The MIM-UALG represented a major leap forward in medical education not only inPortugalbut in the whole ofSouthern Europe. Except for a very few schools in theUKandIreland, there are no other schools which admit only graduates (known as “GEP - graduate-entry programme”), for a four year course. Courses are 6 years in the other schools inPortugal.

There are no traditional lectures and learning is based on real clinical problems (“PBL - Problem Based Learning”) discussed in small group tutorials (8 students). The admissions policy includes an important element of psychological profiling, known as Multiple Mini Interviews (MMI). Admissions in all the other Portuguese schools is exclusively based on high school marks and do not include an interview.

The MMI is a very recent method of psychological profiling, based on published evidence, which can be reliably used to select candidates according to pre-defined characteristics. In the case of medicine, we want good communicators, capable of prioritising moral or resource issues, naturally endowed with compassion and empathy. Contrary to the traditional interview, widely recognised as subject to bias, in the MMIs there are a minimum of 10 interviewers, in separate rooms, each not knowing of what is happening in the other rooms. Half of the interviewers simply observe the interaction between the candidate and an actor during an 8 minute simulation of a challenging moral or social situation. Each interviewer may well be biased in one or another direction, but the effect of adding up the independent scores of 10 or more interviewers is to cancel out the bias.

MMIs originated inMcMasterUniversity, inCanada, who first published the evidence in 2004. The MIM-UALG, together withSt George’sMedicalSchoolinLondonwere the first inEuropeto establish the method to select new students, in 2008. In 2015 more than half of the 33 British medical schools have adopted the method. There is additional evidence of the reliability of the method, collected from the MMIs run by the MIM-ALGover 8 years, which shows that when the same candidate reaches the MMI stage of selection in consecutive years, having not succeeded the first time, the outcome of the second or third attempt is exactly the same despite a different set of simulations and a different set of interviewers.

The UALG medical school introduced several major innovations which can only be found in a few European countries such as theUK,Irelandand The Netherlands. But the MIM-UALG is unique inEurope, as Primary Care (GP practice), rather than Secondary Care (hospital medicine), is at the heart of the curriculum. That is, the major component of clinical learning in the first two years of the course occurs in general practices (Centros de Saúde e Unidades de Saúde Familiar) in theAlgarve.

The shift from hospital practice to general practice as the ideal setting for medical students to learn the basic practical skills, such as history taking, physical examination and therapeutic planning, follows a trend which started in the early 90s in the English speaking countries. This resulted in part from the rapidly increasing costs of overnight hospital stays and the consequent reduction in numbers of patients admitted to hospital for planned surgery. At present, in mostUKhospitals the number of patients operated as “day case” surgery largely exceeds those operated as in-patients. The number of hospital beds has been steadily decreasing, to about half of what they were 30 years ago. Also, most in-patients now are much sicker than they were 30 years ago, many are in intensive or high dependency units, so much fewer are suitable for medical students learning basic skills. The general practice setting presently offers a more varied and more propitious atmosphere for learning basic clinical skills.

In the Algarveregion there are about 300 general practitioners (GPs) and 48 of these have been selected as clinical tutors for the medical school. All GP tutors have been specifically trained and certified as trainers by an European organization known as EURACT ( which offers courses for tutors.

On years 3 and 4 of the MIM-UALG, students go through training rotations in several NHS hospitals in theAlgarve, Alentejo andEstremadura, covering the main medical and surgical specialties. The clinical attachments in the hospitals follow well defined programmes and the tutors are trained in objective assessment methods. Not many medical schools inSouthern Europecan claim that all their clinical tutors undergo specific training as they assume teaching responsibilities.

Some of the innovations introduced by the MIM-UALG originated inCanadaand The Netherlands in the 1960s and were adopted by most top rated US andUKschools over the 70s and 80s. The curriculum of the MIM-UALG, however, originated inFlindersMedicalSchool,Adelaide, Australia, where further developments took place in the 1990s. This innovative curriculum was purchased by St. George’s Medical School University of London in the mid-90s and, after more than 10 years of proven effectiveness, was purchased by the University of Limerick in Ireland in 2005 and then by UALG in 2008.

The MIM-UALG has so far produced four batches of doctors (121 total). The number of admissions is being progressively increased from the initial 32, in multiples of 8, aiming at eventually producing an annual number of doctors sufficient for the region ofAlgarve(64-72).

The MIM-UALG is a project practically unknown within the "expat" community of theAlgarve, but the ultimate consequences of its success will be a significant improvement in medical care offered in the region. The students in the MIM-UALG reflect the population distribution ofPortugal, mostly coming from the North. But so far 2/3 of the newly qualified doctors in UALG have chosen to stay in theAlgarveand a similar proportion has chosen General Practice as a career. This will be of interest to the "foreign" community in theAlgarveas these locally trained doctors will contribute significantly to fill numerous vacancies in general practice and hospital specialties which currently remain unfilled in the regional health service.

As important as the numbers to fill the vacancies, are the ethos of the training and the process of selection of new students for the MIM-UALG. Great care is taken in putting emphasis on the “human” aspect of medicine both in the selection and in the learning programme along the course.

During the 4 year course, equal importance is given to the three “pillars” of medical training: knowledge, practical skills and communication. Students are assessed in these three fundamental aspects multiple times throughout the course, using objective methods.

For example, the testing of practical skills is carried out in a systematic form, three times each year, by means of objective structured clinical examinations (OSCE) a methodology introduced at large in the English speaking countries since the 1970s, but not yet established in the vast majority of the medical schools throughout Southern Europe, including Portugal.

The MIM-UALG was established in 2009 not just as another medical school in Portugal, but also as a school open to new methods of learning medicine, with the aim of encouraging similar developments elsewhere in the country. It is expected that the doctors trained in the UALG have acquired the habit of life long learning and will act as future motors for a gradual change in medical practice where the “human” aspect of medicine plays a central role.

A number of international collaborations were established from the very beginning with medical schools in three continents. McMaster, inCanada, has provided material for the MMIs and for knowledge testing (Personal Progress Index, PPI). The latter allows comparison of outcomes of knowledge tests with students of 6 other medical schools, 3 times each year. St George’s Medical School,London, provided the PBL portfolio, trained the original PBL tutors and provided advice and lecturers in the initial stages.LimerickMedicalSchool, inIreland, provided advice on many aspects of the initial setting up of the course.Flinders University,Australia, also provided advice and recently offered a bursary for a final year student from MIM-UALG to spend an elective period of study at Flinders every year.

The school also has a number of research laboratories with international reputation, working in areas related to cancer biology, developmental biology and regenerative medicine. In addition to first class research work, these laboratories provide an essential component in the training of our future doctors by providing an important insight into the scientific process.

The MIM-UALG is a totally transparent organisation that welcomes visitors interested in innovations in medical education. Enquiries are welcome to the email address below.

José Ponte MD DIC PhD FRCA

Emeritus Professor