The Federal Council of Medicine is considering using the scores from the National Medical Training Assessment Exam (Enamed) as a criterion for granting professional registration to trainees. To do this, he asked the Ministry of Education and the National Institute of Educational Studies and Research Anísio Teixeira (Inep), for microdata from the exam, with the identification of people who scored 1 or 2, considered insufficient. 
Inep, responsible for the evaluation, has not yet responded whether it will comply with the request. This Tuesday (20) the institute released information about each student who took the test, including academic data, grades and answers to the socioeconomic questionnaire. The data, however, does not identify the students.
According to the president of the CFM, José Hiram Gallo, the result of the first edition of Enamed was debated by the council plenary this Tuesday (20).
“One of the proposals is to make a resolution not to register these professionals, but this is still being studied by our legal department.”
Enamed was created in 2025, to evaluate medical training in the country, based on the proficiency level of doctors trained or at the end of their degree. The results showed that around a third of the courses had insufficient performance, the majority from the private or municipal network. Taking the exam is mandatory and the result can be used in the National Residency Exam (Enare). The test is not a requirement for professional performance.
For the CFM, the numbers reflect “a very serious structural problem.”
The president of the CFM supports the sanctions that the Ministry of Education will apply to the faculties with the worst performances, such as suspension of admission and reduction in the number of places available, but believes that only units with a rating of four or five should be able to maintain their activities freely. The MEC considers that faculties with an index from 3 have already shown themselves to be proficient.
Gallo also said that the Enamed results prove the need for a medical proficiency exam as a prerequisite for practicing medicine, similar to what happens with law graduates, who need to pass the Brazilian Bar Association exam to practice.
Two projects to create the exam are being evaluated by the legislature, one in the Chamber of Deputies and the other in the Senate, with advanced processing.
Brazilian Medical Association
The creation of a proficiency exam is also defended by the Brazilian Medical Association (AMB).
“This is not a measure against medical graduates. It is a measure aimed solely and exclusively at the good practice of medicine and patient safety”, argues the association.
The AMB released a statement expressing “extreme concern” about the Enamed numbers, “which reveal a very serious reality in the country’s medical training.” The document highlights that medicine courses are now terminal in Brazil. In other words: the person simply needs to receive their undergraduate degree to be able to obtain professional registration with the Regional Council of Medicine in their state and begin working.
“In these circumstances, it is equivalent to saying that these 13 thousand doctors identified by Enamed as not proficient can, according to current legislation, treat patients in our country. This allows us to state, without a doubt, that our population served by this contingent of non-proficient doctors will be exposed to an incalculable risk of medical malpractice”, the text adds.
The AMB also “criticized the disorderly expansion” of medical courses, “often opened without adequate infrastructure, qualified teaching staff or minimum conditions for the safe training of new doctors, nor medical residency.”
According to the association, this is evident with the Enamed results, as the worst results were presented by students from municipal and private for-profit colleges.
“The central issue is not to indiscriminately increase the number of vacancies, but to ensure that each future doctor has adequate, solid training and compatible with the real demands of the health system. It is not about training more doctors, but about training good doctors, prepared to work in the SUS and to respond to the needs of the Brazilian population.”
Faculties
The Brazilian Association of Higher Education Supporters (ABMES) expressed concern about the “punitive use” of the exam. “As established by the Ministry of Education (MEC), the purpose of Enamed is to evaluate students’ performance in relation to the contents and skills set out in the National Curricular Guidelines (DCNs). The exam does not assess professional aptitude, does not qualify or disable doctors and does not replace legal mechanisms for exercising the profession”, he said in a note.
According to the institution that represents private educational institutions, it is necessary to consider that students were not previously informed that there would be a minimum cutoff of 60 points as proficiency parameters, and many were still in the 11th semester of the course and, “therefore, still had around six months of practical training ahead of them.”
ABMES argued that even so, 70% of students reached the proficiency level, which shows that “both the courses and the students do present a relevant quality standard, especially considering the high level of demand of the exam, whose structure, certainly, was not developed in a formative model”.
In a statement, the CEO of ABMES, Janguiê Diniz, says that the CFM statement “is worrying, although it has no legal validity”.
For Diniz, “this type of discourse has the sole objective of creating a narrative disconnected from reality to serve corporatist interests, which serve a restricted and privileged portion of the category, to the detriment of the real needs of the Brazilian population”.
The president director of ABMES reinforces that the current regulations do not allow any type of discrimination against graduates of higher education courses, and it is up to the professional councils to register citizens who have completed their degree at an institution duly regulated by the MEC.
“ABMES defends institutional dialogue, respect for the legal competencies of each body and the preservation of the rights of students and graduates, avoiding initiatives that could generate legal uncertainty, professional stigmatization and harm to the population’s health care”, it states.
