None of the professions chosen by Nora, Déborah and Joël is subject to a quota. They can begin their studies without being concerned by quotas. Thus begins their higher education experience. But how is their curriculum defined? On what basis is the length of their studies determined? Will they have to complete an internship or not?
All this data is determined within the federal healthcare professions advisory bodies.
The advisory bodies
There are different advisory bodies for the healthcare professions, each with advisory powers. Their mission is to give the Minister of Public Health, at the Minister's request or on its own initiative, advice on the practice of the profession(s) they represent and, if necessary, advice on the accreditation criteria for these practitioners and the internship supervisors and internship centres for the disciplines concerned.
There are currently eight advisory boards and two technical commissions:
Generally speaking, these advisory bodies are mainly composed of representatives of the profession from professional associations or the academic world. Physicians sit on most of them. The exact composition of these advisory bodies differs, however, depending on the profession represented.
To prepare these recommendations, each advisory body can create working groups with a specific mission. These working groups are composed of members of the board or commission concerned and possibly external experts. Fixed working groups may also be established, depending on the specific competencies assigned to the advisory body.
When the profession requires an internship, these working groups are responsible for analysing individual cases and preparing recommendations within the framework of legal procedures (granting or renewal of approval as an internship supervisor, etc.). This is the case for physicians, dentists, hospital pharmacists and the mental health professions.
The recommendations may concern a series of measures affecting the training that students in the various medical professions will undergo.
The following is a non-exhaustive list of the topics that may be the subject of a recommendation:
- the opportunity to create regulated titles or professions
- the revision of existing criteria
- the duration and level of training
- the final skills to be acquired
- the reserved acts, which can be exercised independently, which can be delegated, etc.
- the topics presenting new challenges, such as artificial intelligence, telemedicine, etc.
- if applicable, the number of training hours to be completed
Consult the recommendations issued by the Minister's advisory bodies: consultativebodies.health.belgium.be
In 2021, a total of 32 recommendations were issued.
NUMBER OF RECOMMENDATIONS ISSUED
The health crisis has heavily impacted the work of the advisory bodies since March 2020. They have been asked to provide emergency recommendations on matters specific to this pandemic. In addition, the professionals who sit on these boards and commissions have been heavily involved in the field. For these reasons, non-pandemic work slowed down during the first part of the crisis, although the impact was felt differently by each Council.
The advisory bodies have since resumed their activities at a more usual pace. However, some Councils are in the process of changing or have been very recently changed. This also plays a role in their activities.
The Legislation on proportionality has impacted the work of advisory bodies since 2021. In accordance with the 2018 European Directive, the legislator must justify the proportionality of measures when they have a restrictive impact on access to or the exercise of any profession.
Many recommendations from the Councils and other bodies fall into one or both of these categories. Where this is the case, the body now has to demonstrate that they have an objective of general interest and are well justified.
A proportionality test must therefore be carried out when the measure adds restrictive measures to the access to or practice of a profession. This can be, for example:
- extending the number of years of study
- adding or extending the number of training hours
- introducing continuing education to practise a profession
- making the practice of a profession conditional on membership in a professional body
In addition, the directive also includes a disclosure requirement. The regulations allow any person to be informed of the envisaged measures before they are established. Stakeholders can then react to them if they wish. This right of reaction is granted to practitioners themselves, as well as to students, patients, associations, etc.
For more information on proportionality: www.health.belgium.be
INTERNSHIP SUPERVISOR AND CONTINUING EDUCATION
As mentioned above, for certain professions a decision may be made that training must be organised for interns. This is the case for physicians, dentists, hospital pharmacists, clinical psychologists and clinical orthopedagogues, who are referred to as "interns" for the duration of their internship. These interns are trained by a practising practitioner, called a "internship supervisor". There is an approval process for these supervisors and internship centres. The Minister of Public Health is competent to issue these approvals. According to the legislation, the Minister bases the decision on the recommendations given by the relevant advisory bodies, in particular the Higher Council of Specialist Physicians and General Practitioners, the Dental Council, the Federal Council of Mental Health Professions and the Commission for the Accreditation of Hospital Pharmacists.
To ensure the quality of training, criteria for the approval of supervisors and internship centres have been established for each profession and speciality. These concern both the future supervisor and the activity and supervision that the internship centres can offer.
Criteria adapted to each type of practice guarantee the quality of the training for both a future general physician who trains in general practice and a clinical psychologist who trains in a hospital institution.
These internship supervisor approvals represent a fairly large annual volume of applications. The dossiers are analysed by the administration, then presented to working groups, and the recommendations are confirmed by the competent board before being sent to the Minister, who makes the final decision.
Here are some figures to illustrate the volume of applications and recommendations issued concerning the approval of internship supervisors and continuing education according to the different professions.
Applications for the approval of internship supervisors and centres for hospital pharmacists are processed by the Approval Commission, pending the establishment of the Federal Council of Pharmacists. This commission also decides on applications for the recognition of continuing education for hospital pharmacists. To apply for the renewal of their hospital pharmacist approval, the professionals concerned must submit a dossier to the communities every five years. One of the elements in this dossier is proof of continuing education.
For dentists, the legal basis is the Royal Decree of 10 November 1996, which establishes the modalities for the approval of dental practitioners with a specific professional title. An ongoing working group processes applications for the approval of internship supervisors and services in general and specialised dentistry.
|MENTAL HEALTH PROFESSIONALS
The approval process for mental health internship supervisors and services began in 2021. A total of 184 applications for the approval of internship supervisors and centres have been sub-mitted. Two professions were involved: clinical psychology and clinical orthopedagogue.
In the future, we will have the opportunity to compare the data with subsequent years to obtain a better picture of the evolution of mental health training.
As far as Physicians are concerned, the legal basis is the Royal Decree of 21 April 1983, which establishes the modalities for the approval of specialists and general practitioners.
Two permanent working groups have been set up: "General Practitioners" and "Specialists". Their roles are to:
Nora, Déborah and Joël have completed their higher education training partially based on the advice of the federal councils of their respective professions, and their efforts have paid off.
After years of study, they have reached the end of their academic career and have a diploma in their pocket. What is the next step for them to start their career?
 The Federal Council of Pharmacists is currently being instaured.
Internship is in place for the last two professions but it has not yet been made mandatory.
 These are the numbers of dossiers finalised during year X, i.e. that received a recommendation from the board and a ministerial decision. This is not a volume of activity, since each dossier is counted only once, regardless of the number of intermediate recommendations that the council has issued.
 2020 and 2021 were impacted by the health crisis. The organisation of continuing education was particularly disrupted.