RELATÓRIOS 2001

Faculty of Medicine of Porto University Self-Evaluation Process

1. Introduction

Upon receipt of the notice of an impending CRE review of Medical Schools, with the respective guidelines, the Presidents of the Directive and Scientific Councils set up an Evaluation Committee: Prof. José Amarante, Prof. Isabel Ramos, Prof. Cassiano Abreu-Lima, Prof. Estima Martins, Prof. João Bernardes, Prof. Luciana Couto, Dr. Luís Maciel (appointed by the Director of H. S. João), 6^th year student Filipa Almeida, Mr António Fragoso (Administrative Staff) and Prof. Isabel Azevedo, coordinator.

At its first meeting, on the 17^th April, the Committee decided on the following evaluation strategy:

• study of all evaluation and descriptive reports of the Faculty produced during the last years;

• organization of a series of meetings, each with about 20 persons from all settings of the Faculty – teaching staff, students, administrative staff, and some members of H. S. João, coordinated by one element of the Evaluation Committee, to identify the strengths (S), weaknesses (W), opportunities (O) and threats (T) for the Faculty;

• reunion of the SWOT proceedings from all meetings and setting up of a synthesis with no more than 10 items for each category, considering the most frequently raised points;

• re-submission of the SWOT thus obtained to everybody in the Faculty who will classify the items again according to their importance;

• production of a final SWOT with the most voted 5 items in each category;

• elaboration of a confrontation matrix between the strengths and weaknesses versus opportunities and threats;

• finishing of the Evaluation Report.

Everything has been executed according to planning. The Evaluation Committee worked through 7 meetings (April 17^th, April 27^th, May 8^th, May 14^th, July 10^th, September 5^th), in which the work has been carefully discussed and planned. The Direction of the Faculty provided everything we asked for, such as facilities for the group meetings, computer and projection equipment, including secretariat assistance.

There were 14 group meetings, from the June 4^th to the July 14^th. Seventy four percent of full time teaching staff and 40% of part-time teaching staff attended the meetings. In each meeting there were also one to three students, one to three administrative staff persons and one to three medical doctors from H. S. João.

The meetings were lively and productive. Many participants testified on their interest and usefulness.

2. Present situation of the institution

2.1. Mission: to be a centre of learning for students, faculty, staff, physicians and community members, educating for competence, conscience and compassion, and contributing to the building of knowledge in life and medical sciences.

The vision underlying its mission is, at this time, to keep among the best, significantly improving its facilities, both in qualitative and quantitative terms, to improve its human and material resources for research, to restructure its organization, to markedly increase postgraduate activities, to progressively increase the number of students.

The present mission statement is forseen to stay for many years to come.

The institution feels a deep responsibility to work with the ablest students, who continue to choose as their first option this Faculty of Medicine.

The new needs of the medical profession have been conditioning the efforts of the institution year to year: emphasis is being put on the preparation for lifelong learning, training in search and retrieving of information, critical spirit to be oriented in the huge stream of information, respect for the autonomy of the patient, preparation to work in multidisciplinary teams, acquisition of a scientific way of thinking, awareness of ethical and management duties.

Undergraduate students are frequently invited to attend seminars and workshops aimed at graduate professionals, enrolling in the "real life" of medical doctors and science professionals. Research opportunities are also increasing at the undergraduate level.

A strategic plan for development of the institution is included as appendix 1.

2.2. General context and environment

1. The Faculty has a fixed number of positions both for full and associate professors. That number is strongly dependent on the number of students, may be somewhat negotiated with the University, and may be changed at certain time intervals. Every two years the vacant positions must be announced and a public contest set up for their occupancy.

   a1. Full professors are selected by a jury constituted by the Rector of the University, usually 2 to 5 full professors of the Faculty, mainly from the area under consideration, and 2 to 5 full professors from other Portuguese Universities, as proposed by the scientific council of the Faculty. Candidates must possess PhD and Aggregation degrees. The choice is made through analysis of the curricula of the candidates, taking into consideration their scientific production and pedagogic experience.
   Associate professors are selected through a similar way, only associate professors may also be part of the jury. Candidates must possess a PhD degree.
   The Faculty has to contract as auxiliary professor every assistant with at least 5 years of contract that gets a PhD.
   Assistants for the academic career are recruited through a public contest. Presently, they are a minority, and part of them are not medical doctors (they have graduations in Biology, Pharmacy, Biochemistry, Nutritional Sciences) and are recruited for the basic sciences. Most assistants are invited assistants and they are effectively invited by the chairman of the discipline. They usually work in Hospital S. João as medical doctors, and work part time in the Faculty, either in a clinical discipline or in a basic science. These young professionals constitute a very important live connection between the Faculty and its Associated Hospital, and between basic sciences and clinical medicine.

   a2. Students for the course of Medicine are selected, as all students in Portuguese public Universities, through the national University Access System. The number of students is proposed by the Faculty, but decided by the Government. Medicine is the most wanted course, and our Faculty the most wanted Faculty. That allow us to have the students with the highest marks of the whole system.
   Students for postgraduate courses are selected by the coordination committees of the respective courses.

   a3. There are no significant constraints in the autonomy to allocate funding, the problem with funding is its largely insufficient amount.

   a4. Teaching and learning are the core tasks of the Faculty. Beyond the Medicine course, the Faculty teaches also the basic science disciplines to the Medical Dentistry and Nutritional Sciences students. Teachers are very fond of and assume a great responsibility for that job. They are also very fond of their academic autonomy, what raises difficulties to the effective existence and function of a powerful curriculum committee. The traditional system, by disciplines, is used. Nevertheless both the contents and methods of most disciplines are discreetly but continuously changing and adapting to the new trends and needs. Most basic disciplines function in active research centres, and the trend toward multidisciplinary approaches in research inevitably leads to a more multidisciplinary approach in teaching. Furthermore, as stated above, the strong involvement of hospital residents in the teaching of basic sciences translates into a live interweaving of basic sciences and clinical medicine.
   Clinical medicine is taught through clerkships, some of which function very well, whereas other ones, mainly because of their short duration, with multiple examinations in a short time period, are strongly contested by the students. The chairman of the clerkship is usually the chairman of the clinical department, and he usually has both a hospital and an academic career. There is some Faculty teaching staff in the clinical departments, but many hospital professionals collaborate in teaching for free.
   The 6^th year consists in rotating clerkships in S. João Hospital through Medicine (9 weeks), Surgery (9 weeks), Paediatrics (5 weeks), Mental Health (4 weeks) and Obstetrics (5 weeks), and in urban and rural Community Health Centres (6 weeks). Teaching is oriented by teaching staff of the Faculty and by Hospital and Community Centres medical doctors who work voluntarily (with no salary). In each clerkship one tutor has responsibility for one to three students. In the current year the disciplines of Urology, Bioethics and Legal Medicine are still being taught through lectures and seminars, as they had not been previously studied by the 6^th year students. In the near future, as recently decided by the Scientific Council of the Faculty, there will be no place for teaching those disciplines in the 6^th year, and there will be optional clerkships in medical and surgical specialities as well as optional research training in the basic sciences.
   Didatic approaches are changing toward a more active role of the students, interactive discussions, problem based learning and progressive use of information technologies (unfortunately with important material limitations). Research activity is being implemented at the undergraduate level. A programme of initiation to scientific research, for Medicine and Medical Dentistry undergraduate students, has been organized by the Faculty of Medicine, ICBAS and Faculty of Medical Dentistry in the current academic year. Assessment methodologies, as almost everything else, are decided in quite an autonomous way in disciplines and clerkships, although inside the rules established by the Pedagogic Council, where the students have parity.
   Many disciplines use questionnaires to assess their performance in the opinion of students.
   An extensive study on the curriculum and pedagogic activities of the Faculty was recently made by a team of experts from the Education Sciences of Porto University, on request by the Faculty of Medicine (Appendix 2).

   a5. There are a number of strong research units in the Faculty. For this purpose (to constitute a research unit, funded as such, on a pluri-annual basis, by the Ministry of Science), departments associate in different ways, although they may constitute a research unit by themselves. There are multidisciplinary groups with researchers from other schools from Porto University and from institutions belonging to the Health Ministry, and there are researchers from the Faculty of Medicine integrated in other Centres (IBMC, IPATIMUP, INEB). Depending on the interests of people in each moment, on claiming issues, and on opportunities for funding, associations change and people move among research groups. There are always clinical teaching people doing research in basic science units. PhD and Master students in clinical areas frequently do at least part of their research work in the basic science laboratories. Pre-graduate students are beginning to enrol in research work.
   Research activity, at all levels, is fighting with huge limitations in funding, lack of space and equipment, and lack of technical staff. On the other hand, in many departments there is a huge charge of teaching duties on everybody. It is very difficult to take a time to work at a foreign centre, except during vacations. The law permits a PhD student a leave from teaching work up to three years to make the research work for the thesis, but the conditions in the Faculty are usually not compatible with even a one year leave.
   Nevertheless, the Faculty of Medicine of Porto has a steady production of scientific and medical publications, many of them in high quality international journals, appearing among the first science producers in Portugal. Many national and international scientific and medical meetings are attended and organized, undergraduate students being frequently seen in them.

   a6. There are various kinds of services to the community: medical services by the staff of the Community Medicine Department and teaching staff from the clinical departments (these work simultaneously for the Faculty and S. João Hospital, as the chairmen of these departments usually do); laboratory tests by the Laboratório Nobre, Departments of Pathology, Genetics and Immunology; pedagogic activities at request from various organizations, including secondary schools. A special form of these pedagogical activities is the reception of groups of students to visit the Museum of History of Medicine and the Museum of Anatomy, as well as the Research Centres, where secondary school students may participate in a research project for a few weeks (e.g. under the auspices of Ciência Viva, a programme of the Ministry of Science).
   In the recent past, teachers from our Faculty gave an important help to University of Minho, in the creation of the new course of Medicine in Braga. Five out of the six person committee who made the project for the course were from this Faculty.

2. Financial and economic environment:

   b1. This is a tough time: the national economy is apparently in bad conditions, and both this region (North of Portugal) and this sector of activity (Education, University) are not considered priority by the central Government. Not even the small and limited funding theoretically due to Universities is being paid.

   b2. The governmental funding is calculated through the number of students.

3. Geographical position of the institution.

   Porto is the second largest city in Portugal, located in the North of the Country, by the ocean. It is 300 km from Lisbon and 180 km from Santiago de Compustela in Spain. The Faculty of Medicine of Porto University is located in the same building as Hospital de S. João. This hospital was built to be used by the Faculty. Most clinical teaching activities occur in this hospital, where the chairmen of departments are usually professors of the Faculty. Community Health Centres both in this city and throughout the North of Portugal are used for the community health clerkships.

4. The institution sees in the Inter-ministerial Coordination for Medical Education and in the already approved Contract-Programme for Development and Quality of the Faculty of Medicine of Porto the opportunities to attain the conditions it needs and deserves. On the other hand, the economic crises, impending on an undue consideration of the work developed by the Faculty, may lead to further degradation of facilities and loss of competent professionals.

2.3. Organisation and resources

1. Undergraduate teaching is organized in disciplines. Usually disciplines function in a department (Serviço) with the same name. Departments associate in Groups (close areas) which are represented in the Scientific Council. In the basic science disciplines, departments are also laboratories. In the clinical disciplines, Faculty departments usually coincide with hospital departments. The list of departments, dependent units, departamentos and central departments is in appendix 3.

   Research Units, identified as such and funded by Fundação para a Ciência e a Tecnologia (FCT), may coincide with a department (Centre of Experimental Morphology in the Department of Anatomy), or a group of departments (Centre of Pharmacology and Chemical Biopathology involves the Institute of Pharmacology and Therapeutics and the Department of Biochemistry; Cardiovascular Research and Development Unit of Porto involves staff from the Departments of Cardiology, Epidemiology, Internal Medicine, Obstetrics and Physiology). On the other hand, some researchers from the Institute of Pharmacology and Therapeutics and the staff from the Institute of Histology and Embriology are integrated in IBMC (Institute of Cellular and Molecular Biology, a multidisciplinary research centre from Porto University), and the staff of Biopathology and some researchers from various other departments of the Faculty do their research work in IPATIMUP (Institute of Pathology and Molecular Immunology of Porto University).

   The Faculty ministers under-graduate teaching in the Courses of Medicine (the whole course), Medical Dentistry and Nutritional Sciences (the basic sciences, as well as Clinical Medicine and Clinical Surgery to the Medical Dentistry students) of Porto University.

   The following master courses are currently working:

   • Bioethics
   • Nursing Sciences (Pediatrics)
   • Health Management and Economics
   • Sport Medicine
   • Emergency Medicine
   • Molecular Medicine
   • Public Health

   Master courses in Human Biology, Human Applied Genetics, Medical Genetics, Occupational Medicine and Oncobiology have also been held, although not in the present year.

   Other postgraduate courses presently working:

   • Graduate Programme in Applied Basic Biology (GABBA), providing master and PhD degrees (in collaboration with ICBAS)
   • Medical Hydrology and Climatology
   • Occupational Medicine Course
   There are presently 112 PhD students.

2. Students

   b1. In the current year (2001/02) there are 1000 pre-graduate students in the Medicine Course in the Faculty of Medicine of Porto University. Additionally, basic science disciplines are taught by the Faculty to 230 students in the Medical Dentistry Course and 210 students in the Nutritional Sciences Course. Clinical Medicine and Clinical Surgery are also taught in the Faculty of Medicine to the 4^th year students of Medical Dentistry.
   Details on the entries per access regimen and distribution of students per year are given in appendix 4.
   The number of Master Course students is presently 191. The distribution of Master degrees per course along the last years is given in appendix 5.
   The list of PhD students (112) is given in appendix 6.

   b2. There was a steady growth in the number of pre-graduate students in the Medical Course along the last 5 years (appendices 4 and 7). The number of PhD students is also increasing.

   b3. Around 80% of students complete the graduation in 6 years, the average completion time being 6.2 years (see also appendix 8) . The rate of drop-out is extremely small, about 1 student every three years.

3. Academic staff

   c1. The academic staff is composed, at this time, of 34 full professors, 39 associate professors, 50 auxiliary professors, 10 assistants, 3 training assistants and 10 monitores (students from any of the last two years or just graduated professionals). Invited, part-time staff include 2 full professors, 11 associate professors, 14 auxiliary professors and 87 assistants. The global number of paid teaching staff is 260. All are medical doctors except 5 auxiliary professors (1 Engineer, 1 Pharmacist, 1 with a degree in Nutritional Sciences and 2 with degrees in Biology), 4 assistants (2 with degrees in Biochemistry, 1 with a degree in Biology and 1 with a degree in Law) and 3 monitores (2 with degrees in Biochemistry and 1 with a degree in Nutritional Sciences).
   Adding to this number, 97 volunteer medical staff collaborate in the clinical teaching. Details on the academic career and professional qualifications of the teaching staff are given on appendix 9.

   c2. Student/staff ratio is 6/1. In the current year, the student/staff ratio for the 6^th year is 2-3/1 (however, only a small proportion of this staff has a contract with the Faculty of Medicine, most tutors belong to S. João Hospital and to Community Health Centres).

   c3. An important number of clinicians from Hospital S. João participate in teaching, part of them formally listed as voluntary teachers (see appendix 9). A few clinicians from Hospital Pedro Hispano, as well as many clinicians in Community Health Centres in Porto and the North of the Country do also collaborate in the clinical teaching.

4. Finance:

   d1. Governmental funding in 2000 amounted to 9280 thousand €, in a total funding of 11980 thousand €, i.e., government paid for 77% of the budget.

   d2. Research projects led to an entry of 336 thousand €, European Community to 3900 €, and private companies to 100 thousand €. Others entries, such as fees, covered the remaining budget.

   d3. Research budget was only 2.8% of the total budget.

5. Absence of a powerful curriculum committee, student overwhelming with a high number of short duration clerkships, with no time for optional activities, ambiguity in tutoring of clinical apprenticeship due to the lack of a single board of medical professionals in Hospital S. João/Faculty of Medicine, together with scarcity of material and technical resources, constitute the main weaknesses in the institution. On the other hand, the high profile of the Faculty, probably related with its rich historical/cultural tradition, the quality of its staff, the high level of scientific production, its pos-graduate activities, good student/teacher relationships and the functional interweaving between basic sciences/clinical activities, and Faculty of Medicine /Hospital S. João, will facilitate the implementation of the measures needed for improvement many in the institution advocate since some time.

3. Strategic Management

3.1. Institutional strategies

1. Current decision-making structures and processes

   a1. The main bodies/functions in decision-making are indicated in appendix 10.

   a2.

   1. Budget proposals may be made by anybody in the institution. However, decisions on financial management belong to the Directive Council, who gives instructions to the financial services.

   2. Allocation of the budget
      1. there is a flexible algorithm for internal allocation.
      2. the Directive Council annually establishes an internal budget allocation, considering the payment of salaries, current expenses, recuperation of facilities and other, including budgets for the departments/institutes. A financial report is prepared and submitted to the Accounting Court.
      3. there is no budget left for strategic initiatives, except for very modest things.
      4. allocation of budget to departments/institutes is guided by historical reasons, although there is a small margin for negotiation. The real problem with this budget is its overall ridiculously small size.

2. There are, from time to time, decisions about long-term development of the institution. However, systematic lack of funding precludes execution of the plans.
   The last proposal for development was made three years ago. It is still waiting for funding.

3. The institution has mechanisms to collect information regularly that could impinge on strategic decisions. It has been impossible, however, for many years, to get the necessary funding for strategic development, what leads to a sceptic attitude in the Faculty. This has also led to a lack of strategic vision.

4. The involvement of Community Health Centres in the clinical teaching of our students has been in place for many years. In what respects teaching in hospital, however, although many members of the Faculty consider the affiliation of other hospitals an important gain, allowing a stronger development of an Academic Medical Centre, enrolling a higher number of students, there is also resistance to that concept, manifest in the consideration of the existence of the Faculty and its Associated Hospital in the same building as a strength of the institution. This group of teachers consider the loss of control over clinical teaching as a threat.

5. Lack of strategic vision, the government model with dispersion of decision centres, and the absence of systematic external evaluation were identified as the main weaknesses in the strategic policy-making of the institution. On the other hand, organization and development of postgraduate activities, cooperation with other medical schools and research institutes, and openness to innovation were considered as strengths. The recent change in the law of the University will allow the concentration of chairmanship of the various government bodies in a Dean. Allocation of funding for the development project of the Faculty, and a progressive instalment of an evaluation culture, will permit the necessary improvement in the strategic policy-making in our institution.

3.2. Specific policies

The Faculty is aiming to progress toward a more efficient global medical education. This implies an evolution of the undergraduate/graduate/continuing education programmes, in an articulate manner. For this, work with the Medical Association (Ordem dos Médicos), who must be involved in the resolutions, and the Government (to introduce the pertinent legislation) is indispensable. The Faculty is willing to have a strong involvement in all steps of medical education. The number of undergraduate students will increase, but postgraduate and continuing medical education will increase much more. A much more formal and organized postgraduate teaching will be institutionalised.

The Faculty strongly advocates the development of a long-lasting close cooperation among the ministries of education, health, science and finance in what respects the special problems of medical education, in order to make possible the policies, legislation and means for an efficient function of the system (good quality health care, good quality scientific research, good quality medical education, good quality health care).

The Faculty is very happy with the creation of the National Institute of Biomedical Sciences, to function in Porto, and is willing to have a significant participation in its work.

Activation of the research career does also belong to the policies of the Faculty.

Collaboration with other medical schools as well as hospitals and community health centres will be reinforced, and cooperation contracts will be established with these last ones. Health authorities will be involved in these processes.

Internationalisation of postgraduate education has been fought for for a long time, scarcity of means precluding a more frequent practice of it. Undergraduates are much less exposed to international changes, but for some small programmes for summer work/courses, and current use of international medical literature (textbooks, journals, internet). Development of travel/visiting programmes for undergraduates are in great need, although the complex curriculum and functioning of our education system raises important difficulties.

The Faculty has tremendous needs in ICT equipment and services, a detailed proposal for development having been presented (appendix 11).

Absence of systematic external evaluation, absence of a powerful curriculum committee, the management model, with dispersion of decision centres, and lack of strategic vision constitute the main weaknesses of the institution toward establishment of specific policies. On the other hand, there is a powerful drive to quality, to institutionalisation and development of postgraduate activities, to improvement of conditions, together with openness to innovation.

3.3. Quality assurance

1. a1. Quality of education is monitored discipline by discipline, through pass-rates, marks, surveys of student opinion, performance in subsequent activities.
   Recently an extensive study of the teaching performance of our institution was made by a team of experts from the Department of Education Sciences of Porto University, on request by the Faculty (appendix 2).
   Evaluation of teaching staff, for progress in the academic career, stands much more on the weight of the scientific curriculum than on the pedagogic involvement.
   Funding and monitoring of research activity is made, at short time intervals, by the Fundação para a Ciência e a Tecnologia. The research units of the Faculty have been repeatedly well classified. Monitoring of support services is made, year-to-year, by the Directive Council of the Faculty.
   Every type of activity, including teaching, learning, research, services, is reported with some detail in the annual report of the Faculty, written by the Directive Council. The last report is here provided as appendix 12.

   a2. There is no regular feedback on the performance of graduates on the labour market, but for a number who proceeds with the professional or academic career in this Hospital/Faculty. That regular feedback, although difficult to get, would be a most important information on the appropriateness of curriculum and teaching system.

2. There has been no regular plan to guarantee global quality improvement or to add to a strategic perspective of the institution. The chronic scarcity of funds and the dispersal of decision centres have led people to concentrate on their own problems/jobs/services, fighting for quality at their small scale, and cultivating scepticism as to a more global solution.

   b1. Consultation processes accompanying curriculum or other matters overhauls proceed inside the organization rules: depending on the subject matter, the president of either the scientific or pedagogic council takes the initiative to set up the process. In the scientific council only the senior teaching staff (people with a PhD degree), including invited professors, is represented. The junior academic staff is rarely consulted in a formal way, although informally listened to in the departments. In the pedagogic council there are teachers and students, in parity. The Student Association may also be consulted, but more often takes the initiative to let know the student opinion on any subject on discussion or even on any subject students think is in need of change.

   b2. There are regular evaluations for continuing or reorganising institutes, conducted by the Fundação para a Ciência e a Tecnologia. The Faculty has no intervention in these processes. As a matter of fact, the science policies are determined by the Science Ministry, and directly negotiated with the research groups. This separation between science and education policies, leaving the Faculty out of the research business, has been another fact weakening a strategy planning by the Faculty.

   b3. Overall reviews of the institution have been made on external initiatives (Ministry of Education).

3. The poorness of internal information and people participation, the management model with absence of functioning power, the lack of strategic thinking, the weak articulation with the University and the absence of systematic external evaluation constitute weaknesses toward quality assurance policies in the Faculty. Its strengths are in the quality of its human resources, the quality of services to community and scientific production, the deep affective connection of people to the institution, an openness to innovation and to the modern evaluation culture, together with a strong will to improve.

3.4. Management of Change

1. Keeping an eye on possible and necessary improvements is a responsibility of everybody in the institution, and, above all, of the heads of the management bodies. However, as already stated, dispersion of decision centres and of power, together with a complex organization of the Faculty, make global improvements difficult to plan and execute. Chronic lack of funding strongly adds to those difficulties.
   At the department/service/research unit level, management of change succeeds more easily, albeit with constraints.

2. Feedback information leads to discussions on the topics at the various levels of hierarchy, and eventually, when a consensus is attained between the management bodies, to a strategic decision. This occurs more in an ad hoc manner than a regular one. The process for management of change is slow.

3. Lack of people participation, a strong sense of autonomy, a complex organization of the institution, with dispersion of decision centres, and the co-related difficulty in building a strategic thinking constitute the main weaknesses of the Faculty to react to challenges and opportunities. Its strengths reside in the quality of its student/teaching/administrative staff, its strong historical/cultural tradition, pedagogic experience, good student/teacher relationships, quality of research and post-graduate teaching, its close relationship with Hospital S. João, the staff affective interest in the institution, its relationships with other schools and research institutes and openness to innovation.

4. Challenges and opportunities

The Faculty of Medicine of Porto University is a serious, hard-working, prestigious institution, weakened in its government, due the dispersion of decision power, brought about by the University law active in the last two and a half decades. Chronic lack of funding, probably also resulting from a lack of a strong government with lobbying capacity in Lisbon, add to that weakened situation. Today this institution struggles with a serious lack of space, equipment, logistic facilities, technical staff, mechanisms to quickly react globally. Difficulties in preparing and implementing global strategic decisions led to a concentration of efforts in services and units, most of which survived and even developed in reasonably good conditions. Scientific research has been partly supported and regularly evaluated by Fundação para a Ciência e a Tecnologia, and various units got international recognition. A growing number of students and staff are involved in high quality research. Cooperation with research institutes and other schools reinforced scientific productivity and status. Richness of historical/cultural patrimony, close association with Hospital S. João, with strong interactions between basic sciences and clinical practice, and academic staff and clinical practitioners, and the quality of students/teaching/administrative staff constitute important strengths of the Faculty. It has been for a long time, and continues to be the Portuguese University Institution chosen by candidate students in the first place. However, the absence of an efficient management has precluded the implementation of some necessary measures such as a more efficient curriculum for the medicine course, activation of the research career, instalment of a single medical board in Faculty of Medicine/Hospital S. João, instalment of a regular system of external evaluation.

The threat of further budget cuts due to a putative economic crisis and/or continuing lack of recognition by the government toward the services provided by the Faculty, namely in confrontation with other medical schools, followed by continuing degradation of space and facilities, and precluding the desperately needed developments in equipment, including information technologies equipment and services, and loss of competent professionals, constitute the main concerns of the institution. Inside threats, for many in the institution, include de-humanizing of medical practice carried along by the use of new technologies, super-specialization of teaching, loss of medical teaching staff in basic sciences and loss of control over clinical teaching.

On the other hand, the use of new technologies is also considered an opportunity, as are the development of post-graduate teaching and research, a movement toward restructuring of the Faculty and of the medical course curriculum, and the instalment of control of quality of both teaching and research. External environment opportunities are envisaged in the European integration, inter-ministerial coordination for medical education, and the Contract-Programme for Development and Quality of the Faculty, which includes a new building.