The idea of promoting and supporting the scientific research carried out by undergraduates in research units in our faculty was the result of masterful foresight by Professor David Ferreira, mine and our Master, in 1989. Thus was born the GAPIC – Office for Scientific, Technological and Innovation Research Support. The GAPIC Project, even today, over two decades later, is considered innovative both in Portugal and internationally. It resulted from the foresight that scientific research, in particular in its most basic aspect, would play an increasing role in advanced in modern medicine, and that doctors should have not only Professional training, but also a more and more demanding scientific training, with the risk of their profession rapidly becoming a craft.
The relationship between scientific advance and its consequences on medical practice is difficult to gauge. However, there is a consensus as to the existence of a great hiatus between the quantity and sophistication of the basic knowledge that already exists in biological and biomedical areas and their transformation into real benefits for patients. Put simply, one might say that most of the most fascinating fundamental knowledge is, still, clinically useless. A lot of the reflection on the issue was and is promoted by the NIH, in the United States (USA). Over time, several directives have been followed within the scope of this reflection, with a tendency to close the gap. There have been alterations in the focus of investment, for example from cancer to diabetes, or in the type of research, i.e. more basic/fundamental or more applied. The results have been less than what was hoped for, always. The identification of the factor that is nowadays considered to be the most relevant one was thus late; that factor – the decline of the doctor-scientist. It would be interesting to meditate on this, as for so long it was a factor that is intrinsically human, a figure – the doctor-scientist – confused with other factors with an essentially contingent or circumstantial nature (e.g. financing, type and focus of research)! Given the human nature of the main factor it is no surprise that the most important contingent factor identified was that of time, or rather lack of it.
A sensitive analysis of history has identified the figure of the doctor-scientist as the major promoter of the real advances in medical practice over recent decades, with the exception of the last one. In these decades good, purely clinical research consolidated medical knowledge and set out its ranges and limits, refining it from useless detail. This type of research continues, and with increasing professionalism. Like good traditions, it comes from way back, is here to stay and improves with age. It is essential to have a good medical practice, it is indispensable and necessary; but it is not enough. Also over those decades, good basic/fundamental research revealed new, unsuspected universes, it amazed us, provoked enchantment and raised up hopes; and for a long time it did not let us doctors down. For the younger doctors there were signs that the times of the new sciences were coming, and the old ones being rejuvenated, an interpreter, who was a doctor and practised science that was fundamental or very close to it, and was a scientifically as learned as his peers with other academic training. But he also possessed depth, knowing full well the medical range that many of the new discoveries involved. And he brought them into the clinical domain, he knew the pertinent issues in the area, as he was either a practicing doctor or frequented clinical circuits. He spoke with his peers as an equal, without preconceived ideas or subservience; he understood and made himself understood. The doctor-scientist gained public recognition, won Nobel prizes, filled medical schools with pride and, above all, greatly benefited those who were suffering. Now he remains in a residual manner, like a solitary but often merited example. The doctor-scientist has gone into decline, and for that reason so has the capacity to bring what is being discovered in the most basic sciences into clinical practice as well as the capacity to bring the best questions raised during clinical activity into the laboratory. The doctor-scientist has almost become extinct, almost because he didn’t have time to practice two activities that had both become excessively competitive, professionalised and absorbing. He became the victim of the greatest human lack – that we can make almost anything, except time.
For over a decade there has been the promoting of a change in strategy, so that the enormous successes and experimental resources of modern fundamental science may more rapidly and more widespread become benefits for patients. For this, special attention is being granted to more direct focus on experimental/laboratorial research into problems with great clinical relevance, taking the starting point in issues emerged from clinical practice and, whenever possible, also clinical material obtained directly from patients. This is one of the fundamental pillars, but not the only one, of modern translational medicine. But if one did not meditate deeply on the characteristics of the human agent, i.e., what is the central figure capable of leading this strategy successfully, one would fall into an old mistake. Fortunately that analysis has already begun. And so the figure of the scientifically educated doctor has emerged. This doctor will combine excellent clinical training and scientific training that is also excellent. Ideally he will have carried out more fundamental research, but for a limited time of his academic training, for example during PhD work. His scientific training will be modern and solid from the theoretical point of view. It will be broad. Necessarily broader than that of the doctor-scientist. It will have to be acquired quickly, but be coherent and very demanding. It will allow him to know the local and international scientific medium It will give him the capacity to identify competences and dialogue with them, without hidden subservience. The new doctor will be capable of identifying relevant issues in his clinical practice, because he will also know what can be dealt with through experiments. He will also be able to participate in multidisciplinary teams, or to lead them; he will be a key element, because as a scientifically informed doctor he will be a valuable member. Besides this, he will be capable of interacting with industry, namely the pharmaceutical industry, and companies, more aware of the needs of society and of the economy. He will make scientific questioning an element of his daily practice. Because after the training period in science, his predominant or exclusive activity will be clinical practice. He will not be absorbed by the laboratory like the doctor-scientist; that will be the task of those who collaborate with him or who he leads. Thus, the contribution of the doctor-scientist will not be the time factor. He will be more useful to his patients and will dominate the time factor.
The idea of participating in the scientific training of doctors attracted me from the outset. That scientific training obviously goes beyond the teaching-learning inherent to undergraduate training. I personally think that in the current context the figure of the scientifically educated doctor is the most adequate one to establish continuity between cutting-edge, truly innovative research and clinical practice. In Portugal there have recently been pioneering and excellent private initiatives in order to adapt the advanced scientific training of doctors to the new reality. I can highlight the initiatives of the Calouste Gulbenkian and Champalimaud Foundations, with ministerial support. In order for these kinds of initiatives can be continued, so as to generate in Portugal the critical mass of doctors motivated towards scientific activity, it will be important for contact with it to start during the undergraduate period. Preferably through the practice of science in units of excellence, independently of their more clinical or more Basic/fundamental tendencies, as the type of medical research they will practice will be a continuum between those two stereotypes. In fact, there must only be one type of research: excellence. GAPIC’s aim is to promote this research among medical students. It will certainly contribute towards the training of the new doctor, who will once again be the leading figure in the advancing of the medical sciences. The environment of our faculty is now particularly propitious; it is one of contagious enthusiasm! Signs of this are the formation of the Institute of Molecular Medicine (IMM), the growing involvement of the doctors from the Santa Maria Hospital (HSM) in joint projects with the FMUL-IMM, and the recent creation of the Academic Medical Centre.
Out of all this, the current GAPIC team will take its lines of action as:
1) To maintain the promotion of the scientific activity practised by students in units of excellence, in order to stimulate, without short cuts, the perception of the influence of scientific culture on medical culture;
2) To integrate, whenever possible and desirable, the actions promoted by GAPIC with actions promoted by the students themselves;
3) To promote students’ contact with living forces in our society, coming from other areas of knowledge and businesses, so as to become aware of the context of their future action.
I can guarantee that the current GAPIC team, made up by Professors Ana Espada de Sousa, João Forjaz de Lacerda and João Eurico da Fonseca, besides myself, assisted by Sónia Barroso, is particularly committed to fulfilling these aims.
I must thank the GAPIC coordinators who came before me and with whom I have had closer contact, namely Professors David Ferreira, Leonor Parreira and Ana Sebastião, for how much I owe them for their cultural legacy.

João A. A. Ferreira
Unidade de Biologia da Cromatina (UBCR) | Instituto de Medicina Molecular (IMM)
Faculdade de Medicina – Edifício Egas Moniz Piso3A – sala5
Tel: 21 7999 519 | Fax: 21 7999 418 | Ext. (IMM): 47359/47305
e-mail: hjoao@fm.ul.pt