New National Curriculum Guidelines for Undergraduate Medical Courses 2025: an invitation to transform medical education in BrazilWith the publication in the Federal Official Gazette on 1 October 2025 of CNE/CES Resolution No. 3/2025, which establishes the new National Curriculum Guidelines (DCN) for Undergraduate Medical Courses1, Brazil now has an updated regulatory framework that redefines the profile and fundamental competencies for physicians, as well as the principles and assumptions for their training in the forthcoming decades of the 21st century.
More than updating a standard, the 2025 DCN condense decades of debates, experiences and disputes around medical training, incorporating agendas ranging from social responsibility to digital health, from sustainability to student mental health, from the centrality of and in the Unified Health System (SUS) to the programmatic assessment of competencies. Meanwhile, these guidelines are only fully implemented as a result of extensive mobilisation, listening and collective formulation, fundamentally exemplified by the ABEM-coordinated Rever Project, “Medical Training for Brazil: where we are and where we are heading. A perspective committed to social responsibility in the 21st century”2.
This editorial seeks to situate the new DCN in relation to the trajectory of the 20013 and 20144 guidelines, in dialogue with the legacy of the National Interinstitutional Commission for the Evaluation of Medical Education (CINAEM) and the set of movements around medical education in this century. The challenge at hand is to point the way to future implementation, remaining heedful of the tensions and challenges that arise in order to build the foundations for a real transformation of Brazilian medical education.
Understanding the 2025 DCN requires a return to the cycle of medical education reforms that began in the 1990s, when CINAEM brought together various organisations to perform a far-reaching evaluation of medical schools and proposed profound changes to undergraduate training5. CINAEM produced strong diagnoses of curricular fragmentation, hospital-centredness, distance from the SUS, little value placed on teaching and weak generalist training, and the importance of curricula oriented towards the health needs of the population, primary care and social responsibility. It also pointed out that the strategic axes should necessarily include the professionalisation of teaching, improvements in the school management process and a special emphasis on evaluation, both of students and of schools and the processes of change.
In 2001, this movement resulted in the first National Curriculum Guidelines for Medicine, established by CNE/CES Resolution No. 4 of 7 November 20013. The 2001 DCN broke with the logic of minimum curricula and opened up space for greater autonomy for schools, defining the profile of the graduate as a generalist, humanist, critical and reflective doctor, with training based on comprehensiveness and an understanding of the social determinants of the health-disease process. They encouraged teaching-service integration, theory linked to practice from the first years of the course, with an emphasis on Primary Health Care (PHC).
From a critical point of view, however, several studies show that the implementation of these guidelines has been uneven: there have been significant advances in some institutions, but fragmented curricula, teacher resistance and a mismatch between documents and practice have persisted6);(7);(8);(9. Some obstacles remain to medical course reforms, including, for example, the devaluation of teaching, weak pedagogical training, academic individualism, the hegemonic biomedical model, rigid bureaucratic structures, and political and economic barriers.
In 2014, in the midst of the implementation of the More Doctors Programme (Programa Mais Médicos), instituted by Law No. 12.871/201310, the country approved a new version of the DCN for Medicine, by means of CNE/CES Resolution No. 3/20144. The 2014 DCN reinforced the commitment to the SUS, PHC and urgent/emergency care, structuring training along three main axes (care, management and health education), increasing the minimum hours for resident interns and explicitly establishing the predominance of primary care and urgent/emergency care in the SUS. Competency-based training and the use of active methodologies became the main focus of the text.
The 2014 DCN further aligned medical education with internalisation, expansion of vacancies and responses to the shortage of doctors in vulnerable regions, in line with the goals of the More Doctors Programme10. At the same time, the gap between the normative text and the reality of the schools remained significant: teaching-service integration did not always translate into solid links with the SUS and assessment remained based on traditional models, which diverged from the competency-based logic.
It is against this backdrop of accumulated progress, but also of gaps and ambivalences, that the new 2025 DCN are set. In contrast to the previous guidelines, a competency matrix (containing 27 major competencies) is now explained more systematically, articulating three inseparable dimensions: knowledge, skills and attitudes, orientated towards ethical, safe, critical and socially committed practice. Among the advances, we can highlight:
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the consolidation of the SUS as a guideline for training and as a reference for the organisation of practice settings and environments;
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a broader understanding of the health-disease process and the construction of the social responsibility of both doctors and medical schools;
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the explicit incorporation of the technology-sustainability-mental health triad, recognising that medical training needs to respond to climate change, health emergencies, digital technologies, artificial intelligence, telehealth and big data, without losing sight of ethics, privacy and equity;
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the establishment of programmatic assessment, with continuous, comprehensive and integrated systems, structured feedback and individualised action plans for students with difficulties, and the inclusion of a compulsory comprehensive summative assessment prior to internship;
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valuing student care with an unprecedented emphasis on inclusion, accessibility, diversity and student mental health, the requirement for inclusion and belonging centres, institutional student accompaniment programmes, longitudinal mentoring and the introduction of so-called “green areas” - curricular windows qualified for self-care, in all periods, including internship;
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the reorganisation of the medical internship, maintaining at least 35% of the total hours of the course, and a minimum of 30% of these hours in family and community medicine (an advance on the 2014 DCN which defined the area as primary care) and emergency/urgent care, as well as requiring greater qualification of the external fields and effective teaching supervision;
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the mandatory establishment of a pedagogical support and teaching experience centre, with the inclusion of a structured teacher development programme.
The 2025 DCN, therefore, not only consolidate trends already found in 2001 and 2014, but introduce new elements in line with contemporary debates in medical education worldwide - such as the central role of competencies, a culture of assessment, attention to student well-being and the critical integration of digital technologies and teacher development programmes.
The challenges, meanwhile, are not trivial: the operationalisation of programmatic assessment, the creation of protected learning environments with clinical simulation, the construction of robust inclusion centres and the reorganisation of internships in care networks, which are often weakened, imply structural changes, the availability of resources and strong management capacity.
The dialogue between the National Education Council (CNE) and ABEM through the Rever Project with funding from the Ministry of Health (MS) through the Department for Work Management and Health Education (SGTES/MS), in partnership with the Pan American Health Organisation (PAHO) and support from the Ministry of Education (MEC) was essential for the approval of the 2025 DCN. During their development, nine regional workshops and two national workshops were held in 2024, attended by hundreds of teachers, students, managers, preceptors and representatives of organisations and social control. These workshops produced shared diagnoses11);(12, systematised experiences and generated minimum consensus for the formulation of a proposal for the DCN13 and a matrix of quality indicators for medical courses14.
The most recent debates on the Rever Project, including those that took place at the IV National Workshop, reinforce the medical schools’ perception that ABEM plays a role as a technical, political and training reference for the implementation of the 2025 DCN. Among the expectations mapped out, we highlight the need for: clear technical guidelines, support materials, training courses for managers, teachers and preceptors, the development of collaborative networks for exchanging experiences, specific actions for inclusion and student mental health, liaison with SUS managers to guarantee qualified fields of practice and a national monitoring system for implementation.
In response to this situation, the Rever Project and ABEM have identified the following priorities: (1) the construction of a National Panel of Medical Education Indicators, linked to instruments such as the Progress Test, the National Medical Education Assessment Exam (Enamed), and the assessments of the National Higher Education Assessment System (Sinaes), (2) in partnership with the CNE, the preparation of a “Handbook of guidelines for the implementation of the 2025 DCN”, bringing together structuring concepts (SUS, competency, social responsibility, technology, programme evaluation, management, continuing education, health care) for the different institutional realities, technology, programme evaluation, management, continuing education, health care) and practical examples for the different institutional realities, (3) regional and national workshops to collaborate with schools in implementing the DCN, as well as encouraging and supporting initiatives to expand Diversity, Equity, Inclusion and Accessibility (DEIA) and (4) expanding training offers for medical school managers, teachers and preceptors.
The Rever Project does not merely lay the groundwork for the 2025 DCN, it is concerned with transforming guidelines into curricular life, into pedagogical and care practices, into training experiences embodied in territories, services and communities.
The 2025 DCN for Medicine come into play at a complex historical moment of intersection between the accelerated expansion of courses, persistent regional inequalities, the technological transformation of health work, climate emergencies and the need to deepen the democratisation of the SUS. They represent an important normative advance, the result of a participatory process that had one of its most powerful expressions in the Rever Project, and respond to many of the criticisms and demands that have built up since CINAEM, which persisted even with the publication of the 2001 and 2014 DCN.
At the same time, they are not a point of arrival, but rather a point of departure. The ratification of CNE/CES Resolution No. 3/2025 does not in itself guarantee a fairer, more critical, humanist medical education committed to equity; but it does provide us with a clearer map. The journey will depend on the willingness of each school, each department, each teacher and each student to take on the challenge of changing practices, cultures and structures.
This editorial is therefore also an invitation:
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for medical schools to review their training projects with courage and openness to dialogue;
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for teachers and preceptors to engage in processes of professional development and critical reflection on their practice;
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for students, so that they recognise themselves as active agents of change and demand coherence between words and action;
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for the regulatory bodies and managers of the SUS, so that they support, with consistent resources and policies, the construction of qualified fields of practice and decent working and learning conditions;
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for the scientific community, so that it can accompany, analyse and inspire, with evidence and imagination, the paths that are opening up.
The 2025 DCN, once approved and ratified, call us toward a new cycle of reforms - more demanding and more attentive to inequalities and the concrete subjects of education.
May Brazilian medical education live up to this call. And may the Revista Brasileira de Educação Médica continue to be a living space to collectively narrate, criticise, celebrate and reinvent this process.
References
- 1 Brasil. Resolução CNE/CES nº 3, de 3 de setembro de 2025. Institui as Diretrizes Curriculares Nacionais do Curso de Graduação em Medicina. Diário Oficial da União; 30 set 2025. Seção 1, p. 160.
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2 Associação Brasileira de Educação Médica. Projeto Rever: Formação médica para o Brasil - onde estamos e para onde vamos? Brasília: Abem; 2026 [acesso em 15 jan 2026]. Disponível em: Disponível em: https://website.abem-educmed.org.br/abem-lanca-projeto-voltado-para-formacao-medica-com-responsabilidade-social/
» https://website.abem-educmed.org.br/abem-lanca-projeto-voltado-para-formacao-medica-com-responsabilidade-social/ - 3 Brasil. Resolução CNE/CES nº 4, de 7 de novembro de 2001. Institui Diretrizes Curriculares Nacionais do Curso de Graduação em Medicina. Diário Oficial da União ; 9 nov 2001.
- 4 Brasil. Resolução CNE/CES nº 3, de 20 de junho de 2014. Institui Diretrizes Curriculares Nacionais do Curso de Graduação em Medicina e dá outras providências. Diário Oficial da União ; 23 jun 2014.
- 5 Cruz KT. A formação médica no discurso da CINAEM - Comissão Interinstitucional Nacional de Avaliação do Ensino Médico [dissertação]. Campinas: Universidade Estadual de Campinas; 2004.
- 6 Machado CDB, Wuo A, Heinzle M. Educação médica no Brasil: uma análise histórica sobre a formação acadêmica e pedagógica. Rev Bras Educ Med. 2018;42(4):66-73.
- 7 Rocha VXM. Reformas na educação médica no Brasil: estudo comparativo entre as Diretrizes Curriculares Nacionais dos cursos de graduação em Medicina de 2001 e 2014 [dissertação]. Santos: Universidade Católica de Santos; 2018.
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8 Oliveira CA, Amaral EM, Cyrino EG, Gianini RJ. Encontros e desencontros entre projetos pedagógicos de cursos de Medicina e Diretrizes Curriculares Nacionais: percepções de professores. Interface (Botucatu). 2021; 25: e200076. doi: https://doi.org/10.1590/interface.200076.
» https://doi.org/https://doi.org/10.1590/interface.200076 -
9 Ferreira MMS, Maia LC, Costa SM, Caldeira AP. Diretrizes Curriculares Nacionais para os cursos de Medicina no Brasil: mudanças no processo de formação. J Políticas Educ. 2023;17:e89451. doi: https://doi.org/10.5380/jpe.v17i2.
» https://doi.org/https://doi.org/10.5380/jpe.v17i2 - 10 Brasil. Lei nº 12.871, de 22 de outubro de 2013. Institui o Programa Mais Médicos, altera as Leis nº 8.745/1993 e 6.932/1981, e dá outras providências. Diário Oficial da União ; 23 out 2013.
- 11 Associação Brasileira de Educação Médica. Relatoria do evento de lançamento do Projeto Formação Médica para o Brasil: onde estamos e para onde vamos? Um olhar comprometido com a responsabilidade social no século XXI. Brasília: Abem; 2024.
- 12 Associação Brasileira de Educação Médica. Projeto Rever. Relatório das Oficinas Regionais realizadas nos meses de julho e agosto de 2024. Brasília: Abem ; 2024.
- 13 Associação Brasileira de Educação Médica. Projeto Rever. Proposta para Diretrizes Curriculares Nacionais dos cursos de Medicina. Brasília: Abem ; 2024.
- 14 Associação Brasileira de Educação Médica. Projeto Rever. Proposta para matriz de indicadores. Brasília: Abem ; 2025.
Research data is available in the body of the document.
