Professor José Fernandes e Fernandes
Director of the Faculty of Medicine of the University of Lisbon

Medical education: the needed reform 

Training good doctors with a solid scientific education who are able to act in accordance with the state of the art, be involved in innovation, and willing to be part of, and constructively transform public and private health care is a priority objective for the Faculty of Medicine, in line with its mandatory public responsibility.

The organization of medical education in Portugal deserves careful reflection: substantial changes in the evolution of medicine, in the organization and funding of institutions, the emergence of new needs arising from globalization, and the concomitant decrease in available funds pose challenges to the health system, to the training of professionals, and to the educational model. In Portugal, its organization is based on a dual supervision. The teaching is planned by medical schools within universities that depend on the Ministry of Education (ME), which assesses and accredits the quality of the training. However, clinical training, which is crucial, is carried out in hospitals and health centres under the responsibility of the Ministry of Health (MS).

Medical schools recruit and take on professionals with medical careers independent from a university career as teaching agents, and use the respective clinical services, which represents a gain on the practical preparation of future physicians. This sharing of resources is the most visible expression of inter-institutional cooperation and of collaboration between the corresponding ministries.

However, this is not always without difficulties, particularly in a context of restrictive policies in hospital management that tend to look at teaching as a mission extrinsic to its purpose and as an unforeseen financial cost.

Actually, there is no policy for medical education involving all participants and addressing the requisites and needs of medical education, which I find clearly inappropriate at times of development, change and crisis.

There has been an effort to have reciprocity in functional responsibilities and financial burdens between the two careers, and little else; we have never succeeded in attaining operational and strategic convergence regarding the setting of goals and the planning and adaptation of institutions and clinical units to teaching and research. The organizational model of these institutions where clinical education is conducted depends exclusively on the MS, with potentially negative impact on the educational mission, research, recruitment of professionals, and on a comprehensive and restructured evaluation.

Source: Público Newspaper

Read the full opinion piece here.