Qualificação Profissional
Programa de Formação Médica Avançada
Leonor Parreira
Faculdade de Medicina de Lisboa
N Engl J. Med. 1979;301:1254-1259
…. I refer to the physician who is simultaneously a serious scientist,
and far less to the clinician who may occasionally also do some
research.
1979 – 10% of USA physicians in full-time faculty
positions
It is the progressive decline in the number of new entries
that constitutes the danger to the survival of the species …
Wyngaarden, 1979
The problems of clinical research will not be solved by amateur M.D.
investigators employing Ph.D. investigators. Nor will the pressing
problems of disease be solved by investigators who lack a clinical
background.
What is needed, is an adequate supply of physician investigators,
thoroughly trained in a scientific discipline as well as in a clinical
field of medicine, capable of bringing both their medical insights
and their scientific skills to biomedical science.
Wyngaarden, 1979
American Society for Clinical Investigation (ASCI),
Association of American Physicians (AAP)
American Federation for Medical Research (AFMR).
USA: 1983 –1998 (- 22% physician-scientists)
Varki & Rosenberg, 2002 Nature Medicine 8:437-439
“pipelines” for training physician-scientists
Varki & Rosenberg, 2002 Nat Med 8:437-439
NIH – 1998
career development awards for young physicians to carry out clinical research
new awards for established clinical investigators
awards for academic institutions supporting clinical research training and
infrastructure.
NIH – 2002
competitive loan repayment programs for young physicians
Foundations created new awards for young and established physician-scientists.
The Howard Hughes Medical Institute appointed 12 new MD
investigators engaged in patient-oriented research.
An increasing number of research-intensive medical schools and hospitals have
constructed multifaceted programs aimed at encouraging medical students to becom
involved with research before and after receiving their MD degree and at protecting
the research time of young physician-scientists during their junior faculty appointments
NIH budget from $14 billion in 1998 to $28 billion in 2003.
Medical Research Council; Department of Health; Welcome Trust;
Leukemia Research Fund; Arthritis Research Campaign …
2002 - Implementing the Clinician Scientist Scheme (progress report)
2003 - Strengthening Clinical Research (progress & recommendations)
Recommendation 1: Create a National Network for Clinical Research within the National
Health Service to create and support excellence in clinical research
Recommendation 2: New Office of Science and Technology funding should be made
available through the Medical Research Council to support the programmatic aspects of
clinical research
Recommendation 3: Improved career structures and incentives for those undertaking clinical
research
Recommendation 4: Improve the regulatory environment needed to support clinical research
within the NHS and promote public involvement
Recommendation 5: The NHS should support its clinical research activities with
1.5% of its turnover, so returning to the original goal of the R&D programme
Clinical PhD Programmes
7 Programmes have been established based in centres of excellence
throughout the UK, which can provide research opportunities that will
appeal to clinicians drawn from across the range of specialities.
Each Programme has been structured to reflect the expertise of individual
institutions, and together they offer a unique opportunity for clinicians who
aspire to a career in academic medicine.
University of Oxford
University of Cambridge
Imperial College
Training Programme in Clinical Pharmacology and Translational Medicine
Partners: Newcastle University, Roche, AstraZeneca, Sanofi-Aventis, Sirtris Pharmaceuticals,
PTC Therapeutics and GlaxoSmithKline.
Scientific focus: Mitochondrial medicine, liver disease and diabetes, neuromuscular disease,
inflammatory disease, rheumatology and dermatology, and chronic respiratory disease.
Translational Medicines and Therapeutics at the University of Cambridge
Partners: University of Cambridge and GlaxoSmithKline.
Scientific focus: Metabolic science, neuroscience, oncology, therapeutic immunology, clinical
pharmacology and therapeutics, cardiovascular and pharmacological sciences.
Scottish Translational Medicine and Therapeutics Initiative
Partners: The Universities of Edinburgh, Aberdeen, Dundee and Glasgow, and pharmaceutical
partner Wyeth Research.
Scientific focus: Cardiovascular disease, metabolic disease, inflammatory disease,
musculoskeletal disease, neuroscience and reproductive health.
Experimental Medicine for New Therapeutics Development
Partners: Imperial College London and GlaxoSmithKline.
Scientific focus: Likely to include neuroscience, metabolic medicine, respiratory medicine,
inflammation, cardiovascular sciences and renal medicine.
GlaxoSmithKline and Wyeth, have agreed to match the £11 million of Wellcome Trust
GlaxoSmithKline, Wyeth Research, Roche, AstraZeneca, SanofiAventis, Sirtris Pharmaceuticals and PTC Therapeutics
Doctoral Degrees at FML
(2000-2007)(n=89)
20
19
18
17
16
15
14
13
12
11
10
9
8
7
6
5
4
3
2
1
0
MDs (n=37)
PhDs (n=52)
16
13
7
7
6
5
5
4
5
4
3
2
2
2
1
2000
2001
2002
2003
2004
2005
Mean age
PhDs (30 years)
MDs (48 years)
2006
2007
Programas Gulbenkian de Doutoramento
• Multi-disciplinaridade
• Exposição à melhor ciência possível (“mobile faculty”)
• Liberdade individual
Gulbenkian PhD Programmes
416 students admitted and educated since 1993 (MDs <12)
PGDBM
PGDB
PGBC
PGD
PGCNC
1993 to 1999
2000 to 2004
2005 to 2008
20072007-
(FCG/FCT)
(FCG/FCT)
(FCG/Siemens/FCT)
(FCG/FCT)
(FC/FCG/FCT)
PGDBM - 1993 to1999 (follow-up)
112 admitted
11 “lost” (9 in 1st year; 2 during PhD work)
101 (90%) obtained a doctoral degree at Portuguese or foreign Universities:
61 returned to Portugal
35 hold positions of responsibility in the scientific community:
- Research group leaders,
- University professors
- CEOs of start-ups in biotechnology.
- some “lateral mobility”
MDs in hospitals
grant administrators and officers of science community
NGOs
PROGRAMA DOUTORAL PARA MÉDICOS
Objectivo
Contribuir para que Médicos interessados em aliar à sua actividade
assistencial a investigação de problemas clinicamente relevantes,
adquiram bases científicas sólidas e possam desenvolver projectos
de investigação de qualidade nas suas áreas específicas de
interesse.
http://www.gulbenkian.pt
A quem se destina
Médicos, Internos ou Especialistas, altamente motivados para
actividades de investigação clínica ou de translação, que:
• Estejam convictos de que uma formação científica sólida é o alicerce
de uma investigação médica de excelência e de uma melhor prática
clínica;
• Desejem, no futuro, envolver-se em projectos multidisciplinares e
cooperativos como complemento da sua actividade assistencial.
MODALIDADES (frequência do Programa):
1)
Dedicação em full-time às actividades do Programa
(módulos formativos e investigação):
Vagas disponíveis: cinco (5) por ano.
Internos de Especialidade e Especialistas (todas as especialidades).
2) Dedicação em part-time às actividades do Programa
Vagas disponíveis: cinco (5) por ano .
Internos de Especialidade que pretendam integrar o
Programa sem interrupção do Internato Médico
(Portaria nº 172/2008 de 15 de Fevereiro)
O PROGRAMA OFERECE:
1. Uma formação de excelência em ciências biomédicas e
clínicas, numa perspectiva pluridisciplinar.
2. Apoio financeiro:
•Internos de Especialidade em full-time no Programa:
Bolsa - €24.000/ano, durante 3 anos
Apoio a actividades de investigação - €25.000
•Internos de Especialidade part-time no Programa:
Bolsa de €2000/mês durante 6 meses
Apoio a actividades de investigação - €25.000
Selecção de estudantes
Entrevista
ESTRUTURA
Módulos formativos – 6 meses
Investigação – 2.5 anos (Portugal ou estrangeiro)
Instituições associadas ao Programa (2008-2009)
Instituto Gulbenkian de Ciência, Oeiras
Instituto de Medicina Molecular/FML, Lisboa
IPATIMUP, Porto
Sience & Medicine
2008
October
S
M
T
November
W
T
F
S
1
2
3
4
S
M
T
W
December
T
F
S
S
1
M
T
W
T
F
S
1
2
3
4
5
6
5
6
7
8
9
10
11
2
3
4
5
6
7
8
7
8
9
10
11
12
13
12
13
14
15
16
17
18
9
10
11
12
13
14
15
14
15
16
17
18
19
20
19
20
21
22
23
24
25
16
17
18
19
20
21
22
21
22
23
24
25
26
27
26
27
28
29
30
31
23
24
25
26
27
28
29
28
29
30
31
30
Get together (IGC & IMM)
Cell-cycle & Disease (IGC)
Epidemiology (IGC)
Gene Expression (IMM)
Genetics (IGC)
Structural Biology (IGC)
iRNA & Disease (IMM)
Reading & Discussions
(IGC or IMM)
Reading & Discussions
(IGC or IMM)
Computational Biology (IGC)
Statistics (IGC)
Challenges in Clinical & Translational Research
2009
January
S
M
T
W
March
February
T
F
S
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
S
M
T
W
T
F
S
S
M
T
W
T
F
S
1
2
3
4
5
6
7
1
2
3
4
5
6
7
8
9
10
11
12
13
14
8
9
10
11
12
13
14
15
16
17
18
19
20
21
15
16
17
18
19
20
21
22
23
24
25
26
27
28
22
23
24
25
26
27
28
29
30
31
Cancer (IPATIMUP)
Aging (IMM)
Preparing for Research (IMM)
Immune Disorders (IMM)
Dev Biol (Symposium) (FCG)
Evaluation (FCG)
Microbiology (IMM)
Neurodegenerative Disorders (IMM)
Regenerative Medicine (IMM)
Ethics (IMM)
Docentes internacionais em 2008-2009 (64)
USA
Univ. Harvard
Univ. Michigan
Univ. Philadelphia
Univ. California, San Francisco
Graig Venter Institute
Univ. Rockfeller
NIH, Bethesda
UK
Univ. Cambridge
Univ. Oxford
Univ. College
Univ. Manchester
National Inst. Med. Research
Imperial Colleg
Holland
Univ. Roterdam
Univ. Leiden
France
Univ. Montpellier
Centre d´Immunologie Marseille-Luminy
Univ. Nice-Sophia Antipolis
Germany
Max Plank Institute
Univ. Philipps Marburg
Univ. Koln
Belgium
Univ. Hospital, Ghent
Sweden
Univ. Umea
Univ. Uppsala
Italy
Univ. La Sapienza, Rome
Univ. Firenze
Univ. Milano
Brasil
Spain
Univ. S Paulo
CNB
Fund. Oswaldo Cruz
Univ. Valencia
Univ Pompeu Fabra
Docentes nacionais em 2008-2009 (53)
Univ. Lisboa (Fac Med; Fac Ciências)
Univ. Nova de Lisboa
Univ. Porto (Fac Med)
Univ. Algarve
Instituto Gulbenkian de Ciência
Instituto de Medicina Molecular
IPATIMUP-Porto
IBMC-Porto
ITQB-Oeiras
FULL-TIME
PhD
Ana Cerdeira
Obst Ginecol Int
H St Ant
Univ. Harvard
Filipe Martins
Obst Ginecol Int
HU-Coimbra
Dana Farber Cancer Center
Boston
Sandra Garcês
Reumatol
Int
H. Garcia Orta
Inst. Gulbenkian
M Rita Dionísio
Oncol
Esp IPO-Lx
Univ. Cornell, NY
Sofia Braga
Oncol
Esp IPO-Lx
Inst. Gulbenkian
Ricardo Fernandes Pediatria
Int
HSM
HSM/Univ Amesterdao
Nuno Figueiredo
Cirurgia
Int
HSM
HSM/Inst. Med Molecular
Teresa Braga
Cirurgia
Int
HSM
Inst. Gulbenkian
Joana Azevedo
Hematol
Int
C.H Coimbra
CHC/Kings College
Ana Bastos
Oftalmol
Int
HSM
HSM/IPO
PART-TIME