28 de August, 2019
Whether new graduates or experienced doctors, when we propose to move from continent to continent many of us have to (re)start life from scratch. This readaptation to the new life implies understanding how the labor market works and may require (re)entering a (new) medical specialty.
The medical residence in Portugal, here called medical internship, has a different structure and entry method from our Brazilian model and I will explain a little better how it works and the step-by-step to enter a medical residence in Portugal.
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 what happens in Brazil, where the Ministry of Education is the responsible body.
The ACSS determines whether the formation meets the criteria established by law for formation together with the Colleges of Specialties of the Order of Physicians. And also, indirectly, through the Regional Health Administrations (ARS), it evaluates the requests for change of specialty, internships outside the institution and employment contracts.
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The National Proof of Access (NAP) is the national exam that allows access to medical residence in Portugal. This is a national exam that takes place on the same day and time throughout the country in mid-November. It is held in the following cities of the country: Lisbon, Porto, Coimbra, Covilhã, Funchal and Ponta Delgada.
This is a 150-question multiple-choice exam on various areas of medicine, similar to our medical residency exams in Brazil. The examination lasts 240 minutes and is divided in terms of content as follows: Medicine 50%, Surgery 15%, Pediatrics 15%, Gynecology/Obstetrics 10% and Psychiatry 10%.
The application must be made online through the Medical Internship page of the ACSS, usually in September of the same calendar year in which the test was held, and then mailed the required documents to the ACSS within the deadlines set out in the Notice of Competition. For model and additional information just visit the ACSS page.
It is a two-stage program: General Formation Boarding School and Specific Formation Boarding School.
The first year of the medical residency in Portugal, the General Training Internship, consists of a 12-month programme, of which 3 months of General Surgery, 3 months of Primary Care, 4 months of Internal Medicine and 2 months of Pediatrics.
From the second year on, the boarding school of Specific Formation begins. Currently, there are 48 (forty-eight) areas of specialization, all of which are of direct entry.
The entry into the specialty is divided into 2 stages, just as the training is organized.
After the completion of the NAP, the ACSS site opens in a specific period for the choices of hospitals where there is interest in performing the General Formation, usually late November or early December. A selection of 22 sites is then made in order of preference via the ACSS online platform.
Sorting occurs according to the normalized classification (normalized mean performed by the ACSS according to the final average of course and place of training). Thus, those who have higher normalized averages have a preference in the choice of the place of training.
General Formation begins in the year following the implementation of the PNA, in January, and in its course, in November, the Specific Formation to be carried out is chosen. Here what will count is your final position in the list of candidates who have completed the NAP: the best final marks of the competition and with the best standardized averages have priority.
Example: the candidate Rodrigo was in position 100, because he had 90% of hits in the PNA and had an average of 17 values and Carlos who also made 90% of hits in the PNA, but as he had an average of 16.9 values was in position 101. Rodrigo will have priority of choice and so he will choose his specialty first.
The time of formation is also a differentiating factor of our medical residence in Brazil.
The General Formations, as mentioned above, are made up of 12 compulsory months of training and are part of the medical specialty program. Then begins in fact the Specific Formation, which can vary from 4 to 6 years.
The specialties of general practice and public health, for example, last 4 years. Most medical specialties last 5 years, and finally, surgical specialties last 6 years. Remember that the year of General Formation is compulsory and, therefore, the formations last at least 5 years and at most 7 years.
Even if no compartmentalized entry is required, as is the case in Brazil, for example, there are a number of internships that are necessary to complement the training.
Example: oncology training will require 21 months of internship in Internal Medicine (Medical Clinic), 3 months of Intensive Care and only then will the Doctor go for specific training in Oncology. All of which are part of the direct and specific entry specialty.
Just as in Brazil there is a certain national preference for medical specialties that in many places in the world are considered noble specialties in medicine, such as Dermatology, Ophthalmology and Otorhinolaryngology. Cardiology, Plastic Surgery and Gastroenterology are also among the most popular specialties.
To get an idea, the last person to choose Dermatology in 2018 had a final score of 96% and was placed in the Centro Hospitalar de Lisboa Norte, E.P.E. with the position of 66 in the order of choices. Ophthalmology, on the other hand, had its last vacancy chosen at the Espírito Santo Hospital in Évora, E.P.E. and the candidate had vacancy 112 in the competition of 2342 candidates.
Learn also how to make the registration in the Portuguese Medical Association step by step.
Although specialty tests are not mandatory in Brazil, they are recommended for the exercise of a medical specialty after medical residency. In Portugal the end-of-specialty examination is compulsory.
There is usually continuous evaluation during the internship, but at the end of the years of training it is obligatory to take an end-of-specialty examination with all the practical experience of those years of training.
This examination must be carried out during the period of April or October after the completion of all the training courses.
Once the medical specialty in Portugal is completed, it is possible to apply for its recognition in all the countries that comprise the European Directive on professional recognition (Directive 2005/36/EC of the European Parliament and of the Council of 7 September 2005), following the linguistic criteria determined by each country.
If you want to know more about practicing medicine without borders in Europe, read the article on Global Moving.
The experience and journey of each one of us must be thought and calculated when we propose to leave our country of origin to exercise our profession overseas.
If you like to understand more about the route to the Medical Residence in Portugal (medical internship) and want to know more if the new start is really worth reading, how it is to be a Doctor in Portugal and what the way to get here is.
Author: Mariana Ramalho
Doctor & Consultant