Law mandates Enamed as a requirement for practicing medicine in Brazil
On Friday (6), President Luiz Inácio Lula da Silva signed the Law on the National Examination of Medical Training Assessment (Enamed), making its administration mandatory for students enrolled in Brazilian medical programs starting June 19, 2026. The measure, initially issued as a Provisional Measure and later converted into law, establishes a new benchmark in Brazilian medical education.
The Enamed: a structured assessment throughout undergraduate studies
The exam will be administered at three distinct points during medical undergraduates' graduation — in the second year, fourth year, and sixth year of study. This schedule allows monitoring of students’ academic progress and early identification of potential learning difficulties.
According to official information released by Agência Brasil, the results obtained through Enamed will be used not only to assess future doctors' technical knowledge but also to evaluate the overall quality of courses offered by higher education institutions. The goal is to create a system that enables the government to precisely monitor the effectiveness of medical training nationwide.
The objective: ensure qualified professionals to serve the population
Lula emphasized that the measure's main purpose is to improve the quality of medical care in Brazilian society. In an interview after the law was signed, he stated: "The more qualified our doctors are, the greater our guarantee that we will live longer." This statement reinforces a broad view on health and collective well-being, where professional training is seen not only as an academic process but also as an essential component of mortality prevention.
The president also stressed that responsibility for providing healthcare services must be assumed by the State. He declared: "if the State does not take responsibility for giving fair treatment to the most humble people, no one will," thus underscoring the importance of public role in ensuring equitable access to medical care.
Impact on the Unified Health System (SUS)
The new legislation is viewed as a decisive step toward strengthening the Unified Health System. Professor Ludhmila Hajjar from the Faculty of Medicine at the University of São Paulo (USP) stated that over the past years she has been concerned about her students: "They come already graduated without having ever attended a cardiac arrest, without having seen a patient in circulatory shock or a patient who needed mechanical ventilation." This observation highlights academic sector's concern regarding the lack of practical experience among future professionals.
For professor Hajjar, the Enamed represents the beginning of a new era in Brazilian medicine. She stated that it is not merely an OAB-style exam, but rather a tool to ensure students are truly prepared to work in clinical settings. "The student is not at fault for inadequate training. The student is often the main victim," she said, reinforcing the idea that educational institutions must be held accountable for their ability to produce professionals with practical skills.
Partnerships between ministries and medical councils
The Enamed will be conducted directly through collaboration among the Ministry of Education (MEC), the Ministry of Health (MS) and the Federal Council of Medicine (CFM). Technical coordination of the examination will rely on existing structures within these entities, ensuring an integrated approach to the assessment process. Minister of Education Leonardo Barchini explained that the first function of the test is to evaluate students' performance during undergraduate years.
According to him, the main objective is to contribute to public policy formulation based on real data about medical education. "We will contribute to assessing medical training and formulating public policies with this exam," he stated, emphasizing that the collected information will be fundamental for future government decisions in both educational and health sectors.
Surveillance mechanisms: reduction of quotas and suspension of entrance exams
The new legislation establishes a continuous supervision structure for educational institutions that fail to meet satisfactory results in the Enamed tests. If data indicate significant deficiencies in student training—such as low average scores in clinical competencies or deficits in practical skills—the entities may be subjected to disciplinary measures.
These measures include, among other possibilities, reducing the number of vacancies offered during the selection process and even suspending entrance exams temporarily. The aim is to create a shared responsibility system between educational institutions and the State to ensure all courses meet minimum quality standards.
The context: 60,000 vacancies opened without prior evaluation
Before the implementation of the Enamed, the MEC received approximately 360 judicial processes that determined the opening of more than 60,000 medical course vacancies across the country. Minister Leonardo Barchini highlighted that this unregulated expansion created a serious problem in the management of education resources. "We had no way of verifying whether those medicine vacancies were of good quality or not, whether those schools were properly training students or not," he stated.
This scenario raised concerns about the risk of overloading the health system and inadequate training of professionals with insufficient technical capacity to meet real clinical demands. The Enamed aims to address this imbalance by introducing an objective evaluation mechanism that enables careful selection of educational institutions.
The role of doctors: view from Vice-President Geraldo Alckmin
The Vice-President of the Republic, Geraldo Alckiad — a doctor by training — stated that the Enamed will directly benefit students, universities, and all civil society. He recalled that in the 1970s, when he graduated, most future medical graduates completed residencies at hospitals equipped for practical clinical work."Today it's almost half because many faculties have been opened. And sometimes without having the hospital adequate to allow students to receive their proper training," he said.
This point highlights a criticism of the current model of expanding medical education: while the number of programs grows rapidly, the practical and laboratory conditions of institutions do not keep pace with this growth. The Enamed can help align this dynamic by requiring educational centers to provide real clinical practice environments to students before final graduation.
The Health Minister defends results with long-term impact
The minister Alexandre Padilha highlighted that the approval of the law represents a historic step in strengthening the country's health services. "This sanction is another historical step toward reinforcing our people's health because you cannot have good healthcare without skilled professionals," he stated. He also emphasized that Enamed will bring tangible, long-lasting effects: "We are doing something even more advanced here because it is a test of progress. There will be results ten years from now."
This assessment indicates that exam outcomes will be analyzed over time to measure their impact on the overall quality of doctors trained in Brazil—ranging from clinical efficiency to real-world emergency management.
The debate about health as an integrated system
Lula also used the moment of approval to defend public policies focused on prevention, such as Agora tem Especialistas, Samu, Brasil Sorridente and Farmácia Popular. He stressed that it is necessary to understand the healthcare system not only through medicines or consultations but also through diet and physical activity. "Imagine if every municipality in this country established a small gym. What would it cost to hire a physical education teacher, a physiotherapist to care for these people?", he questioned.
This reflection shows a broader perspective on medical education: future professionals should be trained not only in diagnoses and treatments, but also in preventive health promotion — which requires partnerships between teaching institutions, municipal governance, and social policies.
The Enamed as a historical milestone in the medical sector
The president of the Federal Medical Council (CFM), José Hiran Gallo, called the government's decision "a historic milestone." He expressed gratitude for the government's stance in adopting a measure with strong scientific and ethical foundations. The evaluation of the Enamed will be seen not merely as a technical instrument, but also as a political act of social responsibility.
For the CFM, implementing the law represents a significant shift in how doctors are trained in Brazil — moving from a model centered on theoretical knowledge to one that values practical skills, clinical experience, and the ability to respond to emergency situations.
The future of educational and health policies
The Enamed could serve as a foundation for future reforms in medical education programs. The possibility of reducing or suspending spots at institutions with performance below expectations creates a continuous feedback system between higher education and public healthcare services.
In addition, the data collected can be used by government agencies to adjust job offerings in response to actual demand in the medical labor market—avoiding unnecessary overcapacity and ensuring that every newly graduated professional is truly prepared for clinical practice.
What remains: rules applicable only after June 19, 2026
It should be noted that students already enrolled before June 19, 2026 will continue to be subject to the regulations then in force. Likewise, physicians with nationally recognized diplomas will not be required to undergo Enamed or any other complementary assessment resulting from the new legislation.
This exception ensures a smooth transition between previous models and the new evaluation system—avoiding abrupt impacts on professionals currently operating in the market and maintaining health service stability during the gradual implementation of this measure.