Suggestions for how academia can improve the health of medicine

Abstract

The Brazilian system for postgraduate degrees within the field of medicine is rapidly being transformed into a system for postgraduate degrees in healthcare that congregates all types of professionals. It does not take much effort to see that, even in programs created to develop research in medical specialties, physicians are a minority.This has come about for various reasons, among which the requirement for exclusive dedication that goes with awards of research grants, which provide a monthly income of around R$ 1,020.00 to R$ 1,530.00. In practice, this situation ends up being of interest for non-physicians at the start of their careers.In addition, the criteria for judging curriculums in medical schools have been governed by the same criteria as used in basic medical fields regarding publication in journals with a high impact factor, independent of the quality of studies and the time required for developing them. In other words, the journal in which publication is achieved is evaluated and not the article that is published.It is known that clinical studies generally require several years to reach conclusions and the respective publication. This set of factors forms part of a process that has been progressively weakening academic recognition and the power of dedicated clinicians in medical schools themselves.From a practical point of view, young physicians have great interest in medical residence, through which they can learn a lot. However, they have little stimulus towards research because they have low chances of success, particularly in competition with non-physicians, given that the criteria used are not the same regarding knowledge, skills and attitudes that are of interest within medicine. This is knowledge that, on average, it takes physicians ten years to acquire, but then they would be starting a career from scratch. During this time, non-physicians will have had the time to achieve master's and doctoral degrees and to (deservedly) enrich their Curriculum Vitae. The consequence of this is that physicians lose strength in academic fields and hence also in professional fields, as well as deviating their career objectives away from clinical activity.For many years, the Coordination Office for Advancement of University-level Personnel (Coordenação de Aperfeiçoamento de Pessoal de Nível Superior; Capes) has been endeavoring to put the implementation of scientific evidence into practice. It can be said that this is currently one of the greatest challenges within medicine and healthcare. One of its initiatives has been to stimulate the offer of master's programs as professional qualifications.* This has caused reactions, most obviously among individuals with little medical knowledge, who take the view that there is only one form of science, pure science, independent of applications of its results that are more immediate.Fortunately, they are wrong. Everything requires improvement, particularly when practice shows that new technologies do not correspond to needs. The revolution generated by the evidence-base...