The result of the first edition of the National Medical Training Assessment Exam (Enamed) raised a discussion about the quality of medical training in Brazil. About 30% of courses had unsatisfactory performancebecause less than 60% of students did not reach the minimum score for proficiency. Most of these institutions are municipal or private for-profit institutions.
The Ministry of Education announced sanctions for the worst-performing colleges. With regard to students, entities such as the Federal Council of Medicine once again demanded the creation of a proficiency examwhich evaluates recent graduates before granting professional registration.
But for the professor at the Faculty of Medical Sciences at the State University of Campinas, Eliana Amaral, the most important measure to guarantee quality medical training in Brazil is the strengthening of the regulatory system that supervises the faculties.
“The faculty that invented having a medical school knows that it will transform the person into a doctor and therefore assumed this responsibility towards society. But the regulatory system has to guide what the solution could be, it has to establish a work plan and make this institution commit itself”, argues the professor, who has also presided over the Higher Education Chamber of the São Paulo State Education Council and is now vice-president of the collegiate.
Eliana Amaral remembers that this is the first edition of Enamed, but graduates from medical schools, as well as those from all other courses, were already evaluated by the National Student Performance Exam – Enade. Therefore, according to the professor, many of the problems highlighted by Enamed were already known.
But the professor also emphasizes that it is inappropriate to measure the quality of a course solely by the students’ performance in a test, also because historically Enade was used as an instrument of protest, in the form of a boycott.
Therefore, she recalls that the MEC has a National Higher Education Assessment System that takes Enade grades into account, but also inspects institutions to verify the quality of the training offered on site.
Eliana Amaral highlights that medical training in Brazil has always been of “very high quality”, and the basic guidelines that must be followed by all courses guarantee that the trained professional knows how to deal with emergency issues. Even so, the professor says she hopes that the entire discussion regarding Enamed will act as a “detonator” to strengthen the supervision of faculties, especially regarding practical teaching.
“Where do you learn to take care of people? When you take care of people. And for that, the university has to guarantee a good internship in clinical medicine, pediatrics, surgery. And it depends not only on you understanding the symptoms, what you prescribe, but also your professional attitude, which is highly influenced by the examples acquired from good teachers”
Expansion
The president of the Brazilian Medical Association, César Eduardo Fernandes, also shares the same expectation. For him, there was an “unrestrained expansion” of medical vacancies in the country, putting practical teaching at risk.
“Almost half of the course has to be done in a practical field, and this presupposes good laboratories, good basic care clinics, emergency care units, medium complexity outpatient care.”
Fernandes argues that the problem of the lack of doctors in certain regions of the country should not be solved with the opening of medical colleges, but with better policies for allocating professionals, which include improving the service infrastructure, and offering more attractive salaries.
“It is a mistaken idea to create medical schools as assistance banks. They are often placed in municipalities that are in no condition to assist their population, much less to use these assistance places as a teaching field for doctors. Improving the structure has to come first”
Unicamp professor Eliana Amaral believes that a “society agreement” can improve the current scenario. “The need for expansion to fill places where there were no doctors is a problem in the world. This is not just a problem in Brazil. What we need is a serious partnership agreement and serious regulation. Will opening a school in a certain region help to develop it? So we have to call the Ministry of Health, the Health departments to decide where the students will be able to learn what they need”
Students
Medical student Vanessa Conceição da Cruz graduates this month, after graduating from the Federal University of Viçosa (UFV), in Minas Gerais, which received top marks on Enamed. Despite being in a rural city, with less than 80 thousand inhabitants, Vanessa says that the university offers excellent quality practical training.
“The structure is really very good. We have hospitals and partnerships with neighboring municipalities, which allows us to have a range of very diverse scenarios, more urban, more rural. And contact with patients occurs from the first years of the course. One of the strengths here is this, a lot of contact with the gateway to health, primary care, basic units…”
Vanessa made me believe that this may have also helped UFV students when taking the Enamed, as the test had many questions about diagnoses and treatments, which are better understood during practical internships. The future doctor argues that the test was able to evaluate the basic training of the trainees well, but it also adds to the chorus due to constant supervision of the faculties.
“To see the practical scenarios, whether it is enough for students to have contact, including with primary care. Because emergency care and health posts are generally the areas that newly graduated students look for to work. So it is important that doctors who are graduating already have this experience.”
