leadership competence
Collaboration
Doctors with specialist competence must have a developed capability for
self-knowledge and understanding of their own functions and roles in theorganisation.
Mentoring skills
Doctors with specialist competence must be capable of mentoring other doctors and co-workers, as well as students.
Leadership
Doctors with specialist competence must be capable of leadership characterised by collaboration, openness, and dialogue with co-workers. Leadershipmust further be characterised by participation and activity development
aimed at improvement. The ability to lead the work of the health care teamis essential.
System knowledge
Doctors with specialist competence must have an understanding of the organisation, administration, finances, and regulatory systems of health andmedical care, as well as its governance, in order to make the best use of resources.

Competence within medical science and quality work
Medical science
Doctors with specialist competence must be capable of adopting a medicallyscientific outlook and approach, and must have knowledge of research methodology including basic epidemiological concepts as well as of methods
for evidence-based medicine and review of scientific information.
Improvement and quality work
Doctors with specialist competence must have an understanding of, andcompetence in, evidence-based improvement and quality work. The objective is to be able to initiate, participate in, and be responsible for continuous
systematic improvement work with emphasis on a holistic perspective, patient safety, patient benefit, measurability, and teaching management in order to be able to review and evaluate their own operations.
Public health and prevention
Doctors with specialist competence must have an understanding of the factors determining health, other aspects of public health, and methods forpromoting health and efforts aimed at preventing injury and illness, in order
to be able to take this understanding into account in medical scientific work.

Training structure
During the early part of training, it will be necessary for ST doctors to assimilate the common knowledge base for the surgical specialties. It is particularly important to learn the basic surgical techniques at the beginning, which
may be done either clinically or in a simulated environment. Specialist medical
training in paediatric surgery can begin before, during, or after specialist
medical training in surgery and can be integrated with it.
It is best if the main period of service at the beginning of training takes
place at a surgical unit. The majority of training in paediatric surgery shouldbe after ST doctors has acquired specialist competence in surgery. This
phase of specialist training should initially be focused on ST doctors learning to handle common conditions that require surgical treatment duringchildhood. The latter part of the training will constitute advanced studies inhighly-specialised paediatric surgery. It is, therefore, very important that ST
doctors learns to evaluate and handle common deformities in, above all, thegastrointestinal canal and urinary tract.
In connection with training in surgery, ST doctors should also receive simultaneous additional training in anaesthesiology and intensive care. Thisshould be supplemented with experience of paediatric anaesthesiology andpaediatric intensive care.
As the paediatric surgery area of competence covers many uncommon orvery uncommon conditions, it is extremely important to carry out extensive
theoretical studies in parallel with the practical training. ST doctors should
acquire communicative competence, leadership competence and competence within medical science and quality work at an early stage in parallelwith clinical training.

Special recommendations
The specialty associations and sections of the medical organisations haveformulated special recommendations for their own specialties. The recommendations concern such issues as how specialist medical training should be
structured.

Intermediate objectives

Medical competenceIntermediate objective 1

Teaching methods

Follow-up

To master surgical pathophysiology, basic surgical
techniques and treatment ofdiseases of the skin andhypodermis that could
require surgical treatment.

Clinical service under super- Certificate of successfully
vision in a unit that handles completed clinical service
these conditions
and competence achieved,
issued by current mentor
CourseCertificate of successfullycompleted course, issuedby course leader
Training in a simulated environment
Theoretical studies

Intermediate objective 2

Teaching methods

Follow-up

To master evaluation, diag- Clinical service under supernostics and initial treatment of vision in a unit that handles Certificate of successfullycompleted clinical service
acute abdominal diseases
these conditions
and competence achieved,
issued by current mentor
Theoretical studies

Intermediate objective 3

Teaching methods

Follow-up

To master initial handling ofmajor and minor traumas

Clinical service under
supervision in a unit that
handles these conditions

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Theoretical studies

Intermediate objective 4

Teaching methods

To master basic pain manClinical service underagement, surgical intensive supervision in a unit thatcare and anaesthetic effects handles these conditions
Theoretical studies

Follow-up
Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

Intermediate objective 5

Teaching methods

Follow-up

To be able to handle hernias
and other deformities in theabdominal wall and diaphragmof children and adults.

Clinical service under
supervision in a unitthat handles these
conditions

Certificate of successfully completed clinical service and competence achieved, issued bycurrent mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Theoretical studies

Intermediate objective 6

Teaching methods

To be able to handle deformi- Clinical service under suties and diseases of the upper pervision in a unit that
gastrointestinal canal, includ- handles these conditions
ing the liver, bile ducts, spleen
and pancreas of children andadultsCourseFollow-up
Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor
Certificate of successfullycompleted course, issuedby course leader

Training in a simulated environment
Theoretical studies

Intermediate objective 7

Teaching methods

To be able to handle deforClinical service under sumities and diseases of thepervision in a unit that
small intestine, colon, rectum handles these conditions
and anus of children andadultsCourseTraining in a simulated environment
Theoretical studies

Follow-up

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

Certificate of successfullycompleted course, issuedby course leader

Intermediate objective 8

Teaching methods

Follow-up

To be able to initiallyhandle diseases anddeformities of the bloodand lymphatic vessels ofchildrenClinical service under
supervision in a unit that
handles these conditions

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

Diagnostics and treatment
symposium
Theoretical studies

Intermediate objective 9

Teaching methods

To be able to handle
deformities and diseasesof the kidneys and urinary
tract of children

Clinical service under super- Certificate of successfully
vision in a unit that handles completed clinical service
and competence achieved,these conditions
issued by current mentor
CourseFollow-up

Certificate of successfullycompleted course, issuedby course leader

Theoretical studies

Intermediate objective 10

Teaching methods

To be able to initially handle Clinical service under superdeformities and diseases of vision in a unit that handles
the thorax in children
these conditionsorauscultation under supervision in a unit that handles
these conditions

Follow-up
Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor
orcertificate of approved auscultation and competenceachieved, issued by current
mentor

Theoretical studies

Intermediate objective 11

Teaching methods

To be able to evaluate solid
tumours in children

Clinical service under super- Certificate of successfully
vision in a unit that handles completed clinical service
and competence achieved,these conditions
issued by current mentor
CourseDiagnostics and treatment symposium
Theoretical studies

Follow-up

Certificate of successfullycompleted course, issuedby course leader

Intermediate objective 12

Teaching methods

Follow-up

To have an understanding of embryology,
perinatal physiology,
growth and development, and an understanding of intensive
care and anaesthesiology as regards the growing individual

Clinical service under
supervision in a unit
where such operations
are practised

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor
Certificate of successfullycompleted course, issuedby course leader

CourseTheoretical studies

Communicative competenceIntermediate objective 13

Teaching methods

To be capable of dialogue
and open contact with patients and their next of kin

Clinical service under superCertificate of successfully
vision in a unit where suchcompleted clinical service
operations are practised
and competence achieved,
issued by current mentor

Intermediate objective 14

Teaching methods

To be capable of communication, both oral andwritten, with other doctors
and co-workers

Clinical service under superCertificate of successfully
vision in a unit where suchcompleted clinical service
operations are practised
and competence achieved,
issued by current mentor

Intermediate objective 15

Teaching methods

To be capable of informing
Clinical service under superand instructing patients, next vision in a unit where suchof kin, other doctors, and co- operations are practised
workers, as well as students

Follow-up

Follow-up

Follow-up
Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

Leadership competenceIntermediate objective 16

Teaching methods

Follow-up

To be capable of mentoring other doctors and coworkers as well as students

Clinical service under
supervision in a unit
where such operations
are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Mentoring under supervisionIntermediate objective 17

Teaching methods

Follow-up

To be capable of leading
using collaboration anddialogue with co-workers aswell as within the health care
team

Clinical service under
supervision in a unit
where such operations
are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Teaching methods

Follow-up

CourseCertificate of successfullycompleted course, issuedby course leader

Intermediate objective 18
To have understanding of theorganisation, management,
and regulatory systems ofhealth and medical care

Competence within medical science and quality
work
Intermediate objective 19

Teaching methods

To be capable of a medically Course
scientific outlook and approach
Written individual work
under supervision according to scientific principles
Large professional assembly

Follow-up
Certificate of successfullycompleted course, issuedby course leader
Certificate of approved
written individual work,
issued by current
mentorIntermediate objective 20

Teaching methods

Follow-up

To have an understandingof, and competence in,evidence-based improvement and quality work

Quality and development
work under supervision

Certificate of qualityand development
work, issued bycurrent mentor

Plastic surgery

Introduction
Explanation of terms
General definition of competencies
Definition of area of competence
Competence requirements
Competence requirements for medical competence
Competence requirements for communicative competence, leadershipcompetence, and competence within medical science and quality work
Training structure
Special recommendations
Intermediate objectives
Medical competenceCommunicative competence
Leadership competence
Competence within medical science and quality work.

Introduction

On June 24, 2008, The National Board of Health and Welfare (Socialstyrelsen) decided to issue new regulations and general guidelines for doctors’
specialist medical training (SOSFS 2008:17). The statute consists on the one
hand of a general part with common provisions for all specialties, and on theother hand of a specific part with all descriptions of objectives. The description of objectives for the respective specialties should be understood against
the background of the provisions in the general part.
In each description of objectives, there is a section headed ‘Training
structure’, which constitutes general guidelines. The teaching methods under the heading ‘Intermediate objectives’ where no follow-up is indicatedalso constitute general guidelines.

Explanation of terms

current mentor
a specialist doctor whose specialist competence corresponds to the area ofcompetence indicated by the intermediate objective, and who is responsible
for ST doctors’s professional development during the teaching period or forthe method of teaching indicatedthe assignment as a mentor for an ST doctor generally encompasses the entire period of specialist training but can also encompass part or parts of it
auscultation
during mentoring, and in accordance with a pre-designed programme, tostudy the profession of a specialist doctor or other health care staff by following one or several professionals, as well as carrying out assignments inthe current area
evaluate
to form a sound opinion of a patient or similar person as a basis for further
management
masterbeing fully able to evaluate and handle the medical investigation, diagnostics, treatment, and follow-up of a patient or similar person, and being fully
able to use the techniques relevant to the area
capability
personal capacity to execute or perform a task
have understanding
having acquired knowledge and insight into an area through theoretical studies and/or practical exercise of the profession
have knowledge
having acquired some knowledge in an area through theoretical studies
and/or practical exercise of the profession
mentoring under supervision
as an ST doctor, mentor a co-worker while simultaneously being mentored
by a doctor with specialist competencementorcontinuously, and in dialogue form, supporting and guiding, as well as evaluating, a co-worker’s professional development
mentoringsee mentor
handleto actively carry out measures regarding investigation, diagnostics, treatment, and follow-up of a patient or similar person, and have overall responsibility for carrying out these measuresinitially handle
as the primary physician in charge, to actively carry out measures regarding
investigation, diagnostics, treatment, and follow-up of a patient or similar
person, and have overall responsibility for carrying out these measuresinitially evaluate
as the primary physician in charge, to form a sound opinion of a patient orsimilar person as a basis for further management
intraprofessional group reflection
reflection done in a group together with other doctors, chiefly for the purpose of further education and training
clinical service
health and medical care duties that ST doctors perform under their own professional liability and with the support of a mentor
courseteacher-led training with an established plan, given during a defined periodof timesitting-in
training activity involving an ST doctor observing when a specialist doctor
or other health care staff holds a consultationorassessment activity involving a specialist doctor or other health care staff
observing and evaluating ST doctors during a consultation
seminarinstruction in group form with active participation
training in a simulated environment
training carried out in an environment created to emulate reality

large professional assembly
conference, congress, symposium or similar event
health care centre
health care unit in primary carehealth care team work
work where ST doctors, under supervision, participates in and sometimes
leads a group of co-operating health care staff with various competencies
charged with responsibility for care for an individual patient or group ofpatients

General definition of competencies

Definition of area of competence
The specialty of plastic surgery covers the investigation, diagnostics, nonsurgical and surgical treatment and follow-up of external congenital deformities and acquired external defects and functional limitations caused bytumours, injuries, or other changes to the skin, mucous membranes, andconnective tissue. The evaluation of both acute injuries and diseases, as well
as planned plastic surgery measures for defects and deformities that are either congenital or that have arisen following an earlier trauma or disease,plays a central role and is based on a broad understanding of epidemiology
and diagnostics of the groups of diseases and injuries that occur. An understanding of fundamental principles and terms – as well as well-developed
practical skills regarding the majority of forms of investigation and operating methods, which provides the opportunity to plan and carry out specificoperations – is also of key importance. Plastic surgery technology requires
multidisciplinary collaboration – particularly in ear, nose and throat surgery,orthopaedics, neurological surgery, and surgery – which is necessary fordeveloping the area of competence.
The plastic surgery specialty is a branch specialty of the base specialty ofsurgery.

Competence requirements
Competence requirements for medical competence
For specialist competence in plastic surgery, it is necessary to master fundamental plastic surgery techniques and have an understanding of advanced
plastic surgery technology. It is also necessary to master the handling andtreatment of tumours and wounds involving the skin and soft parts.
It is also necessary to master the diagnostics and handling of burn injuries
as well as trauma caused by injuries to the skin and soft parts. As regards
the facial region, it is also necessary to master damage to the skeleton andnerves. It is also necessary to master the evaluation, diagnostics, and treatment of functional disorders within the groups of diseases and injuries that
occur in plastic surgery.
In addition to this, it is necessary to have an understanding of the diagnostics and treatment of conditions that require chest reconstruction and an understanding of the investigation, diagnostics and treatment of craniofacial
deformities and other deformities that require plastic surgery technology.
For specialist competence in plastic surgery, it is also necessary to master
surgical pathophysiology, basic surgical techniques, initial trauma management, acute surgical diseases in adults and children, basic nutrition management, basic pain management, basic surgical intensive care and the ef-

fects of anaesthetics. This forms the common knowledge base with thebranch specialties (intermediate objectives 1–4).

Competence requirements for communicative competence, leadership competence, and competence within medical scienceand quality work
Communicative competence
The equal and responsible patient
Doctors with specialist competence must be capable of dialogue and of
maintaining open contact with patients and their next of kin. Contact should
be characterised by empathy and trust, as well as respect for the patients’right to information, influence, and participation in decisions. Contact
should also be characterised by co-operation and sensitivity to the patients’needs, desires and right to self-determination, as well as providing incentives for the patients’ involvement and responsibility for their own care.
Multicultural and gender aspects
Communication with patients and their next of kin should be characterisedby an understanding of and respect for cross-cultural and multicultural aspects such as age, language, ethnicity, sexual orientation, and religion, as
well as gender.
Interprofessional relations
Doctors with specialist competence must have the ability to communicate,both in writing and orally, with other doctors and co-workers showing respect for their professional knowledge and competencies. The same applies
to contact with representatives of the public and various civil authorities.
Pedagogical skills
Doctors with specialist competence must have pedagogical capability inorder to inform and instruct not only patients and their next of kin but also
other doctors and co-workers, as well as students.
Professional approach and ethics
Doctors with specialist competence must be capable of working continuously with their professional and medical ethical approaches, with the objectiveof being able to make independent decisions of a medical ethical nature.
Individual professional development
Doctors with specialist competence must be capable of continually examining and identifying their own needs for professional development, in addition to operational requirements, in order to be able to meet requirements forthe best possible patient care.

Leadership competence
Collaboration
Doctors with specialist competence must have a developed capability for
self-knowledge and understanding of their own functions and roles in theorganisation.
Mentoring skills
Doctors with specialist competence must be capable of mentoring other doctors and co-workers, as well as students.
Leadership
Doctors with specialist competence must be capable of leadership characterised by collaboration, openness, and dialogue with co-workers. Leadershipmust further be characterised by participation and activity development
aimed at improvement. The ability to lead the work of the health care teamis essential.
System knowledge
Doctors with specialist competence must have an understanding of the organisation, administration, finances, and regulatory systems of health andmedical care, as well as its governance, in order to make the best use of resources.

Competence within medical science and quality work
Medical science
Doctors with specialist competence must be capable of adopting a medicallyscientific outlook and approach, and must have knowledge of research methodology including basic epidemiological concepts as well as of methods
for evidence-based medicine and review of scientific information.
Improvement and quality work
Doctors with specialist competence must have an understanding of, andcompetence in, evidence-based improvement and quality work. The objective is to be able to initiate, participate in, and be responsible for continuous
systematic improvement work with emphasis on a holistic perspective, patient safety, patient benefit, measurability, and teaching management in order to be able to review and evaluate their own operations.
Public health and prevention
Doctors with specialist competence must have an understanding of the factors determining health, other aspects of public health, and methods forpromoting health and efforts aimed at preventing injury and illness, in order
to be able to take this understanding into account in medical scientific workand quality work.

Training structure
Specialist medical training in plastic surgery can begin before, during, orafter specialist medical training in surgery and can be integrated with it.
Early education and training in basic plastic surgery techniques is essential and should take place in a clinical environment. Training in the initialhandling of plastic surgery diseases, trauma and acute conditions should
begin at an early stage and then continue throughout the entire training with
development of operative treatment and aftercare. Specialised training
should begin at an early stage and take place continually within the areas
offering adequate diagnostics, handling and operative training, such as skintumours, chest surgery and trauma.
During training, it is imperative that ST doctors is given placements atunits that practice burn injury care, reconstructive chest surgery, microsurgery and the treatment of deformities by means of plastic surgery. These
specialised placements should be as closely connected as possible and takeplace at university or regional hospitals. Simultaneous additional training
within adjacent areas should be arranged towards the end of the service period.
Courses and theoretical studies are practiced continually and should be anatural and integral part of the entire training. Communicative competence,leadership competence and competence within medical science and quality
work should be initiated at an early stage.

Special recommendations
The specialty associations and sections of the medical organisations haveformulated special recommendations for their own specialties. The recommendations concern such issues as how specialist medical training should be
structured.

Intermediate objectives

Medical competenceIntermediate objective 1

Teaching methods

Follow-up

To master surgical pathophysiology, basic surgical
techniques and treatment
of diseases of the skinand hypodermis that
could require surgicaltreatment.

Clinical service under
supervision in a unit that
handles these conditions

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Training in a simulated environment
Theoretical studies

Intermediate objective 2

Teaching methods

Follow-up

To master evaluation,
diagnostics and initial
treatment of acute abdominal diseases

Clinical service under
supervision in a unit that
handles these conditions

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

Theoretical studies

Intermediate objective 3

Teaching methods

Follow-up

To master initial handlingof major and minor traumas

Clinical service under
supervision in a unit that
handles these conditions

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Theoretical studies

Intermediate objective 4

Teaching methods

Follow-up

To master basic pain
management, surgicalintensive care andanaesthetic effects

Clinical service under
supervision in a unit that
handles these conditions

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

Theoretical studies

Intermediate objective 5

Teaching methods

Follow-up

To master basic plastic
surgery techniques andhave an understandingof advanced plastic surgery technology for thereconstruction of tissue
defects

Clinical service under
supervision in a unit that
handles these conditions

Certificate of successfullycompleted clinical service
and competenceachieved, issued by cur-CourseCertificate of successfullycompleted course, issuedby course leader

Theoretical studies

Intermediate objective 6

Teaching methods

Follow-up

To master the handlingand treatment of patientswith skin and soft parttumours

Clinical service under supervision in a unit that
handles these conditions

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Diagnostics and treatment symposiumIntermediate objective 7

Teaching methods

Follow-up

To master the diagnostics
and initial handling of burninjuries and also have an
understanding of the treatment of major burn injuries

Clinical service under
supervision in a unit that
handles these conditions

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Theoretical studies

Intermediate objective 8

Teaching methods

Follow-up

To master the diagnostics
and initial handling of trauma caused by skin and soft
part injuries and, as regards
the facial region, also damage to the skeleton andnerves.

Clinical service under supervision in a unit that
handles these conditions

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Theoretical studies

Intermediate objective 9

Teaching methods

Follow-up

To master the evaluation,
diagnostics and treatmentof wounds that require
plastic surgery technology

Clinical service under supervision in a unit that
handles these conditions

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Theoretical studies

Intermediate objective 10

Teaching methods

Follow-up

To master the evaluation,
diagnostics and treatmentof functional disorders
within the groups of diseases and injuries that
occur in plastic surgery

Clinical service under supervision in a unit that
handles these conditions

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Theoretical studies

Intermediate objective 11

Teaching methods

Follow-up

To have an understandingof the diagnostics andtreatment of conditions that
require chest reconstruction

Clinical service under
supervision in a unit that
handles these conditions

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Diagnostics and treatment
symposium
Theoretical studies

Intermediate objective 12

Teaching methods

To have an understanding of the examination,
diagnostics and treatment of craniofacial deformities and other deformities that require
plastic surgery technology

Clinical service under supervision in a unit that
handles these conditions

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Follow-up

Diagnostics and treatment
symposium
Theoretical studies

Communicative competenceIntermediate objective 13

Teaching methods

Follow-up

To be capable of dialogue
and open contact with patients and their next of kin

Clinical service under
supervision in a unit
where such operations
are practised

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

Intermediate objective 14

Teaching methods

Follow-up

To be capable of communication, both oral andwritten, with other doctors
and co-workers

Clinical service under
supervision in a unit
where such operations
are practised

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

Intermediate objective 15

Teaching methods

Follow-up

To be capable of informing
Clinical service under
and instructing patients, next supervision in a unitof kin, other doctors, and co- where such operations
workers, as well as students are practised
Instructing under supervision

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

Leadership competenceIntermediate objective 16

Teaching methods

Follow-up

To be capable of mentoring other doctors and coworkers as well as students

Clinical service under
supervision in a unit
where such operations
are practised

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Mentoring under supervisionIntermediate objective 17

Teaching methods

Follow-up

To be capable of leading
using collaboration anddialogue with co-workers
as well as within the healthcare team

Clinical service under
supervision in a unit
where such operations
are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Teaching methods

Follow-up

CourseCertificate of successfullycompleted course, issuedby course leader

Intermediate objective 18
To have an understandingof the organisation, management, and regulatory
systems of health andmedical care

Competence within medical science and quality
work
Intermediate objective 19

Teaching methods

Follow-up

To be capable of a medically scientific outlook
and approach

CourseCertificate of successfullycompleted course, issuedby course leader

Written individual work
under supervision according to scientific principles
Large professional assembly

Certificate of approved written individual work, issued bycurrent mentor

Intermediate objective 20

Teaching methods

To have an understanding of, andcompetence in, evidence-based improvement and quality work

Quality and development
work under supervision

Follow-up

Certificate of qualityand development
work, issued by current mentor

Vascular surgery

Introduction
Explanation of terms
General definition of competencies
Definition of area of competence
Competence requirements
Competence requirements for medical competence
Competence requirements for communicative competence, leadershipcompetence, and competence within medical science and quality work
Training structure
Special recommendations
Intermediate objectives
Medical competenceCommunicative competence
Leadership competence
Competence within medical science and quality work

Introduction

On June 24, 2008, The National Board of Health and Welfare (Socialstyrelsen) decided to issue new regulations and general guidelines for doctors’
specialist medical training (SOSFS 2008:17). The statute consists of a general part with common provisions for all specialties and a specific part withall the descriptions of objectives. The description of objectives for the respective specialties should be understood against the background of the provisions in the general part.
In each description of objectives, there is a section headed ‘Training
structure’, which constitutes general guidelines. The teaching methods under the heading ‘Intermediate objectives’ where no follow-up is indicatedalso constitute general guidelines.

Explanation of terms

current mentor
a specialist doctor whose specialist competence corresponds to the area ofcompetence indicated by the intermediate objective, and who is responsible
for ST doctors’s professional development during the teaching period or forthe method of teaching indicatedthe assignment as a mentor for an ST doctor generally encompasses the entire period of specialist training but can also encompass part or parts of it
auscultation
during mentoring, and in accordance with a pre-designed programme, tostudy the profession of a specialist doctor or other health care staff by following one or several professionals, as well as carrying out assignments inthe current area
evaluate
to form a sound opinion of a patient or similar person as a basis for further
management
masterbeing fully able to evaluate and handle the medical investigation, diagnostics, treatment, and follow-up of a patient or similar person, and being fully
able to use the techniques relevant to the area
capability
personal capacity to execute or perform a task
have understanding
having acquired knowledge and insight into an area through theoretical studies and/or practical exercise of the profession
have knowledge
having acquired some knowledge in an area through theoretical studies
and/or practical exercise of the profession
mentoring under supervision
as an ST doctor, mentor a co-worker while simultaneously being mentored
by a doctor with specialist competencementorcontinuously, and in dialogue form, supporting and guiding, as well as evaluating, a co-worker’s professional development
mentoringsee mentor
handleto actively carry out measures regarding investigation, diagnostics, treatment, and follow-up of a patient or similar person, and have overall responsibility for carrying out these measuresinitially handle
as the primary physician in charge, to actively carry out measures regarding
investigation, diagnostics, treatment, and follow-up of a patient or similar
person, and have overall responsibility for carrying out these measuresinitially evaluate
as the primary physician in charge, to form a sound opinion of a patient orsimilar person as a basis for further management
intraprofessional group reflection
reflection done in a group together with other doctors, chiefly for the purpose of further education and training
clinical service
health and medical care duties that ST doctors perform under their own professional liability and with the support of a mentor
courseteacher-led training with an established plan, given during a defined periodof timesitting-in
training activity involving an ST doctor observing when a specialist doctor
or other health care staff holds a consultationorassessment activity involving a specialist doctor or other health care staff
observing and evaluating ST doctors during a consultation
seminarinstruction in group form with active participation
training in a simulated environment
training carried out in an environment created to emulate reality

large professional assembly
conference, congress, symposium or similar event
health care centre
health care unit in primary carehealth care team work
work where ST doctors, under supervision, participates in and sometimes
leads a group of co-operating health care staff with various competencies
charged with responsibility for care for an individual patient or group ofpatients

General definition of competencies

Definition of area of competence
The specialty of vascular surgery includes specific knowledge and skills in
diagnosing and treating diseases and injuries that concern peripheral bloodvessels. This includes all the arteries and veins in the body, except the bloodvessels in the heart and brain. This area of competence is closely connected
to radiology, and also to angiology.
The area of competence covers all reconstructive operations that could be
relevant using surgical and endovascular techniques. This also includes athorough understanding of angiology and the pathophysiology of the vascular system and also of pharmacological therapy and an understanding ofradiology diagnostics, with its limitations and possibilities.
The vascular surgery specialty is a branch specialty of the base specialty
of surgery.

Competence requirements
Competence requirements for medical competence
For specialist competence in vascular surgery, it is necessary to master andhave an understanding of evaluation, investigation, diagnostics, surgical andendovascular treatment and the follow-up of patients with peripheral vascular disorders and vascular trauma. An understanding of radiology diagnostics and prophylaxis as well as the pharmacological treatment of vasculardisorders is also necessary.
For specialist competence in vascular surgery, it is also necessary to master surgical pathophysiology, basic surgical techniques, initial trauma management, acute surgical diseases in adults and children, basic nutrition management, basic pain management, basic surgical intensive care and effects ofanaesthetics. This forms the common knowledge base with the branch specialties (intermediate objectives 1–4).

Competence requirements for communicative competence, leadership competence, and competence within medical scienceand quality work
Communicative competence
The equal and responsible patient
Doctors with specialist competence must be capable of dialogue and of
maintaining open contact with patients and their next of kin. Contact should
be characterised by empathy and trust, as well as respect for the patients’right to information, influence, and participation in decisions. Contact

should also be characterised by co-operation and sensitivity to the patients’needs, desires and right to self-determination, as well as providing incentives for the patients’ involvement and responsibility for their own care.
Multicultural and gender aspects
Communication with patients and their next of kin should be characterisedby understanding and respect for cross-cultural and multicultural aspects
such as age, language, ethnicity, sexual orientation, and religion, as well as
gender.
Interprofessional relations
Doctors with specialist competence must have the ability to communicate,both in writing and orally, with other doctors and co-workers showing respect for their professional knowledge and competencies. The same applies
to contact with representatives of the public and various civil authorities.
Pedagogical skills
Doctors with specialist competence must have pedagogical capability inorder to inform and instruct not only patients and their next of kin but also
other doctors and co-workers, as well as students.
Professional approach and ethics
Doctors with specialist competence must be capable of working continuously with their professional and medical ethical approaches, with the objectiveof being able to make independent decisions of a medical ethical nature.
Individual professional development
Doctors with specialist competence must be capable of continually examining and identifying their own needs for professional development, in addition to operational requirements, in order to be able to meet requirements forthe best possible patient care.

Leadership competence
Collaboration
Doctors with specialist competence must have a developed capability for
self-knowledge and understanding of their own functions and roles in theorganisation.
Mentoring skills
Doctors with specialist competence must be capable of mentoring other doctors and co-workers, as well as students.

Leadership
Doctors with specialist competence must be capable of leadership characterised by collaboration, openness, and dialogue with co-workers. Leadershipmust further be characterised by participation and activity development
aimed at improvement. The ability to lead the work of the health care teamis essential.
System knowledge
Doctors with specialist competence must have an understanding of the organisation, administration, finances, and regulatory systems of health andmedical care, as well as its governance, in order to make the best use of resources.

Competence within medical science and quality work
Medical science
Doctors with specialist competence must be capable of adopting a medicallyscientific outlook and approach, and must have knowledge of research methodology including basic epidemiological concepts as well as of methods
for evidence-based medicine and review of scientific information.
Improvement and quality work
Doctors with specialist competence must have understanding of, and competence in, evidence-based improvement and quality work. The objective is
to be able to initiate, participate in, and be responsible for continuous systematic improvement work with emphasis on a holistic perspective, patient
safety, patient benefit, measurability, and teaching management in order tobe able to review and evaluate their own operations.
Public health and prevention
Doctors with specialist competence must have an understanding of the factors determining health, other aspects of public health, and methods forpromoting health and efforts aimed at preventing injury and illness, in order
to be able to take this understanding into account in medical scientific work.

Training structure
Specialist medical training in vascular surgery can begin before, during, orafter specialist medical training in surgery and can be integrated with it.
Early education and training in basic surgical techniques is essential andshould take place in both clinical and simulated environments during
placements within both basic and branch specialties. Training in the initialhandling of acute surgical diseases should begin at an early stage and thencontinue throughout the entire training with development of operative
treatment and aftercare.

Training in surgical pathophysiology, imaging techniques, traumatology
and basic pain management should take place during the first part of the
training and form the basis for the more specialised training.
Simultaneous additional training though service in anaesthesiology andintensive care can be arranged during the latter part of the training. Further,subsequent simultaneous additional training in medical angiology, radiology
and thoracic surgery are also particularly recommended.
The continual development of knowledge in the optimum care of patientswith peripheral vascular disorders should take place in close cooperation
with other areas of knowledge, such as endocrinology, nephrology and cardiology during the entire period of specialist vascular surgery training.
More specific vascular surgery and endovascular training should begin at
an early stage of specialist training in order to enable ST doctors to take partin acute vascular surgery operations during the remainder of the training.
Specific vascular surgery and endovascular training should also be offered to agreat extent under supervision during the latter part of the training. It is also
important that ST doctors is offered ample training in the handling of acutevascular disorders and vascular injuries in order to acquire a good understanding of the subject. It may be beneficial to offer this through service atunits with a greater volume of endovascular and open vascular surgery
treatment during the latter half of the training.
Specialist training should involve logical, clear and continuous professional
development. Well thought-out management of intermediate objectives andtraining elements, including courses, should therefore form part of the individual training plan.
Placements should be as closely connected as possible and only be interrupted by courses on the subject or theoretical studies.
Professional development in areas such as communication, leadership andmedical science should begin as early as possible in the training and thencontinue in parallel and integrated with the remainder of the training.

Special recommendations
The specialty associations and sections of the medical organisations haveformulated special recommendations for their own specialties. The recommendations concern such issues as how specialist medical training should be
structured.

Intermediate objectives

Medical competenceIntermediate objective 1

Teaching methods

Follow-up

To master surgical pathophysiology, basic
surgical techniques andtreatment of diseases ofthe skin and hypodermisthat could require surgical treatment.

Clinical service under supervision in a unit that
handles these conditions

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Training in a simulated environment
Theoretical studies

Intermediate objective 2

Teaching methods

Follow-up

To master evaluation,
diagnostics and initial
treatment of acute abdominal diseases

Clinical service under
supervision in a unit that
handles these conditions

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

Theoretical studies

Intermediate objective 3

Teaching methods

Follow-up

To master initial handling ofmajor and minor traumas

Clinical service under
supervision in a unit that
handles these conditions

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Theoretical studies

Intermediate objective 4

Teaching methods

Follow-up

To master basic pain
management, surgicalintensive care andanaesthetic effects

Clinical service under
supervision in a unit that
handles these conditions

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

Theoretical studies

Intermediate objective 5

Teaching methods

Follow-up

To master evaluation anddiagnostics and also to beable to handle occlusive
disease in peripheral vessels

Clinical service under
supervision in a unit that
handles these conditions

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

Auscultation under superTo have an understanding of vision in a unit that hanpathogenesis and be able to dles these conditions
handle pharmacologicalCoursetreatment and prophylaxis
with regard to peripheral
vascular disorders
Theoretical studies

Certificate of successfullycompleted course, issuedby course leader

Intermediate objective 6

Teaching methods

Follow-up

To master evaluation anddiagnostics and be able todeal with aneurisms in theabdominal aorta, extremity
arteries and visceral arteries

Clinical service under
supervision in a unit that
handles these conditions

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Theoretical studies

Intermediate objective 7

Teaching methods

Follow-up

To master evaluation anddiagnostics and be able
to handle carotid arterydiseases and be able toevaluate disease in thevessels leading from theaortic arch

Clinical service under
supervision in a unit that
handles these conditions

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

Auscultation under supervision in a unit that handles
these conditions
CourseCertificate of successfullycompleted course, issuedby course leader

Theoretical studies

Intermediate objective 8

Teaching methods

Follow-up

To be able to handle
evaluation and diagnostics and have an understanding of the treatmentof thoracic aneurisms
and aortic dissection

Clinical service under supervision in a unit that
handles these conditions

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

Auscultation under supervision in a unit that handles these conditions
Theoretical studies

Intermediate objective 9

Teaching methods

Follow-up

To master diagnostics andtreatment of superficial
venous insufficiency andvenous thrombosis and beable to handle deep venous insufficiency and venous thromboembolism

Clinical service under supervision in a unit that
handles these conditions

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

Auscultation under supervision in a unit that handles these conditions
CourseCertificate of successfullycompleted course, issuedby course leader

Theoretical studies

Intermediate objective 10

Teaching methods

Follow-up

To be able to handle
permanent venous catheters, access for haemodialysis treatment andperitoneal dialysis

Clinical service under
supervision in a unit that
handles these conditions

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

Auscultation under supervision in a unit that handles these conditions
Theoretical studies

Intermediate objective 11

Teaching methods

Follow-up

To be able to evaluate radiology methods for vasculardisorders

Clinical service under
supervision in a unit that
handles these conditions

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

Auscultation under supervision in a unit that handles these conditions
CourseTheoretical studies

Certificate of successfullycompleted course, issuedby course leader

Communicative competenceIntermediate objective 12

Teaching methods

Follow-up

To have a capability for
dialogue and of maintaining
open contact with patientsand their next of kin

Clinical service under
supervision in a unit
where such operations
are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

Intermediate objective 13

Teaching methods

Follow-up

To be capable ofcommunication, bothoral and written, withother doctors and coworkers

Clinical service under
supervision in a unit
where such operations
are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

Intermediate objective 14

Teaching methods

Follow-up

To be capable of informing
Clinical service under
and instructing patients, next supervision in a unitof kin, other doctors, and co- where such operations
workers, as well as students are practised

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

Instructing under supervision

Leadership competenceIntermediate objective 15

Teaching methods

Follow-up

To be capable of mentoring other doctors and coworkers as well as students

Clinical service under
supervision in a unit
where such operations
are practised

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Mentoring under supervision

Intermediate objective 16

Teaching methods

Follow-up

To be capable of leading
using collaboration anddialogue with co-workers aswell as within the healthcare team

Clinical service under
supervision in a unit
where such operations
are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Intermediate objective 17

Teaching methods

Follow-up

To have an understandingof the organisation, management, and regulatory
systems of health and medical care

CourseCertificate of successfullycompleted course, issuedby course leader

Competence within medical science and quality
work
Intermediate objective 18
To be capable of a medicallyscientific outlook and approach

Teaching methods

Follow-up

CourseCertificate of successfullycompleted course, issuedby course leader

Written individual work
under supervisionaccording to scientificprinciples

Certificate of approved written individual work, issued bycurrent mentor

Large professional assemblyIntermediate objective 19
To have an understanding of, andcompetence in, evidence-based improvement and quality work

Teaching methods
Quality and development
work under supervision

Follow-up

Certificate of qualityand development
work, issued by current mentor

Thoracic surgery

Introduction
Explanation of terms
General definition of competencies
Definition of area of competence
Competence requirements
Competence requirements for medical competence
Competence requirements for communicative competence, leadershipcompetence, and competence within medical science and quality work
Training structure
Special recommendations
Intermediate objectives
Medical competenceCommunicative competence
Leadership competence
Competence within medical science and quality work

Introduction

On June 24, 2008, The National Board of Health and Welfare (Socialstyrelsen) decided to issue new regulations and general guidelines for doctors’
specialist medical training (SOSFS 2008:17). The statute consists of a general part with common provisions for all specialties and a specific part withall the descriptions of objectives. The description of objectives for the respective specialties should be understood against the background of the provisions in the general part.
In each description of objectives, there is a section headed ‘Training
structure’, which constitutes general guidelines. The teaching methods under the heading ‘Intermediate objectives’ where no follow-up is indicatedalso constitute general guidelines.

Explanation of terms

current mentor
a specialist doctor whose specialist competence corresponds to the area ofcompetence indicated by the intermediate objective, and who is responsible
for ST doctors’s professional development during the teaching period or forthe method of teaching indicatedthe assignment as a mentor for an ST doctor generally encompasses the entire period of specialist training but can also encompass part or parts of it
auscultation
during mentoring, and in accordance with a pre-designed programme, tostudy the profession of a specialist doctor or other health care staff by following one or several professionals, as well as carrying out assignments inthe current area
evaluate
to form a sound opinion of a patient or similar person as a basis for further
management
masterbeing fully able to evaluate and handle the medical investigation, diagnostics, treatment, and follow-up of a patient or similar person, and being fully
able to use the techniques relevant to the area
capability
personal capacity to execute or perform a task
have understanding
having acquired knowledge and insight into an area through theoretical studies and/or practical exercise of the profession
have knowledge
having acquired some knowledge in an area through theoretical studies
and/or practical exercise of the profession
mentoring under supervision
as an ST doctor, mentor a co-worker while simultaneously being mentored
by a doctor with specialist competencementorcontinuously, and in dialogue form, supporting and guiding, as well as evaluating, a co-worker’s professional development
mentoringsee mentor
handleto actively carry out measures regarding investigation, diagnostics, treatment, and follow-up of a patient or similar person, and have overall responsibility for carrying out these measuresinitially handle
as the primary physician in charge, to actively carry out measures regarding
investigation, diagnostics, treatment, and follow-up of a patient or similar
person, and have overall responsibility for carrying out these measuresinitially evaluate
as the primary physician in charge, to form a sound opinion of a patient orsimilar person as a basis for further management
intraprofessional group reflection
reflection done in a group together with other doctors, chiefly for the purpose of further education and training
clinical service
health and medical care duties that ST doctors perform under their own professional liability and with the support of a mentor
courseteacher-led training with an established plan, given during a defined periodof timesitting-in
training activity involving an ST doctor observing when a specialist doctor
or other health care staff holds a consultationorassessment activity involving a specialist doctor or other health care staff
observing and evaluating ST doctors during a consultation
seminarinstruction in group form with active participation
training in a simulated environment
training carried out in an environment created to emulate reality

large professional assembly
conference, congress, symposium or similar event
health care centre
health care unit in primary carehealth care team work
work where ST doctors, under supervision, participates in and sometimes
leads a group of co-operating health care staff with various competencies
charged with responsibility for care for an individual patient or group ofpatients

General definition of competencies

Definition of area of competence
The specialty of thoracic surgery includes advanced studies and skills in thematter of handling the kind of congenital or acquired disorders and damage
to the organs of the thoracic cavity, the chest wall and diaphragm that aretreated using surgical methods. The specialty includes both acute and nonacute disorders and damage and also acute and planned measures. The majority of cardiac surgical procedures are carried out by means of extracorporeal circulation and open surgery. At the same time, there is a trend towards
endoscopic methods and endovascular techniques that is expected to increase in extent.

Competence requirements
Competence requirements for medical competence
For specialist competence in thoracic surgery, an all-round and advanced
understanding of pathogenesis, pathophysiology, epidemiology, diagnostics
and different treatments for deformities, diseases, and damage to the organsof the thoracic cavity, chest wall, and diaphragm are required. For specialist
competence, good practical skills in the majority of forms of investigationand treatment that occur, as well as the handling of acute conditions, arefurther required. Great emphasis is put on mastering the most common heart
and lung operations and indications for these.

Competence requirements for communicative competence, leadership competence, and competence within medical scienceand quality work
Communicative competence
The equal and responsible patient
Doctors with specialist competence must be capable of dialogue and of
maintaining open contact with patients and their next of kin. Contact should
be characterised by empathy and trust, as well as respect for the patients’right to information, influence, and participation in decisions. Contact
should also be characterised by co-operation and sensitivity to the patients’needs, desires and right to self-determination, as well as providing incentive
for the patients’ involvement and responsibility for their own care.

Multicultural and gender aspects
Communication with patients and their next of kin should be characterisedby an understanding of and respect for cross-cultural and multicultural aspects such as age, language, ethnicity, sexual orientation, and religion, as
well as gender.
Interprofessional relations
Doctors with specialist competence must have the ability to communicate,both in writing and orally, with other doctors and co-workers showing respect for their professional knowledge and competencies. The same applies
to contact with representatives of the public and various civil authorities.
Pedagogical skills
Doctors with specialist competence must have pedagogical capability inorder to inform and instruct not only patients and their next of kin but also
other doctors and co-workers, as well as students.
Professional approach and ethics
Doctors with specialist competence must be capable of working continuously with their professional and medical ethical approaches, with the objectiveof being able to make independent decisions of a medical ethical nature.
Individual professional development
Doctors with specialist competence must be capable of continually examining and identifying their own needs for professional development, in addition to operational requirements, in order to be able to meet requirements forthe best possible patient care.

Leadership competence
Collaboration
Doctors with specialist competence must have a developed capability for
self-knowledge and understanding of their own functions and roles in theorganisation.
Mentoring skills
Doctors with specialist competence must be capable of mentoring other doctors and co-workers, as well as students.
Leadership
Doctors with specialist competence must be capable of leadership characterised by collaboration, openness, and dialogue with co-workers. Leadershipmust further be characterised by participation and activity development
aimed at improvement. The ability to lead the work of the health care teamis essential.

System knowledge
Doctors with specialist competence must have an understanding of the organisation, administration, finances, and regulatory systems of health andmedical care, as well as its governance, in order to make the best use of resources.

Competence within medical science and quality work
Medical science
Doctors with specialist competence must be capable of adopting a medicallyscientific outlook and approach, and must have knowledge of research methodology including basic epidemiological concepts as well as of methods
for evidence-based medicine and review of scientific information.
Improvement and quality work
Doctors with specialist competence must have an understanding of, andcompetence in, evidence-based improvement and quality work. The objective is to be able to initiate, participate in, and be responsible for continuous
systematic improvement work with emphasis on a holistic perspective, patient safety, patient benefit, measurability, and teaching management in order to be able to review and evaluate their own operations.
Public health and prevention
Doctors with specialist competence must have an understanding of the factors determining health, other aspects of public health, and methods forpromoting health and efforts aimed at preventing injury and illness, in order
to be able to take this understanding into account in medical scientific work.

Training structure
The most suitable place for the majority of specialist training is at the thoracic
surgery unit. In addition, the training should include simultaneous additional
training in the specialties of anaesthesiology, intensive care and cardiology.
Specialist training should begin and end at the thoracic surgery unit withsimultaneous additional training organised in the middle of the training.
Training will partially take place in the form of on-call duty, which is a necessity for assimilating medical competence.

Special recommendations
The specialty associations and sections of the medical organisations haveformulated special recommendations for their own specialties. The recommendations concern such issues as how specialist medical training should be
structured.

Intermediate objectives

Medical competenceIntermediate objective 1

Teaching methods

Follow-up

To master basic surgical techniques

Clinical service under
supervision in a unit
where such operations
are practised

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Intermediate objective 2

Teaching methods

Follow-up

To be able to initially handle thoracic
traumaClinical service under supervision in a unit that
handles these conditions

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Theoretical studies

Intermediate objective 3

Teaching methods

Follow-up

To master ordinary arrhythmia treatment andcirculatory arrest

Clinical service under
supervision in a unit that
handles these conditions

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

Theoretical studies

Intermediate objective 4

Teaching methods

Follow-up

To be able to handle
post-operative complications

Clinical service under supervision in a unit that
handles these conditions

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

Theoretical studies

Intermediate objective 5

Teaching methods

To have an understanding of Auscultation under supervision in a unit where such
extracorporeal circulation
operations are practised
and mechanical circulatory
supportCourseFollow-up

Certificate of successfullycompleted course, issuedby course leader

Theoretical studies

Intermediate objective 6

Teaching methods

Follow-up

To master the handlingof post-operative bleeding and tamponade

Clinical service under supervision in a unit that
handles these conditions

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

Intermediate objective 7

Teaching methods

Follow-up

To have an understanding of pacemaker treatment and arrhythmia
surgery

Clinical service under
supervision in a unit that
handles these conditions

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

Theoretical studies

Intermediate objective 8

Teaching methods

Follow-up

To have an understandingof lung cancer treatment
and be able to handle
bullous lung disease

Clinical service under supervision in a unit that
handles these conditions

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

Theoretical studies

Intermediate objective 9

Teaching methods

To have an understanding of Clinical service underangiography, endovascular supervision in a unit thatrevascularisation, aneurism handles these conditions
treatment and valve operations

Follow-up
Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

Intermediate objective 10

Teaching methods

To have an understanding of the diagnostics
and treatment of deformities, valve abnormalities and aortic diseases

Clinical service under super- Certificate of successfully
vision in a unit that handles completed clinical service
and competencethese conditions
achieved, issued by current mentor
CourseFollow-up

Certificate of successfullycompleted course, issuedby course leader

Theoretical studies

Intermediate objective 11

Teaching methods

Follow-up

To master thoracotomy with lung resection and thorascopy

Clinical service under
supervision in a unit that
handles these conditions

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

Intermediate objective 12

Teaching methods

Follow-up

To master coronary
artery surgery and aortic
valve operations

Clinical service under
supervision in a unit that
handles these conditions

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

Communicative competenceIntermediate objective 13

Teaching methods

Follow-up

To be capable of dialogue
and open contact with patients and their next of kin

Clinical service under
supervision in a unit
where such operations
are practised

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

Intermediate objective 14

Teaching methods

Follow-up

To be capable of communication, both oral andwritten, with other doctors
and co-workers

Clinical service under
supervision in a unit
where such operations
are practised

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

Intermediate objective 15

Teaching methods

Follow-up

To be capable of informing
and instructing patients,
next of kin, other doctors,
and co-workers, as well as
students

Clinical service under
supervision in a unit
where such operations
are practised

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

Instructing under supervision

Leadership competenceIntermediate objective 16

Teaching methods

Follow-up

To be capable of mentoringother doctors and coworkers as well as students

Clinical service under
supervision in a unit
where such operations
are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Mentoring under supervisionIntermediate objective 17

Teaching methods

Follow-up

To be capable of leading
using collaboration anddialogue with co-workers aswell as within the healthcare team

Clinical service under
supervision in a unit
where such operations
are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Intermediate objective 18

Teaching methods

Follow-up

To have an understandingof the organisation, management, and regulatory
systems of health andmedical care

CourseCertificate of successfullycompleted course, issuedby course leader

Competence within medical science and quality
work
Intermediate objective 19

Teaching methods

Follow-up

To be capable of adopting a scientific outlook
and approach

CourseCertificate of successfullycompleted course, issuedby course leader

Written individual work
under supervision according to scientific principles

Certificate of approved written individual work, issued bycurrent mentor

Intermediate objective 20

Teaching methods

Follow-up

To have an understandingof, and competence in,evidence-based improvement and quality work

Quality and development
work under supervision

Certificate of quality anddevelopment work, issued
by current mentor

Orthopaedics

Introduction
Explanation of terms
General definition of competencies
Definition of area of competence
Competence requirements
Competence requirements for medical competence
Competence requirements for communicative competence, leadershipcompetence, and competence within medical science and quality work
Training structure
Special recommendations
Intermediate objectives
Medical competenceCommunicative competence
Leadership competence
Competence within medical science and quality work

Introduction

On June 24, 2008, The National Board of Health and Welfare (Socialstyrelsen) decided to issue new regulations and general guidelines for doctors’
specialist medical training (SOSFS 2008:17). The statute consists of a general part with common provisions for all specialties and a specific part withall the descriptions of objectives. The description of objectives for the respective specialties should be understood against the background of the provisions in the general part.
In each description of objectives, there is a section headed ‘Training
structure’, which constitutes general guidelines. The teaching methods under the heading ‘Intermediate objectives’ where no follow-up is indicatedalso constitute general guidelines.

Explanation of terms

current mentor
a specialist doctor whose specialist competence corresponds to the area ofcompetence indicated by the intermediate objective, and who is responsible
for ST doctors’s professional development during the teaching period or forthe method of teaching indicatedthe assignment as a mentor for an ST doctor generally encompasses the entire period of specialist training but can also encompass part or parts of it
auscultation
during mentoring, and in accordance with a pre-designed programme, tostudy the profession of a specialist doctor or other health care staff by following one or several professionals, as well as carrying out assignments inthe current area
evaluate
to form a sound opinion of a patient or similar person as a basis for further
management
masterbeing fully able to evaluate and handle the medical investigation, diagnostics, treatment, and follow-up of a patient or similar person, and being fully
able to use the techniques relevant to the area
capability
personal capacity to execute or perform a task
have understanding
having acquired knowledge and insight into an area through theoretical studies and/or practical exercise of the profession
have knowledge
having acquired some knowledge in an area through theoretical studies
and/or practical exercise of the profession
mentoring under supervision
as an ST doctor, mentor a co-worker while simultaneously being mentored
by a doctor with specialist competencementorcontinuously, and in dialogue form, supporting and guiding, as well as evaluating, a co-worker’s professional development
mentoringsee mentor
handleto actively carry out measures regarding investigation, diagnostics, treatment, and follow-up of a patient or similar person, and have overall responsibility for carrying out these measuresinitially handle
as the primary physician in charge, to actively carry out measures regarding
investigation, diagnostics, treatment, and follow-up of a patient or similar
person, and have overall responsibility for carrying out these measuresinitially evaluate
as the primary physician in charge, to form a sound opinion of a patient orsimilar person as a basis for further management
intraprofessional group reflection
reflection done in a group together with other doctors, chiefly for the purpose of further education and training
clinical service
health and medical care duties that ST doctors perform under their own professional liability and with the support of a mentor
courseteacher-led training with an established plan, given during a defined periodof timesitting-in
training activity involving an ST doctor observing when a specialist doctor
or other health care staff holds a consultationorassessment activity involving a specialist doctor or other health care staff
observing and evaluating ST doctors during a consultation
seminarinstruction in group form with active participation
training in a simulated environment
training carried out in an environment created to emulate reality

large professional assembly
conference, congress, symposium or similar event
health care centre
health care unit in primary carehealth care team work
work where ST doctors, under supervision, participates in and sometimes
leads a group of co-operating health care staff with various competencies
charged with responsibility for care for an individual patient or group ofpatients

General definition of competencies

Definition of area of competence
The speciality of orthopaedics includes an advanced understanding of andskills in congenital and acquired disorders and damage to the musculoskeletal system. The specialty includes both acute and non-acute disorders anddamage: fractures, degenerative and inflammatory conditions in the joints,
tendons, muscles and nerves, spinal diseases and metabolic bone diseases.
Interventions include surgical, pharmacological and rehabilitative measures.
In addition to diagnostics, treatment and follow-up, individual and generalpreventive measures are included.
Diagnostics is based on analysis of the case history and extensive clinicalexamination, supplemented with radiological and endoscopic investigations
and isotope and laboratory investigations. The treatment methods include
surgical operations, medications, physiotherapy, occupational therapy, orthopaedic aids, social support, rehabilitation and health education. The patient perspective, jointly setting out the treatment plan and, the continuity ofthe patient-doctor relationship play a central role.
Orthopaedics is the base specialty for the branch specialty of hand surgery.

Competence requirements
Competence requirements for medical competence
For specialist competence in orthopaedics, it is necessary to master basic
clinical and surgical techniques and fundamental pathophysiology with regard to both acute and chronic conditions in the musculoskeletal systemthrough all the stages of life. It is also necessary to master basic pain management, intensive care and anaesthesiology as regards musculoskeletal
diseases. It is also necessary to be able to initially handle general trauma
situations. In addition to this, an understanding of habilitative and rehabilitative measures and prevention (intermediate objectives 1–3 and 12) is required.
For specialist competence in orthopaedics, it is also necessary to be able
to evaluate and initially handle ordinary orthopaedic trauma in adults andchildren, to be able to handle the most common fractures by means of operations and to have the ability to define an action plan for more severe damage
in consultation with experienced colleagues.
For specialist competence in orthopaedics, the understanding and skills
necessary to be able to evaluate, diagnose and handle common painful conditions in the back and joints and to recognise and initially handle potentially function-threatening conditions are also necessary. It is also necessary too
be able to handle orthopaedic consequences of metabolic and circulatory
disorders and infections and to be able to initially handle these.

Finally, it is necessary to be able to work as part of a team and with representatives from other surgical specialties, anaesthesiology and intensive
care, radiology, rheumatology, geriatrics, general practice, neurology, oncology, internal medicine, and industrial and environmental medicine, as
well as medico-actuarial science.

Competence requirements for communicative competence, leadership competence, and competence within medical scienceand quality work
Communicative competence
The equal and responsible patient
Doctors with specialist competence must be capable of dialogue and of
maintaining open contact with patients and their next of kin. Contact should
be characterised by empathy and trust, as well as respect for the patients’right to information, influence, and participation in decisions. Contact
should also be characterised by co-operation and sensitivity to the patients’needs, desires and right to self-determination, as well as providing incentives for the patients’ involvement and responsibility for their own care.
Multicultural and gender aspects
Communication with patients and their next of kin should be characterisedby understanding and respect for cross-cultural and multicultural aspects
such as age, language, ethnicity, sexual orientation, and religion, as well as
gender.
Interprofessional relations
Doctors with specialist competence must have the ability to communicate,both in writing and orally, with other doctors and co-workers showing respect for their professional knowledge and competencies. The same applies
to contact with representatives of the public and various civil authorities.
Pedagogical skills
Doctors with specialist competence must have pedagogical capability inorder to inform and instruct not only patients and their next of kin but also
other doctors and co-workers, as well as students.
Professional approach and ethics
Doctors with specialist competence must be capable of working continuously with their professional and medical ethical approaches, with the objectiveof being able to make independent decisions of a medical ethical nature.

Individual professional development
Doctors with specialist competence must be capable of continually examining and identifying their own needs for professional development, in addition to operational requirements, in order to be able to meet requirements forthe best possible patient care.

Leadership competence
Collaboration
Doctors with specialist competence must have a developed capability for
self-knowledge and understanding of their own functions and roles in theorganisation.
Mentoring skills
Doctors with specialist competence must be capable of mentoring other doctors and co-workers, as well as students.
Leadership
Doctors with specialist competence must be capable of leadership characterised by collaboration, openness, and dialogue with co-workers. Leadershipmust further be characterised by participation and activity development
aimed at improvement. The ability to lead the work of the health care teamis essential.
System knowledge
Doctors with specialist competence must have an understanding of the organisation, administration, finances, and regulatory systems of health andmedical care, as well as its governance, in order to make the best use of resources.

Competence within medical science and quality work
Medical science
Doctors with specialist competence must be capable of adopting a medicallyscientific outlook and approach, and must have knowledge of research methodology including basic epidemiological concepts as well as of methods
for evidence-based medicine and review of scientific information.
Improvement and quality work
Doctors with specialist competence must have understanding of, and competence in, evidence-based improvement and quality work. The objective is
to be able to initiate, participate in, and be responsible for continuous systematic improvement work with emphasis on a holistic perspective, patient
safety, patient benefit, measurability, and teaching management in order tobe able to review and evaluate their own operations.

Public health and prevention
Doctors with specialist competence must have an understanding of the factors determining health, other aspects of public health, and methods forpromoting health and efforts aimed at preventing injury and illness, in order
to be able to take this understanding into account in medical scientific work.

Training structure
It is important that specialist medical training involves a logically clear andcontinuous professional development. Well thought-out management ofintermediate objectives and teaching elements, in terms of time, including
courses are, therefore, imperative if the doctor is to achieve the objectives
for competencies.
Service can be divided into four stages, all of which include theory andpractical work:
This means that the focus should initially be on acute orthopaedics andtraumatology.
This is then followed by basic orthopaedics, initially replacement arthroplasty of the hip, arthroscopic operations on the knee joint, amputations, simple hand and foot surgery and further fracture surgery.
After that, it is important that ST doctors receives simultaneous additional
training, primarily through service in anaesthesiology and intensive care, butalso with the opportunity for supplementary simultaneous additional training and advanced studies in one or more of the following specialties: handsurgery, neurological surgery, surgery, vascular surgery, plastic surgery andrheumatology.
Finally, it is also important that advanced studies continue in the specialty
and its separate areas, such as musculoskeletal tumour diseases, arthroplastic
surgery, child orthopaedics, and spinal orthopaedics, as well as in medical conditions of the upper and lower extremities and how to handle these. In somecases, there are, therefore, grounds for some of the future advance training
involving service at another unit.
Professional development in leadership, supervision, and instruction, as
well as basic scientific training, should be regarded as integral parts and takeplace continuously during the entire training.

Special recommendations
The specialty associations and sections of the medical organisations haveformulated special recommendations for their own specialties. The recommendations concern such issues as how specialist medical training should be
structured.

Intermediate objectives

Medical competenceIntermediate objective 1

Teaching methods

To master basic clinical and Clinical service under supersurgical techniques
vision in a unit that handles
these conditions

CourseFollow-up
Certificate of successfully completed clinicalservice and competenceachieved, issued bycurrent mentor
Certificate of successfullycompleted course, issuedby course leader

Training in a simulated environment
Theoretical studies

Intermediate objective 2

Teaching methods

Follow-up

Clinical service under
supervision in a unit
where such operations
are practised

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

To have an understandingof basic pathophysiology
and master basic pain management, intensive care andanaesthesiology in musculoskeletal diseases

Theoretical studies

Intermediate objective 3

Teaching methods

Follow-up

To be able to initiallyhandle trauma

Clinical service under
supervision in a unit that
handles these conditions

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Diagnostics and treatment symposium
Theoretical studies

Intermediate objective 4

Teaching methods

Follow-up

To be able to handle orthopaedic traumas, fractures and other acutemusculoskeletal conditions

Clinical service under
supervision in a unit that
handles these conditions

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Diagnostics and treatment symposium
Theoretical studies

Intermediate objective 5

Teaching methods

Follow-up

To be able to handle musculoskeletal injuries, diseases and painful conditions in children

Clinical service under
supervision in a unit that
handles these conditions

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Diagnostics and treatment symposium
Theoretical studies

Intermediate objective 6

Teaching methods

Follow-up

To be able to handle injuries, diseases and painful
conditions in the backClinical service under
supervision in a unit that
handles these conditions

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Diagnostics and treatment
symposium
Theoretical studies

Intermediate objective 7

Teaching methods

Follow-up

To be able to handle injuries, diseases and painful
conditions in the upper
extremity

Clinical service under supervision in a unit that
handles these conditions

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Diagnostics and treatment symposium
Theoretical studies

Intermediate objective 8

Teaching methods

Follow-up

To be able to handle injuries, diseases and painful
conditions in the hip andknee joints

Clinical service under
supervision in a unit that
handles these conditions

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Diagnostics and treatment
symposium
Theoretical studies

Intermediate objective 9

Teaching methods

To be able to handle injuries, diseases and painful
conditions in the foot andankle

Clinical service under supervision in a unit that
handles these conditions

CourseFollow-up

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

Certificate of successfullycompleted course, issuedby course leader

Diagnostics and treatment symposium
Theoretical studies

Intermediate objective 10

Teaching methods

Follow-up

To be able to initiallyhandle tumours in themusculoskeletal system

CourseCertificate of successfullycompleted course, issuedby course leader

Theoretical studies

Intermediate objective 11

Teaching methods

Follow-up

To be able to handle metabolic and circulatory disorders with orthopaedic consequences and handle
musculoskeletal infectious
conditions

Clinical service under supervision in a unit that
handles these conditions

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Diagnostics and treatment symposium
Theoretical studies

Intermediate objective 12

Teaching methods

Follow-up

To be able to handle
strain injuries, habilitation, rehabilitation, insurance medicine and certificates

Clinical service under supervision in a unit that
handles these conditions

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Theoretical studies

Communicative competenceIntermediate objective 13
To be capable of dialogue
and open contact with patients and their next of kin

Intermediate objective 14

To be capable of communication, both oral andwritten, with other doctors
and co-workers

Teaching methods
Clinical service under
supervision in a unit
where such operations
are practised

Teaching methods
Clinical service under
supervision in a unit
where such operations
are practised

Follow-up
Certificate of successfully completed clinicalservice and competenceachieved, issued bycurrent mentor

Follow-up
Certificate of successfully completed clinicalservice and competenceachieved, issued by current mentor

Intermediate objective 15

Teaching methods

Follow-up

To be capable of informing
and instructing patients,
next of kin, other doctors,
and co-workers, as well as
students

Clinical service under
supervision in a unit
where such operations
are practised

Certificate of successfully completed clinicalservice and competenceachieved, issued bycurrent mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Instructing under supervision

Leadership competenceIntermediate objective 16

Teaching methods

Follow-up

To be capable of mentoring other doctors and coworkers as well as students

Clinical service under
supervision in a unit
where such operations arepractised

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Mentoring under supervisionIntermediate objective 17

Teaching methods

Follow-up

To be capable of leading
using collaboration anddialogue with co-workers aswell as within the healthcare team

Clinical service under
supervision in a unit
where such operations
are practised

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Health care teamwork
under supervisionIntermediate objective 18

Teaching methods

Follow-up

To have an understandingof the organisation, management, and regulatory
systems of health and medical care

CourseCertificate of successfullycompleted course, issuedby course leader

Competence within medical science andquality work
Intermediate objective 19

Teaching methods

Follow-up

To be capable of a medically scientific outlook andapproach

CourseCertificate of successfullycompleted course, issuedby course leader

Certificate of approved
Written individual work under supervision according to written individual work,
issued by current mentor
scientific principles
Large professional assemblyIntermediate objective 20

Teaching methods

Follow-up

To have an understandingof, and competence in,evidence-based improvement and quality work

Quality and development
work under supervision

Certificate of quality anddevelopment work, issued
by current mentor

Theoretical studies

Hand surgery

Introduction
Explanation of terms
General definition of competencies
Definition of area of competence
Competence requirements
Competence requirements for medical competence
Competence requirements for communicative competence, leadershipcompetence, and competence within medical science and quality work
Training structure
Special recommendations
Intermediate objectives
Medical competenceCommunicative competence
Leadership competence
Competence within medical science and quality work

Introduction

On June 24, 2008, The National Board of Health and Welfare (Socialstyrelsen) decided to issue new regulations and general guidelines for doctors’
specialist medical training (SOSFS 2008:17). The statute consists of a general part with common provisions for all specialties and a specific part withall the descriptions of objectives. The description of objectives for the respective specialties should be understood against the background of the provisions in the general part.
In each description of objectives, there is a section headed ‘Training
structure’, which constitutes general guidelines. The teaching methods under the heading ‘Intermediate objectives’ where no follow-up is indicatedalso constitute general guidelines.

Explanation of terms

current mentor
a specialist doctor whose specialist competence corresponds to the area ofcompetence indicated by the intermediate objective, and who is responsible
for ST doctors’s professional development during the teaching period or forthe method of teaching indicatedthe assignment as a mentor for an ST doctor generally encompasses the entire period of specialist training but can also encompass part or parts of it
auscultation
during mentoring, and in accordance with a pre-designed programme, tostudy the profession of a specialist doctor or other health care staff by following one or several professionals, as well as carrying out assignments inthe current area
evaluate
to form a sound opinion of a patient or similar person as a basis for further
management
masterbeing fully able to evaluate and handle the medical investigation, diagnostics, treatment, and follow-up of a patient or similar person, and being fully
able to use the techniques relevant to the area
capability
personal capacity to execute or perform a task
have understanding
having acquired knowledge and insight into an area through theoretical studies and/or practical exercise of the profession
have knowledge
having acquired some knowledge in an area through theoretical studies
and/or practical exercise of the profession
mentoring under supervision
as an ST doctor, mentor a co-worker while simultaneously being mentored
by a doctor with specialist competencementorcontinuously, and in dialogue form, supporting and guiding, as well as evaluating, a co-worker’s professional development
mentoringsee mentor
handleto actively carry out measures regarding investigation, diagnostics, treatment, and follow-up of a patient or similar person, and have overall responsibility for carrying out these measuresinitially handle
as the primary physician in charge, to actively carry out measures regarding
investigation, diagnostics, treatment, and follow-up of a patient or similar
person, and have overall responsibility for carrying out these measuresinitially evaluate
as the primary physician in charge, to form a sound opinion of a patient orsimilar person as a basis for further management
intraprofessional group reflection
reflection done in a group together with other doctors, chiefly for the purpose of further education and training
clinical service
health and medical care duties that ST doctors perform under their own professional liability and with the support of a mentor
courseteacher-led training with an established plan, given during a defined periodof timesitting-in
training activity involving an ST doctor observing when a specialist doctor
or other health care staff holds a consultationorassessment activity involving a specialist doctor or other health care staff
observing and evaluating ST doctors during a consultation
seminarinstruction in group form with active participation
training in a simulated environment
training carried out in an environment created to emulate reality

large professional assembly
conference, congress, symposium or similar event
health care centre
health care unit in primary carehealth care team work
work where ST doctors, under supervision, participates in and sometimes
leads a group of co-operating health care staff with various competencies
charged with responsibility for care for an individual patient or group ofpatients

General definition of competencies

Definition of area of competence
The specialty of hand surgery includes investigation, evaluation, diagnostics, surgical and non-surgical treatment, follow-up, and rehabilitation of all
types of injuries and medical conditions in the forearm and hand. The areaof competence also covers conditions that affect the functionality of thehand and arm, such as damaged nerves in the upper extremity and plexus,
spastic conditions and tetraplegia.
Operations within the hand surgery specialty are, to a great extent, highly
specialised, which means taking care of an often select patient group. Common and simple conditions should be able to be remedied within the surgical or
orthopaedic basic health care. In this specialty, patients from all age groups arehandled, but where occupational injuries and conditions constitute a large proportion of hand surgery activity, the average age is low. Functional evaluations
are also performed and some preventive work is also practiced.
The basis of hand surgery activity is the hand as a sense organ, with its
unique integral functionality for gripping and touch. The specialty is characterised by reconstructive and functional thinking. Although surgical methods
are key treatment options, an integrated way of working with habilitation
and rehabilitation units is required.
Cooperation with other specialties is necessary and essential, particularly
with orthopaedics, vascular surgery, radiology diagnostics, clinical neurophysiology, rheumatology, paediatrics and industrial and environmental
medicine.
The hand surgery specialty is a branch specialty of the base specialty oforthopaedics.

Competence requirements
Competence requirements for medical competence
For specialist competence in hand surgery, it is necessary to master clinicalexamination of the upper extremity and its functional and topographic anatomy. An understanding of the interplay between the central and peripheral
nervous systems is also required. It is also necessary to be able to handle
acute conditions, degenerative, post-traumatic and inflammatory disorders
and other medical conditions in the upper extremity. It is also necessary to beable to initially handle dysfunction in the extremity. For reconstruction of theextremity’s functions, special skills in surgical techniques when operating
on both soft tissue and the skeleton and joints in the hand and arm are required.
In order to be able to diagnose and treat injuries and medical conditions in
the area of competence for hand surgery, it is also necessary to be able toevaluate disorders and damage in the rest of the musculoskeletal system andhandle disorders and traumatic conditions that require coverage of the skinof the upper extremity. An understanding of investigatory techniques andrehabilitation is also required.
For specialist competence in hand surgery, it is also necessary to masterbasic clinical and surgical techniques and fundamental pathophysiology
with regard to both acute and chronic conditions in the musculoskeletal system throughout all stages of life. It is also necessary to master basic pain
management, intensive care and anaesthesiology as regards musculoskeletal
diseases. It is also necessary to be able to initially handle general trauma situations. In addition to this, an understanding of habilitative and rehabilitative
measures and prevention (intermediate objectives 1–3 and 12) are required.

Competence requirements for communicative competence, leadership competence, and competence within medical scienceand quality work
Communicative competence
The equal and responsible patient
Doctors with specialist competence must be capable of dialogue and of
maintaining open contact with patients and their next of kin. Contact should
be characterised by empathy and trust, as well as respect for the patients’right to information, influence, and participation in decisions. Contact
should also be characterised by co-operation and sensitivity to the patients’needs, desires and right to self-determination, as well as providing incentive
for the patients’ involvement and responsibility for their own care.
Multicultural and gender aspects
Communication with patients and their next of kin should be characterisedby an understanding of and respect for cross-cultural and multicultural aspects such as age, language, ethnicity, sexual orientation, and religion, as
well as gender.
Interprofessional relations
Doctors with specialist competence must have the ability to communicate,both in writing and orally, with other doctors and co-workers showing respect for their professional knowledge and competencies. The same applies
to contact with representatives of the public and various civil authorities.
Pedagogical skills
Doctors with specialist competence must have pedagogical capability inorder to inform and instruct not only patients and their next of kin but also
other doctors and co-workers, as well as students.

Professional approach and ethics
Doctors with specialist competence must be capable of working continuously with their professional and medical ethical approaches, with the objectiveof being able to make independent decisions of a medical ethical nature.
Individual professional development
Doctors with specialist competence must be capable of continually examining and identifying their own needs for professional development, in addition to operational requirements, in order to be able to meet requirements forthe best possible patient care.

Leadership competence
Collaboration
Doctors with specialist competence must have a developed capability for
self-knowledge and understanding of their own functions and roles in theorganisation.
Mentoring skills
Doctors with specialist competence must be capable of mentoring other doctors and co-workers, as well as students.
Leadership
Doctors with specialist competence must be capable of leadership characterised by collaboration, openness, and dialogue with co-workers. Leadershipmust further be characterised by participation and activity development
aimed at improvement. The ability to lead the work of the health care teamis essential.
System knowledge
Doctors with specialist competence must have an understanding of the organisation, administration, finances, and regulatory systems of health andmedical care, as well as its governance, in order to make the best use of resources.

Competence within medical science and quality work
Medical science
Doctors with specialist competence must be capable of adopting a medicallyscientific outlook and approach, and must have knowledge of research methodology including basic epidemiological concepts as well as of methods
for evidence-based medicine and review of scientific information.
Improvement and quality work
Doctors with specialist competence must have an understanding of, andcompetence in, evidence-based improvement and quality work. The objec-

tive is to be able to initiate, participate in, and be responsible for continuous
systematic improvement work with emphasis on a holistic perspective, patient safety, patient benefit, measurability, and teaching management in order to be able to review and evaluate their own operations.
Public health and prevention
Doctors with specialist competence must have an understanding of the factors determining health, other aspects of public health, and methods forpromoting health and efforts aimed at preventing injury and illness, in order
to be able to take this understanding into account in medical scientific work.

Training structure
Specialist medical training in hand surgery can begin before, during, or after
specialist medical training in orthopaedics and can be integrated with it.
The training should involve logical, clear and continuous professional development. Well thought–out management of service and courses shouldtake place in accordance with the individual training plan. The intention isfor ST doctors to develop the basic understanding and skills required forindependent shift work and further training in hand surgery operations.
Service can be divided into four stages, all of which include theory andpractical work:
1. Initially, a short period of service at a hand surgery clinic will be appropriate, for an introduction and general overview of the subject field.
2. After that, simultaneous additional training in orthopaedics, anaesthesiology and intensive care as well as plastic surgery should be carriedout. Further suitable areas for simultaneous additional training are vascular surgery, neurophysiology, and radiology diagnostics.
3. After this, a long, continuous period at a hand surgery clinic should
follow, so that ST doctors can acquire the basic skills in the hand surgery area in accordance with the intermediate objectives.
4. An advanced understanding and experience in different fields of thearea of competence can begin to be provided during the latter part ofspecialist training. Competence in leadership, supervision and instruction and also science should be acquired at the end of the training period.
ST doctors should also be given the opportunity to take part in national andinternational scientific meetings during the training period.

Special recommendations
The specialty associations and sections of the medical organisations haveformulated special recommendations for their own specialties. The recommendations concern such issues as how specialist medical training should be
structured.

Intermediate objectives

Medical competenceIntermediate objective 1

Teaching methods

Follow-up

To master basic clinical and surgical techniques

Clinical service under
supervision in a unit that
handles these conditions

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Training in a simulated environment
Theoretical studies

Intermediate objective 2

Teaching methods

Follow-up

To have an understandingof basic pathophysiology
and to master basic pain
management, intensive
care and anaesthesiology
in musculoskeletal diseases

Clinical service under
supervision in a unit
where such operations
are practised

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

Theoretical studies

Intermediate objective 3

Teaching methods

Follow-up

To be able to initiallyhandle trauma

Clinical service under
supervision in a unit that
handles these conditions

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Diagnostics and treatment
symposium
Theoretical studies

Intermediate objective 4

Teaching methods

Follow-up

To master clinical examination of the upper extremity
and its functional and topographic anatomy

Clinical service under supervision in a unit that
handles these conditions

Certificate of clinicalservice and competenceachieved, issued bycurrent mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Theoretical studies

Intermediate objective 5

Teaching methods

Follow-up

To be able to evaluate
disorders and damage
within the musculoskeletal
systemClinical service under
supervision in a unit that
handles these conditions

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

Theoretical studies

Intermediate objective 6

Teaching methods

Follow-up

To be able to handle
disorders and traumaticconditions in the area ofcompetence that requires
special measures forcoverage of the skin

Clinical service under
supervision in a unit that
handles these conditions

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

Intermediate objective 7

Teaching methods

Follow-up

To be able to handle
acute conditions within
the area of competence

Clinical service under
supervision in a unit that
handles these conditions

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Theoretical studies

Theoretical studies

Intermediate objective 8

Teaching methods

Follow-up

To be able to handle degenerative, post-traumaticand inflammatory disorders within the area of competence.

Clinical service under
supervision in a unit that
handles these conditions

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Theoretical studies

Intermediate objective 9

Teaching methods

Follow-up

To be able to handle medical conditions in the upper
extremity

Clinical service under supervision in a unit that
handles these conditions

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Theoretical studies

Intermediate objective 10

Teaching methods

Follow-up

To be able to initiallyhandle dysfunctions in
the upper extremity

Clinical service under
supervision in a unit that
handles these conditions

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Theoretical studies

Intermediate objective 11

Teaching methods

Follow-up

To master special surgical techniques for thereconstruction of handfunctionality

Clinical service under
supervision in a unit that
handles these conditions

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Theoretical studies

Intermediate objective 12

Teaching methods

Follow-up

To be able to handle
strain injuries, habilitation, rehabilitation, insurance medicine and certificates

Clinical service under
supervision in a unit that
handles these conditions

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Theoretical studies

Communicative competenceIntermediate objective 13

Teaching methods

Follow-up

To be capable of dialogue
and open contact with patients and their next of kin

Clinical service under
supervision in a unit
where such operations
are practised

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

Intermediate objective 14

Teaching methods

Follow-up

To be capable of communication, both oral andwritten, with other doctors
and co-workers

Clinical service under
supervision in a unit
where such operations
are practised

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

Intermediate objective 15

Teaching methods

Follow-up

To be capable of informing
and instructing patients,
next of kin, other doctors,
and co-workers, as well as
students

Clinical service under
supervision in a unit
where such operations
are practised

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

CourseCertificate of successfullycompleted course, issued
by mentor

Instructing under
supervisionLeadership competenceIntermediate objective 16

Teaching methods

Follow-up

To be capable of mentoring other doctors and coworkers as well as students

Clinical service under
supervision in a unit
where such operations
are practised

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Mentoring under supervisionIntermediate objective 17

Teaching methods

Follow-up

To be capable of leading
using collaboration anddialogue with co-workers
as well as within the healthcare team

Clinical service under
supervision in a unit
where such operations
are practised

Certificate of successfullycompleted clinical service and competenceachieved, issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Health care teamwork
under supervisionIntermediate objective 18

Teaching methods

Follow-up

To have an understandingof the organisation, management, and regulatory
systems of health andmedical care

CourseCertificate of successfullycompleted course, issuedby course leader

Competence within medical science andquality work
Intermediate objective 19

Teaching methods

Follow-up

To be capable of a medically scientific outlook
and approach

CourseCertificate of successfullycompleted course, issuedby course leader

Written individual work
under supervision according to scientific principles

Certificate of approved written individual work, issued bycurrent mentor

Large professional assemblyIntermediate objective 20

Teaching methods

Follow-up

To have an understanding of, andcompetence in, evidence-based improvement and quality work

Quality and development
work under supervision

Certificate of quality anddevelopment work, issued
by current mentor

Theoretical studies

Anaesthesiology and intensive care

Introduction
Explanation of terms
General definition of competencies
Definition of area of competence
Competence requirements
Competence requirements for medical competence
Competence requirements for communicative competence, leadershipcompetence, and competence within medical science and quality work
Training structure
Special recommendations
Intermediate objectives
Medical competenceCommunicative competence
Leadership competence
Competence within medical science and quality work

Introduction

On June 24, 2008, The National Board of Health and Welfare (Socialstyrelsen) decided to issue new regulations and general guidelines for doctors’
specialist medical training (SOSFS 2008:17). The statute consists of a general part with common provisions for all specialties and a specific part withall the descriptions of objectives. The description of objectives for the respective specialties should be understood against the background of the provisions in the general part.
In each description of objectives, there is a section headed ‘Training
structure’, which constitutes general guidelines. The teaching methods under the heading ‘Intermediate objectives’ where no follow-up is indicatedalso constitute general guidelines.

Explanation of terms

current mentor
a specialist doctor whose specialist competence corresponds to the area ofcompetence indicated by the intermediate objective, and who is responsible
for ST doctors’s professional development during the teaching period or forthe method of teaching indicatedthe assignment as a mentor for an ST doctor generally encompasses the entire period of specialist training but can also encompass part or parts of it
auscultation
during mentoring, and in accordance with a pre-designed programme, tostudy the profession of a specialist doctor or other health care staff by following one or several professionals, as well as carrying out assignments inthe current area
evaluate
to form a sound opinion of a patient or similar person as a basis for further
management
masterbeing fully able to evaluate and handle the medical investigation, diagnostics, treatment, and follow-up of a patient or similar person, and being fully
able to use the techniques relevant to the area
capability
personal capacity to execute or perform a task
have understanding
having acquired knowledge and insight into an area through theoretical studies and/or practical exercise of the profession
have knowledge
having acquired some knowledge in an area through theoretical studies
and/or practical exercise of the profession
mentoring under supervision
as an ST doctor, mentor a co-worker while simultaneously being mentored
by a doctor with specialist competencementorcontinuously, and in dialogue form, supporting and guiding, as well as evaluating, a co-worker’s professional development
mentoringsee mentor
handleto actively carry out measures regarding investigation, diagnostics, treatment, and follow-up of a patient or similar person, and have overall responsibility for carrying out these measuresinitially handle
as the primary physician in charge, to actively carry out measures regarding
investigation, diagnostics, treatment, and follow-up of a patient or similar
person, and have overall responsibility for carrying out these measuresinitially evaluate
as the primary physician in charge, to form a sound opinion of a patient orsimilar person as a basis for further management
intraprofessional group reflection
reflection done in a group together with other doctors, chiefly for the purpose of further education and training
clinical service
health and medical care duties that ST doctors perform under their own professional liability and with the support of a mentor
courseteacher-led training with an established plan, given during a defined periodof timesitting-in
training activity involving an ST doctor observing when a specialist doctor
or other health care staff holds a consultationorassessment activity involving a specialist doctor or other health care staff
observing and evaluating ST doctors during a consultation
seminarinstruction in group form with active participation
training in a simulated environment
training carried out in an environment created to emulate reality

large professional assembly
conference, congress, symposium or similar event
health care centre
health care unit in primary carehealth care team work
work where ST doctors, under supervision, participates in and sometimes
leads a group of co-operating health care staff with various competencies
charged with responsibility for care for an individual patient or group ofpatients

General definition of competencies

Definition of area of competence
The specialty of anaesthesiology and intensive care covers pre-, intra- andpost-operative care, anaesthetics and pain management during diagnostic
and therapeutic procedures, intensive care, acute care of patients with serious diseases or injuries, pre-hospital care and transport medicine, and pain
management for acute pain, childbirth and cancer patients.
The specialty is characterised by an interprofessional approach.

Competence requirements
Competence requirements for medical competence
For specialist competence in anaesthesiology and intensive care, the understanding, skills and approaches required in order to be able to work independently in the specialty at hospitals with a wide spectrum of acute specialists, including maternity care and involving round-the-clock operations, arerequired. This requires an understanding of and skills in monitoring, supporting and restoring the body’s vital functions during surgical operations,major injuries or serious diseases in all age groups.
In order to evaluate benefits or risks, an understanding of pathology, diagnostics techniques and therapeutic methods are required in addition to anunderstanding of anaesthetics and medical techniques.
The competence requirement also involves being able to direct the workaround critically ill patients inside and outside the hospital. This involves
prioritising patients with different diseases or injuries and stabilising treatment during transport.
An important competence is being able to handle complex, acute situations adequately and having the ability to make ethical decisions in lifethreatening conditions.

Competence requirements for communicative competence, leadership competence, and competence within medical scienceand quality work
Communicative competence
The equal and responsible patient
Doctors with specialist competence must be capable of dialogue and of
maintaining open contact with patients and their next of kin. Contact should
be characterised by empathy and trust, as well as respect for the patients’right to information, influence, and participation in decisions. Contact
should also be characterised by co-operation and sensitivity to the patients’needs, desires and right to self-determination, as well as providing incentives for the patients’ involvement and responsibility for their own care.
Multicultural and gender aspects
Communication with patients and their next of kin should be characterisedby understanding and respect for cross-cultural and multicultural aspects
such as, language, ethnicity, sexual orientation, and religion, as well as
gender.
Interprofessional relations
Doctors with specialist competence must have the ability to communicate,both in writing and orally, with other doctors and co-workers showing respect for their professional knowledge and competencies. The same applies
to contact with representatives of the public and various civil authorities.
Pedagogical skills
Doctors with specialist competence must have pedagogical capability inorder to inform and instruct not only patients and their next of kin but also
other doctors and co-workers, as well as students.
Professional approach and ethics
Doctors with specialist competence must be capable of working continuously with their professional and medical ethical approaches, with the objectiveof being able to make independent decisions of a medical ethical nature.
Individual professional development
Doctors with specialist competence must be capable of continually examining and identifying their own needs for professional development, in addition to operational requirements, in order to be able to meet requirements forthe best possible patient care.

Leadership competence
Collaboration
Doctors with specialist competence must have a developed capability for
self-knowledge and understanding of their own functions and roles in theorganisation.
Mentoring skills
Doctors with specialist competence must be capable of mentoring other doctors and co-workers, as well as students.
Leadership
Doctors with specialist competence must be capable of leadership characterised by collaboration, openness, and dialogue with co-workers. Leadershipmust further be characterised by participation and activity development
aimed at improvement. The ability to lead the work of the health care teamis essential.
System knowledge
Doctors with specialist competence must have an understanding of the organisation, administration, finances, and regulatory systems of health andmedical care, as well as its governance, in order to make the best use of resources.

Competence within medical science and quality work
Medical science
Doctors with specialist competence must be capable of adopting a medicallyscientific outlook and approach, and must have knowledge of research methodology including basic epidemiological concepts as well as of methods
for evidence-based medicine and review of scientific information.
Improvement and quality work
Doctors with specialist competence must have understanding of, and competence in, evidence-based improvement and quality work. The objective is
to be able to initiate, participate in, and be responsible for continuous systematic improvement work with emphasis on a holistic perspective, patient
safety, patient benefit, measurability, and teaching management in order tobe able to review and evaluate their own operations.
Public health and prevention
Doctors with specialist competence must have an understanding of the factors determining health, other aspects of public health, and methods forpromoting health and efforts aimed at preventing injury and illness, in order
to be able to take this understanding into account in medical scientific work.

Training structure
It is of the utmost importance that service is arranged in care units so that
ST doctors can achieve the training objectives set out, which may involve
one or more units depending on the health care structure. The care units
where the majority of service takes place should have anaesthesiology andintensive care operations with hospital-based on-call duty doctors, and ST
doctors should be included in this on-call rota.
An introductory period should be devoted to clinical activity in anaesthesiology and intensive care. The objective is for ST doctors to be able to independently handle routine anaesthetics with the associated perioperativecare. This period is for the purpose of acquiring the competence to act as a
hospital-based on-call duty doctor.
The period after the introductory period should be devoted to advanced
studies in anaesthesiology and intensive care and also simultaneous addi-

tional training. Anaesthesiology service placements that should be included
are perioperative care in connection with abdominal surgery, vascular surgery, orthopaedics, trauma, obstetrics and ear nose and throat surgery.
The last part of the training should include closely connected, lengthy
placements in an intensive care unit and in specialist anaesthesiology. Someof the intensive care placement should take place at a multi-disciplinary
intensive care unit. Here, specialist anaesthesiology means thoracic, neuroand paediatric anaesthesiology.
Simultaneous additional training should supplement the main training inanaesthesiology and intensive care and ST doctors’s previous experience.
The objective is for ST doctors to gain an insight into disorders that involved an increased peri-operative risk and into the disorders that are relevant for intensive care. In so doing, ST doctors will acquire a greater understanding of his own and other specialties’ activities and approaches, which
will provide opportunities for effective collaboration.
During the entire training, practical work will be sandwiched with theory.
The periods of service should be connected. Theoretical training should takeplace through self-study, instruction at the clinic and participation in courses
and scientific meetings.

Special recommendations
The specialty associations and sections of the medical organisations haveformulated special recommendations for their own specialties. The recommendations concern such issues as how specialist medical training should be
structured.

Intermediate objectives

Medical competenceIntermediate objective 1

Teaching methods

Follow-up

To master suitable elements of the basic medical
and natural sciences.

CourseCertificate of successfullycompleted course, issuedby course leader

Theoretical studies

Intermediate objective 2

Teaching methods

Follow-up

To master the medical
technology equipment usedin the specialty

Clinical service under
supervision in a unit
where such operations
are practised

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Theoretical studies

Intermediate objective 3

Teaching methods

Follow-up

To master risk assessment
and perioperative care inboth surgical operations
and diagnostic and therapeutic procedures

Clinical service under
supervision in a unit
where such operations
are practised

Certificate of successfully completed clinicalservice and competenceachieved, issued bycurrent mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Sitting-in
Theoretical studies

Intermediate objective 4

Teaching methods

Follow-up

To master diagnostic andtherapeutic methods andbenefits/risk assessments

Clinical service under
supervision in a unit
where such operations
are practised
CourseCertificate of successfullycompleted clinical service
and competenceachieved, issued by curttCertificate of successfullycompleted course, issuedby course leader

Sitting-in
Theoretical studies

Intermediate objective 5

Teaching methods

Follow-up

To master anaesthesiology in surgical operations
and in diagnostic and therapeutic procedures

Clinical service under
supervision in a unit
where such operations
are practised

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Sitting-in
Theoretical studies

Intermediate objective 6

Teaching methods

Follow-up

To be able to handle
intensive care in medical
and surgical medical
conditions

Clinical service under supervision in a unit that
handles these conditions

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Sitting-in
Theoretical studies

Intermediate objective 7

Teaching methods

Follow-up

To master a professional
approach to patients andtheir next of kin in connection with making ethicaldecisions on life-threatening
conditions and concluding
when treatment is to end

Clinical service under
supervision in a unit that
handles these conditions

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

Diagnostics and treatment
symposium
Sitting-in

Intermediate objective 8

Teaching methods

Follow-up

To master the evaluationand treatment of acute pain
and childbirth pain and initially handle cancer pain

Clinical service under
supervision in a unit that
handles these conditions

Certificate of successfully completed clinicalservice and competenceachieved, issued bycurrent mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Sitting-in
Theoretical studies

Intermediate objective 9

To master the care of extremely ill and injured patients and be able to handle
complex and acute situations under stress

Teaching methods

Follow-up

Clinical service under supervision in a unit that
handles these conditions

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Training in a simulated environment
Theoretical studies

Intermediate objective 10

Teaching methods

Follow-up

To be able to handle patients at the scene of theaccident and outside ofcare units, transport patients with failing vital functions between and insidehospitals and have a goodunderstanding of catastrophe medicine

Clinical service under
supervision in a unit that
handles these conditions

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Training in a simulated environment
Theoretical studies

Intermediate objective 11

Teaching methods

Follow-up

To be able to handle patients in at least one specialist anaesthesiology areawith associated intensive
care and have an understanding of other specialist
anaesthesiology areas

Clinical service under
supervision in a unit
where such operations
are practised

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Sitting-in
Theoretical studies

Intermediate objective 12

Teaching methods

Follow-up

To have an understandingof the operations and approaches of other specialties that are relevant for a
multi-disciplinary approach

Clinical service under
supervision wheresuch operations arepractised

Certificate of successfullycompleted clinical service and competenceachieved, issued by current mentor

Communicative competenceIntermediate objective 13

Teaching methods

Follow-up

To be capable of dialogue
and open contact with patients and their next of kin

Clinical service under
supervision in a unit
where such operations
are practised

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

Sitting-in

Intermediate objective 14

Teaching methods

Follow-up

To be capable of communication, both oral andwritten, with other doctors
and co-workers

Clinical service under
supervision in a unit
where such operations
are practised

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

Intermediate objective 15

Teaching methods

Follow-up

To be capable of informing
and instructing patients,
next of kin, other doctors,
and co-workers, as well as
students

Clinical service under
supervision in a unit
where such operations
are practised

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Instructing under supervision

Leadership competenceIntermediate objective 16

Teaching methods

Follow-up

To be capable of mentoringother doctors and coworkers as well as students

Clinical service under
supervision in a unit
where such operations
are practised

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Mentoring under supervisionIntermediate objective 17

Teaching methods

Follow-up

To be capable of leading
using collaboration anddialogue with co-workers aswell as within the healthcare team

Clinical service under
supervision in a unit
where such operations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Health care teamwork
under supervisionIntermediate objective 18

Teaching methods

Follow-up

To have an understandingof the organisation, management, and regulatory
systems of health andmedical care

CourseCertificate of successfullycompleted course, issuedby course leader

Competence within medical science andquality work
Intermediate objective 19

Teaching methods

Follow-up

To be capable of a medically Written individual work
under supervision accordscientific outlook and aping to scientific principles
proachCertificate of approved written individual work, issued bycurrent mentor

Intermediate objective 20

Teaching methods

Follow-up

To have an understandingof, and competence in, evidence-based improvement
and quality work

Quality and development
work under supervision

Certificate of qualityand development
work, issued by current mentor

Obstetrics and gynaecology

Introduction
Explanation of terms
General definition of competencies
Definition of area of competence
Competence requirements
Competence requirements for medical competence
Competence requirements for communicative competence, leadershipcompetence, and competence within medical science and quality work
Training structure
Special recommendations
Intermediate objectives
Medical competenceCommunicative competence
Leadership competence
Competence within medical science and quality work

Introduction

On June 24, 2008, The National Board of Health and Welfare (Socialstyrelsen) decided to issue new regulations and general guidelines for doctors’
specialist medical training (SOSFS 2008:17). The statute consists of a general part with common provisions for all specialties and a specific part withall the descriptions of objectives. The description of objectives for the respective specialties should be understood against the background of the provisions in the general part.
In each description of objectives, there is a section headed ‘Training
structure’, which constitutes general guidelines. The teaching methods under the heading ‘Intermediate objectives’ where no follow-up is indicatedalso constitute general guidelines.

Explanation of terms

current mentor
a specialist doctor whose specialist competence corresponds to the area ofcompetence indicated by the intermediate objective, and who is responsible
for ST doctors’s professional development during the teaching period or forthe method of teaching indicatedthe assignment as a mentor for an ST doctor generally encompasses the entire period of specialist training but can also encompass part or parts of it
auscultation
during mentoring, and in accordance with a pre-designed programme, tostudy the profession of a specialist doctor or other health care staff by following one or several professionals, as well as carrying out assignments inthe current area
evaluate
to form a sound opinion of a patient or similar person as a basis for further
management
masterbeing fully able to evaluate and handle the medical investigation, diagnostics, treatment, and follow-up of a patient or similar person, and being fully
able to use the techniques relevant to the area
capability
personal capacity to execute or perform a task
have understanding
having acquired knowledge and insight into an area through theoretical studies and/or practical exercise of the profession
have knowledge
having acquired some knowledge in an area through theoretical studies
and/or practical exercise of the profession
mentoring under supervision
as an ST doctor, mentor a co-worker while simultaneously being mentored
by a doctor with specialist competencementorcontinuously, and in dialogue form, supporting and guiding, as well as evaluating, a co-worker’s professional development
mentoringsee mentor
handleto actively carry out measures regarding investigation, diagnostics, treatment, and follow-up of a patient or similar person, and have overall responsibility for carrying out these measuresinitially handle
as the primary physician in charge, to actively carry out measures regarding
investigation, diagnostics, treatment, and follow-up of a patient or similar
person, and have overall responsibility for carrying out these measuresinitially evaluate
as the primary physician in charge, to form a sound opinion of a patient orsimilar person as a basis for further management
intraprofessional group reflection
reflection done in a group together with other doctors, chiefly for the purpose of further education and training
clinical service
health and medical care duties that ST doctors perform under their own professional liability and with the support of a mentor
courseteacher-led training with an established plan, given during a defined periodof timesitting-in
training activity involving an ST doctor observing when a specialist doctor
or other health care staff holds a consultationorassessment activity involving a specialist doctor or other health care staff
observing and evaluating ST doctors during a consultation
seminarinstruction in group form with active participation
training in a simulated environment
training carried out in an environment created to emulate reality

large professional assembly
conference, congress, symposium or similar event
health care centre
health care unit in primary carehealth care team work
work where ST doctors, under supervision, participates in and sometimes
leads a group of co-operating health care staff with various competencies
charged with responsibility for care for an individual patient or group ofpatients

General definition of competencies

Definition of area of competence
The specialty of obstetrics and gynaecology covers acute and non-acuteconditions and disorders. The specialty includes prevention, investigation,
diagnostics, treatment and follow-up of normal and pathological pregnancy,
childbirth and puerperium and also prevention, investigation, diagnostics,
treatment and follow-up of dysfunctions and disorders of the female reproductive organs and reproductive medical conditions. In the obstetrics and gynaecology specialty, multi-faceted problems are handled and the area of competence includes ethical, psychosocial, social, and multicultural aspects.

Competence requirements
Competence requirements for medical competence
For specialist competence in obstetrics and gynaecology it is necessary tomaster normal pregnancy, childbirth and puerperium, contraconception andinduced abortion, basic surgical techniques, pre- and post-operative evaluation and care, acute gynaecological conditions and differential diagnostics,
investigation, diagnostics and follow-up of sexually transmitted infections,basic investigation, diagnostics, treatment and follow-up of benign conditions in the pelvic floor and lower urinary tract, handling of pre-cancerous
gynaecological conditions and malign tumours in the genitals and initialhandling of benign gynaecological conditions in the vagina, uterus and adnexa. It is also necessary to be able to handle common reproductive endocrinological conditions and sexual assaults and to have an understanding ofinvestigation into and treatment of infertility. Special emphasis is put on therequirement to be able to handle acute conditions independently. For specialist competence, a theoretical understanding, practical skills and the ability to initially handle less common conditions in obstetrics and gynaecology
and to have documented theoretical and practical competence as regards thediagnostic and therapeutic methods available and to have an adequate understanding of the medicine technology equipment used in the specialty arealso required.

Competence requirements for communicative competence, leadership competence, and competence within medical scienceand quality work
Communicative competence
The equal and responsible patient
Doctors with specialist competence must be capable of dialogue and of
maintaining open contact with patients and their next of kin. Contact should
be characterised by empathy and trust, as well as respect for the patients’right to information, influence, and participation in decisions. Contact
should also be characterised by co-operation and sensitivity to the patients’needs, desires and right to self-determination, as well as providing incentives for the patients’ involvement and responsibility for their own care.
Multicultural and gender aspects
Communication with patients and their next of kin should be characterisedby an understanding of and respect for cross-cultural and multicultural aspects such as age, language, ethnicity, sexual orientation, and religion, as
well as gender.
Interprofessional relations
Doctors with specialist competence must have the ability to communicate,both in writing and orally, with other doctors and co-workers showing respect for their professional knowledge and competencies. The same applies
to contact with representatives of the public and various civil authorities.
Pedagogical skills
Doctors with specialist competence must have pedagogical capability inorder to inform and instruct not only patients and their next of kin but also
other doctors and co-workers, as well as students.
Professional approach and ethics
Doctors with specialist competence must be capable of working continuously with their professional and medical ethical approaches, with the objectiveof being able to make independent decisions of a medical ethical nature.
Individual professional development
Doctors with specialist competence must be capable of continually examining and identifying their own needs for professional development, in addition to operational requirements, in order to be able to meet requirements forthe best possible patient care.

Leadership competence
Collaboration
Doctors with specialist competence must have a developed capability for
self-knowledge and understanding of their own functions and roles in theorganisation.
Mentoring skills
Doctors with specialist competence must be capable of mentoring other doctors and co-workers, as well as students.
Leadership
Doctors with specialist competence must be capable of leadership characterised by collaboration, openness, and dialogue with co-workers. Leadershipmust further be characterised by participation and activity development
aimed at improvement. The ability to lead the work of the health care teamis essential.
System knowledge
Doctors with specialist competence must have an understanding of the organisation, administration, finances, and regulatory systems of health andmedical care, as well as its governance, in order to make the best use of resources.

Competence within medical science and quality work
Medical science
Doctors with specialist competence must be capable of adopting a medicallyscientific outlook and approach, and must have knowledge of research methodology including basic epidemiological concepts as well as of methods
for evidence-based medicine and review of scientific information.
Improvement and quality work
Doctors with specialist competence must have understanding of, and competence in, evidence-based improvement and quality work. The objective is
to be able to initiate, participate in, and be responsible for continuous systematic improvement work with emphasis on a holistic perspective, patient
safety, patient benefit, measurability, and teaching management in order tobe able to review and evaluate their own operations.
Public health and prevention
Doctors with specialist competence must have an understanding of the factors determining health, other aspects of public health, and methods forpromoting health and efforts aimed at preventing injury and illness, in order
to be able to take this understanding into account in medical scientific work.

Training structure
The training includes basic training, joint advanced training and simultaneous additional training.
The basic training is an introductory period of service in obstetrics andgynaecological out- and in-patient care with emphasis on commonly occurring acute conditions.
Joint advanced training may involve continued service in all the areas ofthe specialty for lengthy, uninterrupted periods. The aim is for ST doctors toachieve the requirements of the description of objectives.
Simultaneous additional training will involve service in related specialties. Simultaneous additional training in surgery is particularly important in orderfor ST doctors to achieve basic surgical competence and the equivalent inanaesthesiology and intensive care. In obstetric competence, it is particularimportant to obtain experience of service at a large obstetric unit with neonatal care. A further option is for simultaneous additional training in gynaecological oncology to be included in the specialist medical training.
It is important that the ST service constitutes a logically clear and continuous professional development. Well thought-out, timely management ofcompetence requirements and teaching elements, including courses, is important.

Special recommendations
The specialty associations and sections of the medical organisations haveformulated special recommendations for their own specialties. The recommendations concern such issues as how specialist medical training should be
structured.

Intermediate objectives

Medical competenceIntermediate objective 1

Teaching methods

Follow-up

To master normal pregnancy, childbirth andpuerperium

Clinical service under
supervision in a unit
where such operations
are practised

Certificate of successfully completed clinicalservice and competenceachieved, issued bycurrent mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Theoretical studies

Intermediate objective 2

Teaching methods

Follow-up

To be able to initially handle complicated pregnancies

Clinical service under
supervision in a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Theoretical studies

Intermediate objective 3

Teaching methods

Follow-up

To be able to initially handle complicated childbirthand asphyxia in children

Clinical service under
supervision in a unit
where such operations
are practised

Certificate of successfully completed clinicalservice and competenceachieved, issued bycurrent mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Training in a simulated
environment
Theoretical studies

Intermediate objective 4

Teaching methods

Follow-up

To master contraconception and induced abortion

Clinical service under
supervision in a unit
where such operations
are practised

Certificate of successfullycompleted clinical service and competenceachieved, issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Theoretical studies

Intermediate objective 5

Teaching methods

Follow-up

To master basic surgical
techniques and pre-and
post-operative evaluations and care

Clinical service under
supervision in a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Training in a simulated environment
Theoretical studies

Intermediate objective 6

Teaching methods

Follow-up

To master acute gynaecological conditions and differential diagnostics

Clinical service under supervision in a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Theoretical studies

Intermediate objective 7

Teaching methods

Follow-up

To be able to handle common reproductive endocrinological conditions andhave an understanding ofinvestigations into andtreatment of infertility

Clinical service under
supervision in a unit
where such operations
are practised

Certificate of successfullycompleted clinical service and competenceachieved, issued by current mentor

orauscultation under supervision in a unit where suchoperations are practisedorcertificate of approved
auscultation and competence achieved, issued bycurrent mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Theoretical studies

Intermediate objective 8

Teaching methods

Follow-up

To master diagnostics andtreatment of sexually transmitted infections and to beable to initially handle vulvar
disorders

Clinical service under
supervision in a unit
where such operations
are practised

Certificate of successfully completed clinicalservice and competenceachieved, issued bycurrent mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Theoretical studies

Intermediate objective 9

Teaching methods

Follow-up

To master basic investigation into and treatment ofbenign conditions in thepelvic floor and lower urinary tract

Clinical service under
supervision in a unit
where such operations
are practised

Certificate of successfully completed clinicalservice and competenceachieved, issued by current mentor

Theoretical studies

Intermediate objective 10

Teaching methods

Follow-up

To master initial handlingof pre-cancerous gynaecological conditions and malignant tumours in the genitals

Clinical service under
supervision in a unit
where such operations
are practised

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Theoretical studies

Intermediate objective 11

Teaching methods

Follow-up

To master initial handling of
benign gynaecological conditions in the vagina, uterus
and adnexa

Clinical service under
supervision in a unit
where such operations
are practised

Certificate of successfullycompleted clinical service and competenceachieved, issued by current mentor

Theoretical studies

Intermediate objective 12

Teaching methods

Follow-up

To be able to initially evaluate conditions in psychosocial obstetrics andgynaecology, including
sexology, and be able tohandle sexual assaults

Clinical service under
supervision in a unit
where such operations
are practised

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Theoretical studies

Communicative competenceIntermediate objective 13

Teaching methods

Follow-up

To be capable of dialogue
and open contact with patients and their next of kin
on the basis of the individual in question’s requirements and needs taking into
account transcultural aspects and diversity

Clinical service under
supervision in a unit
where such operations
are practised

Certificate of successfullycompleted clinical service and competenceachieved, issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Theoretical studies

Intermediate objective 14

Teaching methods

Follow-up

To be capable of communication with other doctors and co-workers, aswell as with representatives of the public andvarious civil authorities

Clinical service under
supervision in a unit
where such operations
are practised

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Intermediate objective 15

Teaching methods

Follow-up

To be capable of informing
and instructing patients,
next of kin, other doctors,
and co-workers, as well as
students

Clinical service under
supervision in a unit
where such operations
are practised

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Instructing under supervision
Theoretical studies

Leadership competenceIntermediate objective 16

Teaching methods

Follow-up

To be capable of mentoring other doctors and coworkers and students

Clinical service under
supervision in a unit
where such operations
are practised

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Mentoring under supervisionIntermediate objective 17

Teaching methods

Follow-up

To be capable of leading incollaboration and dialogue
with co-workers and within
the health care team

Clinical service under
supervision in a unit
where such operations
are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Intermediate objective 18

To have an understandingof the organisation, management, and regulatory
systems of health andmedical care

Teaching methods

Follow-up

CourseCertificate of successfullycompleted course, issuedby course leader

Competence within medical science andquality work
Intermediate objective 19

Teaching methods

Follow-up

To be capable of a medically scientific outlook
and approach

CourseCertificate of successfullycompleted course, issuedby course leader

Written individual work
under supervision according to scientific principles

Certificate of approved
written individual work,
issued by current
mentorIntermediate objective 20

Teaching methods

Follow-up

To have an understanding of, andcompetence in, evidence-based improvement and development work.

Quality and development work under supervision

Certificate of qualityand development
work, issued by current mentor

Intermediate objective 21

Teaching methods

Follow-up

To have an understanding of researchmethodology

CourseCertificate of successfullycompleted course, issuedby course leader

Otorhinolaryngology

Introduction
Explanation of terms
General definition of competencies
Definition of area of competence
Competence requirements
Competence requirements for medical competence
Competence requirements for communicative competence, leadershipcompetence, and competence within medical science
Training structure
Special recommendations
Intermediate objectivesMedical competenceCommunicative competence
Leadership competence
Competence within medical science and quality work

Introduction

On June 24, 2008, The National Board of Health and Welfare (Socialstyrelsen) decided to issue new regulations and general guidelines for doctors’
specialist medical training (SOSFS 2008:17). The statute consists of a general part with common provisions for all specialties and a specific part withall the descriptions of objectives. The description of objectives for the respective specialties should be understood against the background of the provisions in the general part.
In each description of objectives, there is a section headed ‘Training
structure’, which constitutes general guidelines. The teaching methods under the heading ‘Intermediate objectives’ where no follow-up is indicatedalso constitute general guidelines.

Explanation of terms

current mentor
a specialist doctor whose specialist competence corresponds to the area ofcompetence indicated by the intermediate objective, and who is responsible
for ST doctors’s professional development during the teaching period or forthe method of teaching indicatedthe assignment as a mentor for an ST doctor generally encompasses the entire period of specialist training but can also encompass part or parts of it
auscultation
during mentoring, and in accordance with a pre-designed programme, tostudy the profession of a specialist doctor or other health care staff by following one or several professionals, as well as carrying out assignments inthe current area
evaluate
to form a sound opinion of a patient or similar person as a basis for further
management
masterbeing fully able to evaluate and handle the medical investigation, diagnostics, treatment, and follow-up of a patient or similar person, and being fully
able to use the techniques relevant to the area
capability
personal capacity to execute or perform a task
have understanding
having acquired knowledge and insight into an area through theoretical studies and/or practical exercise of the profession
have knowledge
having acquired some knowledge in an area through theoretical studies
and/or practical exercise of the profession
mentoring under supervision
as an ST doctor, mentor a co-worker while simultaneously being mentored
by a doctor with specialist competencementorcontinuously, and in dialogue form, supporting and guiding, as well as evaluating, a co-worker’s professional development
mentoringsee mentor
handleto actively carry out measures regarding investigation, diagnostics, treatment, and follow-up of a patient or similar person, and have overall responsibility for carrying out these measuresinitially handle
as the primary physician in charge, to actively carry out measures regarding
investigation, diagnostics, treatment, and follow-up of a patient or similar
person, and have overall responsibility for carrying out these measuresinitially evaluate
as the primary physician in charge, to form a sound opinion of a patient orsimilar person as a basis for further management
intraprofessional group reflection
reflection done in a group together with other doctors, chiefly for the purpose of further education and training
clinical service
health and medical care duties that ST doctors perform under their own professional liability and with the support of a mentor
courseteacher-led training with an established plan, given during a defined periodof timesitting-in
training activity involving an ST doctor observing when a specialist doctor
or other health care staff holds a consultationorassessment activity involving a specialist doctor or other health care staff
observing and evaluating ST doctors during a consultation
seminarinstruction in group form with active participation
training in a simulated environment
training carried out in an environment created to emulate reality

large professional assembly
conference, congress, symposium or similar event
health care centre
health care unit in primary carehealth care team work
work where ST doctors, under supervision, participates in and sometimes
leads a group of co-operating health care staff with various competencies
charged with responsibility for care for an individual patient or group ofpatients

General definition of competencies

Definition of area of competence
The specialty of otorhinolaryngology includes diseases, trauma, deformities
and dysfunctions in the ear, temporal bone and lateral base of the skull, in
the nose, sinuses and front base of the skull, in the oral cavity, pharynx, larynx, windpipe, oesophagus, head, throat, thyroid gland, salivary glands andadjacent structures and parts of the head and throat area in children andadults.
The specialty includes investigation, diagnostics, treatment and follow-up
of conditions that affect hearing, balance, the senses of smell and taste,
swallowing, the voice, speech and language and also cranial nerve disorders.
In addition to investigation, diagnostics, treatment and follow-up, preventive activity focusing on individuals or groups is included.
There is a great deal of related knowledge and cooperation with the specialties of audiology and phoniatrics. As a result of related knowledge and skills,
otorhinolaryngology also involves cooperation with the infectious medicine,allergology, respiratory diseases, paediatrics, anaesthesiology and intensive
care, surgery, plastic surgery, neurology and oncology specialties and theoral surgery field of knowledge as well as sharing an extensive area for collaboration with general practice and industrial and environmental medicine.
Cooperation with audiologists, hearing therapists and speech therapists andan understanding of activities in organisations for the handicapped and patients with a connection to the field are also of great importance.
Otorhinolaryngology is the base specialty for the branch specialties of audiology and phoniatrics.

Competence requirements
Competence requirements for medical competence
For specialist competence in otorhinolaryngology, a theoretical understanding of anatomy, physiology, pathology, aetiology and symptomatology isrequired. It is also necessary to master medical investigation and the treatment of the common and serious medical conditions regarding hearing andbalance, the ear, temporal bone, lateral base of the skull, nose, sinuses andfront base of the skull, oral cavity, pharynx, larynx, windpipe, oesophagus,
head, throat, thyroid gland, salivary glands and adjacent structures. Surgicalskills in the aforementioned areas are also required and necessary in order tobe able to handle the common and serious conditions in the specialty independently. This involves a basic understanding of the respective area andpractical skills in the investigation and treatment methods available and infollowing up results. Special emphasis is placed on competence in being
able to handle acute and life-threatening conditions independently (intermediate objectives 1-4).

For specialist competence in otorhinolaryngology, it is also necessary tomaster basic rigid and flexible endoscopic diagnostics and treatment in thefield, including the oesophagus and respiratory system. It is also necessary
to master treatment of the common and important infectious conditions andto be able to handle the investigation and treatment of allergological andinflammatory conditions.
In addition, it is necessary to master diagnostics and to be able to initiallyhandle the treatment of surgical and non-surgical diseases of the nose andsinus. An understanding of diseases of the front base of the skull is also necessary. It is also necessary to be able to handle diagnostics and surgical andnon-surgical treatment of diseases and dysfunction in the oral cavity, pharynx and oesophagus, to master initial diagnostics and to be able to initiallyhandle surgical and non-surgical treatment of suspected tumours in the specialty of otorhinolaryngology. In addition, it is necessary to be able to handle surgically the common and important non-malignant diseases of the soft
parts in the head and throat regions.
For specialist competence in otorhinolaryngology, it is also necessary tomaster acute handling and to be able to initially handle surgical treatment of
trauma in the head and throat region. In addition, it is necessary to be able tohandle surgical diseases of the ear, temporal bone and lateral base of theskull and to be able to handle complications and follow up these conditions.

Competence requirements for communicative competence, leadership competence, and competence within medical scienceand quality work
Communicative competence
The equal and responsible patient
Doctors with specialist competence must be capable of dialogue and of
maintaining open contact with patients and their next of kin. Contact should
be characterised by empathy and trust, as well as respect for the patients’right to information, influence, and participation in decisions. Contact
should also be characterised by co-operation and sensitivity to the patients’needs, desires and right to self-determination, as well as providing incentives for the patients’ involvement and responsibility for their own care.
Multicultural and gender aspects
Communication with patients and their next of kin should be characterisedby an understanding of and respect for cross-cultural and multicultural aspects such as age, language, ethnicity, sexual orientation, and religion, as
well as gender.
Interprofessional relations
Doctors with specialist competence must have the ability to communicate,both in writing and orally, with other doctors and co-workers showing re-spect for their professional knowledge and competencies. The same applies
to contact with representatives of the public and various civil authorities.
Pedagogical skills
Doctors with specialist competence must have pedagogical capability inorder to inform and instruct not only patients and their next of kin but also
other doctors and co-workers, as well as students.
Professional approach and ethics
Doctors with specialist competence must be capable of working continuously with their professional and medical ethical approaches, with the objectiveof being able to make independent decisions of a medical ethical nature.
Individual professional development
Doctors with specialist competence must be capable of continually examining and identifying their own needs for professional development, in addition to operational requirements, in order to be able to meet requirements forthe best possible patient care.

Leadership competence
Collaboration
Doctors with specialist competence must have a developed capability for
self-knowledge and understanding of their own functions and roles in theorganisation.
Mentoring skills
Doctors with specialist competence must be capable of mentoring other doctors and co-workers, as well as students.
Leadership
Doctors with specialist competence must be capable of leadership characterised by collaboration, openness, and dialogue with co-workers. Leadershipmust further be characterised by participation and activity development
aimed at improvement. The ability to lead the work of the health care teamis essential.
System knowledge
Doctors with specialist competence must have an understanding of the organisation, administration, finances, and regulatory systems of health andmedical care, as well as its governance, in order to make the best use of resources.

Competence within medical science and quality work
Medical science
Doctors with specialist competence must be capable of adopting a medicallyscientific outlook and approach, and must have knowledge of research methodology including basic epidemiological concepts as well as of methods
for evidence-based medicine and review of scientific information.
Improvement and quality work
Doctors with specialist competence must have understanding of, and competence in, evidence-based improvement and quality work. The objective is
to be able to initiate, participate in, and be responsible for continuous systematic improvement work with emphasis on a holistic perspective, patient
safety, patient benefit, measurability, and teaching management in order tobe able to review and evaluate their own operations.
Public health and prevention
Doctors with specialist competence must have an understanding of the factors determining health, other aspects of public health, and methods forpromoting health and efforts aimed at preventing injury and illness, in order
to be able to take this understanding into account in medical scientific work.

Training structure
The majority of the clinical service necessary will be obtained in an otorhinolaryngology unit. During the introductory part, emphasis should be put onservice in the specialty’s acute and basic activity. There is a very great dealof related knowledge and cooperation with the specialties of audiology andphoniatrics, which is why ST doctors is strongly recommended to serve
within these branch specialties during training.
Every attempt should be made to ensure connected service periods in the
different fields of activity.
In addition, it is imperative and important that service at a university clinic is
included for a longer period of time. Service at a university clinic should beplanned in such a way that it adds value in addition to the service at the ordinary otorhinolaryngology unit.
The specialty of otorhinolaryngology has a common knowledge base withother surgical specialties. That is why it is extremely important that ST doctors gain basic surgical and anaesthesiological understanding and skills that
include surgical techniques, taking care of acute cases, preventing common
complications and an understanding of different forms of narcososis andpain management.
Simultaneous additional training in another specialty is, therefore, of great
importance, particularly in anaesthesiology and surgery or plastic surgery.
In addition, simultaneous additional training in one or more of the following
areas is useful: paediatrics, infection, neurology, neurological surgery, oncology, pulmonary medicine, allergic diseases, radiology diagnostics and oral sur-gery. This is best achieved by supplementing the main service with service
or auscultation in the aforementioned fields of knowledge.
Theoretical studies will be conducted in parallel with clinical service. ST
doctors should also take part in courses and conferences.

Special recommendations
The specialty associations and sections of the medical organisations haveformulated special recommendations for their own specialties. The recommendations concern such issues as how specialist medical training should be
structured.

Intermediate objectives

Medical competenceIntermediate objective 1

Teaching methods

To master diagnostics andsurgical and non-surgicaltreatment of common andimportant diseases in theotorhinolaryngology, particularly the acute conditions

Clinical service under super- Certificate of successfulvision in a unit that handles ly completed clinicalservice and competencethese conditions
achieved, issued bycurrent mentor
CourseFollow-up

Certificate of successfullycompleted course, issuedby course leader

Theoretical studies

Intermediate objective 2

Teaching methods

Follow-up

To master basic clinicalinvestigation and basic
interpretation of imaging,
functional and laboratory
diagnostics in otorhinolaryngology

Clinical service under
supervision in a unit that
handles these conditions

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

Auscultation under supervision in a unit that handles
these conditions
CourseCertificate of successfullycompleted course, issuedby course leader

Theoretical studies

Intermediate objective 3

Teaching methods

Follow-up

To master basic clinicalinvestigation and interpretation of the common test
methods with regard tohearing and vestibularfunctionality as well as
surgical and non-surgicaltreatment of the common
and important diseases of
the hearing and balance
organsClinical service under
supervision in a unit that
handles these conditions

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Theoretical studies

Intermediate objective 4

Teaching methods

Follow-up

To master clinical investigation and basic surgical andnon-surgical treatment of
the common and serious
medical conditions in thelarynx and respiratory system and voice and speech
function disorders.

Clinical service under
supervision in a unit that
handles these conditions

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Theoretical studies

Intermediate objective 5

Teaching methods

Follow-up

To master fundamental rigid
and flexible endoscopic diagnostics and treatment in
otorhinolaryngology, including the oesophagus andrespiratory system

Clinical service under
supervision in a unit
where such operations
are practised

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Training in a simulated environment

Intermediate objective 6

Teaching methods

Follow-up

To master examination andtreatment of common andimportant infectious conditions and be able to handle
the examination and treatment of allergological andinflammatory conditions in
otorhinolaryngology

Clinical service under supervision in a unit that
handles these conditions

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Theoretical studies

Intermediate objective 7

Teaching methods

Follow-up

To master diagnostics andbe able to initially handle
the treatment of surgicaland non-surgical diseasesof the nose and sinuses andhave an understanding of
diseases of the front baseof the skull

Clinical service under
supervision in a unit that
handles these conditions

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Theoretical studies

Intermediate objective 8

Teaching methods

Follow-up

To be able to handle
diagnostics and nonsurgical treatment ofdiseases and dysfunction of the oral cavity,
pharynx and oesophagus

Clinical service under
supervision in a unit that
handles these conditions

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Training in a simulated environment
Theoretical studies

Intermediate objective 9

Teaching methods

Follow-up

To master initial diagnostics and be able toinitially handle surgical and non-surgicaltreatment of diseases
in otorhinolaryngology

Clinical service under supervision in a unit that
handles these conditions

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Health care teamwork
under supervision
Diagnostics and treatment symposium
Theoretical studies

Intermediate objective 10

Teaching methods

Follow-up

To be able to handle
surgically the common
and important nonmalignant diseases ofthe soft parts of the head
and throat regions

Clinical service under
supervision in a unit that
handles these conditions

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Theoretical studies

Intermediate objective 11

Teaching methods

Follow-up

To master acute handlingand be able to initially handle surgical treatment of
trauma in the head andthroat regions

Clinical service under
supervision in a unit that
handles these conditions

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

Auscultation under supervision in a unit that handles these conditions
CourseCertificate of successfullycompleted course, issuedby course leader

Theoretical studies

Intermediate objective 12

Teaching methods

Follow-up

To be able to handle
surgical diseases of theear, temporal bone andlateral base of the skull
and be able to handle
complications and follow-ups regarding these
diseasesClinical service under super- Certificate of successfully
vision in a unit that handles completed clinical service
and competencethese conditions
achieved, issued by current mentor
CourseCertificate of successfullycompleted course, issuedby course leader
Theoretical studies

Communicative competenceIntermediate objective 13

Teaching methods

Follow-up

To be capable of dialogue
and open contact with patients and their next of kin

Clinical service under
supervision in a unit
where such operations
are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

Intermediate objective 14

Teaching methods

Follow-up

To be capable of communication, both oral andwritten, with other doctors
and co-workers

Clinical service under
supervision in a unit
where such operations
are practised

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

Intermediate objective 15

Teaching methods

Follow-up

To be capable of informing
Clinical service under
and instructing patients, next supervision in a unitof kin, other doctors, and co- where such operations
workers, as well as students are practised
Instructing under
supervision

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

Leadership competenceIntermediate objective 16

Teaching methods

Follow-up

To be capable of mentoring other doctors and coworkers as well as students

Clinical service under
supervision in a unit
where such operations
are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Mentoring under
supervisionIntermediate objective 17

Teaching methods

Follow-up

To be capable of leading
using collaboration anddialogue with co-workers
as well as within the healthcare team

Clinical service under
supervision in a unit
where such operations
are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Intermediate objective 18

Teaching methods

Follow-up

To have understanding of
the organisation, management, and regulatory
systems of health andmedical care

CourseCertificate of successfullycompleted course, issuedby course leader

Competence within medical science and quality
work
Intermediate objective 19

Teaching methods

Follow-up

To be capable of a medically Written individual work
under supervision accordscientific outlook and aping to scientific principles
proachCertificate of approved written individual work, issued bycurrent mentor

Intermediate objective 20

Teaching methods

Follow-up

To have an understanding of, andcompetence in, evidence-based improvement and quality work

Quality and development
work under supervision

Certificate of qualityand development
work, issued by current mentor

Audiology

Introduction
Explanation of terms
General definition of competencies
Definition of area of competence
Competence requirements
Competence requirements for medical competence
Competence requirements for communicative competence, leadershipcompetence, and competence within medical science and quality work
Training structure
Special recommendations
Intermediate objectives
Medical competenceCommunicative competence
Leadership competence
Competence within medical science and quality work

Introduction

On June 24, 2008, The National Board of Health and Welfare (Socialstyrelsen) decided to issue new regulations and general guidelines for doctors’
specialist medical training (SOSFS 2008:17). The statute consists of a general part with common provisions for all specialties and a specific part withall the descriptions of objectives. The description of objectives for the respective specialties should be understood against the background of the provisions in the general part.
In each description of objectives, there is a section headed ‘Training
structure’, which constitutes general guidelines. The teaching methods under the heading ‘Intermediate objectives’ where no follow-up is indicatedalso constitute general guidelines.

Explanation of terms

current mentor
a specialist doctor whose specialist competence corresponds to the area ofcompetence indicated by the intermediate objective, and who is responsible
for ST doctors’s professional development during the teaching period or forthe method of teaching indicatedthe assignment as a mentor for an ST doctor generally encompasses the entire period of specialist training but can also encompass part or parts of it
auscultation
during mentoring, and in accordance with a pre-designed programme, tostudy the profession of a specialist doctor or other health care staff by following one or several professionals, as well as carrying out assignments inthe current area
evaluate
to form a sound opinion of a patient or similar person as a basis for further
management
masterbeing fully able to evaluate and handle the medical investigation, diagnostics, treatment, and follow-up of a patient or similar person, and being fully
able to use the techniques relevant to the area
capability
personal capacity to execute or perform a task
have understanding
having acquired knowledge and insight into an area through theoretical studies and/or practical exercise of the profession
have knowledge
having acquired some knowledge in an area through theoretical studies
and/or practical exercise of the profession
mentoring under supervision
as an ST doctor, mentor a co-worker while simultaneously being mentored
by a doctor with specialist competencementorcontinuously, and in dialogue form, supporting and guiding, as well as evaluating, a co-worker’s professional development
mentoringsee mentor
handleto actively carry out measures regarding investigation, diagnostics, treatment, and follow-up of a patient or similar person, and have overall responsibility for carrying out these measuresinitially handle
as the primary physician in charge, to actively carry out measures regarding
investigation, diagnostics, treatment, and follow-up of a patient or similar
person, and have overall responsibility for carrying out these measuresinitially evaluate
as the primary physician in charge, to form a sound opinion of a patient orsimilar person as a basis for further management
intraprofessional group reflection
reflection done in a group together with other doctors, chiefly for the purpose of further education and training
clinical service
health and medical care duties that ST doctors perform under their own professional liability and with the support of a mentor
courseteacher-led training with an established plan, given during a defined periodof timesitting-in
training activity involving an ST doctor observing when a specialist doctor
or other health care staff holds a consultationorassessment activity involving a specialist doctor or other health care staff
observing and evaluating ST doctors during a consultation
seminarinstruction in group form with active participation
training in a simulated environment
training carried out in an environment created to emulate reality

large professional assembly
conference, congress, symposium or similar event
health care centre
health care unit in primary carehealth care team work
work where ST doctors, under supervision, participates in and sometimes
leads a group of co-operating health care staff with various competencies
charged with responsibility for care for an individual patient or group ofpatients

General definition of competencies

Definition of area of competence
The specialty of audiology includes the handling and treatment of patientswith disorders of the hearing and balance system. Audiology is a medical
specialty that combines medicine and technology with a psychosocial approach. The specialty is individually focused with clinical and laboratory
diagnostics and treatment including medical, technical, habilitative and rehabilitative measures and preventive initiatives. Central to this are knowledge and understanding of the physiology of hearing and balance, and theconsequences of impaired hearing, tinnitus, sensitivity to sound, and balance
disorders for both the individual and society.
Audiology is a branch specialty of the base specialty of otorhinolaryngology.

Competence requirements
Competence requirements for medical competence
For specialist competence in audiology, an understanding is required of theaudiological and vestibular areas in order to be able to independently handle
and treat patients with disorders of and symptoms in the hearing and balancesystem. A method of working that makes it possible to work together withother professional groups in the audiological and adjacent areas, particularly
audiologists and hearing therapists, is also required. An understanding is
also required of the effect that sound and the noise environment have on
people. An understanding of organisations for the handicapped and patientswith a connection to the field is also required.
For specialist competence in audiology, a theoretical understanding of
anatomy, physiology, pathology, aetiology and symptomatology is also required. It is also necessary to master medical investigation and the treatmentof the common and serious medical conditions with regard to hearing andbalance, the ear, temporal bone, lateral base of the skull, nose, sinuses andfront base of the skull, oral cavity, pharynx, larynx, windpipe, oesophagus,
head, throat, thyroid gland, salivary glands and adjacent structures. Surgicalskills in the aforementioned areas are also required and necessary in order tobe able to independently handle common and serious conditions in the specialty. This involves a basic understanding of the respective areas, and practicalskills both in the investigation and treatment methods available and in following up on results. Special emphasis is placed on competence in being able tohandle acute and life-threatening conditions independently (intermediateobjectives 1-4).

Competence requirements for communicative competence, leadership competence, and competence within medical scienceand quality work
Communicative competence
The equal and responsible patient
Doctors with specialist competence must be capable of dialogue and of
maintaining open contact with patients and their next of kin. Contact should
be characterised by empathy and trust, as well as respect for the patients’right to information, influence, and participation in decisions. Contact
should also be characterised by co-operation and sensitivity to the patients’needs, desires and right to self-determination, as well as providing incentives for the patients’ involvement and responsibility for their own care.
Multicultural and gender aspects
Communication with patients and their next of kin should be characterisedby an understanding of and respect for cross-cultural and multicultural aspects such as age, language, ethnicity, sexual orientation, and religion, as
well as gender.
Interprofessional relations
Doctors with specialist competence must have the ability to communicate,both in writing and orally, with other doctors and co-workers showing respect for their professional knowledge and competencies. The same applies
to contact with representatives of the public and various civil authorities.
Pedagogical skills
Doctors with specialist competence must have pedagogical capability inorder to inform and instruct not only patients and their next of kin but also
other doctors and co-workers, as well as students.
Professional approach and ethics
Doctors with specialist competence must be capable of working continuously with their professional and medical ethical approaches, with the objectiveof being able to make independent decisions of a medical ethical nature.
Individual professional development
Doctors with specialist competence must be capable of continually examining and identifying their own needs for professional development, in addition to operational requirements, in order to be able to meet requirements forthe best possible patient care.

Leadership competence
Collaboration
Doctors with specialist competence must have a developed capability for
self-knowledge and understanding of their own functions and roles in theorganisation.
Mentoring skills
Doctors with specialist competence must be capable of mentoring other doctors and co-workers, as well as students.
Leadership
Doctors with specialist competence must be capable of leadership characterised by collaboration, openness, and dialogue with co-workers. Leadershipmust further be characterised by participation and activity development
aimed at improvement. The ability to lead the work of the health care teamis essential.
System knowledge
Doctors with specialist competence must have an understanding of the organisation, administration, finances, and regulatory systems of health andmedical care, as well as its governance, in order to make the best use of resources.

Competence within medical science and quality work
Medical science
Doctors with specialist competence must be capable of adopting a medicallyscientific outlook and approach, and must have knowledge of research methodology including basic epidemiological concepts as well as of methods
for evidence-based medicine and review of scientific information.
Improvement and quality work
Doctors with specialist competence must have an understanding of, andcompetence in, evidence-based improvement and quality work. The objective is to be able to initiate, participate in, and be responsible for continuous
systematic improvement work with emphasis on a holistic perspective, patient safety, patient benefit, measurability, and teaching management in order to be able to review and evaluate their own operations.
Public health and prevention
Doctors with specialist competence must have an understanding of the factors determining health, other aspects of public health, and methods forpromoting health and efforts aimed at preventing injury and illness, in order
to be able to take this understanding into account in medical scientific work.

Training structure
Specialist medical training in audiology can begin before, during, or after
specialist medical training in otorhinolaryngology and can be integrated
with it.
The specialty shares a common knowledge base with the base specialty ofotorhinolaryngology. During the introductory part, emphasis should be put
on service in acute and basic ear, nose, and throat activity. ST doctors
should, however, begin service in audiological and vestibular activity at an
early stage in his training. Service in otorhinolaryngology and audiology
should then be layered in an adequate manner until the stipulated knowledge
requirement has been achieved.
It is at units that perform audiological and vestibular diagnostics andtreatment that the majority of the knowledge required can be obtained withregard to the area of competence of audiology. In order to gain experienceof the continuity of the relationship with the doctor, which is a prerequisite
for understanding patients with permanent dysfunctions, a lengthy uninterrupted period of service will be required. It is also important to have a lengthy period of service at the university clinic so that ST doctors can acquire
an advanced understanding of audiological and vestibular diagnostics andscience.
It is also important for ST doctors to gain experience in the different specialties and activities that have points in common with audiology. This isachieved by supplementing the main service with service in one or more of
the following specialties: neurology, paediatrics, geriatrics, clinical genetics
and psychiatry. Auscultation after study visits may, in some cases, coversmaller elements of the area of competence.
In parallel with clinical service, ST doctors should be given the opportunity to conduct theoretical studies and take part in courses and conferences.

Special recommendations
The specialty associations and sections of the medical organisations haveformulated special recommendations for their own specialties. The recommendations concern such issues as how specialist medical training should be
structured.

Intermediate objectives

Medical competenceIntermediate objective 1

Teaching methods

Follow-up

To master diagnostics andsurgical and non-surgicaltreatment of common andimportant diseases in otorhinolaryngology, particularly
the acute conditions

Clinical service under
supervision in a unit that
handles these conditions

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Theoretical studies

Intermediate objective 2

Teaching methods

Follow-up

To master basic clinicalinvestigation and basic
interpretation of imaging,
functional and laboratory
diagnostics in otorhinolaryngology

Clinical service under
supervision in a unit that
handles these conditions

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

Auscultation under supervision in a unit that handles these conditions
CourseCertificate of successfullycompleted course, issuedby course leader

Theoretical studies

Intermediate objective 3

Teaching methods

Follow-up

To master basic clinicalinvestigation and interpretation of the common test
methods with regard tohearing and vestibularfunctionality as well as
surgical and non-surgicaltreatment of the common
and important diseases of
the hearing and balance
organsClinical service under
supervision in a unit that
handles these conditions

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Theoretical studies

Intermediate objective 4

Teaching methods

Follow-up

To master clinical investigation and basic surgical andnon-surgical treatment of
the common and serious
medical conditions in thelarynx and respiratory system and voice and speech
function disorders.

Clinical service under super- Certificate of successfullycompleted clinical servision in a unit that handles
vice and competencethese conditions
achieved, issued by current mentor
CourseCertificate of successfullycompleted course, issuedby course leader
Theoretical studies

Intermediate objective 5

Teaching methods

Follow-up

To master examination,
diagnostics, treatment andfollow up of the most common reasons for hearing
impairments in adults

Clinical service under supervision in a unit that
handles these conditions

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Large professional assembly
Theoretical studies

Intermediate objective 6

Teaching methods

Follow-up

To master examination,
diagnostics, treatment andfollow up of the most common reasons for hearing
impairments in children

Clinical service under
supervision in a unit that
handles these conditions

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Large professional assembly
Theoretical studies

Intermediate objective 7

Teaching methods

Follow-up

To master examination,
diagnostics, treatment andfollow-up of tinnitus anddysacousia

Clinical service under
supervision in a unit that
handles these conditions

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

Auscultation under supervision in a unit that handles
these conditions
CourseCertificate of successfullycompleted course, issuedby course leader

Health care teamwork
under supervision
Large professional assembly
Theoretical studies

Intermediate objective 8

Teaching methods

Follow-up

To master investigation,
diagnostics, treatment andfollow-up of vestibular vertigo and balance disorders
and to be able to evaluate
the diseases in other areasthat affect the balance system

Clinical service under supervision in a unit that handles
these conditions

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Large professional assembly
Theoretical studies

Intermediate objective 9

Teaching methods

Follow-up

To master medical, technical, psychosocial and pedagogic rehabilitation of adults
and children with peripheraland fundamental hearing
problems

Clinical service under
supervision in a unit that
handles these conditions

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

Auscultation under supervision in a unit that handles
these conditions
CourseHealth care teamwork
under supervision
Large professional assembly
Theoretical studies

Certificate of successfullycompleted course, issuedby course leader

Intermediate objective 10

Teaching methods

Follow-up

To master the execution
and interpretation of available audiological, vestibularand otoneurological test
methods

Clinical service under
supervision in a unit
where such operations
are practised

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Theoretical studies

Intermediate objective 11

Teaching methods

To master indications forhearing aids and have an
understanding of alternative means of communication for the deaf and thosewith impaired hearing

Auscultation under supervision in a unit that handles these conditions
CourseFollow-up

Certificate of successfullycompleted course, issuedby course leader

Health care teamwork
under supervision
Theoretical studies

Intermediate objective 12

Teaching methods

Follow-up

To be able to handle theeffects of noise and thenoise environment on
people for information andprevention and have an
understanding of the physics of sound and acoustics

CourseCertificate of successfullycompleted course, issuedby course leader

Large professional assembly
Theoretical studies

Communicative competenceIntermediate objective 13

Teaching methods

Follow-up

To be capable of dialogue
and open contact with patients and their next of kin

Clinical service under
supervision in a unit
where such operations
are practised

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

Intermediate objective 14

Teaching methods

Follow-up

To be capable of communication, both oral andwritten, with other doctors
and co-workers

Clinical service under
supervision in a unit
where such operations
are practised

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

Intermediate objective 15

Teaching methods

Follow-up

To be capable of informing
and instructing patients,
next of kin, other doctors,
and co-workers, as well as
students

Clinical service under
supervision in a unit
where such operations
are practised

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

Leadership competenceIntermediate objective 16

Teaching methods

Follow-up

To be capable of mentoring other doctors and coworkers as well as students

Clinical service under
supervision in a unit
where such operations
are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Mentoring under
supervisionIntermediate objective 17

Teaching methods

Follow-up

To be capable of leading
using collaboration anddialogue with co-workers
as well as within the healthcare team

Clinical service under
supervision in a unit
where such operations
are practised

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Intermediate objective 18

Teaching methods

Follow-up

To have an understandingof the organisation, management, and regulatory
systems of health andmedical care

CourseCertificate of successfullycompleted course, issuedby course leader

Competence within medical science and quality
work
Intermediate objective 19

Teaching methods

Follow-up

To be capable of a medically Written individual work
under supervision accordscientific outlook and aping to scientific principles
proachCertificate of approved written individual work, issued bycurrent mentor

Intermediate objective 20

Teaching methods

Follow-up

To have an understanding of, andcompetence in, evidence-based improvement and quality work

Quality and development
work under supervision

Certificate of qualityand development
work, issued by current mentor

Phoniatrics

Introduction
Explanation of terms
General definition of competencies
Definition of area of competence
Competence requirements
Competence requirements for medical competence
Competence requirements for communicative competence, leadershipcompetence, and competence within medical science and quality work
Training structure
Special recommendations
Intermediate objectives
Medical competenceCommunicative competence
Leadership competence
Competence within medical science and quality work

Introduction

On June 24, 2008, The National Board of Health and Welfare (Socialstyrelsen) decided to issue new regulations and general guidelines for doctors’
specialist medical training (SOSFS 2008:17). The statute consists of a general part with common provisions for all specialties and a specific part withall the descriptions of objectives. The description of objectives for the respective specialties should be understood against the background of the provisions in the general part.
In each description of objectives, there is a section headed ‘Training
structure’, which constitutes general guidelines. The teaching methods under the heading ‘Intermediate objectives’ where no follow-up is indicatedalso constitute general guidelines.

Explanation of terms

current mentor
a specialist doctor whose specialist competence corresponds to the area ofcompetence indicated by the intermediate objective, and who is responsible
for ST doctors’s professional development during the teaching period or forthe method of teaching indicatedthe assignment as a mentor for an ST doctor generally encompasses the entire period of specialist training but can also encompass part or parts of it
auscultation
during mentoring, and in accordance with a pre-designed programme, tostudy the profession of a specialist doctor or other health care staff by following one or several professionals, as well as carrying out assignments inthe current area
evaluate
to form a sound opinion of a patient or similar person as a basis for further
management
masterbeing fully able to evaluate and handle the medical investigation, diagnostics, treatment, and follow-up of a patient or similar person, and being fully
able to use the techniques relevant to the area
capability
personal capacity to execute or perform a task
have understanding
having acquired knowledge and insight into an area through theoretical studies and/or practical exercise of the profession
have knowledge
having acquired some knowledge in an area through theoretical studies
and/or practical exercise of the profession
mentoring under supervision
as an ST doctor, mentor a co-worker while simultaneously being mentored
by a doctor with specialist competencementorcontinuously, and in dialogue form, supporting and guiding, as well as evaluating, a co-worker’s professional development
mentoringsee mentor
handleto actively carry out measures regarding investigation, diagnostics, treatment, and follow-up of a patient or similar person, and have overall responsibility for carrying out these measuresinitially handle
as the primary physician in charge, to actively carry out measures regarding
investigation, diagnostics, treatment, and follow-up of a patient or similar
person, and have overall responsibility for carrying out these measuresinitially evaluate
as the primary physician in charge, to form a sound opinion of a patient orsimilar person as a basis for further management
intraprofessional group reflection
reflection done in a group together with other doctors, chiefly for the purpose of further education and training
clinical service
health and medical care duties that ST doctors perform under their own professional liability and with the support of a mentor
courseteacher-led training with an established plan, given during a defined periodof timesitting-in
training activity involving an ST doctor observing when a specialist doctor
or other health care staff holds a consultationorassessment activity involving a specialist doctor or other health care staff
observing and evaluating ST doctors during a consultation
seminarinstruction in group form with active participation
training in a simulated environment
training carried out in an environment created to emulate reality

large professional assembly
conference, congress, symposium or similar event
health care centre
health care unit in primary carehealth care team work
work where ST doctors, under supervision, participates in and sometimes
leads a group of co-operating health care staff with various competencies
charged with responsibility for care for an individual patient or group ofpatients

General definition of competencies

Definition of area of competence
The specialty of phoniatrics includes the handling of patients with voice,speech, or language function disorders, and with swallowing problems withthe emphasis on motor activity disorders of the oral cavity, as well as pharynx and larynx-related breathing obstructions. Phoniatrics is a specialty thatcombines medicine with basic linguistics, technology and a psychosocial
approach. The specialty focuses on clinical and laboratory investigation,
diagnostics and treatment, which includes medical, surgical, habilitative,
rehabilitative and preventive measures and the follow-up of these. Evaluation and handling of occupational voice problems - in both persons withoccupations that make demands on their voices and in cases where theworking environment appears to have a harmful effect on the functioning of
the voice – are also part of the sphere of activity.
Cooperation with other occupational groups, particularly speech therapists, but also physiotherapists, neurophysiologists, paediatricians, oncologists, dentists and pulmonologists is of great importance. An understandingof activity in organisations for patients and the handicapped with a connection to the field is also part of this.
Phoniatrics is a branch specialty of the base specialty of otorhinolaryngolgy.

Competence requirements
Competence requirements for medical competenceSpecialist competence in phoniatrics requires an understanding of anatomy,
physiology, pathology, aetiology, symptomology, and the necessary treatments of disorders of the voice, speech and language functions, in order tobe able to independently diagnose and deal with the majority of the conditions in the specialty. This involves a theoretical understanding of the different areas of the specialty and practical skills in the investigation methods
available, both non-surgical and surgical treatment methods and following
up results.
A theoretical understanding of anatomy, physiology, pathology, aetiology
and symptomatology is also required for specialist competence in phoniatrics. It is also necessary to master medical investigation and the treatmentof the common and serious medical conditions with regard to hearing andbalance, the ear, temporal bone, lateral base of the skull, nose, sinuses andfront base of the skull, oral cavity, pharynx, larynx, windpipe, oesophagus,
head, throat, thyroid gland, salivary glands and adjacent structures. Surgicalskills in the aforementioned areas are also required and necessary in order tobe able to handle the common and serious conditions in the specialty independently. This involves a basic understanding of the respective area andpractical skills in the investigation and treatment methods available and infollowing up results. Special emphasis is put on competence in being able tohandle acute and life-threatening conditions (intermediate objectives 1-4).

Competence requirements for communicative competence, leadership competence, and competence within medical scienceand quality work
Communicative competence
The equal and responsible patient
Doctors with specialist competence must be capable of dialogue and of
maintaining open contact with patients and their next of kin. Contact should
be characterised by empathy and trust, as well as respect for the patients’right to information, influence, and participation in decisions. Contact
should also be characterised by co-operation and sensitivity to the patients’needs, desires and right to self-determination, as well as providing incentives for the patients’ involvement and responsibility for their own care.
Multicultural and gender aspects
Communication with patients and their next of kin should be characterisedby an understanding of and respect for cross-cultural and multicultural aspects such as age, language, ethnicity, sexual orientation, and religion, as
well as gender.
Interprofessional relations
Doctors with specialist competence must have the ability to communicate,both in writing and orally, with other doctors and co-workers showing respect for their professional knowledge and competencies. The same applies
to contact with representatives of the public and various civil authorities.
Pedagogical skills
Doctors with specialist competence must have pedagogical capability inorder to inform and instruct not only patients and their next of kin but also
other doctors and co-workers, as well as students.
Professional approach and ethics
Doctors with specialist competence must be capable of working continuously with their professional and medical ethical approaches, with the objectiveof being able to make independent decisions of a medical ethical nature.
Individual professional development
Doctors with specialist competence must be capable of continually examining and identifying their own needs for professional development, in addi-

tion to operational requirements, in order to be able to meet requirements forthe best possible patient care.

Leadership competence
Collaboration
Doctors with specialist competence must have a developed capability for
self-knowledge and understanding of their own functions and roles in theorganisation.
Mentoring skills
Doctors with specialist competence must be capable of mentoring other doctors and co-workers, as well as students.
Leadership
Doctors with specialist competence must be capable of leadership characterised by collaboration, openness, and dialogue with co-workers. Leadershipmust further be characterised by participation and activity development
aimed at improvement. The ability to lead the work of the health care teamis essential.
System knowledge
Doctors with specialist competence must have an understanding of the organisation, administration, finances, and regulatory systems of health andmedical care, as well as its governance, in order to make the best use of resources.

Competence within medical science and quality work
Medical science
Doctors with specialist competence must be capable of adopting a medicallyscientific outlook and approach, and must have knowledge of research methodology including basic epidemiological concepts as well as of methods
for evidence-based medicine and review of scientific information.
Improvement and quality work
Doctors with specialist competence must have understanding of, and competence in, evidence-based improvement and quality work. The objective is
to be able to initiate, participate in, and be responsible for continuous systematic improvement work with emphasis on a holistic perspective, patient
safety, patient benefit, measurability, and teaching management in order tobe able to review and evaluate their own operations.
Public health and prevention
Doctors with specialist competence must have an understanding of the factors determining health, other aspects of public health, and methods forpromoting health and efforts aimed at preventing injury and illness, in order
to be able to take this understanding into account in medical scientific work.

Training structure
Specialist medical training in phoniatrics can begin before, during, or after
specialist medical training in otorhinolaryngology and can be integrated
with this.
The specialty shares a common knowledge base with otorhinolaryngology. During the introductory part, emphasis should be put on service in acuteand basic otorhinolaryngology. The majority of specialist medical training
in phoniatrics should then be obtained at a specialist unit at a university
hospital where ST doctors will have the opportunity to ask for advice whileworking, for mutual sitting-in and joint examination of documentation, withthe focus on recordings of images and audio.
In order for ST doctors to obtain experience of the continuity of the doctor-patient relationship, which is a prerequisite for understanding patientswith verbal communication disorders, a lengthy, uninterrupted period ofservice will be important.
At the same time, it is important that ST doctors gains experience of otherspecialties that have points in common with phoniatrics. A good way toachieve this is through supplementing the main service with simultaneous
additional training, primarily in neurology, radiology and paediatrics, withthe emphasis on habilitation and, in addition to this, in one or more of thefollowing areas: oncology, geriatrics, paedodontics, oral surgery, pulmonary
medicine and plastic surgery. This is best achieved through service, auscultation or study visits.
Theoretical studies should be conducted in parallel with clinical service.
ST doctors should also take part in courses and conferences. Account should
also be taken of the intended focus on phoniatrics when choosing courses
and simultaneous additional training during training in the base specialty.

Special recommendations
The specialty associations and sections of the medical organisations haveformulated special recommendations for their own specialties. The recommendations concern such issues as how specialist medical training should be
structured.

Intermediate objectives

Medical competenceIntermediate objective 1

Teaching methods

Follow-up

To master diagnostics andsurgical and non-surgicaltreatment of common andimportant diseases in otorhinolaryngology, particularly
the acute conditions

Clinical service under
supervision in a unit that
handles these conditions

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Theoretical studies

Intermediate objective 2

Teaching methods

Follow-up

To master basic clinicalinvestigation and basic
interpretation of imaging,
functional and laboratory
diagnostics in otorhinolaryngology

Clinical service under
supervision in a unit that
handles these conditions

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

Auscultation under supervision in a unit that handles these conditions
CourseCertificate of successfullycompleted course, issuedby course leader

Theoretical studies

Intermediate objective 3

Teaching methods

Follow-up

To master basic clinicalinvestigation and interpretation of the common test
methods with regard tohearing and vestibular functionality as well as surgicaland non-surgical treatmentof the common and important diseases of the hearing
and balance organs

Clinical service under
supervision in a unit that
handles these conditions

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Theoretical studies

Intermediate objective 4

Teaching methods

Follow-up

To master clinical investigation and basic
surgical and nonsurgical treatment of
the common and serious medical conditions in the larynx andrespiratory system aswell as voice andspeech function disorders.

Clinical service under
supervision in a unit that
handles these conditions

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Intermediate objective 5

Theoretical studies

Teaching methods

To master an understanding Clinical service underof the anatomy of the vocal
supervision in a unit thatorgans and voice physiology handles these conditions
and to be able to handle
voice disorders resulting fromCoursestrain to the vocal organs,including the professionalor
use of the voice.
Large professional asTo be able to handle presembly
ventive voice care

Follow-up
Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor
Certificate of successfullycompleted course, issuedby course leader

Theoretical studies

Intermediate objective 6

Teaching methods

To handle diagnostics andClinical service under
treatment, including basic
supervision in a unit thatsurgery for voice and breath- handles these conditions
ing disorders caused bystructural changes to the
Courselarynx, including laryngeal
traumaTheoretical studies

Follow-up
Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor
Certificate of successfullycompleted course, issuedby course leader

Intermediate objective 7

Teaching methods

Follow-up

To master diagnostics andtreatment of dysphagia,
including fiber endoscopic
investigation of swallowing
and rigid and flexible oesophagoscopy

Clinical service under super- Certificate of successfully
vision in a unit that handles completed clinical service
and competence achieved,these conditions
issued by current mentor
Auscultation under supervision in a unit that handles
these conditions
CourseorLarge professional assembly

Certificate of successfullycompleted course, issuedby course leader

Theoretical studies

Intermediate objective 8

Teaching methods

Follow-up

To master diagnostics, andfollow-up of laryngeal cancer and be able to handle
treatment of laryngeal
cancer and rehabilitation
after mutilating tumour
treatment of the voice andspeech organs

Clinical service under
supervision in a unit that
handles these conditions

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Diagnostics and treatment
symposium
Theoretical studies

Intermediate objective 9

Teaching methods

To master diagnostics and be Clinical service under superable to handle treatment of vision in a unit that handles
language, voice, speech and these conditions
oral motor disorders in neurological disorders and dysfunctions
Auscultation under superTo be able to handle themedical investigation anddiagnostics of stammeringand other speech rhythm
disorders

Follow-up
Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

vision in a unit that handles these conditions
CourseTheoretical studies

Certificate of successfullycompleted course, issuedby course leader

Intermediate objective 10

Teaching methods

Follow-up

To master investigation
and be able to handle
habilitation and rehabilitation of children and adults
with language, speech andoral motor disorders
caused by deformities ormental retardation

Clinical service under
supervision in a unit that
handles these conditions

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

Auscultation under supervision in a unit that handles
these conditions
Theoretical studies

Intermediate objective 11

Teaching methods

Follow-up

To master diagnostics andbe able to handle patientswith verbal communicationor swallowing disorders
caused by psychological,
psychiatric or behaviouraldisorders

Clinical service under
supervision in a unit that
handles these conditions

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

Intermediate objective 12

Teaching methods

To be able to handle
diagnostics and treatment of voice disorders
caused by respiratory
dysfunction

Clinical service under super- Certificate of successfully
vision in a unit that handles completed clinical service
and competence achieved,these conditions
issued by current mentor

Theoretical studies

Follow-up

Auscultation under supervision in a unit that handles these conditions
Theoretical studies

Communicative competenceIntermediate objective 13

Teaching methods

Follow-up

To be capable of dialogue
and open contact with patients and their next of kin

Clinical service under
supervision in a unit
where such operations
are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

Intermediate objective 14

Teaching methods

Follow-up

To be capable of communication, both oral andwritten, with other doctors
and co-workers

Clinical service under
supervision in a unit
where such operations
are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

Intermediate objective 15

Teaching methods

Follow-up

To be capable of informing
and instructing patients, nextof kin, other doctors, and coworkers, as well as students

Clinical service under
supervision in a unit
where such operations
are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

Instructing under
supervision

Leadership competenceIntermediate objective 16

Teaching methods

Follow-up

To be capable of mentoring other doctors and coworkers as well as students

Clinical service under
supervision in a unit
where such operations
are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Mentoring under
supervisionIntermediate objective 17

Teaching methods

To be capable of leading
Clinical service underusing collaboration and dialo- supervision in a unit
gue with co-workers as well where such operations
as within the health care team are practised

Follow-up
Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Intermediate objective 18

Teaching methods

Follow-up

To have an understandingof the organisation, management, and regulatory
systems of health andmedical care

CourseCertificate of successfullycompleted course, issuedby course leader

Competence within medical science and quality
work
Intermediate objective 19

Teaching methods

To be capable of a medically Written individual work underscientific outlook and apsupervision according to scientifproachic principles

Follow-up
Certificate of approved written
individual work, issued bycurrent mentor

Intermediate objective 20

Teaching methods

Follow-up

To have an understanding of, andcompetence in, evidence-based
improvement and quality work

Quality and development work under
supervision

Certificate of quality anddevelopment work, issued
by current mentor

Ophthalmology

Introduction
Explanation of terms
General definition of competencies
Definition of area of competence
Competence requirements
Competence requirements for medical competence
Competence requirements for communicative competence, leadershipcompetence, and competence within medical science and quality work
Training structure
Special recommendations
Intermediate objectives
Medical competenceCommunicative competence
Leadership competence
Competence within medical science and quality work

Introduction

On June 24, 2008, The National Board of Health and Welfare (Socialstyrelsen) decided to issue new regulations and general guidelines for doctors’
specialist medical training (SOSFS 2008:17). The statute consists of a general part with common provisions for all specialties and a specific part withall the descriptions of objectives. The description of objectives for the respective specialties should be understood against the background of the provisions in the general part.
In each description of objectives, there is a section headed ‘Training
structure’, which constitutes general guidelines. The teaching methods under the heading ‘Intermediate objectives’ where no follow-up is indicatedalso constitute general guidelines.

Explanation of terms

current mentor
a specialist doctor whose specialist competence corresponds to the area ofcompetence indicated by the intermediate objective, and who is responsible
for ST doctors’s professional development during the teaching period or forthe method of teaching indicatedthe assignment as a mentor for an ST doctor generally encompasses the entire period of specialist training but can also encompass part or parts of it
auscultation
during mentoring, and in accordance with a pre-designed programme, tostudy the profession of a specialist doctor or other health care staff by following one or several professionals, as well as carrying out assignments inthe current area
evaluate
to form a sound opinion of a patient or similar person as a basis for further
management
masterbeing fully able to evaluate and handle the medical investigation, diagnostics, treatment, and follow-up of a patient or similar person, and being fully
able to use the techniques relevant to the area
capability
personal capacity to execute or perform a task
h a ve u n d ers tan d i ng
having acquired knowledge and insight into an area through theoretical studies and/or practical exercise of the profession
have knowledge
having acquired some knowledge in an area through theoretical studies
and/or practical exercise of the profession
mentoring under supervision
as an ST doctor, mentor a co-worker while simultaneously being mentored
by a doctor with specialist competencementorcontinuously, and in dialogue form, supporting and guiding, as well as evaluating, a co-worker’s professional development
mentoringsee mentor
handleto actively carry out measures regarding investigation, diagnostics, treatment, and follow-up of a patient or similar person, and have overall responsibility for carrying out these measuresinitially handle
as the primary physician in charge, to actively carry out measures regarding
investigation, diagnostics, treatment, and follow-up of a patient or similar
person, and have overall responsibility for carrying out these measuresinitially evaluate
as the primary physician in charge, to form a sound opinion of a patient orsimilar person as a basis for further management
intraprofessional group reflection
reflection done in a group together with other doctors, chiefly for the purpose of further education and training
clinical service
health and medical care duties that ST doctors perform under their own professional liability and with the support of a mentor
courseteacher-led training with an established plan, given during a defined periodof timesitting-in
training activity involving an ST doctor observing when a specialist doctor
or other health care staff holds a consultationorassessment activity involving a specialist doctor or other health care staff
observing and evaluating ST doctors during a consultation
seminarinstruction in group form with active participation
training in a simulated environment
training carried out in an environment created to emulate reality

large professional assembly
conference, congress, symposium or similar event
health care centre
health care unit in primary carehealth care team work
work where ST doctors, under supervision, participates in and sometimes
leads a group of co-operating health care staff with various competencies
charged with responsibility for care for an individual patient or group ofpatients

General definition of competencies

Definition of area of competence
The specialty of ophthalmology includes an understanding of and skills inboth diseases that primarily affect the eye, and diseases that have an effecton the eyes or the eyesight. The specialty covers all medical conditions that
affect the eye, the eye socket, the adnexa of the eye, and eyesight to someextent in all ages. The specialty also includes an understanding of optics andrefraction, legal aspects of eyesight requirements in regard to traffic andvarious occupations, and also the ability to handle and interpret results fromrelevant testing apparatus. Close cooperation with the rest of the health service and with opticians is central to this. The specialty also includes an understanding of the development of a child’s vision and low vision rehabilitation.

Competence requirements
Competence requirements for medical competenceSpecialist competence in ophthalmology, requires understanding and skills
in order to be able to independently investigate, diagnose, treat and follow
up on diseases of the eye. Theoretical and practical competence and skills incurrent, adequate investigation and treatment methods and the ability to determine refraction and carry out a complete investigation of the eye are also
required. In addition, it is necessary to master current equipment for diagnostics and treatment. Knowledge of anatomy, physiology and medical conditions in the different part of the eye and its adnexa is also required, withthe emphasis on common diseases.

Competence requirements for communicative competence, leadership competence, and competence within medical scienceand quality work
Communicative competence
The equal and responsible patient
Doctors with specialist competence must be capable of dialogue and of
maintaining open contact with patients and their next of kin. Contact should
be characterised by empathy and trust, as well as respect for the patients’right to information, influence, and participation in decisions. Contact
should also be characterised by co-operation and sensitivity to the patients’needs, desires and right to self-determination, as well as providing incentives for the patients’ involvement and responsibility for their own care.
Multicultural and gender aspects
Communication with patients and their next of kin should be characterisedby understanding and respect for cross-cultural and multicultural aspects
such as age, language, ethnicity, sexual orientation, and religion, as well as
gender.
Interprofessional relations
Doctors with specialist competence must have the ability to communicate,both in writing and orally, with other doctors and co-workers showing respect for their professional knowledge and competencies. The same applies
to contact with representatives of the public and various civil authorities.
Pedagogical skills
Doctors with specialist competence must have pedagogical capability inorder to inform and instruct not only patients and their next of kin but also
other doctors and co-workers, as well as students.
Professional approach and ethics
Doctors with specialist competence must be capable of working continuously with their professional and medical ethical approaches, with the objectiveof being able to make independent decisions of a medical ethical nature.
Individual professional development
Doctors with specialist competence must be capable of continually examining and identifying their own needs for professional development, in addition to operational requirements, in order to be able to meet requirements forthe best possible patient care.

Leadership competence
Collaboration
Doctors with specialist competence must have a developed capability for
self-knowledge and understanding of their own functions and roles in theorganisation.
Mentoring skills
Doctors with specialist competence must be capable of mentoring other doctors and co-workers, as well as students.
Leadership
Doctors with specialist competence must be capable of leadership characterised by collaboration, openness, and dialogue with co-workers. Leadershipmust further be characterised by participation and activity development
aimed at improvement. The ability to lead the work of the health care teamis essential.
System knowledge
Doctors with specialist competence must have an understanding of the organisation, administration, finances, and regulatory systems of health andmedical care, as well as its governance, in order to make the best use of resources.

Competence within medical science and quality work
Medical science
Doctors with specialist competence must be capable of adopting a medicallyscientific outlook and approach, and must have knowledge of research methodology including basic epidemiological concepts as well as of methods
for evidence-based medicine and review of scientific information.
Improvement and quality work
Doctors with specialist competence must have an understanding of, andcompetence in, evidence-based improvement and quality work. The objective is to be able to initiate, participate in, and be responsible for continuous
systematic improvement work with emphasis on a holistic perspective, patient safety, patient benefit, measurability, and teaching management in order to be able to review and evaluate their own operations.
Public health and prevention
Doctors with specialist competence must have an understanding of the factors determining health, other aspects of public health, and methods forpromoting health and efforts aimed at preventing injury and illness, in order
to be able to take this understanding into account in medical scientific work.

Training structure
At an early stage in training, the emphasis should be put on investigation
methods and the primary handling of acute eye diseases and injuries. It will
gradually become more important for ST doctors to serve in a unit that handles the entire spectrum of common eye diseases in accordance with theintermediate objectives for the specialty. Every effort should be made to
strive for uninterrupted periods with the focus on the different intermediateobjectives.
Specialist medical training should also be able to provide some scope foradvanced studies in one or more areas. Courses are important elements ofthe training and should, as far as possible, harmonise with ST doctors’s other training, in terms of time.
During training, the opportunity should be taken to serve at different levels, such as service at a regional clinic in cases where ST doctors's homeclinic is not a regional clinic. It is important that the content of the training
during such service then puts great emphasis on the subareas in the specialty
that the home clinic can offer.

Special recommendations
The specialty associations and sections of the medical organisations haveformulated special recommendations for their own specialties. The recommendations concern such issues as how specialist medical training should be
structured.

Intermediate objectives

Medical competenceIntermediate objective 1

Teaching methods

Follow-up

To master optics andrefraction

Clinical service under
supervision in a unit
where such operations
are practised

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Sitting-in

Intermediate objective 2

Teaching methods

Follow-up

To master investigation
methods and instruments
within ophthalmology

Clinical service under
supervision in a unit
where such operations
are practised

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Sitting-in
Theoretical studies

Intermediate objective 3

Teaching methods

Follow-up

To be able to handle diseases of the eye’s outerareas, adnexa and orbita

Clinical service under supervision in a unit that handles these conditions

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Intermediate objective 4

Teaching methods

Follow-up

To be able to handle
cataracts and other diseases of the anterior
segment of the eye

Clinical service under
supervision in a unit that
handles these conditions

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Sitting-in

Intermediate objective 5

Teaching methods

Follow-up

To be able to handle uveitis
and other diseases of theuvea

Clinical service under
supervision in a unit that
handles these conditions

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Intermediate objective 6

Teaching methods

Follow-up

To be able to handle
diabetic retinopathy, macular degeneration andother medical diseases of
the retina

Clinical service under
supervision in a unit that
handles these conditions

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Intermediate objective 7

Teaching methods

Follow-up

To be able to initially handle the surgical diseasesof the retina and vitreous
body and tumours in theposterior segment of theeyeClinical service under
supervision in a unit that
handles these conditions

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Sitting-in

Intermediate objective 8

Teaching methods

Follow-up

To be able to handle diseases of the eye in children and master the development of vision

Clinical service under
supervision in a unit that
handles these conditions

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Sitting-in

Intermediate objective 9

Teaching methods

Follow-up

To be able to handle different types of glaucoma

Clinical service under
supervision in a unit that
handles these conditions

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Intermediate objective 10

Teaching methods

Follow-up

To be able to initiallyhandle neuroophthalmologicaldiseasesClinical service under
supervision in a unit that
handles these conditions

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

Auscultation under supervision in a unit where suchoperations are practised
CourseCertificate of successfullycompleted course, issuedby course leader

Intermediate objective 11

Teaching methods

Follow-up

To be able to initially handle diseases of the eyethat are associated withother illnesses

Clinical service under
supervision in a unit that
handles these conditions

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Theoretical studies

Intermediate objective 12

Teaching methods

To have an understanding of vision
rehabilitation

Auscultation under supervision in a unit wheresuch operations are practised
CourseFollow-up

Certificate of successfullycompleted course, issuedby course leader

Communicative competenceIntermediate objective 13

Teaching methods

Follow-up

To be capable of dialogue
and open contact with patients and their next of kin

Clinical service under
supervision in a unit
where such operations
are practised

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

Sitting-in

Intermediate objective 14

Teaching methods

Follow-up

To be capable of communication, both oral andwritten, with other doctors
and co-workers

Clinical service under
supervision in a unit
where such operations
are practised

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

Intermediate objective 15

Teaching methods

Follow-up

To be capable of informing
and instructing patients,
next of kin, other doctors,
and co-workers, as well as
students

Clinical service under
supervision in a unit
where such operations
are practised

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

Instructing under
supervisionLeadership competenceIntermediate objective 16

Teaching methods

Follow-up

To be capable of mentoring other doctors and coworkers as well as students

Clinical service under
supervision in a unit
where such operations
are practised

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Mentoring under
supervisionIntermediate objective 17

Teaching methods

Follow-up

To be capable of leading
using collaboration anddialogue with co-workers
as well as within the healthcare team

Clinical service under
supervision in a unit
where such operations
are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Theoretical studies

Intermediate objective 18

Teaching methods

Follow-up

To have an understandingof the organisation, management, and regulatory
systems of health andmedical care

CourseCertificate of successfullycompleted course, issuedby course leader

Theoretical studies

Competence within medical science and quality
work
Intermediate objective 19

Teaching methods

Follow-up

To be capable of a medically scientific outlook andapproach

Written individual work under supervision according
to scientific principles

Certificate of approved written individual work, issued bycurrent mentor

Intermediate objective 20

Teaching methods

Follow-up

To have an understanding of, andcompetence in, evidence-based improvement and quality work

Quality and development
work under supervision

Certificate of qualityand development
work, issued by current mentor

Specialities in internal medicine

Internal medicine
Introduction
Explanation of terms
General definition of competences
Definition of area of competence
Competence requirements
Competence requirements for medical competence
Competence requirements for communicative competence, leadershipcompetence, and competence within medical science and quality work
Training structure
Special recommendations
Intermediate objectives
Medical competenceCommunicative competence
Leadership competence
Competence within medical science and quality work

Introduction

On June 24, 2008, The National Board of Health and Welfare (Socialstyrelsen) decided to issue new regulations and general guidelines for doctors’
specialist medical training (SOSFS 2008:17). The statute consists of a general part with common provisions for all specialties and a specific part withall the descriptions of objectives. The description of objectives for the respective specialties should be understood against the background of the provisions in the general part.
In each description of objectives, there is a section headed ‘Training
structure’ which constitutes general guidelines. The teaching methods under
the heading ‘Intermediate objectives’ where no follow-up is indicated also
constitute general guidelines.

Explanation of terms

current mentor
a specialist doctor whose specialist competence corresponds to the area ofcompetence indicated by the intermediate objective, and who is responsible
for ST doctors’s professional development during the teaching period or forthe method of teaching indicatedthe assignment as a mentor for an ST doctor generally encompasses the entire period of specialist training but can also encompass part or parts of it
auscultation
during mentoring, and in accordance with a pre-designed programme, tostudy the profession of a specialist doctor or other health care staff by following one or several professionals, as well as carrying out assignments inthe current area
evaluate
to form a sound opinion of a patient or similar person as a basis for further
management
masterbeing fully able to evaluate and handle the medical investigation, diagnostics, treatment, and follow-up of a patient or similar person, and being fully
able to use the techniques relevant to the area
capability
personal capacity to execute or perform a task
h a ve u n d ers tan d i ng
having acquired knowledge and insight into an area through theoretical studies and/or practical exercise of the profession
have knowledge
having acquired some knowledge in an area through theoretical studies
and/or practical exercise of the profession
mentoring under supervision
as an ST doctor, mentor a co-worker while simultaneously being mentored
by a doctor with specialist competencementorcontinuously, and in dialogue form, supporting and guiding, as well as evaluating, a co-worker’s professional development
mentoringsee mentor
handleto actively carry out measures regarding investigation, diagnostics, treatment, and follow-up of a patient or similar person, and have overall responsibility for carrying out these measuresinitially handle
as the primary physician in charge, to actively carry out measures regarding
investigation, diagnostics, treatment, and follow-up of a patient or similar
person, and have overall responsibility for carrying out these measuresinitially evaluate
as the primary physician in charge, to form a sound opinion of a patient orsimilar person as a basis for further management
intraprofessional group reflection
reflection done in a group together with other doctors, chiefly for the purpose of further education and training
clinical service
health and medical care duties that ST doctors perform under their own professional liability and with the support of a mentor
courseteacher-led training with an established plan, given during a defined periodof timesitting-in
training activity involving an ST doctor observing when a specialist doctor
or other health care staff holds a consultationorassessment activity involving a specialist doctor or other health care staff
observing and evaluating ST doctors during a consultation
seminarinstruction in group form with active participation
training in a simulated environment
training carried out in an environment created to emulate reality

large professional assembly
conference, congress, symposium or similar event
health care centre
health care unit in primary carehealth care team work
work where ST doctors, under supervision, participates in and sometimes
leads a group of co-operating health care staff with various competencies
charged with responsibility for care for an individual patient or group ofpatients

General definition of competence

Definition of area of competenceInternal medicine is a base specialty for the branch specialties of cardiology,
gastroenterology and hepatology, endocrinology and diabetology, renal
medicine (nephrology), respiratory medicine, haematology, and allergology.
The area of internal medicine comprises a general competence that can bepractised independently, at the same time as it is a common platform for the
branch specialties as well as knowledge and a skills base for emergency
operations within the entire field of internal medicine. The focus of the specialty is on system illnesses and illnesses of the internal organs – medical
conditions that are most often treated with non-invasive or minimally invasive methods, primarily medicine. Characteristic of the specialty is that diagnostics are to a great extent based on analyses of case histories and physical examinations supported by radiology, clinical physiology, and endoscopic and the clinical and chemical results of investigation. Patient groups
cover all ages starting in the late teens, but with the emphasis on older patients.

Competence requirements
Competence requirements for medical competenceSpecialist competence in internal medicine requires mastering the knowledge and skills base common to all specialties within internal medicine. Being able to handle acute illnesses within internal medicine and the acutemedical conditions related to internal medicine are included in this generalbase. Additionally, specialists should be able to handle the most commonand frequently occurring illnesses and medical conditions within internal
medicine, as well as the most common and frequently occurring conditions
within all branch specialties and adjacent base specialties. They should also
master invasive and non-invasive measures and methods relevant to the internal medicine area of competence (intermediate objectives 1–3).
Furthermore, specialist competence in internal medicine requires knowledge and skills to be further deepened. This means broad knowledge within
the entire area of competence of internal medicine, as well as practical skill
in common investigation and treatment methods. Deepened knowledge isalso required concerning pharmaceutical treatment, especially as regards thefactors specific to the patient being treated. This also means that evendeeper competence in handling the most common and frequently occurring
illnesses within the branch specialties and adjacent base specialties is required, not only initially but over the long term, as well as being able toevaluate when the patient should be referred to another speciality. Addition-ally, competence in being able to handle internal medical problems that arisein the border areas between internal medicine and psychiatry is required.
Deeper internal medical competence should be such that it is possible toapply an approach with a comprehensive view as regards the patient’s entire
health and illness situation. Additionally, the specialist competence requires
knowledge of the principles of catastrophe medicine during serious events,
especially events that concern the area of competence directly. Knowledgeof laws and regulations, as well as of their application within the area ofcompetence is required, as is being capable of handling the patient in cooperation with other partners, both other health care providers and the authorities.

Competence requirements for communicative competence,leadership competence and competence within medical scienceand quality work
Communicative competence
The equal and responsible patient
Doctors with specialist competence must be capable of dialogue and of
maintaining open contact with patients and their next of kin. Contact should
be characterised by empathy and trust, as well as respect for patients’ rightto information, influence, and participation in decisions. Contact should also
be characterised by co-operation and sensitivity to the patients’ needs, desires and right to self-determination, as well as providing incentive for patients’ involvement in, and responsibility for, their own care.
Multicultural and gender aspects
Communication with patients and their next of kin should be characterisedby understanding and respect for cross-cultural and multicultural aspects
such as age, language, ethnicity, sexual orientation, and religion, as well as
gender.
Interprofessional relations
Doctors with specialist competence must be capable of communicating,both in writing and orally, with other doctors and co-workers showing respect for their professional knowledge and competences. The same applies
to contact with representatives of the public and various civil authorities.
Pedagogical skills
Doctors with specialist competence must have pedagogical capability inorder to inform and instruct not only patients and their next of kin, but also
other doctors and co-workers, as well as students.

Professional approach and ethics
Doctors with specialist competence must be capable of working continuously with their professional and medical ethical approaches, with the objective of being able to make independent decisions of a medical ethical nature.
Individual professional development
Doctors with specialist competence must be capable of continually examining and identifying their own needs for professional development, in addition to operational requirements, in order to be able to meet requirements forthe best possible patient care.

Leadership competence
Collaboration
Doctors with specialist competence must have a developed capability for
self-knowledge and an understanding of their own functions and roles in theorganisation.
Mentoring skills
Doctors with specialist competence must be capable of mentoring other doctors and co-workers, as well as students.
Leadership
Doctors with specialist competence must be capable of leadership characterised by collaboration, openness, and dialogue with co-workers. Leadershipmust further be characterised by participation and activity development
aimed at improvement. The ability to lead the work of the health care teamis essential.
System knowledge
Doctors with specialist competence must have an understanding of the organisation, administration, financial and regulatory systems of health care,
as well as its governance, in order to make the best use of resources.

Competence within medical science and quality work
Medical science
Doctors with specialist competence must be capable of adopting a medicallyscientific outlook and approach, and must have knowledge of researchmethodology, including basic epidemiological concepts, as well as of methods for evidence-based medicine and review of scientific information.

Improvement and quality work
Doctors with specialist competence must have an understanding of, andcompetence in, evidence-based improvement and quality work. The objective is to be able to initiate, participate in, and be responsible for continuous
systematic improvement work with emphasis on a holistic perspective, patient safety, patient benefit, measurability, and teaching management in order to be able to review and evaluate their own operations.
Public health and prevention
Doctors with specialist competence must have an understanding of the factors determining health, other aspects of public health, and methods forpromoting health and efforts aimed at preventing injury and illness, in order
to be able to take this understanding into account in medical scientific work.

Training structure
During an introductory period, emphasis should be laid on service with thegoal of providing a good competence base for emergency operations withininternal medicine. During this time, a course in emergency internal medicine
should be worked into the schedule. The clinical service should involve
placement in units where such emergency health care is practised. Cohesive
periods within all the areas of operation should be sought after while clinicalservice is ongoing. Early on in training, the service should take place in aunit that handles widespread diseases such as heart disease, stroke, diabetes,and obstructive lung disease. The relevant courses should also be planned in
keeping with the clinical service.
During the latter half of specialist medical training, more interests shouldbe accommodated in the planning: on the one hand, a broadening of competence within the areas of the branch specialties and adjacent base specialties;
on the other, a deepening in the elective operations. The contents of the service in other operations within the field of internal medicine should beplanned so that good knowledge of the essential parts within the branch specialties, including outpatient care, is attained. Simultaneous additional training in another operation can supplement this. In such a case the service
should be arranged so that it contains the relevant knowledge for internal
medicine and increases capability. Examples of such simultaneous additional training for internal medicine are intensive care, rheumatology, infections disease care, geriatrics, neurology, emergency psychiatry, radiology,
clinical chemistry, clinical physiology, and general medicine. Courses
should also be planned in keeping with the service during this period.
Internal medicine can be supplemented with ongoing specialist medical
training within a branch specialty, or additional specialty, or be combinedwith another adjacent base specialty, primarily rheumatology, geriatrics,
neurology, and infectious medicine. Coordination of service within thefields relevant to both internal medicine and the intended ongoing specialist
medical training can take place during the latter part of specialist medical
training in internal medicine.

Internal medicine can also constitute a general competence that can be practised independently. The latter part of specialist medical training can then be
arranged for deepening within the area of competence that is relevant tobroad internal medicine operations.

Special recommendations
The specialty associations and sections of the medical organisations haveformulated special recommendations for their own specialties. The recommendations concern such issues as how specialist medical training should be
structured.

Intermediate objectives

Medical competenceIntermediate objective 1

Teaching methods

Follow-up

To be able to handle acuteillnesses within internal medicine and the acute medical
conditions related to internal
medicine

Clinical service under supervision in a unit that handles
these conditions

Certificate of successfully completed clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfully completed course, issued bycourse leader

Sitting-in
Theoretical studies

Intermediate objective 2

Teaching methods

Follow-up

To be able to initially handle themost common and frequently
occurring illnesses and medical
conditions within internal medicine, as well as the most common and frequently occurring
conditions within the branch
specialties and adjacent basespecialties

Clinical service under supervision in a unit that handles
these conditions

Certificate of successfully completed clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfully completed course, issued bycourse leader

Sitting-in
Theoretical studies

Intermediate objective 3

Teaching methods

Follow-up

To master invasive and noninvasive measures and methods relevant to the internal
medicine area of competence

Clinical service under supervision in a unit where such operations are practised

Certificate of successfully completed clinical service andcompetence achieved, issued
by current mentor

Training in a simulated environment
Theoretical studies

Intermediate objective 4

Teaching methods

Follow-up

To be able to handle the mostcommon and frequently occurring illnesses among the branch
specialties of internal medicine,especially in the first few days

Clinical service under supervision in a unit that handles
these conditions

Certificate of successfully completed clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfully completed course, issued bycourse leader

Theoretical studies

Intermediate objective 5

Teaching methods

Follow-up

To be able to handle the mostcommon and frequently occurring illnesses within the adjacent base specialties, especially in the first few days

Clinical service under supervision in a unit that handles
these conditions

Certificate of successfully completed clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfully completed course, issued bycourse leader

Theoretical studies

Intermediate objective 6

Teaching methods

Follow-up

To be able to evaluate when apatient should be referred to abranch specialist or other specialist

Clinical service under supervision in a unit that handles
these conditions

Certificate of successfully completed clinical service andcompetence achieved, issued
by current mentor

Theoretical studies

Intermediate objective 7

Teaching methods

Follow-up

To have an understanding of
medicines, as well as their indications and effects, especiallyregarding the factors specific toan individual

Clinical service under supervision in a unit that handles
these conditions

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Course or seminar or large
professional assembly

Certificate of successfullycompleted course, issued bycourse leader

Theoretical studies

Intermediate objective 8

Teaching methods

Follow-up

To be able to handle somaticinternal medicine problems inpatients with psychiatric illnesses and addictions, as wellas to be able to handle psychosomatic conditions with internal
medical symptoms

Clinical service under supervision in a unit that manages
these conditions

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

SeminarSitting-in

Intermediate objective 9

Teaching methods

Follow-up

To have the knowledge to beable to construct a comprehensive view of the patient, especially in the presence of multiple
diagnoses and problems

Clinical service under supervision in a unit that manages
these conditions

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

SeminarSitting-in

Intermediate objective 10

Teaching methods

Follow-up

To have an understanding of
the working principles of catastrophe medicine during medical
catastrophes

CourseCertificate of successfullycompleted course, issued bycourse leader

Training in a simulated environment

Intermediate objective 11

Teaching methods

Follow-up

To have an understanding of
the regulations for the exerciseof public authority that are relevant to the area of competence,and their application

Clinical service under supervision in a unit that handles
these issues

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Theoretical studies

Intermediate objective 12

Teaching methods

Follow-up

To be able to handle the patientin cooperation with other healthcare providers as well as otherpartners concerned

Clinical service under supervision in a unit that handles
these issues

Certificate of successfully completed clinical service andcompetence achieved, issued
by current mentor

Theoretical studies

Communicative competenceIntermediate objective 13

Teaching methods

Follow-up

To be capable of dialogue andopen contact with patients andtheir next of kin

Clinical service under supervision in a unit where such operations are practised

Certificate of approved clinicalservice and competenceachieved, issued by current
mentorCourse or seminar

Certificate of successfully completed course, issued bycourse leader

Sitting-in

Intermediate objective 14

Teaching methods

Follow-up

To be capable of communication, both oral and written, withother doctors and co-workers

Clinical service under supervision in a unit where such operations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Health care teamwork under
supervisionIntermediate objective 15

Teaching methods

Follow-up

To be capable of informing andinstructing patients, next of kin,other doctors, and co-workers,
as well as students

Clinical service under supervision in a unit where such operations are practised

Certificate of successfully completed clinical service andcompetence achieved, issued
by current mentor

Instruction under supervision

Leadership competenceIntermediate objective 16
To be capable of mentoringother doctors and co-workers,
as well as students

Teaching methods
Clinical service under supervision in a unit where such operations are practised

Follow-up
Certificate of successfully completed clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfully completed course, issued by course
leaderMentoring under supervisionIntermediate objective 17
To be capable of leading using
collaboration and dialogue withco-workers as well as within thehealth care team

Teaching methods
Clinical service under supervision in a unit where such operations are practised

Follow-up
Certificate of successfully completed clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfully completed course, issued bycourse leader

Health care teamwork under
supervision

Intermediate objective 18

Teaching methods

Follow-up

To have an understanding of
the organisation, management
and regulatory systems ofhealth and medical care

CourseCertificate of successfullycompleted course, issued bycourse leader

Theoretical studies

Competence within medical science and quality
work
Intermediate objective 19

Teaching methods

Follow-up

To be capable of a medicallyscientific outlook and approach

CourseCertificate of successfully completed course, issued bycourse leader

Written individual work under
supervision according to scientific principles

Certificate of approved written
individual work issued by current mentor

Theoretical studies

Intermediate objective 20

Teaching methods

Follow-up

To have an understanding of,and competence in, evidencebased improvement and quality
work

CourseCertificate of successfullycompleted course, issued bycourse leader

Quality and development work
under supervision

Certificate of quality and development work, issued by current
mentor

Theoretical studies

Cardiology

Introduction
Explanation of terms
General definition of competences
Definition of area of competence
Competence requirements
Competence requirements for medical competence
Competence requirements for communicative competence, leadershipcompetence, and competence within medical science and quality work
Training structure
Special recommendations
Intermediate objectives
Medical competenceCommunicative competence
Leadership competence
Competence within medical science and quality work

Introduction

On June 24, 2008, The National Board of Health and Welfare (Socialstyrelsen) decided to issue new regulations and general guidelines for doctors’
specialist medical training (SOSFS 2008:17). The statute consists of a general part with common provisions for all specialties and a specific part withall the descriptions of objectives. The description of objectives for the respective specialties should be understood against the background of the provisions in the general part.
In each description of objectives, there is a section headed ‘Training
structure’ which constitutes general guidelines. The teaching methods under
the heading ‘Intermediate objectives’ where no follow-up is indicated also
constitute general guidelines.

Explanation of terms

current mentor
a specialist doctor whose specialist competence corresponds to the area ofcompetence indicated by the intermediate objective, and who is responsible
for ST doctors’s professional development during the teaching period or forthe method of teaching indicatedthe assignment as a mentor for an ST doctor generally encompasses the entire period of specialist training but can also encompass part or parts of it
auscultation
during mentoring, and in accordance with a pre-designed programme, tostudy the profession of a specialist doctor or other health care staff by following one or several professionals, as well as carrying out assignments inthe current area
evaluate
to form a sound opinion of a patient or similar person as a basis for further
management
masterbeing fully able to evaluate and handle the medical investigation, diagnostics, treatment, and follow-up of a patient or similar person, and being fully
able to use the techniques relevant to the area
capability
personal capacity to execute or perform a task
h a ve u n d ers tan d i ng
having acquired knowledge and insight into an area through theoretical studies and/or practical exercise of the profession
have knowledge
having acquired some knowledge in an area through theoretical studies
and/or practical exercise of the profession
mentoring under supervision
as an ST doctor, mentor a co-worker while simultaneously being mentored
by a doctor with specialist competencementorcontinuously, and in dialogue form, supporting and guiding, as well as evaluating, a co-worker’s professional development
mentoringsee mentor
handleto actively carry out measures regarding investigation, diagnostics, treatment, and follow-up of a patient or similar person, and have overall responsibility for carrying out these measuresinitially handle
as the primary physician in charge, to actively carry out measures regarding
investigation, diagnostics, treatment, and follow-up of a patient or similar
person, and have overall responsibility for carrying out these measuresinitially evaluate
as the primary physician in charge, to form a sound opinion of a patient orsimilar person as a basis for further management
intraprofessional group reflection
reflection done in a group together with other doctors, chiefly for the purpose of further education and training
clinical service
health and medical care duties that ST doctors perform under their own professional liability and with the support of a mentor
courseteacher-led training with an established plan, given during a defined periodof timesitting-in
training activity involving an ST doctor observing when a specialist doctor
or other health care staff holds a consultationorassessment activity involving a specialist doctor or other health care staff
observing and evaluating ST doctors during a consultation
seminarinstruction in group form with active participation
training in a simulated environment
training carried out in an environment created to emulate reality

large professional assembly
conference, congress, symposium or similar event
health care centre
health care unit in primary carehealth care team work
work where ST doctors, under supervision, participates in and sometimes
leads a group of co-operating health care staff with various competencies
charged with responsibility for care for an individual patient or group ofpatients

General definition of competence

Definition of area of competence
The specialty of cardiology covers knowledge and skills in the prevention,
investigation, diagnostics, treatment, and follow-up of diseases of the heart,the central vessels, and pulmonary circulation. The area of competence covers both acute and chronic medical conditions, and the patients come fromage groups ranging from the upper teens, with a majority in middle age orolder. Diagnostics is based on an analysis of the case history, a physicalexamination, and the results of clinical and chemical investigations, as wellas various non-invasive and invasive radiology diagnostics methods. The
opportunities for treatment are made up of pharmacological as well as noninvasive and invasive methods.
Cardiology operations are located in clinics, care units, and intensive careunits, as well as intervention labs, and collaborate closely with fields ofknowledge such as radiology, thoracic surgery, paediatric cardiology, anaesthesiology, internal medicine, infections medicine, and general medicine, as
well as geriatrics.
Cardiology is a branch specialty of the internal medicine base specialty.

Competence requirements
Competence requirements for medical competenceSpecialist competence in cardiology requires knowledge of the anatomy andphysiology of the heart and central vessels, as well as the epidemiology,
etiology, and pathology of heart diseases, as well as their interaction with
the illness panorama of the other organ systems.
Heart disease includes coronary disease, heart failure, arrhythmia, valve
disease, pulmonary hypertension, thoracic aortic disease, and heart diseaseduring pregnancy, as well as inflammatory, infectious, and congenital heartdisease. Specialist competence in cardiology requires knowledge in investigation, diagnostics, treatment and follow-up, as well as primary and secondary prevention, of heart disease. Additionally, knowledge and practicalskills are required in the existing
diagnostics and therapeutic methods of the specialty, involving indicationand performance, risks of complications, and interpretation of examination
results. Attaining the necessary knowledge and skills is required for specialist competence in cardiology in order to be able to independently practicebroad competence in cardiology. This includes independently being able tolead an emergency cardiology clinic. Specialist competence in cardiology
further requires mastering the knowledge and skills base common to all internal medicine specialties. Being able to handle acute illnesses within internal medicine and the acute medical conditions related to internal medi-

cine are included in this general base. Additionally, specialists should be
able to handle the most common and frequently occurring illnesses andmedical conditions within internal medicine, as well as the most commonand frequently occurring conditions within all branch specialties and adjacent base specialties. They should also master invasive and non-invasive
measures and methods relevant to the internal medicine area of competence(intermediate objectives 1–3).

Competence requirements for communicative competence,leadership competence and competence within medical scienceand quality work
Communicative competence
The equal and responsible patient
Doctors with specialist competence must be capable of dialogue and of
maintaining open contact with patients and their next of kin. Contact should
be characterised by empathy and trust, as well as respect for patients’ rightto information, influence, and participation in decisions. Contact should also
be characterised by co-operation and sensitivity to the patients’ needs, desires and right to self-determination, as well as providing incentive for patients’ involvement in, and responsibility for, their own care.
Multicultural aspects
Communication with patients and their next of kin must be characterised byunderstanding of and respect for cross-cultural and multicultural aspects
such as age, language, ethnicity, sexual orientation, and religion, as well as
gender.
Interprofessional relations
Doctors with specialist competence must be capable of communicating,both in writing and orally, with other doctors and co-workers showing respect for their professional knowledge and competences. The same applies
to contact with representatives of the public and various civil authorities.
Pedagogical skills
Doctors with specialist competence must have pedagogical capability inorder to inform and instruct not only patients and their next of kin, but also
other doctors and co-workers, as well as students.
Professional approach and ethics
Doctors with specialist competence must be capable of working continuously with their professional and medical ethical approaches, with the objective of being able to make independent decisions of a medical ethical nature.

Individual professional development
Doctors with specialist competence must be capable of continually examining and identifying their own needs for professional development, in addition to operational requirements, in order to be able to meet requirements forthe best possible patient care.

Leadership competence
Collaboration
Doctors with specialist competence must have a developed capability for
self-knowledge and an understanding of their own functions and roles in theorganisation.
Mentoring skills
Doctors with specialist competence must be capable of mentoring other doctors and co-workers, as well as students.
Leadership
Doctors with specialist competence must be capable of leadership characterised by collaboration, openness, and dialogue with co-workers. Leadershipmust further be characterised by participation and activity development
aimed at improvement. The ability to lead the work of the health care teamis essential.
System knowledge
Doctors with specialist competence must have an understanding of the organisation, administration, financial and regulatory systems of health care,
as well as its governance, in order to make the best use of resources.

Competence within medical science and quality work
Medical science
Doctors with specialist competence must be capable of adopting a medicallyscientific outlook and approach, and must have knowledge of researchmethodology, including basic epidemiological concepts, as well as of methods for evidence-based medicine and review of scientific information.
Improvement and quality work
Doctors with specialist competence must have an understanding of, andcompetence in, evidence-based improvement and quality work. The objective is to be able to initiate, participate in, and be responsible for continuous
systematic improvement work with emphasis on a holistic perspective, patient safety, patient benefit, measurability, and teaching management in order to be able to review and evaluate their own operations.

Public health and prevention
Doctors with specialist competence must have an understanding of the factors determining health, other aspects of public health, and methods forpromoting health and efforts aimed at preventing injury and illness, in order
to be able to take this understanding into account in medical scientific work.

Training structure
Specialist medical training in cardiology can begin before, during, or after
specialist medical training in internal medicine and can be integrated with it.
The main part of the training should be planned after the common internal
medicine base training has been completed. Training in cardiology should
be initiated with rotating placement in a cardiology care unit, cardiology
intensive care unit and heart clinic so that ST doctors get a broad, introductory clinical basis within the area of competence. Cohesive placement periods should be sought after during the entire specialist medical training in
cardiology.
It is important that ST doctors be placed in a radiology, diagnostics, orclinical unit for an adequate period of time early on in their training in orderto achieve independent skills in performing echocardiographic examinations, as well as in order to begin training in interpreting examination results
for the diagnostic methods that are otherwise common within cardiology.
Specialist training should thereafter involve service in the following units:
cardiology intensive care unit or corresponding unit that performs primarypercutaneous coronary intervention (PCI), a heart failure unit, and an arrhythmia and pacemaker unit, including placement in a unit for invasive
electrophysiology. A part of the service should thus be located in a hospitalwith highly specialised cardiology.
ST doctors should, continually throughout their training, be given the opportunity to train in invasive diagnostic procedures and monitoring, as wellas to actively participate in invasive therapeutic interventions. Clinical service in cardiology should take place to such an extent that the prepared specialist can independently handle patients with heart disease. Simultaneous
additional training should be individualised and can include service within
paediatric cardiology, thoracic radiology, thoracic surgery, and in a cardiac
intervention laboratory, as well as in intensive care.
ST doctors should be involved in emergency cardiology duty early on in
cardiology training, with their own primary responsibilities for a cardiology
intensive care unit, but not so that the emergency duty service predominates
over the general clinical service time.
ST doctors should additionally be given the opportunity for their own
study of the relevant literature within the area of competence throughout
their entire training. Furthermore, ST doctors should be given the opportunity to take part in the relevant courses and training. ST doctors should specifically take part in courses that discuss ischemic heart disease, heart failure, arrhythmia, valve disease, haemodynamics and monitoring, and echocardiography as well as congenital heart defects.

Special recommendations
The specialty associations and sections of the medical organisations haveformulated special recommendations for their own specialties. The recommendations concern such issues as how specialist medical training should be
structured.

Intermediate objectives

Medical competenceIntermediate objective 1

Teaching methods

Follow-up

To be able to handle acuteillnesses within internal medicine and the acute medical
conditions related to internal
medicine

Clinical service under supervision in a unit that handles
these conditions

Certificate of successfully completed clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfully completed course, issued bycourse leader

Sitting-in
Theoretical studies

Intermediate objective 2

Teaching methods

Follow-up

To be able to initially handle themost common and frequently
occurring illnesses and medical
conditions within internal medicine, as well as the most common and frequently occurring
conditions within the branch
specialties and adjacent basespecialties

Clinical service under supervision in a unit that handles
these conditions

Certificate of successfully completed clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfully completed course, issued bycourse leader

Sitting-in
Theoretical studies

Intermediate objective 3

Teaching methods

Follow-up

To master invasive and noninvasive measures and methods relevant to the internal
medicine area of competence

Clinical service under supervision in a unit that handles
these conditions

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Training in a simulated environment
Theoretical studies

Intermediate objective 4

Teaching methods

Follow-up

To master taking charge of lifethreatening cardiological conditions in an emergency

Clinical service under supervision in a unit that handles
these conditions

Certificate of successfully completed clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfully completed course, issued bycourse leader

Theoretical studies

Intermediate objective 5

Teaching methods

Follow-up

To master diagnostics andhandling of acute coronary
syndrome and chronic ischemic
heart disease

Clinical service under supervision in a unit that handles
these conditions

Certificate of successfully completed clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfully completed course, issued bycourse leader

Theoretical studies

Intermediate objective 6

Teaching methods

Follow-up

To master diagnostics andhandling of acute and chronic
heart failure, as well as heart
valve diseases

Clinical service under supervision in a unit that handles
these conditions

Certificate of successfully completed clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfully completed course, issued bycourse leader

To be able to handle pulmonary
hypertension
Theoretical studies

Intermediate objective 7

Teaching methods

Follow-up

To master acute cardiac arrhythmia

Clinical service under supervision in a unit that handles
these conditions

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

To be able to handle other arrhythmia and syncope

CourseCertificate of successfullycompleted course, issued bycourse leader

Theoretical studies
To have knowledge of electrophysiological investigation andtreatment methods

Intermediate objective 8

Teaching methods

Follow-up

To be able to handle inflammatory and infectious cardiac conditions

Clinical service under supervision in a unit that handles
these conditions

Certificate of successfully completed clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfully completed course, issued bycourse leader

To be able to handle cardiac
cancer
Theoretical studies

Intermediate objective 9

Teaching methods

Follow-up

To be able to initially handle
acute conditions in congenital
cardiac malformations in adults

Clinical service under supervision in a unit that handles
these conditions

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

To have an understanding ofcongenital cardiac malformations in adults
Theoretical studies

To be able to handle heart diseases associated with pregnancy

To have an understanding of
initial handling of hereditaryheart disease

Intermediate objective 10

Teaching methods

Follow-up

To be able to handle aortic
disease and traumatic heartdisease up to and including any
surgical measures

Clinical service under supervision in a unit that handles
these conditions

Certificate of successfully completed clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfully completed course, issued bycourse leader

Theoretical studies

Intermediate objective 11

Teaching methods

Follow-up

To master primary and secondary preventive cardiovascularrisk factors

Clinical service under supervision in a unit that handles
these conditions

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

To master methods of cardiological rehabilitation
Theoretical studies
To have an understanding of
the arteriosclerotic process

Intermediate objective 12

Teaching methods

To have an understanding of
the various non-invasive andinvasive investigative methods
within the area of competence,as well as to have an understanding of their use in investigating cardiological conditions

Clinical service under supervision in a unit that handles
these conditions
CourseFollow-up

Certificate of successfullycompleted course, issued bycourse leader

Theoretical studies

Communicative competenceIntermediate objective 13

Teaching methods

Follow-up

To be capable of dialogue andopen contact with patients andtheir next of kin

Clinical service under supervision in a unit where such operations are practised

Certificate of approved clinicalservice and competenceachieved, issued by current
mentorCourseCertificate of successfully completed course, issued bycourse leaderorseminarSitting-in

Intermediate objective 14

Teaching methods

Follow-up

To be capable of communication, both oral and written, withother doctors and co-workers

Clinical service under supervision in a unit where such operations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Health care teamwork under
supervision

Intermediate objective 15

Teaching methods

Follow-up

To be capable of informing andinstructing patients, next of kin,other doctors, and co-workers,
as well as students

Clinical service under supervision in a unit where such operations are practised

Certificate of successfully completed clinical service andcompetence achieved, issued
by current mentor

Instruction under supervision

Leadership competenceIntermediate objective 16

Teaching methods

Follow-up

To be capable of mentoringother doctors and co-workers,
as well as students

Clinical service under supervision in a unit where such operations are practised

Certificate of successfully completed clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfully completed course, issued bycourse leader

Mentoring under supervisionIntermediate objective 17

Teaching methods

Follow-up

To be capable of leading using
collaboration and dialogue withco-workers as well as within thehealth care team

Clinical service under supervision in a unit where such operations are practised

Certificate of successfully completed clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfully completed course, issued bycourse leader

Health care teamwork under
supervisionIntermediate objective 18

Teaching methods

Follow-up

To have an understanding of
the organisation, management
and regulatory systems ofhealth and medical care

CourseCertificate of successfullycompleted course, issued bycourse leader

Theoretical studies

Competence within medical science and quality
work
Intermediate objective 19

Teaching methods

Follow-up

To be capable of a medicallyscientific outlook and approach

CourseCertificate of successfully completed course, issued bycourse leader

Written individual work under
supervision according to scientific principles

Certificate of approved written
individual work issued by current mentor

Theoretical studies

Intermediate objective 20

Teaching methods

Follow-up

To have an understanding of,and competence in, evidencebased improvement and quality
work

CourseCertificate of successfullycompleted course, issued bycourse leader

Quality and development work
under supervision

Certificate of quality and development work issued by current
mentorGastroenterology and hepatology

Introduction
Explanation of terms
General definition of competences
Definition of area of competence
Competence requirements
Competence requirements for medical competence
Competence requirements for communicative competence, leadershipcompetence, and competence within medical science and quality work
Training structure
Special recommendations
Intermediate objectives
Medical competenceCommunicative competence
Leadership competence
Competence within medical science and quality work

Introduction

On June 24, 2008, The National Board of Health and Welfare (Socialstyrelsen) decided to issue new regulations and general guidelines for doctors’
specialist medical training (SOSFS 2008:17). The statute consists of a general part with common provisions for all specialties and a specific part withall the descriptions of objectives. The description of objectives for the respective specialties should be understood against the background of the provisions in the general part.
In each description of objectives, there is a section headed ‘Training
structure’ which constitutes general guidelines. The teaching methods under
the heading ‘Intermediate objectives’ where no follow-up is indicated also
constitute general guidelines.

Explanation of terms

current mentor
a specialist doctor whose specialist competence corresponds to the area ofcompetence indicated by the intermediate objective, and who is responsible
for ST doctors’s professional development during the teaching period or forthe method of teaching indicatedthe assignment as a mentor for an ST doctor generally encompasses the entire period of specialist training but can also encompass part or parts of it
auscultation
during mentoring, and in accordance with a pre-designed programme, tostudy the profession of a specialist doctor or other health care staff by following one or several professionals, as well as carrying out assignments inthe current area
evaluate
to form a sound opinion of a patient or similar person as a basis for further
management
masterbeing fully able to evaluate and handle the medical investigation, diagnostics, treatment, and follow-up of a patient or similar person, and being fully
able to use the techniques relevant to the area
capability
personal capacity to execute or perform a task
h a ve u n d ers tan d i ng
having acquired knowledge and insight into an area through theoretical studies and/or practical exercise of the profession
have knowledge
having acquired some knowledge in an area through theoretical studies
and/or practical exercise of the profession
mentoring under supervision
as an ST doctor, mentor a co-worker while simultaneously being mentored
by a doctor with specialist competencementorcontinuously, and in dialogue form, supporting and guiding, as well as evaluating, a co-worker’s professional development
mentoringsee mentor
handleto actively carry out measures regarding investigation, diagnostics, treatment, and follow-up of a patient or similar person, and have overall responsibility for carrying out these measuresinitially handle
as the primary physician in charge, to actively carry out measures regarding
investigation, diagnostics, treatment, and follow-up of a patient or similar
person, and have overall responsibility for carrying out these measuresinitially evaluate
as the primary physician in charge, to form a sound opinion of a patient orsimilar person as a basis for further management
intraprofessional group reflection
reflection done in a group together with other doctors, chiefly for the purpose of further education and training
clinical service
health and medical care duties that ST doctors perform under their own professional liability and with the support of a mentor
courseteacher-led training with an established plan, given during a defined periodof timesitting-in
training activity involving an ST doctor observing when a specialist doctor
or other health care staff holds a consultationorassessment activity involving a specialist doctor or other health care staff
observing and evaluating ST doctors during a consultation
seminarinstruction in group form with active participation
training in a simulated environment
training carried out in an environment created to emulate reality

large professional assembly
conference, congress, symposium or similar event
health care centre
health care unit in primary carehealth care team work
work where ST doctors, under supervision, participates in and sometimes
leads a group of co-operating health care staff with various competencies
charged with responsibility for care for an individual patient or group ofpatients

General definition of competence

Definition of area of competence
The specialty of gastroenterology and hepatology covers knowledge andpractical skill in investigating, diagnosing, treating and following up on patients with illnesses of the stomach and intestinal canal, the liver, the biliary
tract, and the pancreas. The most common and frequently occurring conditions are inflammatory bowel diseases, hepatological diseases, ulcers andreflux disease, malabsorption, and functional and motility disorders, as wellas cancer in the stomach and intestinal canal, the liver, and the pancreas.
Endoscopic operations that comprise both diagnostic and advanced therapeutic skills form an important part of gastroenterology. Another importantpart is investigating and treating secondary nutritional disorders in parallelwith taking medical charge of the gastroenterological or hepatological illness.
Gastroenterology and hepatology is a branch specialty of the internal
medicine base specialty. An internal medicine approach lies at the foundation, but operations are practised in close cooperation with gastroenterological surgery, radiology, infectious diseases, oncology, transplant surgery, andpsychiatry.

Competence requirements
Competence requirements for medical competenceSpecialist competence in gastroenterology and hepatology requires broad
theoretical and practical knowledge within the entire field of gastroenterology and hepatology, which forms the basis for being able to independently
diagnose and treat illnesses.
Specialist competence also requires mastering treatment of motility disorders, acute and chronic inflammatory bowel diseases, acute liver failure, andcirrhosis and its complications, as well as autoimmune, metabolic, infectious, toxic, and hereditary gastroenterological illnesses. Furthermore, handling of ulcers and gastroesophageal reflux disease, digestion and malabsorption disorders must be mastered, as well as investigation and treatmentof illness-related nutritional disorders.
Knowledge of radiology, as well as nuclear medicine, pathology, and laboratory medicine, is also required. Additionally, endoscopic diagnostics
and basic therapeutic intervention via endoscopy must be mastered. Specialists should also have an understanding of the treatment of gastroenterological and hepatological illnesses from a surgical perspective in order to jointly
handle patients, in suitable cases – and in the right situations, refer them for
surgical therapy, which can also include liver transplant. Multidisciplinary
cases are to be handled through regular cooperation with the adjacent spe-

cialties of oncology, infection, and psychiatry. This assumes knowledge ofthe different treatment possibilities in these specialties.
Specialist competence in gastroenterology and hepatology further requires
mastering the knowledge and skills base common to all internal medicine
specialties. Being able to handle acute illnesses within internal medicine andthe acute medical conditions related to internal medicine are included in thisgeneral base. Additionally, specialists should be able to handle the mostcommon and frequently occurring illnesses and medical conditions withininternal medicine, as well as the most common and frequently occurring
conditions within all branch specialties and adjacent base specialties. They
should also master invasive and non-invasive measures and methods relevant to the internal medicine area of competence (intermediate objectives 1–
3).

Competence requirements for communicative competence,leadership competence and competence within medical scienceand quality work
Communicative competence
The equal and responsible patient
Doctors with specialist competence must be capable of dialogue and of
maintaining open contact with patients and their next of kin. Contact should
be characterised by empathy and trust, as well as respect for patients’ rightto information, influence, and participation in decisions. Contact should also
be characterised by co-operation and sensitivity to the patients’ needs, desires and right to self-determination, as well as providing incentive for patients’ involvement in, and responsibility for, their own care.
Multicultural and gender aspects
Communication with patients and their next of kin should be characterisedby understanding and respect for cross-cultural and multicultural aspects
such as age, language, ethnicity, sexual orientation and religion, as well as
gender.
Interprofessional relations
Doctors with specialist competence must be capable of communicating,both in writing and orally, with other doctors and co-workers showing respect for their professional knowledge and competences. The same applies
to contact with representatives of the public and various civil authorities.
Pedagogical skills
Doctors with specialist competence must have pedagogical capability inorder to inform and instruct not only patients and their next of kin, but also
other doctors and co-workers, as well as students.

Professional approach and ethics
Doctors with specialist competence must be capable of working continuously with their professional and medical ethical approaches, with the objective of being able to make independent decisions of a medical ethical nature.
Individual professional development
Doctors with specialist competence must be capable of continually examining and identifying their own needs for professional development, in addition to operational requirements, in order to be able to meet requirements forthe best possible patient care.

Leadership competence
Collaboration
Doctors with specialist competence must have a developed capability for
self-knowledge and an understanding of their own functions and roles in theorganisation.
Mentoring skills
Doctors with specialist competence must be capable of mentoring other doctors and co-workers, as well as students.
Leadership
Doctors with specialist competence must be capable of leadership characterised by collaboration, openness, and dialogue with co-workers. Leadershipmust further be characterised by participation and activity development
aimed at improvement. The ability to lead the work of the health care teamis essential.
System knowledge
Doctors with specialist competence must have an understanding of the organisation, administration, financial and regulatory systems of health care,
as well as its governance, in order to make the best use of resources.

Competence within medical science and quality work
Medical science
Doctors with specialist competence must be capable of adopting a medicallyscientific outlook and approach, and must have knowledge of researchmethodology, including basic epidemiological concepts, as well as of methods for evidence-based medicine and review of scientific information.
Improvement and quality work
Doctors with specialist competence must have an understanding of, andcompetence in, evidence-based improvement and quality work. The objective is to be able to initiate, participate in, and be responsible for continuoussystematic improvement work with emphasis on a holistic perspective, patient safety, patient benefit, measurability, and teaching management in order to be able to review and evaluate their own operations.
Public health and prevention
Doctors with specialist competence must have an understanding of the factors determining health, other aspects of public health, and methods forpromoting health and efforts aimed at preventing injury and illness, in order
to be able to take this understanding into account in medical scientific work.

Training structure
Specialist medical training in gastroenterology and hepatology can begin
before, during, or after specialist medical training in internal medicine andcan be integrated with it.
At the beginning of specialist medical training, it is desirable to acquire abase knowledge of gastroenterology, with an emphasis on taking care of thesickest patients, and acquiring theoretical knowledge, as well as practicaltraining in gastroscopy and practise in simpler procedures at the end of theintroductory period.
Thereafter more immersive education in gastroscopy and coloscopy, more
immersive studies in the literature, and own work in outpatient care under
supervision follows, as well as increased responsibility and increased independence in handling patients. More advanced procedures, such as liverbiopsy and basic endoscopic intervention, can be practised during this time.
During the third part of the training, ST doctors should deepen their competence within an elective part of the operations, for example hepatology,
inflammatory bowel disease, or endoscopy. Independent work on rounds, aswell as investigation and treatment of complicated outpatient cases, should
be practised during this time.
Quality development projects should be carried out, and scientific work
encouraged. ST doctors should take gradually increased responsibility for
instruction, administration, and cooperation with other specialties – the latter through clinical service, multidisciplinary treatment conferences, or auscultation. Participation in conferences should be spread evenly throughout
the training period. Participation in seminars and diagnostics and treatment
conferences should be introduced early on in training and be included on acontinuous basis, as communication with adjacent specialties is important
within the specialty.
The service should be distributed between larger and smaller units so that
ST doctors can become acquainted with the various illness panoramas
within the field, which can vary depending on the size of the unit. Knowledge of less common conditions can be broadened and deepened throughservice at larger units.
Simultaneous additional training should be carried out in different areas ofoperations, preferably at hospitals that perform liver transplant operations,so that ST doctors’ experience and approaches can be broadened. Anothervaluable type of simultaneous additional training is service at a gastro-surgical unit, or a unit where operations in oncology, infection, or psychiatry are practised.
ST doctors should be given the opportunity for independent study and tofollow the relevant literature within the area of competence.

Special recommendations
The specialty associations and sections of the medical organisations haveformulated special recommendations for their own specialties. The recommendations concern such issues as how specialist medical training should be
structured.

Intermediate objectives

Medical competenceIntermediate objective 1

Teaching methods

Follow-up

To be able to handle acuteillnesses within internal medicine and the acute medical
conditions related to internal
medicine

Clinical service under supervision in a unit that handles
these conditions

Certificate of successfully completed clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfully completed course, issued bycourse leader

Sitting-in
Theoretical studies

Intermediate objective 2

Teaching methods

Follow-up

To be able to initially handle themost common and frequently
occurring illnesses and medical
conditions within internal medicine, as well as the most common and frequently occurring
conditions within the branch
specialties and adjacent basespecialties

Clinical service under supervision in a unit that handles
these conditions

Certificate of successfully completed clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfully completed course, issued bycourse leader

Sitting-in
Theoretical studies

Intermediate objective 3

Teaching methods

Follow-up

To master invasive and noninvasive measures and methods relevant to the internal
medicine area of competence

Clinical service under supervision in a unit that handles
these conditions

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Training in a simulated environment
Theoretical studies

Intermediate objective 4

Teaching methods

Follow-up

To master diagnostics, treatment, and follow-up of inflammatory bowel disease, both
emergency and long-term

Clinical service under supervision in a unit that handles
these conditions

Certificate of successfully completed clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfully completed course, issued bycourse leader

Seminar
Diagnostics and treatment
conference
Theoretical studies

Intermediate objective 5

Teaching methods

Follow-up

To master investigation of abnormal liver tests and, whereapplicable, treatment of theillnesses behind them, to master diagnostics, treatment, andfollow-up of cirrhosis of theliver, and to be able to handle
diagnostics and treatment of
acute liver failure

Clinical service under supervision in a unit that handles
these conditions

Certificate of successfully completed clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfully completed course, issued bycourse leader

Seminar
Diagnostics and treatment
conference
Theoretical studies

Intermediate objective 6

Teaching methods

Follow-up

To master the relevant endoscopic investigation techniques,
evaluation and treatment offindings made, and to masterbasic intervention treatments
and to have an understandingof advanced therapeutic intervention

Clinical service under supervision in a unit that handles
these conditions

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Training in a simulated environment
Theoretical studies

Intermediate objective 7

Teaching methods

Follow-up

To master diagnostics andtreatment of ulcers, gastritis, andgastroesophageal reflux disease

Clinical service under supervision in a unit that handles
these conditions

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Theoretical studies

Intermediate objective 8

Teaching methods

Follow-up

To master diagnostics andtreatment of functional stomach
and intestinal disorders andmotility disorders

Clinical service under supervision in a unit that handles
these conditions

Certificate of successfully completed clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfully completed course, issued bycourse leader

Theoretical studies

Intermediate objective 9

Teaching methods

Follow-up

To master diagnostics andtreatment of disorders in digestion and absorption

Clinical service under supervision in a unit that handles
these conditions

Certificate of successfully completed clinical service andcompetence achieved, issued
by current mentor

Theoretical studies

Intermediate objective 10

Teaching methods

Follow-up

To master diagnostics of tumour illnesses in the stomach
and intestinal canal, liver, andpancreas, and to have knowledge of the various treatment
alternatives for the illness

Clinical service under supervision in a unit that handles
these conditions

Certificate of successfully completed clinical service andcompetence achieved, issued
by current mentor

Diagnostics and treatment
conference
Theoretical studies

Intermediate objective 11

Teaching methods

Follow-up

To master diagnostics andtreatment of nutritional disorders
as a consequence of a gastroenterological or hepatological disease

Clinical service under supervision in a unit that handles
these conditions

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Health care team work under
supervision
Theoretical studies

Intermediate objective 12

Teaching methods

To have an understanding ofother diagnostic methods in gastroenterological and hepatological investigations

Diagnostics and treatment
conference
Theoretical studies

Follow-up

Communicative competenceIntermediate objective 13

Teaching methods

Follow-up

To be capable of dialogue andopen contact with patients andtheir next of kin

Clinical service under supervision in a unit where such operations are practised

Certificate of approved clinicalservice and competenceachieved, issued by current
mentorCourseCertificate of successfully completed course, issued bycourse leaderorseminarSitting-in

Intermediate objective 14

Teaching methods

Follow-up

To be capable of communication, both oral and written, withother doctors and co-workers

Clinical service under supervision in a unit where such operations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Health care teamwork under
supervisionIntermediate objective 15

Teaching methods

Follow-up

To be capable of informing andinstructing patients, next of kin,other doctors, and co-workers,
as well as students

Clinical service under supervision in a unit where such operations are practised

Certificate of successfully completed clinical service andcompetence achieved, issued
by current mentor

Instruction under supervision

Leadership competenceIntermediate objective 16

Teaching methods

Follow-up

To be capable of mentoringother doctors and co-workers,
as well as students

Clinical service under supervision in a unit where such operations are practised

Certificate of successfully completed clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfully completed course, issued bycourse leader

Mentoring under supervision

Intermediate objective 17

Teaching methods

Follow-up

To be capable of leading using
collaboration and dialogue withco-workers as well as within thehealth care team

Clinical service under supervision in a unit where such operations are practised Course
Health care teamwork under
supervision

Certificate of successfully completed clinical service andcompetence achieved, issued
by current mentor

Certificate of successfully completed course, issued bycourse leader

Intermediate objective 18

Teaching methods

Follow-up

To have an understanding of
the organisation, management
and regulatory systems ofhealth and medical care

CourseCertificate of successfullycompleted course, issued bycourse leader

Theoretical studies

Competence within medical science and quality
work
Intermediate objective 19

Teaching methods

Follow-up

To be capable of a medicallyscientific outlook and approach

CourseCertificate of successfully completed course, issued bycourse leader

Written individual work under
supervision according to scientific principles

Certificate of approved written
individual work issued by current mentor

Theoretical studies

Intermediate objective 20

Teaching methods

Follow-up

To have an understanding of,and competence in, evidencebased improvement and quality
work

CourseCertificate of successfullycompleted course, issued bycourse leader

Quality and development work
under supervision

Certificate of quality and development work issued by current
mentor

Theoretical studies

Endocrinology and diabetology

Introduction
Explanation of terms
General definition of competencies
Definition of area of competence
Competence requirements
Competence requirements for medical competence
Competence requirements for communicative competence, leadershipcompetence, and competence within medical science and quality work
Training structure
Special recommendations
Intermediate objectives
Medical competenceCommunicative competence
Leadership competence
Competence within medical science and quality work

Introduction

On June 24, 2008, The National Board of Health and Welfare (Socialstyrelsen) decided to issue new regulations and general guidelines for doctors’
specialist medical training (SOSFS 2008:17). The statute consists of a general part with common provisions for all specialties and a specific part withall the descriptions of objectives. The description of objectives for the respective specialties should be understood against the background of the provisions in the general part.
In each description of objectives, there is a section headed ‘Training
structure’ which constitutes general guidelines. The teaching methods under
the heading ‘Intermediate objectives’ where no follow-up is indicated also
constitute general guidelines.

Explanation of terms

current mentor
a specialist doctor whose specialist competence corresponds to the area ofcompetence indicated by the intermediate objective, and who is responsible
for ST doctors’s professional development during the teaching period or forthe method of teaching indicatedthe assignment as a mentor for an ST doctor generally encompasses the entire period of specialist training but can also encompass part or parts of it
auscultation
during mentoring, and in accordance with a pre-designed programme, tostudy the profession of a specialist doctor or other health care staff by following one or several professionals, as well as carrying out assignments inthe current area
evaluate
to form a sound opinion of a patient or similar person as a basis for further
management
masterbeing fully able to evaluate and handle the medical investigation, diagnostics, treatment, and follow-up of a patient or similar person, and being fully
able to use the techniques relevant to the area
capability
personal capacity to execute or perform a task
h a ve u n d ers tan d i ng
having acquired knowledge and insight into an area through theoretical studies and/or practical exercise of the profession
have knowledge
having acquired some knowledge in an area through theoretical studies
and/or practical exercise of the profession
mentoring under supervision
as an ST doctor, mentor a co-worker while simultaneously being mentored
by a doctor with specialist competencementorcontinuously, and in dialogue form, supporting and guiding, as well as evaluating, a co-worker’s professional development
mentoringsee mentor
handleto actively carry out measures regarding investigation, diagnostics, treatment, and follow-up of a patient or similar person, and have overall responsibility for carrying out these measuresinitially handle
as the primary physician in charge, to actively carry out measures regarding
investigation, diagnostics, treatment, and follow-up of a patient or similar
person, and have overall responsibility for carrying out these measuresinitially evaluate
as the primary physician in charge, to form a sound opinion of a patient orsimilar person as a basis for further management
intraprofessional group reflection
reflection done in a group together with other doctors, chiefly for the purpose of further education and training
clinical service
health and medical care duties that ST doctors perform under their own professional liability and with the support of a mentor
courseteacher-led training with an established plan, given during a defined periodof timesitting-in
training activity involving an ST doctor observing when a specialist doctor
or other health care staff holds a consultationorassessment activity involving a specialist doctor or other health care staff
observing and evaluating ST doctors during a consultation
seminarinstruction in group form with active participation
training in a simulated environment
training carried out in an environment created to emulate reality

large professional assembly
conference, congress, symposium or similar event
health care centre
health care unit in primary carehealth care team work
work where ST doctors, under supervision, participates in and sometimes
leads a group of co-operating health care staff with various competencies
charged with responsibility for care for an individual patient or group ofpatients

General definition of competence

Definition of area of competence
The specialty of endocrinology and diabetology covers the normal functionsof the endocrine system and its medical conditions. The specialty includes
the investigation, diagnostics, treatment, and follow-up of medical conditions in the endocrine system. This means everything from widespread diseases like Diabetes Type 1 and 2, thyroid diseases, obesity, blood lipid disorders, and osteoporosis to more uncommon endocrine disorders. Knowledge of the hormonal mechanisms that are significant for normal fertility,
pregnancy, the development of the body, growth in height, puberty, andmenopause is also involved. The area of competence is distinguished byclose cooperation with surgical operations intended for treatment, as well aswork on a multifocal professional team.
Endocrinology and diabetology is a branch specialty of the internal medicine base specialty.

Competence requirements
Competence requirements for medical competenceSpecialist competence in endocrinology and diabetology requires theknowledge and skills necessary to independently be able to practise the specialty. The competence requirements comprise charting patient histories andanalysis in combination with radiology investigations, chemical analyses ofhormonal level, both in basic situations and dynamically under so-calledloads, as well as handling of patients with hormonal substitution treatment
and treatment with analogous hormones.
Specialist competence further requires knowledge of acute endocrinology,
as well as treatment and follow-up of chronic endocrine illnesses, reactionsof a psychological character in acute and chronic stages, and the prevention
and management of somatic complications. Knowledge of handling endocrine tumour illnesses with concomitant disorders is also required.
Furthermore, competence in differential diagnostic consideration of uncommon medical conditions is required. These illnesses often have a multifaceted symptom picture, which is why diagnostics for ruling out or confirming hormonal disorders is a very important element. The ability to cooperate with surgical operations on a multiprofessional team is required,especially regarding patients with diabetes or thyroid illnesses.
Specialist competence in endocrinology and diabetology further requires
mastering the knowledge and skills base common to all internal medicine
specialties. Being able to handle acute illnesses within internal medicine andthe acute medical conditions related to internal medicine are included in thisgeneral base. Additionally, specialists should be able to handle the mostcommon and frequently occurring illnesses and medical conditions withininternal medicine, as well as the most common and frequently occurring
conditions within all branch specialties and adjacent base specialties. They
should also master invasive and non-invasive measures and methods relevant to the internal medicine area of competence (intermediate objectives 1–
3).

Competence requirements for communicative competence,leadership competence and competence within medical scienceand quality work
Communicative competence
The equal and responsible patient
Doctors with specialist competence must be capable of dialogue and of
maintaining open contact with patients and their next of kin. Contact should
be characterised by empathy and trust, as well as respect for patients’ rightto information, influence, and participation in decisions. Contact should also
be characterised by co-operation and sensitivity to the patients’ needs, desires and right to self-determination, as well as providing incentive for patients’ involvement in, and responsibility for, their own care.
Multicultural and gender aspects
Communication with patients and their next of kin should be characterisedby understanding and respect for cross-cultural and multicultural aspects
such as age, language, ethnicity, sexual orientation and religion, as well as
gender.
Interprofessional relations
Doctors with specialist competence must be capable of communicating,both in writing and orally, with other doctors and co-workers showing respect for their professional knowledge and competences. The same applies
to contact with representatives of the public and various civil authorities.
Pedagogical skills
Doctors with specialist competence must have pedagogical capability inorder to inform and instruct not only patients and their next of kin, but also
other doctors and co-workers, as well as students.
Professional approach and ethics
Doctors with specialist competence must be capable of working continuously with their professional and medical ethical approaches, with the objective of being able to make independent decisions of a medical ethical nature.

Individual professional development
Doctors with specialist competence must be capable of continually examining and identifying their own needs for professional development, in addition to operational requirements, in order to be able to meet requirements forthe best possible patient care.

Leadership competence
Collaboration
Doctors with specialist competence must have a developed capability for
self-knowledge and an understanding of their own functions and roles in theorganisation.
Mentoring skills
Doctors with specialist competence must be capable of mentoring other doctors and co-workers, as well as students.
Leadership
Doctors with specialist competence must be capable of leadership characterised by collaboration, openness, and dialogue with co-workers. Leadershipmust further be characterised by participation and activity development
aimed at improvement. The ability to lead the work of the health care teamis essential.
System knowledge
Doctors with specialist competence must have an understanding of the organisation, administration, financial and regulatory systems of health care,
as well as its governance, in order to make the best use of resources.

Competence within medical science and quality work
Medical science
Doctors with specialist competence must be capable of adopting a medicallyscientific outlook and approach, and must have knowledge of researchmethodology, including basic epidemiological concepts, as well as of methods for evidence-based medicine and review of scientific information.
Improvement and quality work
Doctors with specialist competence must have an understanding of, andcompetence in, evidence-based improvement and quality work. The objective is to be able to participate in and be responsible for continuous systematic improvement work with emphasis on a holistic perspective, patient
safety, patient benefit, measurability, and teaching management in order tobe able to critically review and evaluate their own operations.

Public health and prevention
Doctors with specialist competence must have an understanding of the factors determining health, other aspects of public health, and methods forpromoting health and efforts aimed at preventing injury and illness, in order
to be able to take this understanding into account in medical scientific work.

Training structure
Specialist medical training in endocrinology and diabetology can begin before, during, or after specialist medical training in internal medicine and canbe integrated with it. During the introductory period, service in endocrinology and diabetology should be aimed at providing a good basis for the consultative operations of the branch specialty. ST doctors should take courses
aimed at initial investigation and treatment during this time. Clinical service
should take place in wards and clinics where diabetology and endocrinology
care is practised.
It is desirable that the service take place in cohesive periods. During thefirst part of training, ST doctors should serve in operations that handle widespread diseases within the specialty. Theoretical courses should be plannedin keeping with the clinical service. During the latter part of the specialist
medical training, ST doctors should immerse themselves in uncommon
medical conditions within endocrinology and diabetology. It is suitable for
ST doctors, where applicable, to be given the opportunity to deepen theircompetences in endocrinology and diabetology at a university hospital orsimilar unit.
ST doctors should actively participate in seminars and account for casereports during training. ST doctors should also have the opportunity for independent study of medical journals and literature. Furthermore, ST doctors
should have the opportunity to participate in the ordinary in-job training of
the clinic and should be able to participate in the follow-up of local and national care programmes.

Special recommendations
The specialty associations and sections of the medical organisations haveformulated special recommendations for their own specialties. The recommendations concern such issues as how specialist medical training should be
structured.

Intermediate objectives

Medical competenceIntermediate objective 1

Teaching methods

Follow-up

To be able to handle acuteillnesses within internal medicine and the acute medical
conditions related to internal
medicine

Clinical service under supervision in a unit that handles
these conditions

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Sitting-in
Theoretical studies

Intermediate objective 2

Teaching methods

Follow-up

To be able to initially handle
the most common and frequently occurring illnesses andmedical conditions within internal medicine, as well as themost common and frequently
occurring conditions within the
branch specialties and adjacent base specialties

Clinical service under supervision in a unit that handles
these conditions

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Sitting-in
Theoretical studies

Intermediate objective 3

Teaching methods

Follow-up

To master invasive and noninvasive measures and methods relevant to the internal
medicine area of competence

Clinical service under supervision in a unit where such operations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Training in a simulated environment
Theoretical studies

Intermediate objective 4

Teaching methods

Follow-up

To master handling of common endocrine conditions,
including investigation, diagnostics, therapy, and followup, as well as to be able toevaluate individual patients’
need for referral to anotherspecialty

Clinical service under supervision in a unit that handles
these conditions

Certificate of successfullycompleted clinical service,
issued by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Health care team work under
supervisionIntermediate objective 5

Teaching methods

Follow-up

To master investigation, diagnostics, therapy, and follow-up
of uncommon endocrine medical conditions, as well as to beable to evaluate the individual
need for referral of these patients

Clinical service under supervision in a unit that handles
these conditions

Certificate of successfullycompleted clinical service,
issued by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leaderorseminar
Diagnostics and treatment
conference
Theoretical studies

Intermediate objective 6

Teaching methods

Follow-up

To be able to handle endocrine illnesses with complications

Clinical service under supervision in a unit that handles
these conditions

Certificate of successfullycompleted clinical service,
issued by current mentor

Auscultation under supervision at a unit that handles
these conditions

Certificate of successfullycompleted course, issued bycourse leader

CourseDiagnostics and treatment
conference

Intermediate objective 7

Teaching methods

Follow-up

To be able to handle individual
patient in relation to the laws
and ordinances that regulate
the exercise of authority within
the area of competence

Clinical service under supervision in a unit that handles
these issues

Certificate of successfullycompleted clinical service,
issued by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Theoretical studies

Intermediate objective 8

Teaching methods

Follow-up

To be able to handle endocrine
medical conditions in connection with intensive care andparenteral nutrition, both preand postoperatively

Clinical service under supervision in a unit that handles
these conditions

Certificate of successfullycompleted clinical service,
issued by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Diagnostics and treatment
conference
Theoretical studies

Intermediate objective 9

Teaching methods

Follow-up

To be able to initially handle
the endocrinology of puberty,
the endocrinology of pregnancy, male and female infertility,
and sexual function and transsexualism, as well as being
able to evaluate the needs ofindividual patients for referral
to another specialty

Clinical service under supervision in a unit that handles
these conditions

Certificate of successfullycompleted clinical service,
issued by current mentor

Seminar
Diagnostics and treatment
conference
Theoretical studies

Intermediate objective 10
To master cooperation withother health care providers

Teaching methods
Clinical service under supervision in a unit where such operations are practised
Health care teamwork under
supervision
Theoretical studies

Follow-up
Certificate of successfully completed clinical service, issued bycurrent mentor

Intermediate objective 11
To have knowledge of hereditary, congenital, and genetic
medical conditions

Teaching methods
CourseFollow-up
Certificate of successfully completed course, issued by course
leader

Theoretical studies
Intermediate objective 12
To have knowledge of the impact
of environmental factors on theemergence of endocrine medical
conditions

Teaching methods
Training in a simulated environment
Theoretical studies

Follow-up

Communicative competenceIntermediate objective 13
To be capable of dialogue andopen contact with patients andtheir next of kin

Teaching methods
Clinical service under supervision in a unit where such operations are practised
CourseorseminarSitting-in

Intermediate objective 14
To be capable of communication,
both oral and written, with otherdoctors and co-workers

Teaching methods
Clinical service under supervision in a unit where such operations are practised

Follow-up
Certificate of approved clinicalservice and competenceachieved, issued by current
mentorCertificate of successfully completed course, issued by course
leaderFollow-up
Certificate of successfully completed clinical service and competence achieved, issued bycurrent mentor

Health care teamwork under
supervisionIntermediate objective 15
To be capable of informing andinstructing patients, next of kin,other doctors, and co-workers,
as well as students

Teaching methods
Clinical service under supervision in a unit where such operations are practised

Follow-up
Certificate of successfully completed clinical service and competence achieved, issued bycurrent mentor

Instruction under supervision

Leadership competenceIntermediate objective 16
To be capable of mentoringother doctors and co-workers, aswell as students

Teaching methods
Clinical service under supervision in a unit where such operations are practised
CourseFollow-up
Certificate of successfully completed clinical service and competence achieved, issued bycurrent mentor
Certificate of successfully completed course, issued by course
leaderMentoring under supervisionIntermediate objective 17
To be capable of leading using
collaboration and dialogue withco-workers as well as within thehealth care team

Teaching methods
Clinical service under supervision in a unit where such operations are practised
CourseFollow-up
Certificate of successfully completed clinical service and competence achieved, issued bycurrent mentor
Certificate of successfully completed course, issued by course
leader

Health care teamwork under
supervisionIntermediate objective 18
To have an understanding of theorganisation, management andregulatory systems of health andmedical care

Teaching methods
CourseTheoretical studies

Follow-up
Certificate of successfully completed course, issued by course
leaderCompetence within medical science and quality
work
Intermediate objective 19
To be capable of a medicallyscientific outlook and approach

Teaching methods
CourseWritten individual work under
supervision according to scientific principles
Theoretical studies
Intermediate objective 20
To have an understanding of,and competence in, evidencebased improvement and quality
work

Teaching methods
CourseQuality and development work
under supervision
Theoretical studies

Follow-up
Certificate of successfully completed course, issued by course
leaderCertificate of approved written
individual work issued by current mentor

Follow-up
Certificate of successfully completed course, issued by course
leaderCertificate of quality and development work issued by current
mentorRenal medicine (nephrology)

Introduction
Explanation of terms
General definition of competencies
Definition of area of competence
Competence requirements
Competence requirements for medical competence
Competence requirements for communicative competence, leadershipcompetence, and competence within medical science and quality work
Training structure
Special recommendations
Intermediate objectives
Medical competenceCommunicative competence
Leadership competence
Competence within medical science and quality work

Introduction

On June 24, 2008, The National Board of Health and Welfare (Socialstyrelsen) decided to issue new regulations and general guidelines for doctors’
specialist medical training (SOSFS 2008:17). The statute consists of a general part with common provisions for all specialties and a specific part withall the descriptions of objectives. The description of objectives for the respective specialties should be understood against the background of the provisions in the general part.
In each description of objectives, there is a section headed ‘Training
structure’ which constitutes general guidelines. The teaching methods under
the heading ‘Intermediate objectives’ where no follow-up is indicated also
constitute general guidelines.

Explanation of terms

current mentor
a specialist doctor whose specialist competence corresponds to the area ofcompetence indicated by the intermediate objective, and who is responsible
for ST doctors’s professional development during the teaching period or forthe method of teaching indicatedthe assignment as a mentor for an ST doctor generally encompasses the entire period of specialist training but can also encompass part or parts of it
auscultation
during mentoring, and in accordance with a pre-designed programme, tostudy the profession of a specialist doctor or other health care staff by following one or several professionals, as well as carrying out assignments inthe current area
evaluate
to form a sound opinion of a patient or similar person as a basis for further
management
masterbeing fully able to evaluate and handle the medical investigation, diagnostics, treatment, and follow-up of a patient or similar person, and being fully
able to use the techniques relevant to the area
capability
personal capacity to execute or perform a task
h a ve u n d ers tan d i ng
having acquired knowledge and insight into an area through theoretical studies and/or practical exercise of the profession
have knowledge
having acquired some knowledge in an area through theoretical studies
and/or practical exercise of the profession
mentoring under supervision
as an ST doctor, mentor a co-worker while simultaneously being mentored
by a doctor with specialist competencementorcontinuously, and in dialogue form, supporting and guiding, as well as evaluating, a co-worker’s professional development
mentoringsee mentor
handleto actively carry out measures regarding investigation, diagnostics, treatment, and follow-up of a patient or similar person, and have overall responsibility for carrying out these measuresinitially handle
as the primary physician in charge, to actively carry out measures regarding
investigation, diagnostics, treatment, and follow-up of a patient or similar
person, and have overall responsibility for carrying out these measuresinitially evaluate
as the primary physician in charge, to form a sound opinion of a patient orsimilar person as a basis for further management
intraprofessional group reflection
reflection done in a group together with other doctors, chiefly for the purpose of further education and training
clinical service
health and medical care duties that ST doctors perform under their own professional liability and with the support of a mentor
courseteacher-led training with an established plan, given during a defined periodof timesitting-in
training activity involving an ST doctor observing when a specialist doctor
or other health care staff holds a consultationorassessment activity involving a specialist doctor or other health care staff
observing and evaluating ST doctors during a consultation
seminarinstruction in group form with active participation
training in a simulated environment
training carried out in an environment created to emulate reality

large professional assembly
conference, congress, symposium or similar event
health care centre
health care unit in primary carehealth care team work
work where ST doctors, under supervision, participates in and sometimes
leads a group of co-operating health care staff with various competencies
charged with responsibility for care for an individual patient or group ofpatients

General definition of competence

Definition of area of competence
Renal medicine, or nephrology, is a specialty that comprises the investigation, diagnostics, treatment, and follow-up of patients with acute andchronic renal illnesses, hypertension, electrolyte disorders, and other complications from these.
An important part of the operation is long-term follow-up and treatmentof patients with chronic renal illnesses of different types, and with varying
degrees of renal impairment. The responsibility for dialysis treatment, as
well as follow-up and supervision of dialysis patients, is a fundamental partof the specialty, as are investigation prior to kidney transplants and followup of kidney transplant patients.
The specialty also comprises taking care of patients with acute renal failure, and acute inflammatory kidney diseases that require immunomodulatory treatment, acute dialysis, or other extracorporeal treatment.
The composite clinical profile of a kidney patient, often with other complicating diseases, implies a need for close cooperation with many otheroperations such as internal medicine, cardiology, endocrinology, clinicalpathology, clinical chemistry, vascular surgery, urology, and transplant surgery.
Renal medicine is a branch specialty of the internal medicine base specialty.

Competence requirements
Competence requirements for medical competenceSpecialist competence in renal medicine requires the knowledge and skills
necessary to independently be able to practise broad competence in renal
medicine. The medical competence involves etiology, pathology, and diagnostics, as well as treatment and follow-up of patients with primary medical
renal illness and with renal illness that is secondary to system illnesses, bothacute and chronic; hypertension, and electrolyte and acid-base disorders, aswell as other complications from these conditions.
Being responsible for various forms of dialysis treatment in chronic renal
failure is required, as is being responsible for treatment of patients withacute renal failure, acute inflammatory kidney diseases including immunomodulatory treatment, emergency dialysis or other extracorporeal treatment,
as well as both investigation prior to kidney transplant and follow-up of
kidney transplant patients.

Furthermore, specialist competence in renal medicine requires mastering theknowledge and skills base common to all internal medicine specialties. Being able to handle acute illnesses within internal medicine and the acutemedical conditions related to internal medicine are included in this generalbase. Additionally, specialists should be able to handle the most commonand frequently occurring illnesses and medical conditions within internal
medicine, as well as the most common and frequently occurring conditions
within all branch specialties and adjacent base specialties. They should also
master invasive and non-invasive measures and methods relevant to the internal medicine area of competence (intermediate objectives 1–3).

Competence requirements for communicative competence,leadership competence and competence within medical scienceand quality work
Communicative competence
The equal and responsible patient
Doctors with specialist competence must be capable of dialogue and of
maintaining open contact with patients and their next of kin. Contact should
be characterised by empathy and trust, as well as respect for patients’ rightto information, influence, and participation in decisions. Contact should also
be characterised by co-operation and sensitivity to the patients’ needs, desires and right to self-determination, as well as providing incentive for patients’ involvement in, and responsibility for, their own care.
Multicultural and gender aspects
Communication with patients and their next of kin should be characterisedby understanding and respect for cross-cultural and multicultural aspects
such as age, language, ethnicity, sexual orientation and religion, as well as
gender.
Interprofessional relations
Doctors with specialist competence must be capable of communicating,both in writing and orally, with other doctors and co-workers showing respect for their professional knowledge and competences. The same applies
to contact with representatives of the public and various civil authorities.
Pedagogical skills
Doctors with specialist competence must have pedagogical capability inorder to inform and instruct not only patients and their next of kin, but also
other doctors and co-workers, as well as students.

Professional approach and ethics
Doctors with specialist competence must be capable of working continuously with their professional and medical ethical approaches, with the objective of being able to make independent decisions of a medical ethical nature.
Individual professional development
Doctors with specialist competence must be capable of continually examining and identifying their own needs for professional development, in addition to operational requirements, in order to be able to meet requirements forthe best possible patient care.

Leadership competence
Collaboration
Doctors with specialist competence must have a developed capability for
self-knowledge and an understanding of their own functions and roles in theorganisation.
Mentoring skills
Doctors with specialist competence must be capable of mentoring other doctors and co-workers, as well as students.
Leadership
Doctors with specialist competence must be capable of leadership characterised by collaboration, openness, and dialogue with co-workers. Leadershipmust further be characterised by participation and activity development
aimed at improvement. The ability to lead the work of the health care teamis essential.
System knowledge
Doctors with specialist competence must have an understanding of the organisation, administration, financial and regulatory systems of health care,
as well as its governance, in order to make the best use of resources.

Competence within medical science and quality work
Medical science
Doctors with specialist competence must be capable of adopting a medicallyscientific outlook and approach, and must have knowledge of researchmethodology, including basic epidemiological concepts, as well as of methods for evidence-based medicine and review of scientific information.
Improvement and quality work
Doctors with specialist competence must have an understanding of, andcompetence in, evidence-based improvement and quality work. The objective is to be able to initiate, participate in, and be responsible for continuoussystematic improvement work with emphasis on a holistic perspective, patient safety, patient benefit, measurability, and teaching management in order to be able to review and evaluate their own operations.
Public health and prevention
Doctors with specialist competence must have an understanding of the factors determining health, other aspects of public health, and methods forpromoting health and efforts aimed at preventing injury and illness, in order
to be able to take this understanding into account in medical scientific work.

Training structure
Specialist medical training in renal medicine can begin before, during, orafter specialist medical training in internal medicine and can be integrated
with it.
The training structure will often differ between large and small renal
medicine units, depending on the different structures of the operations.
Clinical service should involve placement in units where the relevant renal medicine care is practised, including follow-up of kidney transplant patients. It should also involve service in both a haemodialysis unit and a peritoneal dialysis clinic. Additionally, it is of great importance that ST doctors,
early on in their training, should be allowed to handle renal medicine patients that reflect a broad renal medicine illness panorama. It is also important that ST doctors are given the opportunity to continuously follow up on
renal medicine patients. ST doctors should begin their training in various
types of dialysis treatment and follow-up of dialysis patients early on.
Simultaneous additional training is individualised based on ST doctors’
prior experiences and should involve service within transplant surgery.
Other suitable areas of service are infectious medicine and rheumatology.
In specialist training at smaller hospitals, part of the specialist medical
training should be located at a regional or university hospital, and preferably
at the end of specialist medical training.
Throughout the entire specialist medical training, it is suitable for ST doctors to participate in theoretical training in the form of courses and othereducation. ST doctors should also be given the opportunity for independent
study and to follow the relevant literature within the renal medicine area ofcompetence.

Special recommendations
The specialty associations and sections of the medical organisations haveformulated special recommendations for their own specialties. The recommendations concern such issues as how specialist medical training should be
structured.

Intermediate objectives

Medical competenceIntermediate objective 1
To be able to handle acuteillnesses within internal medicine
and the acute medical conditions
related to internal medicine

Teaching methods
Clinical service under supervision in a unit that handles these
conditions
CourseFollow-up
Certificate of successfully completed clinical service and competence achieved, issued bycurrent mentor
Certificate of successfully completed course, issued by course
leaderSitting-in
Theoretical studies
Intermediate objective 2
To be able to initially handle themost common and frequently
occurring illnesses and medical
conditions within internal medicine, as well as the most common and frequently occurring
conditions within the branch
specialties and adjacent basespecialties

Teaching methods
Clinical service under supervision in a unit that handles these
conditions

Intermediate objective 3
To master invasive and noninvasive measures and methods
relevant to the internal medicine
area of competence

Teaching methods
Clinical service under supervision in a unit where such operations are practised

CourseFollow-up
Certificate of successfully completed clinical service and competence achieved, issued bycurrent mentor
Certificate of successfully completed course, issued by course
leaderSitting-in
Theoretical studies
Follow-up
Certificate of successfully completed clinical service and competence achieved, issued bycurrent mentor

Training in a simulated environment
Theoretical studies
Intermediate objective 4
To master investigation, diagnostics, treatment, and follow-up
of primary renal illnesses, andsystem illnesses with renal
involvement

Teaching methods
Clinical service under supervision in a unit that handles these
conditions
CourseFollow-up
Certificate of successfully completed clinical service and competence achieved, issued bycurrent mentor
Certificate of successfully completed course, issued by course
leader

Theoretical studies
Intermediate objective 5
To master investigation, diagnostics, treatment, and follow-up
of acute renal failure

Teaching methods
Clinical service under supervision in a unit that handles these
conditions
CourseTheoretical studies

Follow-up
Certificate of successfully completed clinical service and competence achieved, issued bycurrent mentor
Certificate of successfully completed course, issued by course
leaderIntermediate objective 6
To master investigation, diagnostics, treatment, and follow-up
of chronic renal failure

Teaching methods
Clinical service under supervision in a unit that handles these
conditions
CourseFollow-up
Certificate of successfully completed clinical service and competence achieved, issued bycurrent mentor
Certificate of successfully completed course, issued by course
leader

Theoretical studies
Intermediate objective 7
To master peritoneal dialysis
treatment

Teaching methods
Clinical service under supervision in a unit where such operations are practised
CourseFollow-up
Certificate of successfully completed clinical service and competence achieved, issued bycurrent mentor
Certificate of successfully completed course, issued by course
leader

Theoretical studies
Intermediate objective 8
To master haemodialysis treatment

Teaching methods
Clinical service under supervision in a unit where such operations are practised
CourseFollow-up
Certificate of successfully completed clinical service and competence achieved, issued bycurrent mentor
Certificate of successfully completed course, issued by course
leader

Theoretical studies
Intermediate objective 9
To be able to handle investigations prior to kidney transplants
and the medical follow-up ofthese patients

Teaching methods
Clinical service under supervision in a unit that handles these
conditions
CourseFollow-up
Certificate of successfully completed clinical service and competence achieved, issued bycurrent mentor
Certificate of successfully completed course, issued by course
leader

Theoretical studies
Intermediate objective 10
To master investigation, diagnostics, treatment, and follow-up
of patients with hypertension

Teaching methods
Clinical service under supervision in a unit that handles thiscondition

Follow-up
Certificate of successfully completed clinical service and competence achieved, issued bycurrent mentor

Theoretical studies
Intermediate objective 11
To have knowledge of normal
kidney physiology and electrolyte and acid-base balance, andto be able to handle patientswith disorders in these functions,as well as to master investigation, diagnostics, treatment, andfollow-up of patients with earlysigns of renal illness

Teaching methods
Clinical service under supervision in a unit that handles these
conditions

Intermediate objective 12
To be able to handle ethicalquestions in connection withkidney transplants, as with lifesupport treatment and termination thereof

Teaching methods
Clinical service under supervision in a unit that handles these
conditions

Follow-up
Certificate of successfully completed clinical service and competence achieved, issued bycurrent mentor

Theoretical studies

Theoretical studies

Follow-up
Certificate of successfully completed clinical service and competence achieved, issued bycurrent mentor

Communicative competenceIntermediate objective 13
To be capable of maintaining
dialogue and open contact withpatients and their next of kin

Teaching methods
Clinical service under supervision in a unit where such operations are practised
CourseorseminarSitting-in

Intermediate objective 14
To be capable of communication,
both oral and written, with otherdoctors and co-workers

Teaching methods
Clinical service under supervision in a unit where such operations are practised

Follow-up
Certificate of approved clinicalservice and competenceachieved, issued by current
mentorCertificate of successfully completed course, issued by course
leaderFollow-up
Certificate of successfully completed clinical service and competence achieved, issued bycurrent mentor

Health care teamwork under
supervisionIntermediate objective 15
To be capable of informing andinstructing patients, next of kin,other doctors, and co-workers,
as well as students

Teaching methods
Clinical service under supervision in a unit where such operations are practised

Follow-up
Certificate of successfully completed clinical service and competence achieved, issued bycurrent mentor

Instruction under supervision

Leadership competenceIntermediate objective 16
To be capable of mentoringother doctors and co-workers, aswell as students

Teaching methods
Clinical service under supervision in a unit where such operations are practised
CourseFollow-up
Certificate of successfully completed clinical service and competence achieved, issued bycurrent mentor
Certificate of successfully completed course, issued by course
leaderMentoring under supervisionIntermediate objective 17
To be capable of leading using
collaboration and dialogue withco-workers as well as within thehealth care team

Teaching methods
Clinical service under supervision in a unit where such operations are practised
CourseFollow-up
Certificate of successfully completed clinical service and competence achieved, issued bycurrent mentor
Certificate of successfully completed course, issued by course
leader

Health care teamwork under
supervisionIntermediate objective 18
To have an understanding of theorganisation, management andregulatory systems of health andmedical care

Teaching methods
CourseTheoretical studies

Follow-up
Certificate of successfully completed course, issued by course
leaderCompetence within medical science and quality
work
Intermediate objective 19
To be capable of a medicallyscientific outlook and approach

Teaching methods
CourseWritten individual work under
supervision according to scientific principles
Theoretical studies
Intermediate objective 20
To have an understanding of,and competence in, evidencebased improvement and quality
work

Teaching methods
CourseQuality and development work
under supervision
Theoretical studies

Follow-up
Certificate of successfully completed course, issued by course
leaderCertificate of approved written
individual work issued by current mentor

Follow-up
Certificate of successfully completed course, issued by course
leaderCertificate of quality and development work issued by current
mentorRespiratory medicine

Introduction
Explanation of terms
General definition of competencies
Definition of area of competence
Competence requirements
Competence requirements for medical competence
Competence requirements for communicative competence, leadershipcompetence, and competence within medical science and quality work
Training structure
Special recommendations
Intermediate objectives
Medical competenceCommunicative competence
Leadership competence
Competence within medical science and quality work

Introduction

On June 24, 2008, The National Board of Health and Welfare (Socialstyrelsen) decided to issue new regulations and general guidelines for doctors’
specialist medical training (SOSFS 2008:17). The statute consists of a general part with common provisions for all specialties and a specific part withall the descriptions of objectives. The description of objectives for the respective specialties should be understood against the background of the provisions in the general part.
In each description of objectives, there is a section headed ‘Training
structure’ which constitutes general guidelines. The teaching methods under
the heading ‘Intermediate objectives’ where no follow-up is indicated also
constitute general guidelines.

Explanation of terms

current mentor
a specialist doctor whose specialist competence corresponds to the area ofcompetence indicated by the intermediate objective, and who is responsible
for ST doctors’s professional development during the teaching period or forthe method of teaching indicatedthe assignment as a mentor for an ST doctor generally encompasses the entire period of specialist training but can also encompass part or parts of it
auscultation
during mentoring, and in accordance with a pre-designed programme, tostudy the profession of a specialist doctor or other health care staff by following one or several professionals, as well as carrying out assignments inthe current area
evaluate
to form a sound opinion of a patient or similar person as a basis for further
management
masterbeing fully able to evaluate and handle the medical investigation, diagnostics, treatment, and follow-up of a patient or similar person, and being fully
able to use the techniques relevant to the area
capability
personal capacity to execute or perform a task
h ave u n d ers tan d i ng
having acquired knowledge and insight into an area through theoretical studies and/or practical exercise of the profession
have knowledge
having acquired some knowledge in an area through theoretical studies
and/or practical exercise of the profession
mentoring under supervision
as an ST doctor, mentor a co-worker while simultaneously being mentored
by a doctor with specialist competencementorcontinuously, and in dialogue form, supporting and guiding, as well as evaluating, a co-worker’s professional development
mentoringsee mentor
handleto actively carry out measures regarding investigation, diagnostics, treatment, and follow-up of a patient or similar person, and have overall responsibility for carrying out these measuresinitially handle
as the primary physician in charge, to actively carry out measures regarding
investigation, diagnostics, treatment, and follow-up of a patient or similar
person, and have overall responsibility for carrying out these measuresinitially evaluate
as the primary physician in charge, to form a sound opinion of a patient orsimilar person as a basis for further management
intraprofessional group reflection
reflection done in a group together with other doctors, chiefly for the purpose of further education and training
clinical service
health and medical care duties that ST doctors perform under their own professional liability and with the support of a mentor
courseteacher-led training with an established plan, given during a defined periodof timesitting-in
training activity involving an ST doctor observing when a specialist doctor
or other health care staff holds a consultationorassessment activity involving a specialist doctor or other health care staff
observing and evaluating ST doctors during a consultation
seminarinstruction in group form with active participation
training in a simulated environment
training carried out in an environment created to emulate reality

large professional assembly
conference, congress, symposium or similar event
health care centre
health care unit in primary carehealth care team work
work where ST doctors, under supervision, participates in and sometimes
leads a group of co-operating health care staff with various competencies
charged with responsibility for care for an individual patient or group ofpatients

General definition of competence

Definition of area of competence
The specialty of respiratory medicine is a branch specialty of the internal
medicine base specialty and comprises illnesses of the respiratory organs,which include illnesses involving the lower respiratory tract and the lungs,
the blood vessels of the lungs, the pleura, the mediastinum, the chest wall,and the diaphragm, as well as respiration and its regulation. Diagnostics are
based on an analysis of case history, physical examination, and clinicalchemical and microbiological analyses, as well as invasive and non-invasive
examination methods. Knowledge of the etiology and pathology of lungdiseases, endoscopic examination techniques, and radiology, as well as thephysiology of respiration and circulation, are required for this. Potential
treatment methods include pharmacological, as well as invasive and noninvasive, methods. The area of competence covers both acute and chronic
medical conditions, and also aspects of public health as well as prevention.

Competence requirements
Competence requirements for medical competenceSpecialist competence in respiratory medicine requires the knowledge andskills necessary to independently be able to practise competence in respiratory medicine. It requires knowledge of the etiology and pathology of lungdisease, as well as competence in diagnostics, treatment, and follow-up ofchronic obstructive lung disease (COLD), asthma, and other illnesses of thelower respiratory tract, respiratory allergy, acute and chronic respiratory
failure, illnesses concerning respiration and its regulation, tumour illnesses
in the thorax and tumour-related complications, illnesses in the chest walland diaphragm, illnesses in the mediastinum, pleural illnesses, interstitiallung diseases, lung and respiratory tract-related infectious diseases, illnesses
in the pulmonary blood vessels, hereditary and deformity-related lung diseases, and palliative medicine, as well as occupational and environmentallung diseases. Mastering endoscopic examination techniques and invasive
measures and methods is required, as well as having knowledge of the radiology necessary for the area of competence. Additionally, knowledge of theinteraction of lung diseases with other organ systems and pleuropulmonary
manifestations of other organ diseases is required, as well as knowledge ofpreventing tobacco use and quitting smoking.
Specialist competence in respiratory medicine further requires mastering
the knowledge and skills base common to all internal medicine specialties.
Being able to handle acute illnesses within internal medicine and the acutemedical conditions related to internal medicine are included in this generalbase. Additionally, specialists should be able to handle the most common

and frequently occurring illnesses and medical conditions within internal
medicine, as well as the most common and frequently occurring conditions
within all branch specialties and adjacent base specialties. They should also
master invasive and non-invasive measures and methods relevant to the internal medicine area of competence (intermediate objectives 1–3).

Competence requirements for communicative competence,leadership competence and competence within medical scienceand quality work
Communicative competence
The equal and responsible patient
Doctors with specialist competence must be capable of dialogue and of
maintaining open contact with patients and their next of kin. Contact should
be characterised by empathy and trust, as well as respect for patients’ rightto information, influence, and participation in decisions. Contact should also
be characterised by co-operation and sensitivity to the patients’ needs, desires and right to self-determination, as well as providing incentive for patients’ involvement in, and responsibility for, their own care.
Multicultural and gender aspects
Communication with patients and their next of kin should be characterisedby understanding and respect for cross-cultural and multicultural aspects
such as age, language, ethnicity, sexual orientation and religion, as well as
gender.
Interprofessional relations
Doctors with specialist competence must be capable of communicating,both in writing and orally, with other doctors and co-workers showing respect for their professional knowledge and competences. The same applies
to contact with representatives of the public and various civil authorities.
Pedagogical skills
Doctors with specialist competence must have pedagogical capability inorder to inform and instruct not only patients and their next of kin, but also
other doctors and co-workers, as well as students.
Professional approach and ethics
Doctors with specialist competence must be capable of working continuously with their professional and medical ethical approaches, with the objective of being able to make independent decisions of a medical ethical nature.
Individual professional development
Doctors with specialist competence must be capable of continually examining and identifying their own needs for professional development, in addi-

tion to operational requirements, in order to be able to meet requirements forthe best possible patient care.

Leadership competence
Collaboration
Doctors with specialist competence must have a developed capability for
self-knowledge and an understanding of their own functions and roles in theorganisation.
Mentoring skills
Doctors with specialist competence must be capable of mentoring other doctors and co-workers, as well as students.
Leadership
Doctors with specialist competence must be capable of leadership characterised by collaboration, openness, and dialogue with co-workers. Leadershipmust further be characterised by participation and activity development
aimed at improvement. The ability to lead the work of the health care teamis essential.
System knowledge
Doctors with specialist competence must have an understanding of the organisation, administration, financial and regulatory systems of health care,
as well as its governance, in order to make the best use of resources.

Competence within medical science and quality work
Medical science
Doctors with specialist competence must be capable of adopting a medicallyscientific outlook and approach, and must have knowledge of researchmethodology, including basic epidemiological concepts, as well as of methods for evidence-based medicine and review of scientific information.
Improvement and quality work
Doctors with specialist competence must have an understanding of, andcompetence in, evidence-based improvement and quality work. The objective is to be able to initiate, participate in, and be responsible for continuous
systematic improvement work with emphasis on a holistic perspective, patient safety, patient benefit, measurability, and teaching management in order to be able to review and evaluate their own operations.
Public health and prevention
Doctors with specialist competence must have an understanding of the factors determining health, other aspects of public health, and methods forpromoting health and efforts aimed at preventing injury and illness, in order
to be able to take this understanding into account in medical scientific work.

Training structure
Specialist medical training in respiratory medicine can begin before, during,or after specialist medical training in internal medicine and can be integrated
with it.
The main part of the clinical service should take place in wards and clinics where care in respiratory medicine is practised. Early on in their training
and under supervision, ST doctors should be allowed to handle patients reflecting a broad illness panorama within respiratory medicine. Equally earlyon, ST doctors should begin their training in endoscopic
examination techniques and invasive measures and methods, in order to beable to practise these elements independently at the end of their specialist
medical training. Simultaneous additional training should be individualised
based on ST doctors’ prior experiences and should involve service withinradiology, allergology, and intensive care. Other suitable areas of service areoncology, infectious medicine, thoracic surgery, and rheumatology. Part of
the training should be located at a university hospital, and preferably at theend of specialist medical training. Relevant courses should be integrated
throughout the entire specialist medical training.

Special recommendations
The specialty associations and sections of the medical organisations haveformulated special recommendations for their own specialties. The recommendations concern such issues as how specialist medical training should be
structured.

Intermediate objectives

Medical competenceIntermediate objective 1
To be able to handle acuteillnesses within internal medicine
and the acute medical conditions
related to internal medicine

Teaching methods
Clinical service under supervision in a unit that handles these
conditions
CourseFollow-up
Certificate of successfully completed clinical service and competence achieved, issued bycurrent mentor
Certificate of successfully completed course, issued by course
leaderSitting-in
Theoretical studies
Intermediate objective 2
To be able to initially handle themost common and frequently
occurring illnesses and medical
conditions within internal medicine, as well as the most common and frequently occurring
conditions within the branch
specialties and adjacent basespecialties

Teaching methods
Clinical service under supervision in a unit that handles these
conditions

Intermediate objective 3
To master invasive and noninvasive measures and methods
relevant to the internal medicine
area of competence

Teaching methods
Clinical service under supervision in a unit where such operations are practised

CourseFollow-up
Certificate of successfully completed clinical service and competence achieved, issued bycurrent mentor
Certificate of successfully completed course, issued by course
leaderSitting-in
Theoretical studies

Follow-up
Certificate of successfully completed clinical service and competence achieved, issued bycurrent mentor

Training in a simulated environment
Theoretical studies
Intermediate objective 4
To master COLD and asthma,
as well as to be able to handle
other illnesses in the lower
respiratory tract as well as respiratory tract allergies

Teaching methods
Clinical service under supervision in a unit that handles these
conditions
CourseFollow-up
Certificate of successfully completed clinical service and competence achieved, issued bycurrent mentor
Certificate of successfully completed course, issued by course
leader

Theoretical studies
Intermediate objective 5
To master acute and chronic
respiratory failure and hypoventilation, as well as to be able tohandle obstructive sleep apnoea
syndrome

Teaching methods
Clinical service under supervision in a unit that handles these
conditions
CourseTheoretical studies

Follow-up
Certificate of successfully completed clinical service and competence achieved, issued bycurrent mentor
Certificate of successfully completed course, issued by course
leaderIntermediate objective 6
To be able to handle tumour
illnesses in the lungs and lungtumour-related medical conditions, as well as to be able tohandle tumour illnesses in the
mediastinum, the chest wall, andthe pleura

Teaching methods
Clinical service under supervision in a unit that handles these
conditions
CourseFollow-up
Certificate of successfully completed clinical service and competence achieved, issued bycurrent mentor
Certificate of successfully completed course, issued by course
leader

Theoretical studies
Intermediate objective 7
To master spontaneous pneumothorax, as well as to be able
to handle other illnesses in thepleura, the chest wall, the diaphragm, and the mediastinum

Teaching methods
Clinical service under supervision in a unit that handles these
conditions

Intermediate objective 8
To be able to handle interstitiallung diseases

Teaching methods
Clinical service under supervision in a unit that handles these
conditions
CourseFollow-up
Certificate of successfully completed clinical service and competence achieved, issued bycurrent mentor

Theoretical studies
Follow-up
Certificate of successfully completed clinical service, issued bycurrent mentor
Certificate of successfully completed course, issued by course
leader

Theoretical studies
Intermediate objective 9
To master infection-related lungand respiratory tract illnesses
under normal immune defence,and to be able to handle these
medical conditions under impaired immune defence, as wellas to be able to handle hereditary and deformity-related lungdiseases and tuberculosis

Teaching methods
Clinical service under supervision in a unit that handles these
conditions

Intermediate objective 10
To be able to handle illnesses
involving the pulmonary bloodvessels, as well as to have an
understanding of the interactionof lung diseases with other organsystems and of pleuropulmonary
manifestations of other organ
illnesses

Teaching methods
Clinical service under supervision in a unit that handles these
conditions

Intermediate objective 11
To be able to handle occupational and environmental lungdiseases in the lower respiratory
tract, as well as to have knowledge of the laws and ordinancesthat relate to occupational lungdiseases

Teaching methods
Clinical service under supervision in a unit that handles these
conditions

Intermediate objective 12
To master endoscopic examination techniques and invasive
measures and methods, as wellas to have an understanding ofradiology diagnostics methods
that are relevant to the respiratory medicine area of competence

Teaching methods
Clinical service under supervision in a unit where such operations are practised

CourseFollow-up
Certificate of successfully completed clinical service and competence achieved, issued bycurrent mentor
Certificate of successfully completed course, issued by course
leader

Theoretical studies
Follow-up
Certificate of successfully completed clinical service andcompetence achieved, issued
by current mentor

Theoretical studies

Follow-up
Certificate of successfully completed clinical service and competence achieved, issued bycurrent mentor

Theoretical studies

Theoretical studies

Follow-up
Certificate of successfully completed clinical service and competence achieved, issued bycurrent mentor

Communicative competenceIntermediate objective 13
To be capable of dialogue andopen contact with patients andtheir next of kin

Teaching methods
Clinical service under supervision in a unit where such operations are practised
CourseorseminarSitting-in

Intermediate objective 14
To be capable of communication,
both oral and written, with otherdoctors and co-workers

Teaching methods
Clinical service under supervision in a unit where such operations are practised

Follow-up
Certificate of approved clinicalservice and competenceachieved, issued by current
mentorCertificate of successfully completed course, issued by course
leaderFollow-up
Certificate of successfully completed clinical service and competence achieved, issued bycurrent mentor

Health care teamwork under
supervisionIntermediate objective 15
To be capable of informing andinstructing patients, next of kin,other doctors, and co-workers,
as well as students

Teaching methods
Clinical service under supervision in a unit where such operations are practised

Follow-up
Certificate of successfully completed clinical service and competence achieved, issued bycurrent mentor

Instruction under supervision

Leadership competenceIntermediate objective 16
To be capable of mentoringother doctors and co-workers, aswell as students

Teaching methods
Clinical service under supervision in a unit where such operations are practised
CourseFollow-up
Certificate of successfully completed clinical service and competence achieved, issued bycurrent mentor
Certificate of successfully completed course, issued by course
leaderMentoring under supervisionIntermediate objective 17
To be capable of leading using
collaboration and dialogue withco-workers as well as within thehealth care team

Teaching methods
Clinical service under supervision in a unit where such operations are practised
CourseHealth care teamwork under
supervision

Follow-up
Certificate of successfully completed clinical service and competence achieved, issued bycurrent mentor
Certificate of successfully completed course, issued by course
leaderIntermediate objective 18
To have an understanding of theorganisation, management andregulatory systems of health andmedical care

Teaching methods
CourseFollow-up
Certificate of successfully completed course, issued by course
leader

Theoretical studies

Competence within medical science and quality
work
Intermediate objective 19
To be capable of a medicallyscientific outlook and approach

Teaching methods
CourseWritten individual work under
supervision according to scientific principles
Theoretical studies
Intermediate objective 20
To have an understanding of,and competence in, evidencebased improvement and quality
work

Teaching methods
CourseQuality and development work
under supervision
Theoretical studies

Follow-up
Certificate of successfully completed course, issued by course
leaderCertificate of approved written
individual work issued by current mentor

Follow-up
Certificate of successfully completed course, issued by course
leaderCertificate of quality and development work, issued by current
mentorHaematology

Introduction
Explanation of terms
General definition of competencies
Definition of area of competence
Competence requirements
Competence requirements for medical competence
Competence requirements for communicative competence, leadershipcompetence, and competence within medical science and quality work
Training structure
Special recommendations
Intermediate objectives
Medical competenceCommunicative competence
Leadership competence
Competence within medical science and quality work

Introduction

On June 24, 2008, The National Board of Health and Welfare (Socialstyrelsen) decided to issue new regulations and general guidelines for doctors’
specialist medical training (SOSFS 2008:17). The statute consists of a general part with common provisions for all specialties and a specific part withall the descriptions of objectives. The description of objectives for the respective specialties should be understood against the background of the provisions in the general part.
In each description of objectives, there is a section headed ‘Training
structure’ which constitutes general guidelines. The teaching methods under
the heading ‘Intermediate objectives’ where no follow-up is indicated also
constitute general guidelines.

Explanation of terms

current mentor
a specialist doctor whose specialist competence corresponds to the area ofcompetence indicated by the intermediate objective, and who is responsible
for ST doctors’s professional development during the teaching period or forthe method of teaching indicatedthe assignment as a mentor for an ST doctor generally encompasses the entire period of specialist training but can also encompass part or parts of it
auscultation
during mentoring, and in accordance with a pre-designed programme, tostudy the profession of a specialist doctor or other health care staff by following one or several professionals, as well as carrying out assignments inthe current area
evaluate
to form a sound opinion of a patient or similar person as a basis for further
management
masterbeing fully able to evaluate and handle the medical investigation, diagnostics, treatment, and follow-up of a patient or similar person, and being fully
able to use the techniques relevant to the area
capability
personal capacity to execute or perform a task
h a ve u n d ers tan d i ng
having acquired knowledge and insight into an area through theoretical studies and/or practical exercise of the profession
have knowledge
having acquired some knowledge in an area through theoretical studies
and/or practical exercise of the profession
mentoring under supervision
as an ST doctor, mentor a co-worker while simultaneously being mentored
by a doctor with specialist competencementorcontinuously, and in dialogue form, supporting and guiding, as well as evaluating, a co-worker’s professional development
mentoringsee mentor
handleto actively carry out measures regarding investigation, diagnostics, treatment, and follow-up of a patient or similar person, and have overall responsibility for carrying out these measuresinitially handle
as the primary physician in charge, to actively carry out measures regarding
investigation, diagnostics, treatment, and follow-up of a patient or similar
person, and have overall responsibility for carrying out these measuresinitially evaluate
as the primary physician in charge, to form a sound opinion of a patient orsimilar person as a basis for further management
intraprofessional group reflection
reflection done in a group together with other doctors, chiefly for the purpose of further education and training
clinical service
health and medical care duties that ST doctors perform under their own professional liability and with the support of a mentor
courseteacher-led training with an established plan, given during a defined periodof timesitting-in
training activity involving an ST doctor observing when a specialist doctor
or other health care staff holds a consultationorassessment activity involving a specialist doctor or other health care staff
observing and evaluating ST doctors during a consultation
seminarinstruction in group form with active participation
training in a simulated environment
training carried out in an environment created to emulate reality

large professional assembly
conference, congress, symposium or similar event
health care centre
health care unit in primary carehealth care team work
work where ST doctors, under supervision, participates in and sometimes
leads a group of co-operating health care staff with various competencies
charged with responsibility for care for an individual patient or group ofpatients

General definition of competence

Definition of area of competence
The specialty of haematology covers knowledge and skills in investigation,
diagnostics, treatment, prevention, and follow-up of conditions of the bloodand the haematopoietic, lymphatic, and haemostatic systems. Diagnostics
are to a great extent based on analyses of case histories and physical examinations, supported by such things as radiology and histopathological andclinical chemical examination results. Patient groups cover all ages, fromlate teens to the very oldest, and the area reaches from treatment with curative intent, through treatment and follow-up of long-standing, sometimes
lifelong, incurable medical conditions, both malignant and benign, to palliation and nursing care in the final stages of life.
Haematology is a branch specialty of the internal medicine base specialty.

Competence requirements
Competence requirements for medical competenceSpecialist competence in haematology requires deepened knowledge andskills in investigation, diagnostics, treatment, prevention, and follow-up of
conditions of the blood and the haematopoietic, lymphatic, and haemostatic
systems. This includes mastering methods of diagnostics and treatment, including antitumour agents and radiation therapy. Mastering investigation,
diagnostics, therapy, and follow-up of both non-malignant and malignant
haematology, including subsidiary treatment, acute complications, pain relief, and end-of-life care. Specialist competence also requires mastering thebasic haemostatic disorders.
Specialist competence in haematology further requires mastering theknowledge and skills base common to all internal medicine specialties. Being able to handle acute illnesses within internal medicine and the acutemedical conditions related to internal medicine are included in this generalbase. Additionally, specialists should be able to initially handle the mostcommon and frequently occurring illnesses and medical conditions withininternal medicine, as well as the most common and frequently occurring
conditions within all branch specialties and adjacent base specialties. They
should also master invasive and non-invasive measures and methods relevant to the internal medicine area of competence (intermediate objectives 1–
3).

Competence requirements for communicative competence,leadership competence and competence within medical scienceand quality work
Communicative competence
The equal and responsible patient
Doctors with specialist competence must be capable of dialogue and of
maintaining open contact with patients and their next of kin. Contact should
be characterised by empathy and trust, as well as respect for patients’ rightto information, influence, and participation in decisions. Contact should also
be characterised by co-operation and sensitivity to the patients’ needs, desires and right to self-determination, as well as providing incentive for patients’ involvement in, and responsibility for, their own care.
Multicultural and gender aspects
Communication with patients and their next of kin should be characterisedby understanding and respect for cross-cultural and multicultural aspects
such as age, language, ethnicity, sexual orientation and religion, as well as
gender.
Interprofessional relations
Doctors with specialist competence must be capable of communicating,both in writing and orally, with other doctors and co-workers showing respect for their professional knowledge and competences. The same applies
to contact with representatives of the public and various civil authorities.
Pedagogical skills
Doctors with specialist competence must have pedagogical capability inorder to inform and instruct not only patients and their next of kin, but also
other doctors and co-workers, as well as students.
Professional approach and ethics
Doctors with specialist competence must be capable of working continuously with their professional and medical ethical approaches, with the objective of being able to make independent decisions of a medical ethical nature.
Individual professional development
Doctors with specialist competence must be capable of continually examining and identifying their own needs for professional development, in addition to operational requirements, in order to be able to meet requirements forthe best possible patient care.

Leadership competence
Collaboration
Doctors with specialist competence must have a developed capability for
self-knowledge and an understanding of their own functions and roles in theorganisation.
Mentoring skills
Doctors with specialist competence must be capable of mentoring other doctors and co-workers, as well as students.
Leadership
Doctors with specialist competence must be capable of leadership characterised by collaboration, openness, and dialogue with co-workers. Leadershipmust further be characterised by participation and activity development
aimed at improvement. The ability to lead the work of the health care teamis essential.
System knowledge
Doctors with specialist competence must have an understanding of the organisation, administration, financial and regulatory systems of health care,
as well as its governance, in order to make the best use of resources.

Competence within medical science and quality work
Medical science
Doctors with specialist competence must be capable of adopting a medicallyscientific outlook and approach, and must have knowledge of researchmethodology, including basic epidemiological concepts, as well as of methods for evidence-based medicine and review of scientific information.
Improvement and quality work
Doctors with specialist competence must have an understanding of, andcompetence in, evidence-based improvement and quality work. The objective is to be able to initiate, participate in, and be responsible for continuous
systematic improvement work with emphasis on a holistic perspective, patient safety, patient benefit, measurability, and teaching management in order to be able to review and evaluate their own operations.
Public health and prevention
Doctors with specialist competence must have an understanding of the factors determining health, other aspects of public health, and methods forpromoting health and efforts aimed at preventing injury and illness, in order
to be able to take this understanding into account in medical scientific work.

Training structure
Specialist medical training in haematology can begin before, during, or after
specialist medical training in internal medicine and can be integrated with it.
An introductory period with cohesive service in the more resourceintensive operations within haematology is desirable. Here, ST doctors are
expected to get a comprehensive picture of malignant haematology, as wellas complications in its treatment. Independent haematology clinic operations, where – if possible – continuity regarding the individual patient andvaried content at the same time are desirable, should be initiated early on in
the training. Cohesive service periods are also desirable.
Service within highly specialised haematology, especially transplant
haematology, is very important and should, if possible, take place in thelater phases of the training. Service in another operation, such as transfusion
medicine, haemopathology, and infection, can complement the service
within haematology operations.
Theoretical training in the form of courses and other training activities
should be integrated with the clinical service and distributed equally
throughout the service.
ST doctors should be given the opportunity for independent study and tofollow the relevant literature within the area of competence.

Special recommendations
The specialty associations and sections of the medical organisations haveformulated special recommendations for their own specialties. The recommendations concern such issues as how specialist medical training should be
structured.

Intermediate objectives

Medical competenceIntermediate objective 1
To be able to handle acuteillnesses within internal medicine
and the acute medical conditions
related to internal medicine

Teaching methods
Clinical service under supervision in a unit that handles these
conditions
CourseFollow-up
Certificate of successfully completed clinical service and competence achieved, issued bycurrent mentor
Certificate of successfully completed course, issued by course
leaderSitting-in
Theoretical studies
Intermediate objective 2
To be able to initially handle themost common and frequently
occurring illnesses and medical
conditions within internal medicine, as well as the most common and frequently occurring
conditions within the branch
specialties and adjacent basespecialties

Teaching methods
Clinical service under supervision in a unit that handles these
conditions

Intermediate objective 3
To master invasive and noninvasive measures and methods
relevant to the internal medicine
area of competence

Teaching methods
Clinical service under supervision in a unit where such operations are practised

CourseFollow-up
Certificate of successfully completed clinical service and competence achieved, issued bycurrent mentor
Certificate of successfully completed course, issued by course
leaderSitting-in
Theoretical studies

Follow-up
Certificate of successfully completed clinical service and competence achieved, issued bycurrent mentor

Training in a simulated environment
Theoretical studies
Intermediate objective 4
To master investigation, diagnostics, therapy, and follow-up of
haematological malignancies
including lymphoma, as well as
to have knowledge of radiation
therapy

Teaching methods
Clinical service under supervision in a unit that handles these
conditions
CourseFollow-up
Certificate of successfully completed clinical service and competence achieved, issued bycurrent mentor
Certificate of successfully completed course, issued by course
leaderDiagnostics and treatment
conference
Sitting-in
Intermediate objective 5
To master acute complications of
haematological illnesses andmedical conditions

Teaching methods
Clinical service under supervision in a unit that handles these
conditions
CourseFollow-up
Certificate of successfully completed clinical service and competence achieved, issued bycurrent mentor
Certificate of successfully completed course, issued by course
leaderIntermediate objective 6
To master subsidiary treatment
in connection with haematological illnesses and medical conditions

Teaching methods
Clinical service under supervision in a unit that handles these
conditions
CourseIntermediate objective 7
To master non-malignant haematology

Teaching methods
Clinical service under supervision in a unit that handles these
conditions
CourseIntermediate objective 8
To master haemostatic disorders

Teaching methods
Clinical service under supervision in a unit that handles these
conditions
CourseIntermediate objective 9
To be able to handle patients inpalliative and terminal treatment
phasesTeaching methods
Clinical service under supervision in a unit that handles these
conditions
CourseFollow-up
Certificate of successfully completed clinical service and competence achieved, issued bycurrent mentor
Certificate of successfully completed course, issued by course
leaderFollow-up
Certificate of successfully completed clinical service and competence achieved, issued bycurrent mentor
Certificate of successfully completed course, issued by course
leaderFollow-up
Certificate of successfully completed clinical service and competence achieved, issued bycurrent mentor
Certificate of successfully completed course, issued by course
leaderFollow-up
Certificate of successfully completed clinical service and competence achieved, issued bycurrent mentor
Certificate of successfully completed course, issued by course
leaderSitting-in
Intermediate objective 10
To be able to handle allogeneic
stem cell transplantation

Teaching methods
Clinical service under supervision in a unit that handles these
conditions

Follow-up
Certificate of successfully completed clinical service and competence achieved, issued bycurrent mentor

Diagnostics and treatment
conference
Intermediate objective 11
To master operation mechanisms, complications, and theadministration of antitumour
agentsTeaching methods
Clinical service under supervision in a unit that handles these
conditions
CourseIntermediate objective 12
To master haematology examination methods, as well as tohave an understanding of haematology laboratory diagnostics

Teaching methods
Clinical service under supervision in a unit that handles these
conditions
CourseDiagnostics and treatment
conference

Follow-up
Certificate of successfully completed clinical service and competence achieved, issued bycurrent mentor
Certificate of successfully completed course, issued by course
leaderFollow-up
Certificate of successfully completed clinical service and competence achieved, issued bycurrent mentor
Certificate of successfully completed course, issued by course
leaderCommunicative competenceIntermediate objective 13
To be capable of dialogue andopen contact with patients andtheir next of kin

Teaching methods
Clinical service under supervision in a unit where such operations are practised
CourseorseminarSitting-in

Intermediate objective 14
To be capable of communication,
both oral and written, with otherdoctors and co-workers

Teaching methods
Clinical service under supervision in a unit where such operations are practised

Follow-up
Certificate of approved clinicalservice and competenceachieved, issued by current
mentorCertificate of successfully completed course, issued by course
leaderFollow-up
Certificate of successfully completed clinical service and competence achieved, issued bycurrent mentor

Health care teamwork under
supervisionIntermediate objective 15
To be capable of informing andinstructing patients, next of kin,other doctors, and co-workers,
as well as students

Teaching methods
Clinical service under supervision in a unit where such operations are practised

Follow-up
Certificate of successfully completed clinical service and competence achieved, issued bycurrent mentor

Instruction under supervision

Leadership competenceIntermediate objective 16
To be capable of mentoringother doctors and co-workers, aswell as students

Teaching methods
Clinical service under supervision in a unit where such operations are practised
CourseFollow-up
Certificate of successfully completed clinical service and competence achieved, issued bycurrent mentor
Certificate of successfully completed course, issued by course
leaderMentoring under supervisionIntermediate objective 17
To be capable of leading using
collaboration and dialogue withco-workers as well as within thehealth care team

Teaching methods
Clinical service under supervision in a unit where such operations are practised
CourseFollow-up
Certificate of successfully completed clinical service and competence achieved, issued bycurrent mentor
Certificate of successfully completed course, issued by course
leader

Health care teamwork under
supervisionIntermediate objective 18
To have an understanding of theorganisation, management andregulatory systems of health andmedical care

Teaching methods
CourseTheoretical studies

Follow-up
Certificate of successfully completed course, issued by course
leaderCompetence within medical science and quality
work
Intermediate objective 19
To be capable of a medicallyscientific outlook and approach

Teaching methods
CourseWritten individual work under
supervision according to scientific principles
Theoretical studies
Intermediate objective 20
To have an understanding of,and competence in, evidencebased improvement and quality
work

Teaching methods
CourseQuality and development work
under supervision
Theoretical studies

Follow-up
Certificate of successfully completed course, issued by course
leaderCertificate of approved written
individual work issued by current mentor

Follow-up
Certificate of successfully completed course, issued by course
leaderCertificate of quality and development work issued by current
mentorAllergology

Introduction
Explanation of terms
General definition of competencies
Definition of area of competence
Competence requirements
Competence requirements for medical competence
Competence requirements for communicative competence, leadershipcompetence, and competence within medical science and quality work
Training structure
Special recommendations
Intermediate objectives
Medical competenceCommunicative competence
Leadership competence
Competence within medical science and quality work

Introduction

On June 24, 2008, The National Board of Health and Welfare (Socialstyrelsen) decided to issue new regulations and general guidelines for doctors’
specialist medical training (SOSFS 2008:17). The statute consists of a general part with common provisions for all specialties and a specific part withall the descriptions of objectives. The description of objectives for the respective specialties should be understood against the background of the provisions in the general part.
In each description of objectives, there is a section headed ‘Training
structure’ which constitutes general guidelines. The teaching methods under
the heading ‘Intermediate objectives’ where no follow-up is indicated also
constitute general guidelines.

Explanation of terms

current mentor
a specialist doctor whose specialist competence corresponds to the area ofcompetence indicated by the intermediate objective, and who is responsible
for ST doctors’s professional development during the teaching period or forthe method of teaching indicatedthe assignment as a mentor for an ST doctor generally encompasses the entire period of specialist training but can also encompass part or parts of it
auscultation
during mentoring, and in accordance with a pre-designed programme, tostudy the profession of a specialist doctor or other health care staff by following one or several professionals, as well as carrying out assignments in
the relevant area to a certain extent
evaluate
to form a sound opinion of a patient or similar person as a basis for further
management
masterbeing fully able to evaluate and handle the medical investigation, diagnostics, treatment, and follow-up of a patient or similar person, and being fully
able to use the techniques relevant to the area
capability
personal capacity to execute or perform a task
h a ve u n d ers tan d i ng
having acquired knowledge and insight into an area through theoretical studies and/or practical exercise of the profession
have knowledge
having acquired some knowledge in an area through theoretical studies
and/or practical exercise of the profession
mentoring under supervision
as an ST doctor, mentor a co-worker while simultaneously being mentored
by a doctor with specialist competencementorcontinuously, and in dialogue form, supporting and guiding, as well as evaluating, a co-worker’s professional development
mentoringsee mentor
handleto actively carry out measures regarding investigation, diagnostics, treatment, and follow-up of a patient or similar person, and have overall responsibility for carrying out these measuresinitially handle
as the primary physician in charge, to actively carry out measures regarding
investigation, diagnostics, treatment, and follow-up of a patient or similar
person, and have overall responsibility for carrying out these measuresinitially evaluate
as the primary physician in charge, to form a sound opinion of a patient orsimilar person as a basis for further management
intraprofessional group reflection
reflection done in a group together with other doctors, chiefly for the purpose of further education and training
clinical service
health and medical care duties that ST doctors perform under their own professional liability and with the support of a mentor
courseteacher-led training with an established plan, given during a defined periodof timesitting-in
training activity involving an ST doctor observing when a specialist doctor
or other health care staff holds a consultationorassessment activity involving a specialist doctor or other health care staff
observing and evaluating ST doctors during a consultation
seminarinstruction in group form with active participation
training in a simulated environment
training carried out in an environment created to emulate reality

large professional assembly
conference, congress, symposium or similar event
health care centre
health care unit in primary carehealth care team work
work where ST doctors, under supervision, participates in and sometimes
leads a group of co-operating health care staff with various competencies
charged with responsibility for care for an individual patient or group ofpatients

General definition of competence

Definition of area of competence
The specialty of allergology covers allergies and other hypersensitivities invarious organ systems, chiefly in the upper and lower respiratory tracts, thestomach and intestinal canal, and the skin. Allergic conditions are often systematic, especially in hypersensitivity to foods, medicines, and insect
venom. Allergy illnesses include both acute, life-threatening conditions suchas anaphylaxis and chronic conditions that can last a lifetime. Many allergic
conditions are common among the population and can therefore be designated as widespread diseases.
Diagnostics is based on analysis of case history supported by specificimmunological tests and/or based on various types of provocations. Allergy
illnesses can be limited or relieved by preventive efforts. Knowledge of prevention and counselling on risks and potential measures are an importantpart of the knowledge base of the specialty, as is knowledge of pharmacological and immunomodulatory treatment, especially allergy-specific immunotherapy.
The specialty is closely connected to other areas of knowledge such as
respiratory medicine, audiology, child and adolescent allergology, clinicalimmunology, and dermatology.
Allergology is a branch specialty of the internal medicine base specialty.

Competence requirements
Competence requirements for medical competenceSpecialist competence in allergology requires good theoretical and practicalknowledge in independently investigating and treating allergies and otherhypersensitivities in the upper and lower respiratory tracts, asthma and otherobstructive lung diseases, asthma-like conditions, hypersensitive reactions
involving work or the environment, hypersensitivity to food products andmedicines, anaphylactic reactions and other immunological system reactions, and urticaria and angiooedema, as well as primary immunodeficiency
diseases with symptoms in the respiratory tract. For diagnostics, the ability
to gather and analyse a detailed case history, conduct a physical examinationand evaluate various tests and provocations is required. Treatment requires
knowledge of both pharmacological and non-pharmacological elements.
Specialist competence in allergology further requires mastering theknowledge and skills base common to all internal medicine specialties. Being able to handle acute illnesses within internal medicine and the acutemedical conditions related to internal medicine are included in this generalbase. Additionally, specialists should be able to handle the most commonand frequently occurring illnesses and medical conditions within internal
medicine, as well as the most common and frequently occurring conditions

within all branch specialties and adjacent base specialties. They should also
master invasive and non-invasive measures and methods relevant to the internal medicine area of competence (intermediate objectives 1–3).
Requirements for communicative competence, leadership competence andcompetence within medical science and quality work

Communicative competence
The equal and responsible patient
Doctors with specialist competence must be capable of dialogue and of
maintaining open contact with patients and their next of kin. Contact should
be characterised by empathy and trust, as well as respect for patients’ rightto information, influence, and participation in decisions. Contact should also
be characterised by co-operation and sensitivity to the patients’ needs, desires and right to self-determination, as well as providing incentive for patients’ involvement in, and responsibility for, their own care.
Multicultural and gender aspects
Communication with patients and their next of kin should be characterisedby understanding and respect for cross-cultural and multicultural aspects
such as age, language, ethnicity, sexual orientation and religion, as well as
gender.
Interprofessional relations
Doctors with specialist competence must be capable of communicating,both in writing and orally, with other doctors and co-workers showing respect for their professional knowledge and competences. The same applies
to contact with representatives of the public and various civil authorities.
Pedagogical skills
Doctors with specialist competence must have pedagogical capability inorder to inform and instruct not only patients and their next of kin, but also
other doctors and co-workers, as well as students.
Professional approach and ethics
Doctors with specialist competence must be capable of working continuously with their professional and medical ethical approaches, with the objective of being able to make independent decisions of a medical ethical nature.
Individual professional development
Doctors with specialist competence must be capable of continually examining and identifying their own needs for professional development, in addition to operational requirements, in order to be able to meet requirements forthe best possible patient care.

Leadership competence
Collaboration
Doctors with specialist competence must have a developed capability for
self-knowledge and an understanding of their own functions and roles in theorganisation.
Mentoring skills
Doctors with specialist competence must be capable of mentoring other doctors and co-workers, as well as students.
Leadership
Doctors with specialist competence must be capable of leadership characterised by collaboration, openness, and dialogue with co-workers. Leadershipmust further be characterised by participation and activity development
aimed at improvement. The ability to lead the work of the health care teamis essential.
System knowledge
Doctors with specialist competence must have an understanding of the organisation, administration, financial and regulatory systems of health care,
as well as its governance, in order to make the best use of resources.

Competence within medical science and quality work
Medical science
Doctors with specialist competence must have a scientific outlook and approach, and must have knowledge of research methodology, including basic
epidemiological concepts, as well as of methods for evidence-based medicine and review of scientific information.
Improvement and quality work
Doctors with specialist competence must have an understanding of, andcompetence in, evidence-based improvement and quality work. The objective is to be able to initiate, participate in, and be responsible for continuous
systematic improvement work with emphasis on a holistic perspective, patient safety, patient benefit, measurability, and teaching management in order to be able to review and evaluate their own operations.
Public health and prevention
Doctors with specialist competence must have an understanding of the factors determining health, other aspects of public health, and methods forpromoting health and efforts aimed at preventing injury and illness, in order
to be able to take this understanding into account in medical scientific work.

Training structure
Specialist medical training in allergology can begin before, during, or after
specialist medical training in internal medicine and can be integrated with it.
Service in allergology can be organized in various ways, but it could be
advantageous to change between the main training – that is, service in anallergy clinic – and simultaneous additional training. At the beginning andend of the training, a longer placement at an allergy clinic in order to clarify
the objective of the specialist medical training can be beneficial. The mainpart of service in allergology should be situated at the end of the specialisation.
It is suitable that clinical service in allergology involve placement in aclinic where comprehensive care in allergy medicine is practised. It is, ofcourse, essential that ST doctors be allowed to handle patients reflecting theentire illness panorama of allergy medicine early on in their training. Simultaneous additional training can be individualized based on ST doctors’ priorexperiences. Service should take place within several of the following areasof knowledge: respiratory medicine, audiology, clinical immunology, dermatology, gastroenterology, child and adolescent allergology, and occupational and environmental medicine, as well as clinical physiology. Placement in various units with operations within allergology is encouraged and apart of the service should be located in a university clinic.
ST doctors should be given opportunities for independent study, and it isrecommended that they participate in national and international courses, andother professional assemblies.

Special recommendations
The specialty associations and sections of the medical organisations haveformulated special recommendations for their own specialties. The recommendations concern such issues as how specialist medical training should be
structured.

Intermediate objectives

Medical competenceIntermediate objective 1
To be able to handle acuteillnesses within internal medicine
and the medical conditions
related to internal medicine

Teaching methods
Clinical service under supervision in a unit that handles these
conditions
CourseFollow-up
Certificate of successfully completed clinical service and competence achieved, issued bycurrent mentor
Certificate of successfully completed course, issued by course
leaderSitting-in
Theoretical studies
Intermediate objective 2
To be able to initially handle themost common and frequently
occurring illnesses and medical
conditions within internal medicine, as well as the most common and frequently occurring
conditions within the branch
specialties and adjacent basespecialties

Teaching methods
Clinical service under supervision in a unit that handles these
conditions

Intermediate objective 3
To master invasive and noninvasive measures and methods
relevant to the internal medicine
area of competence

Teaching methods
Clinical service under supervision in a unit that handles these
conditions

CourseFollow-up
Certificate of successfully completed clinical service and competence achieved, issued bycurrent mentor
Certificate of successfully completed course, issued by course
leaderSitting-in
Theoretical studies
Follow-up
Certificate of successfully completed clinical service and competence achieved, issued bycurrent mentor

Training in a simulated environment
Theoretical studies
Intermediate objective 4
To master diagnostics, therapy,
and follow-up of asthma, allergicand non-allergic rhinitis, functional breathing difficulties, andchronic obstructive lung disease

Teaching methods
Clinical service under supervision in a unit where such operations are practised
CourseFollow-up
Certificate of successfully completed clinical service and competence achieved, issued bycurrent mentor
Certificate of successfully completed course, issued by course
leaderLarge professional assembly
Theoretical studies
Intermediate objective 5
To master diagnostics, therapy,
follow-up, and prophylaxis ofsystematic allergic conditions,especially anaphylaxis, hypersensitivity to food products andmedicines, and insect allergies
To have an understanding ofother immunological conditions
including non-IgE mediatedallergies

Teaching methods
Clinical service under supervision in a unit that handles these
conditions
Courseorlarge professional assembly
Sitting-in
Theoretical studies

Follow-up
Certificate of successfully completed clinical service and competence achieved, issued bycurrent mentor
Certificate of successfully completed course, issued by course
leaderIntermediate objective 6
To master diagnostics, therapy,
and follow-up of the allergyassociated skin diseases urticaria and angiooedema, and to beable to handle atopic eczema

Teaching methods
Clinical service under supervision in a unit that handles these
conditions

Intermediate objective 7
To be able to evaluate in vivo
tests, chiefly skin tests andprovocations

Teaching methods
Clinical service under supervision in a unit where such operations are practised

Follow-up
Certificate of successfully completed clinical service and competence achieved, issued bycurrent mentor

Intermediate objective 8
To be able to evaluate in vitro
tests, especially total and specific IgE in serum, and to be able toevaluate other relevant immunological diagnosis methods

Teaching methods
Clinical service under supervision in a unit where such operations are practised

Follow-up
Certificate of successfully completed clinical service andcompetence achieved, issued
by current mentor
Certificate of successfully completed course, issued by course
leaderIntermediate objective 9
To have an understanding ofallergens, and to have knowledge of recombinant allergens
and hapten mechanisms

Teaching methods
Large professional assembly
Theoretical studies

Follow-up

Intermediate objective 10
To master treatment of allergic
conditions with immunomodulatory therapy, especially allergenspecific immunotherapy

Teaching methods
Clinical service under supervision in a unit where such operations are practised

Follow-up
Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor
Certificate
ofsuccessfullycompleted course, issued bycourse leader

Courseorlarge professional assembly
Theoretical studies

Follow-up
Certificate of successfully completed clinical service and competence achieved, issued bycurrent mentor
Certificate of successfully completed course, issued by course
leaderTo be able to evaluate lungfunction tests, chiefly spirometry,
and to be able to evaluate othermethods for asthma diagnostics
and follow-up

Courseorlarge professional assembly
Theoretical studies

CourseLarge professional assembly
Theoretical studies
Intermediate objective 11
To master prevention, counselling, and rehabilitation in allergic
conditions, and to have an understanding of risk factors in theenvironment
To have knowledge of genetics
and epidemiology in allergic
illnesses
Intermediate objective 12
To have an understanding of
medico-actuarial science relevant to the specialty, and tomaster writing a certificate

Teaching methods
Clinical service under supervision in a unit where such operations are practised

Follow-up
Certificate of successfully completed clinical service and competence achieved, issued bycurrent mentor

Large professional assembly
Sitting-in
Theoretical studies

Teaching methods
Clinical service under supervision in a unit that handles theseissuesFollow-up
Certificate of successfully completed clinical service and competence achieved, issued bycurrent mentor

Communicative competenceIntermediate objective 13
To be capable of dialogue andopen contact with patients andtheir next of kin

Teaching methods
Clinical service under supervision in a unit where such operations are practised
CourseorseminarSitting-in

Intermediate objective 14
To be capable of communication,
both oral and written, with otherdoctors and co-workers

Teaching methods
Clinical service under supervision in a unit where such operations are practised

Follow-up
Certificate of approved clinicalservice and competenceachieved, issued by current
mentorCertificate of successfully completed course, issued by course
leaderFollow-up
Certificate of successfully completed clinical service andcompetence achieved, issued
by current mentor

Health care teamwork under
supervisionIntermediate objective 15
To be capable of informing andinstructing patients, next of kin,other doctors, and co-workers,
as well as students

Teaching methods
Clinical service under supervision in a unit where such operations are practised

Follow-up
Certificate of successfully completed clinical service and competence achieved, issued bycurrent mentor

Instruction under supervision

Leadership competenceIntermediate objective 16
To be capable of mentoringother doctors and co-workers, aswell as students

Teaching methods
Clinical service under supervision in a unit where such operations are practised
CourseFollow-up
Certificate of successfully completed clinical service and competence achieved, issued bycurrent mentor
Certificate of successfully completed course, issued by course
leaderMentoring under supervisionIntermediate objective 17
To be capable of leading using
collaboration and dialogue withco-workers as well as within thehealth care team

Teaching methods
Clinical service under supervision in a unit where such operations are practised
CourseFollow-up
Certificate of successfully completed clinical service and competence achieved, issued bycurrent mentor
Certificate of successfully completed course, issued by course
leader

Health care teamwork under
supervisionIntermediate objective 18
To have an understanding of theorganisation, management andregulatory systems of health andmedical care

Teaching methods
CourseTheoretical studies

Follow-up
Certificate of successfully completed course, issued by course
leaderCompetence within medical science and quality
work
Intermediate objective 19
To be capable of a medicallyscientific outlook and approach

Teaching methods
CourseWritten individual work under
supervision according to scientific principles
Theoretical studies

Intermediate objective 20
To have an understanding of,and competence in, evidencebased improvement and quality
work

Teaching methods
CourseQuality and development work
under supervision
Theoretical studies

Follow-up
Certificate of successfully completed course, issued by course
leaderCertificate of approved written
individual work issued by current mentor

Follow-up
Certificate of successfully completed course, issued by course
leaderCertificate of quality and development work issued by current
mentorGeriatrics

Introduction
Explanation of terms
General definition of competencies
Definition of area of competence
Competence requirements
Competence requirements for medical competence
Competence requirements for communicative competence, leadershipcompetence, and competence within medical science and quality work
Training structure
Special recommendations
Intermediate objectives
Medical competenceCommunicative competence
Leadership competence
Competence within medical science and quality work

Introduction

On June 24, 2008, The National Board of Health and Welfare (Socialstyrelsen) decided to issue new regulations and general guidelines for doctors’
specialist medical training (SOSFS 2008:17). The statute consists of a general part with common provisions for all specialties and a specific part withall the descriptions of objectives. The description of objectives for the respective specialties should be understood against the background of the provisions in the general part.
In each description of objectives, there is a section headed ‘Training
structure’ which constitutes general guidelines. The teaching methods under
the heading ‘Intermediate objectives’ where no follow-up is indicated also
constitute general guidelines.

Explanation of terms

current mentor
a specialist doctor whose specialist competence corresponds to the area ofcompetence indicated by the intermediate objective, and who is responsible
for ST doctors’s professional development during the teaching period or forthe method of teaching indicatedthe assignment as a mentor for an ST doctor generally encompasses the entire period of specialist training but can also encompass part or parts of it
auscultation
during mentoring, and in accordance with a pre-designed programme, tostudy the profession of a specialist doctor or other health care staff by following one or several professionals, as well as carrying out assignments in
the relevant area to a certain extent
evaluate
to form a sound opinion of a patient or similar person as a basis for further
management
masterbeing fully able to evaluate and handle the medical investigation, diagnostics, treatment, and follow-up of a patient or similar person, and being fully
able to use the techniques relevant to the area
capability
personal capacity to execute or perform a task
h a ve u n d ers tan d i ng
having acquired knowledge and insight into an area through theoretical studies and/or practical exercise of the profession
have knowledge
having acquired some knowledge in an area through theoretical studies
and/or practical exercise of the profession
mentoring under supervision
as an ST doctor, mentor a co-worker while simultaneously being mentored
by a doctor with specialist competencementorcontinuously, and in dialogue form, supporting and guiding, as well as evaluating, a co-worker’s professional development
mentoringsee mentor
handleto actively carry out measures regarding investigation, diagnostics, treatment, and follow-up of a patient or similar person, and have overall responsibility for carrying out these measuresinitially handle
as the primary physician in charge, to actively carry out measures regarding
investigation, diagnostics, treatment, and follow-up of a patient or similar
person, and have overall responsibility for carrying out these measuresinitially evaluate
as the primary physician in charge, to form a sound opinion of a patient orsimilar person as a basis for further management
intraprofessional group reflection
reflection done in a group together with other doctors, chiefly for the purpose of further education and training
clinical service
health and medical care duties that ST doctors perform under their own professional liability and with the support of a mentor
courseteacher-led training with an established plan, given during a defined periodof timesitting-in
training activity involving an ST doctor observing when a specialist doctor
or other health care staff holds a consultationorassessment activity involving a specialist doctor or other health care staff
observing and evaluating ST doctors during a consultation
seminarinstruction in group form with active participation
training in a simulated environment
training carried out in an environment created to emulate reality

large professional assembly
conference, congress, symposium or similar event
health care centre
health care unit in primary carehealth care team work
work where ST doctors, under supervision, participates in and sometimes
leads a group of co-operating health care staff with various competencies
charged with responsibility for care for an individual patient or group ofpatients

General definition of competence

Definition of area of competence
The specialty of geriatrics covers knowledge and skills in independently
being able to investigate, diagnose, treat, and follow up acute and chronic
conditions in the elderly, as well as knowledge of normal aging and its consequences for functional ability and vulnerability. Geriatrics also means
observing several simultaneous illnesses and impairments, as well as assessing the gains from treatment from an individual perspective. Geriatric healthcare aims at minimizing the limitations in the ability to stay active that arise
as a consequence of illness and aging. Geriatrics implies a focus on the patient’s entire situation: medical, functional, psychological, and social. Workon a team with coordination of efforts between various occupational groups
is necessary in order to meet the elderly patient’s complex needs. The areaof competence is further characterised by an interprofessional approach
where co-ordination of efforts among various forms of health care and responsible authorities is required. This presupposes knowledge of the organisation and operating methods of health care services.

Competence requirements
Competence requirements for medical competenceSpecialist competence in geriatrics requires knowledge and skills in order tobe able to handle older patients with multiple illnesses. Furthermore, theability to understand the older patient’s complex clinical profile, with functional handicaps and an impact on their social situation, is required.
Specialist competence in geriatrics also requires basic knowledge in gerontology and understanding of how normal aging impacts the symptoms andcourse of an illness, as well as effects of treatment.
Moreover, specialist competence in geriatrics requires knowledge inmedical ethics, and being able to prioritise primary and secondary preventive measures. It also requires medical knowledge of internal medicine, orthopaedic, neurological, psychiatric, and surgical illnesses. The ability toevaluate rehabilitation needs and the effects of various efforts on an elderly
individual is crucial. Beyond that, competence in palliative care is required,
as is mastering medicinal treatments for the elderly.
Specialist competence in geriatrics requires the ability to cooperate withvarious health care providers and professional categories. In addition,knowledge of the organisation of elder care, as well as the relevant laws andordinances for geriatrics, is required.

Competence requirements for communicative competence,leadership competence and competence within medical scienceand quality work
Communicative competence
The equal and responsible patient
Doctors with specialist competence must be capable of dialogue and of
maintaining open contact with patients and their next of kin. Contact should
be characterised by empathy and trust, as well as respect for patients’ rightto information, influence, and participation in decisions. Contact should also
be characterised by co-operation and sensitivity to the patients’ needs, desires and right to self-determination, as well as providing incentive for patients’ involvement in, and responsibility for, their own care.
Multicultural and gender aspects
Communication with patients and their next of kin should be characterisedby understanding and respect for cross-cultural and multicultural aspects
such as age, language, ethnicity, sexual orientation and religion, as well as
gender.
Interprofessional relations
Doctors with specialist competence must be capable of communicating,both in writing and orally, with other doctors and co-workers showing respect for their professional knowledge and competences. The same applies
to contact with representatives of the public and various civil authorities.
Pedagogical skills
Doctors with specialist competence must have pedagogical capability inorder to inform and instruct not only patients and their next of kin, but also
other doctors and co-workers, as well as students.
Professional approach and ethics
Doctors with specialist competence must be capable of working continuously with their professional and medical ethical approaches, with the objective of being able to make independent decisions of a medical ethical nature.
Individual professional development
Doctors with specialist competence must be capable of continually examining and identifying their own needs for professional development, in addition to operational requirements, in order to be able to meet requirements forthe best possible patient care.

Leadership competence
Collaboration
Doctors with specialist competence must have a developed capability for
self-knowledge and an understanding of their own functions and roles in theorganisation.
Mentoring skills
Doctors with specialist competence must be capable of mentoring other doctors and co-workers, as well as students.
Leadership
Doctors with specialist competence must be capable of leadership characterised by collaboration, openness, and dialogue with co-workers. Leadershipmust further be characterised by participation and activity development
aimed at improvement. The ability to lead the work of the health care teamis essential.
System knowledge
Doctors with specialist competence must have an understanding of the organisation, administration, financial and regulatory systems of health care,
as well as its governance, in order to make the best use of resources.

Competence within medical science and quality work
Medical science
Doctors with specialist competence must be capable of adopting a medicallyscientific outlook and approach, and must have knowledge of researchmethodology, including basic epidemiological concepts, as well as of methods for evidence-based medicine and review of scientific information.
Improvement and quality work
Doctors with specialist competence must have an understanding of, andcompetence in, evidence-based improvement and quality work. The objective is to be able to initiate, participate in, and be responsible for continuous
systematic improvement work with emphasis on a holistic perspective, patient safety, patient benefit, measurability, and teaching management in order to be able to review and evaluate their own operations.
Public health and prevention
Doctors with specialist competence must have an understanding of the factors determining health, other aspects of public health, and methods forpromoting health and efforts aimed at preventing injury and illness, in order
to be able to take this understanding into account in medical scientific work.

Training structure
It is best that the main part of the training in geriatrics take place throughservice within the doctor’s own specialty. Simultaneous additional training
should cover service within internal medicine and psychiatry and, beyond
that, service within one or several other areas of competence.
The best theoretical training would take place in the form of courses, professional assemblies, and studies of the literature. During the introductory
part of the service, ST doctors should obtain theoretical training in gerontology and common medical conditions among the elderly. Continued theoretical training should be adjusted to clinical service as regards time and content.
To acquire a scientific outlook and approach, it is of great importance that
ST doctors carry out project work. For this work, ST doctors should havethe opportunity to choose a scientifically qualified mentor at a university
clinic.
The clinical service should be begun at a geriatrics unit with a focus on
general geriatrics. The service should provide experience in stroke and fracture rehabilitation, palliative care, cognitive dysfunction, and acute andchronic medical conditions within general geriatrics. Service at individual
residences and in other forms of outpatient care should be included in the
training.
If any of the above parts of the training cannot be supplied by the parent
clinic, that part should preferably be carried out at another clinic. It can beadvantageous to complete clinical service within the specialists’ own operations, as ST doctors then get the opportunity for more advanced job assignments.
Simultaneous additional training aims at giving ST doctors the necessary
knowledge of common conditions in the geriatric patient, but which aremainly handled within other units. During simultaneous additional training
in an internal medicine unit, it is suitable for ST doctors to immerse themselves in the medical conditions that are common for the elderly within cardiology, respiratory medicine, stroke, renal medicine, endocrinology, andgastroenterology. Service in an emergency clinic is also important. Simultaneous additional training within psychiatry should include general geriatric
psychiatry and cognitive disorders, if they cannot be supplied within themain part of training.

Special recommendations
The specialty associations and sections of the medical organisations haveformulated special recommendations for their own specialties. The recommendations concern such issues as how specialist medical training should be
structured.

Intermediate objectives

Medical competenceIntermediate objective 1

Teaching methods

Follow-up

To have an understanding
within gerontology in order
to be able to evaluate thefunctions of an aging person, changed symptoms
and changed conditions
for prevention, diagnostics,
treatment, and rehabilitation

Clinical service under
supervision in a unit that
handles these conditions

Certificate of successfullycompleted clinical service
andcompetenceachieved, issued by current mentor

Course or large professional assembly

Certificate of successfullycompleted course, issuedby course leader

Sitting-in
Theoretical studies
Intermediate objective 2
To be able to handle older patients with multiple illnesses froma comprehensive viewpoint andregarding their medical, functional, psychological, and social
situations

Teaching methods
Clinical service under supervision in a unit that handles these
conditions
CourseFollow-up
Certificate of successfully completed clinical service and competence achieved, issued bycurrent mentor
Certificate of successfully completed course, issued by course
leaderSitting-in
Theoretical studies
Intermediate objective 3
To have an understanding of
medical ethics and to be able tosupply optimal diagnostics andtreatment for the older patient

Teaching methods
Clinical service under supervision
in a unit that handles these
conditions
Courseorlarge professional assembly
Intraprofessional group reflection
Theoretical studies

Intermediate objective 4
To be able to handle common
somatic and psychologicalillnesses and symptoms in theacute and the chronic stage inolder patients, with regard to
impaired organ function, multiple
illnesses, and individual gains
from treatment

Teaching methods
Clinical service under supervision in a unit that handles these
conditions

Intermediate objective 5
To have an understanding of theeffects of aging on pharmacokinetics and pharmacodynamics inthe medicinal treatment of theelderly

Teaching methods
Clinical service under supervision in a unit that handles these
conditions

Courseorlarge professional assembly
Theoretical studies

Courseorlarge professional assembly
Theoretical studies

Follow-up
Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor
Certificate of successfullycompleted course, issued bycourse leader

Follow-up
Certificate of successfully completed clinical service and competence achieved, issued bycurrent mentor
Certificate of successfully completed course, issued by course
leaderFollow-up
Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor
Certificate of successfullycompleted course, issued bycourse leader

Intermediate objective 6
To be able to evaluate the needfor rehabilitation, coordinate
rehabilitation efforts, and assess
rehabilitation results, and tohave knowledge of the areas ofcompetence of various teammembers

Teaching methods
Clinical service under supervision in a unit that handles these
conditions

Intermediate objective 7
To be able to handle older
patients with palliative needs

Teaching methods
Clinical service under supervision in a unit that handles these
conditions

Courseorlarge professional assembly
Health care team work under
supervision
Theoretical studies

Course or large professional
assembly

Follow-up
Certificate of successfully completed clinical service and competence achieved, issued bycurrent mentor
Certificate of successfully completed course, issued by course
leaderFollow-up
Certificate of successfully completed clinical service and competence achieved, issued bycurrent mentor
Certificate of successfully completed course, issued by course
leader

Health care team work under
supervision
Sitting-in
Theoretical studies
Intermediate objective 8
To have an understanding of
how common conditions in theelderly are handled within adjacent specialties, and to be able
to evaluate when a patient
should be referred further toanother specialty

Teaching methods
Clinical service under supervision in a unit that handles these
conditions

Intermediate objective 9
To be able to handle medical
conditions in the elderly withinvarious forms of health care

Teaching methods
Clinical service under supervision in a unit that handles these
conditions

Follow-up
Certificate of successfully completed clinical service and competence achieved, issued bycurrent mentor

Intermediate objective 10
To have an understanding of thehealth risks and illness panorama for elderly people, and to beable to handle prioritising primary and secondary preventive
efforts

Teaching methods
Clinical service under supervision in a unit that handles these
conditions

Follow-up
Certificate of successfully completed clinical service and competence achieved, issued bycurrent mentor
Certificate of successfully completed course, issued by course
leaderIntermediate objective 11
To have an understanding of theorganisation of elder care, and tomaster cooperation with other
health care providers

Teaching methods
Clinical service under supervision in a unit where such operations are practised

Courseorlarge professional assembly
Sitting-in
Theoretical studies

Courseorlarge professional assembly
Theoretical studies

Follow-up
Certificate of successfully completed clinical service and competence achieved, issued bycurrent mentor
Certificate of successfully completed course, issued by course
leaderFollow-up
Certificate of successfully completed clinical service and competence achieved, issued bycurrent mentor

Theoretical studies

Intermediate objective 12
To master the application oflaws and ordinances that concern health care and treatmentof the elderly

Teaching methods
Clinical service under supervision in a unit that handles these
conditions
Theoretical studies

Follow-up
Certificate of successfully completed clinical service and competence achieved, issued bycurrent mentor

Communicative competenceIntermediate objective 13
To be capable of dialogue andopen contact with patients andtheir next of kin

Teaching methods
Clinical service under supervision in a unit where such operations are practised

Follow-up
Certificate of approved clinicalservice and competenceachieved, issued by current
mentorIntermediate objective 14
To be capable of communication,
both oral and written, with otherdoctors and co-workers

Teaching methods
Clinical service under supervision in a unit where such operations are practised

Follow-up
Certificate of approved clinicalservice and competenceachieved, issued by current
mentor

Health care teamwork under
supervisionIntermediate objective 15
To be capable of informing andinstructing patients, next of kin,other doctors, and co-workers,
as well as students

Teaching methods
Clinical service under supervision in a unit where such operations are practised

Follow-up
Certificate of successfully completed clinical service and competence achieved, issued bycurrent mentor

Instruction under supervision
Theoretical studies

Leadership competenceIntermediate objective 16
To be capable of mentoringother doctors and co-workers,
as well as students

Teaching methods
Clinical service under supervision in a unit where such operations are practised
CourseFollow-up
Certificate of successfully completed clinical service and competence achieved, issued bycurrent mentor
Certificate of successfully completed course, issued by course
leaderMentoring under supervision
Large professional assemblyIntermediate objective 17
To be capable of leading using
collaboration and dialogue withco-workers as well as within thehealth care team

Teaching methods
Clinical service under supervision in a unit where such operations are practised
CourseFollow-up
Certificate of successfully completed clinical service and competence achieved, issued bycurrent mentor
Certificate of successfully completed course, issued by course
leaderMentoring under supervision
Large professional assemblyIntermediate objective 18
To have an understanding of theorganisation, management andregulatory systems of health andmedical care

Teaching methods
Clinical service under supervision in a unit where such operations are practised
CourseLarge professional assembly
Theoretical studies

Follow-up
Certificate of successfully completed clinical service and competence achieved, issued bycurrent mentor
Certificate of successfully completed course, issued by course
leaderCompetence within medical science and quality
work
Intermediate objective 19
To be capable of a medicallyscientific outlook and approach

Teaching methods
CourseWritten individual work under
supervision according to scientific principles
Large professional assembly
Theoretical studies
Intermediate objective 20
To have an understanding of,and competence in, evidencebased improvement and quality
work

Teaching methods
CourseQuality and development work
under supervision
Large professional assembly

Follow-up
Certificate of successfully completed course, issued by course
leaderCertificate of approved written
individual work issued by current mentor

Follow-up
Certificate of successfully completed course, issued by course
leaderCertificate of quality and development work issued by current
mentor

Specialties in paediatrics

Paediatrics
Introduction
Explanation of terms
General definition of competencies
Definition of area of competence
Competence requirements
Competence requirements for medical competence
Competence requirements for communicative competence, leadershipcompetence, and competence within medical science and quality work
Training structure
Special recommendations
Intermediate objectives
Medical competenceCommunicative competence
Leadership competence
Competence within medical science and quality work

Introduction

On June 24, 2008, The National Board of Health and Welfare (Socialstyrelsen) decided to issue new regulations and general guidelines for doctors’
specialist medical training (SOSFS 2008:17). The statute consists of a general part with common provisions for all specialties and a specific part withall the descriptions of objectives. The description of objectives for the respective specialties should be understood against the background of the provisions in the general part.
In each description of objectives, there is a section headed ‘Training
structure’, which constitutes general guidelines. The teaching methods under the heading ‘Intermediate objectives’ where no follow-up is indicatedalso constitute general guidelines.

Explanation of terms

current mentor
a specialist doctor whose specialist competence corresponds to the area ofcompetence indicated by the intermediate objective, and who is responsible
for ST doctors’s professional development during the teaching period or forthe method of teaching indicatedthe assignment as a mentor for an ST doctor generally encompasses the entire period of specialist training but can also encompass part or parts of it
auscultation
during mentoring, and in accordance with a pre-designed programme, tostudy the profession of a specialist doctor or other health care staff by following one or several professionals, as well as carrying out assignments in
the relevant area to a certain extent
evaluate
to form a sound opinion of a patient or similar person as a basis for further
management
masterbeing fully able to evaluate and handle the medical investigation, diagnostics, treatment, and follow-up of a patient or similar person, and being fully
able to use the techniques relevant to the area
capability
personal capacity to execute or perform a task
h a ve u n d ers tan d i ng
having acquired knowledge and insight into an area through theoretical studies and/or practical exercise of the profession
have knowledge
having acquired some knowledge in an area through theoretical studies
and/or practical exercise of the profession
mentoring under supervision
as an ST doctor, mentor a co-worker while simultaneously being mentored
by a doctor with specialist competencementorcontinuously, and in dialogue form, supporting and guiding, as well as evaluating, a co-worker’s professional development
mentoringsee mentor
handleto actively carry out measures regarding investigation, diagnostics, treatment, and follow-up of a patient or similar person, and have overall responsibility for carrying out these measuresinitially handle
as the primary physician in charge, to actively carry out measures regarding
investigation, diagnostics, treatment, and follow-up of a patient or similar
person, and have overall responsibility for carrying out these measuresinitially evaluate
as the primary physician in charge, to form a sound opinion of a patient orsimilar person as a basis for further management
intraprofessional group reflection
reflection done in a group together with other doctors, chiefly for the purpose of further education and training
clinical service
health and medical care duties that ST doctors perform under their own professional liability and with the support of a mentor
courseteacher-led training with an established plan, given during a defined periodof timesitting-in
training activity involving an ST doctor observing when a specialist doctor
or other health care staff holds a consultationorassessment activity involving a specialist doctor or other health care staff
observing and evaluating ST doctors during a consultation
seminarinstruction in group form with active participation
training in a simulated environment
training carried out in an environment created to emulate reality

large professional assembly
conference, congress, symposium or similar event
health care centre
health care unit in primary carehealth care team work
work where ST doctors, under supervision, participates in and sometimes
leads a group of co-operating health care staff with various competencies
charged with responsibility for care for an individual patient or group ofpatients

General definition of competences

Definition of area of competence
The specialty of paediatrics involves knowledge and an understanding ofhealth and ill health in children and young people from 0 to 18 years of age.
The specialty involves an understanding of the normal growth of the child.
It also involves an understanding of prevention, investigation, diagnostics,
treatment, follow-up and development of knowledge with regard to diseases,
disorders and injuries related to their different stages.
Paediatrics is the base specialty for the branch specialties of child andadolescent allergology, child and adolescent neurology and habilitation,
neonatology, paediatric oncology and paediatric cardiology.

Competence requirements
Competence requirements for medical competence
For specialist competence in paediatrics, an understanding of and skills in
diagnostics and the treatment of all commonly occurring diseases and more
serious diseases and dysfunctions from the neonatal period until adulthoodis required. In addition, an understanding of the child’s normal growth, rearing and psychomotor and mental development and also diagnostics for the
purposes of being able to diagnose deviations from this at an early stage isnecessary.
The capability to work in a preventive and family focused manner on
general health information, vaccinations and the prevention of accidents is
also required. The capability of taking a comprehensive view of the familywith commitment and respect for the child’s needs, an understanding of how
the disease is affecting the child and its family and the capability to fulfil thechild’s entitlement to participate in evaluation and treatment on the basis of
its level of development is required. In order to achieve this competence, itis necessary to be able to work in multidisciplinary teams and work together
with other specialists in hospitals and out-patient clinics and with the social
services, child welfare, schools, voluntary associations and society’s institutions. For this work, an understanding of and the ability to serve the rightsof children and young people in society, both nationally and globally is required. An ethical and professional approach, good skills in child centeredclinical care at the centre, and the capability of advocating a healthy lifestyleamong children and young people are also required. An understanding of
the process for transferring chronically ill young people from paediatric
medical treatment to adult medical treatment is also required.

Competence requirements for communicative competence, leadership competence, and competence within medical scienceand quality work
Communicative competence
The equal and responsible patient
Doctors with specialist competence must be capable of dialogue and of
maintaining open contact with patients and their next of kin. Contact should
be characterised by empathy and trust, as well as respect for the patients’right to information, influence, and participation in decisions. Contact
should also be characterised by co-operation and sensitivity to the patients’needs, desires and right to self-determination, as well as providing incentive
for patients’ involvement in, and responsibility for, their own care.
Multicultural and gender aspects
Communication with patients and their next of kin should be characterisedby understanding and respect for cross-cultural and multicultural aspects
such as age, language, ethnicity, sexual orientation, and religion, as well as
gender.
Interprofessional relations
Doctors with specialist competence must be capable of communicating,both in writing and orally, with other doctors and co-workers showing respect for their professional knowledge and competences. The same applies
to contact with representatives of the public and various civil authorities.
Pedagogical skills
Doctors with specialist competence must have pedagogical capability inorder to inform and instruct not only patients and their next of kin, but also
other doctors and co-workers, as well as students.
Professional approach and ethics
Doctors with specialist competence must be capable of working continuously with their professional and medical ethical approaches, with the objectiveof being able to make independent decisions of a medical ethical nature.
Individual professional development
Doctors with specialist competence must be capable of continually examining and identifying their own needs for professional development, in addition to operational requirements, in order to be able to meet requirements forthe best possible patient care.

Leadership competence
Collaboration
Doctors with specialist competence must have a developed capability for
self-knowledge and understanding of their own functions and roles in theorganisation.
Mentoring skills
Doctors with specialist competence must be capable of mentoring other doctors and co-workers, as well as students.
Leadership
Doctors with specialist competence must be capable of leadership characterised by collaboration, openness, and dialogue with co-workers. Leadershipmust further be characterised by participation and activity development
aimed at improvement. The ability to lead the work of the health care teamis essential.
System knowledge
Doctors with specialist competence must have an understanding of the organisation, administration, finances, and regulatory systems of health care,
as well as its governance, in order to make the best use of resources.

Competence within medical science and quality work
Medical science
Doctors with specialist competence must be capable of adopting a medicallyscientific outlook and approach, and must have knowledge of research methodology, including basic epidemiological concepts, as well as of methods
for evidence-based medicine and review of scientific information.
Improvement and quality work
Doctors with specialist competence must have an understanding of, andcompetence in, evidence-based improvement and quality work. The objective is to be able to initiate, participate in, and be responsible for continuous
systematic improvement work with emphasis on a holistic perspective, patient safety, patient benefit, measurability, and teaching management in order to be able to review and evaluate their own operations.
Public health and prevention
Doctors with specialist competence must have an understanding of the factors determining health, other aspects of public health, and methods forpromoting health and efforts aimed at preventing injury and illness, in order
to be able to take this understanding into account in medical scientific work.

Training structure
During the first part of training, the emphasis should be on service withinacute and general paediatrics. The training should provide broad basic
knowledge. This should be done through clinical service within acute andgeneral paediatric in- and out patient care, at a neonatal unit and within habilitation. The training should also take place at some of the following paediatric units: allergology and pulmonary diseases, cardiology, neurology,
endocrinology and diabetes, nephrology, rheumatology, gastroenterology
and oncology and haematology.
The training is supplemented with theoretical studies, courses and otherpedagogic methods indicated. The training involves service as a primary oncall duty doctor and at the child welfare clinic. Treating and following the
progress of chronically ill children over a longer continuous period is also
included.
In addition to cross-training in paediatric psychiatry, service within otherspecialties of value for the training may be included.
During the period of training, it is imperative that a scientific way of
thinking is acquired. This should result in ST doctors participating in qualityand development work and also in scientific work to such an extent that it
can be presented at a national meeting or another scientific gathering.

Special recommendations
The specialty associations and sections of the medical organisations haveformulated special recommendations for their own specialties. The recommendations concern such issues as how specialist medical training should be
structured.

Intermediate objectives

Medical competenceIntermediate objective 1

Teaching methods

Follow-up

To master an understandingof the healthy child andyoung person and the influence that heredity, culture,
the environment and society
have on their development
and health

Clinical service under supervision in a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

To master diagnostics ofdeviations
fromnormalgrowth and development
andmasterhealthpromoting work

Theoretical studies

To be able to handle psychosocial problems andhave an understanding of
relevant legislation

Intermediate objective 2

Teaching methods

Follow-up

To master basic and acutepaediatric conditions

Clinical service under supervision in a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Training in a simulated environment
Theoretical studies

Intermediate objective 3

Teaching methods

Follow-up

To be able to handle themost common and frequently
occurring conditions within
the area of neonatology

Clinical service under supervision in a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Training in a simulated environment
Theoretical studies

Intermediate objective 4

Teaching methods

Follow-up

To be able to handle themost common and frequently occurring conditions within
the areas of allergology andpulmonary diseases

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Theoretical studies

Intermediate objective 5

Teaching methods

Follow-up

To be able to handle themost common and frequently
occurring conditions within
the areas of neurology andhabilitation

Clinical service under supervision in a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Theoretical studies

Intermediate objective 6

Teaching methods

Follow-up

To be able to handle themost common and frequently
occurring conditions within
the areas of endocrinology
and metabolic disorders

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Theoretical studies

Intermediate objective 7

Teaching methods

Follow-up

To be able to handle themost common and frequently
occurring conditions within
the area of nephrology

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Theoretical studies

Intermediate objective 8

Teaching methods

Follow-up

To be able to handle themost common and frequently
occurring conditions within
the areas of gastroenterology, hepatology and nutrition

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Theoretical studies

Intermediate objective 9

Teaching methods

Follow-up

To be able to handle the mostcommon and frequently occurring conditions within theareas of infectious diseases,
immunology and rheumatology

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Theoretical studies

Intermediate objective 10

Teaching methods

Follow-up

To be able to handle themost common and frequently
occurring conditions within
the areas of oncology andhaematology

Clinical service under supervision in a unit where such operations are practised

Certificate
ofsuccessfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Theoretical studies

Intermediate objective 11

Teaching methods

Follow-up

To be able to handle the mostcommon and frequently occurring conditions within thearea of cardiology

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Theoretical studies

Intermediate objective 12

Teaching methods

Follow-up

To be able to handle the mostcommon and frequently occurring conditions within thearea of paediatric psychiatry

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

Theoretical studies

Communicative competenceIntermediate objective 13

Teaching methods

Follow-up

To be capable of dialogue andopen contact with patients andtheir next of kin with respect
for the patient’s right to information, influence and participation in decisions and havean understanding and respect
for cross-cultural and multicultural aspects such as age,
language, ethnicity, sexual
orientation, and religion, as
well as gender.

Clinical service under supervision in a unit where such operations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Sitting-in
Intraprofessional group reflection

Intermediate objective 14

Teaching methods

Follow-up

To be capable of communication with other doctors and coworkers, both written and oral,
as well as with representativesof the public and various civil
authorities

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Health care teamwork under
supervision
Intraprofessional group reflection

Intermediate objective 15

Teaching methods

Follow-up

To have a pedagogic capability of instructing patients, nextof kin, other doctors, and coworkers, as well as students

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfully completed clinical service and competence achieved, issued bycurrent mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Instruction under supervision

Mentoring under supervisionLeadership competenceIntermediate objective 16

Teaching methods

Follow-up

To be capable of mentoringother doctors and co-workers aswell as students

Clinical service under supervision in a unit where such operations are practised

Certificate
ofsuccessfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate
ofsuccessfullycompleted course, issued bycourse leader

Intraprofessional group reflection

Intermediate objective 17

Teaching methods

Follow-up

To have a capability of leadingin collaboration and dialogue
with a leadership characterisedby participation and activity
development

Clinical service under supervision in a unit where such operations are practised

Certificate
ofsuccessfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate
ofsuccessfullycompleted course, issued bycourse leader

Intraprofessional group reflection
Theoretical studies

Intermediate objective 18

Teaching methods

Follow-up

To have an understanding of theorganisation,
administration,
finances, and regulatory systemsof health care, as well as its
governance, in order to makethe best use of resources

CourseCertificate
ofsuccessfullycompleted course, issued bycourse leader

Theoretical studies

Competence within medical science and quality
work
Intermediate objective 19

Teaching methods

Follow-up

To have skill in a medical scientific viewpoint and approach

Written individual work under
supervision according to scientific principles

Certificate of approved written
individual work, issued by current mentor

Intraprofessional group reflection

Theoretical studies

Intermediate objective 20

Teaching methods

Follow-up

To have an understanding of,and competence in, evidencebased improvement and quality
work.

Quality and development work
under supervision

Certificate of quality and development work, issued by current
mentor

Theoretical studies

Intermediate objective 21

Teaching methods

To have an understanding of thefactors determining health, otheraspects of public health, andmethods for promoting healthand efforts aimed at preventing
illness

Large professional assembly
Theoretical studies

Follow-up

Child and adolescent allergology

Introduction
Explanation of terms
General definition of competencies
Definition of area of competence
Competence requirements
Competence requirements for medical competence
Competence requirements for communicative competence, leadershipcompetence, and competence within medical science and quality work
Training structure
Special recommendations
Intermediate objectives
Medical competenceCommunicative competence
Leadership competence
Competence within medical science and quality work

Introduction

On June 24, 2008, The National Board of Health and Welfare (Socialstyrelsen) decided to issue new regulations and general guidelines for doctors’
specialist medical training (SOSFS 2008:17). The statute consists of a general part with common provisions for all specialties and a specific part withall the descriptions of objectives. The description of objectives for the respective specialties should be understood against the background of the provisions in the general part.
In each description of objectives, there is a section headed ‘Training
structure’, which constitutes general guidelines. The teaching methods under the heading ‘Intermediate objectives’ where no follow-up is indicatedalso constitute general guidelines.

Explanation of terms

current mentor
a specialist doctor whose specialist competence corresponds to the area ofcompetence indicated by the intermediate objective, and who is responsible
for ST doctors’s professional development during the teaching period or forthe method of teaching indicatedthe assignment as a mentor for an ST doctor generally encompasses the entire period of specialist training but can also encompass part or parts of it
auscultation
during mentoring, and in accordance with a pre-designed programme, tostudy the profession of a specialist doctor or other health care staff by following one or several professionals, as well as carrying out assignments in
the relevant area to a certain extent
evaluate
to form a sound opinion of a patient or similar person as a basis for further
management
masterbeing fully able to evaluate and handle the medical investigation, diagnostics, treatment, and follow-up of a patient or similar person, and being fully
able to use the techniques relevant to the area
capability
personal capacity to execute or perform a task
h a ve u n d ers tan d i ng
having acquired knowledge and insight into an area through theoretical studies and/or practical exercise of the profession
have knowledge
having acquired some knowledge in an area through theoretical studies
and/or practical exercise of the profession
mentoring under supervision
as an ST doctor, mentor a co-worker while simultaneously being mentored
by a doctor with specialist competencementorcontinuously, and in dialogue form, supporting and guiding, as well as evaluating, a co-worker’s professional development
mentoringsee mentor
handleto actively carry out measures regarding investigation, diagnostics, treatment, and follow-up of a patient or similar person, and have overall responsibility for carrying out these measuresinitially handle
as the primary physician in charge, to actively carry out measures regarding
investigation, diagnostics, treatment, and follow-up of a patient or similar
person, and have overall responsibility for carrying out these measuresinitially evaluate
as the primary physician in charge, to form a sound opinion of a patient orsimilar person as a basis for further management
intraprofessional group reflection
reflection done in a group together with other doctors, chiefly for the purpose of further education and training
clinical service
health and medical care duties that ST doctors perform under their own professional liability and with the support of a mentor
courseteacher-led training with an established plan, given during a defined periodof timesitting-in
training activity involving an ST doctor observing when a specialist doctor
or other health care staff holds a consultationorassessment activity involving a specialist doctor or other health care staff
observing and evaluating ST doctors during a consultation
seminarinstruction in group form with active participation
training in a simulated environment
training carried out in an environment created to emulate reality

large professional assembly
conference, congress, symposium or similar event
health care centre
health care unit in primary carehealth care team work
work where ST doctors, under supervision, participates in and sometimes
leads a group of co-operating health care staff with various competencies
charged with responsibility for care for an individual patient or group ofpatients

General definition of competences

Definition of area of competence
The specialty of child and adolescent allergology involves an advanced understanding of and skills in handling asthma, other pulmonary diseases, allergic diseases and hypersensitive reactions of a non-allergic nature in children and young people from the ages of 0 to 18 years of age. In addition toinvestigation, diagnostics, treatment, follow-up and care, individual andgeneral preventive activity, an understanding of the importance of environmental factors for primary and secondary prevention and the development ofknowledge within the area are also included.
Child and adolescent allergology is a branch specialty of the base specialty of paediatrics.

Competence requirements
Competence requirements for medical competence
For specialist competence in child and adolescent allergology, the ability to
independently investigate, diagnose, treat, and follow-up asthma, allergicrhinoconjunctivitis, acute allergic reactions and anaphylaxis, acute andchronic urticaria, eczema, food allergies and hypersensitivity to medicinesand vaccines is required. The capability to initially handle other pulmonary
diseases, increased sensitivity to infections and immunodeficiency is also
required.
The capability of working in multidisciplinary allergy teams with themost seriously ill allergic children is also required. In addition to this, thecapability of working as part of a network of doctors and nurses at paediatric clinics, out-patient, primary health care and nursery and school healthservices and the capability of training everyone in the care chain and structuring the transfer of teenagers to adult care are also required. For specialist
competence in child and adolescent allergology, cooperation with representatives of dermatology, clinical physiology, clinical immunology, pulmonary
medicine, allergology, gastroenterology and ear, nose and throat diseases isalso required.
For specialist competence in child and adolescent allergology, an understanding of and skills in diagnostics and the treatment of all commonly occurring diseases and more serious diseases and dysfunctions from the neonatal period until adulthood are also required. In addition, an understandingof the child’s normal growth, rearing and psychomotor and mental development and also diagnostics for the purposes of being able to diagnose deviations from this at an early stage is necessary. The capability of being able
to work in a preventive and family focused manner on general health information, vaccinations and the prevention of accidents is also required. The
capability of taking a comprehensive view of the family with commitment

and respect for the child’s needs, an understanding of how the disease isaffecting the child and its family and the capability to fulfil the child’s entitlement to participate in evaluation and treatment on the basis of its levelof development are required. In order to achieve such competence, it is necessary to be able to work in multidisciplinary teams and work together withother specialists in hospitals and out-patient clinics and with the social services, child welfare, schools, voluntary associations and society’s institutions. For this work, an understanding of and the ability to serve the rights ofchildren and young people in society, both nationally and globally are required.
An ethical and professional approach, good skills in child centered clinicalcare and the capability of advocating a healthy lifestyle among children andyoung people are also required. An understanding of the process for transferring chronically ill young people from paediatric medical care to adultmedical care is also required (intermediate objectives 1–4)

Competence requirements for communicative competence, leadership competence, and competence within medical scienceand quality work
Communicative competence
The equal and responsible patient
Doctors with specialist competence must be capable of dialogue and of
maintaining open contact with patients and their next of kin. Contact should
be characterised by empathy and trust, as well as respect for the patients’right to information, influence, and participation in decisions. Contact
should also be characterised by co-operation and sensitivity to the patients’needs, desires and right to self-determination, as well as providing incentive
for patients’ involvement in, and responsibility for, their own care.
Multicultural and gender aspects
Communication with patients and their next of kin should be characterisedby understanding and respect for cross-cultural and multicultural aspects
such as age, language, ethnicity, sexual orientation, and religion, as well as
gender.
Interprofessional relations
Doctors with specialist competence must be capable of communicating,both in writing and orally, with other doctors and co-workers showing respect for their professional knowledge and competences. The same applies
to contact with representatives of the public and various civil authorities.
Pedagogical skills
Doctors with specialist competence must have pedagogical capability inorder to inform and instruct not only patients and their next of kin, but also
other doctors and co-workers, as well as students.

Professional approach and ethics
Doctors with specialist competence must be capable of working continuously with their professional and medical ethical approaches, with the objectiveof being able to make independent decisions of a medical ethical nature.
Individual professional development
Doctors with specialist competence must develop the capability of continually examining and identifying, together with the requirements of the operation, their own need of in-service training in order to be able to meet thedemand for the best possible care for the patients.

Leadership competence
Collaboration
Doctors with specialist competence must have a developed capability for
self-knowledge and understanding of their own functions and roles in theorganisation.
Mentoring skills
Doctors with specialist competence must be capable of mentoring other doctors and co-workers, as well as students.
Leadership
Doctors with specialist competence must be capable of leadership characterised by collaboration, openness, and dialogue with co-workers. Leadershipmust further be characterised by participation and activity development
aimed at improvement. The ability to lead the work of the health care teamis essential.
System knowledge
Doctors with specialist competence must have an understanding of the organisation, administration, finances, and regulatory systems of health care,
as well as its governance, in order to make the best use of resources.

Competence within medical science and quality work
Medical science
Doctors with specialist competence must be capable of adopting a medicallyscientific outlook and approach, and must have knowledge of research methodology, including basic epidemiological concepts, as well as of methods
for evidence-based medicine and review of scientific information.
Improvement and quality work
Doctors with specialist competence must have an understanding of, andcompetence in, evidence-based improvement and quality work. The objective is to be able to initiate, participate in, and be responsible for continuoussystematic improvement work with emphasis on a holistic perspective, patient safety, patient benefit, measurability, and teaching management in order to be able to review and evaluate their own operations.
Public health and prevention
Doctors with specialist competence must have an understanding of the factors determining health, other aspects of public health, and methods forpromoting health and efforts aimed at preventing injury and illness, in order
to be able to take this understanding into account in medical scientific work.

Training structure
Specialist medical training in child and adolescent allergology can begin
before, during, or after specialist medical training in paediatrics and can be
integrated with it.
Specialist training in child and adolescent allergology should consist ofservice in a paediatric allergy clinic. The training should include both theoretical and practical elements in all areas of the field of child and adolescentallergology and should take place over a longish continuous period of time.
In order for ST doctors to be able to acquire the basics of child and adolescent allergology, it is important that the training can begin with a long
period of basic training. In order for ST doctors to then be able to acquire anadvanced understanding in the area, part of the service should take place at apaediatric allergy clinic at a university clinic or the equivalent. A shorter
part of the training can take place through cross-training at one or more of
the following units: clinical physiology, clinical immunology, ear nose andthroat diseases, skin diseases and adult medical allergy clinic.
It is imperative that ST doctors acquire a scientific way of thinking during
the training. This should result in ST doctors participating in quality anddevelopment work and also in scientific work to such an extent that it can bepresented at a national meeting or another scientific gathering.

Special recommendations
The specialty associations and sections of the medical organisations haveformulated special recommendations for their own specialties. The recommendations concern such issues as how specialist medical training should be
structured.

Intermediate objectives

Medical competenceIntermediate objective 1

Teaching methods

Follow-up

To master an understanding of
the healthy child and young person and the influence that heredity, culture, the environment andsociety have on their development and health

Clinical service under supervision
in a unit where such operations
are practised

Certificate of successfully completed clinical service and competence achieved, issued bycurrent mentor

CourseTo master diagnostics of deviations from normal growth anddevelopment and master healthpromoting work

Certificate of successfully completed course, issued by course
leader

Theoretical studies

To be able to handle psychosocial problems and have an understanding of the relevant legislation

Intermediate objective 2

Teaching methods

Follow-up

To master basic and acutepaediatric conditions

Clinical service under supervision in a unit wheresuch operations are practised

Certificate of successfully completed clinical service and competence achieved, issued bycurrent mentor

CourseCertificate of successfully completed course, issued by course
leaderTraining in a simulated environment
Theoretical studies

Intermediate objective 3

Teaching methods

Follow-up

To be able to handle the mostcommon and frequently occurring
conditions in the areas of neonatology, allergology and pulmonary
diseases, neurology and habilitation, endocrinology and metabolic
disorders, nephrology, gastroenterology hepatology and nutrition,
infectious diseases, immunology
and rheumatology, oncology andhaematology and cardiology

Clinical service under supervision
in a unit where such operations
are practised

Certificate of successfully completed clinical service and competence achieved, issued bycurrent mentor

CourseCertificate of successfully completed course, issued by course
leaderTraining in a simulated environment
Theoretical studies

Intermediate objective 4

Teaching methods

Follow-up

To be able to handle the mostcommon and frequently occurring
conditions within the area of paediatric psychiatry

Clinical service under supervision
in a unit where such operations
are practised

Certificate of successfully completed clinical service and competence achieved, issued bycurrent mentor

Theoretical studies

Intermediate objective 5

Teaching methods

Follow-up

To master investigation, diagnostics, treatment and follow-up ofasthma and allergic rhinoconjunctivitis

Clinical service under supervision
in a unit where such operations
are practised

Certificate of successfully completed clinical service and competence achieved, issued by current
mentorCourseCertificate of successfully completed course, issued by course
leader

To master methods for investigating pulmonary function and evaluating bronchial provocations
To master inhalation treatment forchildren of all ages

Health care teamwork under supervision
Theoretical studies

Intermediate objective 6

Teaching methods

Follow-up

To master investigation, diagnostics, treatment and follow-up ofacute allergic reactions and anaphylaxis

Clinical service under supervision in a unit where such operations are practised

Certificate of successfully completed clinical service and competence achieved, issued by current
mentor

To master providing instructions for the patient's
own acute treatment

CourseCertificate of successfully completed course, issued by course
leader

Health care teamwork under supervision
Theoretical studies

Intermediate objective 7

Teaching methods

Follow-up

To master investigation, diagnostics, treatment and follow-up ofacute and chronic urticaria

Clinical service under supervision
in a unit where such operations arepractised

Certificate of successfully completed clinical service and competence achieved, issued by current
mentorCourseCertificate of successfully completed course, issued by course
leader

Theoretical studies

Intermediate objective 8

Teaching methods

Follow-up

To master investigation, diagnostics, treatment and follow-up ofeczemaClinical service under supervision
in a unit where such operations arepractised

Certificate of successfully completed clinical service and competence achieved, issued by current
mentorCourseCertificate of successfully completed course, issued by course
leader

Health care teamwork under supervision
Theoretical studies

Intermediate objective 9

Teaching methods

Follow-up

To master investigation, diagnostics, treatment and follow-up offoodstuff allergies

Clinical service under supervision in Certificate of successfully completed clinical service and compea unit where such operations aretence achieved, issued by current
practised
mentorTo be able to handle dietetic treatment
CourseCertificate of successfully completed course, issued by course
leader

Health care teamwork under supervision
Theoretical studies

Intermediate objective 10

Teaching methods

Follow-up

To master treatment using allergenspecific immunotherapy, including
investigation of indications, procedures for treatment and follow-up

Clinical service under supervision in a unit where such operations are practised

Certificate of successfully completed clinical service and competence achieved, issued by current
mentorCourseCertificate of successfully completed course, issued by course
leader

Theoretical studies

Intermediate objective 11

Teaching methods

Follow-up

To master investigation, diagnostics, treatment and follow-up of
hypersensitivity to medicines andvaccines and master the vaccination of high-risk patients

Clinical service under supervision in a unit where such operations are practised

Certificate of successfully completed clinical service and competence achieved, issued by current
mentorCourseCertificate of successfully completed course, issued by course
leader

Theoretical studies

Intermediate objective 12

Teaching methods

Clinical service under supervision in
To be able to initially handle thea unit where such operations are
medical investigation, diagnostics
and treatment of pulmonary diseas- practised
es besides asthma, increased sensitivity to infections and immunodeficiency
CourseFollow-up
Certificate of successfully completed clinical service and competence achieved, issued by current
mentorCertificate of successfully completed course, issued by course
leader

Theoretical studies

Communicative competenceIntermediate objective 13

Teaching methods

Follow-up

To be capable of dialogue and open
contact with patients and their nextof kin with respect for the patient’s
right to information, influence andparticipation in decisions and havean understanding and respect forcross-cultural and multicultural aspects such as age, language, ethnicity, sexual orientation, and religion,
as well as gender.

Clinical service under supervision ina unit where such operations arepractised

Certificate of successfully completed clinical service and competence achieved, issued by current
mentorCourseCertificate of successfully completed course, issued by course
leaderSitting-in
Intraprofessional group reflection

Intermediate objective 14

Teaching methods

Follow-up

To be capable of communication
with other doctors and co-workers,
both written and oral, as well as withrepresentatives of the public andvarious civil authorities

Clinical service under supervision ina unit where such operations arepractised

Certificate of successfully completed clinical service and competence achieved, issued by current
mentorCourseCertificate of successfully completed course, issued by course
leader

Health care teamwork under supervision
Intraprofessional group reflection

Intermediate objective 15

Teaching methods

Clinical service under supervision in
To have a pedagogic capability of
instructing patients, next of kin, other a unit where such operations arepractiseddoctors, and co-workers, as well as
students

CourseFollow-up
Certificate of successfully completed clinical service and competence achieved, issued by current
mentorCertificate of successfully completed course, issued by course
leader

Instruction under supervision
Mentoring under supervision

Leadership competenceIntermediate objective 16

Teaching methods

Follow-up

To be capable of mentoring otherdoctors and co-workers as well as
students

Clinical service under supervision ina unit where such operations arepractised

Certificate of successfully completed clinical service and competence achieved, issued by current
mentorCourseCertificate of successfully completed course, issued by course
leaderintraprofessional group reflection

Intermediate objective 17

Teaching methods

Follow-up

To have a capability of leading incollaboration and dialogue with aleadership characterised by participation and activity development

Clinical service under supervision ina unit where such operations arepractised

Certificate of successfully completed clinical service and competence achieved, issued by current
mentorCourseCertificate of successfully completed course, issued by course
leader

Intraprofessional group reflection

Theoretical studies

Intermediate objective 18
To have an understanding of theorganisation, administration, finances, and regulatory systems ofhealth care, as well as its governance, in order to make the best useof resources

Teaching methods
CourseTheoretical studies

Follow-up
Certificate of successfully completed
course, issued by course leader

Competence within medical science and quality
work
Intermediate objective 19

Teaching methods

Follow-up

To have skill in a medical scientificviewpoint and approach

Written individual work under supervision according to scientific principles

Certificate of approved written individual work, issued by current mentor

Intraprofessional group reflection
Theoretical studies

Intermediate objective 20

Teaching methods

Follow-up

To have an understanding of, andcompetence in, evidence-based improvement and quality work.

Quality and development work under
supervision

Certificate of quality and development work, issued by current mentor

Theoretical studies

Intermediate objective 21

Teaching methods

To have an understanding of the factors determining health, other aspectsof public health, and methods for promoting health and efforts aimed atpreventing illness

Large professional assembly
Theoretical studies

Follow-up

Child and adolescent neurology andhabilitation

Introduction
Explanation of terms
General definition of competencies
Definition of area of competence
Competence requirements
Competence requirements for medical competence
Competence requirements for communicative competence, leadershipcompetence, and competence within medical science and quality work
Training structure
Special recommendations
Intermediate objectives
Medical competenceCommunicative competence
Leadership competence
Competence within medical science and quality work

Introduction

On June 24, 2008, The National Board of Health and Welfare (Socialstyrelsen) decided to issue new regulations and general guidelines for doctors’
specialist medical training (SOSFS 2008:17). The statute consists of a general part with common provisions for all specialties and a specific part withall the descriptions of objectives. The description of objectives for the respective specialties should be understood against the background of the provisions in the general part.
In each description of objectives, there is a section headed ‘Training
structure’, which constitutes general guidelines. The teaching methods under the heading ‘Intermediate objectives’ where no follow-up is indicatedalso constitute general guidelines.

Explanation of terms

current mentor
a specialist doctor whose specialist competence corresponds to the area ofcompetence indicated by the intermediate objective, and who is responsible
for ST doctors’s professional development during the teaching period or forthe method of teaching indicatedthe assignment as a mentor for an ST doctor generally encompasses the entire period of specialist training but can also encompass part or parts of it
auscultation
during mentoring, and in accordance with a pre-designed programme, tostudy the profession of a specialist doctor or other health care staff by following one or several professionals, as well as carrying out assignments in
the relevant area to a certain extent
evaluate
to form a sound opinion of a patient or similar person as a basis for further
management
masterbeing fully able to evaluate and handle the medical investigation, diagnostics, treatment, and follow-up of a patient or similar person, and being fully
able to use the techniques relevant to the area
capability
personal capacity to execute or perform a task
h a ve u n d ers tan d i ng
having acquired knowledge and insight into an area through theoretical studies and/or practical exercise of the profession
have knowledge
having acquired some knowledge in an area through theoretical studies
and/or practical exercise of the profession
mentoring under supervision
as an ST doctor, mentor a co-worker while simultaneously being mentored
by a doctor with specialist competencementorcontinuously, and in dialogue form, supporting and guiding, as well as evaluating, a co-worker’s professional development
mentoringsee mentor
handleto actively carry out measures regarding investigation, diagnostics, treatment, and follow-up of a patient or similar person, and have overall responsibility for carrying out these measuresinitially handle
as the primary physician in charge, to actively carry out measures regarding
investigation, diagnostics, treatment, and follow-up of a patient or similar
person, and have overall responsibility for carrying out these measuresinitially evaluate
as the primary physician in charge, to form a sound opinion of a patient orsimilar person as a basis for further management
intraprofessional group reflection
reflection done in a group together with other doctors, chiefly for the purpose of further education and training
clinical service
health and medical care duties that ST doctors perform under their own professional liability and with the support of a mentor
courseteacher-led training with an established plan, given during a defined periodof timesitting-in
training activity involving an ST doctor observing when a specialist doctor
or other health care staff holds a consultationorassessment activity involving a specialist doctor or other health care staff
observing and evaluating ST doctors during a consultation
seminarinstruction in group form with active participation
training in a simulated environment
training carried out in an environment created to emulate reality

large professional assembly
conference, congress, symposium or similar event
health care centre
health care unit in primary carehealth care team work
work where ST doctors, under supervision, participates in and sometimes
leads a group of co-operating health care staff with various competencies
charged with responsibility for care for an individual patient or group ofpatients

Definition of area of competence

The specialty of child and adolescent neurology and habilitation involves
normal and deviating developments in the central nervous system and the
peripheral neuromuscular systems from the period as a foetus up through thechildhood years and the transition to adulthood, 0 to 18 years of age. The
specialty involves prevention, investigation, diagnostics, treatment, followup and the development of knowledge with regard to diseases of and injuries to these systems and overall multidisciplinary handling of accompanying dysfunctions.
Child and adolescent neurology and habilitation is a branch specialty ofthe base specialty of paediatrics.

Competence requirements
Competence requirements for medical competence
For specialist competence in child and adolescent neurology and habilitation, the capability of being able to investigate and treat diseases and conditions in the entire neuropaediatric field independently and in cooperation
with multiprofessional teams, in the area of both child and adolescent neurology and habilitation, is required. It is necessary to master coordination
work, consultancy functions and multi-professional work.
For specialist competence, it is also necessary to master deviations inmental, cognitive and motor skills development, mental retardation, cognitive disorders, cerebral palsy and epilepsy, which are the most common
conditions in the specialty. In addition, it is necessary to be required to beable to handle other conditions, such as inflammatory and degenerative
brain disease. Brain tumours, deformities, including neural tube defects andhydrocephalus are rarer or require a higher degree of specialisation. It is also
necessary to be able to evaluate and initially handle the extremely rare conditions that require complex investigation at a risk level or international level, which constitute a central part of the neuropaediatric field of knowledge.
Common conditions of a paediatric neurological nature, such as headacheand benign febrile seizures and also the handling of epileptic attacks belong
to the paediatrics area of competence.
For specialist competence in child and adolescent neurology and habilitation, an understanding of and skills in diagnostics and the treatment of allcommonly occurring diseases and more serious diseases and dysfunctions
from the newborn period until adulthood is also required. In addition, an
understanding of the normal growth of the child, rearing and psychomotorand mental development and also diagnostics for the purposes of being able
to diagnose deviations from this at an early stage is necessary. The capability of being able to work in a preventive and family focused manner on general health information, vaccinations and the prevention of accidents is also
required. The capability of taking a comprehensive view of the family with

commitment and respect for the child’s needs, an understanding of how thedisease is affecting the child and its family and the capability of fulfillingthe child’s entitlement to participate in evaluation and treatment on the basisof its level of development are required. In order to achieve such competence, it is necessary to be able to work in multidisciplinary teams and work
together with other specialists in hospitals and out-patient clinics and withthe social services, child welfare, schools, voluntary associations and society’s institutions. For this work, an understanding of and the capability of
advocating the rights of children and young people in society, both nationally and globally is required. An ethical and professional approach, goodskills in child centered clinical care, and the capability of advocating ahealthy lifestyle among children and young people are also required. An
understanding of the process for transferring chronically ill young people
from paediatric medical care to adult medical care is also required (intermediate objectives 1–4)

Competence requirements for communicative competence, leadership competence, and competence within medical scienceand quality work
Communicative competence
The equal and responsible patient
Doctors with specialist competence must be capable of dialogue and of
maintaining open contact with patients and their next of kin. Contact should
be characterised by empathy and trust, as well as respect for the patients’right to information, influence, and participation in decisions. Contact
should also be characterised by co-operation and sensitivity to the patients’needs, desires and right to self-determination, as well as providing incentive
for the patients’ involvement in, and responsibility for, their own care.
Multicultural and gender aspects
Communication with patients and their next of kin should be characterisedby understanding and respect for cross-cultural and multicultural aspects
such as age, language, ethnicity, sexual orientation, and religion, as well as
gender.
Interprofessional relations
Doctors with specialist competence must be capable of communicating,both in writing and orally, with other doctors and co-workers showing respect for their professional knowledge and competences. The same applies
to contact with representatives of the public and various civil authorities.
Pedagogical skills
Doctors with specialist competence must have pedagogical capability inorder to inform and instruct not only patients and their next of kin, but also
other doctors and co-workers, as well as students.

Professional approach and ethics
Doctors with specialist competence must be capable of working continuously with their professional and medical ethical approaches, with the objectiveof being able to make independent decisions of a medical ethical nature.
Individual professional development
Doctors with specialist competence must be capable of continually examining and identifying their own needs for professional development, in addition to operational requirements, in order to be able to meet requirements forthe best possible patient care.

Leadership competence
Collaboration
Doctors with specialist competence must have a developed capability for
self-knowledge and understanding of their own functions and roles in theorganisation.
Mentoring skills
Doctors with specialist competence must be capable of mentoring other doctors and co-workers, as well as students.
Leadership
Doctors with specialist competence must be capable of leadership characterised by collaboration, openness, and dialogue with co-workers. Leadershipmust further be characterised by participation and activity development
aimed at improvement. The ability to lead the work of the health care teamis essential.
System knowledge
Doctors with specialist competence must have an understanding of the organisation, administration, finances, and regulatory systems of health care,
as well as its governance, in order to make the best use of resources.

Competence within medical science and quality work
Medical science
Doctors with specialist competence must be capable of adopting a medicallyscientific outlook and approach, and must have knowledge of research methodology, including basic epidemiological concepts, as well as of methods
for evidence-based medicine and review of scientific information.
Improvement and quality work
Doctors with specialist competence must have understanding of, and competence in, evidence-based improvement and quality work. The objective is
to be able to initiate, participate in, and be responsible for continuous sys-tematic improvement work with emphasis on a holistic perspective, patient
safety, patient benefit, measurability, and teaching management in order tobe able to review and evaluate their own operations.
Public health and prevention
Doctors with specialist competence must have an understanding of the factors determining health, other aspects of public health, and methods forpromoting health and efforts aimed at preventing injury and illness, in order
to be able to take this understanding into account in medical scientific work.

Training structure
Specialist medical training in child and adolescent neurology and habilitation can begin before, during, or after specialist medical training in paediatrics and can be integrated with it.
The neuropaediatric training should take place through service during connected periods in child and adolescent neurology and paediatric habilitation,
integrated with theoretical studies, courses and vocational gatherings.
The paediatric neurological service should be completed with a focus onacute, possibly recurring, conditions and neurological investigation. The
service should mainly take place at a regional hospital with a child and adolescent neurology unit.
Service in paediatric habilitation will be completed within the habilitation's
multidisciplinary structure, focusing on children and young people withneurological dysfunctions. Special emphasis should be put on the doctor’s
training in medically leading a team in paediatric habilitation.
Cross-training should be included in the training, primarily in the form ofservice in clinical neurophysiology and adult neurology. The training may
also include service in clinical genetics, paediatric neuropsychiatry, neurosurgery and neuroradiology.

Special recommendations
The specialty associations and sections of the medical organisations haveformulated special recommendations for their own specialties. The recommendations concern such issues as how specialist medical training should be
structured.

Intermediate objectives

Medical competenceIntermediate objective 1

Teaching methods

Follow-up

To master an understanding of the healthy child andyoung person and the influence that heredity, culture,
the environment and society have on their development and health

Clinical service under supervision in a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

To master diagnostics ofdeviations from normal
growth and development
and master healthpromoting work

Theoretical studies{0>Att kunna handlägga
psykosociala problem samt
att ha kännedom om relevant lagstiftning<}0{>To beable to handle psychosocial
problems and have an understanding of relevant
legislation

Intermediate objective 2

Teaching methods

Follow-up

To master basic and acutepaediatric conditions

Clinical service under supervision in a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Training in a simulated environment
Theoretical studies

Intermediate objective 3

Teaching methods

Follow-up

To be able to handle themost common and frequently occurring conditions in
the areas of neonatology,
allergology and pulmonary
diseases, neurology andhabilitation, endocrinology
and metabolic disorders,
nephrology, hepatology andnutrition, infectious diseases, immunology and rheumatology, oncology andhaematology and cardiology

Clinical service under
supervision in a unit
where such operations
are practised

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Training in a simulated environment
Theoretical studies

Intermediate objective 4

Teaching methods

Follow-up

To be able to handle themost common and frequently occurring conditions
within the area of paediatric
psychiatry

Clinical service under supervision in a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

Theoretical studies

Intermediate objective 5

Teaching methods

Follow-up

To master clinical and laboratory supported investigation and treatment of
epilepsy and other paroxysmal conditions.

Clinical service under
supervision in a unit that
handles these conditions

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Theoretical studies

Intermediate objective 6

Teaching methods

Follow-up

To master mental, cognitiveand social developments
and deviations in these

Clinical service under supervision in a unit that handles these conditions

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

To master investigation andhabilitation of mental retardation and disorders involving the degree of activity
and attentiveness and master autistic spectrum disorders and other cognitive
disorders

Clinical service under supervision in a unit wheresuch operations are practised

CourseHealth care teamwork under supervision
Theoretical studies

Certificate of successfullycompleted course, issuedby course leader

Intermediate objective 7

Teaching methods

Follow-up

To master investigation,
treatment and habilitationand deviations in motor skill
development, cerebral palsy and neural tube defects
as well as in hydrocephalus

Clinical service under supervision in a unit that handles these conditions

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Health care teamwork under supervision
Theoretical studies

Intermediate objective 8

Teaching methods

Follow-up

To be able to handle clinically and laboratory supported investigations,
treatment and rehabilitationof acquired injuries to thenervous system of a vascular, metabolic, inflammatory,
infectious or traumatic nature

Clinical service under
supervision in a unit that
handles these conditions

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

Health care teamwork under supervision
Theoretical studies

Intermediate objective 9

Teaching methods

To be able to handle neurological conditions during theneonatal period, including
dysmorphic conditions andgenetic syndromes

Auscultation under supervision in a unit that handles
these conditions
CourseCertificate of successfullycompleted course, issuedby course leader

Intermediate objective 10

Teaching methods

Follow-up

To be able to handle clinically and laboratory supported diagnostics andhabilitation of neuromuscular diseases

Auscultation under supervision in a unit that handles
these conditions
Course or large occupation
related conference

Follow-up

Certificate of successfullycompleted course, issuedby course leader

Theoretical studies

Intermediate objective 11

Teaching methods

Follow-up

To be able to handle statesof anxiety, painful conditions, complicated headache and be able to handle
sleep and wakefulness
disorders

Clinical service under supervision in a unit that handles these conditions

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

Theoretical studies

Intermediate objective 12

Teaching methods

Follow-up

To be able to handle tumour diseases of the central nervous system in children and young people

Clinical service under
supervision in a unit that
handles these conditions

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

Theoretical studies

Communicative competenceIntermediate objective 13

Teaching methods

Follow-up

To be capable of dialogue
and open contact with patients and their next of kin
with respect for the patient’s
right to information, influence and participation indecisions and have an understanding and respect forcross-cultural and multicultural aspects such as age,
language, ethnicity, sexual
orientation, and religion, as
well as gender.

Clinical service under supervision in a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Intermediate objective 14

Teaching methods

Follow-up

To be capable of communication with other doctors
and co-workers, both written
and oral, as well as withrepresentatives of the public
and various civil authorities

Clinical service under supervision in a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Sitting-in
Intraprofessional groupreflection

Health care teamwork under
supervision
Intraprofessional groupreflection

Intermediate objective 15

Teaching methods

Follow-up

To have a pedagogic capability of instructing patients,
next of kin, other doctors,
and co-workers, as well as
students

Clinical service under supervision in a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Instruction under supervision
Mentoring under supervision

Leadership competenceIntermediate objective 16

Teaching methods

Follow-up

To be capable of mentoringother doctors and coworkers as well as students

Clinical service under supervision in a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Intraprofessional groupreflection

Intermediate objective 17

Teaching methods

Follow-up

To have a capability ofleading in collaboration anddialogue with a leadershipcharacterised by participation and activity development

Clinical service under supervision in a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Intraprofessional groupreflection
Theoretical studies

Intermediate objective 18

Teaching methods

Follow-up

To have an understandingof the organisation, administration, finances, andregulatory systems ofhealth care, as well as its
governance, in order tomake the best use of resources

CourseCertificate of successfullycompleted course, issuedby course leader

Theoretical studies

Competence within medical science and quality
work
Intermediate objective 19

Teaching methods

Follow-up

To have skill in a medical
scientific viewpoint andapproach

Written individual work under supervision according
to scientific principles

Certificate of approved
written individual work,
issued by current mentor

Intraprofessional groupreflection
Theoretical studies

Intermediate objective 20

Teaching methods

Follow-up

To have an understandingof, and competence in,evidence-based improvement and quality work.

Quality and development
work under supervision

Certificate of quality anddevelopment work, issued
by current mentor

Theoretical studies

Intermediate objective 21

Teaching methods

To have an understandingof the factors determining
health, other aspects ofpublic health, and methods
for promoting health andefforts aimed at preventing
illness

Large professional assembly
Theoretical studies

Follow-up

Neonatology

Introduction
Explanation of terms
General definition of competencies
Definition of area of competence
Competence requirements
Competence requirements for medical competence
Competence requirements for communicative competence, leadershipcompetence, and competence within medical science and quality work
Training structure
Special recommendations
Intermediate objectives
Medical competenceCommunicative competence
Leadership competence
Competence within medical science and quality work

Introduction

On June 24, 2008, The National Board of Health and Welfare (Socialstyrelsen) decided to issue new regulations and general guidelines for doctors’
specialist medical training (SOSFS 2008:17). The statute consists of a general part with common provisions for all specialties and a specific part withall the descriptions of objectives. The description of objectives for the respective specialties should be understood against the background of the provisions in the general part.
In each description of objectives, there is a section headed ‘Training
structure’, which constitutes general guidelines. The teaching methods under the heading ‘Intermediate objectives’ where no follow-up is indicatedalso constitute general guidelines.

Explanation of terms

current mentor
a specialist doctor whose specialist competence corresponds to the area ofcompetence indicated by the intermediate objective, and who is responsible
for ST doctors’s professional development during the teaching period or forthe method of teaching indicatedthe assignment as a mentor for an ST doctor generally encompasses the entire period of specialist training but can also encompass part or parts of it
auscultation
during mentoring, and in accordance with a pre-designed programme, tostudy the profession of a specialist doctor or other health care staff by following one or several professionals, as well as carrying out assignments in
the relevant area to a certain extent
evaluate
to form a sound opinion of a patient or similar person as a basis for further
management
masterbeing fully able to evaluate and handle the medical investigation, diagnostics, treatment, and follow-up of a patient or similar person, and being fully
able to use the techniques relevant to the area
capability
personal capacity to execute or perform a task
h a ve u n d ers tan d i ng
having acquired knowledge and insight into an area through theoretical studies and/or practical exercise of the profession
have knowledge
having acquired some knowledge in an area through theoretical studies
and/or practical exercise of the profession
mentoring under supervision
as an ST doctor, mentor a co-worker while simultaneously being mentored
by a doctor with specialist competencementorcontinuously, and in dialogue form, supporting and guiding, as well as evaluating, a co-worker’s professional development
mentoringsee mentor
handleto actively carry out measures regarding investigation, diagnostics, treatment, and follow-up of a patient or similar person, and have overall responsibility for carrying out these measuresinitially handle
as the primary physician in charge, to actively carry out measures regarding
investigation, diagnostics, treatment, and follow-up of a patient or similar
person, and have overall responsibility for carrying out these measuresinitially evaluate
as the primary physician in charge, to form a sound opinion of a patient orsimilar person as a basis for further management
intraprofessional group reflection
reflection done in a group together with other doctors, chiefly for the purpose of further education and training
clinical service
health and medical care duties that ST doctors perform under their own professional liability and with the support of a mentor
courseteacher-led training with an established plan, given during a defined periodof timesitting-in
training activity involving an ST doctor observing when a specialist doctor
or other health care staff holds a consultationorassessment activity involving a specialist doctor or other health care staff
observing and evaluating ST doctors during a consultation
seminarinstruction in group form with active participation
training in a simulated environment
training carried out in an environment created to emulate reality

large professional assembly
conference, congress, symposium or similar event
health care centre
health care unit in primary carehealth care team work
work where ST doctors, under supervision, participates in and sometimes
leads a group of co-operating health care staff with various competencies
charged with responsibility for care for an individual patient or group ofpatients

General definition of competences

Definition of area of competence
The specialty of neonatology involves special knowledge and understandingof health and ill health during the neonatal period. It involves an understanding of the unborn, newborn and infant child’s normal growth and development and prevention, investigation, diagnostics, treatment, follow up anddevelopment of knowledge regarding diseases, disorders and injuries in the
newborn child.
Neonatology is a branch specialty of the base specialty of paediatrics.

Competence requirements
Competence requirements for medical competence
For specialist competence in neonatology, an understanding and practicalskills in diagnostics and treatment of all common diseases and serious diseases during the neonatal period are required. In addition, an understandingof the newborn child's normal adaptation, growth, rearing and psychomotor
development and also diagnostics for the purposes of being able to demonstrate deviations from this at an early stage are necessary.
In addition, the capability of cooperation with obstetrics regarding highrisk pregnancies in order to plan together for an appropriate time and location for the delivery and a suitable means of delivery is required. The capability of taking a comprehensive view of the family with commitment andrespect for the newborn’s needs and integrity and how the disease is affecting the child and its family is also required. An ethical and professional approach, as well as skills in clinical care, with the newborn’s needs at thecentre, is also required.
For specialist competence in neonatology, an understanding of and skills
in diagnostics and the treatment of all commonly occurring diseases andmore serious diseases and dysfunctions from the newborn period until
adulthood are required. In addition, an understanding of the child’s, normal
growth rearing and psychomotor and mental development and also diagnostics for the purposes of being able to diagnose deviations from this at an
early stage is necessary. The capability of being able to work in a preventive
and family focused manner on general health information, vaccinations andthe prevention of accidents is also required. The capability of taking a comprehensive view of the family with commitment and respect for the child’s
needs, an understanding of how the disease is affecting the child and its
family and the capability of fulfilling the child’s entitlement to participate inevaluation and treatment on the basis of its level of development are required. In order to achieve this competence, it is necessary to be able towork in multidisciplinary teams and work together with other specialists in
hospitals and out-patient clinics and with the social services, child welfare,schools, voluntary associations and society’s institutions. For this work, an
understanding of and the ability to serve the rights of children and young
people in society, both nationally and globally are required. An ethical andprofessional approach, good skills in child centered clinical care and thecapability of advocating a healthy lifestyle among children and young
people are also required. An understanding of the process for transferring
chronically ill young people from paediatric medical care to adult medicalcare is also required (intermediate objectives 1–4)

Competence requirements for communicative competence, leadership competence, and competence within medical scienceand quality work
Communicative competence
The equal and responsible patient
Doctors with specialist competence must be capable of dialogue and of
maintaining open contact with patients and their next of kin. Contact should
be characterised by empathy and trust, as well as respect for the patients’right to information, influence, and participation in decisions. Contact
should also be characterised by co-operation and sensitivity to the patients’needs, desires and right to self-determination, as well as providing incentive
for the patients’ involvement in, and responsibility for, their own care.
Multicultural and gender aspects
Communication with patients and their next of kin should be characterisedby understanding and respect for cross-cultural and multicultural aspects
such as age, language, ethnicity, sexual orientation, and religion, as well as
gender.
Interprofessional relations
Doctors with specialist competence must be capable of communicating,both in writing and orally, with other doctors and co-workers showing respect for their professional knowledge and competences. The same applies
to contact with representatives of the public and various civil authorities.
Pedagogical skills
Doctors with specialist competence must have pedagogical capability inorder to inform and instruct not only patients and their next of kin, but also
other doctors and co-workers, as well as students.
Professional approach and ethics
Doctors with specialist competence must be capable of working continuously with their professional and medical ethical approaches, with the objectiveof being able to make independent decisions of a medical ethical nature.

Individual professional development
Doctors with specialist competence must be capable of continually examining and identifying their own needs for professional development, in addition to operational requirements, in order to be able to meet requirements forthe best possible patient care.

Leadership competence
Collaboration
Doctors with specialist competence must have a developed capability for
self-knowledge and understanding of their own functions and roles in theorganisation.
Mentoring skills
Doctors with specialist competence must be capable of mentoring other doctors and co-workers, as well as students.
Leadership
Doctors with specialist competence must be capable of leadership characterised by collaboration, openness, and dialogue with co-workers. Leadershipmust further be characterised by participation and activity development
aimed at improvement. The ability to lead the work of the health care teamis essential.
System knowledge
Doctors with specialist competence must have an understanding of the organisation, administration, finances, and regulatory systems of health care,
as well as its governance, in order to make the best use of resources.

Competence within medical science and quality work
Medical science
Doctors with specialist competence must be capable of adopting a medicallyscientific outlook and approach, and must have knowledge of research methodology, including basic epidemiological concepts, as well as of methods
for evidence-based medicine and review of scientific information.
Improvement and quality work
Doctors with specialist competence must have an understanding of, andcompetence in, evidence-based improvement and quality work. The objective is to be able to initiate, participate in, and be responsible for continuous
systematic improvement work with emphasis on a holistic perspective, patient safety, patient benefit, measurability, and teaching management in order to be able to review and evaluate their own operations.

Public health and prevention
Doctors with specialist competence must have an understanding of the factors determining health, other aspects of public health, and methods forpromoting health and efforts aimed at preventing injury and illness, in order
to be able to take this understanding into account in medical scientific work.

Training structure
Specialist medical training in neonatology can begin before, during, or after
specialist medical training in paediatrics and can be integrated with this.
Specialist training should consist of service at a neonatal unit, including
service at a neonatal intensive care ward at a university hospital. It is imperative that there is a continuous period of service at a university hospital.
Service as a neonatal on-call duty doctor should be included in the training.
The training should be integrated with theoretical studies, courses and regularly recurring further training meetings and conferences. The training
should include service at a maternity ward, another intensive care ward anda paediatric cardiology unit. During the training period, it is imperative thata scientific way of thinking is acquired and that it results in ST doctors participating in quality and development work and, preferably, also in a scientific work of such as scope that it can be presented at a national meeting orsome other scientific gathering.

Special recommendations
The specialty associations and sections of the medical organisations haveformulated special recommendations for their own specialties. The recommendations concern such issues as how specialist medical training should be
structured.

Intermediate objectives

Medical competenceIntermediate objective 1

Teaching methods

Follow-up

To master an understanding of the healthy child andyoung person and the influence that heredity, culture,
the environment and society have on their development and health

Clinical service under supervision in a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

To master diagnostics ofdeviations from normal
growth and development
and master healthpromoting work
Theoretical studies
To be able to handle psychosocial problems andhave an understanding of
relevant legislation

Intermediate objective 2

Teaching methods

Follow-up

To master basic and acutepaediatric conditions

Clinical service under supervision in a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Training in a simulated
environment
Theoretical studies

Intermediate objective 3

Teaching methods

Follow-up

To be able to handle themost common and frequently occurring conditionsin the areas of neonatology,
allergology and pulmonary
diseases, neurology andhabilitation, endocrinology
and metabolic disorders,
nephrology, hepatology andnutrition, infectious diseases, immunology and rheumatology, oncology andhaematology and cardiology

Clinical service under
supervision in a unit
where such operations
are practised

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Training in a simulated
environment
Theoretical studies

Intermediate objective 4

Teaching methods

Follow-up

To be able to handle themost common and frequently occurring conditions within the area of paediatric
psychiatry

Clinical service under supervision in a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

Theoretical studies

Intermediate objective 5
To master an understandingof the unborn child and beable to handle and plan for
optimum delivery conditions

Teaching methods
Clinical service under
supervision in a unit
where such operations
are practised

Follow-up
Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Training in a simulated environment
Theoretical studies

Intermediate objective 6

Teaching methods

Follow-up

To master an understandingof the newborn child and theaffect and adjustment thatbirth constitutes and masterdeviations from normal
adaptation

Clinical service under
supervision in a unit
where such operations
are practised

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Training in a simulated
environment
Theoretical studies

Intermediate objective 7

Teaching methods

Follow-up

To master an understanding of the premature childand the affect, adjustment
and immaturity of variousorgan systems that premature birth entails

Clinical service under
supervision in a unit
where such operations
are practised

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Training in a simulated
environment
Theoretical studies

Intermediate objective 8

Teaching methods

Follow-up

To master cardiopulmonary
resuscitation of newborn
children with asphyxia andthe complications this could
entailClinical service under
supervision in a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

To master an ethical approach in connection withserious asphyxia and to beable to handle the follow-up
of these children

CourseCertificate of successfullycompleted course, issuedby course leader

Training in a simulated
environment
Theoretical studies

Intermediate objective 9

Teaching methods

Follow-up

To be able to handle deformities of different organsystems during the neonatal
period, including syndromes, neuromuscular andmetabolic disorders

Clinical service under supervision in a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Theoretical studies

Intermediate objective 10

Teaching methods

Follow-up

To master infectious diseases and hygiene procedures during the neonatal
periodClinical service under supervision in a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Theoretical studies

Intermediate objective 11

Teaching methods

Follow-up

To master the medical tech- Clinical service under sunology equipment used inpervision in a unit where
the specialty and mastersuch operations are practised
neonatal transport

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

To master ultrasound diagnostics and the interpretation of information regarding
deviations in the CNS and in
the heart’s anatomy andfunction

CourseCertificate of successfullycompleted course, issuedby course leader

Intermediate objective 12

Teaching methods

Follow-up

To master follow-up procedures and evaluation of thedevelopment of prematurechildren and children thathave been ill during theneonatal period

Clinical service under supervision in a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Theoretical studies

Theoretical studies

Communicative competenceIntermediate objective 13

Teaching methods

Follow-up

To be capable of dialogue
and open contact with patients and their next of kin
with respect for the patient’s
right to information, influence and participation indecisions and have an understanding and respect forcross-cultural and multicultural aspects such as age,
language, ethnicity, sexual
orientation, and religion, as
well as gender.

Clinical service under supervision in a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor
Clinical service under supervision in a unit wheresuch operations are practised

CourseSitting-in
Intraprofessional groupreflection

Certificate of successfullycompleted course, issuedby course leader

Intermediate objective 14

Teaching methods

To be capable of communi- Clinical service under sucation with other doctors
pervision in a unit where
and co-workers, both written such operations are pracand oral, as well as with
tised
representatives of the public
and various civil authorities
CourseFollow-up
Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

Certificate of successfullycompleted course, issuedby course leader

Health care teamwork under supervision
Intraprofessional groupreflection

Intermediate objective 15

Teaching methods

Follow-up

To have a pedagogic capability of instructing patients,
next of kin, other doctors,
and co-workers, as well as
students

Clinical service under supervision in a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Instruction under supervision
Mentoring under supervision

Leadership competenceIntermediate objective 16

Teaching methods

Follow-up

To be capable of mentoringother doctors and coworkers as well as students

Clinical service under supervision in a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor
Clinical service under supervision in a unit wheresuch operations are practised

CourseIntraprofessional groupreflection

Certificate of successfullycompleted course, issuedby course leader

Intermediate objective 17

Teaching methods

Follow-up

To have a capability ofleading in collaboration anddialogue with a leadershipcharacterised by participation and activity development

Clinical service under supervision in a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Intraprofessional groupreflection
Theoretical studies

Intermediate objective 18

Teaching methods
CourseTo have an understandingof the organisation, administration, finances, andregulatory systems of healthcare, as well as its goverTheoretical studies
nance, in order to make thebest use of resources

Follow-up
Certificate of successfullycompleted course, issuedby course leader

Competence within medical science and quality
work
Intermediate objective 19

Teaching methods

Follow-up

To have skill in a medical
scientific viewpoint andapproach

Written individual work under supervision according toscientific principles

Certificate of approved
written individual work,
issued by current mentor

Intraprofessional groupreflection
Theoretical studies

Intermediate objective 20

Teaching methods

To have an understandingof, and competence in,evidence-based improvement and quality work.

Quality and development
work under supervision

Theoretical studies

Follow-up

Certificate of quality anddevelopment work, issued
by current mentor

Intermediate objective 21

Teaching methods

To have an understandingof the factors determining
health, other aspects ofpublic health, and methods
for promoting health andefforts aimed at preventing
illness

Large professional assembly
Theoretical studies

Follow-up

Paediatric oncology

Introduction
Explanation of terms
General definition of competencies
Definition of area of competence
Competence requirements
Competence requirements for medical competence
Competence requirements for communicative competence, leadershipcompetence, and competence within medical science and quality work
Training structure
Special recommendations
Intermediate objectives
Medical competenceCommunicative competence
Leadership competence
Competence within medical science and quality work

Introduction

On June 24, 2008, The National Board of Health and Welfare (Socialstyrelsen) decided to issue new regulations and general guidelines for doctors’
specialist medical training (SOSFS 2008:17). The statute consists of a general part with common provisions for all specialties and a specific part withall the descriptions of objectives. The description of objectives for the respective specialties should be understood against the background of the provisions in the general part.
In each description of objectives, there is a section headed ‘Training
structure’, which constitutes general guidelines. The teaching methods under the heading ‘Intermediate objectives’ where no follow-up is indicatedalso constitute general guidelines.

Explanation of terms

current mentor
a specialist doctor whose specialist competence corresponds to the area ofcompetence indicated by the intermediate objective, and who is responsible
for ST doctors’s professional development during the teaching period or forthe method of teaching indicatedthe assignment as a mentor for an ST doctor generally encompasses the entire period of specialist training but can also encompass part or parts of it
auscultation
during mentoring, and in accordance with a pre-designed programme, tostudy the profession of a specialist doctor or other health care staff by following one or several professionals, as well as carrying out assignments in
the relevant area to a certain extent
evaluate
to form a sound opinion of a patient or similar person as a basis for further
management
masterbeing fully able to evaluate and handle the medical investigation, diagnostics, treatment, and follow-up of a patient or similar person, and being fully
able to use the techniques relevant to the area
capability
personal capacity to execute or perform a task
h a ve u n d ers tan d i ng
having acquired knowledge and insight into an area through theoretical studies and/or practical exercise of the profession
have knowledge
having acquired some knowledge in an area through theoretical studies
and/or practical exercise of the profession
mentoring under supervision
as an ST doctor, mentor a co-worker while simultaneously being mentored
by a doctor with specialist competencementorcontinuously, and in dialogue form, supporting and guiding, as well as evaluating, a co-worker’s professional development
mentoringsee mentor
handleto actively carry out measures regarding investigation, diagnostics, treatment, and follow-up of a patient or similar person, and have overall responsibility for carrying out these measuresinitially handle
as the primary physician in charge, to actively carry out measures regarding
investigation, diagnostics, treatment, and follow-up of a patient or similar
person, and have overall responsibility for carrying out these measuresinitially evaluate
as the primary physician in charge, to form a sound opinion of a patient orsimilar person as a basis for further management
intraprofessional group reflection
reflection done in a group together with other doctors, chiefly for the purpose of further education and training
clinical service
health and medical care duties that ST doctors perform under their own professional liability and with the support of a mentor
courseteacher-led training with an established plan, given during a defined periodof timesitting-in
training activity involving an ST doctor observing when a specialist doctor
or other health care staff holds a consultationorassessment activity involving a specialist doctor or other health care staff
observing and evaluating ST doctors during a consultation
seminarinstruction in group form with active participation
training in a simulated environment
training carried out in an environment created to emulate reality

large professional assembly
conference, congress, symposium or similar event
health care centre
health care unit in primary carehealth care team work
work where ST doctors, under supervision, participates in and sometimes
leads a group of co-operating health care staff with various competencies
charged with responsibility for care for an individual patient or group ofpatients

General definition of competences

Definition of area of competence
The specialty of paediatric oncology involves an understanding of oncological and haematological diseases in children and young people from 0 to 18
years of age. The specialty involves epidemiology, investigation, diagnostics, treatment and follow-up of cancer and blood diseases in children andyoung people. The development of knowledge is also part of the area ofcompetence. Late complications that may occur after treating these diseases
during the childhood years are also part of the specialty.
Paediatric oncology is a branch specialty of the base specialty of paediatrics.

Competence requirements
Competence requirements for medical competence
For specialist competence in paediatric oncology, an understanding of andskills in diagnostics and therapy covering the cancer diseases and nonmalignant haematological diseases that occur in children and young people
are required. An understanding of and capability of being able to initiallyhandle haematological malignancies, lymphomas, solid tumours, including
neuroblastoma, nephroblastoma, soft tissue sarcoma, skeletal tumours andtumours of the central nervous system are also required. In addition, an understanding of and capability of being able to initially handle non-malignant
haematological diseases and coagulation disorders is necessary.
An understanding of the molecular biological background of malignant
diseases, the capability of being able to handle suspected malignant diseases
and taking responsibility for the differential diagnostic investigation andbeing able to handle children with leukaemia are also required.
The competence requirement also involves the capability of prescribing
cytostatic agents with their special safety requirements and being able tohandle acute complications following cytostatic treatment.
An understanding of nutrition, antiemetic treatment and pain treatment forthe patient group in question is also required.
For specialist competence, capability of working in multidisciplinary
teams and cooperating with representatives of related specialties is also required. For specialist competence, skill in a medical scientific view and approach, which is relevant to the specialty, and the capability of cooperating
nationally and internationally in the field of knowledge are also required.
For specialist competence in paediatric oncology, an understanding of andskills in diagnostics and the treatment of all common diseases and more serious diseases and dysfunctions from the neonatal period until adulthood arealso required. In addition, an understanding of the child’s normal growth,rearing and psychomotor and mental development and also diagnostics forthe purposes of being able to diagnose deviations from this at an early stage
is necessary. The capability of being able to work in a preventive and family
focused manner on general health information, vaccinations and the prevention of accidents is also required. The capability of taking a comprehensive
view of the family with commitment and respect for the child’s needs, anunderstanding of how the disease is affecting the child and its family and thecapability of fulfilling the child’s entitlement to participate in evaluation andtreatment on the basis of its level of development are required. In order toachieve this competence, it is necessary to be able to work in multidisciplinary teams and work together with other specialists in hospitals and outpatient clinics and with the social services, child welfare, schools, voluntary
associations and society’s institutions. For this work, an understanding ofand the ability to serve the rights of children and young people in society,both nationally and globally, are required. An ethical and professional approach, good skills in child centered clinical care and the capability of advocating a healthy lifestyle among children and young people are also required. An understanding of the process for transferring chronically ill
young people from paediatric medical care to adult medical care is also required (intermediate objectives 1–4)

Competence requirements for communicative competence, leadership competence, and competence within medical scienceand quality work
Communicative competence
The equal and responsible patient
Doctors with specialist competence must be capable of dialogue and of
maintaining open contact with patients and their next of kin. Contact should
be characterised by empathy and trust, as well as respect for the patients’right to information, influence, and participation in decisions. Contact
should also be characterised by co-operation and sensitivity to the patients’needs, desires and right to self-determination, as well as providing incentive
for the patients’ involvement in, and responsibility for, their own care.
Multicultural and gender aspects
Communication with patients and their next of kin should be characterisedby understanding and respect for cross-cultural and multicultural aspects
such as age, language, ethnicity, sexual orientation, and religion, as well as
gender.
Interprofessional relations
Doctors with specialist competence must be capable of communicating,both in writing and orally, with other doctors and co-workers showing respect for their professional knowledge and competences. The same applies
to contact with representatives of the public and various civil authorities.

Pedagogical skills
Doctors with specialist competence must have pedagogical capability inorder to inform and instruct not only patients and their next of kin, but also
other doctors and co-workers, as well as students.
Professional approach and ethics
Doctors with specialist competence must be capable of working continuously with their professional and medical ethical approaches, with the objectiveof being able to make independent decisions of a medical ethical nature.
Individual professional development
Doctors with specialist competence must be capable of continually examining and identifying their own needs for professional development, in addition to operational requirements, in order to be able to meet requirements forthe best possible patient care.

Leadership competence
Collaboration
Doctors with specialist competence must have a developed capability for
self-knowledge and understanding of their own functions and roles in theorganisation.
Mentoring skills
Doctors with specialist competence must be capable of mentoring other doctors and co-workers, as well as students.
Leadership
Doctors with specialist competence must be capable of leadership characterised by collaboration, openness, and dialogue with co-workers. Leadershipmust further be characterised by participation and activity development
aimed at improvement. The ability to lead the work of the health care teamis essential.
System knowledge
Doctors with specialist competence must have an understanding of the organisation, administration, finances, and regulatory systems of health care,
as well as its governance, in order to make the best use of resources.

Competence within medical science and quality work
Medical science
Doctors with specialist competence must be capable of adopting a medicallyscientific outlook and approach, and must have knowledge of research methodology, including basic epidemiological concepts, as well as of methods
for evidence-based medicine and review of scientific information.

Improvement and quality work
Doctors with specialist competence must have an understanding of, andcompetence in, evidence-based improvement and quality work. The objective is to be able to initiate, participate in, and be responsible for continuous
systematic improvement work with emphasis on a holistic perspective, patient safety, patient benefit, measurability, and teaching management in order to be able to review and evaluate their own operations.
Public health and prevention
Doctors with specialist competence must have an understanding of the factors determining health, other aspects of public health, and methods forpromoting health and efforts aimed at preventing injury and illness, in order
to be able to take this understanding into account in medical scientific workand quality work.

Training structure
Specialist medical training in paediatric oncology can begin before, during,or after specialist medical training in the specialty of paediatrics and can be
integrated with this.
In addition to cross-training during service in paediatric psychiatry, service in other areas of knowledge may be of value for the training, primarily
in a haematological laboratory, a radiotherapy and oncology unit or otheractivities relevant to the specialty.
It is very important that service in paediatric oncology takes place at auniversity hospital at a paediatric oncology centre. This service should takeplace over longer continuous periods and include participation in the handling of children with oncological and haematological diseases and should
result in practical skills in diagnostics, treatment and follow-up of children
with oncological and haematological diseases. It is also very important thatthe service develops the competence of being able to work in a team and thecapability of being able to participate in national and international collaboration projects.
During the training period, it is imperative that ST doctors acquire ascientific way of thinking. This should result in a scientific work and also in
quality and development work.

Special recommendations
The specialty associations and sections of the medical organisations haveformulated special recommendations for their own specialties. The recommendations concern such issues as how specialist medical training should be
structured.

Intermediate objectives

Medical competenceIntermediate objective 1

Teaching methods

Follow-up

To master an understandingof the healthy child andyoung person and the influence that heredity, culture,
the environment and society
have on their development
and health

Clinical service under supervision in a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

To master diagnostics ofdeviations from normal
growth and development
and master healthpromoting work

Theoretical studies

To be able to handle psychosocial problems andhave an understanding of
relevant legislation

Intermediate objective 2

Teaching methods

Follow-up

To master basic and acutepaediatric conditions

Clinical service under supervision in a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Training in a simulated
environment
Theoretical studies

Intermediate objective 3

Teaching methods

Follow-up

To be able to handle themost common and frequently occurring conditions in
the areas of neonatology,
allergology and pulmonary
diseases, neurology andhabilitation, endocrinology
and metabolic disorders,
nephrology, hepatology andnutrition, infectious diseases, immunology and rheumatology, oncology andhaematology and cardiology

Clinical service under
supervision in a unit
where such operations
are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of passed course
issued by mentor

Training in a simulated
environment
Theoretical studies

Intermediate objective 4

Teaching methods

Follow-up

To be able to initially handle
the most common and frequently occurring conditions
within the area of paediatric
psychiatry

Clinical service under supervision in a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

Theoretical studies

Intermediate objective 5

Teaching methods

Follow-up

To master ordinary andserious conditions in nonmalignant haematology inchildren and young people

Clinical service under supervision in a unit that handles these conditions

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Theoretical studies

Intermediate objective 6

Teaching methods

Follow-up

To be able to evaluate
children and young people
with haemoglobinpathies,
coagulation disorders anduncommon non-malignant
haematological diseases
and their chronic sequelae

Clinical service under
supervision in a unit that
handles these conditions

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

Auscultation under supervision in a unit that handles
these conditions
CourseCertificate of successfullycompleted course, issuedby course leader

Theoretical studies

Intermediate objective 7

Teaching methods

Follow-up

To master handling of leukaemia and lymphoma inchildren and young people
and their acute treatmentcomplications

Clinical service under supervision in a unit that handles these conditions

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

To master the carrying out
of bone marrow aspiration
and bone marrow biopsies
and intrathecal cytostatic
treatment
To have an understandingof late complications ofdiseases and treatment

Theoretical studies

Intermediate objective 8

Teaching methods

Follow-up

To be able to initially handle
the medical investigationand treatment of children
and young people with tumours of the central nervous system and their acutecomplications

Clinical service under supervision in a unit that handles these conditions

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

To have an understandingof late complications ofdiseases and treatment
Theoretical studies

Intermediate objective 9

Teaching methods

Follow-up

To be able to handle neuroblastoma and renal tumours in children and young
peopleClinical service under supervision in a unit that handles these conditions

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

To have an understandingof late complications ofdiseases and treatment

Theoretical studies

Intermediate objective 10

Teaching methods

Follow-up

To be able to handle soft
tissue sarcoma and skeletal
tumours in children andyoung people

Clinical service under supervision in a unit that handles these conditions

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

To have an understandingof late complications of diseases and treatment

Theoretical studies

Intermediate objective 11

Teaching methods

Follow-up

To master the supporting
treatment in children andyoung people with cancer
diseases in cytostatic andradiation treatment andmaster acute complicationsin this kind of treatment

Clinical service under supervision in a unit that handles these conditions

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

To have an understandingof late complications ofdiseases and treatment

Theoretical studies

Intermediate objective 12

Teaching methods

Follow-up

To have an understandingof allogeneic and autologous stem cell transplantation in children and young
people and have an understanding of immunosuppresssive treatment following allogeneic stem celltransplantation

Clinical service under supervision in a unit that
handles these conditions

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

To have an understandingof late complications of diseases and treatment

Theoretical studies

Communicative competenceIntermediate objective 13

Teaching methods

Follow-up

To be capable of dialogue
and open contact with patients and their next of kin
with respect for the patient’s
right to information, influence and participation indecisions and have an understanding and respect forcross-cultural and multicultural aspects such as age,
language, ethnicity, sexual
orientation, and religion, as
well as gender.

Clinical service under supervision in a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Sitting-in

Intraprofessional groupreflection

Intermediate objective 14

Teaching methods

Follow-up

To be capable of communication with other doctors
and co-workers, both written
and oral, as well as withrepresentatives of the public
and various civil authorities

Clinical service under supervision in a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Health care teamwork under supervision
Intraprofessional groupreflection

Intermediate objective 15

Teaching methods

Follow-up

To have a pedagogic capability of instructing patients,
next of kin, other doctors,
and co-workers, as well as
students

Clinical service under supervision in a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Instruction under supervision
Mentoring under supervision

Leadership competenceIntermediate objective 16

Teaching methods

Follow-up

To be capable of mentoringother doctors and coworkers as well as students

Clinical service under supervision in a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Intraprofessional groupreflection

Intermediate objective 17

Teaching methods

Follow-up

To have a capability of leading in collaboration anddialogue with a leadershipcharacterised by participation and activity development

Clinical service under supervision in a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Intraprofessional groupreflection
Theoretical studies

Intermediate objective 18

Teaching methods

Follow-up

To have an understandingof the organisation, administration, finances, andregulatory systems ofhealth care, as well as its
governance, in order tomake the best use of resources

CourseCertificate of successfullycompleted course, issuedby course leader

Theoretical studies

Competence within medical science and quality
work
Intermediate objective 19

Teaching methods

Follow-up

To have skill in a medical
scientific viewpoint andapproach

Written individual work under supervision according
to scientific principles

Certificate of approved
written individual work,
issued by current mentor

Intraprofessional groupreflection
Theoretical studies

Intermediate objective 20

Teaching methods

Follow-up

To have an understandingof, and competence in,evidence-based improvement and quality work.

Quality and development
work under supervision

Certificate of quality anddevelopment work, issued
by current mentor

Theoretical studies

Intermediate objective 21

Teaching methods

To have an understandingof the factors determining
health, other aspects ofpublic health, and methods
for promoting health andefforts aimed at preventing
illness

Large professional assembly

Theoretical studies

Follow-up

Paediatric cardiology

Introduction
Explanation of terms
General definition of competencies
Definition of area of competence
Competence requirements
Competence requirements for medical competence
Competence requirements for communicative competence, leadershipcompetence, and competence within medical science and quality work
Training structure
Special recommendations
Intermediate objectives
Medical competenceCommunicative competence
Leadership competence
Competence within medical science and quality work

Introduction

On June 24, 2008, The National Board of Health and Welfare (Socialstyrelsen) decided to issue new regulations and general guidelines for doctors’
specialist medical training (SOSFS 2008:17). The statute consists of a general part with common provisions for all specialties and a specific part withall the descriptions of objectives. The description of objectives for the respective specialties should be understood against the background of the provisions in the general part.
In each description of objectives, there is a section headed ‘Training
structure’, which constitutes general guidelines. The teaching methods under the heading ‘Intermediate objectives’ where no follow-up is indicatedalso constitute general guidelines.

Explanation of terms

current mentor
a specialist doctor whose specialist competence corresponds to the area ofcompetence indicated by the intermediate objective, and who is responsible
for ST doctors’s professional development during the teaching period or forthe method of teaching indicatedthe assignment as a mentor for an ST doctor generally encompasses the entire period of specialist training but can also encompass part or parts of it
auscultation
during mentoring, and in accordance with a pre-designed programme, tostudy the profession of a specialist doctor or other health care staff by following one or several professionals, as well as carrying out assignments in
the relevant area to a certain extent
evaluate
to form a sound opinion of a patient or similar person as a basis for further
management
masterbeing fully able to evaluate and handle the medical investigation, diagnostics, treatment, and follow-up of a patient or similar person, and being fully
able to use the techniques relevant to the area
capability
personal capacity to execute or perform a task
h a ve u n d ers tan d i ng
having acquired knowledge and insight into an area through theoretical studies and/or practical exercise of the profession
have knowledge
having acquired some knowledge in an area through theoretical studies
and/or practical exercise of the profession
mentoring under supervision
as an ST doctor, mentor a co-worker while simultaneously being mentored
by a doctor with specialist competencementorcontinuously, and in dialogue form, supporting and guiding, as well as evaluating, a co-worker’s professional development
mentoringsee mentor
handleto actively carry out measures regarding investigation, diagnostics, treatment, and follow-up of a patient or similar person, and have overall responsibility for carrying out these measuresinitially handle
as the primary physician in charge, to actively carry out measures regarding
investigation, diagnostics, treatment, and follow-up of a patient or similar
person, and have overall responsibility for carrying out these measuresinitially evaluate
as the primary physician in charge, to form a sound opinion of a patient orsimilar person as a basis for further management
intraprofessional group reflection
reflection done in a group together with other doctors, chiefly for the purpose of further education and training
clinical service
health and medical care duties that ST doctors perform under their own professional liability and with the support of a mentor
courseteacher-led training with an established plan, given during a defined periodof timesitting-in
training activity involving an ST doctor observing when a specialist doctor
or other health care staff holds a consultationorassessment activity involving a specialist doctor or other health care staff
observing and evaluating ST doctors during a consultation
seminarinstruction in group form with active participation
training in a simulated environment
training carried out in an environment created to emulate reality

large professional assembly
conference, congress, symposium or similar event
health care centre
health care unit in primary carehealth care team work
work where ST doctors, under supervision, participates in and sometimes
leads a group of co-operating health care staff with various competencies
charged with responsibility for care for an individual patient or group ofpatients

General definition of competences

Definition of area of competence
The specialty of paediatric cardiology involves an advanced understandingof and skills in cardiac diseases and circulatory diseases in children andyoung people from 0 to 18 years of age, with prevention, investigation, diagnostics, treatment and follow-up of congenital and acquired diseases of
the circulatory organs and the development of knowledge within the area.
The specialty involves a further understanding of diagnostics of and about
the circulatory organs’ development during the foetal period and late complications and dysfunctions in adults as a result of congenital and acquired
diseases of the circulatory organs during the years of childhood.
Paediatric cardiology is a branch specialty of the base specialty of paediatrics.

Competence requirements
Competence requirements for medical competence
For specialist competence in paediatric cardiology, an understanding is required of the circulatory organs’ normal function and the development of
the normal physiology of the foetal circulation. An understanding of andskills in physical diagnostics and relevant diagnostics methods and an understanding of and skills in diagnostics, investigation, treatment and followup of all the most common and frequently occurring congenital and acquired
disorders of the circulatory organs from the neonatal period to adulthood is
also required. An understanding of how to be able to initially handle themedical investigation, diagnostics and treatment of uncommon congenitaland acquired disorders of the circulatory organs and of circulatory organ
disorders during the foetal period is also required. The capability of working
in a multi-disciplinary manner through close cooperation with representatives of thoracic surgery, anaesthesiology and intensive care and also representatives of paediatrics, medical imaging and technology, clinical physiology, cardiology, obstetrics and gynaecology and psychologists, dieticians,
welfare officers and physiotherapists is also required.
For specialist competence in paediatric cardiology, an understanding ofand skills in diagnostics and the treatment of all common diseases and more
serious diseases and dysfunctions from the neonatal period until adulthood
are also required. In addition, an understanding of the child’s normal
growth, rearing and psychomotor and mental development and also diagnostics for the purposes of being able to diagnose deviations from this at an
early stage is necessary. The capability to work in a preventive and family
focused manner on general health information, vaccinations and the prevention of accidents is also required. The capability to take a comprehensive
view of the family with commitment and respect for the child’s needs, anunderstanding of how the disease is affecting the child and its family and thecapability of fulfilling the child’s entitlement to participate in evaluation andtreatment on the basis of its level of development are required. In order toachieve this competence, it is necessary to be able to work in multidisciplinary teams and work together with other specialists in hospitals and outpatient clinics and with the social services, child welfare, schools, voluntary
associations and society’s institutions. For this work, an understanding ofand the ability to serve the rights of children and young people in society,both nationally and globally, are required. An ethical and professional approach, good skills in child centered clinical care and the capability of advocating a healthy lifestyle among children and young people are also required. An understanding of the process for transferring chronically ill
young people from paediatric medical care to adult medical care is also required (intermediate objectives 1–4)

Competence requirements for communicative competence, leadership competence, and competence within medical scienceand quality work
Communicative competence
The equal and responsible patient
Doctors with specialist competence must be capable of dialogue and of
maintaining open contact with patients and their next of kin. Contact should
be characterised by empathy and trust, as well as respect for the patients’right to information, influence, and participation in decisions. Contact
should also be characterised by co-operation and sensitivity to the patients’needs, desires and right to self-determination, as well as providing incentive
for the patients’ involvement in, and responsibility for, their own care.
Gender and multicultural aspects
Communication with patients and their next of kin should be characterisedby understanding and respect for cross-cultural and multicultural aspects
such as age, language, ethnicity, sexual orientation, and religion, as well as
gender.
Interprofessional relations
Doctors with specialist competence must be capable of communicating,both in writing and orally, with other doctors and co-workers showing respect for their professional knowledge and competences. The same applies
to contact with representatives of the public and various civil authorities.
Pedagogical skills
Doctors with specialist competence must have pedagogical capability inorder to inform and instruct not only patients and their next of kin, but also
other doctors and co-workers, as well as students.

Professional approach and ethics
Doctors with specialist competence must be capable of working continuously with their professional and medical ethical approaches, with the objectiveof being able to make independent decisions of a medical ethical nature.
Individual professional development
Doctors with specialist competence must be capable of continually examining and identifying their own needs for professional development, in addition to operational requirements, in order to be able to meet requirements forthe best possible patient care.

Leadership competence
Collaboration
Doctors with specialist competence must have a developed capability for
self-knowledge and understanding of their own functions and roles in theorganisation.
Mentoring skills
Doctors with specialist competence must be capable of mentoring other doctors and co-workers, as well as students.
Leadership
Doctors with specialist competence must be capable of leadership characterised by collaboration, openness, and dialogue with co-workers. Leadershipmust further be characterised by activity development aimed at improvement. The ability to lead the work of the health care team is essential.
System knowledge
Doctors with specialist competence must have an understanding of the organisation, administration, finances, and regulatory systems of health care,
as well as its governance, in order to make the best use of resources.

Competence within medical science and quality work
Medical science
Doctors with specialist competence must be capable of adopting a medicallyscientific outlook and approach, and must have knowledge of research methodology, including basic epidemiological concepts, as well as of methods
for evidence-based medicine and review of scientific information.
Improvement and quality work
Doctors with specialist competence must have an understanding of, andcompetence in, evidence-based improvement and quality work. The objective is to be able to initiate, participate in, and be responsible for continuous
systematic improvement work with emphasis on a holistic perspective, pa-tient safety, patient benefit, measurability, and teaching management in order to be able to review and evaluate their own operations.
Public health and prevention
Doctors with specialist competence must have an understanding of the factors determining health, other aspects of public health, and methods forpromoting health and efforts aimed at preventing injury and illness, in order
to be able to take this understanding into account in medical scientific work.

Training structure
Specialist medical training in paediatric cardiology can begin before, during,or after specialist medical training in paediatrics and can be integrated with
this.
Specialist training in paediatric cardiology should take place at a paediatric cardiology unit at a university hospital over longish continuous periodsof time. The training should provide a broad basic knowledge of paediatriccardiology and take place through clinical service in both in- and out-patientcare. For this reason, it is imperative that part of the service takes place at an
operative unit. A shorter part of the training can take place through service
primarily at a ward for medical imaging and technology, thoracic surgery or
cardiology.
The training should contain both theoretical and practical elements in allareas of paediatric cardiology. Training in the handling of relevant diagnostic and therapeutic methods should be introduced at an early stage and continue continuously as an integral part of the clinical work during training.
Quality and development work should be carried out during the training
and preferably result in a presentation at a national or international scientificmeeting.

Special recommendations
The specialty associations and sections of the medical organisations haveformulated special recommendations for their own specialties. The recommendations concern such issues as how specialist medical training should be
structured.

Intermediate objectives

Medical competenceIntermediate objective 1

Teaching methods

Follow-up

To master an understanding of the healthy child andyoung person and the influence that heredity, culture,
the environment and society have on their development and health

Clinical service under supervision in a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

To master diagnostics ofdeviations from normal
growth and development
and master healthpromoting work

CourseCertificate of successfullycompleted course, issuedby course leader

Theoretical studies

To be able to handle psychosocial problems andhave an understanding of
relevant legislation

Intermediate objective 2

Teaching methods

Follow-up

To master basic and acutepaediatric conditions

Clinical service under supervision in a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Training in a simulated
environment
Theoretical studies

Intermediate objective 3

Teaching methods

Follow-up

To be able to handle themost common and frequently occurring conditions in
the areas of neonatology,
allergology and pulmonary
diseases, neurology andhabilitation, endocrinology
and metabolic disorders,
nephrology, hepatology andnutrition, infectious diseases, immunology and rheumatology, oncology andhaematology and cardiology

Clinical service under supervision in a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Intermediate objective 4

Teaching methods

Follow-up

To be able to initially handle
the most common and frequently occurring conditions
within the area of paediatric
psychiatry

Clinical service under supervision in a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

Theoretical studies

Intermediate objective 5

Teaching methods

Follow-up

To master the normal function and development of thecirculatory organs and thenormal physiology of the
foetal circulation and adjustment on birth.

Clinical service under supervision in a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

To master physical diagnostics and diagnostic methods for evaluation of thecirculatory organs’ functionin the area of competence

Theoretical studies

Intermediate objective 6

Teaching methods

Follow-up

To master investigation,
diagnostics, medical treatment and follow-up of themost common and frequently occurring congenital heartdiseasesClinical service under supervision in a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

To master investigation,
diagnostics, medical treatment and follow-up of uncommon and complex congenital heart disease

CourseCertificate of successfullycompleted course, issuedby course leader

Intermediate objective 7

Teaching methods

Follow-up

To master investigation,
diagnostics, medical treatment and follow-up of themost common and frequently occurring acquired heartdiseasesClinical service under supervision in a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

To be able to handle themedical investigation, diagnostics, treatment and follow-up of uncommon acquired heart diseases

Theoretical studies

Theoretical studies

Intermediate objective 8

Teaching methods

Follow-up

To master investigation,
diagnostics, medical treatment and follow-up of themost common and frequently occurring cardiac dysrhythmia

Clinical service under supervision in a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

To be able to handle themedical investigation, diagnostics, treatment and follow-up of uncommon cardiac dysrhythmia

CourseCertificate of successfullycompleted course, issuedby course leader

Training in a simulated
environment
Theoretical studies

Intermediate objective 9

Teaching methods

Follow-up

To master investigation,
diagnostics, treatment andfollow-up of heart failure

Clinical service under supervision in a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

To master diagnostics,
investigation, treatment andfollow-up of acute circulatory conditions within thearea of competence

Clinical service under supervision in a unit wheresuch operations are practised

CourseCertificate of successfullycompleted course, issuedby course leader

Training in a simulated environment
Theoretical studies

Intermediate objective 10

Teaching methods

Follow-up

To master investigation,
diagnostics, medical treatment and follow-up of themost common and frequently occurring cardiomyopathies

Clinical service under supervision in a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

To have an understandingof diagnostics, investigation, treatment and followup of uncommon cardiomyopathies and genetic
and metabolic heart diseases

CourseCertificate of successfullycompleted course, issuedby course leader

Theoretical studies

Intermediate objective 11

Teaching methods

Follow-up

To have an understandingof investigation, diagnostics, treatment and followup of diseases of the circulatory organs during the
foetal period

Clinical service under supervision in a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Theoretical studies

Intermediate objective 12

Teaching methods

Follow-up

To have an understandingof investigation, diagnostics,
treatment and follow-up of
terminal heart failure, pulmonary hypertension andtransplantation of thoracic
organsClinical service under supervision in a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

To have an understandingof late complications anddysfunction in congenital
heart disease in children,
young people and adults

Theoretical studies

Communicative competenceIntermediate objective 13

Teaching methods

Follow-up

To be capable of dialogue
and open contact with patients and their next of kin
with respect for the patient’s
right to information, influence and participation indecisions and have an understanding and respect forcross-cultural and multicultural aspects such as age,
language, ethnicity, sexual
orientation, and religion, as
well as gender.

Clinical service under
supervision in a unit
where such operations
are practised

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Sitting-in
Intraprofessional groupreflection

Intermediate objective 14

Teaching methods

Follow-up

To be capable of communication with other doctors
and co-workers, both written and oral, as well as withrepresentatives of the public and various civil authorities

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Health care teamwork under
supervision
Intraprofessional group reflection

Intermediate objective 15

Teaching methods

Follow-up

To have a pedagogic capability of instructing patients,
next of kin, other doctors,
and co-workers, as well as
students

Clinical service under supervision in a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Instruction under supervision
Mentoring under supervision

Leadership competenceIntermediate objective 16

Teaching methods

Follow-up

To be capable of mentoringother doctors and coworkers as well as students

Clinical service under supervision in a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Intraprofessional groupreflection

Intermediate objective 17

Teaching methods

Follow-up

To have a capability ofleading in collaboration anddialogue with a leadershipcharacterised by participation and activity development

Clinical service under supervision in a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Intraprofessional groupreflection
Theoretical studies

Intermediate objective 18

Teaching methods

Follow-up

To have an understandingof the organisation, administration, finances, and regulatory systems of healthcare, as well as its governance, in order to make thebest use of resources

CourseCertificate of successfullycompleted course, issuedby course leader

Theoretical studies

Competence within medical science and quality
work
Intermediate objective 19

Teaching methods

Follow-up

To have skill in a medical
scientific viewpoint andapproach

Written individual work
under supervision according to scientific principles

Certificate of approved
written individual work,
issued by current mentor

Intraprofessional groupreflection
Theoretical studies

Intermediate objective 20

Teaching methods

Follow-up

To have an understandingof, and competence in,evidence-based improvement and quality work.

Quality and development
work under supervision

Certificate of quality anddevelopment work, issued
by current mentor

Theoretical studies

Intermediate objective 21

Teaching methods

To have an understandingof the factors determining
health, other aspects ofpublic health, and methods
for promoting health andefforts aimed at preventing
illness

Large professional assembly
Theoretical studies

Follow-up

Psychiatric specialties

Psychiatry
Introduction
Explanation of terms
General definition of competencies
Definition of area of competence
Competence requirements
Competence requirements for medical competence
Competence requirements for communicative competence, leadershipcompetence, and competence within medical science and quality work
Training structure
Special recommendations
Intermediate objectives
Medical competenceCommunicative competence
Leadership competence
Competence within medical science and quality work

Introduction

On June 24, 2008, The National Board of Health and Welfare (Socialstyrelsen) decided to announce new regulations and general guidelines for doctors’ specialist medical training (SOSFS 2008:17). The statute consists of ageneral part with common provisions for all specialties and a specific partwith all the descriptions of objectives. The description of objectives for therespective specialties should be understood against the background of theprovisions in the general part.
In each description of objectives, there is a section headed ‘Training
structure’, which constitutes general guidelines. The teaching methods under the heading ‘Intermediate objectives’ where no follow-up is indicatedalso constitute general guidelines.

Explanation of terms

current mentor
a specialist doctor whose specialist competence corresponds to the area ofcompetence indicated by the intermediate objective, and who is responsible
for ST doctors’s professional development during the teaching period or forthe method of teaching indicatedthe assignment as a mentor for an ST doctor generally encompasses the entire period of specialist training but can also encompass part or parts of it
auscultation
during mentoring, and in accordance with a pre-designed programme, tostudy the profession of a specialist doctor or other health care staff by following one or several professionals, as well as carrying out assignments in
the relevant area to a certain extent
evaluate
to form a sound opinion of a patient or similar person as a basis for further
management
masterbeing fully able to evaluate and handle the medical investigation, diagnostics, treatment, and follow-up of a patient or similar person, and being fully
able to use the techniques relevant to the area
capability
personal capacity to execute or perform a task
h a ve u n d ers tan d i ng
having acquired knowledge and insight into an area through theoretical studies and/or practical exercise of the profession
have knowledge
having acquired some knowledge in an area through theoretical studies
and/or practical exercise of the profession
mentoring under supervision
as an ST doctor, mentor a co-worker while simultaneously being mentored
by a doctor with specialist competencementorcontinuously, and in dialogue form, supporting and guiding, as well as evaluating, a co-worker’s professional development
mentoringsee mentor
handleto actively carry out measures regarding investigation, diagnostics, treatment, and follow-up of a patient or similar person, and have overall responsibility for carrying out these measuresinitially handle
as the primary physician in charge, to actively carry out measures regarding
investigation, diagnostics, treatment, and follow-up of a patient or similar
person, and have overall responsibility for carrying out these measuresinitially evaluate
as the primary physician in charge, to form a sound opinion of a patient orsimilar person as a basis for further management
intraprofessional group reflection
reflection done in a group together with other doctors, chiefly for the purpose of further education and training
clinical service
health and medical care duties that ST doctors perform under their own professional liability and with the support of a mentor
courseteacher-led training with an established plan, given during a defined periodof timesitting-in
training activity involving an ST doctor observing when a specialist doctor
or other health care staff holds a consultationorassessment activity involving a specialist doctor or other health care staff
observing and evaluating ST doctors during a consultation
seminarinstruction in group form with active participation
training in a simulated environment
training carried out in an environment created to emulate reality

large professional assembly
conference, congress, symposium or similar event
health care centre
health care unit in primary carehealth care team work
work where ST doctors, under supervision, participates in and sometimes
leads a group of co-operating health care staff with various competencies
charged with responsibility for care for an individual patient or group ofpatients

General definition of competences

Definition of area of competence
Psychiatry is a medical specialty involving investigation, evaluation, diagnostics, treatment, and follow-up, as well as care and rehabilitation, of mental illness in adults where the degree of severity is of the nature that it requires the coordinated resources of specialised psychiatry.
Here, the term mental illness also refers to the terms personality disorderand addiction. It means a mental dysfunction with an affliction and/or function restriction.
Psychiatry is the base specialty for the branch specialty of forensic psychiatry.

Competence requirements
Competence requirements for medical competenceSpecialist competence in psychiatry requires being able to handle all common mental illnesses and being able to handle less common mental illnesses. The ability to handle acute psychiatric conditions and to initiate psychiatric measures in the event of catastrophes are also required.
Specialist competence in psychiatry also requires mastering psychopharmacological and electroconvulsive therapy, and having an understanding ofunderlying mechanisms of the origin of mental illness and its treatment. An
understanding of differential diagnostics between internal medicine and neurological or mental illnesses, and being able to initially handle somatic conditions in patients with mental illnesses, are also required.
It is also necessary to be able to handle illnesses in the areas of addiction
medicine and geriatric psychiatry. An understanding of child and adolescent
psychiatry is also required for specialist competence. An understanding of
the theoretical basis for the different psychological treatment methods, anability to evaluate suitable psychological methods for the treatment of different mental illnesses and an ability to handle patients with psychologicaltreatment methods are also necessary.
Mastering the application of the laws and statutes that regulate governance within psychiatry, and having an understanding of other legislationthat is of relevance for psychiatry, is also required.
Finally, it is necessary to have an understanding of the methods for investigating and determining patients’ cognitive function and of the coordinationand follow-up of treatment and rehabilitation measures.

Competence requirements for communicative competence, leadership competence, and competence within medical scienceand quality work
Communicative competence
The equal and responsible patient
Doctors with specialist competence must be capable of dialogue and of
maintaining open contact with patients and their next of kin. Contact should
be characterised by empathy and trust, as well as respect for the patients’right to information, influence, and participation in decisions. Contact
should also be characterised by co-operation and sensitivity to the patients’needs, desires and right to self-determination, as well as providing incentive
for patients’ involvement in, and responsibility for, their own care.
Multicultural and gender aspects
Communication with patients and their next of kin should be characterisedby understanding and respect for cross-cultural and multicultural aspects
such as age, language, ethnicity, sexual orientation, and religion, as well as
gender.
Interprofessional relations
Doctors with specialist competence must be capable of communicating,both in writing and orally, with other doctors and co-workers showing respect for their professional knowledge and competences. The same applies
to contact with representatives of the public and various civil authorities.
Pedagogical skills
Doctors with specialist competence must have pedagogical capability inorder to inform and instruct not only patients and their next of kin, but also
other doctors and co-workers, as well as students.
Professional approach and ethics
Doctors with specialist competence must be capable of working continuously with their professional and medical ethical approaches, with the objectiveof being able to make independent decisions of a medical ethical nature.
Individual professional development
Doctors with specialist competence must be capable of continually examining and identifying their own needs for professional development, in addition to operational requirements, in order to be able to meet requirements forthe best possible patient care.

Leadership competence
Collaboration
Doctors with specialist competence must have a developed capability for
self-knowledge and understanding of their own functions and roles in theorganisation.
Mentoring skills
Doctors with specialist competence must be capable of mentoring other doctors and co-workers, as well as students.
Leadership
Doctors with specialist competence must be capable of leadership distinguished by collaboration, openness, and dialogue with co-workers. Leadership must further be characterised by participation and activity development
aimed at improvement. The ability to lead the work of the health care teamis essential.
System knowledge
Doctors with specialist competence must have an understanding of the organisation, administration, finances, and regulatory systems of health care,
as well as its governance, in order to make the best use of resources.

Competence within medical science and quality work
Medical science
Doctors with specialist competence must be capable of a medically scientific outlook and approach, and must have knowledge of research methodology, including basic epidemiological concepts, as well as of methods for evidence-based medicine and review of scientific information.
Improvement and quality work
Doctors with specialist competence must have an understanding of, andcompetence in, evidence-based improvement and quality work. The objective is to be able to initiate, participate in, and be responsible for continuous
systematic improvement work with emphasis on a holistic perspective, patient safety, patient benefit, measurability, and teaching management in order to be able to review and evaluate their own operations.
Public health and prevention
Doctors with specialist competence must have an understanding of the factors determining health, other aspects of public health, and methods forpromoting health and efforts aimed at preventing injury and illness, in order
to be able to take this understanding into account in medical scientific work.

Training structure
Work within the area of in- and out-patient adult psychiatry forms the basis
for specialist medical training. Early experience in the areas of acute psychiatry and compulsory care are important. Service in addiction medicine
and at units that investigate and treat geriatric psychiatry patients, as well as
service in child and adolescent psychiatry, should also be included in specialist medical training. Service in forensic psychiatry is also recommended.
Service is also recommended at units that handle a mixed clientele of patients, as well as at subspecialised units.
A course in psychotherapy where ST doctors can acquire an understanding of different psychological treatment methods is very important. During
the course, it is important that theory and practical skills are integrated under the supervision of a licensed psychotherapist who is a trained mentor.
The course should be alternated with clinical service so that ST doctors canapply the knowledge in their everyday activities as doctors.
In addition, service in related specialties should form part of specialist
medical training. Service within some area of neurological specialty, preferably neurology or rehabilitation, and in an internal medicine specialty isparticularly valuable. Service within general medicine can, to some extent,
replace internal medicine service. As a conclusion, ST doctors should begiven a placement in adult psychiatry so that the transition to independent
work as a specialist is facilitated.
ST doctors should play an active part in regular local further training
meetings. The exchange of knowledge and experiences internationally isalso recommended.

Special recommendations
The specialty associations and sections of the medical organisations haveformulated special recommendations for their specialties. The recommendations concern such issues as how specialist medical training can be structured.

Intermediate objectives

Medical competenceIntermediate objective 1

Teaching methods

Follow-up

To master the handling ofcommon and serious mental illnesses with emphasison the major endemic illnesses

Clinical service under supervision in a unit that handles these conditions

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

SeminarSitting-in
Theoretical studies

Intermediate objective 2

Teaching methods

To be able to handle different mental illnesses

Clinical service under supervision in a unit that handles these conditions

CourseFollow-up
Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

Certificate of successfullycompleted course, issuedby course leader

SeminarSitting-in
Theoretical studies

Intermediate objective 3

Teaching methods

Follow-up

To be able to handle acute
psychiatric conditions andbe able to initially handle
emergency psychiatric situations

Clinical service under supervision in a unit that handles these conditions

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

SeminarSitting-in
Theoretical studies

Intermediate objective 4

Teaching methods

Follow-up

Clinical service under suTo master psychopharmapervision in a unit that hancological and electroconvulsive therapy and have an dles these conditions
understanding of underlying
mechanisms for the originof mental illness and its
treatment.
CourseCertificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

Certificate of successfullycompleted course, issuedby course leader

Seminar
Theoretical studies

Intermediate objective 5

Teaching methods

Follow-up

To have an understandingof differential diagnostics
between internal medicine
and neurological or mental
illnesses and to be able toinitially handle somatic conditions in patients with mental illnesses

Clinical service under supervision in a unit that
handles these conditions

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

Course Certificate of successfullycompleted course, issuedby course leader
SeminarSitting-in
Theoretical studies

Intermediate objective 6

Teaching methods

Follow-up

To be able to handle ordinary substance addictions
and have an understandingof their comorbidity withinternal medicine conditions
and other mental illnesses

Clinical service under supervision in a unit that handles these conditions

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

SeminarSitting-in
Theoretical studies

Intermediate objective 7

Teaching methods

Follow-up

To have an understandingof neurodegenerative diseases and be able to handle mental illness in theelderly

Clinical service under supervision in a unit that handles these conditions

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

SeminarSitting-in
Theoretical studies

Intermediate objective 8

Teaching methods

Follow-up

To have an understandingof development-related
mental illness and knowledge of the ways that childand adolescent psychiatry
works and of deviant versus
normal psychological andneurological development in
the childhood years.

Clinical service under supervision in a unit that handles these conditions

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Seminar
Theoretical studies

Intermediate objective 9

Teaching methods

Follow-up

To have an understanding of
the theoretical basis for thedifferent psychologicaltreatment methods, to beable to evaluate suitable
psychological methods forthe treatment of different
mental illnesses and to beable to handle patients bymeans of– psychologicaltreatment methods

Clinical service under supervision in a unit that handles these conditions

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Theoretical studies

Intermediate objective 10

Teaching methods

Follow-up

To master the application oflaws and statutes that regulate governance within thearea of competence and tohave an understanding ofother legislation that is of
relevance for psychiatry andalso have knowledge of theorganisation and duties offorensic psychiatry

Clinical service under supervision in a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Seminar
Theoretical studies

Intermediate objective 11

Teaching methods

Follow-up

To have an understandingof cognitive functional disorders, their importance inthe patient’s care andtreatment and to have an
understanding of testing
methods for these

Clinical service under supervision in a unit that handles these conditions

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Seminar
Theoretical studies

Intermediate objective 12

Teaching methods

Follow-up

To have an understandingof the coordination andfollow-up of patients over along period of time.

Clinical service under
supervision in a unit that
handles these conditions

Certificate of successfullycompleted clinical service and competenceachieved, issued by current mentor

Seminar

Cli i

l

i

d

Theoretical studies

Communicative competenceIntermediate objective 13

Teaching methods

Follow-up

To be capable of dialogue
and open contact with patients and their next of kin
and to be capable of communication, both oral andwritten, with other doctors
and co-workers

Clinical service under supervision in a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Health care teamwork under supervisionIntermediate objective 14

Teaching methods

Follow-up

To be capable of informing
and instructing patients,
next of kin, other doctors,
and co-workers, as well as
students

Clinical service under
supervision in a unit
where such operations
are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

Instruction under supervision

Intermediate objective 15

Teaching methods

Follow-up

To be capable of working
continuously on a professional and medical ethicalapproach

Clinical service under supervision in a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

SeminarLeadership competenceIntermediate objective 16

Teaching methods

Follow-up

To be capable of mentoringother doctors and coworkers as well as students

Clinical service under supervision in a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Mentoring under supervision
Theoretical studies

Intermediate objective 17

Teaching methods

Follow-up

To be capable of leading
using collaboration anddialogue with co-workers aswell as within the healthcare team and an understanding of one’s own rolein the organisation

Clinical service under supervision in a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issued
by current course leader

Health care teamwork under supervisionIntermediate objective 18

Teaching methods

To have an understandingof the organisation, management, and regulatory
systems of health care

CourseTheoretical studies

Follow-up
Certificate of successfullycompleted course, issued
by current course leader

Competence within medical science and quality
work
Intermediate objective 19
To be capable of a medically scientific outlook andapproach

Teaching methods
CourseFollow-up

Written individual work
under supervision according to scientific principles

Certificate of approved
written individual work,
issued by current mentor

Certificate of successfullycompleted course, issuedby course leader

SeminarLarge professional assembly
Theoretical studies

Intermediate objective 20

Teaching methods

Follow-up

To have an understandingof, and competence in,evidence-based improvement and quality work

Quality and development
work under supervision

Certificate of quality anddevelopment work, issued
by current mentor

Intermediate objective 21

Teaching methods

Follow-up

To have an understandingof the factors determining
health and other aspects ofpublic health, as well as
methods for promoting
health and efforts to prevent illness

CourseSeminar
Theoretical studies

Certificate of successfullycompleted course, issued
by current course leader

Forensic psychiatry

Introduction
Explanation of terms
General definition of competencies
Definition of area of competence
Competence requirements
Competence requirements for medical competence
Competence requirements for communicative competence, leadershipcompetence, and competence within medical science and quality work
Training structure
Special recommendations
Intermediate objectives
Medical competenceCommunicative competence
Leadership competence
Competence within medical science and quality work

Introduction

On June 24, 2008, The National Board of Health and Welfare (Socialstyrelsen) decided to announce new regulations and general guidelines for doctors’ specialist medical training (SOSFS 2008:17). The statute consists of ageneral part with common provisions for all specialties and a specific partwith all the descriptions of objectives. The description of objectives for therespective specialties should be understood against the background of theprovisions in the general part.
In each description of objectives, there is a section headed ‘Training
structure’, which constitutes general guidelines. The teaching methods under the heading ‘Intermediate objectives’ where no follow-up is indicatedalso constitute general guidelines.

Explanation of terms

current mentor
a specialist doctor whose specialist competence corresponds to the area ofcompetence indicated by the intermediate objective, and who is responsible
for ST doctors’s professional development during the teaching period or forthe method of teaching indicatedthe assignment as a mentor for an ST doctor generally encompasses the entire period of specialist training but can also encompass part or parts of it
auscultation
during mentoring, and in accordance with a pre-designed programme, tostudy the profession of a specialist doctor or other health care staff by following one or several professionals, as well as carrying out assignments in
the relevant area to a certain extent
evaluate
to form a sound opinion of a patient or similar person as a basis for further
management
masterbeing fully able to evaluate and handle the medical investigation, diagnostics, treatment, and follow-up of a patient or similar person, and being fully
able to use the techniques relevant to the area
capability
personal capacity to execute or perform a task
h a ve u n d ers tan d i ng
having acquired knowledge and insight into an area through theoretical studies and/or practical exercise of the profession
have knowledge
having acquired some knowledge in an area through theoretical studies
and/or practical exercise of the profession
mentoring under supervision
as an ST doctor, mentor a co-worker while simultaneously being mentored
by a doctor with specialist competencementorcontinuously, and in dialogue form, supporting and guiding, as well as evaluating, a co-worker’s professional development
mentoringsee mentor
handleto actively carry out measures regarding investigation, diagnostics, treatment, and follow-up of a patient or similar person, and have overall responsibility for carrying out these measuresinitially handle
as the primary physician in charge, to actively carry out measures regarding
investigation, diagnostics, treatment, and follow-up of a patient or similar
person, and have overall responsibility for carrying out these measuresinitially evaluate
as the primary physician in charge, to form a sound opinion of a patient orsimilar person as a basis for further management
intraprofessional group reflection
reflection done in a group together with other doctors, chiefly for the purpose of further education and training
clinical service
health and medical care duties that ST doctors perform under their own professional liability and with the support of a mentor
courseteacher-led training with an established plan, given during a defined periodof timesitting-in
training activity involving an ST doctor observing when a specialist doctor
or other health care staff holds a consultationorassessment activity involving a specialist doctor or other health care staff
observing and evaluating ST doctors during a consultation
seminarinstruction in group form with active participation
training in a simulated environment
training carried out in an environment created to emulate reality

large professional assembly
conference, congress, symposium or similar event
health care centre
health care unit in primary carehealth care team work
work where ST doctors, under supervision, participates in and sometimes
leads a group of co-operating health care staff with various competencies
charged with responsibility for care for an individual patient or group ofpatients

General definition of competences

Definition of area of competence
Forensic psychiatry is a medical specialty based on the field of psychiatry
field and the legal control of mentally disturbed law-breakers. The aim offorensic psychiatry is to investigate, evaluate, diagnose, treat, habilitate or
rehabilitate, and follow-up on mentally disturbed law-breakers. This includes an assessment of the risk of patients harming themselves or others,
and how these risks should be managed. A central task in the forensic psychiatry specialty is analysing and managing the connection between mental
disturbance, criminal tendencies, and social adaptation.
Forensic psychiatry is a branch specialty of the base specialty of psychiatry.

Competence requirements
Competence requirements for medical competenceSpecialist competence in forensic psychiatry requires being able to performforensic psychiatric evaluations of mentally disturbed law-breakers on behalf of the courts. It also requires being responsible for diagnostics, treatment, habilitation or rehabilitation, and follow-up of patients in forensic
psychiatric care and correctional care. It is also necessary to be able to identify and manage situations that are important with regard to the risk overtime of the patients or the people being examined harming themselves orothers.
An understanding of the ethical and professional difficulties that ensue
from working with patients who have been deprived of their liberty and arein compulsory care is also required. Knowledge of and skills in cooperatingwith the authorities and organisations needed for evaluation, treatment, andhabilitation or rehabilitation of mentally disturbed law-breakers is also required.
Medical competence in accordance with the description of objectives forpsychiatry is also required for specialist competence in forensic psychiatry.

Competence requirements for communicative competence, leadership competence, and competence within medical scienceand quality work
Communicative competence
The equal and responsible patient
Doctors with specialist competence must be capable of dialogue and of
maintaining open contact with patients and their next of kin. Contact should
be characterised by empathy and trust, as well as respect for the patients’right to information, influence, and participation in decisions. Contact
should also be characterised by co-operation and sensitivity to the patients’needs, desires and right to self-determination, as well as providing incentive
for patients’ involvement in, and responsibility for, their own care.
Multicultural and gender aspects
Communication with patients and their next of kin should be characterisedby understanding and respect for cross-cultural and multicultural aspects
such as age, language, ethnicity, sexual orientation, and religion, as well as
gender.
Interprofessional relations
Doctors with specialist competence must be capable of communicating,both in writing and orally, with other doctors and co-workers showing respect for their professional knowledge and competences. The same applies
to contact with representatives of the public and various civil authorities.
Pedagogical skills
Doctors with specialist competence must have pedagogical capability inorder to inform and instruct not only patients and their next of kin, but also
other doctors and co-workers, as well as students.
Professional approach and ethics
Doctors with specialist competence must be capable of working continuously with their professional and medical ethical approaches, with the objectiveof being able to make independent decisions of a medical ethical nature.
Individual professional development
Doctors with specialist competence must be capable of continually examining and identifying their own needs for professional development, in addition to operational requirements, in order to be able to meet requirements forthe best possible patient care.

Leadership competence
Collaboration
Doctors with specialist competence must have a developed capability for
self-knowledge and understanding of their own functions and roles in theorganisation.
Mentoring skills
Doctors with specialist competence must be capable of mentoring other doctors and co-workers, as well as students.
Leadership
Doctors with specialist competence must be capable of leadership distinguished by collaboration, openness, and dialogue with co-workers. Leadership must further be characterised by participation and activity development
aimed at improvement. The ability to lead the work of the health care teamis essential.
System knowledge
Doctors with specialist competence must have an understanding of the organisation, administration, finances, and regulatory systems of health care,
as well as its governance, in order to make the best use of resources.

Competence within medical science and quality work
Medical science
Doctors with specialist competence must be capable of a medically scientific outlook and approach, and must have knowledge of research methodology, including basic epidemiological concepts, as well as of methods for evidence-based medicine and review of scientific information.
Improvement and quality work
Doctors with specialist competence must have an understanding of, andcompetence in, evidence-based improvement and quality work. The objective is to be able to initiate, participate in, and be responsible for continuous
systematic improvement work with emphasis on a holistic perspective, patient safety, patient benefit, measurability, and teaching management in order to be able to review and evaluate their own operations.

Public health and prevention
Doctors with specialist competence must have an understanding of the factors determining health, other aspects of public health, and methods forpromoting health and efforts aimed at preventing injury and illness, in order
to be able to take this understanding into account in medical scientific work.

Training structure
Specialist medical training in forensic psychiatry can begin before, during,or after specialist medical training in psychiatry and can be integrated withit.
Clinical service in both investigation and a forensic psychiatry unit providing care is the basis for specialist training in forensic psychiatry.
Investigative forensic psychiatry includes service at the investigation unit andactive participation in the unit’s investigation work. ST doctors should attend
court proceedings.
In forensic psychiatric care, it is imperative that the prospective specialist
serves in both in- and out-patient care, preferably at units with different security classifications. An important element in this work is participation incounty administrative court negotiations and in meetings with municipalities
and other care providers prior to leave of absence and discharges being
granted. It is also important to formulate care plans, including risk and needs
analyses.
It is also important for prospective specialists to gain practical experiencein work with mentally disturbed law-breakers who are subject to care atopen corrective training and prison establishments. This may take place inthe form of auscultation or as clinical service.
The sequence between, and the possibility of integrating, investigativeand care unit service can be organised on the basis of local conditions. The
same applies to service at non-institutional authorities and prison establishments.
ST doctors should actively participate in training programmes that are
threaded throughout training with instruction in the different areas concerning forensic psychiatry. ST doctors should also be given the opportunity forstudy visits and auscultations abroad during the training period.

Special recommendations
The specialty associations and sections of the medical organisations haveformulated special recommendations for their specialties. The recommendations concern such issues as how specialist medical training can be structured.

Intermediate objectives

Medical competenceIntermediate objective 1

To master the carrying out
of forensic psychiatric investigations on behalf ofcourtsTeaching methods
Clinical service under supervision in a unit wheresuch operations are practised

Follow-up
Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

Intermediate objective 2

Teaching methods

Follow-up

To have an understandingof the connection between
the degree of mental disturbance, transgressions of thelaw and the risk of reoffending

SeminarIntraprofessional groupreflection

Intermediate objective 3

Teaching methods

To have an understandingof deviant and normal development during the childhood years, particularly withregard to norm transgressions and offences

Seminar
Theoretical studies

Intermediate objective 4

Teaching methods

Follow-up

To have an understandingof criminology and criminal
empires

CourseCertificate of successfullycompleted course, issuedby course leader

Theoretical studies

Seminar

Follow-up

Intermediate objective 5

Teaching methods

Follow-up

To master the application oflaws and statutes that regulate governance within thearea of competence and tohave an understanding ofother legislation that is of
relevance for psychiatry

Clinical service under supervision in a unit that handles these issues

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Seminar
Theoretical studies

Intermediate objective 6

Teaching methods

Follow-up

To master forensic psychiatric care, both institutionaland non-institutional

Clinical service under supervision in a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

Intermediate objective 7

Teaching methods

Follow-up

To master the identificationand management of staticand dynamic factors thatare importance for the riskover a period of time ofharming oneself and others

Clinical service under supervision in a unit that handles these issues

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Theoretical studies

Intermediate objective 8

Teaching methods

Clinical service under suTo have an understanding
pervision in a unit that hanof the different roles anddles these issues
functions of forensic psychiatry in relation to patientsor inmates

Follow-up
Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

SeminarIntermediate objective 9

Teaching methods

Follow-up

To have an understandingof professional approach
towards mentally disturbed
law-breakers

Clinical service under supervision in a unit that handles these issues

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

SeminarIntermediate objective 10

Teaching methods

Follow-up

To have an understandingof correctional care’s organisation, regulatory systems
and conditions for providing
psychiatric care

Clinical service under supervision in a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

ororauscultation under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Intermediate objective 11

Teaching methods

Follow-up

To have an understandingof consultation work withregard to psychiatry, correctional care, social services
and other current care providers

Clinical service under supervision in a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

ororauscultation under supervision in a unit where suchoperations are practised

certificate of approved
auscultation and competence achieved, issued bycurrent mentor

Intermediate objective 12

Teaching methods

Follow-up

To be able to handle ethicalproblems that are linked tocorrectional treatment andforensic psychiatric work

Clinical service under supervision in a unit that
handles these issues

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

Intraprofessional groupreflection

Communicative competenceIntermediate objective 13

Teaching methods

Follow-up

To be capable of dialogue
and open contact with patients and their next of kin
and to be capable of communication, both oral andwritten, with other doctors
and co-workers

Clinical service under supervision in a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Health care teamwork under supervision

Intermediate objective 14

Teaching methods

Follow-up

To be capable of informing
and instructing patients,
next of kin, other doctors,
and co-workers, as well as
students

Clinical service under supervision in a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

Instruction under supervisionIntermediate objective 15

Teaching methods

Follow-up

To be capable of working
continuously on a professional and medical ethicalapproach

Clinical service under supervision in a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

SeminarLeadership competenceIntermediate objective 16

Teaching methods

Follow-up

To be capable of mentoringother doctors and coworkers as well as students

Clinical service under supervision in a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Mentoring under supervisionIntermediate objective 17

Teaching methods

To be capable of leading
using collaboration anddialogue with co-workers aswell as within the healthcare team and to have an
understanding of one’s
individual role in the organisation

Clinical service under supervision in a unit wheresuch operations are practised

CourseHealth care teamwork under supervision

Follow-up
Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

Certificate of successfullycompleted course, issuedby course leader

Intermediate objective 18
To have an understandingof the organisation, management, and regulatory
systems of health care

Teaching methods
CourseFollow-up
Certificate of successfullycompleted course, issuedby course leader

Theoretical studies

Competence within medical science and quality
work
Intermediate objective 19

Teaching methods

Follow-up

To be capable of a medically scientific outlook andapproach

CourseCertificate of successfullycompleted course, issuedby course leader

Written individual work under supervision according toscientific principles

Certificate of approved
written individual work,
issued by current mentor

SeminarLarge professional assembly
Theoretical studies

Intermediate objective 20

Teaching methods

Follow-up

To have an understandingof, and competence in, evidence-based improvement
and quality work

Quality and development
work under supervision

Certificate of quality anddevelopment work, issued
by current mentor

Intermediate objective 21

Teaching methods

Follow-up

To have an understandingof the factors determining
health and other aspects ofpublic health, as well as
methods for promoting
health and efforts to prevent
illness

CourseCertificate of successfullycompleted course, issuedby course leader

SeminarChild and adolescent psychiatry

Introduction
Explanation of terms
General definition of competencies
Definition of area of competence
Competence requirements
Competence requirements for medical competence
Competence requirements for communicative competence, leadershipcompetence, and competence within medical science and quality work
Training structure
Special recommendations
Intermediate objectives
Medical competenceCommunicative competence
Leadership competence
Competence within medical science and quality work

Introduction

On June 24, 2008, The National Board of Health and Welfare (Socialstyrelsen) decided to announce new regulations and general guidelines for doctors’ specialist medical training (SOSFS 2008:17). The statute consists of ageneral part with common provisions for all specialties and a specific partwith all the descriptions of objectives. The description of objectives for therespective specialties should be understood against the background of theprovisions in the general part.
In each description of objectives, there is a section headed ‘Training
structure’, which constitutes general guidelines. The teaching methods under the heading ‘Intermediate objectives’ where no follow-up is indicatedalso constitute general guidelines.

Explanation of terms

current mentor
a specialist doctor whose specialist competence corresponds to the area ofcompetence indicated by the intermediate objective, and who is responsible
for ST doctors’s professional development during the teaching period or forthe method of teaching indicatedthe assignment as a mentor for an ST doctor generally encompasses the entire period of specialist training but can also encompass part or parts of it
auscultation
during mentoring, and in accordance with a pre-designed programme, tostudy the profession of a specialist doctor or other health care staff by following one or several professionals, as well as carrying out assignments in
the relevant area to a certain extent
evaluate
to form a sound opinion of a patient or similar person as a basis for further
management
masterbeing fully able to evaluate and handle the medical investigation, diagnostics, treatment, and follow-up of a patient or similar person, and being fully
able to use the techniques relevant to the area
capability
personal capacity to execute or perform a task
h a ve u n d ers tan d i ng
having acquired knowledge and insight into an area through theoretical studies and/or practical exercise of the profession
have knowledge
having acquired some knowledge in an area through theoretical studies
and/or practical exercise of the profession
mentoring under supervision
as an ST doctor, mentor a co-worker while simultaneously being mentored
by a doctor with specialist competencementorcontinuously, and in dialogue form, supporting and guiding, as well as evaluating, a co-worker’s professional development
mentoringsee mentor
handleto actively carry out measures regarding investigation, diagnostics, treatment, and follow-up of a patient or similar person, and have overall responsibility for carrying out these measuresinitially handle
as the primary physician in charge, to actively carry out measures regarding
investigation, diagnostics, treatment, and follow-up of a patient or similar
person, and have overall responsibility for carrying out these measuresinitially evaluate
as the primary physician in charge, to form a sound opinion of a patient orsimilar person as a basis for further management
intraprofessional group reflection
reflection done in a group together with other doctors, chiefly for the purpose of further education and training
clinical service
health and medical care duties that ST doctors perform under their own professional liability and with the support of a mentor
courseteacher-led training with an established plan, given during a defined periodof timesitting-in
training activity involving an ST doctor observing when a specialist doctor
or other health care staff holds a consultationorassessment activity involving a specialist doctor or other health care staff
observing and evaluating ST doctors during a consultation
seminarinstruction in group form with active participation
training in a simulated environment
training carried out in an environment created to emulate reality

large professional assembly
conference, congress, symposium or similar event
health care centre
health care unit in primary carehealth care team work
work where ST doctors, under supervision, participates in and sometimes
leads a group of co-operating health care staff with various competencies
charged with responsibility for care for an individual patient or group ofpatients

General definition of competences

Definition of area of competence
The specialty of child and adolescent psychiatry is a multidisciplinary medical discipline in which biological, psychological, pedagogic, and social
knowledge is integrated. It is the specialty that involves an understanding ofand skills in recognising, investigating, diagnosing, treating, and following
up on, as well as preventing, mental illness and disturbances in children andyoung people. The specialty also involves a detailed understanding of how
psychopathological symptoms in young people are affected by age, gender,
development level, and physical health, as well as by psychological andsocial factors. The specialty involves the child and adolescent psychiatricconditions described in international psychiatric classification systems andwhich are combined with serious suffering or a serious prognosis. The areaof competence includes children and young people as well as their families.

Competence requirements
Competence requirements for medical competenceSpecialist competence in child and adolescent psychiatry requires being
capable of handling relevant acute conditions, being capable of evaluating
and prioritising the need for care, and being capable of investigating, diagnosing, treating, and following up in the area of common and serious conditions.
A capability of distinguishing between normal and deviant development
during the childhood years, and of adapting conversations and communications in connection with care so that optimum consideration is taken of theyoung patient’s circumstances and needs, are also required.
Specialist competence also requires knowledge and skills in pharmacological treatment, an understanding of psychological and psychotherapeutic
treatment, an understanding of child and adolescent psychiatry’s cooperation with other civil authorities, and an understanding of and skills in thelaws that affect the physical health and welfare of children and young
people.
Specialist competence also requires an understanding of the comorbidity
between drug abuse and child and adolescent psychiatric conditions, and anunderstanding of relevant adult psychiatry, paediatrics, and forensic psychiatry.

Competence requirements for communicative competence, leadership competence, and competence within medical scienceand quality work
Communicative competence
The equal and responsible patient
Doctors with specialist competence must be capable of dialogue and of
maintaining open contact with patients and their next of kin. Contact should
be characterised by empathy and trust, as well as respect for the patients’right to information, influence, and participation in decisions. Contact
should also be characterised by co-operation and sensitivity to the patients’needs, desires and right to self-determination, as well as providing incentive
for patients’ involvement in, and responsibility for, their own care.
Multicultural and gender aspects
Communication with patients and their next of kin should be characterisedby understanding and respect for cross-cultural and multicultural aspects
such as age, language, ethnicity, sexual orientation, and religion, as well as
gender.
Interprofessional relations
Doctors with specialist competence must be capable of communicating,both in writing and orally, with other doctors and co-workers showing respect for their professional knowledge and competences. The same applies
to contact with representatives of the public and various civil authorities.
Pedagogical skills
Doctors with specialist competence must have pedagogical capability inorder to inform and instruct not only patients and their next of kin, but also
other doctors and co-workers, as well as students.
Professional approach and ethics
Doctors with specialist competence must be capable of working continuously with their professional and medical ethical approaches, with the objectiveof being able to make independent decisions of a medical ethical nature.
Individual professional development
Doctors with specialist competence must be capable of continually examining and identifying their own needs for professional development, in addition to operational requirements, in order to be able to meet requirements forthe best possible patient care.

Leadership competence
Collaboration
Doctors with specialist competence must have a developed capability for
self-knowledge and understanding of their own functions and roles in theorganisation.
Mentoring skills
Doctors with specialist competence must be capable of mentoring other doctors and co-workers, as well as students.
Leadership
Doctors with specialist competence must be capable of leadership distinguished by collaboration, openness, and dialogue with co-workers. Leadership must further be characterised by participation and activity development
aimed at improvement. The ability to lead the work of the health care teamis essential.
System knowledge
Doctors with specialist competence must have an understanding of the organisation, administration, finances, and regulatory systems of health care,
as well as its governance, in order to make the best use of resources.

Competence within medical science and quality work
Medical science
Doctors with specialist competence must be capable of a medically scientific outlook and approach, and must have knowledge of research methodology, including basic epidemiological concepts, as well as of methods for evidence-based medicine and review of scientific information.
Improvement and quality work
Doctors with specialist competence must have an understanding of, andcompetence in, evidence-based improvement and quality work. The objective is to be able to initiate, participate in, and be responsible for continuous
systematic improvement work with emphasis on a holistic perspective, patient safety, patient benefit, measurability, and teaching management in order to be able to review and evaluate their own operations.
Public health and prevention
Doctors with specialist competence must have an understanding of the factors determining health, other aspects of public health, and methods forpromoting health and efforts aimed at preventing injury and illness, in order
to be able to take this understanding into account in medical scientific work.

Training structure
The main training should begin with service at a child and adolescent psychiatric unit. Cross-training should then follow, through service in the areasof child, adolescent and adult psychiatry The specialist training should beconcluded with service at a child and adolescent psychiatric unit to facilitate
the transition to independent work as a specialist.
A course in psychotherapy where ST doctors can acquire an understandingof psychological treatment methods is very important. During the course, it
is important that theory and practical skills are integrated under the supervision of a licensed psychotherapist who is a trained mentor. The courseshould be alternated with clinical service so that ST doctors can apply theknowledge in their everyday activities as doctors.
During the main training, a longer, uninterrupted period of service will be ofgreat importance. This is so that ST doctors can be given good opportunities tofollow up patients over a longer period of time. ST doctors should also be assured of extensive experience in acute care and child and adolescent psychiatric in-patient care during training.
In its entirety, the training should give ST doctors the opportunity to acquire both broad and in-depth competence. The training should, therefore,be supplemented with service at a university clinic or the equivalent whereappropriate.

Special recommendations
The specialty associations and sections of the medical organisations haveformulated special recommendations for their specialties. The recommendations concern such issues as how specialist medical training can be structured.

Intermediate objectives

Medical competenceIntermediate objective 1

Teaching methods

Follow-up

To master evaluation andhandling of acute child andadolescent psychiatric conditions

Clinical service under supervision in a unit that handles these conditions

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

SeminarSitting-in
Theoretical studies

Intermediate objective 2

Teaching methods

Follow-up

To master evaluation andprioritisation of children andyoung people’s psychiatriccare needs in light of biological, psychological andsocial factors that lead to anincreased risk of mental
illness

Clinical service under supervision in a unit that handles these conditions

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

SeminarSitting-in
Theoretical studies

Intermediate objective 3

Teaching methods

Follow-up

To master investigation,
diagnostics, medical treatment and follow-up ofcommon and serious childand adolescent psychiatricconditions

Clinical service under supervision in a unit that handles these conditions

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Seminar
Diagnostics and treatment
conference
Sitting-in
Theoretical studies

Intermediate objective 4

Teaching methods

Follow-up

To master evaluation of
deviant and normal development during the childhood years

Clinical service under supervision in a unit that handles these conditions

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

To master the capability of
being able to converse andcommunicate with children
and young people, taking
account of their needs anddevelopment level

SeminarSitting-in
Theoretical studies

Intermediate objective 5

Teaching methods

Follow-up

To master pharmacologicaltreatment of child and adolescent psychiatric conditions

Clinical service under supervision in a unit that handles these conditions

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

SeminarSitting-in
Theoretical studies

Intermediate objective 6

Teaching methods

Clinical service under suTo have an understanding
pervision in a unit that hanof psychological and psydles these conditions
chotherapeutic treatment
methods with regard to childand adolescent psychiatricconditions
CourseFollow-up
Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor
Certificate of successfullycompleted course, issuedby course leader

Theoretical studies

Intermediate objective 7

Teaching methods

Follow-up

To have an understandingof child and adolescent
psychiatry’s cooperation
with other civil authorities

Clinical service under supervision in a unit that handles these issues

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

Health care teamwork under supervision
Theoretical studies

Intermediate objective 8

Teaching methods

Follow-up

To have an understanding oflegislation on medical careand treatment, social services and handicapped carerelevant to the specialty andof the application of thislegislation

Clinical service under supervision in a unit that handles these conditions

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

CourseTo master handling in accordance with the Compulsory Psychiatric Care Act

Certificate of successfullycompleted course, issuedby course leader

Seminar
Theoretical studies

Intermediate objective 9

Teaching methods

Follow-up

To have an understandingof drug abuse and its comorbidity with child and adolescent psychiatric conditions

Clinical service under supervision in a unit that handles these conditions

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Seminar
Theoretical studies

Intermediate objective 10

Teaching methods

Follow-up

To have an understandingof psychiatric conditions at
an adult age, particularly inyoung adults

Clinical service under supervision in a unit that handles these conditions

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Seminar
Theoretical studies

Intermediate objective 11

Teaching methods

Follow-up

To have an understandingof paediatrics, particularly
paediatric neurology andhabilitation

Clinical service under supervision in a unit that handles these conditions

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Seminar
Theoretical studies

Intermediate objective 12

Teaching methods

To have an understandingof forensic psychiatry’sorganisation and duties

Auscultation under supervision in a unit where suchoperations are practised

CourseFollow-up

Certificate of successfullycompleted course, issuedby course leader

Theoretical studies

Communicative competenceIntermediate objective 13

Teaching methods

Follow-up

To be capable of dialogue
and open contact with patients and their next of kin
and to be capable of communication, both oral andwritten, with other doctors
and co-workers

Clinical service under
supervision in a unit
where such operations
are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Health care teamwork under supervisionIntermediate objective 14

Teaching methods

Follow-up

To be capable of informing
and instructing patients,
next of kin, other doctors,
and co-workers, as well as
students

Clinical service under supervision in a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

Instruction under supervisionIntermediate objective 15

Teaching methods

Follow-up

To be capable of working
continuously on a professional and medical ethicalapproaches

Clinical service under supervision in a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

SeminarLeadership competenceIntermediate objective 16

Teaching methods

Follow-up

To be capable of mentoringother doctors and coworkers as well as students

Clinical service under supervision in a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Mentoring under supervisionIntermediate objective 17

Teaching methods

Follow-up

To be capable of leading
using collaboration anddialogue with co-workers aswell as within the healthcare team and to have an
understanding of one’s
individual role in the organisation

Clinical service under supervision in a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Health care teamwork under supervisionIntermediate objective 18

Teaching methods

Follow-up

To have understanding of
the organisation, management, and regulatory systems of health care

CourseCertificate of successfullycompleted course, issuedby course leader

Theoretical studies

Competence within medical science and quality
work
Intermediate objective 19

Teaching methods

To be capable of a medically scientific outlook andapproach

CourseWritten individual work
under supervision according to scientific principles

Follow-up
Certificate of successfullycompleted course, issued
by current mentor
Certificate of approved
written individual work,
issued by current course
leaderSeminarLarge professional assembly
Theoretical studies

Intermediate objective 20

Teaching methods

Follow-up

To have an understandingof, and competence in,evidence-based improvement and quality work

Quality and development
work under supervision

Certificate of quality anddevelopment work, issued
by current mentor

Intermediate objective 21

Teaching methods

Follow-up

To have an understandingof the factors determining
health and other aspects ofpublic health, as well as
methods for promoting
health and efforts to prevent
illness

Seminar
Theoretical studies

Specialties in radiology

Radiology
Introduction
Explanation of terms
General definition of competencies
Definition of area of competence
Competence requirements
Competence requirements for medical competence
Competence requirements for communicative competence, leadershipcompetence, and competence within medical science and quality work
Training structure
Special recommendations
Intermediate objectives
Medical competenceCommunicative competence
Leadership competence
Competence within medical science and quality work

Introduction

On June 24, 2008, The National Board of Health and Welfare (Socialstyrelsen) decided to announce new regulations and general guidelines for doctors’ specialist medical training (SOSFS 2008:17). The statute consists of ageneral part with common provisions for all specialties and a specific partwith all the descriptions of objectives. The description of objectives for therespective specialties should be understood against the background of theprovisions in the general part.
In each description of objectives, there is a section headed ‘Training
structure’, which constitutes general guidelines. The teaching methods under the heading ‘Intermediate objectives’ where no follow-up is indicatedalso constitute general guidelines.

Explanation of terms

current mentor
a specialist doctor whose specialist competence corresponds to the area ofcompetence indicated by the intermediate objective, and who is responsible
for ST doctors’s professional development during the teaching period or forthe method of teaching indicatedthe assignment as a mentor for an ST doctor generally encompasses the entire period of specialist training but can also encompass part or parts of it
auscultation
during mentoring, and in accordance with a pre-designed programme, tostudy the profession of a specialist doctor or other health care staff by following one or several professionals, as well as carrying out assignments in
the relevant area to a certain extent
evaluate
to form a sound opinion of a patient or similar person as a basis for further
management
masterbeing fully able to evaluate and handle the medical investigation, diagnostics, treatment, and follow-up of a patient or similar person, and being fully
able to use the techniques relevant to the area
capability
personal capacity to execute or perform a task
h a ve u n d ers tan d i ng
having acquired knowledge and insight into an area through theoretical studies and/or practical exercise of the profession
have knowledge
having acquired some knowledge in an area through theoretical studies
and/or practical exercise of the profession
mentoring under supervision
as an ST doctor, mentor a co-worker while simultaneously being mentored
by a doctor with specialist competencementorcontinuously, and in dialogue form, supporting and guiding, as well as evaluating, a co-worker’s professional development
mentoringsee mentor
handleto actively carry out measures regarding investigation, diagnostics, treatment, and follow-up of a patient or similar person, and have overall responsibility for carrying out these measuresinitially handle
as the primary physician in charge, to actively carry out measures regarding
investigation, diagnostics, treatment, and follow-up of a patient or similar
person, and have overall responsibility for carrying out these measuresinitially evaluate
as the primary physician in charge, to form a sound opinion of a patient orsimilar person as a basis for further management
intraprofessional group reflection
reflection done in a group together with other doctors, chiefly for the purpose of further education and training
clinical service
health and medical care duties that ST doctors perform under their own professional liability and with the support of a mentor
courseteacher-led training with an established plan, given during a defined periodof timesitting-in
training activity involving an ST doctor observing when a specialist doctor
or other health care staff holds a consultationorassessment activity involving a specialist doctor or other health care staff
observing and evaluating ST doctors during a consultation
seminarinstruction in group form with active participation
training in a simulated environment
training carried out in an environment created to emulate reality

large professional assembly
conference, congress, symposium or similar event
health care centre
health care unit in primary carehealth care team work
work where ST doctors, under supervision, participates in and sometimes
leads a group of co-operating health care staff with various competencies
charged with responsibility for care for an individual patient or group ofpatients

General definition of competences

Definition of area of competenceRadiology is a clinical specialty that diagnoses, divides into stages, forecasts, evaluates therapy, and treats or rules out diseases by means of imaging morphology and technical methods. The result of the work is communicated through clinically responsible doctors and affects the handling of thepatient.
The area of competence includes the main responsibility for how the methods involved in the specialty are used in all organ systems. The specialty
plays a crucial advisory role in how investigations employing these methods
will be carried out.
Work in radiology takes place in cooperation with, by and large, all otherspecialties.
Radiology involves understanding the originating mechanisms and courseof diseases and applying this understanding using the methods and techniques involved in radiology.
The area of competence also includes describing and understanding themethods and techniques involved in radiology, using a scientific approach,and being intimate with its strengths, limitations, risks and development. It
also includes a responsibility for training co-workers both in and outside of
the area of radiology in the strengths, limitations and risks of the method.
Radiology is the base specialty for the branch specialties of clinical physiology, neuroradiology, and nuclear medicine.

Competence requirements
Competence requirements for medical competenceSpecialist competence in radiology, requires being able to evaluate and document the results of investigations using the most common radiology analyses in the areas of clinical radiology, clinical physiology, neuroradiology,
and nuclear medicine; being familiar with how they are performed, and having an understanding of treatment and intervention within the area. Specialists must be able to document and communicate knowledge, results andevaluations, and master medical image processing in the field of knowledge.
Being able to initially handle common diagnostic and therapeutic issues inorder to decide which methods in the field of knowledge are optimal and, in
addition, being able to prioritise patients and investigations on the basis of
medical benefits, safety and the degree of urgency is required. Specialists
must know how investigation results and therapy can influence medical
handling and its consequences for the individual patient and for society.
They must also have an understanding of the risks of the diagnostic and therapeutic methods involved in the field of knowledge, be familiar with phys-ics related to the area, including radiation physics and protection against
radiation, and also have knowledge of relevant legislation that touches upon
the operations. Also required is an understanding of physical, technical, mathematical, and statistical principles with regard to the most common methods, of the strengths and weaknesses of the methods, and of medical andtechnical quality assurance of investigation data. It is necessary to masterthe anatomy, physiology and pathophysiology of relevance for radiology(intermediate objectives 1-6).
Specialist competence in radiology also requires the knowledge and skillsin the radiology area of competence necessary to be able to independently
practice the specialty. This involves theoretical knowledge and practicalskills in existing investigative and treatment methods.
Mastering the most common radiology analyses and being able to initiallyhandle other radiology examinations of the thorax, including the chest organs, abdominal organs, musculoskeletal system, nervous system including
the spine, the head and throat organs, the pelvic and urogenital organs andthe vascular system, and examinations in the field of general acute operations in children and adults within the area of competence, are also necessary for specialist competence in radiology.

Competence requirements for communicative competence, leadership competence, and competence within medical scienceand quality work
Communicative competence
The equal and responsible patient
Doctors with specialist competence must be capable of dialogue and of
maintaining open contact with patients and their next of kin. Contact should
be characterised by empathy and trust, as well as respect for the patients’right to information, influence, and participation in decisions. Contact
should also be characterised by co-operation and sensitivity to the patients’needs, desires and right to self-determination, as well as providing incentive
for patients’ involvement in, and responsibility for, their own care.
Multicultural and gender aspects
Communication with patients and their next of kin should be characterisedby understanding and respect for cross-cultural and multicultural aspects
such as age, language, ethnicity, sexual orientation, and religion, as well as
gender.
Interprofessional relations
Doctors with specialist competence must be capable of communicating,both in writing and orally, with other doctors and co-workers showing respect for their professional knowledge and competences. The same applies
to contact with representatives of the public and various civil authorities.

Pedagogical skills
Doctors with specialist competence must have pedagogical capability inorder to inform and instruct not only patients and their next of kin, but also
other doctors and co-workers, as well as students.
Professional approach and ethics
Doctors with specialist competence must be capable of working continuously with their professional and medical ethical approaches, with the objectiveof being able to make independent decisions of a medical ethical nature.
Individual professional development
Doctors with specialist competence must be capable of continually examining and identifying their own needs for professional development, in addition to operational requirements, in order to be able to meet requirements forthe best possible patient care.

Leadership competence
Collaboration
Doctors with specialist competence must have a developed capability for
self-knowledge and understanding of their own functions and roles in theorganisation.
Mentoring skills
Doctors with specialist competence must be capable of mentoring other doctors and co-workers, as well as students.
Leadership
Doctors with specialist competence must be capable of leadership distinguished by collaboration, openness, and dialogue with co-workers. Leadership must further be characterised by participation and activity development
aimed at improvement. The ability to lead the work of the health care teamis essential.
System knowledge
Doctors with specialist competence must have an understanding of the organisation, administration, finances, and regulatory systems of health care,
as well as its governance, in order to make the best use of resources.

Competence within medical science and quality work
Medical science
Doctors with specialist competence must be capable of a medically scientific outlook and approach, and must have knowledge of research methodology, including basic epidemiological concepts, as well as of methods for evidence-based medicine and review of scientific information.

Improvement and quality work
Doctors with specialist competence must have an understanding of, andcompetence in, evidence-based improvement and quality work. The objective is to be able to initiate, participate in, and be responsible for continuous
systematic improvement work with emphasis on a holistic perspective, patient safety, patient benefit, measurability, and teaching management in order to be able to review and evaluate their own operations.
Public health and prevention
Doctors with specialist competence must have an understanding of the factors determining health, other aspects of public health, and methods forpromoting health and efforts aimed at preventing injury and illness, in order
to be able to take this understanding into account in medical scientific work.

Training structure
In order for the prospective specialist to be given the opportunity during
training to develop in all the intermediate objectives, it is essential that thetraining can be carried out both at university hospitals or similar units thathave extensive and specialised activities, and at units with more generalactivities. It is important that the specialist training provides logical, clear
and continuous professional development with sufficiently long uninterrupted periods of training in the respective units. In order to provide the opportunity to obtain knowledge in a structured fashion, the placement at auniversity hospital should be for a continuous period of time. Cooperation
with other clinical specialties is necessary and, for this reason, simultaneous
additional training through service in another specialty closely involved
with patients should be carried out. It is of great importance that the prospective specialist be trained in quality and development work. It is also of
the greatest importance that research and development work and participation in instruction be included in the training.
The training should be based on the practical application of theoreticalknowledge that has been obtained. The theoretical training should consist ofboth private studies and obtaining knowledge externally. ST doctors should,
therefore, be allowed to take part in national and international courses andconferences during training. In order to be able to build up applied knowledge within the area of radiology on a theoretical basis and create conditions for an evidence-based working method, it is also imperative that, in
relation to clinical work, advanced theoretical training take place in directconnection with practical work.
The training should be planned in such a way that a basic understandingof the methods involved in radiology and the most common illnesses in bothelective and acute activities are featured at an early stage of the training in
the common competence base.

Special recommendations
The specialty associations and sections of the medical organisations haveformulated special recommendations for their specialties. The recommendations concern such issues as how specialist medical training can be structured.

Intermediate objectives

Medical competenceIntermediate objective 1

Teaching methods

Follow-up

To be able to evaluate anddocument the result of investigations using the mostcommon radiology analyses
and have an understandingof treatment and intervention that occurs within theradiology field of knowledge

Clinical service under supervision in a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Large professional assembly
Diagnostics and treatment
conference
Theoretical studies

Intermediate objective 2

Teaching methods

Follow-up

To be able to initially handle common diagnostic andtherapeutic issues in orderto decide which methods inthe field of knowledge are
optimal and have an understanding of risks in the
diagnostic and therapeutic
methods involved in thefield of knowledge

Clinical service under supervision in a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

To have an understandingof prioritising patients andinvestigations on the basisof medical benefits, safety
and the degree of urgency

Large professional assembly
Diagnostics and treatment
conference
Theoretical studies

Intermediate objective 3

Teaching methods

Follow-up

To have an understandingof how radiology investigation results and therapeutic
operations may affect medical handling and its consequences for the individual
patient and to master documentation and communication in the field of knowledge of knowledge, results
and evaluation.

Clinical service under supervision in a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Large professional assembly
Diagnostics and treatment
conference
Theoretical studies

Intermediate objective 4

Teaching methods

Follow-up

To have an understandingof how common investigations are carried out to haveknowledge of how otherinvestigations and therapeutic measures in the field ofknowledge are carried out
and have an understandingof medical and technicalquality assurance of investigation data

Clinical service under supervision in a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

To master medical image
processing in the area ofradiology

Large professional assembly
Diagnostics and treatment
conference
Theoretical studies

Intermediate objective 5

Teaching methods

Follow-up

To master anatomy, physiology and pathophysiology
relevant to radiology

Clinical service under supervision in a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Theoretical studies

Intermediate objective 6

Teaching methods

Follow-up

To have an understandingof physical, technical, mathematical and statisticalprinciples regarding themost common methods inthe area of radiology, as
well as their strengths andweaknesses and have an
understanding of the physics related to the area ofcompetence, including radiation physics and protection
against radiation

Clinical service under supervision in a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

To have knowledge of relevant legislation regarding
radiology

Theoretical studies

Intermediate objective 7

Teaching methods

Follow-up

To master the most common investigations and beable to initially handle otherinvestigations of the thorax
including the chest organsof children and adults

Clinical service under supervision in a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Large professional assembly
Diagnostics and treatment
conference
Theoretical studies

Intermediate objective 8

Teaching methods

Follow-up

To master the most common investigations and beable to initially handle otherinvestigations of the abdominal organs of children
and adults

Clinical service under supervision in a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Large professional assembly
Diagnostics and treatment
conference
Theoretical studies

Intermediate objective 9

Teaching methods

Follow-up

To master the most common investigations and beable to initially handle otherinvestigations of the musculoskeletal system ofchildren and adults

Clinical service under supervision in a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Large professional assembly
Diagnostics and treatment
conference
Theoretical studies

Intermediate objective 10

Teaching methods

Follow-up

To master the most common investigations and beable to initially handle otherinvestigations of the nervous system, including thespine and head and throatorgans, of children andadultsClinical service under supervision in a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Large professional assembly
Diagnostics and treatment
conference
Theoretical studies

Intermediate objective 11

Teaching methods

Follow-up

To master the most common investigations and beable to initially handle investigations within the pelvic and urogenital organs
and vascular system ofchildren and adults

Clinical service under supervision in a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Large professional assembly
Diagnostics and treatment
conference
Theoretical studies

Intermediate objective 12

Teaching methods

Follow-up

To master the most common investigations and beable to initially handle otherinvestigations in the area of
acute activity involving
children and adults

Clinical service under supervision in a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Large professional assembly
Diagnostics and treatment
conference
Theoretical studies

Communicative competenceIntermediate objective 13

Teaching methods

Follow-up

To be capable of dialogue
and open contact with patients and their next of kin

Clinical service under supervision in a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

Intermediate objective 14

Teaching methods

Follow-up

To be capable of communication, both oral and written,
with other doctors and coworkers

Clinical service under supervision in a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

Large professional assembly
Diagnostics and treatment
conferenceIntermediate objective 15

Teaching methods

Follow-up

To be capable of informing
and instructing patients,
next of kin, other doctors,
and co-workers, as well as
students

Clinical service under supervision in a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Instruction under supervision
Large professional assembly
Diagnostics and treatment
conference

Leadership competenceIntermediate objective 16

Teaching methods

Follow-up

To be capable of mentoringother doctors and coworkers as well as students

Clinical service under supervision in a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Mentoring under supervision
Large professional assembly
Diagnostics and treatment
conference

Intermediate objective 17

Teaching methods

Follow-up

To be capable of leading incollaboration and dialogue
with co-workers as well as
within the health care team

Clinical service under supervision in a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseClinical service under sui i i
it hCertificate of successfullycompleted course, issuedby course leader

Large professional assembly
Diagnostics and treatment
conferenceIntermediate objective 18

Teaching methods

Follow-up

To have an understandingof the organisation, management, and regulatory
systems of health care

CourseCertificate of successfullycompleted course, issuedby course leader

Theoretical studies

Competence within medical science and quality
work
Intermediate objective 19

Teaching methods

Follow-up

To be capable of a medically scientific outlook andapproach

Written individual work
under supervision according to scientific principles

Certificate of approved
written individual work,
issued by current mentor

Large professional assembly
Diagnostics and treatment
conference

Intermediate objective 20

Teaching methods

Follow-up

To have an understandingof, and competence in,evidence-based improvement and quality work

Quality and development
work under supervision

Certificate of quality anddevelopment work, issued
by current mentor

Large professional assembly
Diagnostics and treatment
conferenceNeuroradiology

Introduction
Explanation of terms
General definition of competencies
Definition of area of competence
Competence requirements
Competence requirements for medical competence
Competence requirements for communicative competence, leadershipcompetence, and competence within medical science and quality work
Training structure
Special recommendations
Intermediate objectives
Medical competenceCommunicative competence
Leadership competence
Competence within medical science and quality work

Introduction

On June 24, 2008, The National Board of Health and Welfare (Socialstyrelsen) decided to announce new regulations and general guidelines for doctors’ specialist medical training (SOSFS 2008:17). The statute consists of ageneral part with common provisions for all specialties and a specific partwith all the descriptions of objectives. The description of objectives for therespective specialties should be understood against the background of theprovisions in the general part.
In each description of objectives, there is a section headed ‘Training
structure’, which constitutes general guidelines. The teaching methods under the heading ‘Intermediate objectives’ where no follow-up is indicatedalso constitute general guidelines.

Explanation of terms

current mentor
a specialist doctor whose specialist competence corresponds to the area ofcompetence indicated by the intermediate objective, and who is responsible
for ST doctors’s professional development during the teaching period or forthe method of teaching indicatedthe assignment as a mentor for an ST doctor generally encompasses the entire period of specialist training but can also encompass part or parts of it
auscultation
during mentoring, and in accordance with a pre-designed programme, tostudy the profession of a specialist doctor or other health care staff by following one or several professionals, as well as carrying out assignments in
the relevant area to a certain extent
evaluate
to form a sound opinion of a patient or similar person as a basis for further
management
masterbeing fully able to evaluate and handle the medical investigation, diagnostics, treatment, and follow-up of a patient or similar person, and being fully
able to use the techniques relevant to the area
capability
personal capacity to execute or perform a task
h a ve u n d ers tan d i ng
having acquired knowledge and insight into an area through theoretical studies and/or practical exercise of the profession
have knowledge
having acquired some knowledge in an area through theoretical studies
and/or practical exercise of the profession
mentoring under supervision
as an ST doctor, mentor a co-worker while simultaneously being mentored
by a doctor with specialist competencementorcontinuously, and in dialogue form, supporting and guiding, as well as evaluating, a co-worker’s professional development
mentoringsee mentor
handleto actively carry out measures regarding investigation, diagnostics, treatment, and follow-up of a patient or similar person, and have overall responsibility for carrying out these measuresinitially handle
as the primary physician in charge, to actively carry out measures regarding
investigation, diagnostics, treatment, and follow-up of a patient or similar
person, and have overall responsibility for carrying out these measuresinitially evaluate
as the primary physician in charge, to form a sound opinion of a patient orsimilar person as a basis for further management
intraprofessional group reflection
reflection done in a group together with other doctors, chiefly for the purpose of further education and training
clinical service
health and medical care duties that ST doctors perform under their own professional liability and with the support of a mentor
courseteacher-led training with an established plan, given during a defined periodof timesitting-in
training activity involving an ST doctor observing when a specialist doctor
or other health care staff holds a consultationorassessment activity involving a specialist doctor or other health care staff
observing and evaluating ST doctors during a consultation
seminarinstruction in group form with active participation
training in a simulated environment
training carried out in an environment created to emulate reality

large professional assembly
conference, congress, symposium or similar event
health care centre
health care unit in primary carehealth care team work
work where ST doctors, under supervision, participates in and sometimes
leads a group of co-operating health care staff with various competencies
charged with responsibility for care for an individual patient or group ofpatients

General definition of competences

Definition of area of competence
Neuroradiology is a clinical specialty that diagnoses, divides into stages,
forecasts, evaluates therapy, and treats diseases of the central nervous system and ear, nose and throat area in children and adults by means of imaging morphology and technology methods. The result of this work is communicated through clinically responsible doctors and affects the handling of
the patient. The neuroradiology area of competence involves the main responsibility for how the specialty's methods are used in the brain, back,head, and throat, as well as competence in being a central adviser as to how
neuroradiological investigations are carried out. The work is done in cooperation with specialists in many other specialties.
The clinical neuroradiology area of competence includes knowledge andan understanding of the originating mechanisms and course of diseases, andof how this understanding is applied in work using the methods and techniques of neuroradiology.
The neuroradiology area of competence also includes understanding andmastering the methods and techniques of the specialty, and being familiar
with their development, strengths, limitations, and risks. Finally, the clinicalneuroradiology area of competence includes training specialists and prospective specialists in other specialties in the strengths, limitations and risksof neuroradiological methods.
Neuroradiology is a branch specialty of the base specialty of radiology.

Competence requirements
Competence requirements for medical competenceSpecialist competence in neuroradiology requires a fundamental understanding of and skills in the field of neuroradiology, which means being able toindividually handle, evaluate and provide advice on the most common diagnostic neuroradiological methods. An understanding of existing therapeutic
neuro-radiological methods, their indications, limitations, risks, and complications is also required.
Specialist competence in neuroradiology, also requires being able to evaluate and document the results of investigations using the most common
radiology analyses in the areas of clinical radiology, clinical physiology,
neuroradiology and nuclear medicine, and being familiar with how they are
performed; and also having an understanding of treatment and intervention
within the area. It is necessary to be able to document and communicate
knowledge, results and evaluations and master medical image processing in
the field of knowledge. Being able to handle common diagnostic and therapeutic issues in order to decide which methods in the field of knowledge areoptimal and, in addition, being able to prioritise patients and investigations
on the basis of medical benefits, safety and the degree of urgency is also
required. It is necessary to know how examination results and therapy can
influence medical handling, and their consequences for the individual patient and for society. It is also necessary to have an understanding of therisks of the diagnostic and therapeutic methods involved in the field ofknowledge, be familiar with physics related to the area including radiation
physics and protection against radiation, and also to have knowledge of relevant legislation touching on the activity. It is necessary to have an understanding of physical, technical, mathematical and statistical principles withregard to the most common methods, of the strengths and weaknesses of themethods, and of medical and technical quality assurance of investigation
data. It is necessary to master anatomy, physiology and pathophysiology of
relevance for radiology (intermediate objectives 1-6).

Competence requirements for communicative competence, leadership competence, and competence within medical scienceand quality work
Communicative competence
The equal and responsible patient
Doctors with specialist competence must be capable of dialogue and of
maintaining open contact with patients and their next of kin. Contact should
be characterised by empathy and trust, as well as respect for the patients’right to information, influence, and participation in decisions. Contact
should also be characterised by co-operation and sensitivity to the patients’needs, desires and right to self-determination, as well as providing incentive
for patients’ involvement in, and responsibility for, their own care.
Multicultural and gender aspects
Communication with patients and their next of kin should be characterisedby understanding and respect for cross-cultural and multicultural aspects
such as age, language, ethnicity, sexual orientation, and religion, as well as
gender.
Interprofessional relations
Doctors with specialist competence must be capable of communicating,both in writing and orally, with other doctors and co-workers showing respect for their professional knowledge and competences. The same applies
to contact with representatives of the public and various civil authorities.
Pedagogical skills
Doctors with specialist competence must have pedagogical capability inorder to inform and instruct not only patients and their next of kin, but also
other doctors and co-workers, as well as students.

Professional approach and ethics
Doctors with specialist competence must be capable of working continuously with their professional and medical ethical approaches, with the objectiveof being able to make independent decisions of a medical ethical nature.
Individual professional development
Doctors with specialist competence must be capable of continually examining and identifying their own needs for professional development, in addition to operational requirements, in order to be able to meet requirements forthe best possible patient care.

Leadership competence
Collaboration
Doctors with specialist competence must have a developed capability for
self-knowledge and understanding of their own functions and roles in theorganisation.
Mentoring skills
Doctors with specialist competence must be capable of mentoring other doctors and co-workers, as well as students.
Leadership
Doctors with specialist competence must be capable of leadership distinguished by collaboration, openness, and dialogue with co-workers. Leadership must further be characterised by participation and activity development
aimed at improvement. The ability to lead the work of the health care teamis essential.
System knowledge
Doctors with specialist competence must have an understanding of the organisation, administration, finances, and regulatory systems of health care,
as well as its governance, in order to make the best use of resources.

Competence within medical science and quality work
Medical science
Doctors with specialist competence must be capable of a medically scientific outlook and approach, and must have knowledge of research methodology, including basic epidemiological concepts, as well as of methods for evidence-based medicine and review of scientific information.
Improvement and quality work
Doctors with specialist competence must have an understanding of, andcompetence in, evidence-based improvement and quality work. The objective is to be able to initiate, participate in, and be responsible for continuoussystematic improvement work with emphasis on a holistic perspective, patient safety, patient benefit, measurability, and teaching management in order to be able to review and evaluate their own operations.
Public health and prevention
Doctors with specialist competence must have an understanding of the factors determining health, other aspects of public health, and methods forpromoting health and efforts aimed at preventing injury and illness, in order
to be able to take this understanding into account in medical scientific work.

Training structure
There is basically a great deal of freedom regarding the reciprocal arrangement of training elements in radiology and neuroradiology and the specialised training in neuroradiology may, in principle, take place during all partsof the training period. Specialist medical training in neuroradiology can,therefore, begin before, during, or after specialist medical training in radiology and can be integrated with it.
The specific service in neuroradiology should be carried out at neuroradiological units at university hospitals that provide care to adults and children
in the areas of neurology, neurosurgery and otorhinolaryngology. Clinicaltraining at another unit is imperative in order to ensure continuous contact
with other specialties in those cases where this kind of training cooperation
is a prerequisite for the scope and quality of the training. For cooperation
with other clinical specialties, it is important to have cross-training throughservice in another specialty that is of relevance for the training, primarily in
one or more of the following specialties: clinical neurophysiology, neurology and neurosurgery. It is also important that the prospective specialist can betrained in quality and development work. It is also of the greatest importancethat research and development work and participation in instruction canform part of the training.
Training should be based on the practical application of the theoreticalknowledge obtained. Theoretical training should consist of both private studies
and obtaining knowledge externally. ST doctors should, therefore, be given
the opportunity to take part in national and international courses and conferences during training. These courses in clinical neuroradiology and also
theoretical advanced private studies should, if possible, be arranged in directconnection with the current placement. In order for the training to achievesatisfactory depth, the training period should be utilised in such a way that
ST doctors are given the opportunity for a sufficiently long continuous period in each defined work operation.
During the training period, time should be set aside for individual workthat may include cross-training through service in other clinical or theoretical specialties with a link to neuroscientific subjects or private researchwork.

Special recommendations
The specialty associations and sections of the medical organisations haveformulated special recommendations for their specialties. The recommendations concern such issues as how specialist medical training can be structured.

Intermediate objectives

Medical competenceIntermediate objective 1

Teaching methods

Follow-up

To be able to evaluate anddocument the result of investigations using the mostcommon radiology analyses
and have an understandingof treatment and intervention that occurs within theradiology field of knowledge

Clinical service under supervision in a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issued
by current mentor

Large professional assembly
Diagnostics and treatment
conference
Theoretical studies

Intermediate objective 2

Teaching methods

Follow-up

To be able to initially handle
common diagnostic andtherapeutic issues in orderto decide which methods inthe field of knowledge are
optimal and have an understanding of risks in the diagnostic and therapeutic methods involved in the field ofknowledge

Clinical service under supervision in a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issued
by current mentor

To have an understanding ofprioritising patients and investigations on the basis of
medical benefits, safety andthe degree of urgency

Large professional assembly
Diagnostics and treatment
conference
Theoretical studies

Intermediate objective 3

Teaching methods

Follow-up

To have an understandingof how radiology investigation results and therapeutic
operations may affect medical handling and its consequences for the individual
patient and to master documentation and communication in the field of knowledge of knowledge, results
and evaluation.

Clinical service under supervision in a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issued
by current mentor

Large professional assembly
Diagnostics and treatment
conference
Theoretical studies

Intermediate objective 4

Teaching methods

Follow-up

To have an understandingof how common investigations are carried out and tohave knowledge of how
other investigations andtherapeutic measures in thefield of knowledge are carried out and have an understanding of medical andtechnical quality assurance
of investigation data

Clinical service under supervision in a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issued
by current mentor

To master medical image
processing in the area ofradiology

Large professional assembly
Diagnostics and treatment
conference
Theoretical studies

Intermediate objective 5

Teaching methods

Follow-up

To master the anatomy,
physiology and pathophysiology relevant to radiology

Clinical service under supervision in a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issued
by current mentor

Theoretical studies

Intermediate objective 6

Teaching methods

Follow-up

To have an understanding ofphysical, technical, mathematical and statistical principles with regard to themost common methods inradiology and their strengths
and weaknesses and also
have an understanding ofphysics related to the areaof competence, including
radiation physics and protection against radiation.

Clinical service under supervision in a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issued
by current mentor

Theoretical studies

To have knowledge of relevant legislation regarding
radiology

Intermediate objective 7

Teaching methods

Follow-up

To master neuroanatomy
and have an understandingof neuropathology and neurophysiology

Clinical service under supervision in a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

To have an understandingof the most common relevant diseases in related
clinical specialties

CourseCertificate of successfullycompleted course, issued
by current mentor

Diagnostics and treatment
conference
Theoretical studies

Intermediate objective 8

Teaching methods

Follow-up

To have an understandingof diseases, injuries anddeformities in the brain,
head, throat, back andspinal marrow of adults andchildrenClinical service under supervision in a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issued
by current mentor

SeminarLarge professional assembly
Diagnostics and treatment
conference
Theoretical studies

Intermediate objective 9

Teaching methods

Follow-up

To master neuroradiologicaldiagnostics and its importance in the handling andcare of the patient and also
be able to handle and makedecisions in matters of a
medical ethical nature inclinical neuroradiology

Clinical service under supervision in a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issued
by current mentor

SeminarLarge professional assembly
Diagnostics and treatment
conference
Theoretical studies

Intermediate objective 10

Teaching methods

Follow-up

To master neuroradiologicaldiagnostics in posttherapeutic conditions andbe able to handle follow-up
treatment.

Clinical service under supervision in a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

To be able to evaluate surgical and medical treatment
results, including interventional neuroradiology and beable to handle diagnostics
and treatment complications

CourseCertificate of successfullycompleted course, issued
by current mentor

Large professional assembly
Diagnostics and treatment
conference
Theoretical studies

Intermediate objective 11

Teaching methods

Follow-up

To master neuroradiological
techniques by having an
understanding of indications, counterindications
and limitations, complications and side effects of themost common diagnostic
methods and have knowledge of similar aspects ininterventional and functional
neuroradiology

Clinical service under supervision in a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issued
by current mentor

Instruction under supervision
Large professional assembly
Diagnostics and treatment
conference
Theoretical studies

Intermediate objective 12

Teaching methods

Follow-up

To master special paediatricapplications in neuroradiology, particularly with regard
to the development of thebrain, child abuse and protection against radiation

Clinical service under supervision in a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issued
by current mentor

Diagnostics and treatment
conference
Theoretical studies

Communicative competenceIntermediate objective 13

Teaching methods

Follow-up

To be capable of dialogue
and open contact with patients and their next of kin

Clinical service under supervision in a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

Intermediate objective 14

Teaching methods

Follow-up

To be capable of communication, both oral and written, with other doctors andco-workers

Clinical service under supervision in a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

Large professional assembly
Diagnostics and treatment
conference

Intermediate objective 15

Teaching methods

Follow-up

To be capable of informing
and instructing patients,
next of kin, other doctors,
and co-workers, as well as
students

Clinical service under supervision in a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issued
by current mentor

Instruction under supervision
Large professional assembly
Diagnostics and treatment
conference

Leadership competenceIntermediate objective 16

Teaching methods

Follow-up

To be capable of mentoringother doctors and coworkers as well as students

Clinical service under supervision in a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Mentoring under supervision
Large professional assembly
Diagnostics and treatment
conferenceIntermediate objective 17

Teaching methods

Follow-up

To be capable of leading incollaboration and dialogue
with co-workers as well as
within the health care team

Clinical service under supervision in a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Large professional assembly
Diagnostics and treatment
conference

Intermediate objective 18

Teaching methods

Follow-up

To have an understandingof the organisation, management, and regulatory
systems of health care

CourseCertificate of successfullycompleted course, issuedby course leader

Theoretical studies

Competence within medical science and quality
work
Intermediate objective 19

Teaching methods

Follow-up

To be capable of a medically scientific outlook andapproach

Written individual work
under supervision according to scientific principles

Certificate of approved
written individual work,
issued by current mentor

Large professional assembly
Diagnostics and treatment
conference

Intermediate objective 20

Teaching methods

Follow-up

To have an understandingof, and competence in,evidence-based improvement and quality work

Quality and development
work under supervision

Certificate of quality anddevelopment work, issued
by current mentor

Large professional assembly
Diagnostics and treatment
conferenceNuclear medicine

Introduction
Explanation of terms
General definition of competencies
Definition of area of competence
Competence requirements
Competence requirements for medical competence
Competence requirements for communicative competence, leadershipcompetence, and competence within medical science and quality work
Training structure
Special recommendations
Intermediate objectives
Medical competenceCommunicative competence
Leadership competence
Competence within medical science and quality work

Introduction

On June 24, 2008, The National Board of Health and Welfare (Socialstyrelsen) decided to announce new regulations and general guidelines for doctors’ specialist medical training (SOSFS 2008:17). The statute consists of ageneral part with common provisions for all specialties and a specific partwith all the descriptions of objectives. The description of objectives for therespective specialties should be understood against the background of theprovisions in the general part.
In each description of objectives, there is a section headed ‘Training
structure’, which constitutes general guidelines. The teaching methods under the heading ‘Intermediate objectives’ where no follow-up is indicatedalso constitute general guidelines.

Explanation of terms

current mentor
a specialist doctor whose specialist competence corresponds to the area ofcompetence indicated by the intermediate objective, and who is responsible
for ST doctors’s professional development during the teaching period or forthe method of teaching indicatedthe assignment as a mentor for an ST doctor generally encompasses the entire period of specialist training but can also encompass part or parts of it
auscultation
during mentoring, and in accordance with a pre-designed programme, tostudy the profession of a specialist doctor or other health care staff by following one or several professionals, as well as carrying out assignments in
the relevant area to a certain extent
evaluate
to form a sound opinion of a patient or similar person as a basis for further
management
masterbeing fully able to evaluate and handle the medical investigation, diagnostics, treatment, and follow-up of a patient or similar person, and being fully
able to use the techniques relevant to the area
capability
personal capacity to execute or perform a task
h a ve u n d ers tan d i ng
having acquired knowledge and insight into an area through theoretical studies and/or practical exercise of the profession
have knowledge
having acquired some knowledge in an area through theoretical studies
and/or practical exercise of the profession
mentoring under supervision
as an ST doctor, mentor a co-worker while simultaneously being mentored
by a doctor with specialist competencementorcontinuously, and in dialogue form, supporting and guiding, as well as evaluating, a co-worker’s professional development
mentoringsee mentor
handleto actively carry out measures regarding investigation, diagnostics, treatment, and follow-up of a patient or similar person, and have overall responsibility for carrying out these measuresinitially handle
as the primary physician in charge, to actively carry out measures regarding
investigation, diagnostics, treatment, and follow-up of a patient or similar
person, and have overall responsibility for carrying out these measuresinitially evaluate
as the primary physician in charge, to form a sound opinion of a patient orsimilar person as a basis for further management
intraprofessional group reflection
reflection done in a group together with other doctors, chiefly for the purpose of further education and training
clinical service
health and medical care duties that ST doctors perform under their own professional liability and with the support of a mentor
courseteacher-led training with an established plan, given during a defined periodof timesitting-in
training activity involving an ST doctor observing when a specialist doctor
or other health care staff holds a consultationorassessment activity involving a specialist doctor or other health care staff
observing and evaluating ST doctors during a consultation
seminarinstruction in group form with active participation
training in a simulated environment
training carried out in an environment created to emulate reality

large professional assembly
conference, congress, symposium or similar event
health care centre
health care unit in primary carehealth care team work
work where ST doctors, under supervision, participates in and sometimes
leads a group of co-operating health care staff with various competencies
charged with responsibility for care for an individual patient or group ofpatients

General definition of competences

Definition of area of competence
Nuclear medicine is a clinical specialty in which one monitors physiologicaland pathophysiological processes in all organs and organ systems by meansof special detectors after adding radiopharmaceuticals. This is in order todiagnose, divide into stages, forecast and treat or rule out diseases and evaluate therapy. Biochemical processes can be visualised at a cellular and subcellular level and pathological processes can be established before they manifest themselves in morphological changes.
The results are communicated through clinically responsible doctors andform the basis for the handling of the patient. This work is carried out inclose cooperation with other specialties.
The competence also covers how all methods involved in the specialty areused in all organ systems and advice on how these methods should be investigated. It also covers responsibility for developing and managing scientificand quality work in the specialty.
Nuclear medicine is a branch specialty of the base specialty of radiology.

Competence requirements
Competence requirements for medical competenceSpecialist competence in nuclear medicine requires having an understandingof and the skills in the nuclear medicine area of competence necessary to beable to independently practice the specialty. This involves broad theoreticalknowledge and practical skills in the investigative and treatment methods
available in nuclear medicine. An understanding of the physics related to thearea, including radiation protection, and legislation relevant to the area isalso required.
Specialist competence in nuclear medicine also requires being able to evaluate and document the results of investigations using the most common
radiology analyses in the areas of clinical radiology, clinical physiology,
neuroradiology and nuclear medicine, being familiar with how they are performed, and also having an understanding of treatment and intervention
within the area. Specialists must be able to document and communicate
knowledge, results and evaluations and master medical image processing in
the field of knowledge. They must also be able to handle common diagnostic and therapeutic issues in order to decide which methods in the field ofknowledge are optimal and, in addition, be able to prioritise patients andinvestigations on the basis of medical benefits, safety and the degree of urgency. Specialists must know how investigation results and therapy can influence medical handling, and their consequences for the individual patientand for society. They must also have an understanding of the risks of thediagnostic and therapeutic methods involved in the field of knowledge, befamiliar with physics related to the area, including radiation physics andprotection against radiation, and have knowledge of relevant legislation that
affects the activity. Specialists must have an understanding of physical,
technical, mathematical and statistical principles with regard to the mostcommon methods, of the strengths and weaknesses of the methods and of
medical and technical quality assurance of investigation data. They mustalso master anatomy, physiology and pathophysiology of relevance for radiology (intermediate objectives 1-6).

Competence requirements for communicative competence, leadership competence, and competence within medical scienceand quality work
Communicative competence
The equal and responsible patient
Doctors with specialist competence must be capable of dialogue and of
maintaining open contact with patients and their next of kin. Contact should
be characterised by empathy and trust, as well as respect for the patients’right to information, influence, and participation in decisions. Contact
should also be characterised by co-operation and sensitivity to the patients’needs, desires and right to self-determination, as well as providing incentive
for patients’ involvement in, and responsibility for, their own care.
Multicultural and gender aspects
Communication with patients and their next of kin should be characterisedby understanding and respect for cross-cultural and multicultural aspects
such as age, language, ethnicity, sexual orientation, and religion, as well as
gender.
Interprofessional relations
Doctors with specialist competence must be capable of communicating,both in writing and orally, with other doctors and co-workers showing respect for their professional knowledge and competences. The same applies
to contact with representatives of the public and various civil authorities.
Pedagogical skills
Doctors with specialist competence must have pedagogical capability inorder to inform and instruct not only patients and their next of kin, but also
other doctors and co-workers, as well as students.
Professional approach and ethics
Doctors with specialist competence must be capable of working continuously with their professional and medical ethical approaches, with the objectiveof being able to make independent decisions of a medical ethical nature.

Individual professional development
Doctors with specialist competence must be capable of continually examining and identifying their own needs for professional development, in addition to operational requirements, in order to be able to meet requirements forthe best possible patient care.

Leadership competence
Collaboration
Doctors with specialist competence must have a developed capability for
self-knowledge and understanding of their own functions and roles in theorganisation.
Mentoring skills
Doctors with specialist competence must be capable of mentoring other doctors and co-workers, as well as students.
Leadership
Doctors with specialist competence must be capable of leadership distinguished by collaboration, openness, and dialogue with co-workers. Leadership must further be characterised by participation and activity development
aimed at improvement. The ability to lead the work of the health care teamis essential.
System knowledge
Doctors with specialist competence must have an understanding of the organisation, administration, finances, and regulatory systems of health care,
as well as its governance, in order to make the best use of resources.

Competence within medical science and quality work
Medical science
Doctors with specialist competence must be capable of a medically scientific outlook and approach, and must have knowledge of research methodology, including basic epidemiological concepts, as well as of methods for evidence-based medicine and review of scientific information.
Improvement and quality work
Doctors with specialist competence must have an understanding of, andcompetence in, evidence-based improvement and quality work. The objective is to be able to initiate, participate in, and be responsible for continuous
systematic improvement work with emphasis on a holistic perspective, patient safety, patient benefit, measurability, and teaching management in order to be able to review and evaluate their own operations.

Public health and prevention
Doctors with specialist competence must have an understanding of the factors determining health, other aspects of public health, and methods forpromoting health and efforts aimed at preventing injury and illness, in order
to be able to take this understanding into account in medical scientific work.

Training structure
Specialist medical training in nuclear medicine can begin before, during, orafter specialist medical training in radiology and can be integrated with it.
In order for prospective specialists to be given the opportunity during
training to develop in all the intermediate objectives, it is essential that thetraining be carried out both at university hospitals or similar units that haveextensive and specialised activities, and at units with more general activities.
It is important that the specialist training involves logical, clear and continuous professional development with sufficiently long uninterrupted periodsof training in the respective units. Cooperation with other clinical specialties
is necessary and simultaneous additional training within another specialty
that is relevant to the training should, therefore, be carried out. The prospective specialist should be trained in quality and development work and it is of
the utmost importance that research and development work and participation
in instruction can form part of the training.
In order to be able to base the applied knowledge of nuclear medicine inan evidence-based working method, it is important that, in relation to clinical work, advanced theory be included in direct connection with practicalwork. Theoretical training should consist of both private studies and obtaining knowledge externally. ST doctors should, therefore, be given the opportunity to take part in national and international courses and conferences during training.
A great deal of scope can be given to individually adapted requirements
regarding where in the training the various training objectives are carriedout.

Special recommendations
The specialty associations and sections of the medical organisations haveformulated special recommendations for their specialties. The recommendations concern such issues as how specialist medical training can be structured.

Intermediate objectives

Medical competenceIntermediate objective 1

Teaching methods

Follow-up

To be able to evaluate anddocument the result of investigations using the mostcommon radiology analyses
and have an understandingof treatment and intervention that occurs within theradiology field of knowledge

Clinical service under supervision in a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issued
by current mentor

Large professional assembly
Diagnostics and treatment
conference
Theoretical studies

Intermediate objective 2

Teaching methods

Follow-up

To be able to initially handle
common diagnostic andtherapeutic issues in orderto decide which methods inthe field of knowledge are
optimal and have an understanding of risks in the diagnostic and therapeutic methods involved in the field ofknowledge

Clinical service under supervision in a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issued
by current mentor

To have an understandingof prioritising patients andinvestigations on the basisof medical benefits, safety
and the degree of urgency

Large professional assembly
Diagnostics and treatment
conference
Theoretical studies

Intermediate objective 3

Teaching methods

Follow-up

To have an understandingof how radiology investigation results and therapeutic
operations may affect medical handling and its consequences for the individual
patient and to master documentation and communication in the field of knowledge of knowledge, results
and evaluation.

Clinical service under supervision in a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issued
by current mentor

Large professional assembly
Diagnostics and treatment
conference
Theoretical studies

Intermediate objective 4

Teaching methods

Follow-up

To have an understandingof how common investigations and to have knowledge of how other investigations and therapeuticmeasures in the field ofknowledge are carried out
and have an understandingof medical and technicalquality assurance of investigation data

Clinical service under supervision in a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issued
by current mentor

To master medical image
processing in the area ofradiology

Large professional assembly
Diagnostics and treatment
conference
Theoretical studies

Intermediate objective 5

Teaching methods

To master anatomy, physiology and pathophysiology
relevant to radiology

Clinical service under supervision in a unit wheresuch operations are practised

CourseTheoretical studies

Follow-up
Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

Certificate of successfullycompleted course, issued
by current mentor

Intermediate objective 6

Teaching methods

Follow-up

To have an understanding ofphysical, technical, mathematical and statistical principles with regard to themost common methods inradiology and their strengths
and weaknesses and also
have an understanding ofphysics related to the field ofknowledge, including radiation physics and protection
against radiation.

Clinical service under supervision in a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issued
by current mentor

Theoretical studies

To have knowledge of relevant legislation regarding
radiology

Intermediate objective 7

Teaching methods

Follow-up

To master the most common investigations and beable to initially handle othernuclear medicine investigations of the thorax including
the chest organs of children
and adults

Clinical service under supervision in a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issued
by current mentor

Large professional assembly
Diagnostics and treatment
conference
Theoretical studies

Intermediate objective 8
To master the most common investigations and beable to initially handle othernuclear medicine investigations of the abdomen, pelvis
and urogenital organs ofchildren and adults

Teaching methods
Clinical service under supervision in a unit wheresuch operations are practised

Follow-up
Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issued
by current mentor

Large professional assembly
Diagnostics and treatment
conference
Theoretical studies

Intermediate objective 9

Teaching methods

Follow-up

To master the most common investigations and beable to initially handle othernuclear medicine investigations of the musculoskeletal system of children andadultsClinical service under supervision in a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issued
by current mentor

Large professional assembly
Diagnostics and treatment
conference
Theoretical studies

Intermediate objective 10

Teaching methods

Follow-up

To master the most common investigations and beable to initially handle othernuclear medicine investigations of the nervous system,
including the spine and ear,nose and throat organs, ofchildren and adults

Clinical service under supervision in a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issued
by current mentor

Large professional assembly
Diagnostics and treatment
conference
Theoretical studies

Intermediate objective 11

Teaching methods

Follow-up

To master the most common investigations and beable to initially handle othernuclear medicine therapeutic measures with regard tochildren and adults

Clinical service under supervision in a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issued
by current mentor

Theoretical studies

Intermediate objective 12

Teaching methods

Follow-up

To have an understandingof physical, technical, mathematical and statisticalprinciples with regard to themost common methods andtheir strengths and weaknesses and have an understanding of nuclear medicine, including radiation
physics and protection
against radiation.

CourseCertificate of successfullycompleted course, issued
by current mentor

Theoretical studies

To have an understandingof relevant legislation affecting nuclear medicine

Communicative competenceIntermediate objective 13

Teaching methods

Follow-up

To be capable of dialogue
and open contact with patients and their next of kin

Clinical service under
supervision in a unit
where such operations
are practised

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

Intermediate objective 14

Teaching methods

Follow-up

To be capable of communication, both oral and written,
with other doctors and coworkers

Clinical service under supervision in a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

Large professional assembly
Diagnostics and treatment
conferenceIntermediate objective 15

Teaching methods

Follow-up

To be capable of informing
and instructing patients,
next of kin, other doctors,
and co-workers, as well as
students

Clinical service under supervision in a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issued
by current mentor

Instruction under supervision
Large professional assembly
Diagnostics and treatment
conference

Leadership competenceIntermediate objective 16

Teaching methods

Follow-up

To be capable of mentoringother doctors and coworkers as well as students

Clinical service under supervision in a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Mentoring under supervision
Large professional assembly
Diagnostics and treatment
conference

Intermediate objective 17

Teaching methods

Follow-up

To be capable of leading incollaboration and dialogue
with co-workers as well as
within the health care team

Clinical service under supervision in a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Large professional assembly
Diagnostics and treatment
conferenceIntermediate objective 18

Teaching methods

Follow-up

To have an understandingof the organisation, management, and regulatory
systems of health care

CourseCertificate of successfullycompleted course, issuedby course leader

Theoretical studies

Competence within medical science and quality
work
Intermediate objective 19

Teaching methods

Follow-up

To be capable of a medically scientific outlook andapproach

Written individual work
under supervision according to scientific principles

Certificate of approved
written individual work,
issued by current mentor

Large professional assembly
Diagnostics and treatment
conference

Intermediate objective 20

Teaching methods

Follow-up

To have an understandingof, and competence in,evidence-based improvement and quality work

Quality and development
work under supervision

Certificate of quality anddevelopment work, issued
by current mentor

Large professional assembly
Diagnostics and treatment
conferenceClinical physiology

Introduction
Explanation of terms
General definition of competencies
Definition of area of competence
Competence requirements
Competence requirements for medical competence
Competence requirements for communicative competence, leadershipcompetence, and competence within medical science and quality work
Training structure
Special recommendations
Intermediate objectives
Medical competenceCommunicative competence
Leadership competence
Competence within medical science and quality work

Introduction

On June 24, 2008, The National Board of Health and Welfare (Socialstyrelsen) decided to announce new regulations and general guidelines for doctors’ specialist medical training (SOSFS 2008:17). The statute consists of ageneral part with common provisions for all specialties and a specific partwith all the descriptions of objectives. The description of objectives for therespective specialties should be understood against the background of theprovisions in the general part.
In each description of objectives, there is a section headed ‘Training
structure’, which constitutes general guidelines. The teaching methods under the heading ‘Intermediate objectives’ where no follow-up is indicatedalso constitute general guidelines.

Explanation of terms

current mentor
a specialist doctor whose specialist competence corresponds to the area ofcompetence indicated by the intermediate objective, and who is responsible
for ST doctors’s professional development during the teaching period or forthe method of teaching indicatedthe assignment as a mentor for an ST doctor generally encompasses the entire period of specialist training but can also encompass part or parts of it
auscultation
during mentoring, and in accordance with a pre-designed programme, tostudy the profession of a specialist doctor or other health care staff by following one or several professionals, as well as carrying out assignments in
the relevant area to a certain extent
evaluate
to form a sound opinion of a patient or similar person as a basis for further
management
masterbeing fully able to evaluate and handle the medical investigation, diagnostics, treatment, and follow-up of a patient or similar person, and being fully
able to use the techniques relevant to the area
capability
personal capacity to execute or perform a task
h a ve u n d ers tan d i ng
having acquired knowledge and insight into an area through theoretical studies and/or practical exercise of the profession
have knowledge
having acquired some knowledge in an area through theoretical studies
and/or practical exercise of the profession
mentoring under supervision
as an ST doctor, mentor a co-worker while simultaneously being mentored
by a doctor with specialist competencementorcontinuously, and in dialogue form, supporting and guiding, as well as evaluating, a co-worker’s professional development
mentoringsee mentor
handleto actively carry out measures regarding investigation, diagnostics, treatment, and follow-up of a patient or similar person, and have overall responsibility for carrying out these measuresinitially handle
as the primary physician in charge, to actively carry out measures regarding
investigation, diagnostics, treatment, and follow-up of a patient or similar
person, and have overall responsibility for carrying out these measuresinitially evaluate
as the primary physician in charge, to form a sound opinion of a patient orsimilar person as a basis for further management
intraprofessional group reflection
reflection done in a group together with other doctors, chiefly for the purpose of further education and training
clinical service
health and medical care duties that ST doctors perform under their own professional liability and with the support of a mentor
courseteacher-led training with an established plan, given during a defined periodof timesitting-in
training activity involving an ST doctor observing when a specialist doctor
or other health care staff holds a consultationorassessment activity involving a specialist doctor or other health care staff
observing and evaluating ST doctors during a consultation
seminarinstruction in group form with active participation
training in a simulated environment
training carried out in an environment created to emulate reality

large professional assembly
conference, congress, symposium or similar event
health care centre
health care unit in primary carehealth care team work
work where ST doctors, under supervision, participates in and sometimes
leads a group of co-operating health care staff with various competencies
charged with responsibility for care for an individual patient or group ofpatients

General definition of competences

Definition of area of competence
Clinical physiology is a clinical specialty in which the physiological andpathophysiological course of the patient’s illness is measured, analysed andevaluated in an integrative and scientific manner. This is done using radiology methods for diagnostics, forecasting, and treatment purposes. The coreof any clinical physiological evaluation and assessment of the investigation
results is observing dynamics and periods of time. The common characteristic of the work is problem-solving and it takes place in close cooperation
with other specialties. The specialty of clinical physiology also includes anunderstanding of measuring equipment and its underlying physical, technical, mathematical and statistical principles. Methods development and scientific problem-solving with the patient at the centre is also part of the area ofcompetence.
Clinical physiology is a branch specialty of the base specialty of radiology.

Competence requirements
Competence requirements for medical competenceSpecialist competence in clinical physiology requires understanding andskills in order to master work involving the most common investigations inclinical physiology. This involves mastering indications and initial prioritisation in the most common examinations in clinical physiology and also
having an understanding of evaluating the examination results. In addition,
an understanding of treatment and intervention in the field of knowledge isrequired. An understanding of the practical execution of the most common
radiology analyses in clinical physiology is also required, along with an understanding of methods, primarily with the focus on the advantages and limitations of the analyses, which leads to an understanding of medical benefits and risks.
Specialist competence in clinical physiology also requires an understanding of the medical handling, care and treatment of the patients undergoinginvestigations in clinical physiology, which provides a perspective of whatconsequences the results of the investigation will have for the patient. Specialists should also master documenting and communicating the results of
examinations in a suitable and medically correct manner and to be able toput the results into a physiological and pathophysiological context and thereby provide a basis for the optimisation of the medical evaluation and thecare of patients.
Specialist competence in clinical physiology also requires being able to evaluate and document the results of investigations using the most common

radiology analyses in the subject fields of radiology, clinical physiology,
neuroradiology and nuclear medicine, being familiar with how they are performed, and also having an understanding of treatment and intervention
within the area. Specialists must be able to document and communicate
knowledge, results and evaluations and master medical image processing in
the field of knowledge. They must also be able to handle common diagnostic and therapeutic issues in order to decide which methods in the field ofknowledge are optimal and, in addition, they must be able to prioritise patients and investigations on the basis of medical benefits, safety and the degree of urgency. Specialists must know how examination results and therapy
can influence medical handling, and their consequences for the individual
patient and for society. They must also have an understanding of the risks ofthe diagnostic and therapeutic methods involved in the field of knowledge,
to be familiar with physics related to the area including radiation physics
and protection against radiation, and also have knowledge of relevant legislation that affects the activity. Specialists must have an understanding ofphysical, technical, mathematical and statistical principles with regard to themost common methods, of the strengths and weaknesses of the methods,
and of medical and technical quality assurance of investigation data. They
must master the anatomy, physiology and pathophysiology of relevance forradiology (intermediate objectives 1-6).

Competence requirements for communicative competence, leadership competence, and competence within medical scienceand quality work
Communicative competence
The equal and responsible patient
Doctors with specialist competence must be capable of dialogue and of
maintaining open contact with patients and their next of kin. Contact should
be characterised by empathy and trust, as well as respect for the patients’right to information, influence, and participation in decisions. Contact
should also be characterised by co-operation and sensitivity to the patients’needs, desires and right to self-determination, as well as providing incentive
for patients’ involvement in, and responsibility for, their own care.
Multicultural and gender aspects
Communication with patients and their next of kin should be characterisedby understanding and respect for cross-cultural and multicultural aspects
such as age, language, ethnicity, sexual orientation, and religion, as well as
gender.
Interprofessional relations
Doctors with specialist competence must be capable of communicating,both in writing and orally, with other doctors and co-workers showing re-spect for their professional knowledge and competences. The same applies
to contact with representatives of the public and various civil authorities.
Pedagogical skills
Doctors with specialist competence must have pedagogical capability inorder to inform and instruct not only patients and their next of kin, but also
other doctors and co-workers, as well as students.
Professional approach and ethics
Doctors with specialist competence must be capable of working continuously with their professional and medical ethical approaches, with the objectiveof being able to make independent decisions of a medical ethical nature.
Individual professional development
Doctors with specialist competence must be capable of continually examining and identifying their own needs for professional development, in addition to operational requirements, in order to be able to meet requirements forthe best possible patient care.

Leadership competence
Collaboration
Doctors with specialist competence must have a developed capability for
self-knowledge and understanding of their own functions and roles in theorganisation.
Mentoring skills
Doctors with specialist competence must be capable of mentoring other doctors and co-workers, as well as students.
Leadership
Doctors with specialist competence must be capable of leadership distinguished by collaboration, openness, and dialogue with co-workers. Leadership must further be characterised by participation and activity development
aimed at improvement. The ability to lead the work of the health care teamis essential.
System knowledge
Doctors with specialist competence must have an understanding of the organisation, administration, finances, and regulatory systems of health care,
as well as its governance, in order to make the best use of resources.

Competence within medical science and quality work
Medical science
Doctors with specialist competence must be capable of a medically scientific outlook and approach, and must have knowledge of research methodology, including basic epidemiological concepts, as well as of methods for evidence-based medicine and review of scientific information.
Improvement and quality work
Doctors with specialist competence must have an understanding of, andcompetence in, evidence-based improvement and quality work. The objective is to be able to initiate, participate in, and be responsible for continuous
systematic improvement work with emphasis on a holistic perspective, patient safety, patient benefit, measurability, and teaching management in order to be able to review and evaluate their own operations.
Public health and prevention
Doctors with specialist competence must have an understanding of the factors determining health, other aspects of public health, and methods forpromoting health and efforts aimed at preventing injury and illness, in order
to be able to take this understanding into account in medical scientific work.

Training structure
Specialist medical training in clinical physiology can begin before, during,or after specialist medical training in radiology and can be integrated with it.
Specialist training in clinical physiology should mainly be carried out
through clinical service at units practicing clinical physiology, at units using
clinical physiology skills, through theoretical studies, and through projectoriented work. The different training elements in the ST training in clinicalphysiology can be organised among themselves very flexibly.
The specialist training should be set out logically and professional development should, as far as possible, take place gradually and continually. In
order for the training to be of a satisfactorily advanced level, sufficiently
long and uninterrupted training periods should are desirable, and the clinicalservice should include a longer period of service at a university hospital. In
order to acquire good proficiency in the field of knowledge, ST doctors
should also be given placements in units that are particularly proficient andmodern in specific areas, methodologically or regarding subject. Theoreticaltraining elements should include regular in-depth theoretical training inconnection with the clinical work, and also participation in national and international courses and conferences. It is desirable that courses and conferences are planned for suitable stages of the specialist training.
As a result of the nature of the specialty, where a critical and analyticalworking method is essential, ST doctors should carry out project work,where medical scientific work is chiefly recommended. This is also important due the rapid pace of development of methodology in radiology diagnostics. The project may also deal with other subject areas, such as quality de-velopment, method development, patient safety work or organisation ofhealth care.

Special recommendations
The specialty associations and sections of the medical organisations haveformulated special recommendations for their specialties. The recommendations concern such issues as how specialist medical training can be structured.

Intermediate objectives

Medical competenceIntermediate objective 1

Teaching methods

Follow-up

To be able to evaluate anddocument the results ofinvestigations using themost common radiology
analyses and have an understanding of treatment
and intervention that occurs
within the radiology field ofknowledge

Clinical service under supervision in a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Large professional assembly
Diagnostics and treatment
conference
Theoretical studies

Intermediate objective 2

Teaching methods

Follow-up

To initially handle common
diagnostic and therapeutic
issues in order to decide
which methods in the areaof knowledge are optimaland have an understandingof risks in the diagnostic
and therapeutic methods
involved in the field ofknowledge

Clinical service under supervision in a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

To have an understandingof prioritising patients andinvestigations on the basisof medical benefits, safety
and the degree of urgency

Large professional assembly

Diagnostics and treatment
conference

Theoretical studies

Intermediate objective 3

Teaching methods

Follow-up

To have an understandingof how radiology investigation results and therapeutic
operations may affect medical handling and its consequences for the individual
patient and to master documentation and communication in the field of knowledge of knowledge, results
and evaluation.

Clinical service under supervision in a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Large professional assembly
Diagnostics and treatment
conference
Theoretical studies

Intermediate objective 4

Teaching methods

Follow-up

To have an understandingof how common investigations are carried out and tohave knowledge of how
other investigations andtherapeutic measures in thefield of knowledge are carried out and have an understanding of medical andtechnical quality assurance
of investigation data

Clinical service under supervision in a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

To master medical image
processing in the area ofradiology

Large professional assembly
Diagnostics and treatment
conference
Theoretical studies

Intermediate objective 5

Teaching methods

Follow-up

To master the anatomy,
physiology and pathophysiology relevant to radiology

Clinical service under supervision in a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Theoretical studies

Intermediate objective 6

Teaching methods

Follow-up

To have an understandingof physical, technical, mathematical and statisticalprinciples with regard to themost common methods inradiology and theirstrengths and weaknesses
and also have an understanding of physics related
to the field of knowledge,
including radiation physics
and protection against radiation.

Clinical service under supervision in a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Theoretical studies

To have knowledge of relevant legislation regarding
radiology

Intermediate objective 7

Teaching methods

Follow-up

To master the choice of
methods within the clinicalphysiology area of competence for distinct diagnostic
and therapeutic issues
taking into account themethods’ advantages, limitations and risks

Clinical service under supervision in a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Large professional assembly
Theoretical studies

Intermediate objective 8

Teaching methods

Follow-up

To be able to evaluate investigation results obtained
through the most common
medical imaging and analyses in clinical physiology
and have knowledge oftreatment and intervention
in the field of knowledge.

Clinical service under supervision in a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Large professional assembly
Theoretical studies

Intermediate objective 9

Teaching methods

Follow-up

To master the practicalexecution of the mostcommon radiology analyses
in clinical physiology andhave knowledge of thepractical execution of otherinvestigations in clinicalphysiology

Clinical service under supervision in a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Theoretical studies

Intermediate objective 10

Teaching methods

Follow-up

To master documentationof investigation results fromthe most common radiology
analyses in clinical physiology and master communication of investigation results to the parties concerned

Clinical service under supervision in a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Large professional assembly
Theoretical studies

Intermediate objective 11

Teaching methods

Follow-up

To have an understandingof how diagnostics, intervention and therapy in clinical physiology can affectthe medical care of theindividual patient

Clinical service under supervision in a unit that handles these conditions

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseTo master initial prioritisation of patients and investigations on the basis of
medical benefits, safety andLarge professional assemthe degree of urgency
bly

Certificate of successfullycompleted course, issuedby course leader

Theoretical studies

Intermediate objective 12

Teaching methods

Follow-up

To master anatomy, physiology and pathophysiology
as well as an understandingof physics, technology,
mathematics, statistics
medical image processing
and quality assurance ofinvestigation results of relevance for clinical physiology

Clinical service under
supervision in a unit
where such operations
are practised

Certificate of successfullycompleted clinical service
and competenceachieved, issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Large professional assembly
Theoretical studies

Communicative competenceIntermediate objective 13

Teaching methods

Follow-up

To be capable of dialogue
and open contact with patients and their next of kin

Clinical service under supervision in a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

Intermediate objective 14

Teaching methods

Follow-up

To be capable of communication, both oral and written, with other doctors andco-workers

Clinical service under supervision in a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

Large professional assembly
Diagnostics and treatment
conference

Intermediate objective 15

Teaching methods

Follow-up

To be capable of informing
and instructing patients,
next of kin, other doctors,
and co-workers, as well as
students

Clinical service under supervision in a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Instruction under supervision
Large professional assembly
Diagnostics and treatment
conferenceLeadership competenceIntermediate objective 16

Teaching methods

Follow-up

To be capable of mentoringother doctors and coworkers as well as students

Clinical service under supervision in a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Mentoring under supervision
Large professional assembly
Diagnostics and treatment
conference

Intermediate objective 17

Teaching methods

Follow-up

To be capable of leading incollaboration and dialogue
with co-workers as well as
within the health care team

Clinical service under supervision in a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issuedby course leader

Large professional assembly
Diagnostics and treatment
conference

Intermediate objective 18

Teaching methods

Follow-up

To have an understandingof the organisation, management, and regulatory
systems of health care

CourseCertificate of successfullycompleted course, issuedby course leader

Theoretical studies

Competence within medical science and quality
work
Intermediate objective 19

Teaching methods

To be capable of a medically scientific outlook andapproach

Certificate of approved
Written individual work under supervision according to written individual work,
issued by current mentor
scientific principles

Follow-up

Large professional assembly
Diagnostics and treatment
conference

Intermediate objective 20

Teaching methods

Follow-up

To have an understandingof, and competence in, evidence-based improvement
and quality work

Quality and development
work under supervision

Certificate of quality anddevelopment work, issued
by current mentor

Large professional assembly
Diagnostics and treatment
conferenceSpecialties in laboratory medicine

Clinical immunology and transfusion medicine
Introduction
Explanation of terms
General definition of competencies
Definition of area of competence
Competence requirements
Competence requirements for medical competence
Competence requirements for communicative competence, leadershipcompetence, and competence within medical science and quality work
Training structure
Special recommendations
Intermediate objectives
Medical competenceCommunicative competence
Leadership competence
Competence within medical science and quality work

Introduction

On June 24, 2008, The National Board of Health and Welfare (Socialstyrelsen) decided to issue new regulations and general guidelines for doctors’
specialist medical training (SOSFS 2008:17). The statute consists of a general part with common provisions for all specialties and a specific part withall the descriptions of objectives. The description of objectives for each specialty should be understood against the background of the provisions in thegeneral part.
In each description of objectives, there is a section headed ‘Training
structure’ which constitutes general guidelines. The teaching methods under
the heading ‘Intermediate objectives’ where no follow-up is indicated also
constitute general guidelines.

Explanation of terms

current mentor
a specialist doctor whose specialist competence corresponds to the area ofcompetence indicated by the intermediate objective, and who is responsible
for ST doctors’s professional development during the teaching period or forthe method of teaching indicatedthe assignment as a mentor for an ST doctor generally encompasses the entire period of specialist training but can also encompass part or parts of it
auscultation
during mentoring, and in accordance with a pre-designed programme, tostudy the profession of a specialist doctor or other health care staff by following one or several professionals, as well as carrying out assignments in
the relevant area to a certain extent
evaluate
to form a sound opinion of a patient or similar person as a basis for further
management
masterbeing fully able to evaluate and handle the medical investigation, diagnostics, treatment, and follow-up of a patient or similar person, and being fully
able to use the techniques relevant to the area
capability
personal capacity to execute or perform a task
h a ve u n d ers tan d i ng
having acquired knowledge and insight into an area through theoretical studies and/or practical exercise of the profession
have knowledge
having acquired some knowledge in an area through theoretical studies
and/or practical exercise of the profession
mentoring under supervision
as an ST doctor, mentor a co-worker while simultaneously being mentored
by a doctor with specialist competencementorcontinuously, and in dialogue form, supporting and guiding, as well as evaluating, a co-worker’s professional development
mentoringsee mentor
handleto actively carry out measures regarding investigation, diagnostics, treatment, and follow-up of a patient or similar person, and have overall responsibility for carrying out these measuresinitially handle
as the primary physician in charge, to actively carry out measures regarding
investigation, diagnostics, treatment, and follow-up of a patient or similar
person, and have overall responsibility for carrying out these measuresinitially evaluate
as the primary physician in charge, to form a sound opinion of a patient orsimilar person as a basis for further management
intraprofessional group reflection
reflection done in a group together with other doctors, chiefly for the purpose of further education and training
clinical service
health and medical care duties that ST doctors perform under their own professional liability and with the support of a mentor
courseteacher-led training with an established plan, given during a defined periodof timesitting-in
training activity involving an ST doctor observing when a specialist doctor
or other health care staff holds a consultationorassessment activity involving a specialist doctor or other health care staff
observing and evaluating ST doctors during a consultation
seminarinstruction in group form with active participation
training in a simulated environment
training carried out in an environment created to emulate reality

large professional assembly
conference, congress, symposium or similar event
health care centre
health care unit in primary carehealth care team work
work where ST doctors, under supervision, participates in and sometimes
leads a group of co-operating health care staff with various competencies
charged with responsibility for care for an individual patient or group ofpatients

General definition of competence

Definition of area of competence
The specialty of clinical immunology and transfusion medicine encompasses laboratory diagnostics and therapy based on immunological principles. The area of competence covers all age groups and has broad interfaces
with other medical specialties. The field of knowledge is linked to and dependent on research and development within this area.

Competence requirements
Competence requirements for medical competenceSpecialist competence in clinical immunology and transfusion medicine
requires knowledge and proficiency in being able to independently interpretand evaluate laboratory results, and handle treatments and investigations
arising from various clinical issues within the field. A further requirement is
the capability of guidance in clinical immunology and transfusion medicine,and for serving as a consultant regarding such issues across the entire medical field. This also includes the management of queries and contacts to dowith donors of blood and other tissue.
More specifically, knowledge and proficiency in providing medical advice, in laboratory diagnostics, donor management, bloodletting, the production of components for haemotherapy, infection immunology, transplant,
and immune modulation as well as therapeutic aphaeresis are required. The
type of laboratory diagnostics in the requirement comprises blood groupserology testing, diagnostics and follow-up of immunodeficiencies, autoimmunity, inflammations, and allergies, as well as transplant studies.

Competence requirements for communicative competence,leadership competence and competence within medical scienceand quality work
Communicative competence
The equal and responsible patient
Doctors with specialist competence must be capable of dialogue and of
maintaining open contact with patients and their next of kin, as well as
blood donors. Contact must be characterised by empathy and trust, as well
as respect for patients’ right to information, influence, and participation indecisions. It must also be characterised by cooperation and sensitivity topatients’ needs, wishes and right to self-determination, and must stimulatepatients’ commitment to and responsibility for their own care.
Multicultural and gender aspects
Communication with patients and their next of kin should be characterisedby understanding and respect for cross-cultural and multicultural aspects
such as age, language, ethnicity, sexual orientation and religion, as well as
gender.
Interprofessional relations
Doctors with specialist competence must be capable of communicating,both in writing and orally, with other doctors and co-workers showing respect for their professional knowledge and competencies. The same applies
to contact with representatives of the public and various civil authorities.
Pedagogical skills
Doctors with specialist competence must have pedagogical capability inorder to inform and instruct not only patients and their next of kin, but also
other doctors and co-workers, as well as students.
Professional approach and ethics
Doctors with specialist competence must be capable of working continuously with their professional and medical ethical approaches, with the objective of being able to make independent decisions of a medical ethical nature.
Individual professional development
Doctors with specialist competence must be capable of continually examining and identifying their own needs for professional development, in addition to operational requirements, in order to be able to meet requirements forthe best possible patient care.

Leadership competence
Collaboration
Doctors with specialist competence must have a developed capability for
self-knowledge and an understanding of their own functions and roles in theorganisation.
Mentoring skills
Doctors with specialist competence must be able to mentor other doctors
and co-workers, as well as students.
Leadership
Doctors with specialist competence must have a capability for leadershipcharacterised by collaboration, openness, and dialogue with co-workers.
Leadership must further be characterised by participation and activity development aimed at improvement. The ability to lead the work of the healthcare team is essential.
System knowledge
Doctors with specialist competence must have an understanding of the organisation, administration, financial and regulatory systems of health care,
as well as its governance, in order to make the best use of resources.

Competence within medical science and quality work
Medical science
Doctors with specialist competence must be capable of adopting a medicallyscientific outlook and approach, and must have knowledge of researchmethodology, including basic epidemiological concepts, as well as of methods for evidence-based medicine and review of scientific information.
Improvement and quality work
Doctors with specialist competence must have an understanding of, andcompetence in, evidence-based improvement and quality work. The objective is to be able to initiate, participate in, and be responsible for continuous
systematic improvement work with emphasis on a holistic perspective, patient safety, patient benefit, measurability, and teaching management in order to be able to review and evaluate their own operations.
Public health and prevention
Doctors with specialist competence must have an understanding of the factors determining health, other aspects of public health, and methods forpromoting health and efforts aimed at preventing injury and illness, in order
to be able to take this understanding into account in medical scientific work.

Training structure
It is important that training and service be based at a unit within clinicalimmunology and transfusion medicine. In drawing up the training programme, comparable service time is to be scheduled within clinical immunology and transfusion medicine. Training should be planned in such a waythat ST doctors are able to acquire essential knowledge and skills early on,
so that he or she can handle emergencies as well as common issues. Service
periods in the various areas of activity within the specialty should be continuous. Simultaneous additional training through courses designed for the
specialist doctor target group will supplement this. It is appropriate for simultaneous additional training to be held at a patient care unit in close contact with clinical immunology and transfusion medicine operations.

Special recommendations
The specialty associations and sections of the medical organisations haveformulated special recommendations for their own specialties. The recommendations concern such issues as how specialist medical training should be
structured.

Intermediate objectives

Medical competenceIntermediate objective 1

Teaching methods

Follow-up

To have an understanding of
the structure and function of
the immune system

CourseCertificate of successfullycompleted course, issued bycourse leader

Seminaror
large professional assembly
Theoretical studies

Intermediate objective 2

Teaching methods

Follow-up

To master methods, testingand equipment for determining
humoral, cellular, inflammatoryand genetic parameters

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Seminaror
large professional assembly
Theoretical studies

Intermediate objective 3

Teaching methods

Follow-up

To be able to handle laboratory testing and results relating
to allergies

Clinical service under supervision in a unit where such operations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Auscultation under supervision in a unit that handles
such conditions

Certificate of successfullycompleted course, issued bycourse leaderordiagnostics and treatment
conference
CourseSeminaror
large professional assembly
Theoretical studies

Intermediate objective 4

Teaching methods

Follow-up

To be able to handle laboratory testing and results relating
to autoimmune conditions

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Auscultation under supervision in a unit that handles
such conditionsordiagnostics and treatment
conference
CourseSeminaror
large professional assembly
Theoretical studies

Certificate of successfullycompleted course, issued bycourse leader

Intermediate objective 5

Teaching methods

Follow-up

To be able to handle laboratory testing and results relating
to immune deficiency andinfection conditions

Clinical service under supervision in a unit where such operations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Auscultation under supervision in a unit that handles
such conditionsordiagnostics and treatment
conference
CourseCertificate of successfullycompleted course, issued bycourse leader

Seminaror
large professional assembly
Theoretical studies

Intermediate objective 6

Teaching methods

Follow-up

To master reception and careof blood donors

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Seminar or large professional
assembly
Theoretical studies

Intermediate objective 7

Teaching methods

Follow-up

To be able to handle transplant immunology investigations

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Auscultation under supervision in a unit that handles
such conditions or diagnostics
and treatment conference
CourseCertificate of successfullycompleted course, issued bycourse leader

Seminar or large professional
assembly
Theoretical studies

Intermediate objective 8

Teaching methods

Follow-up

To master the collection, production, storage, control, andtransfusion of components forhaemotherapy, transplant, andimmune modulation

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Seminaror
large professional assembly
Theoretical studies

Intermediate objective 9

Teaching methods

Follow-up

To master analyses of immune haematology precedingtransfusion and in pregnancy

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Seminar or large professional
assembly
Diagnostics and treatment
conference
Theoretical studies

Intermediate objective 10

Teaching methods

Follow-up

To master treatments using
blood components and complications related to transfusion and transplant

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Seminar or large professional
assembly
Diagnostics and treatment
conference
Theoretical studies

Intermediate objective 11

Teaching methods

Follow-up

To master indications of therapeutic aphaeresis and otherhaemotherapeutic treatments

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Seminar or large professional
assembly
Diagnostics and treatment
conference
Theoretical studies

Intermediate objective 12

Teaching methods

Follow-up

To have an understanding of
humoral and cellular immune
modulated treatments including vaccinations

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Auscultation under supervision in a unit that handles
such conditions or diagnostics
and treatment conference

Certificate of successfullycompleted course, issued bycourse leader

CourseSeminar or large professional
assembly
Theoretical studies

Communicative competenceIntermediate objective 13

Teaching methods

Follow-up

To be capable of dialogue andopen contact with patients andtheir next of kin, and to be capable of communication, bothoral and written, with otherdoctors and co-workers

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Intermediate objective 14

Teaching methods

Follow-up

To be capable of dialogue andopen contact with blood donors

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Intermediate objective 15

Teaching methods

Follow-up

To be capable of informing
and instructing patients, nextof kin, other doctors, and coworkers, as well as students

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Instruction under supervisionLeadership competenceIntermediate objective 16

Teaching methods

Follow-up

To be capable of mentoringother doctors and co-workers
as well as students

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Mentoring under supervisionIntermediate objective 17

Teaching methods

Follow-up

To be capable of leading using
collaboration and dialogue withco-workers as well as within
the health care team

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Intermediate objective 18

Teaching methods

Follow-up

To have an understanding of
the organisation, management,
and regulatory systems ofhealth care

CourseCertificate of successfullycompleted course, issued bycourse leader

Theoretical studies

Competence within medical science and quality
work
Intermediate objective 19

Teaching methods

Follow-up

To be capable of a medicallyscientific outlook and approach

Written individual work under
supervision according toscientific principles

Certificate of approved written individual work, issued bycurrent mentor

Intermediate objective 20

Teaching methods

Follow-up

To have an understanding of,and competence in, evidencebased improvement and quality work

Quality and development work
under supervision

Certificate of quality and development work, issued bycurrent mentor

Clinical bacteriology and virology

Introduction
Explanation of terms
General definition of competencies
Definition of area of competence
Competence requirements
Competence requirements for medical competence
Competence requirements for communicative competence, leadershipcompetence, and competence within medical science and quality work
Training structure
Special recommendations
Intermediate objectives
Medical competenceCommunicative competence
Leadership competence
Competence within medical science and quality work

Introduction

On June 24, 2008, The National Board of Health and Welfare (Socialstyrelsen) decided to issue new regulations and general guidelines for doctors’
specialist medical training (SOSFS 2008:17). The statute consists of a general part with common provisions for all specialties and a specific part withall the descriptions of objectives. The description of objectives for each specialty should be understood against the background of the provisions in thegeneral part.
In each description of objectives, there is a section headed ‘Training
structure’ which constitutes general guidelines. The teaching methods under
the heading ‘Intermediate objectives’ where no follow-up is indicated also
constitute general guidelines.

Explanation of terms

current mentor
a specialist doctor whose specialist competence corresponds to the area ofcompetence indicated by the intermediate objective, and who is responsible
for ST doctors’s professional development during the teaching period or forthe method of teaching indicatedthe assignment as a mentor for an ST doctor generally encompasses the entire period of specialist training but can also encompass part or parts of it
auscultation
during mentoring, and in accordance with a pre-designed programme, tostudy the profession of a specialist doctor or other health care staff by following one or several professionals, as well as carrying out assignments in
the relevant area to a certain extent
evaluate
to form a sound opinion of a patient or similar person as a basis for further
management
masterbeing fully able to evaluate and handle the medical investigation, diagnostics, treatment, and follow-up of a patient or similar person, and being fully
able to use the techniques relevant to the area
capability
personal capacity to execute or perform a task
h a ve u n d ers tan d i ng
having acquired knowledge and insight into an area through theoretical studies and/or practical exercise of the profession
have knowledge
having acquired some knowledge in an area through theoretical studies
and/or practical exercise of the profession
mentoring under supervision
as an ST doctor, mentor a co-worker while simultaneously being mentored
by a doctor with specialist competencementorcontinuously, and in dialogue form, supporting and guiding, as well as evaluating, a co-worker’s professional development
mentoringsee mentor
handleto actively carry out measures regarding investigation, diagnostics, treatment, and follow-up of a patient or similar person, and have overall responsibility for carrying out these measuresinitially handle
as the primary physician in charge, to actively carry out measures regarding
investigation, diagnostics, treatment, and follow-up of a patient or similar
person, and have overall responsibility for carrying out these measuresinitially evaluate
as the primary physician in charge, to form a sound opinion of a patient orsimilar person as a basis for further management
intraprofessional group reflection
reflection done in a group together with other doctors, chiefly for the purpose of further education and training
clinical service
health and medical care duties that ST doctors perform under their own professional liability and with the support of a mentor
courseteacher-led training with an established plan, given during a defined periodof timesitting-in
training activity involving an ST doctor observing when a specialist doctor
or other health care staff holds a consultationorassessment activity involving a specialist doctor or other health care staff
observing and evaluating ST doctors during a consultation
seminarinstruction in group form with active participation
training in a simulated environment
training carried out in an environment created to emulate reality

large professional assembly
conference, congress, symposium or similar event
health care centre
health care unit in primary carehealth care team work
work where ST doctors, under supervision, participates in and sometimes
leads a group of co-operating health care staff with various competencies
charged with responsibility for care for an individual patient or group ofpatients

General definition of competence

Definition of area of competence
The specialty of clinical bacteriology and virology encompasses fundamental knowledge about microbes that cause infectious diseases, the spread of
microbes in the population, and the risks posed by microbes to the individual, the community and to health care. The specialty further encompasses
fundamental knowledge of the genetics and taxonomy of microbes, and of
the host’s defence mechanisms. The specialty also includes knowledge
about the immune system, mechanisms for antimicrobial treatment and thedevelopment of resistance, the protection and effect mechanisms of vaccines, and about normal flora.
The area of competence further includes working as a consultant, using
and interpreting methods of diagnostic microbiology, communicating analysis results to clinically responsible doctors, providing advice on diagnostics,
treatment and prevention of infectious diseases from a national, a European
and a global perspective, following the health care services’ prescriptions ofantibiotics, antivirals and antimycotics, treating invasion disease, and monitoring, reporting on and drawing up strategies in the case of resistance development.
Other important parts of the area of competence include the identificationand prevention of infections that spread within the health care services, infectious disease prevention and control in the local region and nationally,
research and development in the areas of microbiology, infectious disease
prevention and control and infection control, and teaching.

Competence requirements
Competence requirements for medical competenceSpecialist competence in clinical bacteriology and virology requires knowledge about the pathogenesis of infectious diseases and their natural course,
the genetics and taxonomy of microbes, microbial metabolism and replication, the host’s defence mechanisms, mechanisms for antimicrobial treatment, the development of resistance in microbes, and the geno- and phenotyping of microbes.
The specialist competence further requires the ability to choose relevant
microbiological analysis methods, on the basis of the patient’s clinicalsymptoms, and the ability to interpret analysis results in the areas of clinicalbacteriology, clinical virology, clinical mycology and clinical parasitology.
Knowledge is also required of diagnostics of unusual infectious diseases,
which is only offered at regional or national reference laboratories.

The specialist competence further requires knowledge about the management, treatment and prevention - including vaccination where possible - ofcommon infectious diseases, opportunistic infections and health care-related
infections. Knowledge of contact tracing of notifiable diseases is also required.
Finally, the specialist competence requires knowledge about the fundamental principles of microbiological diagnostics in accordance with current
quality and accreditation norms, as well as knowledge about systematic
evaluation and development of new analysis methods from a patient benefit
perspective, and of analytical and statistical processing of analysis results.

Competence requirements for communicative competence,leadership competence and competence within medical scienceand quality work
Communicative competence
The equal and responsible patient
Doctors with specialist competence must be capable of dialogue and of
maintaining open contact with patients and their next of kin. Contact should
be characterised by empathy and trust, as well as respect for the patients’right to information, influence, and participation in decisions. Contact
should also be characterised by co-operation and sensitivity to the patients’needs, desires and right to self-determination, as well as providing incentive
for patients’ involvement in, and responsibility for, their own care.
Multicultural and gender aspects
Communication with patients and their next of kin should be characterisedby understanding and respect for cross-cultural and multicultural aspects
such as age, language, ethnicity, sexual orientation and religion, as well as
gender.
Interprofessional relations
Doctors with specialist competence must be capable of communicating,both in writing and orally, with other doctors and co-workers showing respect for their professional knowledge and competencies. The same applies
to contact with representatives of the public and various civil authorities.
Pedagogical skills
Doctors with specialist competence must have pedagogical capability inorder to inform and instruct not only patients and their next of kin, but also
other doctors and co-workers, as well as students. Doctors with specialist
competence must be capable of working continuously with their professional and medical ethical approaches, with the objective of being able to
make independent decisions of a medical ethical nature.

Individual professional development
Doctors with specialist competence must be capable of continually examining and identifying their own needs for professional development, in addition to operational requirements, in order to be able to meet requirements forthe best possible patient care.

Leadership competence
Collaboration
Doctors with specialist competence must have a developed capability for
self-knowledge and an understanding of their own functions and roles in theorganisation. Mentoring skills Doctors with specialist competence must beable to mentor other doctors and co-workers, as well as students.
Leadership
Doctors with specialist competence must have a capability for leadershipcharacterised by collaboration, openness, and dialogue with co-workers.
Leadership must further be characterised by participation and activity development aimed at improvement. The ability to lead the work of the healthcare team is essential.
System knowledge
Doctors with specialist competence must have an understanding of the organisation, administration, financial and regulatory systems of health care,
as well as its governance, in order to make the best use of resources.

Competence within medical science and quality work
Medical science
Doctors with specialist competence must be capable of adopting a medicallyscientific outlook and approach, and must have knowledge of researchmethodology, including basic epidemiological concepts as well as of methods for evidence-based medicine and critical examination of scientific information.
Improvement and quality work
Doctors with specialist competence must have an understanding of, andcompetence in, evidence-based improvement and quality work. The objective is to be able to initiate, participate in, and be responsible for continuous
systematic improvement work with emphasis on a holistic perspective, patient safety, patient benefit, measurability, and teaching management in order to be able to review and evaluate their own operations.
Public health and prevention
Doctors with specialist competence must have an understanding of the factors determining health, other aspects of public health, and methods forpromoting health and efforts aimed at preventing injury and illness, in order
to be able to take this understanding into account in medical scientific work.

Training structure
During the course of the specialist training programme, ST doctors should
acquire a broad knowledge of the area of microbiology. This is achieved bymeans of clinical service at units practising clinical bacteriology, clinicalvirology, clinical parasitology, clinical mycology, infectious disease prevention and control, and infection control. Placements should be planned suchthat all diagnostics areas in the description of objectives for the specialty aremet, but the emphasis should be on clinical bacteriology and virology, divided into essentially equal parts, and on infection control.
Within the framework of the specialist training programme, ST doctors
should have some opportunity for advanced studies in one of the following
areas: clinical bacteriology, clinical virology, clinical mycology and clinicalparasitology. ST doctors should also acquire knowledge about the management, diagnostics and treatment of patients with common infectious diseases
and opportunistic infectious diseases during the specialist training programme. This is achieved by means of clinical service and consultancy atclinics where frequent contact with such patients occur.
Early on in the training, emphasis should be on a basic introduction to theelements common to all aspects of the specialty, such as the taking ofspecimens, logistics, quality assurance and routine methods for the determination of common microbiological agents. When ST doctors are placed in
the various laboratory units, great importance should be attached to the
choice of relevant analysis methods based on the patient’s clinical symptoms, the registering of methods results, and the interpretation of the clinicalsignificance of obtained analysis results. When necessary, a risk assessment
should also be made based on obtained results.
Around the middle of the specialist training programme, ST doctors
should be offered service in a microbiology laboratory at a university clinic,
or in a reference laboratory if the local unit is unable to offer complete training in clinical bacteriology, clinical virology, clinical mycology or clinicalparasitology. In order to achieve a breadth of knowledge, ST doctors should
also pursue advanced studies through service or auscultation in a laboratorythat deals with rare diagnostics and diagnoses of rare infectious diseases
caused by bacteriological, virological, mycological and parasitologicalagents requiring biological safety level 3 and possibly 4.
During the specialist training programme, it is important that ST doctors
undergo simultaneous additional training through service in infection or
another knowledge area with frequent patient contact and infection issues.
Additionally, in parallel with the whole specialist training programme, ST
doctors should regularly participate in clinical consultancy at different typesof units that handle patients with infectious diseases. ST doctors should also
receive training in infectious disease prevention and control, and infection
control, through clinical service in an infectious disease unit and an infection control unit.

It is appropriate to obtain knowledge about the pathogenesis and natural
course of infectious diseases, the biology and characteristics of microorganisms and their mechanisms for dealing with antimicrobial substances,
the theoretical background to microbiological analysis methods, nationalguidelines on management and treatment of infectious diseases, and careprogrammes about infectious diseases, as well as existing statutes and laws,
through courses and theoretical studies.
ST doctors should further be provided the opportunity to practice teaching. ST doctors should also carry out scientific work under supervision. Thisshould be begun early on in specialist medical training. Additionally, ST
doctors should be offered leadership training, and supervision training, inorder to be able to lead teamwork as well as the medical, clinical and financial work at a microbiology laboratory.

Special recommendations
The specialty associations and sections of the medical organisations haveformulated special recommendations for their own specialties. The recommendations concern such issues as how specialist medical training should be
structured.

Intermediate objectives

Medical competenceIntermediate objective 1

Teaching methods

Follow-up

To master the knowledge areaof infectious diseases, theirpathogenesis, natural courseand diagnostics

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Theoretical studies

Intermediate objective 2

Teaching methods

Follow-up

To master the knowledge areaof microbe genetics and taxonomy, microbial metabolism
and replication, the host’s
defence mechanisms including
the immune system, mechanisms for antimicrobial treatment and the development ofresistance, and the possibilityof prevention by means ofvaccination

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Intermediate objective 3

Teaching methods

Follow-up

To master the choice of analysis method for culture, molecular biology methodology, morphological determination, immunological methodology andtests for typing and contact
tracing, as well as to masterthe interpretation of analysis
results for diagnostics of medically relevant bacterial infections

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Theoretical studies

Theoretical studies

Intermediate objective 4

Teaching methods

Follow-up

To master the choice of analysis method for culture, molecular biology methodology, morphological determination, immunological methodology andtests for typing and contact
tracing, as well as to masterthe interpretation of analysis
results for diagnostics of medically relevant viral infections

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Theoretical studies

Intermediate objective 5

Teaching methods

Follow-up

To master the choice of analysis method for culture, molecular biology methodology, morphological determination, immunological methodology andtests for typing and contact
tracing, as well as to masterthe interpretation of analysis
results for diagnostics of medically relevant parasitic infections

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Intermediate objective 6

Teaching methods

Follow-up

To master the choice of analysis method for culture, molecular biology methodology, morphological determination, immunological methodology andtests for typing and contact
tracing, as well as to masterthe interpretation of analysis
results for diagnostics of medically relevant fungal infections

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Theoretical studies

Theoretical studies

Intermediate objective 7

Teaching methods

Follow-up

To master effects mechanisms
for antimicrobial treatment andmethods for determining theresistance of microbes

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Theoretical studies

Intermediate objective 8

Teaching methods

Follow-up

To master the fundamental
principles of microbiologicaldiagnostics in accordance withcurrent quality norms

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

To master systematic evaluation and development of new
analysis methods from a patient benefit perspective

Theoretical studies

To master statisticalprocessing of analysis results

Intermediate objective 9

Teaching methods

Follow-up

To have an understanding of
unusual microbiological analyses at reference laboratories

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor or certificate of successfully completed auscultation and competence achieved, issued bycurrent mentor

orauscultation under supervision in a unit where suchoperations are practised
Theoretical studies

Intermediate objective 10

Teaching methods

Follow-up

To master principles of prevention of health care-related
infections

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

To master management of
occurring health care-related
infections

Theoretical studies

Intermediate objective 11

Teaching methods

Follow-up

To master principles of infectious disease prevention andcontrol, including notifiablediseases in the Communicable
Diseases Act

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

To have knowledge of infection
epidemiology
Theoretical studies

Intermediate objective 12

Teaching methods

Follow-up

To master diagnostics and beable to handle investigationand treatment of common andopportunistic infectious diseases

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Theoretical studies

Communicative competenceIntermediate objective 13

Teaching methods

Follow-up

To be capable of dialogue andopen contact with patients andtheir next of kin, and to havethe ability to communicate,both in writing and orally, withother doctors, co-workers andstudents, as well as with various civil authorities

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Intermediate objective 14

Teaching methods

Follow-up

To be capable of informing
and instructing patients, nextof kin, other doctors, and coworkers, as well as students

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Intermediate objective 15

Teaching methods

Follow-up

To be capable of making independent decisions in mattersof medical ethics

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Leadership competenceIntermediate objective 16

Teaching methods

Follow-up

To be capable of mentoringother doctors and co-workers
as well as students

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Mentoring under supervision

Intermediate objective 17

Teaching methods

Follow-up

To be capable of leading using
collaboration and dialogue withco-workers as well as within
the health care team

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Intermediate objective 18

Teaching methods

Follow-up

To have an understanding of
the organisation, management,
and regulatory systems ofhealth care

CourseCertificate of successfullycompleted course, issued bycourse leader

Competence within medical science and quality
work
Intermediate objective 19

Teaching methods

Follow-up

To be capable of a medicallyscientific outlook and approach

Written individual work under
supervision according toscientific principles

Certificate of approved written individual work, issued bycurrent mentor

Intermediate objective 20

Teaching methods

Follow-up

To have an understanding of,and competence in, evidencebased improvement and quality work

Quality and development work
under supervision

Certificate of quality and development work, issued bycurrent mentor

Theoretical studies

Intermediate objective 21

Teaching methods

To have an understanding of
methods for the review ofscientific information

Large professional assembly
Theoretical studies

Follow-up

Clinical chemistry

Introduction
Explanation of terms
General definition of competencies
Definition of area of competence
Competence requirements
Competence requirements for medical competence
Competence requirements for communicative competence, leadershipcompetence, and competence within medical science and quality work
Training structure
Special recommendations
Intermediate objectives
Medical competenceCommunicative competence
Leadership competence
Competence within medical science and quality work

Introduction

On June 24, 2008, The National Board of Health and Welfare (Socialstyrelsen) decided to issue new regulations and general guidelines for doctors’
specialist medical training (SOSFS 2008:17). The statute consists of a general part with common provisions for all specialties and a specific part withall the descriptions of objectives. The description of objectives for each specialty should be understood against the background of the provisions in thegeneral part.
In each description of objectives, there is a section headed ‘Training
structure’ which constitutes general guidelines. The teaching methods under
the heading ‘Intermediate objectives’ where no follow-up is indicated also
constitute general guidelines.

Explanation of terms

current mentor
a specialist doctor whose specialist competence corresponds to the area ofcompetence indicated by the intermediate objective, and who is responsible
for ST doctors’s professional development during the teaching period or forthe method of teaching indicatedthe assignment as a mentor for an ST doctor generally encompasses the entire period of specialist training but can also encompass part or parts of it
auscultation
during mentoring, and in accordance with a pre-designed programme, tostudy the profession of a specialist doctor or other health care staff by following one or several professionals, as well as carrying out assignments in
the relevant area to a certain extent
evaluate
to form a sound opinion of a patient or similar person as a basis for further
management
masterbeing fully able to evaluate and handle the medical investigation, diagnostics, treatment, and follow-up of a patient or similar person, and being fully
able to use the techniques relevant to the area
capability
personal capacity to execute or perform a task
h a ve u n d ers tan d i ng
having acquired knowledge and insight into an area through theoretical studies and/or practical exercise of the profession
have knowledge
having acquired some knowledge in an area through theoretical studies
and/or practical exercise of the profession
mentoring under supervision
as an ST doctor, mentor a co-worker while simultaneously being mentored
by a doctor with specialist competencementorcontinuously, and in dialogue form, supporting and guiding, as well as evaluating, a co-worker’s professional development
mentoringsee mentor
handleto actively carry out measures regarding investigation, diagnostics, treatment, and follow-up of a patient or similar person, and have overall responsibility for carrying out these measuresinitially handle
as the primary physician in charge, to actively carry out measures regarding
investigation, diagnostics, treatment, and follow-up of a patient or similar
person, and have overall responsibility for carrying out these measuresinitially evaluate
as the primary physician in charge, to form a sound opinion of a patient orsimilar person as a basis for further management
intraprofessional group reflection
reflection done in a group together with other doctors, chiefly for the purpose of further education and training
clinical service
health and medical care duties that ST doctors perform under their own professional liability and with the support of a mentor
courseteacher-led training with an established plan, given during a defined periodof timesitting-in
training activity involving an ST doctor observing when a specialist doctor
or other health care staff holds a consultationorassessment activity involving a specialist doctor or other health care staff
observing and evaluating ST doctors during a consultation
seminarinstruction in group form with active participation
training in a simulated environment
training carried out in an environment created to emulate reality

large professional assembly
conference, congress, symposium or similar event
health care centre
health care unit in primary carehealth care team work
work where ST doctors, under supervision, participates in and sometimes
leads a group of co-operating health care staff with various competencies
charged with responsibility for care for an individual patient or group ofpatients

General definition of competence

Definition of area of competence
The specialty of clinical chemistry encompasses biochemical and medical
knowledge and skills in the use of various laboratory methods for analysing
biological material in order to diagnose diseases, establish indications of
illness, evaluate risks of disease, and monitor the effects of treatment. Clinical chemistry is the expert skill intended to promote optimal and evidencebased use of clinical chemical laboratory activities in health care.

Competence requirements
Competence requirements for medical competenceSpecialist competence in clinical chemistry requires knowledge and skills
within clinical chemical laboratory activities. This involves competence inthe use of commonly occurring clinical chemical analyses in medical investigation, and theoretical skills in the use of less common clinical chemical
analyses in medical investigation. The competence includes knowledge
about the principles underlying existing methods of clinical chemical analysis. Additionally, expertise in the role played by clinical chemical laboratory
operations in patient work, as well as good knowledge about logistics, fromtaking specimens to issuing results, is required.
Additionally, expertise is required in following and applying informationfrom relevant medical literature, as well as expertise in evaluating, introducing and providing medical advice about new analyses. Specialist competence in clinical chemistry also requires good knowledge of the principles
underlying quality, as well as of the ethical and legal principles that governclinical chemical laboratory activities.

Competence requirements for communicative competence,leadership competence and competence within medical scienceand quality work
Communicative competence
The equal and responsible patient
Doctors with specialist competence must be capable of dialogue and of
maintaining open contact with patients and their next of kin. Contact should
be characterised by empathy and trust, as well as respect for the patients’right to information, influence, and participation in decisions. Contact
should also be characterised by co-operation and sensitivity to the patients’needs, desires and right to self-determination, as well as providing incentive
for patients’ involvement in, and responsibility for, their own care.

Multicultural and gender aspects
Communication with patients and their next of kin must be characterised byunderstanding of and respect for cross-cultural and multicultural aspects
such as age, language, ethnicity, sexual orientation, and religion, as well as
gender.
Interprofessional relations
Doctors with specialist competence must be capable of communicating,both in writing and orally, with other doctors and co-workers showing respect for their professional knowledge and competencies. The same applies
to contacts with representatives of the general public, various civil authorities, and other important parties for the area of competence.
Pedagogical skills
Doctors with specialist competence must have pedagogical capability inorder to inform and instruct not only patients and their next of kin, but also
other doctors and co-workers, as well as students. Professional approach andethics Doctors with specialist competence must be capable of working continuously with their professional and medical ethical approaches, with theobjective of being able to make independent decisions of a medical ethicalnature.
Individual professional development
Doctors with specialist competence must be capable of continually examining and identifying their own needs for professional development, in addition to operational requirements, in order to be able to meet requirements forthe best possible patient care.

Leadership competence
Collaboration
Doctors with specialist competence must have a developed capability for
self-knowledge and an understanding of their own functions and roles in theorganisation.
Mentoring skills
Doctors with specialist competence must be able to mentor other doctors
and co-workers, as well as students.
Leadership
Doctors with specialist competence must have a capability for leadershipcharacterised by collaboration, openness, and dialogue with co-workers.
Leadership must further be characterised by participation and activity development aimed at improvement. The ability to lead the work of the healthcare team is essential.

System knowledge
Doctors with specialist competence must have an understanding of the organisation, administration, financial and regulatory systems of health care,
as well as its governance, in order to make the best use of resources.

Competence within medical science and quality work
Medical science
Doctors with specialist competence must be capable of adopting a medicallyscientific outlook and approach, and must have knowledge of researchmethodology, including basic epidemiological concepts, as well as of methods for evidence-based medicine and review of scientific information.
Improvement and quality work
Doctors with specialist competence must have an understanding of, andcompetence in, evidence-based improvement and quality work. The objective is to be able to initiate, participate in and be responsible for continuous
systematic quality improvement, with emphasis on a holistic perspective,
patient safety, patient benefit, measurability and teaching management inorder to be able to review and evaluate their own operations.
Public health and prevention
Doctors with specialist competence must have an understanding of the factors determining health, other aspects of public health, and methods forpromoting health and efforts aimed at preventing injury and illness, in order
to be able to take this understanding into account in medical scientific work.

Training structure
Most of the specialist training programme should be held at a unit for clinical chemistry. During the introductory period, the emphasis should be on a
general insight into elements common to all aspects of the specialty, such as
the taking and handling of specimens, logistics, quality assurance and routine activities. ST doctors should then be given the opportunity of advanced
study in the various knowledge areas of the field through clinical service ineach area, at laboratories that carry out such activities. Various knowledge
areas that should be covered during the course of the training include general chemistry, haematology, protein chemistry, coagulation, molecular biology, abuse, endocrinology, metabolic diseases and patient analysis.
Through the various placements, ST doctors should obtain knowledge of thevarious common analysis methods and their medical use. For ST doctors
whose principal placements are at a smaller unit for clinical chemistry, thismay mean that they should do part of their training at a university or regional hospital, or at a similar unit.
Over the course of the training, the demands on ST doctors should gradually increase in respect of the independent introduction of new analysis
methods, quality assessment of methods and processes, and the preparing ofinformation for clinics. In parallel with training in medical elements, ST
doctors should also be given the opportunity to learn leadership and communication through mentoring and courses. Additionally, ST doctors
should, under supervision, plan, carry out and present a scientific project ora development project. The timing of this project will be determined by theconditions governing the activity. During the latter part of the training, ST
doctors should also carry out supplementary service within an internal
medicine or similar specialty.

Special recommendations
The specialty associations and sections of the medical organisations haveformulated special recommendations for their own specialties. The recommendations concern such issues as how specialist medical training should be
structured.

Intermediate objectives

Medical competenceIntermediate objective 1

Teaching methods

Follow-up

To have an understanding ofclinical chemical laboratory
methods

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Theoretical studies

Intermediate objective 2

Teaching methods

Follow-up

To master the most common
clinical chemical analyses

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Theoretical studies

Intermediate objective 3

Teaching methods

Follow-up

To have an understanding of
the less common clinicalchemical analyses

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Theoretical studies

Intermediate objective 4

Teaching methods

Follow-up

To master the evaluation andintroduction of new analysis
methods

Clinical service under supervision in a unit where such operations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Quality and development work
under supervision

Certificate of quality and development work, issued bycurrent mentor

Theoretical studies

Intermediate objective 5

Teaching methods

Follow-up

To have an understanding oflogistics, from ordering analyses to issuing results

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Intermediate objective 6

Teaching methods

Follow-up

To master the principles underlying quality, including
statistics, within clinical chemical laboratory activities

Clinical service under supervision in a unit where such operations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Quality and development work
under supervision

Certificate of quality and development work, issued bycurrent mentor

Theoretical studies

Intermediate objective 7

Teaching methods

Follow-up

To master giving advice regarding clinical chemical analyses in connection with medical investigations

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Quality and development work
under supervision

Certificate of quality and development work, issued bycurrent mentor

Theoretical studies

Intermediate objective 8

Teaching methods

Follow-up

To master the requirements
and conditions for analysis
methods when working withpatients

Clinical service under supervision in a unit where such operations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Quality and development work
under supervision

Certificate of quality and development work, issued bycurrent mentor

Intermediate objective 9

Teaching methods

Follow-up

To master the role of clinicalchemical analysis activities inwork with patients

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Intermediate objective 10

Teaching methods

Follow-up

To master the most important
ethical and legal principles that
apply to clinical chemical laboratory activities

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Theoretical studies

Intermediate objective 11

Teaching methods

Follow-up

To have knowledge of theactivities of other specialties oflaboratory medicine

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Auscultation under supervision in a unit where suchoperations are practised

Intermediate objective 12

Teaching methods

Follow-up

To master routines for systematically following relevant
medical literature in order to beable to make use of that knowledge in practical work

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Theoretical studies

Communicative competenceIntermediate objective 13

Teaching methods

Follow-up

To be capable of communication, both oral and written, with
doctors and co-workers, as wellas with patients and next of kin

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Large professional assemblyIntermediate objective 14

Teaching methods

Follow-up

To be capable of communication with representatives of thegeneral public, civil authorities
and other important parties forthe field

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Intermediate objective 15

Teaching methods

Follow-up

To be capable of informing
and instructing other doctors
and co-workers, as well as
students

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Instruction under supervision

Leadership competenceIntermediate objective 16

Teaching methods

Follow-up

To be capable of mentoringother doctors and co-workers,
as well as students

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Mentoring under supervision

Intermediate objective 17

Teaching methods

Follow-up

To be capable of leading using
collaboration and dialogue withco-workers

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Intermediate objective 18

Teaching methods

Follow-up

To have an understanding of
the organisation, management,
and regulatory systems ofhealth care

CourseCertificate of successfullycompleted course, issued bycourse leader

Competence within medical science and quality
work
Intermediate objective 19

Teaching methods

Follow-up

To be capable of a medicallyscientific outlook and approach

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Written individual work under
supervision according toscientific principles

Certificate of successfullycompleted course, issued bycourse leader

Large professional assemblyIntermediate objective 20

Teaching methods

Follow-up

To have an understanding of,and competence in, evidencebased improvement and quality work

Quality and development work
under supervision

Certificate of quality and development work, issued bycurrent mentor

Clinical pharmacology

Introduction
Explanation of terms
General definition of competencies
Definition of area of competence
Competence requirements
Competence requirements for medical competence
Competence requirements for communicative competence, leadershipcompetence, and competence within medical science and quality work
Training structure
Special recommendations
Intermediate objectives
Medical competenceCommunicative competence
Leadership competence
Competence within medical science and quality work

Introduction

On June 24, 2008, The National Board of Health and Welfare (Socialstyrelsen) decided to issue new regulations and general guidelines for doctors’
specialist medical training (SOSFS 2008:17). The statute consists of a general part with common provisions for all specialties and a specific part withall the descriptions of objectives. The description of objectives for each specialty should be understood against the background of the provisions in thegeneral part.
In each description of objectives, there is a section headed ‘Training
structure’ which constitutes general guidelines. The teaching methods under
the heading ‘Intermediate objectives’ where no follow-up is indicated also
constitute general guidelines.

Explanation of terms

current mentor
a specialist doctor whose specialist competence corresponds to the area ofcompetence indicated by the intermediate objective, and who is responsible
for ST doctors’s professional development during the teaching period or forthe method of teaching indicatedthe assignment as a mentor for an ST doctor generally encompasses the entire period of specialist training but can also encompass part or parts of it
auscultation
during mentoring, and in accordance with a pre-designed programme, tostudy the profession of a specialist doctor or other health care staff by following one or several professionals, as well as carrying out assignments in
the relevant area to a certain extent
evaluate
to form a sound opinion of a patient or similar person as a basis for further
management
masterbeing fully able to evaluate and handle the medical investigation, diagnostics, treatment, and follow-up of a patient or similar person, and being fully
able to use the techniques relevant to the area
capability
personal capacity to execute or perform a task
h a ve u n d ers tan d i ng
having acquired knowledge and insight into an area through theoretical studies and/or practical exercise of the profession
have knowledge
having acquired some knowledge in an area through theoretical studies
and/or practical exercise of the profession
mentoring under supervision
as an ST doctor, mentor a co-worker while simultaneously being mentored
by a doctor with specialist competencementorcontinuously, and in dialogue form, supporting and guiding, as well as evaluating, a co-worker’s professional development
mentoringsee mentor
handleto actively carry out measures regarding investigation, diagnostics, treatment, and follow-up of a patient or similar person, and have overall responsibility for carrying out these measuresinitially handle
as the primary physician in charge, to actively carry out measures regarding
investigation, diagnostics, treatment, and follow-up of a patient or similar
person, and have overall responsibility for carrying out these measuresinitially evaluate
as the primary physician in charge, to form a sound opinion of a patient orsimilar person as a basis for further management
intraprofessional group reflection
reflection done in a group together with other doctors, chiefly for the purpose of further education and training
clinical service
health and medical care duties that ST doctors perform under their own professional liability and with the support of a mentor
courseteacher-led training with an established plan, given during a defined periodof timesitting-in
training activity involving an ST doctor observing when a specialist doctor
or other health care staff holds a consultationorassessment activity involving a specialist doctor or other health care staff
observing and evaluating ST doctors during a consultation
seminarinstruction in group form with active participation
training in a simulated environment
training carried out in an environment created to emulate reality

large professional assembly
conference, congress, symposium or similar event
health care centre
health care unit in primary carehealth care team work
work where ST doctors, under supervision, participates in and sometimes
leads a group of co-operating health care staff with various competencies
charged with responsibility for care for an individual patient or group ofpatients

General definition of competence

Definition of area of competence
The specialty of clinical pharmacology encompasses the evaluation of theeffects and safety of medicines at the individual, patient group and community levels. It further includes the provision of both objective medicinal information and the production of new knowledge about the effects and side
effects of medicines. Clinical pharmacology thus represents expertise in
medicine within health care, promoting evidence-based and rational medicinal treatments.

Competence requirements
Competence requirements for medical competenceSpecialist competence in clinical pharmacology requires knowledge andskills enabling the independent practice of the profession. This involves
expertise in critically evaluating medicine from the perspective of both effects and safety, which assumes fundamental pharmacological, medical,
statistical and epidemiological knowledge. It also involves the ability to use
this expertise in the choice of medicines for both individual patients and forpatient or diagnosis groups. The choice and follow-up of medicines must
further be based on pharmacokinetic principles and the results of medicinal
and abuse analyses.
Specialist competence further requires knowledge in order to work for therational and socially beneficial use of medicine, e.g. by means of objective,
producer-independent medicinal information, orally and in writing. Knowledge about the development of medicines and about the national organisation for medicines is also essential.
Besides broad expertise in the field of clinical pharmacology, competence
in a patient-oriented, medicine-intensive specialty is required.

Competence requirements for communicative competence,leadership competence and competence within medical scienceand quality work
Communicative competence
The equal and responsible patient
Doctors with specialist competence must be capable of dialogue and of
maintaining open contact with patients and their next of kin. Contact should
be characterised by empathy and trust, as well as respect for the patients’right to information, influence, and participation in decisions. It must also
be characterised by cooperation and sensitivity to patients’ needs, wishes
and right to self-determination, and must stimulate patients’ commitment toand responsibility for their own care.
Multicultural and gender aspects
Communication with patients and their next of kin should be characterisedby understanding and respect for cross-cultural and multicultural aspects
such as age, language, ethnicity, sexual orientation and religion, as well as
gender.
Interprofessional relations
Doctors with specialist competence must be capable of communicating,both in writing and orally, with other doctors and co-workers showing respect for their professional knowledge and competencies. The same applies
to contact with representatives of the public and various civil authorities.
Pedagogical skills
Doctors with specialist competence must have pedagogical capability inorder to inform and instruct not only patients and their next of kin, but also
other doctors and co-workers, as well as students.
Professional approach and ethics
Doctors with specialist competence must be capable of working continuously with their professional and medical ethical approaches, with the objective of being able to make independent decisions of a medical ethical nature.
Individual professional development
Doctors with specialist competence must be capable of continually examining and identifying their own needs for professional development, in addition to operational requirements, in order to be able to meet requirements forthe best possible patient care.

Leadership competence
Collaboration
Doctors with specialist competence must have a developed capability for
self-knowledge and an understanding of their own functions and roles in theorganisation.
Mentoring skills
Doctors with specialist competence must be able to mentor other doctors
and co-workers, as well as students.
Leadership
Doctors with specialist competence must have a capability for leadershipcharacterised by collaboration, openness, and dialogue with co-workers.
Leadership must further be characterised by participation and activity development aimed at improvement. The ability to lead work in a team is essential.
System knowledge
Doctors with specialist competence must have an understanding of the organisation, administration, financial and regulatory systems of health care,
as well as its governance, in order to make the best use of resources.

Competence within medical science and quality work
Medical science
Doctors with specialist competence must be capable of adopting a medicallyscientific outlook and approach, and must have knowledge of researchmethodology, including basic epidemiological concepts, as well as of methods for evidence-based medicine and review of scientific information.
Improvement and quality work
Doctors with specialist competence must have understanding of, and competence in, evidence-based improvement and quality work. The objective is
to be able to initiate, participate in, and be responsible for continuous systematic improvement work with emphasis on a holistic perspective, patient
safety, patient benefit, measurability, and teaching management in order tobe able to review and evaluate their own operations.
Public health and prevention
Doctors with specialist competence must have an understanding of the factors determining health, other aspects of public health, and methods forpromoting health and efforts aimed at preventing injury and illness, in order
to be able to take this understanding into account in medical scientific work.

Training structure
It is important that most of the necessary competence is obtained at a clinical pharmacology unit. Specialist medical training should begin with an
introduction to the various activities within clinical pharmacology, after
which ST doctors will actively participate in the various activities. The individual elements of service can vary depending on the operational circumstances of the activity, but it is essential that ST doctors receive gradually
increasing responsibility and become increasingly independent during their
specialist medical training.
In order for ST doctors to obtain clinical experience in medicinal treatment of patients, it is important that service at a clinical pharmacologicalunit is supplemented with extended service within a patient oriented, drugsintensive specialty for a lengthier period. In order to reap the greatest benefit
from the supplementary service, ST doctors should perform service withinclinical pharmacology, following supplementary training, in order to be able
to use his or her clinical expertise in clinical pharmacological practice. Service at a drugs authority, drugs unit or in the drugs industry may also be
considered.
During specialist medical training it is of great value that ST doctors areable to plan and carry out a research or development project within the fieldof clinical pharmacology, and that this project be presented at a scientificassembly or in a science periodical. The timing of this project will be determined by the conditions governing the activity.

Special recommendations
The specialty associations and sections of the medical organisations haveformulated special recommendations for their own specialties. The recommendations concern such issues as how specialist medical training should be
structured.

Intermediate objectives

Medical competenceIntermediate objective 1

Teaching methods

Follow-up

To master evaluation of theeffects of medicines

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Theoretical studies

Intermediate objective 2

Teaching methods

Follow-up

To master evaluation of thesafety of medicines

Clinical service under supervision in a unit that handles
these issues

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Theoretical studies

Intermediate objective 3

Teaching methods

Follow-up

To master fundamental statistical and epidemiological methods in the field of medicine

Clinical service under supervision in a unit that handles
these issues

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Theoretical studies

Intermediate objective 4

Teaching methods

Follow-up

To master giving advice toindividual patients regarding
medicinal treatment

Clinical service under supervision in a unit that handles
these issues

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Theoretical studies

Intermediate objective 5

Teaching methods

Follow-up

To master giving advice topatient or diagnosis groups
regarding medicinal treatment

Clinical service under supervision in a unit that handles
these issues

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Theoretical studies

Intermediate objective 6

Teaching methods

Follow-up

To have an understanding ofpharmacokinetics, medicinal
analyses, and abuse analyses

Clinical service under supervision in a unit that handles
these issues

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

ororauscultation under supervision in a unit that handles
these issues

certificate of successfullycompleted auscultation andcompetence achieved, issued
by current mentor

Theoretical studies

Intermediate objective 7

Teaching methods

Follow-up

To master promoting the rational and socially beneficial
use of medicines

Clinical service under supervision in a unit that handles
these issues

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Theoretical studies

Intermediate objective 8

Teaching methods

Follow-up

To master the provision of
objective, producerindependent medicine information, orally and in writing

Clinical service under supervision in a unit that handles
these issues

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Instruction under supervision
Theoretical studies

Intermediate objective 9

Teaching methods

Follow-up

To have an understanding of
all phases of the clinical development of medicine

Clinical service under supervision in a unit that handles
these issues

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

ororauscultation under supervision in a unit that handles
these issues

certificate of successfullycompleted auscultation andcompetence achieved, issued
by current mentor

Theoretical studies

Intermediate objective 10

Teaching methods

Follow-up

To have an understanding of
the national organisation for
medicines

Clinical service under supervision in a unit that handles
these issues

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Theoretical studies

Intermediate objective 11

Teaching methods

Follow-up

To have an in-depth understanding of at least one therapy area

Clinical service under supervision in a unit that handles
these issues

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Mentoring under supervision
Theoretical studies

Intermediate objective 12

Teaching methods

Follow-up

To have an understanding ofinvestigation, diagnostics andtreatment within one specialty

Clinical service under supervision in a unit that handles
such conditions

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Theoretical studies

Communicative competenceIntermediate objective 13

Teaching methods

Follow-up

To be capable of dialogue andopen contact with patients andtheir next of kin, and with otherdoctors and co-workers

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Intermediate objective 14

Teaching methods

Follow-up

To be capable of informing
and instructing patients, nextof kin, other doctors, and coworkers, as well as students

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Instruction under supervisionIntermediate objective 15

Teaching methods

Follow-up

To be capable of a professional, medically ethical approach

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Leadership competenceIntermediate objective 16

Teaching methods

Follow-up

To be capable of mentoringother doctors and co-workers,
as well as students

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Mentoring under supervisionIntermediate objective 17

Teaching methods

Follow-up

To be capable of leading using
collaboration and dialogue withco-workers as well as in a
team

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Intermediate objective 18

Teaching methods

Follow-up

To have an understanding of
the organisation, management,
and regulatory systems ofhealth care

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Competence within medical science and quality
work
Intermediate objective 19

Teaching methods

Follow-up

To be capable of a medicallyscientific outlook and approach

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Written individual work under
supervision according toscientific principles

Certificate of approved written
individual work, issued bycurrent mentor

Intermediate objective 20

Teaching methods

Follow-up

To have an understanding of,and competence in, evidencebased improvement and quality work

Quality and development work
under supervision

Certificate of quality and development work, issued bycurrent mentor

Clinical pathology

Introduction
Explanation of terms
General definition of competencies
Definition of area of competence
Competence requirements
Competence requirements for medical competence
Competence requirements for communicative competence, leadershipcompetence, and competence within medical science and quality work
Training structure
Special recommendations
Intermediate objectives
Medical competenceCommunicative competence
Leadership competence
Competence within medical science and quality work

Introduction

On June 24, 2008, The National Board of Health and Welfare (Socialstyrelsen) decided to issue new regulations and general guidelines for doctors’
specialist medical training (SOSFS 2008:17). The statute consists of a general part with common provisions for all specialties and a specific part withall the descriptions of objectives. The description of objectives for each specialty should be understood against the background of the provisions in thegeneral part.
In each description of objectives, there is a section headed ‘Training
structure’ which constitutes general guidelines. The teaching methods under
the heading ‘Intermediate objectives’ where no follow-up is indicated also
constitute general guidelines.

Explanation of terms

current mentor
a specialist doctor whose specialist competence corresponds to the area ofcompetence indicated by the intermediate objective, and who is responsible
for ST doctors’s professional development during the teaching period or forthe method of teaching indicatedthe assignment as a mentor for an ST doctor generally encompasses the entire period of specialist training but can also encompass part or parts of it
auscultation
during mentoring, and in accordance with a pre-designed programme, tostudy the profession of a specialist doctor or other health care staff by following one or several professionals, as well as carrying out assignments in
the relevant area to a certain extent
evaluate
to form a sound opinion of a patient or similar person as a basis for further
management
masterbeing fully able to evaluate and handle the medical investigation, diagnostics, treatment, and follow-up of a patient or similar person, and being fully
able to use the techniques relevant to the area
capability
personal capacity to execute or perform a task
h a ve u n d ers tan d i ng
having acquired knowledge and insight into an area through theoretical studies and/or practical exercise of the profession
have knowledge
having acquired some knowledge in an area through theoretical studies
and/or practical exercise of the profession
mentoring under supervision
as an ST doctor, mentor a co-worker while simultaneously being mentored
by a doctor with specialist competencementorcontinuously, and in dialogue form, supporting and guiding, as well as evaluating, a co-worker’s professional development
mentoringsee mentor
handleto actively carry out measures regarding investigation, diagnostics, treatment, and follow-up of a patient or similar person, and have overall responsibility for carrying out these measuresinitially handle
as the primary physician in charge, to actively carry out measures regarding
investigation, diagnostics, treatment, and follow-up of a patient or similar
person, and have overall responsibility for carrying out these measuresinitially evaluate
as the primary physician in charge, to form a sound opinion of a patient orsimilar person as a basis for further management
intraprofessional group reflection
reflection done in a group together with other doctors, chiefly for the purpose of further education and training
clinical service
health and medical care duties that ST doctors perform under their own professional liability and with the support of a mentor
courseteacher-led training with an established plan, given during a defined periodof timesitting-in
training activity involving an ST doctor observing when a specialist doctor
or other health care staff holds a consultationorassessment activity involving a specialist doctor or other health care staff
observing and evaluating ST doctors during a consultation
seminarinstruction in group form with active participation
training in a simulated environment
training carried out in an environment created to emulate reality

large professional assembly
conference, congress, symposium or similar event
health care centre
health care unit in primary carehealth care team work
work where ST doctors, under supervision, participates in and sometimes
leads a group of co-operating health care staff with various competencies
charged with responsibility for care for an individual patient or group ofpatients

General definition of competence

Definition of area of competence
The specialty of clinical pathology encompasses knowledge and skills in
diagnosing or ruling out illness in cell and tissue specimens from patientsand screening populations, as well as in clinical autopsies. Diagnoses are
based on macroscopic and microscopic observations, and on findings thatemerge through the use of various supplementary methods. All types of somatic illness fall within the area of clinical pathology. However, diagnostics
of precancerous conditions and malignant oncogenesis constitute a central
task. The field includes a major responsibility for experimental and clinicalresearch, and for training of doctors, biomedical analysts and other medical
personnel.

Competence requirements
Competence requirements for medical competenceSpecialist competence in clinical pathology requires the ability to carry out
independent diagnostic work based on histopathological and cytologicalmaterial, as well as on investigations in connection with clinical autopsies.
This also encompasses knowledge about how tissue should be collected,
handled and readied for the production of histopathological and cytologicalpreparations, how immunological and molecular biology methods are usedin diagnostics, and the ability to evaluate quality aspects of produced preparations.
Further, knowledge is required about the laws and regulations that regulate the activities at a laboratory of clinical pathology, and of laws and regulations that regulate the practical application of the Autopsy Act. Knowledge is also required of macroscopic and microscopic anatomy, pathophysiology, tumour biology and digital image processing, as well as of the role ofpathology and cytology in screening activities, and knowledge of diagnosis
registers.

Competence requirements for communicative competence,leadership competence and competence within medical scienceand quality work
Communicative competence
The equal and responsible patient
Doctors with specialist competence must be capable of dialogue and of
maintaining open contact with patients and their next of kin. Contact should
be characterised by empathy and trust, as well as respect for the patients’right to information, influence, and participation in decisions. It must also
be characterised by cooperation and sensitivity to patients’ needs, wishes
and right to self-determination, and must stimulate patients’ commitment toand responsibility for their own care.
Gender and multicultural aspects
Communication with patients and their next of kin must be characterised byunderstanding of and respect for cross-cultural and multicultural aspects
such as age, language, ethnicity, sexual orientation, and religion, as well as
gender.
Interprofessional relations
Doctors with specialist competence must be capable of communicating,both in writing and orally, with other doctors and co-workers showing respect for their professional knowledge and competencies. The same applies
to contact with representatives of the public and various civil authorities.
Pedagogical skills
Doctors with specialist competence must have pedagogical capability inorder to inform and instruct not only patients and their next of kin, but also
other doctors and co-workers, as well as students.
Professional approach and ethics
Doctors with specialist competence must be capable of working continuously with their professional and medical ethical approaches, with the objective of being able to make independent decisions of a medical ethical nature.
Individual professional development
Doctors with specialist competence must be capable of continually examining and identifying their own needs for professional development, in addition to operational requirements, in order to be able to meet requirements forthe best possible patient care.

Leadership competence
Collaboration
Doctors with specialist competence must have a developed capability for
self-knowledge and an understanding of their own functions and roles in theorganisation.
Mentoring skills
Doctors with specialist competence must be able to mentor other doctors
and co-workers, as well as students.

Leadership
Doctors with specialist competence must have a capability for leadershipcharacterised by collaboration, openness, and dialogue with co-workers.
Leadership must further be characterised by participation and activity development aimed at improvement. The ability to lead the work of the healthcare team is essential.
System knowledge
Doctors with specialist competence must have an understanding of the organisation, administration, financial and regulatory systems of health care,
as well as its governance, in order to make the best use of resources.

Competence within medical science and quality work
Medical science
Doctors with specialist competence must be capable of adopting a medicallyscientific outlook and approach, and must have knowledge of researchmethodology, including basic epidemiological concepts, as well as of methods for evidence-based medicine and review of scientific information.
Improvement and quality work
Doctors with specialist competence must have understanding of, and competence in, evidence-based improvement and quality work. The objective is
to be able to initiate, participate in, and be responsible for continuous systematic improvement work with emphasis on a holistic perceptive, patient
safety, patient benefit, measurability, and teaching management in order tobe able to review and evaluate their own operations.
Public health and prevention
Doctors with specialist competence must have an understanding of the factors determining health, other aspects of public health, and methods forpromoting health and efforts aimed at preventing injury and illness, in order
to be able to take this understanding into account in medical scientific work.

Training structure
Specialist medical training in clinical pathology should begin with a brief
period of orientation service to give ST doctors a general understanding of
the roles of the pathologist and the function and place of pathology laboratories in the health care chain, as well as knowledge about the expertise andareas of responsibility of other professional categories. In parallel with this,ST doctors should begin macroscopic and microscopic diagnostics and autopsy work, and participate in clinical conferences.
During the first half of the training programme, the emphasis should be
on ST doctors obtaining a thorough knowledge of basic diagnostics. The
objective should be ST doctors becoming well versed in morphologicalevaluation and investigation of the majority of common cases in the mostcommon areas of diagnostics. It is further recommended that ST doctors beallowed to evaluate cytological preparations early during training, sincesuch preparations often form an important part of the investigation and diagnostics of many groups of tumours. It is advisable that ST doctors achievesome degree of independence in their work within both macroscopic andmicroscopic diagnostics during this period, and that they are given the opportunity to respond independently to cases.
During the second half of specialist medical training, a number of interests should be seen to. ST doctors should broaden their diagnostic capabilities to include handling of the entire spectrum of preparations that routinely
occur in histopathological and cytological material. The opportunity for advanced study in one or several areas is also important. Such advanced study
should not only include purely morphological methods; during this period
ST doctors should also become familiar with how tissue can be used forcomplementary and molecular biology investigations. As during the firstyears, cytological diagnostics should be included as an important part ofeveryday tasks. During the second half of the training, ST doctors should begiven the opportunity to participate in or lead administrative commissions.
During the entire course of the programme, ST doctors should be given
the opportunity to pursue studies of the literature and to choose courses well
adapted to training needs and the skill in question. It will be a clear advantage if the service has involved work both at university units and at otherunits.

Special recommendations
The specialty associations and sections of the medical organisations haveformulated special recommendations for their own specialties. The recommendations concern such issues as how specialist medical training should be
structured.

Intermediate objectives

Medical competenceIntermediate objective 1

Teaching methods

Follow-up

To master histopathologicaldiagnostics and managing
preparations for cytologicaldiagnostics

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Large professional assembly
Diagnostics and treatment
conference
Theoretical studies

Intermediate objective 2

Teaching methods

Follow-up

To master managing fixed andunfixed samples for histopathological, cytological and nonmorphological diagnostics

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

Theoretical studies

Intermediate objective 3

Teaching methods

Follow-up

To have an understanding of
the preparation, production andcolouring of histopathologicaland cytological preparations,
including knowledge of puncture techniques

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Intermediate objective 4

Teaching methods

Follow-up

To master quality assessmentof histopathological and cytological samples, and to be able
to evaluate aspiration cytology
material regarding techniqueand quality

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Theoretical studies

Theoretical studies

Intermediate objective 5

Teaching methods

Follow-up

To master carrying out clinicalautopsies and microscopic
diagnostics based on autopsy
findings

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Theoretical studies

Intermediate objective 6

Teaching methods

Follow-up

To be able to handle cases inwhich the issue of forensic
autopsy may emerge

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Auscultation under supervision in a unit where suchoperations are practised
Theoretical studies

Intermediate objective 7

Teaching methods

Follow-up

To master the use and interpretation of immunochemical investigations, and to have an
understanding of supplementary methods and how these canbe used in diagnostics

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Theoretical studies

Intermediate objective 8

Teaching methods

Follow-up

To have an understanding of
the statutes regulating theactivities at a pathology andcytology laboratory, and tohave an understanding of theirapplication

Clinical service under supervision in a unit that handles
such conditions

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Theoretical studies

Intermediate objective 9

Teaching methods

Follow-up

To have an understanding of
the organ systems’ macro- andmicroscopic anatomy, physiology and pathophysiology, and tohave an understanding of general tumour biology

Clinical service under supervision in a unit that handles
such conditions

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Theoretical studies

Intermediate objective 10

Teaching methods

Follow-up

To have knowledge of andunderstanding of general principles and methods of screening for pathological conditions
with the use of pathologicaland cytological techniques

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Intermediate objective 11

Teaching methods

Follow-up

To have an understanding ofdigital image processing

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Intermediate objective 12

Teaching methods

Follow-up

To have an understanding of
diagnosis registers, tumour
registers, and of patient andlaboratory data registers

Clinical service under supervision in a unit that handles
these conditions

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Communicative competenceIntermediate objective 13

Teaching methods

Follow-up

To be capable of communication, both oral and written, withother doctors and co-workers

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Diagnostics and treatment
conferenceIntermediate objective 14

Teaching methods

Follow-up

To be capable of informing
and instructing patients, nextof kin, other doctors, and coworkers, as well as students

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Instruction under supervisionIntermediate objective 15

Teaching methods

Follow-up

To be capable of dialogue andopen contact with patients andtheir next of kin

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Leadership competenceIntermediate objective 16

Teaching methods

Follow-up

To be capable of mentoringother doctors and co-workers,
as well as students

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Mentoring under supervisionIntermediate objective 17

Teaching methods

Follow-up

To be capable of leading using
collaboration and dialogue withco-workers as well as within
the health care team

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Intermediate objective 18

Teaching methods

Follow-up

To have an understanding of
the organisation, management,
and regulatory systems ofhealth care

CourseCertificate of successfullycompleted course, issued bycourse leader

Competence within medical science and quality
work
Intermediate objective 19

Teaching methods

Follow-up

To be capable of a medicallyscientific outlook and approach

Written individual work under
supervision according toscientific principles

Certificate of approved written individual work, issued bycurrent mentor

Large professional assembly
Theoretical studies

Intermediate objective 20

Teaching methods

Follow-up

To have an understanding of,and competence in, evidencebased improvement and quality work

Quality and development work
under supervision

Certificate of quality and development work, issued bycurrent mentor

Theoretical studies

Forensic medicine

Introduction
Explanation of terms
General definition of competencies
Definition of area of competence
Competence requirements
Competence requirements for medical competence
Competence requirements for communicative competence, leadershipcompetence, and competence within medical science and quality work
Training structure
Special recommendations
Intermediate objectives
Medical competenceCommunicative competence
Leadership competence
Competence within medical science and quality work

Introduction

On June 24, 2008, The National Board of Health and Welfare (Socialstyrelsen) decided to issue new regulations and general guidelines for doctors’
specialist medical training (SOSFS 2008:17). The statute consists of a general part with common provisions for all specialties and a specific part withall the descriptions of objectives. The description of objectives for each specialty should be understood against the background of the provisions in thegeneral part.
In each description of objectives, there is a section headed ‘Training
structure’ which constitutes general guidelines. The teaching methods under
the heading ‘Intermediate objectives’ where no follow-up is indicated also
constitute general guidelines.

Explanation of terms

current mentor
a specialist doctor whose specialist competence corresponds to the area ofcompetence indicated by the intermediate objective, and who is responsible
for ST doctors’s professional development during the teaching period or forthe method of teaching indicatedthe assignment as a mentor for an ST doctor generally encompasses the entire period of specialist training but can also encompass part or parts of it
auscultation
during mentoring, and in accordance with a pre-designed programme, tostudy the profession of a specialist doctor or other health care staff by following one or several professionals, as well as carrying out assignments in
the relevant area to a certain extent
evaluate
to form a sound opinion of a patient or similar person as a basis for further
management
masterbeing fully able to evaluate and handle the medical investigation, diagnostics, treatment, and follow-up of a patient or similar person, and being fully
able to use the techniques relevant to the area
capability
personal capacity to execute or perform a task
h a ve u n d ers tan d i ng
having acquired knowledge and insight into an area through theoretical studies and/or practical exercise of the profession
have knowledge
having acquired some knowledge in an area through theoretical studies
and/or practical exercise of the profession
mentoring under supervision
as an ST doctor, mentor a co-worker while simultaneously being mentored
by a doctor with specialist competencementorcontinuously, and in dialogue form, supporting and guiding, as well as evaluating, a co-worker’s professional development
mentoringsee mentor
handleto actively carry out measures regarding investigation, diagnostics, treatment, and follow-up of a patient or similar person, and have overall responsibility for carrying out these measuresinitially handle
as the primary physician in charge, to actively carry out measures regarding
investigation, diagnostics, treatment, and follow-up of a patient or similar
person, and have overall responsibility for carrying out these measuresinitially evaluate
as the primary physician in charge, to form a sound opinion of a patient orsimilar person as a basis for further management
intraprofessional group reflection
reflection done in a group together with other doctors, chiefly for the purpose of further education and training
clinical service
health and medical care duties that ST doctors perform under their own professional liability and with the support of a mentor
courseteacher-led training with an established plan, given during a defined periodof timesitting-in
training activity involving an ST doctor observing when a specialist doctor
or other health care staff holds a consultationorassessment activity involving a specialist doctor or other health care staff
observing and evaluating ST doctors during a consultation
seminarinstruction in group form with active participation
training in a simulated environment
training carried out in an environment created to emulate reality

large professional assembly
conference, congress, symposium or similar event
health care centre
health care unit in primary carehealth care team work
work where ST doctors, under supervision, participates in and sometimes
leads a group of co-operating health care staff with various competencies
charged with responsibility for care for an individual patient or group ofpatients

General definition of competence

Definition of area of competence
Forensic medicine encompasses diagnostics of illness or injury or other external impact on a living or dead person, with opinions on legal issues. The
specialty also includes aid to judicial authorities in the form of other medical expertise required for these authorities’ evaluation.
In view of the judicial implications it is of particular importance that conclusions conveyed are at the cutting edge of science and that they express aneutral and objective attitude. The relationship with examined subjects, theirnext of kin, and other interested parties cannot be regarded in the light of a
traditional doctor-patient relationship.
The area of competence includes responsibility for the training of doctors,
lawyers, and police officers in medico-legal matters, as well as a research
responsibility.

Competence requirements
Competence requirements for medical competence
The specialist competence of forensic medicine requires the ability to independently carry out forensic examinations of living and dead persons, andthe ability to document and interpret examination findings, as well as toissue opinions. Further, it requires the capability of providing assistanceduring crime scene investigations, participating in identification, and appearing as an expert in a court of law.
In order to achieve this, very good oral and written communicative competence is required, as well as active participation in quality managementand development within the field of activity. It is also a requirement that ST
doctors apply a scientific outlook in all aspects of routine practice. Criticalreview of both one’s own work and evaluations, as well as that of colleagues, is a natural part of this.

Competence requirements for communicative competence,leadership competence and competence within medical scienceand quality work
Communicative competence
The citizen’s perspective
Doctors with specialist competence must be capable of dialogue and of
maintaining open contact with the persons being examined, and of approaching them in a professional and respectful manner. In examining thedeceased, doctors with specialist competence must be capable of combiningimpartiality and precision with involvement and empathy, in order to offer
the customer professional support. Contacts must be characterised by service-mindedness and expertise.
Multicultural and gender aspects
Communication with examinees and their next of kin must be characterisedby understanding of and respect for cross-cultural and diversity aspects suchas age, language, ethnicity, sexual orientation, and religion, as well as gender.
Interprofessional relations
Doctors with specialist competence must be capable of communication,
both written and oral, with other doctors and co-workers, and with representatives of public authorities, while respecting their professional knowledge
and expertise. The same applies to contact with representatives of the public
and various civil authorities.
Pedagogical skills
Doctors with specialist competence must have the pedagogical skills to inform and instruct others, primarily examinees, their families and representatives of public authorities, but also other doctors and co-workers, as well as
students.
Professional approach and ethics
Doctors with specialist competence must be capable of working continuously with their professional and medical ethical approaches, with the objective of being able to make independent decisions of a medical ethical nature.
Individual professional development
Doctors with specialist competence must be capable of continually examining and identifying their own needs for professional development, in addition to operational requirements, in order to be able to meet requirements forthe best possible investigations.

Leadership competence
Collaboration
Doctors with specialist competence must have a developed capability for
self-knowledge and an understanding of their own functions and roles in theorganisation.
Mentoring skills
Doctors with specialist competence must be able to mentor other doctors
and co-workers, as well as students.

Leadership
Doctors with specialist competence must have a capability for leadershipcharacterised by collaboration, openness, and dialogue with co-workers.
Leadership must further be characterised by participation and activity development aimed at improvement. The ability to lead work in a team is essential.
System knowledge
Doctors with specialist competence must have an understanding of publicauthorities with a connection to forensic medicine, their organisation, administration, finances, regulatory framework, as well as their areas of responsibility and competence, for the best collaboration and use of resources.

Competence within medical science and quality work
Medical science
Doctors with specialist competence must be capable of adopting a medicallyscientific outlook and approach, and must have knowledge of researchmethodology, including basic epidemiological concepts, as well as of methods for evidence-based medicine and review of scientific information.
Improvement and quality work
Doctors with specialist competence must have understanding of, and competence in, evidence-based improvement and quality work. The objective is
to be able to initiate, participate in, and be responsible for continuous systematic improvement work with emphasis on a holistic perspective, patient
safety, patient benefit, measurability, and teaching management in order tobe able to review and evaluate their own operations.
Public health and prevention
Doctors with specialist competence must have an understanding of the factors determining health, other aspects of public health, and methods forpromoting health and efforts aimed at preventing injury and illness, in order
to be able to take this understanding into account in medical scientific work.

Training structure
It is recommended that specialist medical training in forensic medicine begin with a brief period of orientation service to give ST doctors a general
understanding of the role of the medico-legal expert and the function andplace of forensic medicine in the judicial process. In parallel with this, ST
doctors should begin examination under supervision of both living and deceased persons.
During the first part of training, ST doctors should obtain a thoroughknowledge of basic forensic medicine, in particular with respect to the relevant legal regulation and to good and efficient examination techniques. It is
important that ST doctors acquire knowledge about the examination andevaluation of commonly occurring cases, including the taking of samples
and additional examinations, during this period. It is important throughout
the training programme that ST doctors pursue theoretical studies, and thatthey are trained in the critical review of their own and others’ evaluations.
It is important that ST doctors are well schooled early on in training, interms of language as well as facts, in recording and in writing forensic opinions and expert advice. ST doctors should further be trained in communication with examinees, their next of kin and colleagues, and in evaluating,
together with the supervisor, analysis results regarding additional examinations, so that ST doctors achieve a satisfactory degree of independence inthese respects.
During the second part of specialist training, it is important that skills are
deepened and broadened by including confident handling of the entire spectrum of evaluations that routinely occur in the forensic expert’s work. During this period, ST doctors should regularly take part in evaluations of complex matters, e.g. sexual assault of children, murder or manslaughter, deaths
in connection with suspected errors or negligence in health care, and crime
scene investigations. During the latter part of the training programme, ST
doctors should also be trained in advanced dissection techniques, and be
given the opportunity of appearing independently as an expert before a courtof law. It is important that ST doctors be given the opportunity to pursue
advanced studies in one or several specialist areas, and to participate in orlead administrative tasks.
Service in forensic medicine should include work at more than one forensic department, of which several should ideally be outside Sweden. Supplementary training should further include service at a clinical pathology laboratory, and can include service within activities with frequent patient contact
as well, e.g. clinical radiology, paediatrics, dermatology, anaesthesiology,
orthopaedics or gynaecology.

Special recommendations
The specialty associations and sections of the medical organisations haveformulated special recommendations for their own specialties. The recommendations concern such issues as how specialist medical training should be
structured.

Intermediate objectives

Medical competenceIntermediate objective 1

Teaching methods

Follow-up

To master forensic examination of a living person

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

orlarge professional assembly
Theoretical studies

Intermediate objective 2

Teaching methods

Follow-up

To master forensic examination of a deceased person

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

orlarge professional assembly
Theoretical studies

Intermediate objective 3

Teaching methods

Follow-up

To master serving as an expert before a court of law

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Sitting-in

Intermediate objective 4

Teaching methods

Follow-up

To master knowledge of statutes and other regulations
governing forensic operations

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Theoretical studies

Intermediate objective 5

Teaching methods

Follow-up

To be capable of evaluating
toxicological analysis results

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Auscultation under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted course, issued bycourse leader

orcourseTheoretical studies

Intermediate objective 6

Teaching methods

Follow-up

To be capable of evaluating
histological preparations

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Theoretical studies

Intermediate objective 7

Teaching methods

Follow-up

To be able to handle classification of illnesses and injuries,
as well as registration in theauthority’s database

Clinical service under supervision in a unit where such operations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Quality and development work
under supervision

Certificate of quality and development work, issued bycurrent mentor

Theoretical studies

Intermediate objective 8

Teaching methods

Follow-up

To be able to handle photography and digital image
processing

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Theoretical studies

Intermediate objective 9

Teaching methods

Follow-up

To be able to handle tasks at
discovery and crime scenes

Clinical service under supervision in a unit where such operations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Auscultation under supervision in a unit where such operations are practised

Certificate of successfullycompleted course, issued bycourse leader

orcourseTheoretical studies

Intermediate objective 10

Teaching methods

Follow-up

To have an understanding ofvarious additional examinations and how these may be
used in diagnostics

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Theoretical studies

Intermediate objective 11

Teaching methods

Follow-up

To have an understanding of
fixing, production and colouringof histopathological preparations

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

ortheoretical studies

Intermediate objective 12

Teaching methods

Follow-up

To be able to evaluate theresults of radiological examinations relevant to the field ofknowledge

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Theoretical studies

Communicative competenceIntermediate objective 13

Teaching methods

Follow-up

To be capable of communication with examinees and theirnext of kin in an impartial, precise and empathic manner

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Intermediate objective 14

Teaching methods

Follow-up

To be capable of communication, both oral and written, withother doctors and co-workers,
and with representatives ofpublic authorities

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Instruction under supervision
Large professional assemblyIntermediate objective 15

Teaching methods

Follow-up

To be capable of informing andinstructing examinees, theirnext of kin, and representativesof public authorities

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Instruction under supervision

Leadership competenceIntermediate objective 16

Teaching methods

Follow-up

To be capable of mentoringother doctors, co-workers andstudents

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseMentoring under supervisionIntermediate objective 17

Teaching methods

Follow-up

To be capable of leading using
collaboration and dialogue withco-workers

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Intermediate objective 18

Teaching methods

Follow-up

To have an understanding of
the organisation, management,
and regulatory systems ofhealth care

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Competence within medical science and quality
work
Intermediate objective 19

Teaching methods

Follow-up

To be capable of a medicallyscientific outlook and approach, and to have an understanding of methods for evidence-based medicine and thereview of scientific information

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Written individual work under
supervision according toscientific principles

Certificate of approved written
individual work, issued bycurrent mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Large professional assembly
Seminar
Theoretical studies

Intermediate objective 20

Teaching methods

Follow-up

To have an understanding of,and competence in, evidencebased improvement and quality work

Quality and development work
under supervision

Certificate of quality and development work, issued bycurrent mentor

Neurological specialties

Neurology
Introduction
Explanation of terms
General definition of competencies
Definition of area of competence
Competence requirements
Competence requirements for medical competence
Competence requirements for communicative competence, leadershipcompetence, and competence within medical science and quality work
Training structure
Special recommendations
Intermediate objectives
Medical competenceCommunicative competence
Leadership competence
Competence within medical science and quality work

Introduction

On June 24, 2008, the Board of Health and Welfare decided to issue new
regulations and general guidelines for doctors’ specialist medical training(SOSFS 2008:17). The statute consists of a general part with common provisions for all specialties and a specific part with all the descriptions of objectives. The description of objectives for the respective specialties should
be understood against the background of the provisions in the general part.
In each description of objectives, there is a section headed ‘Training structure’ which constitutes general guidelines. The teaching methods under theheading ‘Intermediate objectives’ where no follow-up is indicated also constitute general guidelines.

Explanation of terms

current mentor
a specialist doctor whose specialist competence corresponds to the area ofcompetence indicated by the intermediate objective, and who is responsible
for ST doctors’s professional development during the teaching period or forthe method of teaching indicatedthe assignment as a mentor for an ST doctor generally encompasses the entire period of specialist training but can also encompass part or parts of it
auscultation
during mentoring, and in accordance with a pre-designed programme, tostudy the profession of a specialist doctor or other health care staff by following one or several professionals, as well as carrying out assignments in
the relevant area to a certain extent
evaluate
to form a sound opinion of a patient or similar person as a basis for further
management
masterbeing fully able to evaluate and handle the medical investigation, diagnostics, treatment, and follow-up of a patient or similar person, and being fully
able to use the techniques relevant to the area
capability
personal capacity to execute or perform a task
h a ve u n d ers tan d i ng
having acquired knowledge and insight into an area through theoretical studies and/or practical exercise of the profession
have knowledge
having acquired some knowledge in an area through theoretical studies
and/or practical exercise of the profession
mentoring under supervision
as an ST doctor, mentor a co-worker while simultaneously being mentored
by a doctor with specialist competencementorcontinuously, and in dialogue form, supporting and guiding, as well as evaluating, a co-worker’s professional development
mentoringsee mentor
handleto actively carry out measures regarding investigation, diagnostics, treatment, and follow-up of a patient or similar person, and have overall responsibility for carrying out these measuresinitially handle
as the primary physician in charge, to actively carry out measures regarding
investigation, diagnostics, treatment, and follow-up of a patient or similar
person, and have overall responsibility for carrying out these measuresinitially evaluate
as the primary physician in charge, to form a sound opinion of a patient orsimilar person as a basis for further management
intraprofessional group reflection
reflection done in a group together with other doctors, chiefly for the purpose of further education and training
clinical service
health and medical care duties that ST doctors perform under their own professional liability and with the support of a mentor
courseteacher-led training with an established plan, given during a defined periodof timesitting-in
training activity involving an ST doctor observing when a specialist doctor
or other health care staff holds a consultationorassessment activity involving a specialist doctor or other health care staff
observing and evaluating ST doctors during a consultation
seminarinstruction in group form with active participation
training in a simulated environment
training carried out in an environment created to emulate reality

large professional assembly
conference, congress, symposium or similar event
health care centre
health care unit in primary carehealth care team work
work where ST doctors, under supervision, participates in and sometimes
leads a group of co-operating health care staff with various competencies
charged with responsibility for care for an individual patient or group ofpatients

General definition of competence

Definition of area of competence
The neurology specialty comprises illness and injuries to the central andperipheral nervous systems in adults.
The nervous system is the body’s most complex and extensive organ.
Consequently, the illness panorama is especially multifaceted and is characterised by a considerable degree of variation, even among patients sufferingfrom the same illness. The majority of patients undergo a neurological examination with no established diagnosis. The basis of neurology is therefore
the skill of being able to clinically analyse and evaluate the symptom array,especially disorders of muscle power, sensation, balance, coordination,
movement, levels of consciousness, intellect and personality, as well as
symptoms of seizures, headaches and other pain conditions.
Improved diagnostic methods within imaging diagnostics and molecular
genetics have expanded, and will continue to expand, the neurological illness panorama.
Opportunities for both emergency and long term therapeutic efforts tocombat neurological illnesses have increased radically. Many neurologicalillnesses manifest as an acute condition and require emergency treatment. It
is then necessary to intervene early in the course of the illness and follow
the effects of treatment.
As neurological illnesses can cause cognitive and linguistic disorders, andaffect the autonomy of the patient, good communicative competence is essential.

Competence requirements
Competence requirements for medical competence
For specialist competence in neurology, knowledge and proficiencies thatenable the practitioner to independently master the investigation, diagnostics, treatment and follow-up of illnesses of, and injuries to, the nervous
system in its wider sense are necessary. This includes the mastery of neurological, clinical diagnostics and complementary examination methods.
In addition, specialist competence requires that the practitioner masters
the diagnostics and treatment of acute, dangerous conditions and injuries of
the nervous system, epilepsy and other neurological seizure illnesses,
movement disorders, basal ganglia illnesses and serious dementia conditions, neuromuscular illnesses and illnesses of the peripheral nervous system, demyelinating and inflammatory illnesses of the nervous system,neurovascular illnesses and forms of headache. In addition it is necessarythat the practitioner is able to deal with neurological trauma, tumours andinfections of the nervous system.

Finally, knowledge is necessary concerning neurophysiological, neuroradiological, neuroopthalmological, neurourological and neuropsychiatricaspects as well as opportunities for neurological rehabilitation after neurological injuries and illnesses.

Competence requirements for communicative competence,leadership competence and competence within medical scienceand quality work
Communicative competence
The equal and responsible patient
Doctors with specialist competence must be capable of dialogue and of
maintaining open contact with patients and their next of kin. Contact should
be characterised by empathy and trust, as well as respect for patients’ rightto information, influence, and participation in decisions. Contact should also
be characterised by cooperation and sensitivity to the patients’ needs, desires and right to self-determination, as well as providing incentive for patients’ involvement in, and responsibility for, their own care.
Multicultural and gender aspects
Communication with patients and their next of kin should be characterisedby understanding and respect for cross-cultural and multicultural aspects
such as age, language, ethnicity, sexual orientation and religion, as well as
gender.
Interprofessional relations
Doctors with specialist competence must have the ability to communicate,both in writing and orally, with other doctors and co-workers showing respect for their professional knowledge and competences. The same applies
to contact with representatives of the public and various civil authorities.
Pedagogical skills
Doctors with specialist competence must have pedagogical capability inorder to inform and instruct not only patients and their next of kin, but also
other doctors and co-workers, as well as students.
Professional approach and ethics
Doctors with specialist competence must be capable of working continuously with their professional and medical ethical approaches, with the objective of being able to make independent decisions of a medical ethical nature.
Individual professional development
Doctors with specialist competence must be capable of continually examining and identifying their own needs for professional development, in addi-

tion to operational requirements, in order to be able to meet requirements forthe best possible patient care.

Leadership competence
Collaboration
Doctors with specialist competence must have a developed capability for
self-knowledge and an understanding of their own functions and roles in theorganisation.
Mentoring skills
Doctors with specialist competence must be able to mentor other doctors
and co-workers, as well as students.
Leadership
Doctors with specialist competence must be capable of leadership characterised by collaboration, openness and dialogue with co-workers. Leadershipmust further be characterised by participation and operational development
aimed at improvement. The ability to lead the work of the health care teamis essential.
System knowledge
Doctors with specialist competence must have an understanding of the organisation, administration, financial and regulatory systems of health care,
as well as its governance, in order to make the best use of resources.

Competence within medical science and quality work
Medical competence
Doctors with specialist competence must be capable of adopting a medicallyscientific outlook and approach, and must have knowledge of researchmethodology including basic epidemiological concepts, as well as of methods for evidence-based medicine and review of scientific information.
Improvement and quality work
Doctors with specialist competence must have an understanding of, andcompetence in, evidence-based improvement and quality work. The objective is to be able to initiate, participate in and be responsible for continuous
systematic improvement work with emphasis on a holistic perspective, patient safety, patient benefit, measurability, and teaching management in order to be able to review and evaluate their own operations.
Public health and prevention
Doctors with specialist competence must have an understanding of the factors determining health, other aspects of public health, and methods forpromoting health and activities aimed at preventing injury and illness, inorder to be able to take this understanding into account in medical scientificwork.

Training structure
At an early stage of specialist training, emphasis should be placed on examination techniques, analysis of neurological phenomenology, and goodlevels of familiarity with neurological diagnostics plus primary treatment of
acute, common and dangerous illnesses and injuries to the nervous system.
It is desirable that ST doctors, early on in their training, achieve a certain
independence in their clinical work. Over this period it is suitable that ST
doctors work within operations that treat all the major neurological illnesses.
Concentrated periods, focussing on the various intermediate objectives
should be the aim, as should opportunities for more in-depth experience. In
addition, course, seminar and participation in larger, professional meetings
are an important complement which, as far as possible, should be harmonised as far as timing with the rest of the training course is concerned.
The operations of the units at which specialist training is carried out
should be of such scope and breadth within all the major areas of clinicalneurology that ST doctors have the background to achieve the relevant
competence level within all the competence areas. These units should be led
by neurologists with specialist competence.
The hospital should be an emergency ward, and the practical service
should include ward, clinical and on-call duties at the neurological unit.
In order to ensure that ST doctors are able to gain experience of unusual
and rare neurological illnesses that are not available at their own units, acertain period of the later part of the specialist medical training should bespent in a unit that deals with such conditions.
Simultaneous additional training through service should be carried out
primarily within the following areas: neurological surgery, clinical neurophysiology, psychiatry, and internal medicine. The ST doctor is also expected to pursue theoretical studies throughout the entire training period.

Special recommendations
The specialty associations and sections of the medical organisations haveformulated special recommendations for their own specialties. These recommendations concern such issues as how specialist medical training
should be structured.

Intermediate objectives

Medical competenceIntermediate objective 1

Teaching methods

Follow-up

To master the diagnostics andtreatment of severe and dangerous illnesses and injuries
to the nervous system

Clinical service under supervision in a unit that treatsthese conditions

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Teaching under supervision
SeminarLarge professional assembly
Theoretical studies

Intermediate objective 2

Teaching methods

Follow-up

To master the diagnostics,
and the acute and long-term
treatment, of epilepsy andother seizure illnesses

Clinical service under supervision in a unit that treatsthese conditions

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Teaching under supervision
SeminarLarge professional assembly
Theoretical studies

Intermediate objective 3

Teaching methods

Follow-up

To master diagnostics, andthe acute and long-term
treatment, of neurologicaldegenerative illnesses withspecial emphasis on movement problems and basal
ganglia illnesses plus serious
dementia conditions

Clinical service under supervision in a unit that treats these
conditions

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Teaching under supervision
SeminarLarge professional assembly
Theoretical studies

Intermediate objective 4

Teaching methods

Follow-up

To master the diagnostics,
and the acute and long-term
treatment, of neurologicalmuscular illnesses and illnesses of the peripheral nervous system

Clinical service under supervision in a unit that treatsthese conditions

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Teaching under supervision
SeminarLarge professional assembly
Theoretical studies

Intermediate objective 5

Teaching methods

Follow-up

To master the diagnostics, andthe acute and long-term treatment, of the nervous system's
inflammatory and demyelinating illnesses

Clinical service under supervision in a unit that treatsthese conditions

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Teaching under supervision
SeminarLarge professional assembly
Theoretical studies

Intermediate objective 6

Teaching methods

Follow-up

To master the diagnostics,
and the acute and long-term
treatment, of tumours in the
nervous system

Clinical service under supervision in a unit that treats these
conditions

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

SeminarLarge professional assembly
Theoretical studies

Intermediate objective 7

Teaching methods

Follow-up

To master diagnostics, and theacute and long-term treatment,of neurovascular illness

Clinical service under supervision in a unit that treatsthese conditions

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Teaching under supervision
SeminarLarge professional assembly
Theoretical studies

Intermediate objective 8

Teaching methods

Follow-up

To master diagnostics, andthe acute and long-term
treatment, of neurologicaltraumaClinical service under supervision in a unit that treatsthese conditions

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

alternativelyorauscultation under supervision at a unit that treats these
conditions

SeminarLarge professional assembly
Theoretical studies

certificate of approved auscultation and competenceachieved, issued by current
mentorIntermediate objective 9

Teaching methods

Follow-up

To master diagnostics plus theacute and long-term treatmentof headaches

Clinical service under supervision in a unit that treats these
conditions

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Teaching under supervision
SeminarLarge professional assembly
Theoretical studies

Intermediate objective 10

Teaching methods

Follow-up

To be able to initially handle
diagnostics and the acute andlong-term treatment of infections of the nervous system

Clinical service under supervision in a unit that treatsthese conditions

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

alternativelyorauscultation under supervision at a unit that treats these
conditions

certificate of approved auscultation and competenceachieved, issued by current
mentorSeminarLarge professional assembly
Theoretical studies

Intermediate objective 11

Teaching methods

Follow-up

To master neurological clinicaldiagnostics with additional
investigative methods especially lumbar puncture and the
diagnosis of brain death

Clinical service under supervision in a unit that treats these
conditions

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Teaching under supervision
SeminarLarge professional assembly
Theoretical studies

Intermediate objective 12

Teaching methods

Follow-up

To have knowledge of neurophysiological, neuroradiological,
neuroopthalmological, neurootological, neurourological andneuropsychiatric aspects andneurorehabilitation opportunities
for neurological injuries andillnesses

Clinical service under supervision in a unit that treatsthese conditions

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

alternativelyorauscultation under supervision at a unit that treatsthese conditions

certificate of approved auscultation and competenceachieved, issued by current
mentor

Theoretical studies

Communicative competenceIntermediate objective 13

Teaching methods

Follow-up

To be capable of dialogue andopen contact with patients andtheir next of kin

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Intermediate objective 14

Teaching methods

Follow-up

To be capable of communication, both oral and written, withother doctors and co-workers

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Intermediate objective 15

Teaching methods

Follow-up

To be capable of informing
and instructing patients, nextof kin, other doctors, and coworkers, as well as students

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Teaching under supervision
Theoretical studies

Leadership competenceIntermediate objective 16

Teaching methods

Follow-up

To be capable of mentoringother doctors and co-workers
as well as students

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Mentoring under supervisionIntermediate objective 17

Teaching methods

Follow-up

To be capable of leading using
collaboration and dialogue
with co-workers as well as
within the health care team

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Intermediate objective 18

Teaching methods

Follow-up

To have an understanding of
the organisation, management
and regulatory systems ofhealth and medical care

CourseCertificate of successfullycompleted course, issued bycourse leader

Theoretical studies

Competence within medical science and quality
work
Intermediate objective 19

Teaching methods

Follow-up

To be capable of a medical
scientific outlook and approach

Written individual work under
supervision according toscientific principles

Certificate of approved written
individual work, issued bycurrent mentor

Large professional assembly
Theoretical studies

Intermediate objective 20

Teaching methods

Follow-up

To develop an understandingof, and competence in, evidence-based improvement
and quality work

Quality and development work
under supervision

Certificate of successful completion of quality and development work, issued by current mentor

Theoretical studies

Neurological surgery

Introduction
Explanation of terms
General definition of competencies
Definition of area of competence
Competence requirements
Competence requirements for medical competence
Competence requirements for communicative competence, leadershipcompetence, and competence within medical science and quality work
Training structure
Special recommendations
Intermediate objectives
Medical competenceCommunicative competence
Leadership competence
Competence within medical science and quality work

Introduction

On June 24, 2008, the Board of Health and Welfare decided to issue new
regulations and general guidelines for doctors’ specialist medical training(SOSFS 2008:17). The statute consists of a general part with common provisions for all specialties and a specific part with all the descriptions of objectives. The description of objectives for the respective specialties should
be understood against the background of the provisions in the general part.
In each description of objectives, there is a section headed ‘Training
structure’ which constitutes general guidelines. The teaching methods under
the heading ‘Intermediate objectives’ where no follow-up is indicated also
constitute general guidelines.

Explanation of terms

current mentor
a specialist doctor whose specialist competence corresponds to the area ofcompetence indicated by the intermediate objective, and who is responsible
for ST doctors’s professional development during the teaching period or forthe method of teaching indicatedthe assignment as a mentor for an ST doctor generally encompasses the entire period of specialist training but can also encompass part or parts of it
auscultation
during mentoring, and in accordance with a pre-designed programme, tostudy the profession of a specialist doctor or other health care staff by following one or several professionals, as well as carrying out assignments in
the relevant area to a certain extent
evaluate
to form a sound opinion of a patient or similar person as a basis for further
management
masterbeing fully able to evaluate and handle the medical investigation, diagnostics, treatment, and follow-up of a patient or similar person, and being fully
able to use the techniques relevant to the area
capability
personal capacity to execute or perform a task
h a ve u n d ers tan d i ng
having acquired knowledge and insight into an area through theoretical studies and/or practical exercise of the profession
have knowledge
having acquired some knowledge in an area through theoretical studies
and/or practical exercise of the profession
mentoring under supervision
as an ST doctor, mentor a co-worker while simultaneously being mentored
by a doctor with specialist competencementorcontinuously, and in dialogue form, supporting and guiding, as well as evaluating, a co-worker’s professional development
mentoringsee mentor
handleto actively carry out measures regarding investigation, diagnostics, treatment, and follow-up of a patient or similar person, and have overall responsibility for carrying out these measuresinitially handle
as the primary physician in charge, to actively carry out measures regarding
investigation, diagnostics, treatment, and follow-up of a patient or similar
person, and have overall responsibility for carrying out these measuresinitially evaluate
as the primary physician in charge, to form a sound opinion of a patient orsimilar person as a basis for further management
intraprofessional group reflection
reflection done in a group together with other doctors, chiefly for the purpose of further education and training
clinical service
health and medical care duties that ST doctors perform under their own professional liability and with the support of a mentor
courseteacher-led training with an established plan, given during a defined periodof timesitting-in
training activity involving an ST doctor observing when a specialist doctor
or other health care staff holds a consultationorassessment activity involving a specialist doctor or other health care staff
observing and evaluating ST doctors during a consultation
seminarinstruction in group form with active participation
training in a simulated environment
training carried out in an environment created to emulate reality

large professional assembly
conference, congress, symposium or similar event
health care centre
health care unit in primary carehealth care team work
work where ST doctors, under supervision, participates in and sometimes
leads a group of co-operating health care staff with various competencies
charged with responsibility for care for an individual patient or group ofpatients

General definition of competence

Definition of area of competence
The specialty of neurosurgery encompasses in-depth knowledge and proficiencies in the treatment of congenital and acquired illnesses, and injuries tothe nervous system that are treated with neurological surgical methods.
Consequently, surgical operating skills are crucial.
The profile of this specialty extends from acute, lifesaving procedures tohighly qualified elective surgery using minimally invasive methods and neurological intensive care. The patient group includes all ages.

Competence requirements
Competence requirements for medical science
Specialist competence in neurosurgery requires the ability to treat all formsof emergency neurological surgery, a good level of knowledge of the treatment of elective neurological surgical issues, and having performed standard
operations. It is also necessary that doctors have received an orientation in
extremely unusual neurological surgical conditions and advanced neurological surgical procedures.

Competence requirements for communicative competence,leadership competence and competence within medical scienceand quality work
Communicative competence
The equal and responsible patient
Doctors with specialist competence must be capable of dialogue and of
maintaining open contact with patients and their next of kin. Contact should
be characterised by empathy and trust, as well as respect for patients’ rightto information, influence, and participation in decisions. Contact should also
be characterised by cooperation and sensitivity to the patients’ needs, desires and right to self-determination, as well as providing incentive for patients’ involvement in, and responsibility for, their own care.
Multicultural and gender aspects
Communication with patients and their next of kin should be characterisedby understanding and respect for cross-cultural and multicultural aspects
such as age, language, ethnicity, sexual orientation and religion, as well as
gender.

Interprofessional relations
Doctors with specialist competence must have the ability to communicate,both in writing and orally, with other doctors and co-workers showing respect for their professional knowledge and competences. The same applies
to contact with representatives of the public and various civil authorities.
Pedagogical skills
Doctors with specialist competence must have pedagogical capability inorder to inform and instruct not only patients and their next of kin, but also
other doctors and co-workers, as well as students.
Professional approach and ethics
Doctors with specialist competence must be capable of working continuously with their professional and medical ethical approaches, with the objective of being able to make independent decisions of a medical ethical nature.
Individual professional development
Doctors with specialist competence must be capable of continually examining and identifying their own needs for professional development, in addition to operational requirements, in order to be able to meet requirements forthe best possible patient care.

Leadership competence
Collaboration
Doctors with specialist competence must have a developed capability for
self-knowledge and an understanding of their own functions and roles in theorganisation.
Mentoring skills
Doctors with specialist competence must be able to mentor other doctors
and co-workers, as well as students.
Leadership
Doctors with specialist competence must be capable of leadership characterised by collaboration, openness and dialogue with co-workers. Leadershipmust further be characterised by participation and operational development
aimed at improvement. The ability to lead the work of the health care teamis essential.
System knowledge
Doctors with specialist competence must have an understanding of the organisation, administration, financial and regulatory systems of health care,
as well as its governance, in order to make the best use of resources.

Competence within medical science and quality work
Medical science
Doctors with specialist competence must be capable of adopting a medicallyscientific outlook and approach, and must have knowledge of researchmethodology including the basic epidemiological concepts, as well as ofmethods for evidence-based medicine and review of scientific information.
Improvement and quality work
Doctors with specialist competence must have an understanding of, andcompetence in, evidence-based improvement and quality work. The objective is to be able to initiate, participate in and be responsible for continuous
systematic improvement work with emphasis on a holistic perspective, patient safety, patient benefit, measurability, and teaching management in order to be able to review and evaluate their own operations.
Public health and prevention
Doctors with specialist competence must have an understanding of the factors determining health, other aspects of public health, and methods forpromoting health and activities aimed at preventing injury and illness, inorder to be able to take this understanding into account in medical scientificwork.

Training structure
At an early stage of service, emphasis should be placed on neurological surgical examination techniques and primary treatment of acute neurologicalsurgical conditions. The ST doctor should regularly, and as an integrated
participant, participate as an assistant in emergency and elective operations.
As time passes, the ST doctor’s service should be in concentrated periods,
focusing on the various partial areas.
At the end of specialist medical training, the ST doctors should haveachieved such a level of competence that they can independently carry out
standard surgical procedures in accordance with the stipulations in the intermediate objectives.
During the entire course of their service, ST doctors should pursue relevant theoretical studies and participate in course planned jointly with their
mentors.

Special recommendations
The specialty associations and sections of the medical organisations haveformulated special recommendations for their own specialties. These recommendations concern such issues as how specialist medical training
should be structured.

Intermediate objectives

Medical science
Intermediate objective 1

Teaching methods

Follow-up

To master neurological surgical investigation and examination techniques

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Theoretical studies

Intermediate objective 2

Teaching methods

Follow-up

To master basic surgical techniques

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Theoretical studies

Intermediate objective 3

Teaching methods

Follow-up

To be able to initially handle
neurotraumatic injuries

Clinical service under supervision in a unit that treatsthese conditions

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Auscultation under supervision at a unit that treats these
conditions
Theoretical studies

Intermediate objective 4

Teaching methods

Follow-up

To master basic neurologicalintensive care and to gain
knowledge of neuroanaesthesiology

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Theoretical studies

Intermediate objective 5

Teaching methods

Follow-up

To be able to handle tumour
conditions within the central
nervous system

Clinical service under supervision in a unit that treatsthese conditions

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Theoretical studies

Intermediate objective 6

Teaching methods

Follow-up

To be able to handle neurovascular conditions

Clinical service under supervision in a unit that treatsthese conditions

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Auscultation under supervision at a unit that treats these
conditions

Certificate of successfullycompleted course, issued bycourse leader

CourseTheoretical studies

Intermediate objective 7

Teaching methods

Follow-up

To be able to handle degenerative spinal conditions

Clinical service under supervision in a unit that treatsthese conditions

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Theoretical studies

Intermediate objective 8

Teaching methods

Follow-up

To be able to handle neuropaediatric and congenital conditions

Clinical service under supervision in a unit that treatsthese conditions

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Theoretical studies

Intermediate objective 9

Teaching methods

Follow-up

To be able to handle liquor
circulation disorders

Clinical service under supervision in a unit that treatsthese conditions

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Theoretical studies

Intermediate objective 10

Teaching methods

Follow-up

To be able to handle primaryand secondary neurologicalsurgical infections

Clinical service under supervision in a unit that treatsthese conditions

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Theoretical studies

Intermediate objective 11

Teaching methods

Follow-up

To be able to initially handle
and gain knowledge of functional neurological surgicalconditions

Clinical service under supervision in a unit that treats these
conditions

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Diagnostics and treatment
symposiums
Theoretical studies

Intermediate objective 12

Teaching methods

Follow-up

To be able to handle neurological surgical complications

Clinical service under supervision in a unit that treatsthese conditions

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Theoretical studies

Communicative competenceIntermediate objective 13

Teaching methods

Follow-up

To be capable of maintaining
dialogue and open contact
with the patient and their nextof kinClinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Care team operations under
supervisionIntermediate objective 14

Teaching methods

Follow-up

To be capable of communication, both oral and written, withother doctors and co-workers

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Intermediate objective 15

Teaching methods

Follow-up

To be capable of informing
and instructing patients, nextof kin, other doctors, and coworkers, as well as students

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Teaching under supervision
SeminarLarge professional assembly

Leadership competenceIntermediate objective 16

Teaching methods

Follow-up

To be capable of mentoringother doctors and co-workers
as well as students

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Mentoring under supervision

Intermediate objective 17

Teaching methods

Follow-up

To be capable of leading using
collaboration and dialogue
with co-workers as well as
within the health care team

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Intermediate objective 18

Teaching methods

Follow-up

To have an understanding of
the organisation, management
and regulatory systems ofhealth and medical care

CourseCertificate of successfullycompleted course, issued bycourse leader

Competence within medical science and quality
work
Intermediate objective 19

Teaching methods

Follow-up

To be capable of a medicallyscientific outlook and approach

Written individual work under
supervision according toscientific principles

Certificate of approved written
individual work, issued bycurrent mentor

Intermediate objective 20

Teaching methods

Follow-up

To develop an understandingof, and competence in, evidence-based improvement
and quality work

Quality and development work
under supervision

Certificate of successful completion of quality and development work, issued by current mentor

Clinical neurophysiology

Introduction
Explanation of terms
General definition of competencies
Definition of area of competence
Competence requirements
Competence requirements for medical competence
Competence requirements for communicative competence, leadershipcompetence, and competence within medical science and quality work
Training structure
Special recommendations
Intermediate objectives
Medical competenceCommunicative competence
Leadership competence
Competence within medical science and quality work

Introduction

On June 24, 2008, the Board of Health and Welfare decided to issue new
regulations and general guidelines for doctors’ specialist medical training(SOSFS 2008:17). The statute consists of a general part with common provisions for all specialties and a specific part with all the descriptions of objectives. The description of objectives for the respective specialties should
be understood against the background of the provisions in the general part.
In each description of objectives, there is a section headed ‘Training
structure’ which constitutes general guidelines. The teaching methods under
the heading ‘Intermediate objectives’ where no follow-up is indicated also
constitute general guidelines.

Explanation of terms

current mentor
a specialist doctor whose specialist competence corresponds to the area ofcompetence indicated by the intermediate objective, and who is responsible
for ST doctors’s professional development during the teaching period or forthe method of teaching indicatedthe assignment as a mentor for an ST doctor generally encompasses the entire period of specialist training but can also encompass part or parts of it
auscultation
during mentoring, and in accordance with a pre-designed programme, tostudy the profession of a specialist doctor or other health care staff by following one or several professionals, as well as carrying out assignments in
the relevant area to a certain extent
evaluate
to form a sound opinion of a patient or similar person as a basis for further
management
masterbeing fully able to evaluate and handle the medical investigation, diagnostics, treatment, and follow-up of a patient or similar person, and being fully
able to use the techniques relevant to the area
capability
personal capacity to execute or perform a task
h a ve u n d ers tan d i ng
having acquired knowledge and insight into an area through theoretical studies and/or practical exercise of the profession
have knowledge
having acquired some knowledge in an area through theoretical studies
and/or practical exercise of the profession
mentoring under supervision
as an ST doctor, mentor a co-worker while simultaneously being mentored
by a doctor with specialist competencementorcontinuously, and in dialogue form, supporting and guiding, as well as evaluating, a co-worker’s professional development
mentoringsee mentor
handleto actively carry out measures regarding investigation, diagnostics, treatment, and follow-up of a patient or similar person, and have overall responsibility for carrying out these measuresinitially handle
as the primary physician in charge, to actively carry out measures regarding
investigation, diagnostics, treatment, and follow-up of a patient or similar
person, and have overall responsibility for carrying out these measuresinitially evaluate
as the primary physician in charge, to form a sound opinion of a patient orsimilar person as a basis for further management
intraprofessional group reflection
reflection done in a group together with other doctors, chiefly for the purpose of further education and training
clinical service
health and medical care duties that ST doctors perform under their own professional liability and with the support of a mentor
courseteacher-led training with an established plan, given during a defined periodof timesitting-in
training activity involving an ST doctor observing when a specialist doctor
or other health care staff holds a consultationorassessment activity involving a specialist doctor or other health care staff
observing and evaluating ST doctors during a consultation
seminarinstruction in group form with active participation
training in a simulated environment
training carried out in an environment created to emulate reality

large professional assembly
conference, congress, symposium or similar event
health care centre
health care unit in primary carehealth care team work
work where ST doctors, under supervision, participates in and sometimes
leads a group of co-operating health care staff with various competencies
charged with responsibility for care for an individual patient or group ofpatients

General definition of competence

Definition of area of competence
The specialty of clinical neurophysiology demonstrates and evaluateschanges and functional impairments, primarily using electrophysiologicalmethods, within the central and peripheral nervous systems, muscles andsensory organs. Patient-based diagnostics covers all age groups.
Clinical neurophysiology offers diagnostic support not only to other neurological specialties but also to a number of other specialties. Importantelements of operations include emergency activities, intensive care, intraoperative monitoring and distance consultations. Clinical neurophysiology
also includes the ability to plan and implement investigation programmes
for mapping, analysis and prognosis assessment of the conditions causing
the patient’s problems. Methodological development and research form an
important element of the activities in this area of competence.

Competence requirements
Competence requirements for medical science
For specialist competence in clinical neurophysiology it is necessary to gain
in-depth knowledge of the development, anatomy, and physiology of thenervous system, as well as of illnesses and injuries to the nervous system,
muscles and sensory organs. In addition, theoretical knowledge of, and practical proficiencies in, neurophysiological methods are essential. Relevant
knowledge of digital and IT technology is required, as well as knowledge ofother neurofunctional examination techniques, for example within radiology
and nuclear medicine. Additionally, being capable of evaluating neurophysical results in their medical context, establishing neurophysiologicalopinions, and presenting and discussing results are required. Knowledge of
research methodology and methodological development is also necessary.

Competence requirements for communicative competence,leadership competence and competence within medical scienceand quality work
Communicative competence
The equal and responsible patient
Doctors with specialist competence must be capable of dialogue and of
maintaining open contact with patients and their next of kin. Contact should
be characterised by empathy and trust, as well as respect for patients’ rightto information, influence, and participation in decisions. Contact should also
be characterised by cooperation and sensitivity to the patients’ needs, de-sires and right to self-determination, as well as providing incentive for patients’ involvement in, and responsibility for, their own care.
Multicultural and gender aspects
Communication with patients and their next of kin should be characterisedby understanding and respect for cross-cultural and multicultural aspects
such as age, language, ethnicity, sexual orientation and religion, as well as
gender.
Interprofessional relations
Doctors with specialist competence must have the ability to communicate,both in writing and orally, with other doctors and co-workers showing respect for their professional knowledge and competences. The same applies
to contact with representatives of the public and various civil authorities.
Pedagogical skills
Doctors with specialist competence must have pedagogical capability inorder to inform and instruct not only patients and their next of kin, but also
other doctors and co-workers, as well as students.
Professional approach and ethics
Doctors with specialist competence must be capable of working continuously with their professional and medical ethical approaches, with the objective of being able to make independent decisions of a medical ethical nature.
Individual professional development
Doctors with specialist competence must be capable of continually examining and identifying their own needs for professional development, in addition to operational requirements, in order to be able to meet requirements forthe best possible patient care.

Leadership competence
Collaboration
Doctors with specialist competence must have a developed capability for
self-knowledge and an understanding of their own functions and roles in theorganisation.
Mentoring skills
Doctors with specialist competence must be able to mentor other doctors
and co-workers, as well as students.
Leadership
Doctors with specialist competence must be capable of leadership characterised by collaboration, openness and dialogue with co-workers. Leadershipmust further be characterised by participation and operational development
aimed at improvement. The ability to lead the work of the health care teamis essential.
System knowledge
Doctors with specialist competence must have an understanding of the organisation, administration, financial and regulatory systems of health care,
as well as its governance, in order to make the best use of resources.

Competence within medical science and quality work
Medical science
Doctors with specialist competence must be capable of adopting a medicallyscientific outlook and approach, and must have knowledge of researchmethodology including basic epidemiological concepts, as well as of methods for evidence-based medicine and review of scientific information.
Improvement and quality work
Doctors with specialist competence must have an understanding of, andcompetence in, evidence-based improvement and quality work. The objective is to be able to initiate, participate in and be responsible for continuous
systematic improvement work with emphasis on a holistic perspective, patient safety, patient benefit, measurability, and teaching management in order to be able to review and evaluate their own operations.
Public health and prevention
Doctors with specialist competence must have an understanding of the factors determining health, other aspects of public health, and methods forpromoting health and activities aimed at preventing injury and illness, inorder to be able to take this understanding into account in medical scientificwork.

Training structure
Training should be initiated with clinical service aimed at providing theoretical knowledge as well as training proficiencies in basic EEG, EMG andneurographical methods. ST doctors should participate in the treatment ofemergency examinations early on. ST doctors should also, on a continuous
basis, participate in rounds and clinical conferences and have the opportunity to lead such operations.
During the course of continued training, competence should be developed
so that ST doctors, at the end of their training period, have mastered themost common forms of neurophysiological examination methods. In addition, ST doctors must learn to master other neurophysiological examination
methods such as magnet stimulation and sleep registration. They must also
gain good levels of knowledge of brain reaction potential and methods of
examining the autonomous nervous system.

During the latter part of the training period, ST doctors should obtainknowledge of special neurophysiological activities such as epilepsy surgery
and intraoperative monitoring. It is also important that ST doctors gain
knowledge of other neurophysiological examination methods within radiology as well as nuclear medicine.
ST doctors should undertake simultaneous additional training throughservice in neurology, something that can advantageously be scheduled early
on in the training period. Additional in-service training is aimed at providing the knowledge and skills necessary to be able to plan and implement
relevant neurophysiological investigations, based on a referral. Consequently the emphasis should be placed on training the capability of carryingout and evaluating patient histories, and the neurological status of children
and adults, as well as providing improved competence within the neurological knowledge field. Additional in-service training or auscultation, primarily
within child and adolescent neurology but also within other areas of neurology, form valuable complements. The same can be said for additional inservice training at other neurophysiological units.
ST doctors should be given the opportunity, during the entire course of
their training, to pursue theoretical studies parallel with their practical training, and after the initial service period to acquire competence in communications and leadership as well as in medical science and quality work.

Special recommendations
The specialty associations and sections of the medical organisations haveformulated special recommendations for their own specialties. These recommendations concern such issues as how specialist medical training
should be structured.

Intermediate objectives

Medical science
Intermediate objective 1

Teaching methods

Follow-up

To have knowledge of the
anatomy, physiology and development of the nervous
systemClinical service under supervision in a unit that treatsthese conditions

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Seminar
Theoretical studies

Intermediate objective 2

Teaching methods

Follow-up

To have knowledge of illnesses
and injuries of the nervous
system, sensory organs and in
the muscles, as well as of underlying pathophysiologicalmechanisms

Clinical service under supervision in a unit that treatsthese conditions

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Seminar
Theoretical studies

Intermediate objective 3

Teaching methods

Follow-up

To have knowledge of theoretical neurophysiology and of
measuring techniques, electronics, signal analysis, digitaltechnology and network communications, to the relevant
degreeClinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Seminar
Theoretical studies

Intermediate objective 4

Teaching methods

Follow-up

To master the most common
examination methods withinclinical neurophysiology

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Sitting-in
Theoretical studies

Intermediate objective 5

Teaching methods

Follow-up

To be able to handle the application of the less-common
examination methods withinclinical neurophysiology

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Auscultation under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted course, issued bycourse leader

CourseTheoretical studies

Intermediate objective 6

Teaching methods

Follow-up

To gain knowledge of neurofunctional examination methods within other specialties

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Auscultation under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted course, issued bycourse leader

CourseSitting-in

Intermediate objective 7

Teaching methods

Follow-up

To be able to evaluate medical
conditions relevant to thisspecialty

Clinical service under supervision in a unit that treatsthese conditions

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Diagnostics and treatment
symposium
Sitting-in

Intermediate objective 8

Teaching methods

Follow-up

To master neurophysiologicalinvestigations based on various
issuesClinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Diagnostics and treatment
symposium
Sitting-in

Intermediate objective 9

Teaching methods

Follow-up

To be able to handle the prioritisation of patients and examinations based on medical
benefit and security plus degree of urgency

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Health care teamwork under
supervision
Diagnostics and treatment
symposiumIntermediate objective 10

Teaching methods

Follow-up

To be able to evaluate neurophysiological results in their
medical context and how theyaffect medical treatment

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Health care teamwork under
supervision
Diagnostics and treatment
symposium

Intermediate objective 11

Teaching methods

Follow-up

To be able to handle evaluation and testing of new methods in clinical neurophysiology praxis

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Written individual work under
supervision according toscientific principles

Certificate of approved written
individual work, issued bycurrent mentor

Quality and development
work under supervision

Certificate of approved qualityand development activities,
issued by current mentor

Large professional assemblyIntermediate objective 12

Teaching methods

Follow-up

To have knowledge of the limitations and risks of neurophysiological methods

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Seminar
Theoretical studies

Communicative competenceIntermediate objective 13

Teaching methods

Follow-up

To be capable of dialogue andmaintaining open contact withpatients and their next of kin

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

SeminarSitting-in

Intermediate objective 14

Teaching methods

Follow-up

To be capable of communication, both oral and written, withother doctors and co-workers

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Teaching under supervision
Large professional assembly
Diagnostics and treatment
symposiums

Intermediate objective 15

Teaching methods

Follow-up

To be capable of informing
and instructing patients, nextof kin, other doctors, and coworkers, as well as students

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Teaching under supervision
Health care teamwork under
supervision
Sitting-in

Leadership competenceIntermediate objective 16

Teaching methods

Follow-up

To be capable of mentoringother doctors and co-workers
as well as students

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Mentoring under supervisionIntermediate objective 17

Teaching methods

Follow-up

To be capable of leading using
collaboration and dialogue
with co-workers as well as
within the health care team

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Health care teamwork under
supervisionIntermediate objective 18

Teaching methods

Follow-up

To have an understanding of
the organisation, management
and regulatory systems ofhealth and medical care

CourseCertificate of successfullycompleted course, issued bycourse leader

Competence within medical science and quality
work
Intermediate objective 19

Teaching methods

Follow-up

To be capable of a medicallyscientific outlook and approach

Written individual work under
supervision according toscientific principles

Certificate of approved written
individual work, issued bycurrent mentor

Intermediate objective 20

Teaching methods

Follow-up

To develop an understandingof, and competence in, evidence-based improvement
and quality work

Quality and development work
under supervision

Certificate of successful completion of quality and development work, issued by current mentor

Intermediate objective 21

Teaching methods

Follow-up

To have an understanding ofresearch methods as well as
methods for evidence-based
medicine and review of scientific information

Written individual work under
supervision according toscientific principles

Certificate of approved written
individual work, issued bycurrent mentor

SeminarLarge professional assembly
Theoretical studies

Physiotherapy and rehabilitation

Introduction
Explanation of terms
General definition of competencies
Definition of area of competence
Competence requirements
Competence requirements for medical competence
Competence requirements for communicative competence, leadershipcompetence, and competence within medical science and quality work
Training structure
Special recommendations
Intermediate objectives
Medical competenceCommunicative competence
Leadership competence
Competence within medical science and quality work

Introduction

On June 24, 2008, the Board of Health and Welfare decided to issue new
regulations and general guidelines for doctors’ specialist medical training(SOSFS 2008:17). The statute consists of a general part with common provisions for all specialties and a specific part with all the descriptions of objectives. The description of objectives for the respective specialties should
be understood against the background of the provisions in the general part.
In each description of objectives, there is a section headed ‘Training structure’ which constitutes general guidelines. The teaching methods under theheading ‘Intermediate objectives’ where no follow-up is indicated also constitute general guidelines.

Explanation of terms

current mentor
a specialist doctor whose specialist competence corresponds to the area ofcompetence indicated by the intermediate objective, and who is responsible
for ST doctors’s professional development during the teaching period or forthe method of teaching indicatedthe assignment as a mentor for an ST doctor generally encompasses the entire period of specialist training but can also encompass part or parts of it
auscultation
during mentoring, and in accordance with a pre-designed programme, tostudy the profession of a specialist doctor or other health care staff by following one or several professionals, as well as carrying out assignments in
the relevant area to a certain extent
evaluate
to form a sound opinion of a patient or similar person as a basis for further
management
masterbeing fully able to evaluate and handle the medical investigation, diagnostics, treatment, and follow-up of a patient or similar person, and being fully
able to use the techniques relevant to the area
capability
personal capacity to execute or perform a task
h a ve u n d ers tan d i ng
having acquired knowledge and insight into an area through theoretical studies and/or practical exercise of the profession
have knowledge
having acquired some knowledge in an area through theoretical studies
and/or practical exercise of the profession
mentoring under supervision
as an ST doctor, mentor a co-worker while simultaneously being mentored
by a doctor with specialist competencementorcontinuously, and in dialogue form, supporting and guiding, as well as evaluating, a co-worker’s professional development
mentoringsee mentor
handleto actively carry out measures regarding investigation, diagnostics, treatment, and follow-up of a patient or similar person, and have overall responsibility for carrying out these measuresinitially handle
as the primary physician in charge, to actively carry out measures regarding
investigation, diagnostics, treatment, and follow-up of a patient or similar
person, and have overall responsibility for carrying out these measuresinitially evaluate
as the primary physician in charge, to form a sound opinion of a patient orsimilar person as a basis for further management
intraprofessional group reflection
reflection done in a group together with other doctors, chiefly for the purpose of further education and training
clinical service
health and medical care duties that ST doctors perform under their own professional liability and with the support of a mentor
courseteacher-led training with an established plan, given during a defined periodof timesitting-in
training activity involving an ST doctor observing when a specialist doctor
or other health care staff holds a consultationorassessment activity involving a specialist doctor or other health care staff
observing and evaluating ST doctors during a consultation
seminarinstruction in group form with active participation
training in a simulated environment
training carried out in an environment created to emulate reality

large professional assembly
conference, congress, symposium or similar event
health care centre
health care unit in primary carehealth care team work
work where ST doctors, under supervision, participates in and sometimes
leads a group of co-operating health care staff with various competencies
charged with responsibility for care for an individual patient or group ofpatients

General definition of competence

Definition of area of competence
The specialty of physiotherapy and rehabilitation encompasses in-depth
knowledge and skills in investigating patients with considerable functional
impairments and in leading, coordinating, and implementing qualified rehabilitation activities based on a bio-psycho-social approach. The point of departure for both investigation and rehabilitation measures is a holistic approach including an analysis of function, capabilities and participation, taking into consideration both personal factors and factors affecting the patient's surroundings. The general term rehabilitation stands for complex, upto-date, coordinated activities of the medical, psychological, pedagogicaland social type. The aim is to eliminate, reduce or compensate for serious
impairments to function and activity ability caused by illnesses and injuries.

Competence requirements
Competence requirements for medical science
For specialist competence in physiotherapy and rehabilitation it is essential
to master the rehabilitation of traumatic, vascular, and other injuries andillnesses within the central and peripheral nervous systems resulting in extensive functional impairment as a result, using the relevant knowledge ofanatomy, neurobiology and physiology as the point of departure. This includes long-term pain conditions. In addition knowledge concerning rehabilitation of functional impairments of the locomotory organs and chronic
neurological illnesses is necessary.
Specialist competence in physiotherapy and rehabilitation also requires
knowledge of the treatment of internal medical complications and conditions that may occur during rehabilitation, plus knowledge of adult habilitation. In addition it is necessary to master the psychological consequences ofthese illnesses for the patients and their next of kin, plus the effects of psychiatric illnesses on rehabilitation.
Special emphasis is to be placed on the interdisciplinary working methodthat characterises physiotherapy and rehabilitation, which includes knowledge of different professions and actors and their methods.

Competence requirements for communicative competence,leadership competence and competence within medical scienceand quality work

Communicative competence
The equal and responsible patient
Doctors with specialist competence must be capable of dialogue and of
maintaining open contact with patients and their next of kin. Contact should
be characterised by empathy and trust, as well as respect for patients’ rightto information, influence, and participation in decisions. Contact should also
be characterised by co-operation and sensitivity to the patients’ needs, desires and right to self-determination, as well as providing incentive for thepatients’ involvement in and responsibility for their own care.
Multicultural and gender aspects
Communication with patients and their next of kin should be characterisedby understanding and respect for cross-cultural and multicultural aspects
such as age, language, ethnicity, sexual orientation and religion, as well as
gender.
Interprofessional relations
Doctors with specialist competence must have the ability to communicate,both in writing and orally, with other doctors and co-workers showing respect for their professional knowledge and competences. The same applies
to contact with representatives of the public and various civil authorities.
Pedagogical skills
Doctors with specialist competence must have pedagogical capability inorder to inform and instruct not only patients and their next of kin, but also
other doctors and co-workers, as well as students. Professional approach andethics Doctors with specialist competence must be capable of working continuously with their professional and medical ethical approaches, with theobjective of being able to make independent decisions of a medical ethicalnature.
Individual professional development
Doctors with specialist competence must be capable of continually examining and identifying their own needs for professional development, in addition to operational requirements, in order to be able to meet requirements forthe best possible patient care.

Leadership competence
Collaboration
Doctors with specialist competence must have a developed capability for
self-knowledge and an understanding of their own functions and roles in theorganisation.

Mentoring skills
Doctors with specialist competence must be able to mentor other doctors
and co-workers, as well as students.
Leadership
Doctors with specialist competence must be capable of leadership characterised by collaboration, openness and dialogue with co-workers. Leadershipmust further be characterised by participation and operational development
aimed at improvement. The ability to lead the work of the health care teamis essential.
System knowledge
Doctors with specialist competence must have an understanding of the organisation, administration, financial and regulatory systems of health care,
as well as its governance, in order to make the best use of resources.

Competence within medical science and quality work
Medical science
Doctors with specialist competence must be capable of adopting a medicallyscientific outlook and approach, and must have knowledge of researchmethodology including basic epidemiological concepts, as well as of methods for evidence-based medicine and review of scientific information.
Improvement and quality work
Doctors with specialist competence must have an understanding of, andcompetence in, evidence-based improvement and quality work. The objective is to be able to initiate, participate in and be responsible for continuous
systematic improvement work with emphasis on a holistic perspective, patient safety, patient benefit, measurability, and teaching management in order to be able to review and evaluate their own operations.
Public health and prevention
Doctors with specialist competence must have an understanding of the factors determining health, other aspects of public health, and methods forpromoting health and activities aimed at preventing injury and illness, inorder to be able to take this understanding into account in medical scientificwork.

Training structure
ST doctors in physiotherapy and rehabilitation should initially be trained ininterdisciplinary team work in a specialised rehabilitation unit. The objective is that ST doctors will eventually be able to lead their teams in theevaluation, prioritisation and planning of rehabilitation activities. This also
includes training in the keeping of documentation and also in various forms

of contacts with other rehabilitation partners inside and outside the medicalcare system.
When basic knowledge of the primary areas in the specialty of neurological and pain rehabilitation has been acquired, it is suitable that the ST doctors begin their in-service training through clinical service primarily withininternal medical, psychiatric and neurological operations. Suitable areas forother service or auscultation could include adult habilitation, orthopaedics,
rheumatology, neurophysiology, neurosurgery plus occupational and environmental medicine. Specialist training should be concluded with a period
in which the ST doctors are given the opportunity to independently lead arehabilitation team. It is important that ST doctors are given the opportunity
to participate in course within the primary areas of the specialty as an integrated element of their specialist medical training. In addition, ST doctors
should participate in further training both internally at the clinics and externally throughout their entire period of specialist training, as well as being
allocated time for knowledge acquisition and in-depth study of the literature.
In consultation with their mentors, ST doctors should also carry out an independent development or exploration project, as well as being afforded theopportunity to instruct patients and their next of kin, as well as co-workers,
under supervision.

Special recommendations
The specialty associations and sections of the medical organisations haveformulated special recommendations for their own specialties. These recommendations concern such issues as how specialist medical training
should be structured.

Intermediate objectives

Medical science
Intermediate objective 1

Teaching methods

Follow-up

To master anatomy, neurobiology, and neurophysiology as atheoretical foundation for clinical evaluation and handling

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

orlarge professional assembly
Theoretical studies

Intermediate objective 2

Teaching methods

Follow-up

To master the investigation offunction, capabilities, andparticipation and to be able toevaluate rehabilitation potential, prioritise activities andformulate a rehabilitation plan,
based on these assessments

Clinical service under supervision in a unit that handles
these issues

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Health care team work under
supervision
Theoretical studies

Intermediate objective 3

Teaching methods

Follow-up

To have knowledge of themethods of investigation andrehabilitation used by all the
professions in the interdisciplinary rehabilitation team

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Health care teamwork under
supervision
Sitting-in
Theoretical studies

Intermediate objective 4

Teaching methods

Follow-up

To have knowledge of how
psychological factors andpsychiatric illnesses affect therehabilitation process and on
how these conditions can betreatedClinical service under supervision in a unit that treatsthese conditions

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Seminar
Theoretical studies

Intermediate objective 5

Teaching methods

Follow-up

To have knowledge aboutother rehabilitation partners
both inside and outside themedical and health care systems and to collaborate withthem

Clinical service under supervision in a unit that treats these
conditions

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Diagnostics and treatment
symposiums
Theoretical studies

Intermediate objective 6

Teaching methods

Follow-up

To master rehabilitation ofbrain damage in a patient

Clinical service under supervision in a unit that treatsthese conditions

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Course Health care teamwork under supervision

Certificate of successfullycompleted course, issued bycourse leader

Theoretical studies

Intermediate objective 7

Teaching methods

Follow-up

To master rehabilitation of
spinal cord injuries

Clinical service under supervision in a unit that treatsthese conditions

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Health care team work under
supervision
Theoretical studies

Intermediate objective 8

Teaching methods

Follow-up

To be able to handle rehabilitation of peripheral nerve
damage and chronic neurological conditions

Clinical service under supervision in a unit that treatsthese conditions

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Health care team work under
supervision
Theoretical studies

Intermediate objective 9

Teaching methods

Follow-up

To master rehabilitation ofpatients suffering from longterm pain

Clinical service under supervision in a unit that treatsthese conditions

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Health care team work under
supervision
Diagnostics and treatment
symposium
Theoretical studies

Intermediate objective 10

Teaching methods

Follow-up

To be able to handle rehabilitation of injuries and illnesses
in locomotor and support organs

Clinical service under supervision in a unit that treatsthese conditions

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

alternativelyorauscultation under supervision at a unit that treats these
conditions

CourseTheoretical studies

certificate of approved auscultation and competenceachieved, issued by current
mentorCertificate of successfullycompleted course, issued bycourse leader

Intermediate objective 11

Teaching methods

Follow-up

To be able to handle rehabilitation

Clinical service under supervision in a unit that treats these
conditions

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor or certificate of approved auscultationand competence achieved,
issued by current mentor

alternatively
auscultation under supervision
at a unit that treats these conditions
Sitting-in
Theoretical studies

Intermediate objective 12

Teaching methods

Follow-up

To be able to handle internal
medical conditions in connection with rehabilitation

Clinical service under supervision in a unit that treatsthese conditions

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Theoretical studies

Communicative competenceIntermediate objective 13

Teaching methods

Follow-up

To be capable of dialogue andmaintaining open contact withpatients and their next of kin

Clinical service under supervision in a unit where suchoperations are practised

Certificate of approved clinicalservice and competence issued by current mentor

Sitting-in

Intermediate objective 14

Teaching methods

Follow-up

To be capable of communication, both oral and written, withother doctors and co-workers

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Diagnostics and treatment
symposiums
Sitting-in

Intermediate objective 15

Teaching methods

Follow-up

To be capable of informing
and instructing patients, nextof kin, other doctors, and coworkers, as well as students

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Teaching under supervision

Leadership competenceIntermediate objective 16

Teaching methods

Follow-up

To be capable of mentoringother doctors and co-workers
as well as students

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Mentoring under supervision
Sitting-in

Intermediate objective 17

Teaching methods

Follow-up

To be capable of leading using
collaboration and dialogue
with co-workers as well as
within the health care team

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Sitting-in
Theoretical studies

Intermediate objective 18

Teaching methods

Follow-up

To have an understanding of
the organisation, management
and regulatory systems ofhealth and medical care

CourseCertificate of successfullycompleted course, issued bycourse leader

Theoretical studies

Competence within medical science and quality
work
Intermediate objective 19

Teaching methods

Follow-up

To be capable of a medicallyscientific outlook and approach

Written individual work under
supervision according toscientific principles

Certificate of approved written
individual work issued bycurrent mentor

Theoretical studies

Intermediate objective 20

Teaching methods

Follow-up

To develop an understandingof, and competence in, evidence-based improvement
and quality work

Quality and development work
under supervision

Certificate of successful completion of quality and development work, issued by current mentor

Seminar
Theoretical studies

Separate base specialties

Family medicine
Introduction
Explanation of terms
General definition of competencies
Definition of area of competence
Competence requirements
Competence requirements for medical competence
Competence requirements for communicative competence, leadershipcompetence, and competence within medical science and quality work
Training structure
Special recommendations
Intermediate objectives
Medical competenceCommunicative competence
Leadership competence
Competence within medical science and quality work

Introduction

On June 24, 2008, The National Board of Health and Welfare (Socialstyrelsen) decided to issue new regulations and general guidelines for doctors’
specialist medical training (SOSFS 2008:17). The statute consists of a general part with common provisions for all specialties and a specific part withall the descriptions of objectives. The description of objectives for the respective specialties should be understood against the background of the provisions in the general part.
In each description of objectives, there is a section headed ‘Training
structure’ which constitutes general guidelines. The teaching methods under
the heading ‘Intermediate objectives’ where no follow-up is indicated also
constitute general guidelines.

Explanation of terms

current mentor
a specialist doctor whose specialist competence corresponds to the area ofcompetence indicated by the intermediate objective, and who is responsible
for ST doctors’s professional development during the teaching period or forthe method of teaching indicatedthe assignment as a mentor for an ST doctor generally encompasses the entire period of specialist training but can also encompass part or parts of it
auscultation
during mentoring, and in accordance with a pre-designed programme, tostudy the profession of a specialist doctor or other health care staff by following one or several professionals, as well as carrying out assignments in
the relevant area to a certain extent
evaluate
to form a sound opinion of a patient or similar person as a basis for further
management
masterbeing fully able to evaluate and handle the medical investigation, diagnostics, treatment, and follow-up of a patient or similar person, and being fully
able to use the techniques relevant to the area
capability
personal capacity to execute or perform a task
h a ve u n d ers tan d i ng
having acquired knowledge and insight into an area through theoretical studies and/or practical exercise of the profession
have knowledge
having acquired some knowledge in an area through theoretical studies
and/or practical exercise of the profession
mentoring under supervision
as an ST doctor, mentor a co-worker while simultaneously being mentored
by a doctor with specialist competencementorcontinuously, and in dialogue form, supporting and guiding, as well as evaluating, a co-worker’s professional development
mentoringsee mentor
handleto actively carry out measures regarding investigation, diagnostics, treatment, and follow-up of a patient or similar person, and have overall responsibility for carrying out these measuresinitially handle
as the primary physician in charge, to actively carry out measures regarding
investigation, diagnostics, treatment, and follow-up of a patient or similar
person, and have overall responsibility for carrying out these measuresinitially evaluate
as the primary physician in charge, to form a sound opinion of a patient orsimilar person as a basis for further management
intraprofessional group reflection
reflection done in a group together with other doctors, chiefly for the purpose of further education and training
clinical service
health and medical care duties that ST doctors perform under their own professional liability and with the support of a mentor
courseteacher-led training with an established plan, given during a defined periodof timesitting-in
training activity involving an ST doctor observing when a specialist doctor
or other health care staff holds a consultationorassessment activity involving a specialist doctor or other health care staff
observing and evaluating ST doctors during a consultation
seminarinstruction in group form with active participation
training in a simulated environment
training carried out in an environment created to emulate reality

large professional assembly
conference, congress, symposium or similar event
health care centre
health care unit in primary carehealth care team work
work where ST doctors, under supervision, participates in and sometimes
leads a group of co-operating health care staff with various competencies
charged with responsibility for care for an individual patient or group ofpatients

General definition of competence

Definition of area of competence
Family medicine is a medical specialty that emphasizes interaction withpatients. The specialty involves the ability to meet people of all ages with all
kinds of health-related problems, and independently to evaluate and treat
them, including experiences and complaints not caused by a definable illness.
The practice of family medicine also requires the ability to follow thevarious health problems of an individual over a long period of time, and theconsequent ability to consider his or her overall life situation when evaluating these health problems.

Competence requirements
Competence requirements for medical competenceSpecialist competence in family medicine requires knowledge and skills
within the entire area of competence of general medicine, focusing on individuals and illnesses, as well as an awareness of ethical issues. Further requirements include being capable of a holistic view – being able to consider
the patient’s overall situation in medical assessments and treatment – andbeing capable of working with continuity – that is, being able to follow andevaluate changes to an individual’s state of health over an extended periodof time.
Capability in prioritising based on the degree of medical urgency and being able to collaborate with other entities within health care, as well as being
able to switch between short emergency visits, longer consultations, andhouse calls are all essential for specialist competence.
Specialist competence in general medicine further requires knowledge ofdiagnostics and treatment of health-related complaints in people of all ages,
knowledge of basic paediatric and maternity care, knowledge of preventive
and rehabilitation measures, and mastering the types of public authority assignments that occur in general medical practice.
Specialist competence in family medicine also requires being able to continuously evaluate one’s own expertise, and to supplement and develop it
based on the result.

Competence requirements for communicative competence,leadership competence, and competence within medical science and quality work
Communicative competence
The equal and responsible patient
Doctors with specialist competence must be capable of dialogue and of
maintaining open contact with patients and their next of kin. Contact must
be characterised by empathy and trust, as well as respect for patients’ rightto information, influence, and participation in decisions. Contact should also
be characterised by co-operation and sensitivity to the patients’ needs, desires and right to self-determination, as well as providing incentive for patients’ involvement in, and responsibility for, their own care.
Multicultural and gender aspects
Communication with patients and their next of kin should be characterisedby understanding and respect for cross-cultural and multicultural aspects
such as age, language, ethnicity, sexual orientation and religion, as well as
gender.
Intraprofessional relations
Doctors with specialist competence must be capable of communicating,both in writing and orally, with other doctors and co-workers showing respect for their professional knowledge and competences. The same applies
to contact with representatives of the public and various civil authorities.
Pedagogical skills
Doctors with specialist competence must have pedagogical capability inorder to inform and instruct not only patients and their next of kin, but also
other doctors and co-workers, as well as students.
Professional approach and ethics
Doctors with specialist competence must be capable of working continuously with their professional and medical ethical approaches, with the objective of being able to make independent decisions of a medical ethical nature.
Individual professional development
Doctors with specialist competence must be capable of continually examining and identifying their own needs for professional development, in addition to operational requirements, in order to be able to meet requirements forthe best possible patient care.

Leadership competence
Collaboration
Doctors with specialist competence must have a developed capability for
self-knowledge and an understanding of their own functions and roles in theorganisation.
Mentoring skills
Doctors with specialist competence must be capable of mentoring other doctors and co-workers, as well as students.
Leadership
Doctors with specialist competence must be capable of leadership characterised by collaboration, openness, and dialogue with co-workers. Leadershipmust further be characterised by participation and activity development
aimed at improvement. The ability to lead the work of the health care teamis essential.
System knowledge
Doctors with specialist competence must have an understanding of the organisation, administration, finances, and regulatory systems of health care,
as well as its governance, in order to make the best use of resources.

Competence within medical science and quality work
Medical science
Doctors with specialist competence must be capable of adopting a medicallyscientific outlook and approach, and must have knowledge of researchmethodology, including basic epidemiological concepts, as well as of methods for evidence-based medicine and review of scientific information.
Improvement and quality work
Doctors with specialist competence must have understanding of, and competence in, evidence-based improvement and quality work. The objective is
to be able to initiate, participate in, and be responsible for continuous systematic improvement work with emphasis on a holistic perspective, patient
safety, patient benefit, measurability, and teaching management in order tobe able to critically review and evaluate their own operations.
Public health and prevention
Doctors with specialist competence must have an understanding of the factors determining health, other aspects of public health, and methods forpromoting health and efforts aimed at preventing injury and illness, in order
to be able to take this understanding into account in medical scientific work.

Training structure
Specialist training is intended to provide a common qualification for all
family medical practitioners, which can later be supplemented depending on
the circumstances of the work to carried out.
Most of the expertise necessary for specialist competence in family medicine should be acquired at a local health care centre. It is therefore of theutmost importance that the training begin with extended, continuous service
at the care centre where the training is principally to be held. Training inemergency medicine should be held early on in specialist medical training.
In order for ST doctors to gain experience of the continuity of the doctorpatient relationship, which is a cornerstone of competence in family medicine, a long, continuous period of clinical service at the training care centre
is required, as well as the possibility of regular contact with that centre during periods of service in other units. At the same time, it is important to gain
experience of different ways of working in family medicine. This is best
achieved by supplementing the main clinical service with shorter periods ofservice, auscultations or study visits to other medical care centres, within or
outside of the country. Clinical service at a care centre is to be supplemented
with other service, as necessary.
The opportunity for feedback and training which occurs in most specialties, for example in the form of participation in various types of medicalrounds, is usually not present in family medical practice, as this is most often carried out in private with the patient. To achieve specialist competence
in general medicine, intraprofessional discussion and reflection is therefore
necessary, for instance in FQ groups – a special form of regularly recurringcollegial training and quality development – or in special seminars for ST
doctors. Balint groups are another example of a method for such professional development.
In order for ST doctors to achieve satisfactory communicative competence, it is of the utmost importance that recurring mutual sitting-in is carried out, as that way they get the chance to see how an experienced colleague - preferably the mentor - deals with patients, as well as the opportunity of being seen in their own work with patients.

Special recommendations
The specialty associations and sections of the medical organisations haveformulated special recommendations for their own specialties. The recommendations concern such issues as how specialist medical training should be
structured.

Intermediate objectives

Medical competenceIntermediate objective 1

Teaching methods

Follow-up

To master evaluating andmanaging health problems
that occur in Sweden, basedon a professional and ethicalapproach

Clinical service under supervision at a medical care centre

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Clinical service under supervision in a unit where such operations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Intraprofessional group reflection
Theoretical studies

Intermediate objective 2

Teaching methods

Follow-up

To master determining thedegree of medical urgency
and prioritising among thoseseeking care in an ethicallysatisfactory way

Clinical service under supervision in a health care centre

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Clinical service under supervision in a unit where such operations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Intraprofessional group reflection
Theoretical studies

Intermediate objective 3

Teaching methods

Follow-up

To master following a patient
over an extended period oftime, taking the patient’s
whole life situation into consideration, and when meetingthe patient, to be capable oftaking his or her perceptions,
expectations, and fears into
account

Clinical service under supervision in a health care centre

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Intraprofessional group reflection

Intermediate objective 4

Teaching methods

Follow-up

To master diagnosing, treating, and following patients of
all ages with health problems
and common widespreaddiseasesClinical service under supervision in a health care centre

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Intraprofessional group reflection
Theoretical studies

Intermediate objective 5

Teaching methods

Follow-up

To master initially evaluating,referring, and following individuals with medical conditions requiring care beyond
the capacities of ST doctors’s
own unit

Clinical service under supervision in a health care centre

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Clinical service under supervision in a unit where such operations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Intraprofessional group reflection
Theoretical studies

Intermediate objective 6

Teaching methods

Follow-up

To master practising healthcare for children and youth

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Theoretical studies

Intermediate objective 7

Teaching methods

Follow-up

To master commonly occurring
gynaecological complaints andillnesses in women of various
ages, and in maternity care fornormal pregnancies

Clinical service under supervision in a health care centre

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Clinical service at a unit
where such operations arepractised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Theoretical studies

Intermediate objective 8

Teaching methods

Follow-up

To master the special healthproblems of elderly people,
and to master home care andpalliative care in the final
stages of life for people of all
ages

Clinical service under supervision in a health care centre

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Clinical service at a unit wheresuch operations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Intraprofessional group reflection
Theoretical studies

Intermediate objective 9

Teaching methods

Follow-up

To master house calls as an
instrument of diagnostics andtreatment, and in order togain a complete picture of apatient’s situation

Clinical service under supervision in a health care centre

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Intraprofessional group reflection

Intermediate objective 10

Teaching methods

Follow-up

To master initiating and participating in medical rehabilitation and occupational rehabilitation, in collaboration withother social resources

Clinical service under supervision in a health care centre

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Intraprofessional group reflection
Theoretical studies

Intermediate objective 11

Teaching methods

Follow-up

To master the public authority
assignments that are included
in general medical practice,including the prevention andcontrol of infection

Clinical service under supervision in a health care centre

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Intraprofessional group reflection
Theoretical studies

Intermediate objective 12

Teaching methods

Follow-up

To have an understanding of
how to discover, identify andprevent injuries and other
health problems in the local
community

Clinical service under supervision in a health care centre

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

Intraprofessional group reflection
Theoretical studies

Communicative competenceIntermediate objective 13

Teaching methods

Follow-up

To be capable of maintaining
dialogue and open contact
with patients and their next ofkin, and to be capable ofcommunication, both written
and oral, with other doctors
and co-workers, representatives of the general public andof various civil authorities

Clinical service under supervision at a medical care centre

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Sitting-in
Intraprofessional group reflection

Intermediate objective 14

Teaching methods

Follow-up

To be capable of informing
and instructing in a pedagogic
mannerClinical service under supervision in a health care centre

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Instruction under supervision
Intraprofessional group reflection
Theoretical studies

Intermediate objective 15

Teaching methods

Follow-up

To be capable of continually
examining and identifying
one’s own needs for professional development, together
with operational requirements

Clinical service under supervision in a health care centre

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Intraprofessional group reflection

Leadership competenceIntermediate objective 16

Teaching methods

Follow-up

To be capable of mentoringother doctors and co-workers,
as well as students

Clinical service under supervision at a medical care centre

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Mentoring under supervisionIntermediate objective 17

Teaching methods

Follow-up

To be capable of selfawareness and have an understanding of one’s ownfunction and role in the organisation, and to be capable ofleadership

Clinical service under supervision in a health care centre

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Intraprofessional group reflection

Intermediate objective 18

Teaching methods

Follow-up

To have an understanding of
the organisation, administration, finances, and regulatory
systems of health care, as
well as its governance, inorder to make the best use ofresources

CourseCertificate of successfullycompleted course, issued bycourse leader

Intraprofessional group reflection
Theoretical studies

Competence within medical science and quality
work
Intermediate objective 19

Teaching methods

Follow-up

To be capable of a medical
scientific outlook and approach

Written individual work under
supervision according to scientific principles

Certificate of approved written
individual work, issued bycurrent mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Intraprofessional group reflection
Theoretical studies

Intermediate objective 20

Teaching methods

Follow-up

To have an understanding of,and competence in, evidencebased improvement and quality work

Quality and development work
under supervision

Certificate of quality and development work, issued bycurrent mentor

Intraprofessional group reflection
Theoretical studies

Intermediate objective 21

Teaching methods

To have an understanding of
the factors determining health,other aspects of public health,and methods for promoting
health and efforts aimed atpreventing injury and illness, inorder to be able to take thisunderstanding into account inmedical scientific work

Intraprofessional group reflection
Theoretical studies

Follow-up

Oncology

Introduction
Explanation of terms
General definition of competencies
Definition of area of competence
Competence requirements
Competence requirements for medical competence
Competence requirements for communicative competence, leadershipcompetence, and competence within medical science and quality work
Training structure
Special recommendations
Intermediate objectives
Medical competenceCommunicative competence
Leadership competence
Competence within medical science and quality work

Introduction

On June 24, 2008, The National Board of Health and Welfare (Socialstyrelsen) decided to issue new regulations and general guidelines for doctors’
specialist medical training (SOSFS 2008:17). The statute consists of a general part with common provisions for all specialties and a specific part withall the descriptions of objectives. The description of objectives for the respective specialties should be understood against the background of the provisions in the general part.
In each description of objectives, there is a section headed ‘Training
structure’ which constitutes general guidelines. The teaching methods under
the heading ‘Intermediate objectives’ where no follow-up is indicated also
constitute general guidelines.

Explanation of terms

current mentor
a specialist doctor whose specialist competence corresponds to the area ofcompetence indicated by the intermediate objective, and who is responsible
for ST doctors’s professional development during the teaching period or forthe method of teaching indicatedthe assignment as a mentor for an ST doctor generally encompasses the entire period of specialist training but can also encompass part or parts of it
auscultation
during mentoring, and in accordance with a pre-designed programme, tostudy the profession of a specialist doctor or other health care staff by following one or several professionals, as well as carrying out assignments in
the relevant area to a certain extent
evaluate
to form a sound opinion of a patient or similar person as a basis for further
management
masterbeing fully able to evaluate and handle the medical investigation, diagnostics, treatment, and follow-up of a patient or similar person, and being fully
able to use the techniques relevant to the area
capability
personal capacity to execute or perform a task
h a ve u n d ers tan d i ng
having acquired knowledge and insight into an area through theoretical studies and/or practical exercise of the profession
have knowledge
having acquired some knowledge in an area through theoretical studies
and/or practical exercise of the profession
mentoring under supervision
as an ST doctor, mentor a co-worker while simultaneously being mentored
by a doctor with specialist competencementorcontinuously, and in dialogue form, supporting and guiding, as well as evaluating, a co-worker’s professional development
mentoringsee mentor
handleto actively carry out measures regarding investigation, diagnostics, treatment, and follow-up of a patient or similar person, and have overall responsibility for carrying out these measuresinitially handle
as the primary physician in charge, to actively carry out measures regarding
investigation, diagnostics, treatment, and follow-up of a patient or similar
person, and have overall responsibility for carrying out these measuresinitially evaluate
as the primary physician in charge, to form a sound opinion of a patient orsimilar person as a basis for further management
intraprofessional group reflection
reflection done in a group together with other doctors, chiefly for the purpose of further education and training
clinical service
health and medical care duties that ST doctors perform under their own professional liability and with the support of a mentor
courseteacher-led training with an established plan, given during a defined periodof timesitting-in
training activity involving an ST doctor observing when a specialist doctor
or other health care staff holds a consultationorassessment activity involving a specialist doctor or other health care staff
observing and evaluating ST doctors during a consultation
seminarinstruction in group form with active participation
training in a simulated environment
training carried out in an environment created to emulate reality

large professional assembly
conference, congress, symposium or similar event
health care centre
health care unit in primary carehealth care team work
work where ST doctors, under supervision, participates in and sometimes
leads a group of co-operating health care staff with various competencies
charged with responsibility for care for an individual patient or group ofpatients

General definition of competence

Definition of area of competence
The specialty of oncology involves in-depth knowledge of the managementof patients with cancer including lymphoma, as well as general knowledgeof haematologic and gynaecological malignancies. This requires an overall
view of the problems of oncology, which includes knowledge of epidemiology, tumour biology, prevention, targeted health controls, tumour diagnostics, medical and radiotherapeutic treatment, follow-up and management ofside effects of the illness and treatment, rehabilitation, psychosocial care andpalliative measures as well as care during the final stages of life. The area ofcompetence incorporates a multidisciplinary work approach.
Oncology is the base specialty of the branch specialty gynaecological oncology.

Competence requirements
Competence requirements for medical competenceSpecialist competence in oncology requires fundamental theoretical knowledge of epidemiology, aetiology, tumour biology, genetics, diagnostic
methods, basic radiation physics and radiation biology, as well as oncological pharmacology. Mastering medical oncological treatment methods andradiotherapy is a further requirement. The qualified specialist must also beable to manage acute and chronic complications, and master care during thefinal stages of life based on a holistic view of the patient (intermediate objectives 1-7).
Specialist competence in oncology further requires being able to independently investigate, treat, and follow up patients with common forms ofcancer in the curative and palliative phases, as well as being able to initiallyhandle unusual forms of cancer. Additionally, knowledge of the side effectsof illness and treatment is required. The ability to initially evaluate gynaecological and haematological malignancies is also a requirement, as is having
knowledge of nuclear medicine treatments.

Competence requirements for communicative competence,leadership competence, and competence within medical science and quality work

Communicative competence
The equal and responsible patient
Doctors with specialist competence must be capable of dialogue and of
maintaining open contact with patients and their next of kin. Contact must
be characterised by empathy and trust, as well as respect for patients’ rightto information, influence, and participation in decisions. Contact should also
be characterised by co-operation and sensitivity to the patients’ needs, desires and right to self-determination, as well as providing incentive for patients’ involvement in, and responsibility for, their own care.
Multicultural and gender aspects
Communication with patients and their next of kin should be characterisedby understanding and respect for cross-cultural and multicultural aspects
such as age, language, ethnicity, sexual orientation and religion, as well as
gender.
Interprofessional relations
Doctors with specialist competence must be capable of communicating,both in writing and orally, with other doctors and co-workers showing respect for their professional knowledge and competences. The same applies
to contact with representatives of the public and various civil authorities.
Pedagogical skills
Doctors with specialist competence must have pedagogical capability inorder to inform and instruct not only patients and their next of kin, but also
other doctors and co-workers, as well as students.
Professional approach and ethics
Doctors with specialist competence must be capable of working continuously with their professional and medical ethical approaches, with the objective of being able to make independent decisions of a medical ethical nature.
Individual professional development
Doctors with specialist competence must be capable of continually examining and identifying their own needs for professional development, in addition to operational requirements, in order to be able to meet requirements forthe best possible patient care.

Leadership competence
Collaboration
Doctors with specialist competence must have a developed capability for
self-knowledge and an understanding of their own functions and roles in theorganisation.

Mentoring skills
Doctors with specialist competence must be capable of mentoring other doctors and co-workers, as well as students.
Leadership
Doctors with specialist competence must be capable of leadership characterised by collaboration, openness, and dialogue with co-workers. Leadershipmust further be characterised by participation and activity development
aimed at improvement. The ability to lead the work of the health care teamis essential.
System knowledge
Doctors with specialist competence must have an understanding of the organisation, administration, finances, and regulatory systems of health care,
as well as its governance, in order to make the best use of resources.

Competence within medical science and quality work
Medical science
Doctors with specialist competence must be capable of adopting a medicallyscientific outlook and approach, and must have knowledge of researchmethodology, including basic epidemiological concepts, as well as of methods for evidence-based medicine and review of scientific information.
Improvement and quality work
Doctors with specialist competence must have understanding of, and competence in, evidence-based improvement and quality work. The objective is
to be able to initiate, participate in, and be responsible for continuous systematic improvement work with emphasis on a holistic perspective, patient
safety, patient benefit, measurability, and teaching management in order tobe able to critically review and evaluate their own operations.
Public health and prevention
Doctors with specialist competence must have an understanding of the factors determining health, other aspects of public health, and methods forpromoting health and efforts aimed at preventing injury and illness, in order
to be able to take this understanding into account in medical scientific work.

Training structure
An uninterrupted period spent in inpatient oncological care should comeearly on in the training programme, to give ST doctors a comprehensive
picture of the panorama of cancer and of the complications of the conditions
as well as their treatment. In order to benefit from the specialist training in
the best possible way, ST doctors should receive an early introduction tomedical oncological treatment and radiotherapy. Courses in pain management and palliative medicine should also be included during this period.
In the following stage, the service should take place at units treating the
major forms of cancer. Courses in chemotherapy and other pharmacologicaloncological treatment should be included at this stage, as well as tumourspecific courses.
Radiation treatment is one of the cornerstones of oncological treatment.
Training in radiation treatment should ideally occur during the middle of the
training programme. It should take the form of an extended and uninterrupted placement at a radiation treatment unit. This period should include
courses in radiation physics, radiation biology and radiation treatment.
During later stages of the training programme, ST doctors should beplaced at units treating less common tumour forms.
Simultaneous additional training through service is particularly important
within units that handle gynaecological cancers, and should ideally be held
during the first half of the training programme with a view to commonlyoccurring haematological diseases and joint emergency duty. Other appropriate simultaneous additional training could be in one or more of the following: pain unit and palliative unit, pathology and cytology, radiology diagnostics, infectious diseases, and an organ-specific medical or surgical
specialty.
Generally speaking it is important to try to achieve the most coherent
placements possible. Communicative competence, leadership competence
and competence within medical science and quality work should be initiatedearly on and should continue to feature as a natural and integrated element
throughout the training.

Special recommendations
The specialty associations and sections of the medical organisations haveformulated special recommendations for their own specialties. The recommendations concern such issues as how specialist medical training should be
structured.

Intermediate objectives

Medical competenceIntermediate objective 1

Teaching methods

Follow-up

To master the principles ofchemotherapy and other formsof medical treatment of cancer

Clinical service under supervision in a unit that handles
these conditions

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Theoretical studies

Intermediate objective 2

Teaching methods

Follow-up

To master external radiation
treatment for common cancers, and to have an understanding of the physical andbiological principles of radiation treatment

Clinical service under supervision in a unit that handles
these conditions

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Theoretical studies

Intermediate objective 3

Teaching methods

Follow-up

To have knowledge of otherradiation treatment modalities
and techniques, as well as
their theoretical foundations

Clinical service under supervision at a unit that handles
these conditions

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

ororauscultation under supervision at a unit that handles
these conditions

Theoretical studies

certificate of successfullycompleted auscultation andcompetence achieved, issued
by current mentor

Intermediate objective 4

Teaching methods

Follow-up

To be able to handle acuteoncological conditions, common complications of cancer,
and to be able to manage
acute side effects of treatment

Clinical service under supervision in a unit that handles
these conditions

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Theoretical studies

Intermediate objective 5

Teaching methods

Follow-up

To master diagnostics and the
medical treatment of pain andother symptoms related tocancer, in the curative and thepalliative phases

Clinical service under supervision in a unit that handles
these conditions

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Theoretical studies

Intermediate objective 6

Teaching methods

Follow-up

To have an understanding ofclinically relevant tumour biology, carcinogenesis and genetics

Clinical service under supervision in a unit that handles
these conditions

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Theoretical studies

Intermediate objective 7

Teaching methods

Follow-up

To have an understanding of
diagnostic methods including
pathology, cytology and radiology diagnostics for investigation, diagnostics and follow-up
of cancer

Clinical service under supervision in a unit that handles
these conditions

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Diagnostics and treatment
conference
Theoretical studies

Intermediate objective 8

Teaching methods

Follow-up

To master the investigationand diagnostics of cancer tohave an understanding of its
aetiology and epidemiology
and to master the principles of
prevention and screening

Clinical service under supervision in a unit that handles
these conditions

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Theoretical studies

Intermediate objective 9

Teaching methods

Follow-up

To master managing patientswith common cancers, and theability to initially manage othercancers, in the curative andthe palliative phases

Clinical service under supervision at a unit that handles
these conditions

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Large professional assembly
Diagnostics and treatment
conference
Theoretical studies

Intermediate objective 10

Teaching methods

Follow-up

To be able to manage thefollow-up of patients treatedfor cancer, after-effects oftreatment, and initial rehabilitation

Clinical service under supervision in a unit that handles
these conditions

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Theoretical studies

Intermediate objective 11

Teaching methods

Follow-up

To have an understanding of,and to be able to initially evaluate, gynaecological andhaematologic malignancies,
including common complications associated with them

Clinical service under supervision in a unit that handles
these conditions

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Intermediate objective 12

Teaching methods

Follow-up

To have knowledge of techniques of nuclear medicine
and their application

Clinical service under supervision in a unit that handles
these conditions

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Theoretical studies

Theoretical studies

Communicative competenceIntermediate objective 13

Teaching methods

Follow-up

To be capable of communication, both oral and written, withpatients and their next of kin,
as well as with other doctors
and co-workers

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

SeminarIntermediate objective 14

Teaching methods

Follow-up

To be capable of informing
and instructing patients, nextof kin, other doctors, and coworkers, as well as students

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Instruction under supervisionIntermediate objective 15

Teaching methods

To be capable of professional
development based on one’s
own requirements as well as
those of the operation

Seminar

Follow-up

Large professional assembly
Theoretical studies

Leadership competenceIntermediate objective 16

Teaching methods

Follow-up

To be capable of mentoringother doctors and co-workers,
as well as students

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Mentoring under supervision

Intermediate objective 17

Teaching methods

Follow-up

To be capable of leading using
collaboration and dialogue
with co-workers as well as
within the health care team

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Intermediate objective 18

Teaching methods

Follow-up

To have an understanding of
the organisation, management,
and regulatory systems ofhealth care

CourseCertificate of successfullycompleted course, issued bycourse leader

Competence within medical science and quality
work
Intermediate objective 19

Teaching methods

Follow-up

To be capable of a medicallyscientific outlook and approach

Written individual work under
supervision according toscientific principles

Certificate of approved written
individual work, issued bycurrent mentor

Intermediate objective 20

Teaching methods

Follow-up

To have an understanding of,and competence in, evidencebased improvement and quality work

Quality and development work
under supervision

Certificate of quality and development work, issued bycurrent mentor

Gynaecological oncology

Introduction
Explanation of terms
General definition of competencies
Definition of area of competence
Competence requirements
Competence requirements for medical competence
Competence requirements for communicative competence, leadershipcompetence, and competence within medical science and quality work
Training structure
Special recommendations
Intermediate objectives
Medical competenceCommunicative competence
Leadership competence
Competence within medical science and quality work

Introduction

On June 24, 2008, The National Board of Health and Welfare (Socialstyrelsen) decided to issue new regulations and general guidelines for doctors’
specialist medical training (SOSFS 2008:17). The statute consists of a general part with common provisions for all specialties and a specific part withall the descriptions of objectives. The description of objectives for the respective specialties should be understood against the background of the provisions in the general part.
In each description of objectives, there is a section headed ‘Training
structure’ which constitutes general guidelines. The teaching methods under
the heading ‘Intermediate objectives’ where no follow-up is indicated also
constitute general guidelines.

Explanation of terms

current mentor
a specialist doctor whose specialist competence corresponds to the area ofcompetence indicated by the intermediate objective, and who is responsible
for ST doctors’s professional development during the teaching period or forthe method of teaching indicatedthe assignment as a mentor for an ST doctor generally encompasses the entire period of specialist training but can also encompass part or parts of it
auscultation
during mentoring, and in accordance with a pre-designed programme, tostudy the profession of a specialist doctor or other health care staff by following one or several professionals, as well as carrying out assignments in
the relevant area to a certain extent
evaluate
to form a sound opinion of a patient or similar person as a basis for further
management
masterbeing fully able to evaluate and handle the medical investigation, diagnostics, treatment, and follow-up of a patient or similar person, and being fully
able to use the techniques relevant to the area
capability
personal capacity to execute or perform a task
h a ve u n d ers tan d i ng
having acquired knowledge and insight into an area through theoretical studies and/or practical exercise of the profession
have knowledge
having acquired some knowledge in an area through theoretical studies
and/or practical exercise of the profession
mentoring under supervision
as an ST doctor, mentor a co-worker while simultaneously being mentored
by a doctor with specialist competencementorcontinuously, and in dialogue form, supporting and guiding, as well as evaluating, a co-worker’s professional development
mentoringsee mentor
handleto actively carry out measures regarding investigation, diagnostics, treatment, and follow-up of a patient or similar person, and have overall responsibility for carrying out these measuresinitially handle
as the primary physician in charge, to actively carry out measures regarding
investigation, diagnostics, treatment, and follow-up of a patient or similar
person, and have overall responsibility for carrying out these measuresinitially evaluate
as the primary physician in charge, to form a sound opinion of a patient orsimilar person as a basis for further management
intraprofessional group reflection
reflection done in a group together with other doctors, chiefly for the purpose of further education and training
clinical service
health and medical care duties that ST doctors perform under their own professional liability and with the support of a mentor
courseteacher-led training with an established plan, given during a defined periodof timesitting-in
training activity involving an ST doctor observing when a specialist doctor
or other health care staff holds a consultationorassessment activity involving a specialist doctor or other health care staff
observing and evaluating ST doctors during a consultation
seminarinstruction in group form with active participation
training in a simulated environment
training carried out in an environment created to emulate reality

large professional assembly
conference, congress, symposium or similar event
health care centre
health care unit in primary carehealth care team work
work where ST doctors, under supervision, participates in and sometimes
leads a group of co-operating health care staff with various competencies
charged with responsibility for care for an individual patient or group ofpatients

General definition of competence

Definition of area of competence
Gynaecological oncology is a specialty with collected medical expertise intreating women with gynaecological cancers. A defining characteristic of
the specialty is that diagnostics and treatment are based on the integration of
gynaecological and oncological methods and skills. This requires an overall
view involving knowledge of aetiology, epidemiology, tumour biology, prevention, targeted health controls, tumour diagnosis, treatment, follow-up
and management of side effects of the illness and treatment including aspects concerning sexuality and fertility, rehabilitation, psychosocial care,and palliative measures, as well as care during the final stages of life. The
area of competence incorporates a multidisciplinary work approach.
Gynaecological oncology is a branch specialty of the base specialty of
oncology.

Competence requirements
Competence requirements for medical competenceSpecialist competence in gynaecological oncology requires being able toindependently investigate, treat and follow up on patients with gynaecological cancers in the curative and palliative phases. In order to achieve this the
specialist must master gynaecological examination techniques and diagnostics, minor gynaecological surgery, and brachytherapy. Additionally,knowledge of the side effects of gynaecological oncological illness andtreatment, including effects on sexuality and fertility, is required.
Specialist competence in gynaecological oncology additionally requires
fundamental theoretical knowledge of epidemiology, aetiology, tumour biology, genetics, diagnostic methods, basic radiation physics and radiation
biology, and oncological pharmacology. Mastering medical oncologicaltreatment methods and radiotherapy is a further requirement. The qualified
specialist must also be able to manage acute and chronic complications, andmaster care during the final stages of life based on a holistic view of thepatient (intermediate objectives 1-7).

Competence requirements for communicative competence,leadership competence, and competence within medical science and quality work

Communicative competence
The equal and responsible patient
Doctors with specialist competence must be capable of dialogue and of
maintaining open contact with patients and their next of kin. Contact must
be characterised by empathy and trust, as well as respect for patients’ rightto information, influence, and participation in decisions. Contact should also
be characterised by co-operation and sensitivity to the patients’ needs, desires and right to self-determination, as well as providing incentive for patients’ involvement in, and responsibility for, their own care.
Multicultural and gender aspects
Communication with patients and their next of kin should be characterisedby understanding and respect for cross-cultural and multicultural aspects
such as age, language, ethnicity, sexual orientation and religion, as well as
gender.
Interprofessional relations
Doctors with specialist competence must be capable of communicating,both in writing and orally, with other doctors and co-workers showing respect for their professional knowledge and competences. The same applies
to contact with representatives of the public and various civil authorities.
Pedagogical skills
Doctors with specialist competence must have pedagogical capability inorder to inform and instruct not only patients and their next of kin, but also
other doctors and co-workers, as well as students.
Professional approach and ethics
Doctors with specialist competence must be capable of working continuously with their professional and medical ethical approaches, with the objective of being able to make independent decisions of a medical ethical nature.
Individual professional development
Doctors with specialist competence must be capable of continually examining and identifying their own needs for professional development, in addition to operational requirements, in order to be able to meet requirements forthe best possible patient care.

Leadership competence
Collaboration
Doctors with specialist competence must have a developed capability for
self-knowledge and an understanding of their own functions and roles in theorganisation.

Mentoring skills
Doctors with specialist competence must be capable of mentoring other doctors and co-workers, as well as students.
Leadership
Doctors with specialist competence must be capable of leadership characterised by collaboration, openness, and dialogue with co-workers. Leadershipmust further be characterised by participation and activity development
aimed at improvement. The ability to lead the work of the health care teamis essential.
System knowledge
Doctors with specialist competence must have an understanding of the organisation, administration, finances, and regulatory systems of health care,
as well as its governance, in order to make the best use of resources.

Competence within medical science and quality work
Medical science
Doctors with specialist competence must be capable of adopting a medicallyscientific outlook and approach, and must have knowledge of researchmethodology, including basic epidemiological concepts, as well as of methods for evidence-based medicine and review of scientific information.
Improvement and quality work
Doctors with specialist competence must have understanding of, and competence in, evidence-based improvement and quality work. The objective is
to be able to initiate, participate in, and be responsible for continuous systematic improvement work with emphasis on a holistic perspective, patient
safety, patient benefit, measurability, and teaching management in order tobe able to critically review and evaluate their own operations.
Public health and prevention
Doctors with specialist competence must have an understanding of the factors determining health, other aspects of public health, and methods forpromoting health and efforts aimed at preventing injury and illness, in order
to be able to take this understanding into account in medical scientific work.

Training structure
Specialist medical training in gynaecological oncology can begin before,
during or after specialist medical training in oncology, and may be integrated with it.
An uninterrupted period spent in inpatient oncological care should comeearly on in training, to provide a comprehensive picture of the panorama ofcancers and of the complications of the illnesses as well as their treatment.

In order to benefit from the specialist training in the best possible way, ST
doctors should receive an early introduction to medical oncological treatment and radiotherapy. Courses in pain management and palliative medicine
should also be included during this period.
In the following stage, the service should be located at units treating the
major forms of cancer. Courses in chemotherapy and other pharmacologicaloncological treatment should be included at this stage, as well as tumourspecific courses.
Radiation treatment is one of the cornerstones of oncological treatment
and can ideally be dealt with around the middle of the training. It shouldtake the form of an extended and uninterrupted placement at a radiation
treatment unit. This period should include courses in radiation physics, radiation biology and radiation treatment.
Beginning the training in gynaecological oncology in the joint programmewithin a field that includes the common curative and palliative aspects canbe advantageous.
In the training programme for gynaecological oncologists, simultaneous
additional training through service in gynaecology should be held early,
with the emphasis on common gynaecological diseases, gynaecological examination techniques, and minor surgical procedures, as well as placement
at a unit where gynaecological tumour surgery is carried out.
Towards the end of the programme, the emphasis should be on training inbrachytherapy at a unit where such therapy is practised.
Generally speaking it is important to try to achieve the most coherent
placements possible. Communicative competence, leadership competence
and competence within medical science and quality work should be initiatedearly on and should continue to feature as a natural and integrated element
throughout the training programme.

Special recommendations
The specialty associations and sections of the medical organisations haveformulated special recommendations for their own specialties. The recommendations concern such issues as how specialist medical training should be
structured.

Intermediate objectives

Medical competenceIntermediate objective 1

Teaching methods

Follow-up

To master the principles ofchemotherapy and other formsof medical treatment of cancer

Clinical service under supervision in a unit that handles
these conditions

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Theoretical studies

Intermediate objective 2

Teaching methods

Follow-up

To master external radiation
treatment for common cancers, and to have an understanding of the physical andbiological principles of radiation treatment

Clinical service under supervision in a unit that handles
these conditions

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Theoretical studies

Intermediate objective 3

Teaching methods

Follow-up

To have knowledge of otherradiation treatment modalities
and techniques, as well as
their theoretical foundations

Clinical service under supervision at a unit that handles
these conditions

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

ororauscultation under supervision at a unit that handles
these conditions

Theoretical studies

certificate of successfullycompleted auscultation andcompetence achieved, issued
by current mentor

Intermediate objective 4

Teaching methods

Follow-up

To be able to handle acuteoncological conditions, common complications of cancer,
and to be able to manage
acute side effects of treatment

Clinical service under supervision in a unit that handles
these conditions

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Theoretical studies

Intermediate objective 5

Teaching methods

Follow-up

To master diagnostics and the
medical treatment of pain andother symptoms related tocancer, in the curative and thepalliative phases

Clinical service under supervision in a unit that handles
these conditions

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Theoretical studies

Intermediate objective 6

Teaching methods

Follow-up

To have an understanding ofclinically relevant tumour biology, carcinogenesis and genetics

Clinical service under supervision in a unit that handles
these conditions

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Theoretical studies

Intermediate objective 7

Teaching methods

Follow-up

To have an understanding of
diagnostic methods including
pathology, cytology and medical imaging and technology
diagnostics for investigation,
diagnostics and follow-up ofcancerClinical service under supervision in a unit that handles
these conditions

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Diagnostics and treatment
conference
Theoretical studies

Intermediate objective 8

Teaching methods

Follow-up

To master the investigationand diagnostics of gynaecological cancer, and to have an
understanding of its aetiology
and epidemiology, as well asof the principles of prevention
and screening

Clinical service under supervision in a unit that handles
these conditions

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Theoretical studies

Intermediate objective 9

Teaching methods

Follow-up

To master managing patientswith gynaecological cancers in
the curative and the palliative
phasesClinical service under supervision at a unit that handles
these conditions

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Large professional assembly
Diagnostics and treatment
conference
Theoretical studies

Intermediate objective 10

Teaching methods

Follow-up

To be able to manage followup of patients treated for gynaecological cancer and theafter-effects of treatment, as
well as being able to initiate
rehabilitation while taking reproductive, endocrine andsexual aspects into accountClinical service under supervision in a unit that handles
these conditions

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Intermediate objective 11

Teaching methods

Follow-up

To master the technique ofgynaecological brachytherapy,
and the ability to evaluate theextent of the treatment area

Clinical service under supervision in a unit that handles
these conditions

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Theoretical studies

Theoretical studies

Intermediate objective 12

Teaching methods

Follow-up

To master gynaecologicalexamination techniques andminor gynaecological procedures, and to have an understanding of gynaecologicaltumour surgery and postoperative complications

Clinical service under supervision in a unit that handles
these conditions

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Communicative competenceIntermediate objective 13

Teaching methods

Follow-up

To be capable of communication, both oral and written, withpatients and their next of kin,
as well as with other doctors
and co-workers

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

SeminarIntermediate objective 14

Teaching methods

Follow-up

To be capable of informing
and instructing patients, nextof kin, other doctors, and coworkers, as well as students

Clinical service under supervision in a unit where suchoperations are practised Instruction under supervision

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Intermediate objective 15

Teaching methods

Follow-up

To be capable of professional
development based on one’s
own needs and the requirements of the operation

SeminarLarge professional assembly
Theoretical studies

Leadership competenceIntermediate objective 16

Teaching methods

Follow-up

To be capable of mentoringother doctors and co-workers,
as well as students

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Mentoring under supervision

Intermediate objective 17

Teaching methods

Follow-up

To be capable of leading using
collaboration and dialogue
with co-workers as well as
within the health care team

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Intermediate objective 18

Teaching methods

Follow-up

To have an understanding of
the organisation, management,
and regulatory systems ofhealth care

CourseCertificate of successfullycompleted course, issued bycourse leader

Competence within medical science and quality
work
Intermediate objective 19

Teaching methods

Follow-up

To be capable of a medicallyscientific outlook and approach

Written individual work under
supervision according toscientific principles

Certificate of approved written
individual work, issued bycurrent mentor

Intermediate objective 20

Teaching methods

Follow-up

To have an understanding of,and competence in, evidencebased improvement and quality work

Quality and development work
under supervision

Certificate of quality and development work, issued bycurrent mentor

Infectious diseases

Introduction
Explanation of terms
General definition of competencies
Definition of area of competence
Competence requirements
Competence requirements for medical competence
Competence requirements for communicative competence, leadershipcompetence, and competence within medical science and quality work
Training structure
Special recommendations
Intermediate objectives
Medical competenceCommunicative competence
Leadership competence
Competence within medical science and quality work

Introduction

On June 24, 2008, The National Board of Health and Welfare (Socialstyrelsen) decided to issue new regulations and general guidelines for doctors’
specialist medical training (SOSFS 2008:17). The statute consists of a general part with common provisions for all specialties and a specific part withall the descriptions of objectives. The description of objectives for the respective specialties should be understood against the background of the provisions in the general part.
In each description of objectives, there is a section headed ‘Training
structure’ which constitutes general guidelines. The teaching methods under
the heading ‘Intermediate objectives’ where no follow-up is indicated also
constitute general guidelines.

Explanation of terms

current mentor
a specialist doctor whose specialist competence corresponds to the area ofcompetence indicated by the intermediate objective, and who is responsible
for ST doctors’s professional development during the teaching period or forthe method of teaching indicatedthe assignment as a mentor for an ST doctor generally encompasses the entire period of specialist training but can also encompass part or parts of it
auscultation
during mentoring, and in accordance with a pre-designed programme, tostudy the profession of a specialist doctor or other health care staff by following one or several professionals, as well as carrying out assignments in
the relevant area to a certain extent
evaluate
to form a sound opinion of a patient or similar person as a basis for further
management
masterbeing fully able to evaluate and handle the medical investigation, diagnostics, treatment, and follow-up of a patient or similar person, and being fully
able to use the techniques relevant to the area
capability
personal capacity to execute or perform a task
h a ve u n d ers tan d i ng
having acquired knowledge and insight into an area through theoretical studies and/or practical exercise of the profession
have knowledge
having acquired some knowledge in an area through theoretical studies
and/or practical exercise of the profession
mentoring under supervision
as an ST doctor, mentor a co-worker while simultaneously being mentored
by a doctor with specialist competencementorcontinuously, and in dialogue form, supporting and guiding, as well as evaluating, a co-worker’s professional development
mentoringsee mentor
handleto actively carry out measures regarding investigation, diagnostics, treatment, and follow-up of a patient or similar person, and have overall responsibility for carrying out these measuresinitially handle
as the primary physician in charge, to actively carry out measures regarding
investigation, diagnostics, treatment, and follow-up of a patient or similar
person, and have overall responsibility for carrying out these measuresinitially evaluate
as the primary physician in charge, to form a sound opinion of a patient orsimilar person as a basis for further management
intraprofessional group reflection
reflection done in a group together with other doctors, chiefly for the purpose of further education and training
clinical service
health and medical care duties that ST doctors perform under their own professional liability and with the support of a mentor
courseteacher-led training with an established plan, given during a defined periodof timesitting-in
training activity involving an ST doctor observing when a specialist doctor
or other health care staff holds a consultationorassessment activity involving a specialist doctor or other health care staff
observing and evaluating ST doctors during a consultation
seminarinstruction in group form with active participation
training in a simulated environment
training carried out in an environment created to emulate reality

large professional assembly
conference, congress, symposium or similar event
health care centre
health care unit in primary carehealth care team work
work where ST doctors, under supervision, participates in and sometimes
leads a group of co-operating health care staff with various competencies
charged with responsibility for care for an individual patient or group ofpatients

General definition of competence

Definition of area of competence
The specialty of infectious diseases encompasses in-depth knowledge ofprevention, investigation, diagnostics, treatment, and follow-up of infections
from a national and an international perspective. The specialty encompasses
both acute and chronic infections. It serves as support to other specialties
regarding complicated infection issues.
The area of competence involves in-depth knowledge of the care and isolation of patients with infectious diseases, the rational use of antimicrobial
therapy, and knowledge of the epidemiological situation. This presupposes
close cooperation with disease prevention and control agencies, infection
control and clinical microbiology.

Competence requirements
Competence requirements for medical competenceSpecialist competence in infectious diseases requires the medical competence necessary to be able to work independently in the area and offer expert
assistance on infection issues to other specialties.
Specialist competence requires knowledge of investigation, diagnostics,
treatment, follow-up and prevention of infectious diseases contracted bothin Sweden and abroad. This includes the initial management of acute, lifethreatening infections. Additionally, sound knowledge is required of microbiology, epidemiology, care-related infections, prevention of infections andthe spreading of infections, disease control, the rational use of antibiotics,
and problems related to resistance.
Specialist competence further requires knowledge of how to manage andprevent infection in patients with an increased risk of infection. Additionally, knowledge of how to individualise treatment in consideration of age andother conditions is required.
Further, expertise in being able initially to manage acute, life-threatening
non-infectious conditions, as well as being able to manage relevant illnesses
within the field of internal medicine, is required.

Competence requirements for communicative competence, leadership competence, and competence within medical scienceand quality work
Communicative competence
The equal and responsible patient
Doctors with specialist competence must be capable of dialogue and of
maintaining open contact with patients and their next of kin. Contact must
be characterised by empathy and trust, as well as respect for patients’ rightto information, influence, and participation in decisions. Contact should also
be characterised by co-operation and sensitivity to the patients’ needs, desires and right to self-determination, as well as providing incentive for patients’ involvement in, and responsibility for, their own care.
Multicultural and gender aspects
Communication with patients and their next of kin must be characterised byunderstanding of and respect for cross-cultural and multicultural aspects
such as age, language, ethnicity, sexual orientation, and religion, as well as
gender.
Interprofessional relations
Doctors with specialist competence must be capable of communicating,both in writing and orally, with other doctors and co-workers showing respect for their professional knowledge and competences. The same applies
to contact with representatives of the public and various civil authorities.
Pedagogical skills
Doctors with specialist competence must have pedagogical capability inorder to inform and instruct not only patients and their next of kin, but also
other doctors and co-workers, as well as students.
Professional ethics and approach
Doctors with specialist competence must be capable of working continuously with their professional and medical ethical approaches, with the objective of being able to make independent decisions of a medical ethical nature.
Individual professional development
Doctors with specialist competence must be capable of continually examining and identifying their own needs for professional development, in addition to operational requirements, in order to be able to meet requirements forthe best possible patient care.

Leadership competence
Collaboration
Doctors with specialist competence must have a developed capability for
self-knowledge and an understanding of their own functions and roles in theorganisation.
Mentoring skills
Doctors with specialist competence must have developed the capability ofmentoring other doctors and co-workers, as well as students.
Leadership
Doctors with specialist competence must be capable of leadership characterised by collaboration, openness, and dialogue with co-workers. Leadershipmust further be characterised by participation and activity development
aimed at improvement. The ability to lead the work of the health care teamis essential.
System knowledge
Doctors with specialist competence must have an understanding of the organisation, administration, finances, and regulatory systems of health care,
as well as its governance, in order to make the best use of resources.

Competence within medical science and quality work
Medical science
Doctors with specialist competence must be capable of adopting a medicallyscientific outlook and approach, and must have knowledge of researchmethodology, including basic epidemiological concepts, as well as of methods for evidence-based medicine and review of scientific information.
Improvement and quality work
Doctors with specialist competence must have understanding of, and competence in, evidence-based improvement and quality work. The objective is
to be able to initiate, participate in, and be responsible for continuous systematic improvement work with emphasis on a holistic perspective, patient
safety, patient benefit, measurability, and teaching management in order tobe able to critically review and evaluate their own operations.
Public health and prevention
Doctors with specialist competence must have an understanding of the factors determining health, other aspects of public health, and methods forpromoting health and efforts aimed at preventing injury and illness, in order
to be able to take this understanding into account in medical scientific work.

Training structure
Training in infectious diseases should be held at a unit with both inpatientand outpatient care of infectious diseases. Since the objective is to acquirecomprehensive expertise, the service may need to be supplemented withplacement at another infection clinic in order for ST doctors to acquire morein-depth knowledge of special areas or a broader knowledge of common
infectious diseases. Uninterrupted periods of service should be the goal in
the various clinical service placements.
In the early stages of training, emphasis should be on managing common
acute infectious diseases. This includes initial management of seriously illpatients and participation in emergency duty. Training should then become
more in-depth and be supplemented with service in other sections or activities. Within the operations, service as general infection consultant should beoffered at the end of the training, as well as service through which ST doctors will obtain insight into specialised clinic and consultancy activities.
Supplementary service abroad may provide valuable knowledge and perspectives.
Simultaneous additional training through service in the microbiology area
is important for obtaining more in-depth knowledge of diagnostic methods
and microbiological agents.
Internal medicine issues are common within the specialty, which meansthat simultaneous additional training through service in internal medicine
and its branch specialties is very important. Paediatrics and intensive careare suitable for simultaneous additional training through service, but othersupplementary programmes may also be considered. Infection prevention
and control are other activities with which the infectious disease specialist
often comes into contact, and where more in-depth knowledge is required.
Theoretical training is done partly through individual study and throughthe host clinic’s internal training programme, where ST doctors are expectedto participate and contribute actively. ST doctors are also expected to attend
several national courses. Essential courses in this category include antimicrobial therapy and tropical diseases. During training, ST doctors should begiven the opportunity to participate in a large professional assembly. It isalso important that doctors acquire the ability to evaluate scientific articles,
as well as knowledge of scientific methods and routines. This may beachieved in various ways, ranging from projects and quality management
within the clinic’s area of activity to research projects tied to universities.

Special recommendations
The specialty associations and sections of the medical organisations haveformulated special recommendations for their own specialties. The recommendations concern such issues as how specialist medical training should be
structured.

Intermediate objectives

Medical competenceIntermediate objective 1

Teaching methods

Follow-up

To master investigation andtreatment of endemic, community-acquired infections

Clinical service under supervision at a unit that handles
these conditions

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Seminar
Theoretical studies

Intermediate objective 2

Teaching methods

Follow-up

To master the investigationand treatment of infectionsacquired abroad, and to haveknowledge of the global infection panorama

Clinical service under supervision in a unit that handles
these conditions

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Theoretical studies

Intermediate objective 3

Teaching methods

Follow-up

To master the initial reception
and care of acute lifethreatening infections

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Theoretical studies

Intermediate objective 4

Teaching methods

Follow-up

To master the prevention of
infections, and disease control

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Theoretical studies

Intermediate objective 5

Teaching methods

Follow-up

To master the treatment of
infectious agents, and to havean understanding of their resistance

Clinical service under supervision in a unit that handles
these issues

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Theoretical studies

Intermediate objective 6

Teaching methods

Follow-up

To master the selection ofdiagnostic methods for infectious agents, and to be able toevaluate diagnostics results

Clinical service under supervision at a unit that handles
these issues

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Theoretical studies

Intermediate objective 7

Teaching methods

Follow-up

To master work as an expert
on infection issues concerning
patients being managed within
another specialty

Clinical service under supervision in a unit where such operations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Auscultation under supervision in a unit where such operations are practised
Theoretical studies

Intermediate objective 8

Teaching methods

Follow-up

To be able to handle treatment
and prevention of infections inpatients with an increased
infection risk

Clinical service under supervision in a unit that handles
these conditions

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Theoretical studies

Intermediate objective 9

Teaching methods

Follow-up

To be able to handle patientswith care-related infections
and infectious complications ofsurgery

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Theoretical studies

Intermediate objective 10

Teaching methods

Follow-up

To be able to initially handle
acute life-threatening noninfectious conditions

Clinical service under supervision in a unit that handles
these conditions

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Theoretical studies

Intermediate objective 11

Teaching methods

Follow-up

To be able to handle relevant
illnesses within the field ofinternal medicine

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Theoretical studies

Intermediate objective 12

Teaching methods

Follow-up

To be able to handle infectionsin an individualised manner,
taking age and other conditions into accountClinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Theoretical studies

Communicative competenceIntermediate objective 13

Teaching methods

Follow-up

To be capable of dialogue andopen contact with patients andtheir next of kin

Clinical work under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Intermediate objective 14

Teaching methods

Follow-up

To be capable of communicating with, informing, and instructing patients, their next ofkin, other doctors and coworkers, and students, both inwriting and orally

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Intermediate objective 15

Teaching methods

Follow-up

To be capable of a professional and ethical approach

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Leadership competenceIntermediate objective 16

Teaching methods

Follow-up

To be capable of mentoringother doctors and co-workers,
as well as students

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Mentoring under supervisionIntermediate objective 17

Teaching methods

Follow-up

To be capable of leading using
collaboration and dialogue
with co-workers as well as
within the health care team

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Intermediate objective 18

Teaching methods

Follow-up

To have an understanding of
the organisation, management,
and regulatory systems ofhealth care

CourseCertificate of successfullycompleted course, issued bycourse leader

Theoretical studies

Competence within medical science and quality
work
Intermediate objective 19

Teaching methods

Follow-up

To be capable of a medical
scientific outlook and approach

CourseCertificate of successfullycompleted course, issued bycourse leader

Written individual work under
supervision according toscientific principles

Certificate of approved written
individual work, issued bycurrent mentor

SeminarIntermediate objective 20

Teaching methods

Follow-up

To have an understanding of,and competence in, evidencebased improvement and quality work

CourseCertificate of successfullycompleted course, issued bycourse leader

Quality and development work
under supervision

Certificate of quality and development work, issued bycurrent mentor

SeminarIntermediate objective 21

Teaching methods

Follow-up

To have an understanding ofresearch methodology

Course or seminar

Certificate of successfullycompleted course, issued bycourse leader

Clinical genetics

Introduction
Explanation of terms
General definition of competencies
Definition of area of competence
Competence requirements
Competence requirements for medical competence
Competence requirements for communicative competence, leadershipcompetence, and competence within medical science and quality work
Training structure
Special recommendations
Intermediate objectives
Medical competenceCommunicative competence
Leadership competence
Competence within medical science and quality work

Introduction

On June 24, 2008, The National Board of Health and Welfare (Socialstyrelsen) decided to issue new regulations and general guidelines for doctors’
specialist medical training (SOSFS 2008:17). The statute consists of a general part with common provisions for all specialties and a specific part withall the descriptions of objectives. The description of objectives for the respective specialties should be understood against the background of the provisions in the general part.
In each description of objectives, there is a section headed ‘Training
structure’ which constitutes general guidelines. The teaching methods under
the heading ‘Intermediate objectives’ where no follow-up is indicated also
constitute general guidelines.

Explanation of terms

current mentor
a specialist doctor whose specialist competence corresponds to the area ofcompetence indicated by the intermediate objective, and who is responsible
for ST doctors’s professional development during the teaching period or forthe method of teaching indicatedthe assignment as a mentor for an ST doctor generally encompasses the entire period of specialist training but can also encompass part or parts of it
auscultation
during mentoring, and in accordance with a pre-designed programme, tostudy the profession of a specialist doctor or other health care staff by following one or several professionals, as well as carrying out assignments in
the relevant area to a certain extent
evaluate
to form a sound opinion of a patient or similar person as a basis for further
management
masterbeing fully able to evaluate and handle the medical investigation, diagnostics, treatment, and follow-up of a patient or similar person, and being fully
able to use the techniques relevant to the area
capability
personal capacity to execute or perform a task
h a ve u n d ers tan d i ng
having acquired knowledge and insight into an area through theoretical studies and/or practical exercise of the profession
have knowledge
having acquired some knowledge in an area through theoretical studies
and/or practical exercise of the profession
mentoring under supervision
as an ST doctor, mentor a co-worker while simultaneously being mentored
by a doctor with specialist competencementorcontinuously, and in dialogue form, supporting and guiding, as well as evaluating, a co-worker’s professional development
mentoringsee mentor
handleto actively carry out measures regarding investigation, diagnostics, treatment, and follow-up of a patient or similar person, and have overall responsibility for carrying out these measuresinitially handle
as the primary physician in charge, to actively carry out measures regarding
investigation, diagnostics, treatment, and follow-up of a patient or similar
person, and have overall responsibility for carrying out these measuresinitially evaluate
as the primary physician in charge, to form a sound opinion of a patient orsimilar person as a basis for further management
intraprofessional group reflection
reflection done in a group together with other doctors, chiefly for the purpose of further education and training
clinical service
health and medical care duties that ST doctors perform under their own professional liability and with the support of a mentor
courseteacher-led training with an established plan, given during a defined periodof timesitting-in
training activity involving an ST doctor observing when a specialist doctor
or other health care staff holds a consultationorassessment activity involving a specialist doctor or other health care staff
observing and evaluating ST doctors during a consultation
seminarinstruction in group form with active participation
training in a simulated environment
training carried out in an environment created to emulate reality

large professional assembly
conference, congress, symposium or similar event
health care centre
health care unit in primary carehealth care team work
work where ST doctors, under supervision, participates in and sometimes
leads a group of co-operating health care staff with various competencies
charged with responsibility for care for an individual patient or group ofpatients

General definition of competence

Definition of area of competence
The specialty of clinical genetics encompasses diagnostics and managementof genetically conditioned diseases, as well as genetic guidance in the eventof such diseases. The activity encompasses all age groups and addresses all
medical specialties in which genetic issues occur.

Competence requirements
Competence requirements for medical competenceSpecialist competence in clinical genetics requires knowledge of medical
genetics and competence in the interpretation of laboratory analyses, inclinic, consultancy and training operations, and in development work. Morespecifically, the clinical genetics specialist must be well versed in the principles of genetic diagnostics in order to be able to use various diagnostic
methods, to be able to interpret the results, and have practical skill in the
management of genetic investigations regarding both hereditary and acquired genetic conditions, and in prenatal diagnostics.
The medical specialist must also have the ability to provide genetic guidance and to serve as consultant regarding genetic issues across the entire
field of medicine. Additionally, the specialist must be well versed in genealogical tree analysis and database management, and must have overall
knowledge of complex genetics.
The specialist must further be capable of speaking with patients aboutlife-determining issues while taking ethical principles and values into account. An additional requirement is the ability to follow the development ofknowledge and be up to date about current research in the field, as well as
the ability to use new knowledge and methods to change forms and content
in professional practice.

Competence requirements for communicative competence,leadership competence, and competence within medical science and quality work

Communicative competence
The equal and responsible patient
Doctors with specialist competence must be capable of dialogue and of
maintaining open contact with patients and their next of kin. Contact must
be characterised by empathy and trust, as well as respect for patients’ rightto information, influence, and participation in decisions. Contact should also
be characterised by co-operation and sensitivity to the patients’ needs, desires and right to self-determination, as well as providing incentive for patients’ involvement in, and responsibility for, their own care.
Multicultural and gender aspects
Communication with patients and their next of kin should be characterisedby understanding and respect for cross-cultural and multicultural aspects
such as age, language, ethnicity, sexual orientation and religion, as well as
gender.
Interprofessional relations
Doctors with specialist competence must be capable of communicating,both in writing and orally, with other doctors and co-workers showing respect for their professional knowledge and competences. The same applies
to contact with representatives of the public and various civil authorities.
Pedagogical skills
Doctors with specialist competence must have pedagogical capability inorder to inform and instruct not only patients and their next of kin, but also
other doctors and co-workers, as well as students.
Professional approach and ethics
Doctors with specialist competence must be capable of working continuously with their professional and medical ethical approaches, with the objective of being able to make independent decisions of a medical ethical nature.
Individual professional development
Doctors with specialist competence must be capable of continually examining and identifying their own needs for professional development, in addition to operational requirements, in order to be able to meet requirements forthe best possible patient care.

Leadership competence
Collaboration
Doctors with specialist competence must have a developed capability for
self-knowledge and an understanding of their own functions and roles in theorganisation.
Mentoring skills
Doctors with specialist competence must be capable of mentoring other doctors and co-workers, as well as students.
Leadership
Doctors with specialist competence must be capable of leadership characterised by collaboration, openness, and dialogue with co-workers. Leadershipmust further be characterised by participation and activity development
aimed at improvement. The ability to lead the work of the health care teamis essential.
System knowledge
Doctors with specialist competence must have an understanding of the organisation, administration, finances, and regulatory systems of health care,
as well as its governance, in order to make the best use of resources.

Competence within medical science and quality work
Medical science
Doctors with specialist competence must be capable of adopting a medicallyscientific outlook and approach, and must have knowledge of researchmethodology, including basic epidemiological concepts, as well as of methods for evidence-based medicine and review of scientific information.
Improvement and quality work
Doctors with specialist competence must have understanding of, and competence in, evidence-based improvement and quality work. The objective is
to be able to initiate, participate in, and be responsible for continuous systematic improvement work with emphasis on a holistic perspective, patient
safety, patient benefit, measurability, and teaching management in order tobe able to critically review and evaluate their own operations.
Public health and prevention
Doctors with specialist competence must have an understanding of the factors determining health, other aspects of public health, and methods forpromoting health and efforts aimed at preventing injury and illness, in order
to be able to take this understanding into account in medical scientific work.

Training structure
Specialist training is carried out principally at a health care unit for clinicalgenetics. In order to achieve broad knowledge of genetic diagnostics, ST
doctors should acquire laboratory diagnostics competence in both cytogenetics and molecular genetics. Management of genetic investigations, ofboth hereditary and acquired genetic conditions, should be done with increasing independence during training. Genetic guidance of increasing complexity is also an important part of training. The order in which individual
ST doctors do in-depth studies for the various intermediate objectives within
the area of competence will depend on previous experience and current focus.
Certain elements of service may need to be done at another clinical genetics unit in order for ST doctors to achieve particular intermediate objectives.
It is further important to do supplementary service or auscultation in otherspecialty areas in order for ST doctors to deepen their expertise in clinicalgenetics. This is important in patient care activities such as paediatrics, gynaecology and obstetrics, neurology, oncology and haematology, as well as
in laboratory activities such as clinical pathology and clinical chemistry.
Research experience should also form a natural part of the training programme.

Special recommendations
The specialty associations and sections of the medical organisations haveformulated special recommendations for their own specialties. The recommendations concern such issues as how specialist medical training should be
structured.

Intermediate objectives

Medical competenceIntermediate objective 1

Teaching methods

Follow-up

To have an understanding of
medical genetics, cytogenetics
and molecular biology

CourseCertificate of successfullycompleted course, issued bycourse leader

Theoretical studies

Intermediate objective 2

Teaching methods

Follow-up

To master genetic diagnostics
and investigation, and to havean understanding of the treatment and prevention of hereditary genetic conditions

Clinical service under supervision at a unit that handles
these conditions

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Large professional assembly
Diagnostics and treatment
conference
Theoretical studies

Intermediate objective 3

Teaching methods

Follow-up

To master genetic diagnostics
and investigation, and to havean understanding of the treatment and prevention of acquired genetic conditions

Clinical service under supervision at a unit that handles
these conditions

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Large professional assembly
Diagnostics and treatment
conference
Theoretical studies

Intermediate objective 4

Teaching methods

Follow-up

To master genetic laboratory
diagnostics

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Theoretical studies

Intermediate objective 5

Teaching methods

Follow-up

To be able to initially handle
syndrome investigation

Clinical service under supervision in a unit where such operations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

ororauscultation under supervision
in a unit where such operations are practised

Coursecertificate of successfullycompleted auscultation andcompetence achieved, issued
by current mentor
Certificate of successfullycompleted course, issued bycourse leader

Theoretical studies

Intermediate objective 6

Teaching methods

Follow-up

To master prenatal diagnostics, and to have an understanding of preimplantation
genetic diagnostics

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

ororauscultation under supervision in a unit where suchoperations are practised

CourseTheoretical studies

certificate of successfullycompleted auscultation andcompetence achieved, issued
by current mentor
Certificate of successfullycompleted course, issued bycourse leader

Intermediate objective 7

Teaching methods

Follow-up

To master genetic guidance
for individuals and families

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Sitting-in
Theoretical studies

Intermediate objective 8

Teaching methods

Follow-up

To master genealogical tree
analysis and risk assessment

Clinical service under supervision in a unit that handles
these issues

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Intermediate objective 9

Teaching methods

Follow-up

To master using databases as
a diagnostic aid

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Intermediate objective 10

Teaching methods

Follow-up

To be able to manage genetic
consultation in health care

Clinical service under supervision in a unit where such operations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

ororauscultation under supervision
in a unit where such operations are practised

Large professional assembly
Diagnostics and treatment
conference

certificate of successfullycompleted auscultation andcompetence achieved, issued
by current mentor

Intermediate objective 11

Teaching methods

Follow-up

To have an understanding ofcomplex genetic relationships

CourseCertificate of successfullycompleted course, issued bycourse leader

Theoretical studies

Intermediate objective 12

Teaching methods

Follow-up

To have an understanding of
how research results can beclinically applied

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

ororauscultation at a unit wheresuch operations are practised

certificate of successfullycompleted auscultation andcompetence achieved, issued
by current mentor

Large professional assembly
Theoretical studies

Communicative competenceIntermediate objective 13

Teaching methods

Follow-up

To be capable of dialogue andopen contact with patients andtheir next of kin

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Sitting-in
Theoretical studies

Intermediate objective 14

Teaching methods

Follow-up

To be capable of communication, both oral and written, withother doctors and co-workers

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Large professional assemblyIntermediate objective 15

Teaching methods

Follow-up

To be capable of informing
and instructing patients, nextof kin, other doctors, and coworkers, as well as students

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Instruction under supervision

Leadership competenceIntermediate objective 16

Teaching methods

Follow-up

To be capable of mentoringother doctors and co-workers,
as well as students

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Mentoring under supervision
Theoretical studies

Intermediate objective 17

Teaching methods

Follow-up

To be capable of leading using
collaboration and dialogue
with co-workers as well as in a
team

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Intermediate objective 18

Teaching methods

Follow-up

To have an understanding of
the organisation, management, and regulatory systemsof health care

CourseCertificate of successfullycompleted course, issued bycourse leader

Mentoring under supervision
Theoretical studies

Competence within medical science and quality
work
Intermediate objective 19

Teaching methods

Follow-up

To be capable of a medicallyscientific outlook and approach

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Written individual work under
supervision according toscientific principles

Certificate of approved written
individual work, issued bycurrent mentor

Seminar
Theoretical studies

Intermediate objective 20

Teaching methods

Follow-up

To have an understanding of,and competence in, evidencebased improvement and quality work

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Quality and development work
under supervision

Certificate of quality and development work, issued bycurrent mentor

Large professional assembly
Theoretical studies

Intermediate objective 21

Teaching methods

Follow-up

To have an understanding ofresearch methodology

CourseCertificate of successfullycompleted course, issued bycourse leader

Written individual work under
supervision according toscientific principles

Certificate of approved written
individual work, issued bycurrent mentor

Theoretical studies

Occupational and environmental
medicine

Introduction
Explanation of terms
General definition of competencies
Definition of area of competence
Competence requirements
Competence requirements for medical competence
Competence requirements for communicative competence, leadershipcompetence, and competence within medical science and quality work
Training structure
Special recommendations
Intermediate objectives
Medical competenceCommunicative competence
Leadership competence
Competence within medical science and quality work

Introduction

On June 24, 2008, The National Board of Health and Welfare (Socialstyrelsen) decided to issue new regulations and general guidelines for doctors’
specialist medical training (SOSFS 2008:17). The statute consists of a general part with common provisions for all specialties and a specific part withall the descriptions of objectives. The description of objectives for the respective specialties should be understood against the background of the provisions in the general part.
In each description of objectives, there is a section headed ‘Training
structure’ which constitutes general guidelines. The teaching methods under
the heading ‘Intermediate objectives’ where no follow-up is indicated also
constitute general guidelines.

Explanation of terms

current mentor
a specialist doctor whose specialist competence corresponds to the area ofcompetence indicated by the intermediate objective, and who is responsible
for ST doctors’s professional development during the teaching period or forthe method of teaching indicatedthe assignment as a mentor for an ST doctor generally encompasses the entire period of specialist training but can also encompass part or parts of it
auscultation
during mentoring, and in accordance with a pre-designed programme, tostudy the profession of a specialist doctor or other health care staff by following one or several professionals, as well as carrying out assignments in
the relevant area to a certain extent
evaluate
to form a sound opinion of a patient or similar person as a basis for further
management
masterbeing fully able to evaluate and handle the medical investigation, diagnostics, treatment, and follow-up of a patient or similar person, and being fully
able to use the techniques relevant to the area
capability
personal capacity to execute or perform a task
h a ve u n d ers tan d i ng
having acquired knowledge and insight into an area through theoretical studies and/or practical exercise of the profession
have knowledge
having acquired some knowledge in an area through theoretical studies
and/or practical exercise of the profession
mentoring under supervision
as an ST doctor, mentor a co-worker while simultaneously being mentored
by a doctor with specialist competencementorcontinuously, and in dialogue form, supporting and guiding, as well as evaluating, a co-worker’s professional development
mentoringsee mentor
handleto actively carry out measures regarding investigation, diagnostics, treatment, and follow-up of a patient or similar person, and have overall responsibility for carrying out these measuresinitially handle
as the primary physician in charge, to actively carry out measures regarding
investigation, diagnostics, treatment, and follow-up of a patient or similar
person, and have overall responsibility for carrying out these measuresinitially evaluate
as the primary physician in charge, to form a sound opinion of a patient orsimilar person as a basis for further management
intraprofessional group reflection
reflection done in a group together with other doctors, chiefly for the purpose of further education and training
clinical service
health and medical care duties that ST doctors perform under their own professional liability and with the support of a mentor
courseteacher-led training with an established plan, given during a defined periodof timesitting-in
training activity involving an ST doctor observing when a specialist doctor
or other health care staff holds a consultationorassessment activity involving a specialist doctor or other health care staff
observing and evaluating ST doctors during a consultation
seminarinstruction in group form with active participation
training in a simulated environment
training carried out in an environment created to emulate reality

large professional assembly
conference, congress, symposium or similar event
health care centre
health care unit in primary carehealth care team work
work where ST doctors, under supervision, participates in and sometimes
leads a group of co-operating health care staff with various competencies
charged with responsibility for care for an individual patient or group ofpatients

General definition of competence

Definition of area of competence
The specialty of occupational and environmental medicine encompasses indepth knowledge of and proficiency in how factors in the physical environment in general and in the work environment affect the health and functionaland occupational abilities of individuals and groups within the population,
as well as investigation, treatment and follow-up of certain environmentrelated illnesses and injuries. The specialty focuses on evaluating connections between the environment and health, and also includes prevention,
occupational rehabilitation, evaluation of work capacity and other healthpromotion work. This means that the area of competence covers a wide area
which includes occupational and environmental medicine as well as occupational health care. The activity is characterised by the integration of medical
knowledge with knowledge of work organisation, behavioural science, ergonomics, chemistry, technology and toxicology, and by the coordination of
resources and knowledge from various areas of medical activity with thoseof other sectors of society.

Competence requirements
Competence requirements for medical competenceSpecialist competence in occupational and environmental medicine requires
being capable of mastering the evaluation of connections, for groups as well
as for individuals, between ill health and exposure to biological, ergonomic,
physical, chemical, organisational and psychosocial factors in the work environment, and between ill health and exposure in the environment in general. Another requirement is the ability to carry out statutory medical controls and employability assessments, as well as to devise and carry out groupexaminations with the aim of charting connections between ill health andexposure. Being capable of mastering the evaluation of individual work capacity is further required.
This in turn requires knowledge of the evaluation, investigation andtreatment of common illnesses in the working population, as well as of occupational rehabilitation. Skill is further required in health promotion andpreventive work at the organisational, group and individual levels. To master evaluating connections between ill health and exposure, knowledge ofthe identification, evaluation, and control of risk factors in the work environment and in the general environment, as well as of all applicable legislation, is additionally required.
Further, a high level of competence in acting as an independent and advisory expert is required. The specialist must additionally master such medical
ethical issues as may arise in the relationship with employers or with otherparties outside of health and medical care.

Competence requirements for communicative competence,leadership competence, and competence within medical science and quality work

Communicative competence
The equal and responsible patient
Doctors with specialist competence must be capable of dialogue and of
maintaining open contact with patients and their next of kin. Contact must
be characterised by empathy and trust, as well as respect for patients’ rightto information, influence, and participation in decisions. Contact should also
be characterised by co-operation and sensitivity to the patients’ needs, desires and right to self-determination, as well as providing incentive for patients’ involvement in, and responsibility for, their own care.
Multicultural and gender aspects
Communication with patients and their next of kin should be characterisedby understanding and respect for cross-cultural and multicultural aspects
such as age, language, ethnicity, sexual orientation and religion, as well as
gender.
Interprofessional relations
Doctors with specialist competence must be capable of communicating,both in writing and orally, with other doctors and co-workers showing respect for their professional knowledge and competences. The same applies
to contact with representatives of the public and various civil authorities.
Pedagogical skills
Doctors with specialist competence must have the pedagogical ability to
inform and instruct not only patients and their next of kin, but also otherdoctors, co-workers and students, as well as the various groups in working
life, and the general public.
Professional approach and ethics
Doctors with specialist competence must be capable of working continuously with their professional and medical ethical approaches, with the objective of being able to make independent decisions of a medical ethical nature.
Individual professional development
Doctors with specialist competence must be capable of continually examining and identifying their own needs for professional development, in addition to operational requirements, in order to be able to meet requirements forthe best possible patient care, as well as being able to correctly evaluate theinfluence of various environmental factors on health.

Leadership competence
Collaboration
Doctors with specialist competence must have a developed capability for
self-knowledge and an understanding of their own functions and roles in theorganisation.
Mentoring skills
Doctors with specialist competence must be capable of mentoring other doctors and co-workers, as well as students.
Leadership
Doctors with specialist competence must be capable of leadership characterised by collaboration, openness, and dialogue with co-workers. Leadershipmust further be characterised by participation and activity development
aimed at improvement. The ability to lead the work of the team or healthcare team is essential.
System knowledge
Doctors with specialist competence must have an understanding of the organisation, administration, finances, and regulatory systems of health care,
as well as its governance, in order to make the best use of resources. The
doctor with specialist competence must also have an understanding of public authorities and organisations in the areas of environment and health.

Competence within medical science and quality work
Medical science
Doctors with specialist competence must be capable of adopting a medicallyscientific outlook and approach, and must have knowledge of researchmethodology, including basic epidemiological concepts, as well as of methods for evidence-based medicine and review of scientific information.
Improvement and quality work
Doctors with specialist competence must have understanding of, and competence in, evidence-based improvement and quality work. The objective is
to be able to initiate, participate in, and be responsible for continuous systematic improvement work with emphasis on a holistic perspective, patient
safety, patient benefit, measurability, and teaching management in order tobe able to critically review and evaluate their own operations.

Public health and prevention
Doctors with specialist competence must have an understanding of the factors determining health, other aspects of public health, and methods forpromoting health and efforts aimed at preventing injury and illness, in order
to be able to take this understanding into account in medical scientific work.

Training structure
Ideally, the specialist training programme begins and ends with service
within the two main areas of the specialty, i.e. occupational and environmental medicine and occupational health care.
During service at an occupational and environmental medicine unit, it isimportant that ST doctors independently manage a number of clinical patient investigations and also take part in workplace visits.
Additionally, ST doctors should participate in various investigations into
exposure and morbidity in workplaces, as well as in environmental medicine
investigations that include risk assessment and providing risk information to
the affected parties. In this part of the clinical service, ST doctors should
also carry out projects that can be presented as scientific reports. It is also
important that ST doctors are able to take part in the clinic’s training andinformation activities.
During clinical service in occupational health care, ST doctors should independently manage a number of clinical patient investigations and workwith occupational rehabilitation and evaluations of work capacity. Duringservice, it is of the utmost importance that ST doctors participate in the client company’s work environment efforts and contribute actively to its training activities. ST doctors should also take part in carrying out statutory
medical controls and requisite employability assessments. Additionally, ST
doctors should carry out, compile, and report on a group investigation.
The specialty requires broad basic medical competence. For this reason,
simultaneous additional training through clinical service in family medicine,internal medicine and psychiatry is of the utmost importance. Other simultaneous additional training through clinical service which can be valuable
for ST doctors includes dermatology, clinical physiology, neurology, orthopaedics, orthopaedic medicine and physiotherapy and rehabilitation.
ST doctors should acquire knowledge of other relevant areas not coveredby the aforementioned clinical service by means of various separate course
elements. Courses and theoretical studies are suitably integrated with thecurrent clinical service in order to spread these elements out over the courseof the training.

Special recommendations
The specialty associations and sections of the medical organisations haveformulated special recommendations for their own specialties. The recommendations concern such issues as how specialist medical training should be
structured.

Intermediate objectives

Medical competenceIntermediate objective 1

Teaching methods

Follow-up

To master evaluating connections between ill health andexposure in the work environment and in the environment
in general

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Large professional assembly
Diagnostics and treatment
conference
Theoretical studies

Intermediate objective 2

Teaching methods

Follow-up

To master evaluation of individual work capacity and occupational rehabilitation

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Theoretical studies

Intermediate objective 3

Teaching methods

Follow-up

To master carrying out statutory medical controls and, whereapplicable, employability assessments

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Sitting-in

Intermediate objective 4

Teaching methods

Follow-up

To master medical ethicalissues in relation to both employers and other parties outside of health and medical
care

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Sitting-in

Intermediate objective 5

Teaching methods

Follow-up

To master carrying out group
investigations and to master
reporting back to the affectedparties

Clinical service under supervision in a unit where such operations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Quality and development work
under supervision

Certificate of quality and development work, issued bycurrent mentor

Intermediate objective 6

Teaching methods

Follow-up

To master devising medical
examinations or other chartingof ill health based on current
exposure

Clinical service under supervision in a unit where such operations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Quality and development work
under supervision

Certificate of quality and development work, issued bycurrent mentor

Teamwork under supervisionIntermediate objective 7

Teaching methods

Follow-up

To be able to manage clinicalinvestigations of patients withconditions related to exposurein the work environment or thegeneral environment

Clinical service under supervision in a unit that handles
these conditions

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Diagnostics and treatment
conference
Theoretical studies

Intermediate objective 8

Teaching methods

Follow-up

To be able to initially handle
common medical conditions in
the working population

Clinical service under supervision in a unit that handles
these conditions

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Diagnostics and treatment
conference

Intermediate objective 9

Teaching methods

Follow-up

To be able to evaluate investigations of exposure conditions
in different environments, andmeasures to influence them

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Large professional assembly
Theoretical studies

Intermediate objective 10

Teaching methods

Follow-up

To have an understanding of
the organisation’s effect on
individuals and groups, and ofhealth promotion and preventive work

Clinical service under supervision in a unit that handles
these issues

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Large professional assembly
Theoretical studies

Intermediate objective 11

Teaching methods

Follow-up

To have an understanding of
the identification, evaluationand control of risk factors inwork and wider environments

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Large professional assembly
Theoretical studies

Intermediate objective 12

Teaching methods

Follow-up

To have an understanding ofwork environment and healthand safety legislation, and ofother applicable legislation

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Theoretical studies

Communicative competenceIntermediate objective 13

Teaching methods

Follow-up

To be capable of dialogue andopen contact with patients andtheir next of kin

Clinical work under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Intermediate objective 14

Teaching methods

Follow-up

To be capable of communication, both oral and written, withother doctors and co-workers

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Teamwork under supervision

Intermediate objective 15

Teaching methods

Follow-up

To be capable of informing
and instructing patients, theirnext of kin, other doctors, coworkers, and students, as wellas the various groups in working life and the general public

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Instruction under supervision

Leadership competenceIntermediate objective 16

Teaching methods

Follow-up

To be capable of mentoringother doctors and co-workers,
as well as students

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Mentoring under supervisionIntermediate objective 17

Teaching methods

Follow-up

To be capable of leading using
collaboration and dialogue
with co-workers as well as in a
team

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Teamwork under supervisionIntermediate objective 18

Teaching methods

Follow-up

To have an understanding of
the organisation, management,
and regulatory systems ofhealth care, as well as of public authorities and organisations within the environmentand health sectors

CourseCertificate of successfullycompleted course, issued bycourse leader

Intermediate objective 19

Teaching methods

Follow-up

To be capable of a medicallyscientific outlook and approach

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Written individual work under
supervision according toscientific principles

Certificate of approved written
individual work, issued bycurrent mentor

SeminarIntermediate objective 20

Teaching methods

Follow-up

To have an understanding ofresearch methods, including
basic concepts of epidemiology, and of methods for evidence-based medicine and thereview of scientific information

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Written individual work under
supervision according toscientific principles

Certificate of approved written
individual work, issued bycurrent mentor

SeminarIntermediate objective 21

Teaching methods

Follow-up

To have an understanding of,and competence in, evidencebased improvement and quality work

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Quality and development work
under supervision

Certificate of quality and development work, issued bycurrent mentorDermatology and venereology

Introduction
Explanation of terms
General definition of competencies
Definition of area of competence
Competence requirements
Competence requirements for medical competence
Competence requirements for communicative competence, leadershipcompetence, and competence within medical science and quality work
Training structure
Special recommendations
Intermediate objectives
Medical competenceCommunicative competence
Leadership competence
Competence within medical science and quality work

Introduction

On June 24, 2008, The National Board of Health and Welfare (Socialstyrelsen) decided to issue new regulations and general guidelines for doctors’
specialist medical training (SOSFS 2008:17). The statute consists of a general part with common provisions for all specialties and a specific part withall the descriptions of objectives. The description of objectives for the respective specialties should be understood against the background of the provisions in the general part.
In each description of objectives, there is a section headed ‘Training
structure’ which constitutes general guidelines. The teaching methods under
the heading ‘Intermediate objectives’ where no follow-up is indicated also
constitute general guidelines.

Explanation of terms

current mentor
a specialist doctor whose specialist competence corresponds to the area ofcompetence indicated by the intermediate objective, and who is responsible
for ST doctors’s professional development during the teaching period or forthe method of teaching indicatedthe assignment as a mentor for an ST doctor generally encompasses the entire period of specialist training but can also encompass part or parts of it
auscultation
during mentoring, and in accordance with a pre-designed programme, tostudy the profession of a specialist doctor or other health care staff by following one or several professionals, as well as carrying out assignments in
the relevant area to a certain extent
evaluate
to form a sound opinion of a patient or similar person as a basis for further
management
masterbeing fully able to evaluate and handle the medical investigation, diagnostics, treatment, and follow-up of a patient or similar person, and being fully
able to use the techniques relevant to the area
capability
personal capacity to execute or perform a task
h a ve u n d ers tan d i ng
having acquired knowledge and insight into an area through theoretical studies and/or practical exercise of the profession
have knowledge
having acquired some knowledge in an area through theoretical studies
and/or practical exercise of the profession
mentoring under supervision
as an ST doctor, mentor a co-worker while simultaneously being mentored
by a doctor with specialist competencementorcontinuously, and in dialogue form, supporting and guiding, as well as evaluating, a co-worker’s professional development
mentoringsee mentor
handleto actively carry out measures regarding investigation, diagnostics, treatment, and follow-up of a patient or similar person, and have overall responsibility for carrying out these measuresinitially handle
as the primary physician in charge, to actively carry out measures regarding
investigation, diagnostics, treatment, and follow-up of a patient or similar
person, and have overall responsibility for carrying out these measuresinitially evaluate
as the primary physician in charge, to form a sound opinion of a patient orsimilar person as a basis for further management
intraprofessional group reflection
reflection done in a group together with other doctors, chiefly for the purpose of further education and training
clinical service
health and medical care duties that ST doctors perform under their own professional liability and with the support of a mentor
courseteacher-led training with an established plan, given during a defined periodof timesitting-in
training activity involving an ST doctor observing when a specialist doctor
or other health care staff holds a consultationorassessment activity involving a specialist doctor or other health care staff
observing and evaluating ST doctors during a consultation
seminarinstruction in group form with active participation
training in a simulated environment
training carried out in an environment created to emulate reality

large professional assembly
conference, congress, symposium or similar event
health care centre
health care unit in primary carehealth care team work
work where ST doctors, under supervision, participates in and sometimes
leads a group of co-operating health care staff with various competencies
charged with responsibility for care for an individual patient or group ofpatients

General definition of competence

Definition of area of competence
The specialty of dermatology and venereology encompasses in-depth
knowledge of aetiology, pathomechanisms, epidemiology, investigation,
diagnostics, treatment, follow-up and rehabilitation of skin and venereal
diseases in children and adults. This also includes preventive measuresagainst the emergence and spread of such diseases.
The specialty covers treatment of both acute and chronic diseases in patients of all ages. Diagnostics are largely based on case history and clinicalexamination, supplemented with histopathological, physiological, chemical,
microbiological, allergological, immunological and genetic examinations.
Treatment methods comprise drugs, light and surgery. Contact tracing, psychosocial measures, and prevention play essential roles.
Knowledge of how skin and venereal diseases affect the individual andsociety is important, as is the capability of collaborating with other professional groups in health care, social services, the Social Insurance Office,public authorities in occupational care, occupational health care, and primary care. Further, collaboration with other specialties is necessary.

Competence requirements
Competence requirements for medical competenceSpecialist competence in dermatology and venereology requires all-round,broad knowledge of skin biology, epidemiology, pathophysiology, and of
diagnostics and treatment of diseases of the skin and genitals. Another requirement is a good level of practical skill in the majority of existing examination and treatment methods.
Further, the specialist must be able independently to manage psoriasis,eczema, skin tumours, dyshidrosis, other autoimmune diseases of the skinand photodermatoses, age-related skin complaints, skin infections, varicose
ulcers and vascular diseases, drug allergies and urticaria, occupation-relatedskin problems, skin manifestations in inflammatory system diseases, internal diseases, mental illness, the most common genetic dermatoses, andsexually transmitted infections including initial handling of HIV infection.
Specialist competence further requires good knowledge and experience of
medical conditions on the borders of other specialties, including experienceof consulting work in a hospital, current legislation on infectious disease
prevention and control and current social insurance legislation, as well as
being informed about rare skin diseases, advanced diagnostic and operative
methods, and about the socio-economic aspects of skin and venereal diseases. Finally, in-depth knowledge of the opportunities for preventing disease and injury is required.

Competence requirements for communicative competence,leadership competence, and competence within medical science and quality work
Communicative competence
The equal and responsible patient
Doctors with specialist competence must be capable of dialogue and of
maintaining open contact with patients and their next of kin. Contact must
be characterised by empathy and trust, as well as respect for patients’ rightto information, influence, and participation in decisions. Contact should also
be characterised by co-operation and sensitivity to the patients’ needs, desires and right to self-determination, as well as providing incentive for patients’ involvement in, and responsibility for, their own care.
Multicultural and gender aspects
Communication with patients and their next of kin should be characterisedby understanding and respect for cross-cultural and multicultural aspects
such as age, language, ethnicity, sexual orientation and religion, as well as
gender.
Interprofessional relations
Doctors with specialist competence must be capable of communicating,both in writing and orally, with other doctors and co-workers showing respect for their professional knowledge and competences. The same applies
to contact with representatives of the public and various civil authorities.
Pedagogical skills
Doctors with specialist competence must have pedagogical capability inorder to inform and instruct not only patients and their next of kin, but also
other doctors and co-workers, as well as students.
Professional approach and ethics
Doctors with specialist competence must be capable of working continuously with their professional and medical ethical approaches, with the objective of being able to make independent decisions of a medical ethical nature.
Individual professional development
Doctors with specialist competence must be capable of continually examining and identifying their own needs for professional development, in addition to operational requirements, in order to be able to meet requirements forthe best possible patient care.

Leadership competence
Collaboration
Doctors with specialist competence must have a developed capability for
self-knowledge and an understanding of their own functions and roles in theorganisation.
Mentoring skills
Doctors with specialist competence must be capable of mentoring other doctors and co-workers, as well as students.
Leadership
Doctors with specialist competence must be capable of leadership characterised by collaboration, openness, and dialogue with co-workers. Leadershipmust further be characterised by participation and activity development
aimed at improvement. The ability to lead the work of the health care teamis essential.
System knowledge
Doctors with specialist competence must have an understanding of the organisation, administration, finances, and regulatory systems of health care,
as well as its governance, in order to make the best use of resources.

Competence within medical science and quality work
Medical science
Doctors with specialist competence must be capable of adopting a medicallyscientific outlook and approach, and must have knowledge of researchmethodology, including basic epidemiological concepts, as well as of methods for evidence-based medicine and review of scientific information.
Improvement and quality work
Doctors with specialist competence must have understanding of, and competence in, evidence-based improvement and quality work. The objective is
to be able to initiate, participate in, and be responsible for continuous systematic improvement work with emphasis on a holistic perspective, patient
safety, patient benefit, measurability, and teaching management in order tobe able to critically review and evaluate their own operations.
Public health and prevention
Doctors with specialist competence must have an understanding of the factors determining health, other aspects of public health, and methods forpromoting health and efforts aimed at preventing injury and illness, in order
to be able to take this understanding into account in medical scientific work.

Training structure
The service should be planned in such a way that ST doctors initially havethe opportunity of evaluating most patients in close consultation with a specialist. In the outpatient placement, particular emphasis should be placed on
training in skin surgery. The specialist medical training service should also
include clinical service in dermatological inpatient care, in order to meet thetraining requirements regarding investigation and treatment of rare and serious conditions, advanced treatment methods, and familiarity with conditions
within internal medicine. It is suitable for the inpatient placement to fall
during the first half of clinical service.
The second half of clinical service should include placement at a unit
where occupational medicine or occupational dermatology is practised.
It is important that ST doctors continually be given opportunities to train
in the skill of making independent evaluations as a hospital consultant
throughout the training programme.
Theoretical studies should be pursued in parallel with the clinical service.
ST doctors should also participate in supplementary training in the form ofcourses and conferences. Training may be supplemented with simultaneous
additional training through service in adjacent fields of knowledge: internal
medicine, surgery, infection, rheumatology or pathology. Courses in histopathology and dermatoscopy, dermatological surgery, STI and dermatology
in adjacent fields should be included, as should courses in occupational skinand sores, and skin and psyche.

Special recommendations
The specialty associations and sections of the medical organisations haveformulated special recommendations for their own specialties. The recommendations concern such issues as how specialist medical training should be
structured.

Intermediate objectives

Medical competenceIntermediate objective 1

Teaching methods

Follow-up

To have an understanding of
the skin’s basic biology, pathophysiology and morphology

SeminarIntermediate objective 2

Teaching methods

To have an understanding of
the occurrence and distributionof the various dermatologicaland venereal diseases in the
population

SeminarIntermediate objective 3

Teaching methods

Follow-up

To master dermatological andvenereological examination
techniques and terminology

Clinical service under supervision in a unit that handles
these conditions

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Theoretical studies

Follow-up

Theoretical studies

Theoretical studies

Intermediate objective 4

Teaching methods

Follow-up

To master common and frequently occurring dermatological and venereal diseases

Clinical service under supervision in a unit that handles
these conditions

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Large professional assembly
Theoretical studies

Intermediate objective 5

Teaching methods

Follow-up

To be able to manage histopathological opinions and to havean understanding of dermatopathology

Clinical service under supervision in a unit that handles
these issues

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Theoretical studies

Intermediate objective 6

Teaching methods

Follow-up

To be able to handle immunological diagnostics and to havean understanding of the immunological and inflammatory
processes in skin diseases

Clinical service under supervision in a unit that handles
these conditions

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Theoretical studies

Intermediate objective 7

Teaching methods

Follow-up

To master diagnostics andtreatment, including skin surgery, of common and important skin tumours and vascular
deformities

Clinical service under supervision in a unit that handles
these conditions

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Theoretical studies

Intermediate objective 8

Teaching methods

Follow-up

To master pathophysiology,
diagnostics, and therapy as
regards the healing of wounds

Clinical service under supervision in a unit that handles
these conditions

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Theoretical studies

Intermediate objective 9

Teaching methods

Follow-up

To master local and systemtreatment, including phototherapy, for dermatological conditions

Clinical service under supervision in a unit that handles
these conditions

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Theoretical studies

Intermediate objective 10

Teaching methods

Follow-up

To master sexually transmitted
infections, common and frequently occurring genital dermatoses, and proficiency inmicrobiological diagnostics

Clinical service under supervision in a unit that handles
these conditions

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Theoretical studies

Intermediate objective 11

Teaching methods

Follow-up

To be able to handle workrelated skin diseases, including the adaptation of workroutines, rehabilitation andmedico-actuarial science incooperation

Clinical service under supervision in a unit that handles
these conditions

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Theoretical studies

Intermediate objective 12

Teaching methods

Follow-up

To be able to initially manage
common conditions in adjacent fields of knowledge

Clinical service under supervision in a unit that handles
these conditions

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Communicative competenceIntermediate objective 13

Teaching methods

Follow-up

To be capable of dialogue andopen contact with patients andtheir next of kin

Clinical work under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Intermediate objective 14

Teaching methods

Follow-up

To be capable of communication, both oral and written, withother doctors and co-workers

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Intermediate objective 15

Teaching methods

Follow-up

To be capable of informing
and instructing patients, nextof kin, other doctors, and coworkers, as well as students

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Instruction under supervision

Leadership competenceIntermediate objective 16

Teaching methods

Follow-up

To be capable of mentoringother doctors and co-workers,
as well as students

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Mentoring under supervision

Intermediate objective 17

Teaching methods

Follow-up

To be capable of leading using
collaboration and dialogue
with co-workers as well as
within the health care team

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Intermediate objective 18

Teaching methods

Follow-up

To have an understanding of
the organisation, management,
and regulatory systems ofhealth care

CourseCertificate of successfullycompleted course, issued bycourse leader

Competence within medical science and quality
work
Intermediate objective 19

Teaching methods

Follow-up

To be capable of a medicallyscientific outlook and approach

Written individual work under
supervision according toscientific principles

Certificate of approved written
individual work, issued bycurrent mentor

Intermediate objective 20

Teaching methods

Follow-up

To have an understanding of,and competence in, evidencebased improvement and quality work

Quality and development work
under supervision

Certificate of quality and development work

Intermediate objective 21

Teaching methods

Follow-up

To have an understanding of
measures to prevent disease

Clinical service under supervision in a unit that handles
these issues

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Rheumatology

Introduction
Explanation of terms
General definition of competencies
Definition of area of competence
Competence requirements
Competence requirements for medical competence
Competence requirements for communicative competence, leadershipcompetence, and competence within medical science and quality work
Training structure
Special recommendations
Intermediate objectives
Medical competenceCommunicative competence
Leadership competence
Competence within medical science and quality work

Introduction

On June 24, 2008, The National Board of Health and Welfare (Socialstyrelsen) decided to issue new regulations and general guidelines for doctors’
specialist medical training (SOSFS 2008:17). The statute consists of a general part with common provisions for all specialties and a specific part withall the descriptions of objectives. The description of objectives for the respective specialties should be understood against the background of the provisions in the general part.
In each description of objectives, there is a section headed ‘Training
structure’ which constitutes general guidelines. The teaching methods under
the heading ‘Intermediate objectives’ where no follow-up is indicated also
constitute general guidelines.

Explanation of terms

current mentor
a specialist doctor whose specialist competence corresponds to the area ofcompetence indicated by the intermediate objective, and who is responsible
for ST doctors’s professional development during the teaching period or forthe method of teaching indicatedthe assignment as a mentor for an ST doctor generally encompasses the entire period of specialist training but can also encompass part or parts of it
auscultation
during mentoring, and in accordance with a pre-designed programme, tostudy the profession of a specialist doctor or other health care staff by following one or several professionals, as well as carrying out assignments in
the relevant area to a certain extent
evaluate
to form a sound opinion of a patient or similar person as a basis for further
management
masterbeing fully able to evaluate and handle the medical investigation, diagnostics, treatment, and follow-up of a patient or similar person, and being fully
able to use the techniques relevant to the area
capability
personal capacity to execute or perform a task
h a ve u n d ers tan d i ng
having acquired knowledge and insight into an area through theoretical studies and/or practical exercise of the profession
have knowledge
having acquired some knowledge in an area through theoretical studies
and/or practical exercise of the profession
mentoring under supervision
as an ST doctor, mentor a co-worker while simultaneously being mentored
by a doctor with specialist competencementorcontinuously, and in dialogue form, supporting and guiding, as well as evaluating, a co-worker’s professional development
mentoringsee mentor
handleto actively carry out measures regarding investigation, diagnostics, treatment, and follow-up of a patient or similar person, and have overall responsibility for carrying out these measuresinitially handle
as the primary physician in charge, to actively carry out measures regarding
investigation, diagnostics, treatment, and follow-up of a patient or similar
person, and have overall responsibility for carrying out these measuresinitially evaluate
as the primary physician in charge, to form a sound opinion of a patient orsimilar person as a basis for further management
intraprofessional group reflection
reflection done in a group together with other doctors, chiefly for the purpose of further education and training
clinical service
health and medical care duties that ST doctors perform under their own professional liability and with the support of a mentor
courseteacher-led training with an established plan, given during a defined periodof timesitting-in
training activity involving an ST doctor observing when a specialist doctor
or other health care staff holds a consultationorassessment activity involving a specialist doctor or other health care staff
observing and evaluating ST doctors during a consultation
seminarinstruction in group form with active participation
training in a simulated environment
training carried out in an environment created to emulate reality

large professional assembly
conference, congress, symposium or similar event
health care centre
health care unit in primary carehealth care team work
work where ST doctors, under supervision, participates in and sometimes
leads a group of co-operating health care staff with various competencies
charged with responsibility for care for an individual patient or group ofpatients

General definition of competence

Definition of area of competence

The specialty of rheumatology encompasses knowledge and skills concerning
medical diseases of the motor organs and systemic inflammatory and autoimmune
diseases in adults. The area of competence comprises both inflammatory and noninflammatory conditions of the motor organs, but the specialty deals principallywith inflammatory diseases in and outside of the joints.
These diseases may be acute and temporary in character, recurring, or may develop into chronic conditions. Both disease and treatment sometimes require follow-up over an extended period of time due to risk of relapse and complications.
Diagnostics are done above all through medical history and status, in combination
with immunological, imaging and laboratory methods. Treatment often includes
both immune modulation and pain relief, frequently in combination with physicaltraining.
Rheumatic diseases can afflict people of all ages, and often affect their situationand quality of life considerably. The specialty is characterised by long-term, patient-centred cooperation with other specialties and professional expertise.

Competence requirements
Competence requirements for medical competenceSpecialist competence in rheumatology requires knowledge and skills allowing the specialist to carry out independent work. The requirements comprise knowledge of aetiology, immunology, pathology, investigation, diagnostics, treatment, evaluation and follow-up of acute and chronic inflammatory joint and back illnesses, inflammatory system diseases and vasculitis.
The medial specialist must also be able to manage non-inflammatory illnesses of the joints and soft parts in terms of diagnostics and initial treatment.
The depth of knowledge must be greatest for inflammatory rheumatic illnesses and must reflect occurrence and severity in terms of morbidity andmortality. Knowledge of those organ systems that may be affected in case ofrheumatic illness, and how to examine them, is also required. In particular,
knowledge of the anatomy and pathology of the motor organs is required.
The medical specialist must further be able to carry out and interpret detailed joint and back examinations, and be able to show practical knowledgeof joint injection techniques. Knowledge of immunological and inflammatory processes against the background of the pathophysiology of rheumatic
illnesses is also required. Additionally, knowledge of the mechanisms ofaction, indications, effects and side effects of drugs used in rheumatology isrequired.
In order to be able to take care of complications of rheumatic illnesses
and carry out differential diagnostics with other specialties, the medical specialist must be able to initially handle common conditions in adjacent fields

of knowledge. It is of particular importance that the medical specialist isable to handle acute internal medicine conditions.
As the majority of rheumatic illnesses are chronic, expertise is also required in managing patients with long-term illnesses with a holistic perspective that includes both psychosocial and medical aspects. This means that
ST doctors are familiar with the rheumatology team’s areas of competence
and with current rehabilitation methods, and that they have an understandingof the treatment possibilities in surgical rheumatology. Further, experienceof cooperating with the Social Insurance Office, the Employment Service
and other stakeholders significant for the patient’s health is required.

Competence requirements for communicative competence,leadership competence, and competence within medical science and quality work
Communicative competence
The equal and responsible patient
Doctors with specialist competence must be capable of dialogue and of
maintaining open contact with patients and their next of kin. Contact must
be characterised by empathy and trust, as well as respect for patients’ rightto information, influence, and participation in decisions. Contact should also
be characterised by co-operation and sensitivity to the patients’ needs, desires and right to self-determination, as well as providing incentive for patients’ involvement in, and responsibility for, their own care.
Multicultural and gender aspects
Communication with patients and their next of kin should be characterisedby understanding and respect for cross-cultural and multicultural aspects
such as age, language, ethnicity, sexual orientation and religion, as well as
gender.
Interprofessional relations
Doctors with specialist competence must be capable of communicating,both in writing and orally, with other doctors and co-workers showing respect for their professional knowledge and competences. The same applies
to contact with representatives of the public and various civil authorities.
Pedagogical skills
Doctors with specialist competence must have pedagogical capability inorder to inform and instruct not only patients and their next of kin, but also
other doctors and co-workers, as well as students.

Professional approach and ethics
Doctors with specialist competence must be capable of working continuously with their professional and medical ethical approaches, with the objective of being able to make independent decisions of a medical ethical nature.
Individual professional development
Doctors with specialist competence must be capable of continually examining and identifying their own needs for professional development, in addition to operational requirements, in order to be able to meet requirements forthe best possible patient care.

Leadership competence
Collaboration
Doctors with specialist competence must have a developed capability for
self-knowledge and an understanding of their own functions and roles in theorganisation. Mentoring skills Doctors with specialist competence must be
capable of mentoring other doctors and co-workers, as well as students.
Leadership
Doctors with specialist competence must be capable of leadership characterised by collaboration, openness, and dialogue with co-workers. Leadershipmust further be characterised by participation and activity development
aimed at improvement. The ability to lead the work of the health care teamis essential.
System knowledge
Doctors with specialist competence must have an understanding of the organisation, administration, finances, and regulatory systems of health care,
as well as its governance, in order to make the best use of resources.

Competence within medical science and quality work
Medical science
Doctors with specialist competence must be capable of adopting a medicallyscientific outlook and approach, and must have knowledge of researchmethodology, including basic epidemiological concepts, as well as of methods for evidence-based medicine and review of scientific information.
Improvement and quality work
Doctors with specialist competence must have understanding of, and competence in, evidence-based improvement and quality work. The objective is
to be able to initiate, participate in, and be responsible for continuous systematic improvement work with emphasis on a holistic perspective, patientsafety, patient benefit, measurability, and teaching management in order tobe able to critically review and evaluate their own operations.
Public health and prevention
Doctors with specialist competence must have an understanding of the factors determining health, other aspects of public health, and methods forpromoting health and efforts aimed at preventing injury and illness, in order
to be able to take this understanding into account in medical scientific work.

Training structure
The clinical part of the training programme is based mainly on clinical service at a nursing ward and health centre where rheumatology care is practised. Initially, clinical service should be planned such that ST doctors acquire knowledge of the most common illnesses within the specialty. It istherefore best if the the first placement is in rheumatology. Early on in the
training programme, ST doctors should also be introduced to working inrheumatological outpatient care, and should acquire skills in joint and backexamination techniques, as well as injection technique.
In order to meet the training requirement regarding investigation andtreatment of rare rheumatological illnesses and advanced treatment methods,
it is important to have an extended and uninterrupted period of service ininpatient care at a regional or university hospital. It is suitable for this period
to come at the end of the training programme. During training, ST doctors
should also be given the opportunity of taking part in rheumatological consultancy in primary care or the equivalent.
Simultaneous additional training and courses should be chosen so thatthey are relevant for the panorama of rheumatological illness. Simultaneous
additional training should include clinical service at an internal medicine
emergency ward. Other suitable clinical service areas include internal medicine and its branch specialties, infectious diseases, neurology, skin diseases,
clinical immunology, medical rehabilitation, orthopaedic surgery and handsurgery. It is an advantage if the supplementary training in medical rehabilitation, orthopaedic surgery and hand surgery is done as part the placement at
a rheumatological clinic, if the clinic has its own rehabilitation resources
and if evaluations are done together with an orthopedist and a hand surgeon,
respectively.
ST doctors should acquire theoretical knowledge through relevant textbooks, scientific journals and courses planned in concert with the clinicalservice. A scientific approach, with medical literature studies, should be
introduced early and continue throughout the training programme. Additionally, courses on inflammatory joint illnesses and basic inflammation andimmune reactions should come early in the training. ST doctors should also
be given the opportunity of participating in an international congress during
the training programme.

Special recommendations
The specialty associations and sections of the medical organisations haveformulated special recommendations for their own specialties. The recommendations concern such issues as how specialist medical training should be
structured.

Intermediate objectives

Medical competenceIntermediate objective 1

Teaching methods

Follow-up

To master the investigation,
diagnostics, treatment andfollow-up of acute and chronic
inflammatory joint and backillnesses in adults

Clinical service under supervision in a unit that handles
these conditions

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Large professional assembly
Sitting-in
Theoretical studies

Intermediate objective 2

Teaching methods

Follow-up

To master investigation, diagnostics, treatment, and followup of the most commonly occurring acute and chronic
inflammatory system diseases
and vasculitis in adults

Clinical service under supervision in a unit that handles
these conditions

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Large professional assembly
Sitting-in
Theoretical studies

Intermediate objective 3

Teaching methods

Follow-up

To be able to initially handle
rheumatological system diseases and to have an understanding of their long-term
management

Clinical service under supervision in a unit that handles
these conditions

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Theoretical studies

Intermediate objective 4

Teaching methods

Follow-up

To master detailed joint andback examination, and injection technique

Clinical service under supervision in a unit that handles
these conditions

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Sitting-in
Theoretical studies

Intermediate objective 5

Teaching methods

Follow-up

To master differential diagnostics and initial handling of other illnesses with symptoms
and findings from the motor
apparatus

Clinical service under supervision in a unit that handles
these conditions

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Theoretical studies

Intermediate objective 6

Teaching methods

Follow-up

To master indications, effects
and side effects, and to havean understanding of mechanisms of action and interaction
for drugs used in rheumatology

Clinical service under supervision in a unit that treatsthese conditions

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Seminar
Theoretical studies

Intermediate objective 7

Teaching methods

Follow-up

To be able to handle patientswith long-term rheumatic illness with a holistic outlook,including both psychosocialand medical consequences

Clinical service under supervision in a unit that handles
these conditions

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Health care team work under
supervision
Theoretical studies

Intermediate objective 8

Teaching methods

Follow-up

To have an understanding of
the immunological and inflammatory processes inrheumatic illness, and to beable to handle immunologicaldiagnostics

Clinical service under supervision at a unit that handles
these conditions

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

ororauscultation under supervision at a unit that handles
these conditions

Coursecertificate of successfullycompleted auscultation andcompetence achieved, issued
by current mentor
Certificate of successfullycompleted course, issued bycourse leader

Diagnostics and treatment
conference
Theoretical studies

Intermediate objective 9

Teaching methods

Follow-up

To be able to evaluate indications and results of imaging,physiological and laboratory
diagnostics

Clinical service under supervision at a unit that handles
these conditions

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

ororauscultation under supervision at a unit that handles
these conditions

Diagnostics and treatment
conference
Theoretical studies

certificate of successfullycompleted auscultation andcompetence achieved, issued
by current mentor

Intermediate objective 10

Teaching methods

Follow-up

To be able to evaluate theneed for rheumatological rehabilitation and surgical rheumatology

Clinical service under supervision at a unit that handles
these conditions

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

ororauscultation under supervision at a unit that handles
these conditions

certificate of successfullycompleted auscultation andcompetence achieved, issued
by current mentor

Health care teamwork under
supervision
Diagnostics and treatment
conference
Sitting-in

Intermediate objective 11

Teaching methods

Follow-up

To be able to initially handle
acute medical conditions within internal medicine

Clinical service under supervision in a unit that handles
these conditions

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leaderorseminarTraining in a simulated environment
Theoretical studies

Intermediate objective 12

Teaching methods

Follow-up

To be able to initially handle
common conditions in adjacent fields of knowledge

Clinical service under supervision in a unit that treatsthese conditions

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Seminar
Theoretical studies

Communicative competenceIntermediate objective 13

Teaching methods

Follow-up

To be capable of dialogue andopen contact with patients andtheir next of kin

Clinical work under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Sitting-in

Intermediate objective 14

Teaching methods

Follow-up

To be capable of communication, both oral and written, withother doctors and co-workers

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Intermediate objective 15

Teaching methods

Follow-up

To be capable of informing
and instructing patients, nextof kin, other doctors, and coworkers, as well as students

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Instruction under supervision

Leadership competenceIntermediate objective 16

Teaching methods

Follow-up

To be capable of mentoringother doctors and co-workers,
as well as students

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Mentoring under supervision

Intermediate objective 17

Teaching methods

Follow-up

To be capable of leading using
collaboration and dialogue
with co-workers as well as
within the health care team

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Health care teamwork under
supervisionIntermediate objective 18

Teaching methods

Follow-up

To have an understanding of
the organisation, management,
and regulatory systems ofhealth care

CourseCertificate of successfullycompleted course, issued bycourse leader

Competence within medical science and quality
work
Intermediate objective 19

Teaching methods

Follow-up

To be capable of a medicallyscientific outlook and approach

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Written individual work under
supervision according toscientific principles

Certificate of approved written
individual work, issued bycurrent mentor

Intermediate objective 20

Teaching methods

Follow-up

To have an understanding of,and competence in, evidencebased improvement and quality work

Quality and development work
under supervision

Certificate of quality and development work, issued bycurrent mentor
SeminarSocial medicine

Introduction
Explanation of terms
General definition of competencies
Definition of area of competence
Competence requirements
Competence requirements for medical competence
Competence requirements for communicative competence, leadershipcompetence, and competence within medical science and quality work
Training structure
Special recommendations
Intermediate objectives
Medical competenceCommunicative competence
Leadership competence
Competence within medical science and quality work

Introduction

On June 24, 2008, The National Board of Health and Welfare (Socialstyrelsen) decided to issue new regulations and general guidelines for doctors’
specialist medical training (SOSFS 2008:17). The statute consists of a general part with common provisions for all specialties and a specific part withall the descriptions of objectives. The description of objectives for the respective specialties should be understood against the background of the provisions in the general part.
In each description of objectives, there is a section headed ‘Training
structure’ which constitutes general guidelines. The teaching methods under
the heading ‘Intermediate objectives’ where no follow-up is indicated also
constitute general guidelines.

Explanation of terms

current mentor
a specialist doctor whose specialist competence corresponds to the area ofcompetence indicated by the intermediate objective, and who is responsible
for ST doctors’s professional development during the teaching period or forthe method of teaching indicatedthe assignment as a mentor for an ST doctor generally encompasses the entire period of specialist training but can also encompass part or parts of it
auscultation
during mentoring, and in accordance with a pre-designed programme, tostudy the profession of a specialist doctor or other health care staff by following one or several professionals, as well as carrying out assignments in
the relevant area to a certain extent
evaluate
to form a sound opinion of a patient or similar person as a basis for further
management
masterbeing fully able to evaluate and handle the medical investigation, diagnostics, treatment, and follow-up of a patient or similar person, and being fully
able to use the techniques relevant to the area
capability
personal capacity to execute or perform a task
h a ve u n d ers tan d i ng
having acquired knowledge and insight into an area through theoretical studies and/or practical exercise of the profession
have knowledge
having acquired some knowledge in an area through theoretical studies
and/or practical exercise of the profession
mentoring under supervision
as an ST doctor, mentor a co-worker while simultaneously being mentored
by a doctor with specialist competencementorcontinuously, and in dialogue form, supporting and guiding, as well as evaluating, a co-worker’s professional development
mentoringsee mentor
handleto actively carry out measures regarding investigation, diagnostics, treatment, and follow-up of a patient or similar person, and have overall responsibility for carrying out these measuresinitially handle
as the primary physician in charge, to actively carry out measures regarding
investigation, diagnostics, treatment, and follow-up of a patient or similar
person, and have overall responsibility for carrying out these measuresinitially evaluate
as the primary physician in charge, to form a sound opinion of a patient orsimilar person as a basis for further management
intraprofessional group reflection
reflection done in a group together with other doctors, chiefly for the purpose of further education and training
clinical service
health and medical care duties that ST doctors perform under their own professional liability and with the support of a mentor
courseteacher-led training with an established plan, given during a defined periodof timesitting-in
training activity involving an ST doctor observing when a specialist doctor
or other health care staff holds a consultationorassessment activity involving a specialist doctor or other health care staff
observing and evaluating ST doctors during a consultation
seminarinstruction in group form with active participation
training in a simulated environment
training carried out in an environment created to emulate reality

large professional assembly
conference, congress, symposium or similar event
health care centre
health care unit in primary carehealth care team work
work where ST doctors, under supervision, participates in and sometimes
leads a group of co-operating health care staff with various competencies
charged with responsibility for care for an individual patient or group ofpatients

General definition of competence

Definition of area of competence
The specialty of social medicine encompasses expertise in the interaction ofpeople’s health and sickness with the surrounding community.
Social medicine is characterised by knowledge of determinant factors forhealth such as social and psychosocial reasons for ill health and disease, thesignificance of the social structure, the environment, the health care systems, working life and people’s living conditions and ways of life for thehealth of different groups, and the distribution of health in the population, as
well as the social consequences of illness. Social medicine also includes
clinical knowledge of widespread diseases, particularly among marginalised
groups.
Such social medicine expertise and skills in epidemiology as well as
health promotion and disease prevention are an important resource in healthand medical care. With a background in health care and medicine, social
medicine contributes expert knowledge of public health efforts and global
health, and the planning, organisation, development and evaluation of healthand medical care, as well as of society’s other sectors.

Competence requirements
Competence requirements for medical competenceSpecialist competence in social medicine requires fundamental knowledge
and skills in the four principal areas of competence in social medicine: epidemiology, health and medical care research, administrative medicine, andpublic health and prevention.
The medical specialist must further be able to independently map, monitor and analyse the health situation and determinant factors for health anddisease in the population; plan, implement and evaluate health promoting
and disease preventive actions; analyse social consequences of disease andill health; analyse and propose measures against inequality in health; andmonitor health development in society’s vulnerable groups; as well as follow and communicate research in the social sciences and medicine onmechanisms for health and disease. In addition to thisthe medical specialist must be able to independently initially manage
common, acute and chronic medical conditions, primarily among marginalised groups.
Further requirements include good knowledge of the management, control, organisation and health orientation of health and medical care, of themethods of health economy and their application, and of social insurance
systems and medico-actuarial science. Some experience of analysing andprioritising health care and rehabilitation needs; of planning and evaluatingthe effect of health care and rehabilitation efforts at the individual, groupand population levels; and of teaching and spreading knowledge in otherforms is also required.
Finally, the medical specialist must have knowledge of or have been involved with research projects concerning epidemiology, health promoting
and preventive actions or health and medical care research, international
cooperation projects on social medicine issues, method development in thearea of competence of social medicine, policy work in health promotion, theworking methods of social services, and the medical conditions of marginalised groups.

Competence requirements for communicative competence,leadership competence, and competence within medical science and quality work

Communicative competence
The equal and responsible patient
Doctors with specialist competence must be capable of dialogue and of
maintaining open contact with patients and their next of kin. Contact must
be characterised by empathy and trust, as well as respect for patients’ rightto information, influence, and participation in decisions. Contact should also
be characterised by co-operation and sensitivity to the patients’ needs, desires and right to self-determination, as well as providing incentive for patients’ involvement in, and responsibility for, their own care.
Multicultural and gender aspects
Communication with patients and their next of kin should be characterisedby understanding and respect for cross-cultural and multicultural aspects
such as age, language, ethnicity, sexual orientation and religion, as well as
gender.
Interprofessional relations
Doctors with specialist competence must be capable of communicating,both in writing and orally, with other doctors and co-workers showing respect for their professional knowledge and competences. The same applies
to contact with representatives of the public and various civil authorities.
Pedagogical skills
Doctors with specialist competence must have pedagogical capability inorder to inform and instruct not only patients and their next of kin, but also
other doctors and co-workers, as well as students.

Professional approach and ethics
Doctors with specialist competence must be capable of working continuously with their professional and medical ethical approaches, with the objective of being able to make independent decisions of a medical ethical nature.
Individual professional development
Doctors with specialist competence must be capable of continually examining and identifying their own needs for professional development, in addition to operational requirements, in order to be able to meet requirements forthe best possible patient care.

Leadership competence
Collaboration
Doctors with specialist competence must have a developed capability for
self-knowledge and an understanding of their own functions and roles in theorganisation.
Mentoring skills
Doctors with specialist competence must be capable of mentoring other doctors and co-workers, as well as students.
Leadership
Doctors with specialist competence must be capable of leadership characterised by collaboration, openness, and dialogue with co-workers. Leadershipmust further be characterised by participation and operational development
aimed at improvement. The ability to lead the work of the health care teamis essential.
System knowledge
Doctors with specialist competence must have an understanding of the organisation, administration, management, finances, and regulatory systems ofhealth care, as well as its governance, in order to make the best use of resources.

Competence within medical science and quality work
Medical science
Doctors with specialist competence must be capable of adopting a medicallyscientific outlook and approach, and must have knowledge of researchmethodology, including basic epidemiological concepts, as well as of methods for evidence-based medicine and review of scientific information.

Improvement and quality work
Doctors with specialist competence must have understanding of, and competence in, evidence-based improvement and quality work. The objective is
to be able to initiate, participate in and lead continuous systematic quality
improvement, emphasising patient and public health utility, patient safety, aholistic perspective and efficiency.
Public health and prevention
Doctors with specialist competence must have an understanding of the factors determining health, other aspects of public health, and methods forpromoting health and efforts aimed at preventing injury and illness, in order
to be able to take this understanding into account in medical scientific work.

Training structure
Theoretical knowledge is mainly to be provided through courses in social
medicine and public health science, with a qualification equivalent to a Master’s degree. ST doctors will acquire practical skills in social medicine bymeans of supervised clinical service in the four principal areas of competence of the specialty: epidemiology, health and medical care research, administrative medicine, and public health and prevention.
It is recommended that the training programme be completed mainly at asocial medicine unit or equivalent, and that it be suitably interspersed with
the necessary theoretical training and with clinical service involving patientcare within specialties that deal with widespread diseases and the illnessesof marginalised groups, both in inpatient and outpatient care.
It is recommended that ST doctors begin clinical service at a social medicine unit, while attending courses in fundamental subjects of the specialty inparallel.
After this, ST doctors can carry out an independent project in the publichealth area, at a level equivalent to a Master’s degree. Clinical service involving patient care should be done in parallel with this. ST doctors should
then continue his or her clinical service at a social medicine unit, interspersed with courses.
Further work is then done at a social medicine unit, interspersed withcourses in leadership and communication, and clinical service involving
patient care.
The training programme ideally ends with clinical service involving patient care.

Special recommendations
The specialty associations and sections of the medical organisations haveformulated special recommendations for their own specialties. The recommendations concern such issues as how specialist medical training should be
structured.

Intermediate objectives

Medical competenceIntermediate objective 1

Teaching methods

Follow-up

To master mapping and analysis of the health situation anddeterminant factors for healthand disease in the population

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Intermediate objective 2

Teaching methods

Follow-up

To master analysing the causes of health inequality, and to
be able to manage measuresagainst health inequality

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Intermediate objective 3

Teaching methods

Follow-up

To master health development
in society’s marginalised
groups, and to have knowledge of the work and methods of social services

Auscultation under supervision at a unit where suchoperations are practised

Certificate of successfullycompleted course, issued bycourse leader

CourseIntermediate objective 4

Teaching methods

Follow-up

To master the application ofhealth economy methods, andto have an understanding of
the management, control andorganisation of health andmedical care

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Intermediate objective 5

Teaching methods

Follow-up

To be able to handle quality
improvement aimed at making
health and medical care betterat promoting health

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Intermediate objective 6

Teaching methods

Follow-up

To master the application of
the social insurance system
and medico-actuarial science,and to have an understandingof the social consequences of
disease and ill health

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Intermediate objective 7

Teaching methods

Follow-up

To master the planning, implementation, and evaluation ofhealth promoting actions at theindividual, group and society
levelsClinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Intermediate objective 8

Teaching methods

Follow-up

To master planning, implementation, and evaluation of preventive actions at the individual, group and society levels

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Intermediate objective 9

Teaching methods

Follow-up

To have knowledge of international social medicine projects

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Intermediate objective 10

Teaching methods

Follow-up

To be able to handle common
acute and chronic medical
conditions, in particular medical problems, in marginalised
groupsClinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Intermediate objective 11

Teaching methods

Follow-up

To master research in social
science, behavioural science,and medicine on mechanismsof health and illness

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Communicative competenceIntermediate objective 12

Teaching methods

Follow-up

To be capable of dialogue andopen contact with patients andtheir next of kin

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Intermediate objective 13

Teaching methods

Follow-up

To be capable of communication, both oral and written, withother doctors and co-workers

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Instruction under supervisionIntermediate objective 14

Teaching methods

Follow-up

To be capable of informing
and instructing patients, nextof kin, other doctors, and coworkers, as well as students

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Instruction under supervisionLeadership competenceIntermediate objective 15

Teaching methods

Follow-up

To be capable of mentoringother doctors and co-workers,
as well as students

Service under supervision in aunit where such operations
are practised

Certificate of successfullycompleted service and competence achieved, issued bycurrent mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Mentoring under supervisionIntermediate objective 16

Teaching methods

Follow-up

To be capable of leading using
collaboration and dialogue
with co-workers as well as
within the health care team

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Health care teamwork under
supervisionIntermediate objective 17

Teaching methods

Follow-up

To have an understanding of
the organisation, management, and regulatory systemsof health care

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Competence within medical science and quality
work
Intermediate objective 18

Teaching methods

Follow-up

To be capable of a medicallyscientific outlook and approach

Service under supervision in aunit where such operations
are practised

Certificate of successfullycompleted service and competence achieved, issued bycurrent mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Written individual work under
supervision according toscientific principles

Certificate of approved written
individual work, issued bycurrent mentor

Intermediate objective 19

Teaching methods

Follow-up

To have an understanding of,and competence in, evidencebased improvement and quality work

CourseCertificate of successfullycompleted course, issued bycourse leader

Quality and development work
under supervision

Certificate of quality and development work, issued bycurrent mentor

Additional specialties

Emergency medicine
Introduction
Explanation of terms
General definition of competencies
Definition of area of competence
Competence requirements
Competence requirements for medical competence
Competence requirements for communicative competence, leadershipcompetence, and competence within medical science and quality work
Training structure
Special recommendations
Intermediate objectives
Medical competenceCommunicative competence
Leadership competence
Competence within medical science and quality work

Introduction

On June 24, 2008, Socialistyrelsen decided to issue new regulations andgeneral guidelines for doctors’ specialist medical training (SOSFS 2008:17).
The statute consists of a general part with common provisions for all specialties and a specific part with all the descriptions of objectives. The description of objectives for the respective specialties should be understoodagainst the background of the provisions in the general part.
In each description of objectives, there is a section headed ‘Training
structure’ which constitutes general guidelines. The teaching methods under
the heading ‘Intermediate objectives’ where no follow-up is indicated also
constitute general guidelines.

Explanation of terms

current mentor
a specialist doctor whose specialist competence corresponds to the area ofcompetence indicated by the intermediate objective, and who is responsible
for ST doctors’s professional development during the teaching period or forthe method of teaching indicatedthe assignment as a mentor for an ST doctor generally encompasses the entire period of specialist training but can also encompass part or parts of it
auscultation
during mentoring, and in accordance with a pre-designed programme, tostudy the profession of a specialist doctor or other health care staff by following one or several professionals, as well as carrying out assignments in
the relevant area to a certain extent
evaluate
to form a sound opinion of a patient or similar person as a basis for further
management
masterbeing fully able to evaluate and handle the medical investigation, diagnostics, treatment, and follow-up of a patient or similar person, and being fully
able to use the techniques relevant to the area
capability
personal capacity to execute or perform a task
h a ve u n d ers tan d i ng
having acquired knowledge and insight into an area through theoretical studies and/or practical exercise of the profession
have knowledge
having acquired some knowledge in an area through theoretical studies
and/or practical exercise of the profession
mentoring under supervision
as an ST doctor, mentor a co-worker while simultaneously being mentored
by a doctor with specialist competencementorcontinuously, and in dialogue form, supporting and guiding, as well as evaluating, a co-worker’s professional development
mentoringsee mentor
handleto actively carry out measures regarding investigation, diagnostics, treatment, and follow-up of a patient or similar person, and have overall responsibility for carrying out these measuresinitially handle
as the primary physician in charge, to actively carry out measures regarding
investigation, diagnostics, treatment, and follow-up of a patient or similar
person, and have overall responsibility for carrying out these measuresinitially evaluate
as the primary physician in charge, to form a sound opinion of a patient orsimilar person as a basis for further management
intraprofessional group reflection
reflection done in a group together with other doctors, chiefly for the purpose of further education and training
clinical service
health and medical care duties that ST doctors perform under their own professional liability and with the support of a mentor
courseteacher-led training with an established plan, given during a defined periodof timesitting-in
training activity involving an ST doctor observing when a specialist doctor
or other health care staff holds a consultationorassessment activity involving a specialist doctor or other health care staff
observing and evaluating ST doctors during a consultation
seminarinstruction in group form with active participation
training in a simulated environment
training carried out in an environment created to emulate reality

large professional assembly
conference, congress, symposium or similar event
health care centre
health care unit in primary carehealth care team work
work where ST doctors, under supervision, participates in and sometimes
leads a group of co-operating health care staff with various competencies
charged with responsibility for care for an individual patient or group ofpatients

General definition of competence

Definition of area of competence
The emergency medicine specialty comprises investigation, diagnostics, andtreatment, as well as follow-up, of acute medical conditions and accidents inall age groups. Emergency medicine comprises the capability of applying
broad differential diagnostic knowledge in a limited time and with limited
background information on the patient, and being able to prioritize and coordinate health care efforts based on the patient’s condition and available
resources.
Furthermore, emergency medicine comprises assessing the risks andbenefits of various management alternativess, as well as multidisciplinary
collaboration with other specialties and professions within the health careorganisation. Emergency medicine also includes pre-hospital work, leading
health care efforts in situations where the need for health care initially exceeds the available resources, and preventive work through epidemiologicalknowledge. Emergency medicine is an additional specialty to base specialties in accordance with Chapter 5, Section 2 or 3 of the regulations.

Competence requirements
Competence requirements for medical competence
The capability of being able to identify, prioritise, stabilise, and treat patients with unstable vital functions and life-threatening acute medical conditions, both pre-hospital and in hospital, is required for specialist competencein emergency medicine.
Furthermore, being able to independently prioritize, investigate, andbased on a probability assessment treat patients with acute medical conditions of all ages, and with every foreseeable reason to contact an emergency
ward. Epidemiological knowledge and a capability of working preventively
are required for this. Moreover, the capability of also assessing the risks andbenefits of various management alternativess from a perspective of ethics,
patient safety, and logistics is required.
Being able to plan for the patient’s continued care is also required forspecialist competence in emergency medicine, which means being responsible for medically safe transport and being able to plan follow-up both within
and outside one’s own health care unit. A capability for leadership, communication, and a multidisciplinary work method under stress is further required.
Moreover, specialist competence in a base specialty is required for specialist
competence in emergency medicine in accordance with Chapter 5, Section 2
or 3 of the regulations.

Competence requirements for communicative competence,leadership competence, and competence within medical science and quality work
Communicative competence
The equal and responsible patient
Doctors with specialist competence must be capable of dialogue and of
maintaining open contact with patients and their next of kin. Contact should
be characterised by empathy and trust, as well as respect for the patients’right to information, influence, and participation in decisions. Contact
should also be characterised by co-operation and sensitivity to the patients’needs, desires and right to self-determination, as well as providing incentive
for patients’ involvement in, and responsibility for, their own care.
Multicultural and gender aspects
Communication with patients and their next of kin should be characterisedby understanding and respect for cross-cultural aspects and multicultural
aspects such as age, language, ethnicity, sexual orientation, and religion, as
well as gender.
Interprofessional relations
Doctors with specialist competence must have the ability to communicate,both in writing and orally, with other doctors and co-workers showing respect for their professional knowledge and competencies.
The same applies to contact with representatives of the public and various
civil authorities.
Pedagogical skills
Doctors with specialist competence must have pedagogical capability inorder to inform and instruct not only patients and their next of kin, but also
other doctors and co-workers, as well as students.
Professional approach and ethics
Doctors with specialist competence must be capable of working continuously with their professional and medical ethical approaches, with the objectiveof being able to make independent decisions of a medical ethical nature.
Individual professional development
Doctors with specialist competence must be capable of continually examining and identifying their own needs for professional development, in addition to operational requirements, in order to be able to meet requirements forthe best possible patient care.

Leadership competence
Collaboration
Doctors with specialist competence must have a developed capability for
self-knowledge and understanding of their own functions and roles in theorganisation.
Mentoring skills
Doctors with specialist competence must be capable of mentoring other doctors and co-workers, as well as students.
Leadership
Doctors with specialist competence must be capable of leadership characterised by collaboration, openness, and dialogue with co-workers. Leadershipmust further be characterised by participation and activity development
aimed at improvement. The ability to lead the work of the health care teamis essential.
System knowledge
Doctors with specialist competence must have an understanding of the organisation, administration, finances, and regulatory systems of health care,
as well as its governance, in order to make the best use of resources.

Competence within medical science and quality work
Medical science
Doctors with specialist competence must be capable of adopting a medicallyscientific outlook and approach, and must have knowledge of research methodology, including basic epidemiological concepts, as well as of methods
for evidence-based medicine and review of scientific information.
Improvement and quality work
Doctors with specialist competence must have an understanding of, andcompetence in, evidence-based improvement and quality work. The objective is to be able to initiate, participate in, and be responsible for continuous
systematic improvement work with emphasis on a holistic perspective, patient safety, patient benefit, measurability, and teaching management in order to be able to review and evaluate their own operations.
Public health and prevention
Doctors with specialist competence must have an understanding of the factors determining health, other aspects of public health, and methods forpromoting health and efforts aimed at preventing injury and illness, in order
to be able to take this understanding into account in medical scientific work.

Training structure
Specialist medical training in emergency medicine can begin before, during,or after specialist medical training in the base specialty and can be integrated with it.
It is desirable that specialist medical training constitute a logically clear
and continuous in-service training. The training is to be adapted to the individual doctor’s background.
ST doctors should be trained to identify and handle life-threatening conditions early on in the training. Thereafter, the training should concentrate on
handling patients based on symptoms at presentation with a development of
proficiency in differential diagnostics and probability assessment.
The development of leadership in emergency situations should occur
gradually from leadership in individual patient cases to leadership comprising skill in controlling resources and the flow of patients in the emergency
ward and at the accident site.
The primary competence is best acquired through clinical service in an
emergency ward where the patients are not sorted according to other medical specialties. The service should comprise handling of acutely ill patientsof all ages, with every foreseeable reason to visit an emergency ward. The
unit where most of the service takes place should have round-the-clock operations in connection with intensive care and surgical operations. In orderto achieve competence in emergency medicine, suitable supplementarycross-training within concurrent specialties is desirable where this competence cannot be provided for through the base specialty or within the own
unit.
Theoretical training and self-study should be supplemented with practicaltraining in a simulated hands-on environment and through Sitting-in. ST
doctors can get training in structured care of the gravely ill through, for example, courses that follow the ‘ABCDE’ concept. Courses and exercises inprobability assessment and differential diagnostics as well as triage are also
desirable, as is working pre-hospital and in mass casualty situations. Feedback concerning ethics, leadership, and communication should preferably begiven through Sitting-in and specialist doctor staff meetings.
It is important that time for studies, practical training, courses, and scientificmeetings are continuously integrated into the clinical service. It is furthermore desirable that ST doctors participate in instruction as well as quality,
development, and research projects.

Special recommendations
The specialty associations and sections of the medical organisations haveformulated special recommendations for their own specialties. The recommendations concern such issues as how specialist medical training should be
structured.

Intermediate objectives

Medical competenceIntermediate objective 1

Teaching methods

Follow-up

To master the identificationand handling of severe andpotentially life-threatening
conditions

Clinical service under supervision in a unit that handles
these conditions

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Training in a simulated environment
Sitting-in

Intermediate objective 2

Teaching methods

Follow-up

Being able to evaluate a degree of medical priority and toprioritize among those seeking
care

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Training in a simulated environment
Sitting-in

Intermediate objective 3

Teaching methods

Follow-up

To master evaluation of patients’ symptoms based on
differential diagnostic knowledge and to master probability
assessment for various conditions based on the information
available

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

SeminarTraining in a simulated environment
Sitting-in
Theoretical studies

Intermediate objective 4

Teaching methods

Follow-up

To master emergency diagnostic and therapeutic proficiencies and the unit’s medical
technical equipment

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Training in a simulated environment
Sitting-in

Intermediate objective 5

Teaching methods

Follow-up

To master evaluation of risks
and benefits for various management alternatives from a
medical, ethical, and logisticalperspective, as well as from aperspective of patient safety

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Written individual work under
supervision according toscientific principles

Certificate of approved written
individual work, issued bycurrent mentor

Training in a simulated environment
Sitting-in

Intermediate objective 6

Teaching methods

Follow-up

To be able to handle an acutecondition based on current
treatment strategies

Clinical service under supervision in a unit that handles
these conditions

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Seminar
Diagnostics and treatment
symposium
Sitting-in
Theoretical studies

Intermediate objective 7

Teaching methods

Follow-up

To master leading work in an
emergency ward and use ofavailable competencies andexisting resources

Clinical service under supervision in a unit that handles
these conditions

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Health care teamwork under
supervision
Training in a simulated environment
Sitting-in

Intermediate objective 8

Teaching methods

Follow-up

To master responsibility forpatients’ medical safety, including during transport, until
responsibility is assumed byanother health care provider

Clinical service under supervision in a unit that handles
these issues

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Health care teamwork under
supervision
Training in a simulated environment
Sitting-in

Intermediate objective 9

Teaching methods

Follow-up

To master leadership of medical work pre-hospital as wellas in catastrophe and masscasualty situations

Clinical service under supervision in a unit where such operations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Training in a simulated environment
Theoretical studies

Intermediate objective 10

Teaching methods

Follow-up

To be able to handle patientsin accordance with applicablelegislation and in collaboration
with social resources outsideof health care

Clinical service under supervision in a unit that handles
these issues

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

SeminarIntermediate objective 11

Teaching methods

Follow-up

To be able to evaluate changes
in health problems within society through high epidemiologicalawareness and to master preventive measures based on thevariations of illness and injury
through time and space

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Seminar
Theoretical studies

Communicative competenceIntermediate objective 12

Teaching methods

Follow-up

To be capable of dialogue
and open contact with patients and their next of kin

Clinical work under supervision
in a unit where such operations
are practised

Certificate of successfullycompleted clinical service
and competence achieved,
issued by current mentor

Course or seminar

Certificate of successfullycompleted course, issued bycourse leader

Sitting-in
Intraprofessional reflection ingroupsIntermediate objective 13

Teaching methods

Follow-up

To be capable of communication, both oral and written, withother doctors and co-workers,
as well as with representativesof the public and various civil
authorities

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Health care teamwork under
supervisionIntermediate objective 14

Teaching methods

Follow-up

To be capable of informing
and instructing patients, nextof kin, other doctors, and coworkers, as well as students

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Instruction under supervisionLeadership competenceIntermediate objective 15

Teaching methods

Follow-up

To be capable of mentoringother doctors and co-workers
as well as students

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Mentoring under supervisionIntermediate objective 16

Teaching methods

Follow-up

To be capable of leading using
collaboration and dialogue withco-workers as well as within
the health care team

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Health care teamwork under
supervisionIntermediate objective 17

Teaching methods

Follow-up

To have an understanding of
the organisation, management,
and regulatory systems ofhealth and medical care

CourseCertificate of successfullycompleted course, issued bycourse leader

Theoretical studies

Competence within medical science and quality
work
Intermediate objective 18

Teaching methods

Follow-up

To be capable of a medicallyscientific outlook and approach

CourseCertificate of successfullycompleted course, issued bycourse leader

Written individual work under
supervision according toscientific principles

Certificate of approved written
individual work, issued bycurrent mentor

Seminar
Theoretical studies

Intermediate objective 19

Teaching methods

Follow-up

To have an understanding of,and competence in, evidencebased improvement and quality work

CourseCertificate of successfullycompleted course, issued bycourse leader

Quality and development work
under supervision

Certificate of quality and development work, issued bycurrent mentor

Theoretical studies

Intermediate objective 20

Teaching methods

Follow-up

To have an understanding ofresearch methods as well as
methods for evidence-based
medicine and review of scientific information

CourseCertificate of successfullycompleted course, issued bycourse leader

Written individual work under
supervision according toscientific principles

Certificate of approved written
individual work, issued bycurrent mentor

Seminar
Theoretical studies

Pain management

Introduction
Explanation of terms
General definition of competencies
Definition of area of competence
Competence requirements
Competence requirements for medical competence
Competence requirements for communicative competence, leadershipcompetence, and competence within medical science and quality work
Training structure
Special recommendations
Intermediate objectives
Medical competenceCommunicative competence
Leadership competence
Competence within medical science and quality work

Introduction

On June 24, 2008, Socialistyrelsen decided to issue new regulations andgeneral guidelines for doctors’ specialist medical training (SOSFS 2008:17).
The statute consists of a general part with common provisions for all specialties and a specific part with all the descriptions of objectives. The description of objectives for the respective specialties should be understoodagainst the background of the provisions in the general part.
In each description of objectives, there is a section headed ‘Training
structure’ which constitutes general guidelines.
The teaching methods under the heading ‘Intermediate objectives’ where no
follow-up is indicated also constitute general guidelines.

Explanation of terms

current mentor
a specialist doctor whose specialist competence corresponds to the area ofcompetence indicated by the intermediate objective, and who is responsible
for ST doctors’s professional development during the teaching period or forthe method of teaching indicatedthe assignment as a mentor for an ST doctor generally encompasses the entire period of specialist training but can also encompass part or parts of it
auscultation
during mentoring, and in accordance with a pre-designed programme, tostudy the profession of a specialist doctor or other health care staff by following one or several professionals, as well as carrying out assignments in
the relevant area to a certain extent
evaluate
to form a sound opinion of a patient or similar person as a basis for further
management
masterbeing fully able to evaluate and handle the medical investigation, diagnostics, treatment, and follow-up of a patient or similar person, and being fully
able to use the techniques relevant to the area
capability
personal capacity to execute or perform a task
h a ve u n d ers tan d i ng
having acquired knowledge and insight into an area through theoretical studies and/or practical exercise of the profession
have knowledge
having acquired some knowledge in an area through theoretical studies
and/or practical exercise of the profession
mentoring under supervision
as an ST doctor, mentor a co-worker while simultaneously being mentored
by a doctor with specialist competencementorcontinuously, and in dialogue form, supporting and guiding, as well as evaluating, a co-worker’s professional development
mentoringsee mentor
handleto actively carry out measures regarding investigation, diagnostics, treatment, and follow-up of a patient or similar person, and have overall responsibility for carrying out these measuresinitially handle
as the primary physician in charge, to actively carry out measures regarding
investigation, diagnostics, treatment, and follow-up of a patient or similar
person, and have overall responsibility for carrying out these measuresinitially evaluate
as the primary physician in charge, to form a sound opinion of a patient orsimilar person as a basis for further management
intraprofessional group reflection
reflection done in a group together with other doctors, chiefly for the purpose of further education and training
clinical service
health and medical care duties that ST doctors perform under their own professional liability and with the support of a mentor
courseteacher-led training with an established plan, given during a defined periodof timesitting-in
training activity involving an ST doctor observing when a specialist doctor
or other health care staff holds a consultationorassessment activity involving a specialist doctor or other health care staff
observing and evaluating ST doctors during a consultation
seminarinstruction in group form with active participation
training in a simulated environment
training carried out in an environment created to emulate reality

large professional assembly
conference, congress, symposium or similar event
health care centre
health care unit in primary carehealth care team work
work where ST doctors, under supervision, participates in and sometimes
leads a group of co-operating health care staff with various competencies
charged with responsibility for care for an individual patient or group ofpatients

General definition of competence

Definition of area of competence
The specialty of pain management encompasses understanding and proficiency in investigating, diagnosing, evaluating, treating, and following up
all types of pain conditions that occur in the population, regardless of patients’ ages and the genesis of the pain. The competence covers all healthcare environments, from unselected patient material in primary care tohighly specialised health care. Pain management also encompasses instruction, preventive measures, and rehabilitation. The area of competence ischaracterised by an interprofessional approach where co-ordination of efforts among various occupational groups, forms of health care, and responsible authorities is required. Understanding the organisation of health care,
as well as familiarity with its working methods, are important for the specialty.
Pain management is an additional specialty to the base specialties in accordance with Chapter 5, Section 4 or 5 of the regulations.

Competence requirements
Competence requirements for medical competence
An understanding and proficiency within pain management is required forspecialist competence in pain management in order to be able in practice toinvestigate, diagnose, evaluate, and treat pain conditions of an acute andlong-standing nature, independent of the underlying illness process. This
includes practical proficiency in research and treatment methods, both
pharmacological and non-pharmacological, as well as continued management, rehabilitation, and follow-up.
Apart from knowledge within the area of competence of one’s own basespecialty, knowledge of pain conditions and illness processes outside one’s
own base specialty is required.
Moreover, specialist competence in a base specialty is required for specialist competence in pain management in accordance with Chapter 5, Section 4 or 5 of the regulations, which implies a deeper understanding of thecommon underlying illness processes of the base specialty.

The understanding includes investigating, diagnosing, evaluating, and treating the panorama of pain conditions that originate from these illness processes.

Competence requirements for communicative competence,leadership competence, and competence within medical science and quality work
Communicative competence
The equal and responsible patient
Doctors with specialist competence must be capable of dialogue and of
maintaining open contact with patients and their next of kin. Contact should
be characterised by empathy and trust, as well as respect for the patients’right to information, influence, and participation in decisions. Contact
should also be characterised by co-operation and sensitivity to the patients’needs, desires and right to self-determination, as well as providing incentive
for patients’ involvement in, and responsibility for, their own care.
Multicultural and gender aspects
Communication with patients and their next of kin should be characterisedby understanding and respect for cross-cultural aspects and multicultural
aspects such as age, language, ethnicity, sexual orientation, and religion, as
well as gender.
Interprofessional relations
Doctors with specialist competence must have the ability to communicate,both in writing and orally, with other doctors and co-workers showing respect for their professional knowledge and competencies. The same applies
to contact with representatives of the public and various civil authorities.
Pedagogical skills
Doctors with specialist competence must have pedagogical capability inorder to inform and instruct not only patients and their next of kin, but also
other doctors and co-workers, as well as students.
Professional approach and ethics
Doctors with specialist competence must be capable of working continuously with their professional and medical ethical approaches, with the objective of being able to make independent decisions of a medical ethical nature.
Individual professional development
Doctors with specialist competence must be capable of continually examining and identifying, together with the requirements of the operation, theirown need of in-service training in order to be able to meet the demand forthe best possible care for the patients.

Leadership competence
Collaboration
Doctors with specialist competence must have a developed capability for
self-knowledge and understanding of their own functions and roles in theorganisation.
Mentoring skills
Doctors with specialist competence must be capable of mentoring other doctors and co-workers, as well as students.
Leadership
Doctors with specialist competence must be capable of leadership distinguished by collaboration, openness, and dialogue with co-workers. Leadership must further be characterised by participation and activity development
aimed at improvement. The ability to lead the work of the health care teamis essential.
System knowledge
Doctors with specialist competence must have an understanding of the organisation, administration, finances, and regulatory systems of health care,
as well as its governance, in order to make the best use of resources.

Competence within medical science and quality work
Medical science
Doctors with specialist competence must be capable of adopting a medicallyscientific outlook and approach, and must have knowledge of research methodology including basic epidemiological concepts, as well as of methods
for evidence-based medicine and review of scientific information.

Improvement and quality work
Doctors with specialist competence must have understanding of, and competence in, evidence-based improvement and quality work. The objective is
to be able to initiate, participate in, and be responsible for continuous systematic improvement work with emphasis on a holistic perspective, patient
safety, patient benefit, measurability, and teaching management in order tobe able to review and evaluate their own operations.

Public health and prevention
Doctors with specialist competence must have an understanding of the factors determining health, other aspects of public health, and methods forpromoting health and efforts aimed at preventing injury and illness, in order
to be able to take this understanding into account in medical scientific work.

Training structure
Specialist medical training in pain management can begin before, during, orafter specialist medical training in the base specialty and can be integrated
with it.
The introductory part of the specialist training should include a longer,
sustained period of service concentrating on pain conditions that normallyexist within the area of competence in one’s own base specialty. This service should concentrate on investigating, diagnosing, evaluating, treating,and following up on the pain diagnoses normally existing within the area ofbase competence.
After the introductory period, it could be valuable for ST doctors to get acertain amount of cross-training through service or auscultation within asurgical and/or pharmacologically intensive specialty, such as anaesthesiology and intensive care or neurosurgery. This is in order to broaden the competence base outside of those parts of specialist training naturally coveredby one’s own base specialty.
Certain parts of specialist training are specific to the respective base specialties, such as surgical management within orthopaedics, obstetrics andgynaecology, and urology, as well as oncology; invasive interventional
treatment within anaesthesiology and intensive care as well as neurosurgery;and specific pain rehabilitation within physiotherapy and rehabilitation.
A longer, continuous part of the service should include operations in multidisciplinary pain consulting or in a pain clinic, in accordance with Socialstyrelsen’s report Behandling av långvarig smärta 1994:4, Chapter 3. Thispart of the specialist training can be scheduled when suitable, and does notneed to be tied to a certain part. It is advantageous to perform the service ina unit where more disciplines and professions collaborate than those coveredby the concept of multidisciplinary pain surgery in Socialstyrelsen’s report
Behandling av långvarig smärta 1994:4, Chapter 3.
In the later part of the specialist training, cross-training in the form of service or auscultation involving one or more of the following items is desirable, to the extent that they are not covered by the base specialty: cancerrelated pain, acute and post-operative pain, and long-standing non-cancer
related pain.
At the end of the specialist training, it is important that ST doctors be given the opportunity to work independently with pain management within
their own base specialty.
Continuously alternating and integrating the specialist medical training
with theoretical elements is desirable. The training should include ST doctors’ participation in relevant courses and the opportunity to participate in anational or international scientific meeting.

Special recommendations
The specialty associations and sections of the medical organisations haveformulated special recommendations for their specialties. The recommendations concern such things as how specialist medical training can be structured.

Intermediate objectives

Medical competenceIntermediate objective 1

Teaching methods

Follow-up

To master pain analysis, diagnostics, and treatment of acute
pain

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Intermediate objective 2

Teaching methods

Follow-up

To master pain analysis, diagnostics, and treatment of tumour-related pain

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

ororauscultation under supervision in a unit where suchoperations are practised

certificate of approved auscultation and competenceachieved, issued by current
mentorIntermediate objective 3

Teaching methods

Follow-up

To master pain analysis, diagnostics, and treatment of otherpain related to cancer or its
treatment

Clinical service under supervision in a unit where such operations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

ororauscultation under supervision in a unit where such operations are practised

Coursecertificate of approved auscultation and competenceachieved, issued by current
mentorCertificate of successfullycompleted course, issued bycourse leader

Intermediate objective 4

Teaching methods

Follow-up

To master pain analysis, diagnostics, and treatment of neuropathic pain

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

ororauscultation under supervision in a unit where suchoperations are practised

certificate of approved auscultation and competenceachieved, issued by current
mentorCourseCertificate of successfullycompleted course, issued bycourse leader

Intermediate objective 5

Teaching methods

Follow-up

To master pain analysis, diagnostics, and treatment of visceral pain

Clinical service under supervision in a unit where such operations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

ororauscultation under supervision in a unit where such operations are practised

certificate of approved auscultation and competenceachieved, issued by current
mentorCourseCertificate of successfullycompleted course, issued bycourse leader

Intermediate objective 6

Teaching methods

Follow-up

To master pain analysis, diagnostics, and treatment of longstanding musculoskeletal pain

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

ororauscultation under supervision in a unit where suchoperations are practised

Coursecertificate of approved auscultation and competenceachieved, issued by current
mentorCertificate of successfullycompleted course, issued bycourse leader

Intermediate objective 7

Teaching methods

Follow-up

To master the choice of pharmacological and nonpharmacological treatment ofpain

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

ororauscultation under supervision in a unit where suchoperations are practised

certificate of approved auscultation and competenceachieved, issued by current
mentorCourseCertificate of successfullycompleted course, issued bycourse leader

Intermediate objective 8

Teaching methods

Follow-up

To master the investigation,
diagnostics, handling, evaluation, treatment, and follow-up
of common pain conditions

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Diagnostics and treatment
symposium

Intermediate objective 9

Teaching methods

To be able to initially handle
conditions with psychogenic
pain

SeminarIntermediate objective 10

Teaching methods

To be able to initially handle
patients with addictions to
medicine

Auscultation under supervision
in a unit that handles these
conditions

Follow-up

Theoretical studies

Sitting-in
Diagnostics and treatment
symposium
Theoretical studies

Follow-up

Intermediate objective 11

Teaching methods

To be able to evaluate theform of rehabilitation in normally occurring pain conditions

Auscultation under supervision in a unit that handles
these conditions
CourseFollow-up

Certificate of successfullycompleted course, issued bycourse leader

Diagnostics and treatment
symposium
Theoretical studies

Intermediate objective 12

Teaching methods

Follow-up

To be able to handle the tasks
of a doctor in multidisciplinary
teamwork

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Health care teamwork under
supervision
Diagnostics and treatment
symposium

Communicative competenceIntermediate objective 13

Teaching methods

Follow-up

To be capable of dialogue andopen contact with patients andtheir next of kin

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Sitting-in

Intermediate objective 14

Teaching methods

Follow-up

To be capable of communication, both oral and written, withother doctors and co-workers

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Health care teamwork under
supervision
Sitting-in

Intermediate objective 15

Teaching methods

Follow-up

To be capable of informing
and instructing patients, nextof kin, other doctors, and coworkers, as well as students

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Instructing under supervision
Sitting-in

Leadership competenceIntermediate objective 16

Teaching methods

Follow-up

To be capable of mentoringother doctors and co-workers
as well as students

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

CourseCertificate of successfullycompleted course, issued bycourse leader

Mentoring under supervision

Intermediate objective 17

Teaching methods

Follow-up

To be capable of leading using
collaboration and dialogue withco-workers as well as within
the health care team

Clinical service under supervision in a unit where suchoperations are practised

Certificate of successfullycompleted clinical service andcompetence achieved, issued
by current mentor

Health care teamwork under
supervisionIntermediate objective 18

Teaching methods

Follow-up

To have an understanding of
the organisation, management,
and regulatory systems ofhealth care

CourseCertificate of successfullycompleted course, issued bycourse leader

Large professional assemblyCompetence within medical science and quality
work
Intermediate objective 19

Teaching methods

Follow-up

To be capable of a medicallyscientific outlook and approach

Written individual work under
supervision according toscientific principles

Certificate of approved written individual work, issued bycurrent mentor

SeminarLarge professional assembly
Theoretical studies

Intermediate objective 20

Teaching methods

Follow-up

To have an understanding of,and competence in, evidencebased improvement and quality work

Quality and development work
under supervision

Certificate of quality and development work, issued bycurrent mentor

Seminar
Theoretical studies