Postgraduate education among family and community physicians in Brazil: the Trajetórias MFC project

Abstract

ObjectiveOur objective was to describe the postgraduate education trajectories of family and community physicians in Brazil, where neither primary healthcare nor family and community medicine is recognised as a knowledge area for the purpose of research and postgraduate education (master’s and PhD degrees).DesignAn observational, exploratory study, using administrative data. A nationwide list of family and community physicians as of late November 2018 was compiled from multiple sources. Data on the mode of specialisation was obtained from the same sources and were correlated with data on master’s and PhD degrees, obtained from the curricula vitae on the Lattes Platform.SettingThis study was set in Brazil.Participants6238 family and community physicians (58.3% female), of whom 2795 had earned a specialist certificate (identified from the list of physicians certified by Sociedade Brasileira de Medicina de Família e Comunidade) and 3957 had completed medical residency (identified from SisCNRM, the national information system for medical residency).ResultsA master’s degree was held by 747 (12.0%) family and community physicians, and a PhD by 170 (2.7%); most degrees were in collective health (47.0% and 42%, respectively). Men were more likely than women to hold a master’s degree (adjusted odds ratio (aOR) 1.24, 95% uncertainty interval (UI) 1.07–1.45) and even more likely to a hold PhD (aOR 1.86, 95% UI 1.35–2.59). Family and community physicians were also less likely to hold a PhD degree if their master’s degree was professional (oriented towards jobs outside academia) instead of academic (aOR 0.15, 95% UI 0.05–0.39) or in some area other than collective health or medicine (aOR 0.41, 95% UI 0.21–0.78, compared with a master’s degree in collective health). The postgraduate degree was more likely to precede specialisation for family and community physicians specialising through certification (master’s degree 39.9%, PhD 33%) than through medical residency (master’s degree 9.1%, PhD 6%).ConclusionFamily and community physicians in Brazil increasingly earn academic and professional master’s and PhD degrees, with an emphasis on collective health, even though women seemingly face barriers to advance their education. The consequences of different postgraduate trajectories should be critically examined.

In which journals do family and community physicians in Brazil publish? The Trajetórias MFC project

“…The downside is that some of the excluded articles might be relevant, too. Last, our findings are probably overrepresentative of early career researchers, because most family and community physicians concluded their medical residencies or were certificated in the last 10 years 14 and, as a result, the specialty has a fairly young demographic profile. 32…”

“…Another reason might be that most family and community physicians in Brazil earn their master’s and Ph.D. degrees in collective health, not medicine. 14 This prevalence of postgraduate degrees in collective health might explain why, as reported by Almeida et al, 28 primary care research in Brazil has a focus on healthcare services and policies, instead of clinical research. This focus, in turn, might explain why family and community physicians submit so much research to public health (collective health) journals.…”

“…This was an observational, exploratory study, using administrative data from multiple sources, as part of the Trajetórias MFC project. 14 Ethical approval was obtained from the research ethics committee in Universidade Vila Velha (certificate 02957118.2.0000.5064), and data on specialist certification was obtained with permission from SBMFC ( Sociedade Brasileira de Medicina de Família e Comunidade , the Brazilian Society on Family and Community Medicine). Three authors (LFF, DJB, and TDS) are family and community physicians and discussed the research project informally with their peers, but stakeholders were not formally included in the study planning.…”

“…As previously described, 14 we compiled the list of family and community physicians in Brazil using data from SisCNRM ( Sistema da Comissão Nacional de Residência Médica , the national information system on medical residency) in November 2018 and SBMFC in late December 2018, and obtained their curricula vitae from the Lattes Platform (the national information system on the evaluation of science, technology, and innovation 15 ), also in late December 2018.…”

Postgraduate education among family and community physicians in Brazil: the Trajetórias MFC project

“…Thus, before initiating the data collection we obtained approval by the research ethics committee of Universidade Vila Velha (certificate 02957118.2.0000.5064). Because our data is personally identifiable, it will be available to other researchers only if they present an ethically-approved research project with an analysis plan 42 .…”