Qualificação Profissional. Programa de Formação Médica Avançada

Transcrição

1 Qualificação Profissional Programa de Formação Médica Avançada Leonor Parreira Faculdade de Medicina de Lisboa

2 N Engl J. Med. 1979;301: I refer to the physician who is simultaneously a serious scientist, and far less to the clinician who may occasionally also do some research.

3 % 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

4 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

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6 American Society for Clinical Investigation (ASCI), Association of American Physicians (AAP) American Federation for Medical Research (AFMR). USA: (- 22% physician-scientists)

7 Varki & Rosenberg, 2002 Nature Medicine 8:

8 pipelines for training physician-scientists Varki & Rosenberg, 2002 Nat Med 8:

9 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.

10 Medical Research Council; Department of Health; Welcome Trust; Leukemia Research Fund; Arthritis Research Campaign

11 Implementing the Clinician Scientist Scheme (progress report) 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

12 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

13 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, Sanofi- Aventis, Sirtris Pharmaceuticals and PTC Therapeutics

14 Doctoral Degrees at FML ( )(n=89) MDs (n=37) PhDs (n=52) Mean age PhDs (30 years) MDs (48 years)

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17 Programas Gulbenkian de Doutoramento Multi-disciplinaridade Exposição à melhor ciência possível ( mobile faculty ) Liberdade individual

18 Gulbenkian PhD Programmes 416 students admitted and educated since 1993 (MDs <12) PGDBM 1993 to 1999 (FCG/FCT) PGDB 2000 to 2004 (FCG/FCT) PGBC 2005 to 2008 (FCG/Siemens/FCT) PGD (FCG/FCT) PGCNC (FC/FCG/FCT) PGDBM 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

19 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.

20 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.

21 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)

22 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 /ano, durante 3 anos Apoio a actividades de investigação Internos de Especialidade part-time no Programa: Bolsa de 2000/mês durante 6 meses Apoio a actividades de investigação

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24 Selecção de estudantes Entrevista

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26 ESTRUTURA Módulos formativos 6 meses Investigação 2.5 anos (Portugal ou estrangeiro) Instituições associadas ao Programa ( ) Instituto Gulbenkian de Ciência, Oeiras Instituto de Medicina Molecular/FML, Lisboa IPATIMUP, Porto

27 2008 Sience & Medicine October S M T W T F S November S M T W T F S December S M T W T F S Get together (IGC & IMM) Gene Expression (IMM) Structural Biology (IGC) Reading & Discussions (IGC or IMM) Cell-cycle & Disease (IGC) Genetics (IGC) irna & Disease (IMM) Computational Biology (IGC) Statistics (IGC) Epidemiology (IGC) Reading & Discussions (IGC or IMM)

28 2009 Challenges in Clinical & Translational Research January S M T W T F S February S M T W T F S March S M T W T F S Cancer (IPATIMUP) Immune Disorders (IMM) Microbiology (IMM) Aging (IMM) Dev Biol (Symposium) (FCG) Neurodegenerative Disorders (IMM) Regenerative Medicine (IMM) Ethics (IMM) Preparing for Research (IMM) Evaluation (FCG)

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30 Docentes internacionais em (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 Sweden Univ. Umea Univ. Uppsala 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 Italy Univ. La Sapienza, Rome Univ. Firenze Univ. Milano Spain CNB Univ. Valencia Univ Pompeu Fabra Brasil Univ. S Paulo Fund. Oswaldo Cruz

31 Docentes nacionais em (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

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33 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 PART-TIME 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