Sound like a broken record? Vacancies, alternative careers, and the quality of medical training

It has become immoral to talk about excessive medical training.

Sound like a broken record? Vacancies, alternative careers, and the quality of medical training

Over the past 20 years, have been traded in the public arena arguments in favor of limiting access to medical courses in Portugal. Justifications were associated with several orders:  the high cost of training; the inability to ensure quality pre and postgraduate education (this being probably the most relevant); the number of available doctors in Portugal, comparing with other countries; wage costs, among others. Even admitting that this limitation was justified, this reasoning was incomprehensible to the public opinion since, simultaneously, there were successive, glaring, and embarrassing difficulties in the National Health Service (SNS) responsiveness.

And suddenly a pandemic arises, a deep emotional upheaval on a global scale, in which healthcare professionals were precisely one of the most scarce assets. From one moment to another, opinions were unanimous: there were not enough doctors. While it may be true that many of the arguments previously mentioned may continue to be valid, it has become immoral to talk about excessive medical training as long as there is a memory of medical resources exhaustion that has been experienced.

In Portugal, the National Health System has evolved from a mostly deliever domain to focus also on research, post-graduate training, and, very recently, a pivot of pre-graduate training, strands that were considered for many years to be an exclusive responsibility of the public service and public higher education institutions. The evolution of higher education and medical training led us to the existence of quality post-graduate training in private health institutions. Recently, even pre-graduate education has become a reality in the private sector, in parallel with what is seen in many other countries.

Therefore, it’s clear that the speech of limitation in quantity, regardless of the reasons that may justify it, will have to be replaced, exclusively, by an uncompromising defense of quality. And it is not enough to assume that training in Portugal, or any other country, has a parallel (or even more quality) with other markets, using as a justification the doctors that trained in a given country can enter internship programs abroad. Furthermore, doctors have a broad impact on the society as a result of the influence of their clinical work, their leadership, and many other factors, but whose real impact remains to be assessed.

The quality of medical training should go through areas that are already within the scope of these professionals' skills, but that only rarely becomes an option. A process that has already started and that will need to be boosted in the short term.

The pandemic we are experiencing has made it clear that doctors can - and should be - in health planning, not only at a theoretical level but also at the operational level, as well as in the discussion of sensitive ethical issues or the decision-making processes of health authorities.

These are careers that have a very significant impact on people's lives and that need, along with the care settings, to have the best doctors. Everything that underlies clinical reasoning contributes to a thought process that is a unique asset, as proved by the central and growing role that doctors have in the entrepreneurship ecosystem, creating health technologies that lead us to the development of transformative processes or new visions for the doctor-patient-social relation.

In all contexts, the digitization has been transformative. Biomedical simulation jumped from a training and teaching paradigm to a strategy for optimizing clinical performance algorithms; augmented reality is not just another way of learning anatomy and is now present in operating theaters; the very domain of technology as a communication tool is nuclear.

Paradoxically, these “new” competencies must coexist with classic domains of medical training, whether they are physiopathology, ethics, or even communication and medical semiology, which, moreover, are the basis of clinical reasoning.

All in all, there are great challenges to overcome. Quality of medical education have to be an obsession, along with the promotion of new skills that will allow doctors to play an even more active role in society, expanding their performance in areas that were considered less relevant because they deviate from the classic view of the physician.

[Opinion Article previously published in Dinheiro Vivo]