10 de September, 2022
Residency, which in the country is called internship, has a different structure and entry method than the Brazilian model. In this article, we will explain how it works and the step-by-step process on how to do medical residency in Portugal.
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In the case of foreign doctors, to do medical residency in Portugal you must, first of all, revalidate your medical diploma in Portugal and register at the Ordem dos Médicos (Portuguese Medical Association).
Then, it is necessary to follow the same procedure for Portuguese doctors, passing the National Access Test (PNA), which evaluates doctors for the beginning of residency.
According to Portaria nº 268/2018 (which approved the General Training training program), medical residency in Portugal is composed of two stages: the General Training Internship and the Specific Training Internship. Both stages must be attended by internal medicine physicians (residents).
The first year of medical residency in Portugal, the Internato de Formação Geral, consists of a 12-month program, divided this way:
From the second year on, the Internship for Specific Training begins. Currently, there are 48 areas of specialization, all of which are for direct entry.
The specialty areas defined in the Medical Internship Regulations(Portaria nº 79/2018) are:
The duration of medical residency in Portugal is different from the residency performed in Brazil.
General Training, as mentioned earlier, is 12 months of mandatory training and is part of the medical specialty program. Then the Specific Training actually begins, which can vary from 4 to 6 years, depending on the area of specialty.
The specialties of Family Medicine and Public Health, for example, last 4 years. Most medical specialties last 5 years, and finally, surgical specialties last 6 years.
Remember that the General Formation year is compulsory and, therefore, the formations last a minimum of 5 years and a maximum of 7 years.
Even if compartmentalized entry is not required, as it is in Brazil, for example, there are a number of internships that are necessary to complement the training.
Oncology training will require 21 months of internship in Internal Medicine (Internal Medicine), 3 months of Intensive Care, and only then will the doctor go on to oncology-specific training.
It is worth pointing out that the weekly workload of the medical internship in Portugal is 40 hours, unlike in Brazil, where, by law, it would be 60 hours a week.
These 40 hours are not of exclusive dedication, and the intern may, if compatible with his formal work schedule in the internship, work outside his institution as a general practitioner, for example, or even in other functions that are of his interest.
In this case, it is necessary to request authorization from the hospital where you work as an intern to accumulate duties, always with the authorization of the Director of the Clinical Service where you are a resident.
It is best to consult the General and Specialized Training Program in question.
According to the Regulation of the Internship, programs must inform the total duration of training, the sequence and duration of internships, and other specifications.
Entry into the specialty is divided into two stages, just as the entire residency training is organized.
After the PNA is done, the Central Administration of the Health System (ACSS) website opens, in a specific period, a deadline for choices of hospitals where one is interested in doing the General Training. This usually happens in late November or early December.
The physician makes a selection of 22 places where he/she would like to do the residency, in order of preference, through the ACSS online platform.
Seriation is done according to the normalized classification (normalized average performed by the ACSS according to the final average of the course and place of training). Thus, those with higher normalized averages have preference in the choice of training location.
General Training begins the year after the PNA, in January, and during the course of it, in November, you choose which area of Specific Training you will take.
So what will count is the final position in the list of candidates who took the PNA: the best final test scores and the best normalized averages have the priority of choice.
Candidate Ricardo was in position 100, as he got 90% right on the PNA and an average of 17 values, while Carlos, who also got 90% right on the PNA, had an average of 16.9 values, placing him in position 101.
Ricardo will have priority of choice and thus will opt first for his area of specialty in the medical residency.
The Prova Nacional de Acesso (PNA) is the national exam that allows access to medical residency in Portugal. It is a national competition that takes place on the same day and time throughout the country in mid-November.
Currently (according to the PNA 2021 regulation) it is carried out in the metropolitan areas of Porto and Lisbon, in Coimbra and in the Autonomous Regions.
The PNA is a 150-question multiple-choice exam on various areas of medicine, similar to the medical residency exams in Brazil.
The exam is 240 minutes long, in two stages of 120 minutes, and is divided in terms of content as follows:
The application must be made online through the Internato Médico page on the ACSS website, usually in September of the same calendar year of the exam.
Subsequently, the required documents must be sent by mail to the ACSS within the deadlines set in the National Access Examination Regulations, which can be consulted on the same page.
The content matrix and the bibliographic reference list for the exam are also made available in the annual PNA regulations.
Among the documents required for registration are mandatory:
The Central Administration of the Health System (ACSS) belongs to the Ministry of Health and is the government body responsible for managing access to the specialty. This is different from Brazil, where the responsible body is the Ministry of Education.
The ACSS determines whether the training meets the criteria established by law for training together with the Colleges of Specialties of the Medical Association.
And also, indirectly, through the Regional Health Administrations (ARS), it evaluates requests to change specialty, internships outside the institution, and work contracts.
Just as in Brazil, in Portugal there is a certain preference for medical specialties that, in many places in the world, are considered noble specialties in Medicine, such as Dermatology, Ophthalmology, and Plastic Surgery.
According to the 2021 statistics of the Portuguese Medical Association, the areas with more doctors are Internal Medicine, Pediatrics, Anesthesiology, and Gynecology and Obstetrics. However, the figures consider all doctors working in the country, not only the newly graduated ones.
To give you an idea, the last person to choose the Dermatology specialty in 2021 had a final score of 129 on the PNA and ranked 38 in the order of choices.
Ophthalmology had its last vacancy chosen by a candidate with a 125 rating in the PNA, who was in 89th position. In Plastic Surgery, the last doctor who could choose the vacancy had a 123 rating in the PNA, placing 156th in the order of choice.
This contest had a total of 2462 physicians enrolled.
Yes, in Portugal, the end-of-specialty exam is mandatory. In Brazil, although specialty exams are not mandatory, they are recommended.
There is continuous evaluation throughout the internship, but at the end of the training years a final exam is mandatory.
In continuous assessment, at the end of each training block, an evaluation is performed on a scale of zero to 20 points, and the intern who obtains at least a score of 10 is approved.
The final evaluation takes place through a set of tests, after the conclusion of all stages of training: curricular, practical, and theoretical discussion. At the end, the intern doctor will be assigned a score between zero and 20 points.
The exam is held in February or March (regular season) or September/October (special season).
Many people wonder if it is possible to change specialty areas during residency, and the answer is yes!
Imagine you enter a specialty and realize that it was not quite what you expected and you want to change, but at the same time you don’t want to lose the security of a guaranteed position.
It is provided in Ordinance No. 79/2018 that internal medicine physicians may change specialties up to twice.
In this regard, resident physicians can make the switch without having to submit a new application to the competition procedure, provided that the following conditions are met:
Also understand how to apply for medical specialty recognition in Portugal.
For foreign doctors who intend to live in Portugal and work as doctors in the country, it is an excellent path, even for those who wish to do a new training in a different specialty area.
Furthermore, it is interesting to remember that, according to European Union regulations, the medical specialty obtained in Portugal can be recognized in other European countries. This is a good requirement for those who intend to work in other countries as well.
In any case, each physician should analyze his or her career path and professional intentions to conclude if it is worth doing medical residency in Portugal.
Article originally published on the Euro Tips website.