RAMB 07/07/2014

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Rev Assoc Med B ras 2014; 60(3):187 187
Editorial
An insight of undergraduate medical education and residency programs in Brazil
Uma visão da graduação e da residência médica no Brasil
Perhaps the medical practice in Brazil has never experienced
moments as difficult as today’s. We always had problems, such
as the relationship with health insurance companies and ca-
reer recognition, but there was never any doubt as to the qua-
lity and training of Brazilian doctors. The Brazilian medical
practice has always been renowned for the quality of its un-
dergraduate and residency programs, which produce profes-
sionals as qualified as any other in the so-called First World.
A reflection must be done: What happens when so many
qualified professionals, renowned teachers and reputable me-
dical organizations begin to question medical training?
Let’s start our analysis with the job market for the newly
graduated physician. There is no doubt that in recent years
there has been an improvement in remuneration for medical
graduates and a larger number of job vacancies compared to
other professions. This led to an increased demand for me-
dical courses, attracting the attention of educational institu-
tions more concerned with profit than with the quality of tea-
ching. These institutions began to impose the creation of new
medical courses, and - for some time - it was possible to curb
this trend by adopting a more serious educational policy that
did not allow the indiscriminate opening of new courses. Ho-
wever, the current government policy came into line with the-
se institutions and started to ratify the opening of new me-
dical schools - if we can call them that - and some do not have
any conditions to form medical professionals. Absurdly ex-
pensive courses began to appear without qualified teachers,
without appropriate laboratories, and most of all without
their own teaching hospitals. Medical internship, which has
always been the basis of clinical quality training in these
schools, is done in public or privately insured hospitals that
have little or no commitment to teaching. Usually, in these
hospitals, the intern is trained by a resident physician or a
physician on duty without any preparation for teaching, des-
pite being willing to share his or her knowledge. They end up
as low quality medical training courses, whose main purpo-
se is to generate business profit. Acting as diploma factories,
these schools train thousands of poorly-prepared doctors
who are absorbed into the marked due to the strong demand.
The residency programs have also gone through a crisis that
has multiple causes. One is, in fact, the cheap labor that some
institutions aimwhen they open a residency program, as these
practitioners work 60 hours per week for a bargain salary. This
would not be a big problem if there were trained teachers to gui-
de residents, and/or facilities appropriate for teaching. However,
this is the case in only a few institutions that strive to have spe-
cialists among their teachers, with master’s degrees and docto-
rates, and a minimum number of hours devoted to teaching.
In addition, the federal government initiated a policy of
intervention in residency, signaling to determine which me-
dical specialties will be allowed, the obligation to study up to
two years of family practice (according to the specialty cho-
sen), and to allow the opening of indiscriminate residency
programs without the proper conditions and the approval or
supervision of medical specialty societies.
In view of this, all of us who are committed to medical
education, both in undergraduate and residency-level, have
been fighting for quality training in large hospitals with qua-
lified teachers; for the lack of mandatory family medicine in
all specialties; for the closing of medical schools without ade-
quate educational structure and for the appreciation of the
medical profession.
So far, despite the efforts of medical organizations, re-
gional boards and specialty societies, little has been achieved
since the struggle against political and financial interests is
very uneven across our country. What can we do then, as me-
dical students and residents at this moment, while our aspi-
rations fail to materialize?
Pondering over this, a text by the great Professor Fares
Rahal on how to be a good doctor came to my mind. This
text was written based on his personal experience as Profes-
sor and as a trainer of several generations of doctors in the
last fifty years in the Faculty of Medical Sciences of Santa
Casa de São Paulo. Below is a summary of the recommenda-
tions of this great master of medicine to young people:
“Professional success starts with a calling; it continues with
the school attended; the efficiency of the course; dedication to
all subjects. Medical residency; the choice of the specialty; res-
pect to ethics and tomoral principles; perfect knowledge of one’s
mother tongue and of two foreign languages​; internships in Bra-
zil and abroad; work companionship and, away fromwork, the
Hospitals commonly visited; and family support are also requi-
rements for success. In addition to these factors, participating
as assistant in college; doing postgraduate courses; and publi-
shing in academic journals. Having an updated memorial, an
office with competent colleagues, in an appropriate location, be-
ing recognized as a respected and skilled professional”.
I truly hope that this brief analysis and thoughts may con-
tribute in some way towards improving our dear Brazilian me-
dical practice, so wronged and mistreated in recent times, and
guide the youngest on the way to being good doctors.
ELIAS JIRJOSS ILIAS
PhD PROFESSOR AT THE SURGERY DEPARTMENT, SANTA CASA DE SÃO PAULO
FULL MEMBER OF THE BRAZILIAN COLLEGE OF SURGEONS
ASSOCIATE EDITOR AT RAMB