Physician training, university hospitals, and the Unified Health System in Brazil

There are 80 medical schools in Brazil, of which 14 were selected for this study based on their regional distribution and representative characteristics. A survey in 1995 showed a heavy concentration (86%) of in-house practical training in major university hospitals. Only 14% of the hands-on training of students occurred in primary health or community-based clinics or other services related to the nationwide Unified Health System (SUS). University hospitals have been organized according to the specialized ward model, with extensive fragmentation of health care. This article makes several proposals for improving medical training. Changes in medical care are considered crucial to improvement of physician training. Reforms in medical care in such hospitals would be more important than reformulating the medical school itself. A move towards other health care services is recommended; more time devoted to teaching in primary health care systems and other extramural services is crucial for achieving better physician responsibility and competence.