News Report / Profile
Professor Madalena Patrício – a life at the service of Medical Education
On a car trip to Alentejo, she received a phone call asking if she would accept the International Peace Prize of Gusi Foundation. While at first she thought it was a joke, it quickly became clear that she would soon be travelling to the Philippines where she would be awarded what many call the 'Asian Nobel'.
Madalena Patrício, Retired Assistant Professor of the FMUL, was the director of the Department of Medical Education (DEM). For 7 years she presided over the largest medical education organisation in the world, the AMEE (the International Association for Medical Education), with which she continues to actively collaborate as President ex officio.
Passionate about the messages she carries when travelling around the world, some Faculty staff members say that Professor Madalena Patrício is an extraordinary "calling card" for the Institution, a label she refuses peremptorily, because praises should not be given individually, but to the teams with which one works. With altruism and passion, she commits herself to things with a very unique dedication.
While initially she felt her vocation was Physical Chemistry, she eventually traded it for Pedagogy. She attended the Maria Ulrich School of Early Childhood Educators, working as vocational internship supervisor in the early years. But, for personal reasons, her professional career was put on standby for a few years, because Madalena Patrício moved to Paris. It was there that she enriched her training. She completed a postgraduate course at the Institute Supérieur de Pédagogie of Paris and, a few years later, after returning to Portugal, she started working in the Children and Youth Mental Health Centre of Lisbon. At the time she was in contact with children with serious relationships problems, and she remembers specific cases as though they had just happened. Then, an opportunity came up, for those who already had academic education and professional experience, to apply for Higher Education, and she completed a bachelor's degree and a Master's Degree in Educational Sciences at the Faculty of Psychology and Educational Sciences of the University of Lisbon.
Mother of 3, her energy is a characteristic that the Faculty of Medicine came to know well and that was always in her nature. Even today she plays tennis at least twice a week, usually before going to work; In the same month she can visit more than one continent, she sleeps little and works a lot.
It was 1995 and the Faculty of Medicine of the University of Lisbon created the Department of Medical Education, under the direction of Prof. Gomes-Pedro, who was Professor of Paediatrics at the time. Professor Gomes Pedro challenged Madalena Patrício, who applied for the existing vacancy and joined the DEM where, in collaboration with many professors, she created an ambitious Training Program along many other activities in the field of Medical Education.
Madalena Patricio started by teaching Introduction to Medicine, a 1st-year subject (today Module III-I "Clinical Medicine: the doctor, the person and the patient", whose goal was raising the future doctors' awareness of the more human aspects of Medicine early on. "We wanted them to see the whole person and not only the patient, because it is very important to understand the role of empathy in the doctor-patient relationship".
With Introduction to Medicine, and with the arduous determination of the teaching team, emerged the idea of raising the future doctors' awareness of the "Transformation of Society". The 1st-year students were sent in small groups to different places, such as prisons, elderly homes, rehabilitation centres, kindergartens to meet kids whose mothers had AIDS, or circuits of social work services to join the night projects. They all shared one feature, being a project of excellence to support vulnerable people.
While moving forward with her work at the Faculty, she brought to Portugal AMEE Conference 2002, the annual Congress of the largest international Medical Association with 1200 participants. In the AMEE she was in the group that created and developed the program ‘Aspire-to-Excellence’ – which argues that Medical Schools should not be limited to fulfilling the basic standards required for accreditation, instead they should pursue "Excellence" in one or more teaching areas. In order to do so, criteria of Excellence were defined for 6 areas, among which the Social Responsibility of Medical Schools.
At the international level, she faced another major challenge, the BEME (Best Evidence in Medical Education) Collaboration, of which she is currently President of the Board, which argues that in Education we cannot continue making opinion-based decisions, instead, like in Medicine, decisions should be based on the best available evidence. "It is very difficult to establish evidence in Education because it is a human science, with confounding variables. In the FMUL the BEME is integrated into the CEMBE (Centre for Evidence-Based Medicine Studies), whose President is Professor António Vaz Carneiro who always supported this area and was also the President of the BEME Board.
Throughout the 17 years in which the activity of the DEM was suspended, Madalena Patrício never stopped collaborating in teaching Introduction to Medicine, the area which currently collaborates with more than 60 institutions in the Community.
It was with surprise and enthusiasm that the team that integrates the Institute for Introduction to Medicine, coordinated by Professor António Barbosa, realised that the teaching proposal, put forward by the Lancet Report in 2010, with 3 teaching levels, met the pillars they had always defended, both initially in "Introduction to Medicine", and later on in "Module III_I”:
- An informative teaching based on skills and knowledge to train experts
- A formative teaching, socialising students about attitudes and values to train professionals
- A transformative teaching, giving students leadership skills to train knowledgeable agents of change in society
In2015, the DEM was reactivated as one of the top priorities of the first mandate of the Director of the FMUL, Professor Fausto Pinto.
What messages were the students bringing back from institutions they visited?
Madalena Patrício: Often, after their visits to the Community, first in a small group and later on individually (to interview a user, a family member or a technician), the students were coming back with the idea that one person may be enough to make a difference in an Institution. After the Visits, the students are required to do a group work to share their experiences in the community with their colleagues, particularly "the main message drawn from their experience as future healthcare professionals". The Experience Sharing Seminar is always very emotional because we hear about moments that left a mark on the students. Based on the experiences shared, on the portfolios and also on the assessment of teaching by the students, it is very clear to us that we are raising the students' awareness so that one day they can lead the change to a better society. As the Lancet Report ‘says, how this will happen in the future is an individual prerogative”.
When we think about students who choose Medicine, we think that they are automatically sensitive to human problems. But is that a fact? Realistically speaking, are most of these young people in the group ready for the scenarios they will be facing?
Madalena Patrício: There are some with great sensitivity, but not everybody has it. Some of them simply because they are not familiar with it. In the evaluation questionnaires many answered that 1 or 2 km from their homes they discovered realities they knew nothing about. Many said "we've discovered that we are not treating a body, but a person". Nowadays, many students come to study Medicine with aims that are very different from what we've mentioned above. They come because it is still a very secure job, because of the status, often because their parents are both doctors, etc. The majority has always lived very protected lives, always intensively focused on studying to get into Medicine. To get here, many give up on having a boyfriend or girlfriend, they don't practise sports, because they need to study intensively...
As for your question, sometimes students don't even know what surrounds them well enough, so how can they be sensitive to the most fragile members of society.
And is the first year the right moment for this clash?
Madalena Patrício: It is very important to "catch" students right at the beginning of their course, because they come with dreams and great expectations to help, they are very open to the awareness we want to raise. Please keep in mind that we are not destroying the students' dreams, we are just guiding them because they are often unfamiliar with the reality of human vulnerability that they will be facing. The beginning of the first year is the moment of greater enthusiasm for ideals, before they are completely engrossed in evaluations and assignments in different areas.
In terms of external recognition, in 2007 when the Faculty was subject to an external evaluation, Module III-I was clearly praised in the document with the final conclusions of the External Commission. It was mentioned that these areas were very well structured, being crucially important for students, and that the only flaw was that they had virtually no continuity throughout the course.
Have you tried to uphold that continuity?
Madalena Patrício: It is hard because the curriculum is completely filled and new, extremely relevant areas are always emerging in medical education. Some of the key aspects of this awareness-raising were resumed in the areas of Paediatrics throughout the MIM. I think, however, that maybe we didn't try as hard as we should have, because I believe it is very important not to let this message of raising awareness of the vulnerability and humanisation of Medicine during the studies die.
As a person who sees the world as you do and who is a member of the most important organisations of Medical Education worldwide, would you say that we are still lagging far behind in these matters in our country?
Madalena Patrício: No, absolutely not. We already have a very good level of Medical Education, but there is always room for improvement and, as far as I can see, I believe we can do more, especially in collaboration with other Schools. We have a huge problem, especially in Medical Faculties in Porto, Lisbon and Coimbra, which has to do with the number of students and the structure of the buildings. In our Faculty we receive more than 300 students every year, and these figures have nothing to do with those of more recent Universities, which receive 100 students every year, at most. The lack of tutors and appropriate premises also makes it harder to introduce student-centred methodologies.
You've already told me you don't like individual compliments. And, on the phone, on your way to Manila, you confessed that you didn't think you were worthy of a Gusi International Peace Prize.
Madalena Patrício: I know it sounds like lack of modesty saying that I don't deserve it, but it is true... There are so many people better than me.
Tell me how it felt to receive the award.
Madalena Patrício: It was a touching experience I will never forget. The fact that in most of the official ceremonies there was a Portuguese Flag, brought a different dimension to this award. It wasn't me...it was Portugal along with other countries. At the Award Ceremony, each candidate entered the Congress Room (with nearly 7,000 people) behind his or her country's flag. The same occurred in the Military Parade and in both cases I am not able to put into words how it felt.
Besides, being with 15 people who also received the award is, in itself, something very special and a great joy. They are all people with exciting stories. It is such a special moment that, at that point, we forget that we didn't even deserve the award that much. (Laughs) When I was given the award I mentioned that the Gusi International Peace Prize is a form of motivation to transform people into agents of change to a better society, it is a citizenship award. We can always do better and when news come out about this Award they convey a message about a fight for a better society. Then, there were other special moments, we receive messages and calls not only from family, friends and colleagues, but also from people we hadn't seen in years, and that was very rewarding.
More time has passed, but you also received an Honorary degree last summer in Porto Alegre, in Brazil. Those are honourable situations which say something about your path.
Madalena Patrício: I had no idea, because they never asked me to send my curriculum. They asked the AMEE, so I didn't know anything until the final decision. In fact, I received an invitation to go to Porto Alegre, to the Federal University of Health Sciences to speak at conferences and other initiatives, so I contacted them in advance asking for information about the audience and the curriculum, so I could to adapt my speech to the reality of the Institution. I received a message with answers to my questions, which mentioned that they had sent me an email which would probably please me. I rushed to read it. It was formal invitation informing me of the University's decision.
You are now leaving your legacy to Professor Isabel Pavão Martins. Is this a smooth transition?
Madalena Patrício: Professor Isabel Pavão Martins will be an excellent Director. She has an excellent past as President of the Pedagogical Council, where she revealed a deep understanding of the problems faced by the School and their possible resolution. She asked Professor Luis Soares de Almeida, to be Subdirector; he is "passionate" about Medical Education and attended all the training courses of the DEM. Both of them suggested I should continue to collaborate with the DEM being responsible for training professors and assisting in specific areas. It was with great joy that I accepted this invitation that keeps me connected to the FMUL. The DEM is going to offer teacher training in close connection with Pedagogical Council to raise the professors' awareness of Medical Education.
How do you see this slowdown that society imposes on a person turning 70?
Madalena Patrício: Different things: on the one hand, it is bad because people who are still energetic and would like to continue working can't do it. These people should be able to remain active and give their contribution. On the other hand, leaving is good because it gives the opportunity for new people to come in, preventing less energetic people from keeping their positions. It is also good to slow down so we can do other things we like and spend more time with our families, especially with our grandchildren..
On the day after this interview, Professor Madalena was leaving at 5 am to Scotland to attend another meeting about Medical Education.
When I asked her if she was looking for some necessary silence in her agitated life, I realised that this is no more than a cliché to her, because she doesn’t need a specific time or place for introspection, "I find silence inside me."
Even though she is still connected to the DEM and the FMUL through teacher training, she regrets the fact that in Portugal, unlike in foreign universities, there are no opportunities for retired professors to continue their collaboration. “That doesn't happen here, with a few exceptions like, for example, in the case of Prof. Francisco Antunes, who is still doing a remarkable work".
Students, the group that drives her the most, are also those who are sowing the seeds of her lessons, a sign, perhaps, that her commitment and years of work have not been in vain. Recently, when she had to take a very old family member to the Santa Maria emergency ward, in a crammed consulting room (because there were students following the consultation), Madalena Patrício decided not to go in and wait outside instead. From inside the room the doctor called her "Dr. Madalena Patrício please come in, the students were telling me about you because you are connected to Introduction to Medicine and I would like to talk to you. I wanted to tell you that I changed my practice in terms of the way I speak to the patients thanks to these students, I learnt with them".
A proof of the humanisation of Medicine that shows that there are visible changes in this area.
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