Medical education in Brazil

POINT OF VIEW

Medical education in Brazil

Charles Mady

Instituto do Coração (InCor) - HC-FMUSP, São Paulo, SP - Brazil

^{Mailing Address}

Key Words: Education,Higher; Education, Medical; Brazil.

The function of teaching, at all levels, is to educate. No society can evolve healthily in the lack of adequate education. This is, in my opinion, the major problem among all the obstacles that Brazil faces.

In following the line of thought of his master Socrates, Plato realized the need to reach the truth by means of dialogue, in which the inquirer plays the role of helping the interlocutor, the latter being the one to give birth to truth. For this purpose, he chose a woodland area not too far away from Athens as his teaching premises, a place named after the legendary hero Academus, this being the origin of the name Academy for his school. With the same idea, Aristotle founded the Lyceum, a name originated in the temple that lay nearby and which was dedicated to Apollo Lykeios, whose meaning is wolf killer in Greek. There, like Plato, he gave classes while walking with his students the livelong day, in constant conversation. This habit gave origin to the expression peripatetic philosophy, which means lecturing while walking, stressing the need for a favorable environment, time, presence and patience. In this system, it was important that everyone's opinions were debated, with agreements and disagreements being freely expressed, and it became clear that disagreements are often a source of both intellectual and moral progress. They knew that controversies and different standpoints were the major safeguards of the freedom of thought. The Academy symbolically became the precursor of universities that emerged as from the Middle Ages and introduced concepts that remain true despite not being frequently followed today.

Teaching is not a process of merely disseminating information, and should not be made within a system of dogmas that have to be obligatorily accepted. The merit of the Greek philosophers was to have understood how genuine education should be performed, with the teacher's role being that of guiding, leading the student to see things by himself. Learning how to think is not a skill that comes quickly; it has to be achieved by means of personal effort, with time and the help of a mentor, or mentors, and there are no shortcuts to the acquisition of this ability. This is the method of supervised teaching, as we know it today. The interaction between students and teachers is the best way to reach real learning, and an institution can only be called academic if it fulfills this key requirement, generating healthy mental habits associated with an investigative spirit independent of momentary trends and prejudices. In sum, education is to learn to think for oneself, under proper supervision, in genuine interaction. If a university fails in this task, it becomes a simple doctrinal environment. Despite having lived in absolutely distinct times, the Greek Heraclitus and the German Hegel transmitted the following and definitive lesson to us very clearly: learning many things does not teach one how to comprehend. Reading, by itself, even if intensively, will not improve our understanding of any subject. Dialogues, information exchange, living together in an academic environment, reflection and meditation are fundamental in acquiring adequate and impartial knowledge. This, therefore, arises from varied sources, and contradictions are both positive and productive. Also, each source should understand that teaching is not transferring knowledge, but creating conditions for knowledge to be produced. As Pythagoras taught us, this is the good knowledge deemed ethically correct. This is what Menocal magisterially comments on her book The ornament of the world, in which she describes the exemplary coexistence of Jews, Christians and Muslims in the Iberian Peninsula, on the occasion known as Al-Andalus or Sefarad, with the following phrase: "And when cultural intertwining follows from that tolerance, who can say that there will not be a better way to find solutions for seemingly intractable ideological and political differences?". Norberto Bobbio¹ completes this line of thought with this humble phrase: "I learned to respect other's ideas, to hold myself in front of each conscience's secrets, to understand before discussing, to discuss before judging". They are heirs to that old, but still prevailing, form of thinking.

And our teaching reality, where is it today? By reason of my profession, I will restrict myself to the medical field. This is an extremely costly course and, because of its complexity, it necessarily requires adequate facilities, a hospital with a university profile and, above all, a faculty that gives priority to the institution it is affiliated to, joining assistance, teaching and research activities in a high degree of balance. Assistance is the key point, since it is around the patient and because of the patient that all the rest will occur. Therefore, medical teaching cannot exist without an adequate teaching hospital. Such hospital would necessarily be able to offer medical residency to all its students. When public and private colleges are analyzed, we verify that in many of them the students are virtually abandoned, so they have to search for other medical schools, usually private ones, to get a training course. That is when they become nothing more than cheap labor for other interests. After finishing their courses, they desperately seek for places where they can do medical residency, because the schools where they graduated have no conditions to offer this program, which is fundamental for their exercising their future specialties with dignity. To make this dramatic situation even worse, many faculties include famous and distinguished names that are hardly ever present before the students. These professors live in other cities or states, and therefore have no chance to bring knowledge to their students. Such schools (if at all they can be so called) cast aside the lessons that the ancient Greeks gave us. They hire absent or itinerant professors not highly committed to the quality of education that they should provide.

Unfortunately, as Shakespeare² wrote, "the evil that men do lives after them". If it could be estimated, what is the social burden of poor education? Until when will we be forced to watch the dramatic situation of these students that supplement their education in what we can call "steakhouse classes", sponsored by heaven knows who? Society pleads for quality. This is not the way to achieve it. The ancient Greeks, be where they may, are probably ashamed of us.

References

Manuscript received April 13, 2009; revised manuscript received May 13, 2009; accepted May 13, 2009.

• 1. Bobbio N. Conclusão do prefácio "Italia Civile". Manduria-Bari-Perugia:Laccita;1964.
• 2. Shakespeare W. Trecho do sonêto 47 (Online). [Acesso em 2008 dez.4].Disponível em http://www.pensador.info/autor/William_Shakespeare/

Publication Dates

• Publication in this collection
  24 Nov 2009
• Date of issue
  Oct 2009