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Editorial
321
Rev Bras Hematol Hemoter. 2012;34(5):321-2
Challenges for medical residency in hematology and transfusion medicine in Brazil
Hematology and transfusion medicine cover a wide range of knowledge and skills
including hematological neoplasms, the hematological consequences of systemic diseases,
anemia, hemostatic disorders, bone marrow transplantation, transfusion medicine and cell
therapy. Despite the scientific and clinical relevance, our specialty is relatively little known
and also little divulged among future physicians on medicine courses. This issue is not only
being discussed in Brazil; it was the theme of a recent editorial in the journal Haematologica,
the official organ of the European Haematology Association, with the evocative title “The
importance of calling yourself a hematologist”. The authors reported that hematology in Europe
is a specialty that is unknown to the public at large which results in negative repercussions on
the development of the specialty.
For years now, too few physicians have been trained in Brazil to meet the needs of
transfusion medicine, bone marrow transplantation and cell therapy services.
From the observation that a substantial number of positions for residents in
hematology and transfusion medicine remain unfilled and aiming to improve medical
residency programs in hematology in Brazil, the
Associação Brasileira de Hematologia,
Hemoterapia e Terapia Celular
(ABHH) held the “I Forum of Medical Residency in
Hematology and Transfusion Medicine” in Campinas on May 29, 2012.
The meeting brought together representatives of 14 institutions that have residency
programs in hematology and transfusion therapy and benefited from the presence of Professor
Maria do Patrocínio Tenório Nunes, associate professor in the
Disciplina de Clínica Geral
e Propedêutica do Departamento de Clínica Médica da Universidade de São Paulo
, and
Executive Secretary of the
Comissão Nacional de Residência Médica
.
In a study kindly prepared by Prof. Maria do Patrocínio, a list of 47 accredited
medical residency programs in hematology and transfusion medicine in Brazil,
distributed over 12 States was presented, with 130 vacancies for the first and second
years. For the optional third year in bone marrow transplantation, there are 12 accredited
programs, with 20 places in five States (Rio Grande do Sul, Paraná, São Paulo, Rio de
Janeiro and Minas Gerais).
Despite the significant number of programs, the official figures confirm the impression
in respect to unfilled places. The vacancy rate is 52% for hematology and transfusion therapy
residency programs, 50% for bone marrow transplantation fellowship programs and 60% in
pediatric hematology residency.
Preliminary evaluation and debate
In preparation for the forum, a questionnaire was sent to several institutions that have
medical residency programs - 14 were represented at the meeting (Table 1).
The collected data confirmed difficulties in attracting residents and that these
difficulties began before the prerequisite of completing a medical residency in internal
medicine, although the situation worsened after this measure was introduced in federal
universities and blood centers.
One of the possible factors that contributed to this situation is the current fragile
situation of federal university hospitals, which may discourage students and reduce the
demand for positions in medical residency programs. The very long duration of training,
competition of oncology fellowships and, above all, the other professional areas that
are today more attractive to young trainees were also considered factors that make our
specialty less popular.
The advantages and disadvantages of the prerequisite of a clinical medicine residence
were also discussed. Most of the meeting participants believe that the initial training in
clinical medicine provides more mature individuals in the hematology residency program
who are more able to care for patients with serious diseases. The inevitable disadvantage is
the prolonged length of training.
Angelo Maiolino
Nelson Spector
Faculdade de Medicina da Universidade
Federal do Rio de Janeiro – UFRJ, Rio de
Janeiro, RJ, Brazil
Conflict-of-interest disclosure:
The authors declare no competing financial
interest
Submitted: 9/29/2012
Accepted: 10/1/2012
Corresponding author:
Angelo Maiolino
Departamento de Clinica Médica
Programa de Transplante de Medula
Óssea e Mieloma Múltiplo
Hospital Universitário Clementino Fraga
Filho, Universidade Federal do Rio de
Janeiro, URFJ
Rua Professor Rodolpho Paulo Rocco,
nº 255 4o andar, Sala 4A12
21941-913 Cidade Universitária, Ilha
do Fundão, Rio de Janeiro, RJ, Brazil
Phone: 55 21- 2562 2460
maiolino@hucff.ufrj.br
www.rbhh.org or www.scielo.br/rbhh
DOI: 10.5581/1516-8484.20120081