Lato sensu postgraduate courses in Brazilian medical education: a qualitative study

Sousa, Juliana; Dolci, José Eduardo Lutaif; Scheffer, Mário César

doi:10.1590/1806-9282.20251299

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Original Article • Rev. Assoc. Med. Bras. 71 (11) • 2025 • https://doi.org/10.1590/1806-9282.20251299 linkcopy

Lato sensu postgraduate courses in Brazilian medical education: a qualitative study

Authorship SCIMAGO INSTITUTIONS RANKINGS

SUMMARY

OBJECTIVE: The aim of this study was to analyze the provision of lato sensu postgraduate courses within the context of specialist medical training in Brazil.

METHODS: Using a qualitative research approach, in-depth interviews were conducted based on a semi-structured guide with 24 key informants occupying strategic roles in the training of medical specialists. Participants included health system managers, medical educators, leaders of professional Medical Societies, and representatives from both public and private sectors.

RESULTS: Four core themes emerged from the interviews regarding lato sensu postgraduate courses in medicine, reflecting key concerns and perceptions raised by participants: the lack of regulation and oversight amid an expanding market; risks to the quality of specialist medical training; the predominance of private-sector provision, often misaligned with the needs of Brazil's Unified Health System; and the importance of preserving the existing framework for specialist certification, as overseen by the National Commission for Medical Residency and the Brazilian Medical Association.

CONCLUSION: Lato sensu postgraduate courses may serve a complementary role in the continuing education of doctors, but they are not a substitute for Medical Residency or the Specialist title granted by the Brazilian Association or Society of the respective specialty, which is affiliated to the Brazilian Medical Association. These programs should be subject to formal regulation and oversight, whether implemented by governmental authorities or delegated to competent civil society organizations.

KEYWORDS:
Specialization; Distance education; Physicians; Medical education; Private sector

Institution or sector of origin of affiliation	Selection criteria
National Commission for Medical Residency (CNRM)	Individuals occupying formally designated strategic positions.
State Medical Residency Commissions (Cerems)	Coordinators from states with the highest number of medical resident positions.
Medical Societies affiliated with the Brazilian Medical Association	Representatives from the six societies with the largest number of certified specialists.
Public-sector health and education agencies	Individuals in formal strategic roles within the CNRM Plenary.
Private-sector institutions involved in medical education	Executives from leading private-sector organizations engaged in physician training.
Academic researchers in medical training	Selected based on academic output and recognized expertise in the field.

Themes	Key issues	Selected quotes from interviewees
1. LSPG courses: Regulation and oversight	Unclear roles of the federal government and medical associations in the regulation of LSPG courses Litigation to grant specialist status to physicians completing LSPG courses	We need a new regulatory framework for specialisation that ensures universities retain their autonomy and allows individuals to pursue complementary training pathways. (…) There is no problem with professionals undertaking a LSPG specialisation. The issue lies in how we regulate certification (Public sector representative). These programmes are recognised by the Ministry of Education as postgraduate courses, but they cannot be promoted as courses that confer specialist status. Some do advertise them this way, and in such cases, we take legal action (Representative of a medical society). I'm very sorry that these matters end up in Court, but those primarily responsible are the ones who should reflect on whether they should pursue that path in the first place. It's not a legitimate path, it's a shortcut to obtaining the specialist title. Consider the difference in time, structure and opportunity between a hands-on residency programme and one that is purely theoretical, held on weekends, or even delivered remotely (Medical education specialist).
2. LSPG courses: Quality of specialized medical training	Incompatible workload and formats with quality standards Lack of a pedagogical framework and a competency matrix	[About the LSPG course] How many faculty members are there? Publications? Qualifications? Workload? Student-to-teacher ratio? Hospital? Laboratory? Library? This demands a thorough evaluation (Representative of a medical society). We will have to change our approach and stop offering low-quality products instead providing high-quality [LSPG] courses so that they begin to gain a good reputation. Someday, one of our students may prefer to pursue a top-tier postgraduate LSPG course rather than a substandard residency (Private sector representative). There are no simulation models that can replace direct patient experience [as occurs in Medical Residency]. The safety level of a graduate who has completed a 2,880-h residency is markedly different from that of someone who underwent remote training totaling 360 h. Direct comparisons are not feasible (Public sector representative).
3. LSPG courses: Commercialization of specialist medical training	Unregulated commercial provision, predominantly costly and fee-based Limited provision in public institutions and weak alignment with SUS needs	Investing in a physician means investing in 50 potential years of product consumption: getting into medical school, paying for school itself, entering residency, the various LSPG courses they'll pay for later, and continuing medical education (Medical education specialist). [About] Private courses, entrepreneurs see a market niche and are creating training opportunities supported by strong marketing strategies on social media, showcasing "success stories". This has attracted an audience in Brazil that is actively seeking such options, especially since not everyone is entering residency (Representative of a medical society). We have the SUS, what's missing now is the work to build on that. (…) I would like to see any educational group truly adopt the Medical Residency model and succeed in training specialists through that approach. It doesn't matter whether it's public or private, as long as it follows the scientific and ethical principles of the health professions. Will LSPG courses also begin to prioritise the fields most needed to better meet social needs? (Public sector representative)
4. Model for specialist certification and credentialing	Medical Residency as the gold standard in specialist training Medical Societies as certifying bodies for specialist titles LSPG courses as a tool for the continuing medical education of doctors	Specialist training through residency programs constitutes the gold standard. This model has stood the test of time, remaining exemplary in the education of medical specialists by immersing trainees in clinical practice, fostering opportunities for peer discussion, ensuring regular supervision, and exposing them to professional role models. Undoubtedly, there is a need for a comprehensive review of the entire system. However, the overarching aim should be to broaden access to such training, rather than maintain the current level of restriction (Medical education specialist). With regard to the ability of these professionals to obtain specialist title, it is noteworthy that this group [trained through LSPG] is consistently among those with the highest failure rates in the board examinations administered [by Medical Societies] (Representative of a medical society). There is a clear role for LSPG in the context of continuing professional development, particularly for doctors, who have completed their formal training, hold specialist title and seek to update their skills in response to emerging technologies or practices, such as the introduction of robotic-assisted surgery (Private sector representative).

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Associação Médica Brasileira R. São Carlos do Pinhal, 324, 01333-903 São Paulo SP - Brazil, Tel: +55 11 3178-6800, Fax: +55 11 3178-6816 - São Paulo - SP - Brazil
E-mail: ramb@amb.org.br

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[TFN1] Source: Elaborated by the authors based on in-depth interviews using a semi-structured script. DMB, 2025.