Tiago Villanueva: Does it matter where you do your medical training?

Tiago_VillanuevaThe standards of both undergraduate and postgraduate medical training vary widely around the world. This partly explains why the medical profession is so fiercely regulated when a doctor wishes to practise in a country different to where they trained. Whether better training necessarily predicts more professional success and competence is a different matter. I don’t think it does, so I don’t think that it matters where doctors do their training. But controversy has surfaced following the recent announcement that a Portuguese private higher education institution, CESPU, has made an agreement with a private Spanish university, Alfonso X El Sabio, to allow the graduates of its three year biomedical sciences programme to automatically enter the fourth year of medical school in Spain, starting in the upcoming academic year.

Medical degrees in Portugal are awarded only by public universities. The North Portugal regional council of the Portuguese Medical Association has pointed out, in a press release, that “it is not acceptable that any new medical degree does not fully comply with the demands of quality in undergraduate training, which ensure a solid medical training. That is the only way it will be possible to avoid the existence of first and second class doctors [translated by the author].” The  same press release states that two of the most recent medical programmes in Portugal, at the University of Aveiro and the University of the Algarve, do not meet the same standards as the seven other medical schools in Portugal, which all have six year programmes. The press release adds that those degrees have a “controversial quality” and are “absolutely unnecessary.” Those two programmes are very different from the others as they tend to use innovative teaching methods, accept only graduate students, and last for only four years.

Furthermore, even the president of the Portuguese Medical Association, José Manuel Silva, pointed out that despite the current shortage of doctors in some specialties in Portugal, the country may not have enough specialist training positions for all graduates starting in 2012, which may lead to many doctors leaving the country or potentially facing unemployment, as newly qualified doctors in Portugal are not yet fully licensed to practise independently. Dr Silva has previously mentioned a study that says that Portugal could end up with a surplus of 6000 doctors by the end of the decade.

Perhaps not surprisingly, the Portuguese Medical Students’ Association released a paper last year, which stated that the country may already be training too many future doctors and pointed out that Portugal  now has nine medical schools for a population of around 10,5 million, whereas “the indicators of the World Health Organization point, on average, for one medical school per 2 million inhabitants”.

Nevertheless, medical graduate entry programmes with a four year duration are not new, and the course at St George’s, for example, immediately comes to my mind. I can understand how there can be concerns when four year medical degrees are introduced for the first time in a country that has only had six year degrees to date. But from my experience of doing six year degrees in Portugal, I think that the course could have been substantially compacted. I don’t know what to think of the agreement between the Portuguese and the Spanish university, as I have never seen anything similar elsewhere. I hope  good doctors come out of it, but I am more worried that we may already be training too many doctors. Due to the volume of doctors we are now training, many may end up unemployed and leaving the country, and it will not matter where they trained, but whether they are competent, caring doctors who are committed to their patients and who look after their continuous professional development. Most patients won’t ask you where you went to medical school or did your specialty training.

Tiago Villanueva is a locum GP based in Portugal, and a former BMJ Clegg scholar and student editor, Student BMJ. He can be followed on Twitter at @TiagoMGF