Brazil Sanctions Medical Schools After Poor National Exam Results

Brazil’s Ministry of Education has sanctioned medical schools after a new national exam found weak performance across dozens of courses, intensifying a debate over whether the country expanded doctor training faster than it could maintain quality.

The ministry, known in Brazil as MEC, published five ordinances in March opening supervision proceedings against medical courses based on the 2025 National Exam for the Evaluation of Medical Training, or Enamed. The exam, administered by the federal education-testing agency Inep, assessed 351 medical courses. According to G1, 107 received grades 1 or 2 on a five-point scale, making them subject to federal scrutiny.

What the Ministry Did

The sanctions vary by course performance. The most severe group, composed of courses with grade 1 and less than 30% of students rated proficient, faces an immediate suspension of new student admissions, restrictions on federal student-financing programs and a ban on expanding places.

A second group, with grade 1 and proficiency between 30% and 40%, had 50% of authorized places cut. A third group, with grade 2 and proficiency between 40% and 50%, had 25% of places cut. Other courses entered supervision without immediate punishment.

The measures also restrict access to federal programs such as Fies, Brazil’s student-loan fund, and Prouni, a scholarship program for low-income students. According to the ministry, the measures took effect when the ordinances were published and do not affect students who entered at the start of 2026. Institutions will have 30 days to respond and may request time to correct deficiencies.

Federal universities were also included. The Federal University of Pará was the only public institution to face an immediate sanction, with a 50% cut in places and a suspension of requests to expand them. Federal universities in Maranhão, the Latin American Integration University and the Federal University of Southern Bahia were placed under supervision, according to G1 and Agência Brasil.

A Wider Quality Debate

The sanctions have not settled the argument. In an opinion article for Poder360, Cândido Vaccarezza, a doctor and former federal lawmaker from São Paulo, argued that punishing individual schools is necessary but insufficient. He said Brazil needs a deeper reform of medical education, including a debate over curriculum, faculty training and the use of hospitals and clinics for practical training.

Vaccarezza wrote that Brazil’s medical education system entered a structural crisis after a rapid expansion of private, for-profit schools, some without adequate laboratories, ambulatory care, teaching hospitals or properly qualified faculty. He also said the number of graduates now greatly exceeds the number of residency places, pushing young doctors into emergency shifts before they receive fuller specialist training.

His article is opinion, not a government finding. But it echoes concerns raised by medical councils. G1 and Agência Brasil reported the federal sanctions; Poder360 cited the São Paulo Regional Medical Council’s president, Ângelo Vattimo, warning that indiscriminate undergraduate expansion, without stronger residency training and territorial planning, risks worsening professional conditions, medical education and patient care.

Licensing Dispute

One of the sharpest disputes concerns whether graduates from low-performing schools should be barred from registering with regional medical councils, the bodies that authorize doctors to practice. Legismap reported, citing São Paulo’s medical council, that Cremesp planned to work toward blocking registration for doctors trained at institutions with low Enamed results.

Vaccarezza opposed that route. He argued that creating a large group of graduates with medical degrees but no professional registration could push them into poorly paid, informal or outsourced health work, rather than protect the public.

The Education Ministry says Enamed is meant to create an annual, interpretable measure of medical training and to guide regulation, supervision and financing policy. The next test of the policy will be whether federal supervision corrects weak programs—or merely limits places after the damage has already reached students and patients.