The quality of medical education in Brazil has come under renewed scrutiny following the release of results from the first National Examination for the Assessment of Medicine (Enamed). The findings have intensified debate among educators, regulators and medical professionals, who warn that deficiencies in undergraduate training may be translating into risks for patients across the country.
Data compiled by the Instituto Nacional de Estudos e Pesquisas Educacionais Anísio Teixeira (Inep) indicate that 30.7 per cent of assessed medical schools received grades classified as insufficient (levels 1 or 2). In practical terms, this suggests that nearly one in three newly qualified doctors may enter the workforce without demonstrating mastery of core competencies considered essential for safe medical practice.
Approximately 13,000 graduating students in this edition of the examination were enrolled in programmes deemed to be of low quality. Professional associations argue that the figures corroborate longstanding concerns about the rapid expansion and commercialisation of medical education in Brazil, particularly within the private sector. More than half of private institutions assessed reportedly achieved unsatisfactory scores.
Government response and regulatory debate
Brazil’s Minister of Education, Camilo Santana, announced a package of sanctions targeting institutions with weak performance. Measures include restrictions on the expansion of student places and the suspension of access to public student financing schemes such as Fies for courses graded at levels 1 and 2.
According to the Ministry, underperforming programmes will be placed under supervision and may face escalating penalties, including suspension of new admissions and reductions in authorised intake, depending on the proportion of graduates considered proficient. Current students, however, will not be affected by the immediate measures.
While the Minister has stated that the objective is not to close universities indiscriminately but to compel investment in faculty, laboratories and infrastructure, critics contend that administrative sanctions alone may be insufficient. They argue that without a clearer statutory framework and more rigorous oversight mechanisms, structural weaknesses in training will persist.
Professional oversight and calls for reform
The Conselho Federal de Medicina (CFM) has expressed concern that the current examination may underestimate the scale of the problem. Representatives have highlighted the absence of a practical clinical skills component and questioned the cancellation of several questions in the most recent test. In their view, a more robust model incorporating objective assessment and structured practical stations would provide a more accurate measure of competence.
Some within the profession advocate the creation of a legally established proficiency examination—comparable in concept to a bar examination in law—to ensure minimum standards prior to full professional practice. Proposals such as the so-called Profimed, currently debated in Brazil’s National Congress, remain controversial.
The broader regulatory discussion also centres on the opening of medical schools in regions lacking adequate teaching hospitals, outpatient facilities and qualified academic staff. Critics argue that Brazil has reached a saturation point in the number of medical faculties and that priority should shift from expansion to quality assurance.
Patient safety in focus
Recent high-profile clinical incidents have intensified public concern about training standards. In December 2025, the death of a six-year-old child in Manaus was attributed to a prescribing error involving the intravenous administration of adrenaline for laryngitis, where inhaled therapy would typically be indicated. The physician involved had graduated from a medical school that received one of the lowest Enamed ratings.
Although isolated cases cannot be generalised to the entire profession, experts stress that inadequate preparation in pharmacology, emergency care and clinical reasoning can have serious consequences. International medical education literature consistently underscores that structured clinical exposure, supervised practice and competency-based assessment are critical to safeguarding patient outcomes.
Growth of supplementary training
Amid these concerns, some graduates have turned to additional courses and private training initiatives to compensate for perceived gaps in undergraduate education. According to practitioners involved in emergency medicine training, demand for complementary instruction—particularly focused on urgent and emergency care—has increased significantly in recent years.
Observers note that many new programmes place strong emphasis on outpatient care and theoretical content, sometimes at the expense of hands-on experience in emergency settings. This imbalance may leave newly qualified doctors feeling underprepared for frontline roles in public hospitals and urgent care units, where many begin their careers.
Furthermore, the expansion of undergraduate places has not been matched by proportional growth in medical residency positions. As residency remains the gold standard for specialist training in Brazil, limited availability may encourage graduates to seek alternative postgraduate pathways.
A systemic challenge
The unfolding debate in Brazil highlights a complex intersection of educational policy, market forces and patient safety. While the introduction of a national assessment represents a step towards accountability, stakeholders broadly agree that evaluation alone will not resolve structural deficiencies.
Ensuring high-quality medical education requires sustained investment in teaching infrastructure, rigorous supervision, transparent standards and alignment between training and real-world clinical demands. As Brazil confronts the consequences of rapid expansion in its medical education sector, the central question remains how to balance access with excellence—so that the ultimate beneficiaries, patients, are not placed at risk.