Statement of the Council of Portuguese Medical Schools (CEMP)
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CEMP's reaction to statements by the Minister of Science, Technology and Higher Education

The Council of Portuguese Medical Schools hereby makes public its dismay at the recent statements made by the Minister of Science, Technology and Higher Education, Professor Manuel Heitor, regarding medical training in Portugal. It seems essential to clarify aspects of the reality of medical training in Portugal, which are in no way similar to the aforementioned statements. Thus, resorting to factual conditions and without interfering in political issues, we must clarify the following: 

“It can be seen that in Portugal, by option of the institutions themselves and also of the professional associations, all doctors are trained in the same way.”

This statement is totally false, since:

  • all Portuguese Medical Schools have the duty, pursuant to the legal norms for vocational training, to provide their students with a set of core competencies (core curriculum) in the areas of legally recognized medical specialties. However, the syllabus of undergraduate medical training, with a duration of 6 years, is by no means limited to training in the areas of these specialties. Within the scope of their scientific autonomy, the Portuguese Medical Schools include, in their syllabi, mandatory or optional training appropriate to the areas of training that they consider to be a priority regarding the global training of physicians or the training for alternative paths to the care career;
  • As all those who have a role in education should also know that, in any area of training, teaching, learning and assessment methodologies play an absolutely central role in the profile of graduates. Accordingly, the Portuguese Medical Schools, enjoying their pedagogical autonomy, promote totally different training and assessment models, and a huge diversity of methodologies. This diversity is visible in the volume of knowledge produced throughout the world in the field of Medical Education.

The training diversity in teaching, learning and assessment methodologies, which underwent  a major expansion with the creation of new Medical Schools after the April 1974  revolution, actually raised the quality of medical training in Portugal, recognized worldwide, not only within Medical Education, but also in national health systems.

 “It seems to me that it is clear that more doctors are needed in Portugal.”

As we have been trying to warn in various ways, currently, there is a much higher undergraduate training offer than postgraduate training offer leading to medical specialization. Actually, the number of medical graduates from the Portuguese Medical Schools has been systematically higher than the number of places made available by the those responsible for Health Issues for postgraduate training, within the scope of the medical internship. This has led to an increasingly higher number of undifferentiated doctors in Portugal, who do not have the specialized training necessary to meet the country's needs. It is therefore important to clarify definitively that the increase in doctors in Portugal does not depend on the increase in the number of places for medical degrees, supervised by the MCTES, but on the increase in the number of specialized training, supervised by the Ministry of Health.

This is one of the main reasons why the Portuguese Medical Schools have systematically decided not to increase the number of places for the national exam to access higher education, as they are obliged, by their nature, to ensure a balance between the training offer and the job market. On the other hand, and like any other areas of training, they have to guarantee the quality of training. To a large extent, it depends not only on adequate funding (which has not kept up with the pressures related to the systematic increase in places), but also on the capacity of health institutions, mostly public, in which clinical training takes place.

Also in this regard, and despite the fact that the Portuguese Medical Schools were not, at any time, called upon to support this decision, we would like to point out that the distribution of doctors with specialized training has been neglecting the need, as in any training area, to create incentives to encourage them to work in the most needy areas.

“To train an experienced family doctor it is not necessary, perhaps, to have the same level and duration of training, as an oncology specialist or a specialist in mental illnesses"

The Portuguese Medical Schools have the duty to clarify that the specialty in general and family medicine is one of the most important specialties of any health system and that the general quality of health care depends, to a great extent, on it. The assessment of the disease and of patients and the proper relationship with other medical specialties requires not only a very in-depth knowledge of all medical areas, but also a large set of skills, namely in clinical management. Therefore, we believe that it is a tremendous mistake to consider that the precariousness of training models depending on the medical specialty would be beneficial.

Finally, we cannot but regret the total lack of dialogue between the MCTES and the Portuguese Medical Schools, which could help the Authorities to have a global and informed understanding of medical training in Portugal. However, we are, as we always have been, available to contribute to this dialogue.

 

Portugal, 2 September 2021

 

The Council of Portuguese Medical Schools,

Henrique Cyrne Carvalho, President of CEMP and Director of the Abel Salazar Institute of Biomedical Sciences of the University of Porto

Altamiro da Costa Pereira, Director of the Faculty of Medicine of the University of Porto

Carlos Robalo Cordeiro, Director of the Faculty of Medicine of the University of Coimbra

Fausto J. Pinto, Director of the Faculty of Medicine of the University of Lisbon

Isabel Palmeirim, Director of the Faculty of Medicine and Biomedical Sciences of the University of Algarve

Jaime Branco, Director of Nova Medical School | FCM of the New University of Lisbon

Miguel Castelo Branco, President of the Faculty of Health Sciences of the University of Beira Interior

Nuno Sousa, Director of the School of Medicine of the University of Minho