Exames de licenciamento em medicina: uma análise da discussão brasileira e internacional.

Abstract

The possible implementation of a medical licensing examination for Brazilian graduates implicates physicians, students, teachers, government agencies, healthcare employers e the public opinion. The debate, however, is not particular to Brazil and is ongoing in various countries, oftentimes for similar reasons. Moreover, stances adopted by these stakeholders reflect political e corporate interests that they do not discuss openly and that lead them to oppose or support specific assessment modalities. It is thus necessary to identify these interests, by which ways they influence current assessment systems in Brazilian medical education, and which obstacles they can pose to the development of sound, useful assessments. In a systematic review, information about the stakeholders opinions and initiatives in regards to medical assessment is collected. Relying upon some essential references in the sociology of education and the history of medicine, an interpretivist theoretical background is adopted to select, from the data, recurring patterns of discourse and action that allow the identification of relevant interests and their influences on the current configuration of assessment systems in Brazilian medical education. There are four main stakeholders in the discussion. ABEM, with DENEM s support, rejects licensing examinations and attempts to preserve the autonomy of university teachers (whom it represents) in the conduction of what it perceives as constituting their, and no one else s, affairs. National governments have been pursuing, since the 1990s, a politics of massification of higher learning through looser credentialing regulations and financial investments for private universities, which leads them to also oppose licensing tests and the negative consequences they could exert on these schools reputations. CREMESP, in association with educators from leading medical schools in the state of São Paulo and with selected healthcare employers, supports medical licensing and has been actively trying to implemente it, at least on a regional level. And Brazilian medical boards, both federal and regional, have been showing little consistency and agreement with one another, thus indicating the lack of corporate unity and political strength of the medical profession and an influence of specific subgroups antagonistic interests. The discussion about medical licensing in Brazil has been marred by extreme polarization. Main stakeholders compete for hegemony in the field e refuse to acknowledge their antagonists legitimate interests and demands. The outcome is a proliferation of assessment modalities that, due to severe inconsistencies in their design and a lack of clarity in assessment goals, have limited utility and do not provide the population with any guarantees on the graduates levels of proficiency. It is thus necessary to develop a public, formal arena in which stakeholders are able to clearly state their demands and agree on making mutual concessions, so that an agreement as to whether medical licensing tests are needed is reached and, in any case, the best possible assessment modalities are developed.