Bioethics Program in Faculties of Medicine in Portuguese-Speaking Countries | BMC Medical Education


Structure of the medical degree

To obtain a medical degree in Brazil or Portugal, a 6-year program is required that includes both theoretical and practical courses. During this period, the program is divided into a pre-clinical and clinical cycle, which differ in the 2 countries; the clinical cycle in Brazil begins in the 3rd year, while in Portugal it begins in the 4th year of the course. Another difference is that the last year of the course in Portugal is reserved for the supervised internship, which in Brazil corresponds to the internship that takes place in the last 2 years of the course.

Concerning the duration of the teaching of bioethics, our results indicate that in 50% (not= 29) among the medical schools analyzed, bioethics was taught mainly during a single year of the medical program; specifically, this was the case in 52.9% (not= 27) of medical schools in Brazil and 28.6% of (not= 2) medical schools in Portugal. In addition, 24.1% (not= 14) of the schools analyzed offered bioethical content in the curriculum for 2 years of the MD program: 23.5% (not= 12) of schools in Brazil and 28.6% (not= 2) schools in Portugal. In addition, 7.8% (not= 4) of medical schools in Brazil and 14.3% (not= 1) in Portugal taught bioethics content throughout the 3 years of the course, and 9.8% (not= 5) medical faculties in Brazil have taught bioethics throughout the 4 years of the course. A total of 3.4% (not= 2) the faculties of medicine had a bioethical content present throughout the 5 years of the medical course: 2% (not= 1) of schools in Brazil and 14.3% (not= 1) schools in Portugal. Finally, 14.3% (not= 1) of the Faculty of Medicine in Portugal offered bioethics content throughout the 6 years of the medical degree.

Teaching hours of bioethics

Among the Brazilian medical schools analyzed, the study programs were mainly organized in modules or thematic axes in 62.75% (not= 32) of faculties, without specific subjects necessarily included in the structure of the programme. Of these, some schools have described the hourly load intended for each subject, while others only mention the subject’s attendance. This aspect of the organization of the curricula has made it difficult to analyze the weight of the theme of bioethics, because the specific time load assigned to it is diluted between the different themes of the modules. Thus, after analyzing the presence of the theme of bioethics in the courses, a workload of more than 30 hours (the minimum recommended by the Tronc Curriculum) was identified in 60.8% (not= 31) of the programs analyzed (Table 2).

Table 2 Breakdown of course hours by country, in absolute and relative frequencies, n(%)

Of the seven Portuguese medical faculties analysed, five have organized their programs by discipline. All the Portuguese medical faculties offered the subject of bioethics with a minimum hourly load of 90 hours in 1 year, some offering up to 180 hours.

Our analysis revealed that all the Portuguese universities analyzed explicitly indicate the minimum hourly load recommended by the UNESCO core curriculum in their official program documents, 60.8% (not= 31) of the Brazilian universities analyzed clearly show that this subject is addressed in their formal curricula, with the appropriate timetable load in accordance with this recommendation.

When in the program where bioethics is offered

The distribution of bioethics content offered in the preclinical and clinical cycle curriculum differs between the two countries: it was more common for medical schools to offer bioethics content only in the preclinical cycle in Brazil (37.3%; not= 19) and Portugal (71.4%; not= 71.4%). The number of medical schools that offered bioethics content only in the clinical cycle was lower: 29.4% (not= 15) for schools in Brazil and 14.3% (not= 1) for schools in Portugal. Nevertheless, some medical schools offered bioethics content in both the preclinical cycle and the clinical cycle: 29.4% (not= 15) for schools in Brazil and 14.3% (not= 1) for schools in Portugal. In addition, 3.9% (not= 2) medical faculties in Brazil did not offer bioethics content in any of the cycles.

The point in the curriculum at which bioethics is offered varies greatly from school to school. Table 3 presents the distribution of bioethics course units per year in the faculties of medicine of each country studied.

Table 3 Distribution of bioethics content in medical schools in each country, n (%)

In Brazilian faculties of medicine, bioethics is the most offered in the 1st year (52.9%; not= 27) and 2nd year (33.3%; not= 17); the two periods during which the students are still quite immature. We also found that bioethics rarely appears as a subject in its own right in the formal curriculum of the years of medical internship, during which students experience privileged moments of contact with patients. Only three schools describe this theme in the 5th year, which represents 5.9% (not= 3), and four schools in the 6th year, representing 7.8% (not= 4) schools.

In Portugal, the moment in the program when the subject of bioethics is most often taught is in the 3rd year, corresponding to the last year of the preclinical cycle (71.4%; not= 5). Of the seven faculties of medicine in the country, four begin to offer the subject from the 3rd year, a period which marks the end of the preclinical cycle and precedes the so-called “clinical” years, during which students begin to come into direct contact with patients. It is worth highlighting the fact that Portugal has a faculty of medicine which officially includes the subject in the curriculum of each year of the medical course.

Teaching contents of bioethics in the programs

We collected data by comparing the explicit contents of the curricula of the medical faculties of Portugal and Brazil, with the 17 content themes organized on the basis of the curriculum proposed by UNESCO.

An important fact to highlight is that all Portuguese schools (100%; not= 7) proposed the topic “What is ethics?” », while only 66.7% (not= 34) Brazilian schools did.

The second most frequently offered subjects in the curricula of Portuguese schools are those of “autonomy and individual responsibility” and “respect for human vulnerability and personal integrity”, which were explicitly described in 85.7 % (not= 6) school programs. “What is bioethics? is the third most frequently proposed topic, found in 71.4% (not= 5) schools, as well as ‘human dignity and human rights’, ‘consent’ and ‘persons incapable of giving consent’.

In Brazil, “What is ethics? and “What is bioethics?” are the most prevalent topics, appearing with a similar frequency in programs at 66.7% (not= 34) of the schools analyzed. The second most common themes are “human dignity and human rights” with 31.4% (not= 16), “social responsibility and health” with 29.4% (not= 15), and “equality, justice and equity” with 27.5% (not= 14) Figure 1.

Fig. 1

Distribution of curricular content offered by UNESCO in medical faculties in Brazil and Portugal (%)

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