On Wednesday, April 23, 2025, the Brazilian Ministry of Education (Ministério da Educação, MEC) announced the launch of the Exame Nacional de Avaliação da Formação Médica (Enamed), a national examination designed to assess the quality of medical education in Brazil. This initiative aims to ensure that future doctors acquire the necessary competencies to effectively serve in the country’s public health system, Sistema Único de Saúde (SUS), and other healthcare environments.
The inaugural Enamed is set to take place in October 2025, with individual results expected to be released in December. This annual examination will be mandatory for all medical students graduating in that year, with registrations opening in July 2025. It is projected that around 42,000 recent graduates will participate in the first edition of the Enamed, alongside already qualified physicians looking to enter medical residency programs.
Conducted by the Instituto Nacional de Estudos e Pesquisas Educacionais Anísio Teixeira (Inep) in collaboration with the Empresa Brasileira de Serviços Hospitalares (Ebserh), the Enamed will include 100 multiple-choice questions covering a range of medical disciplines. These areas will encompass Clinical Medicine, General Surgery, Gynecology and Obstetrics, Pediatrics, Family and Community Medicine, Mental Health, and Collective Health.
The primary objectives of the Enamed are multifaceted. Firstly, it aims to evaluate whether medical graduates meet the competencies and skills outlined in the National Curriculum Guidelines (Diretrizes Curriculares Nacionais, DCNs). Secondly, it will provide essential feedback to improve the quality of medical education in Brazil. Furthermore, the Enamed will streamline the selection process for medical residency by integrating the assessments of the Enade and the Exame Nacional de Residência (Enare).
Minister of Education Camilo Santana emphasized the strategic importance of the Enamed for medical training in Brazil, stating, "The results of this exam will have a direct impact on the SUS and the entry of new professionals into the job market." He noted that a working group would be formed to discuss the proposal and ensure a comprehensive evaluation format, involving various stakeholders including class entities.
In a similar vein, Minister of Health Alexandre Padilha remarked that the Enamed represents a collective effort by the federal government to enhance medical training. He highlighted that this exam would allow for ongoing monitoring of student performance throughout their training, ultimately leading to improvements in educational institutions.
While the Enamed has been welcomed by many, some medical associations have raised concerns about its implications. Antonio José Gonçalves, president of the Associação Paulista de Medicina, cautioned against conflating the Enamed with the proposed Exame Nacional de Proficiência Médica, which is currently under consideration in the Senate. He stated, "The proficiency exam is necessary to ensure that only those who demonstrate a minimum mastery of the competencies required are allowed to practice medicine."
Marcelo Morales, a physician and advisor to Senator Marcos Pontes, echoed this sentiment, emphasizing that while the Enamed is a significant step toward improving medical education, it does not replace the need for a proficiency exam. He explained, "The Enamed will assess courses and may aid residency selection, but it is crucial to ensure that all graduates are competent to provide care. This is the gap that the proficiency exam aims to fill."
The implementation of the Enamed is part of a broader strategy to enhance the quality of medical education in Brazil. The MEC plans to analyze the results of the Enamed to identify institutions that may need to improve their programs. Additionally, discussions are underway for a second phase of the Enamed, which would evaluate students' performance mid-way through their studies, allowing for timely interventions.
On April 11, 2025, the Inep released the results of the Exame Nacional de Desempenho dos Estudantes (Enade) for 2023, revealing that the Faculdade de Medicina da UFMG achieved the highest scores in all three of its evaluated courses: Medicine, Speech Therapy, and Radiology. However, only six medical courses nationwide received the maximum score in the Conceito Preliminar de Curso (CPC), which assesses various factors including faculty qualifications and infrastructure.
In a podcast episode titled "How Are Medical Courses Evaluated?" aired on April 16, 2025, Professor Cristina Alvim from UFMG discussed the challenges of interpreting evaluation indicators. She pointed out that while the Enade is a well-constructed exam assessing graduates' knowledge, the weight of the Indicador de Diferença entre os Desempenhos Observado e Esperado (IDD) in the CPC calculation is disproportionately high. "The IDD simplifies the reality by reducing the value added by the institution to the student to a mere comparison between Enem and Enade scores," she explained.
The launch of the Enamed signifies a pivotal moment in Brazil's approach to medical education. It aims not only to enhance the quality of training but also to ensure that new healthcare professionals are well-equipped to meet the demands of the public health system. As the first edition approaches, the focus remains on collaboration among educational institutions, health ministries, and professional associations to ensure the examination meets its goals.
