Family medicine education in Brazil: challenges, opportunities, and innovations

Since 1988, Brazil's public health system has tried to build a national health system that responds to the needs and expectations of Brazil's population. In 1994, the government created the Family Health Program to help carry out that goal. However, the dearth of family physicians in Brazil-the central figures in that program-limits the program's effectiveness. The lack of family physicians can be traced primarily to the medical schools, which at that time were not training such physicians. This, in turn, can be traced to a number of conditions in Brazil (e.g., the bias toward specialization in both medical education and care) that favor specialists and discourage generalists. In 1992, a group of physicians founded an academic society in São Paulo to promote the humanistic dimensions of doctoring and "establish the proper basis and scientific methodology for family medicine." The society's board eventually began teaching humanistic medicine to medical students, who became interested in family medicine. The board realized that its mission should expand to find ways to introduce and integrate family medicine into the medical schools of Brazil, to establish family medicine's academic credentials, help attract students to family medicine as a career, and secure family medicine's credibility in the marketplace. Since that time, the society has developed a variety of initiatives involving students, faculty, and medical schools to pursue these goals. The authors describe these initiatives, the progress made, and the challenges ahead.