From leadership research to district action: Strengthening medical education through health policy and management training: a cross-sectional study among Portuguese medical students

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Evidence and transfer

Education-related source: verify which participants, institutions and outcomes were actually studied before district adoption. Source publication type: research-article. License and identity checks do not establish study quality or causality.

Original authors’ abstract, reproduced under the source license:

Abstract Background and objectives Modern health systems require physicians to not only provide high-quality clinical care but also understand, navigate, and lead complex healthcare organizations. However, undergraduate medical education in Portugal remains predominantly focused on clinical skills, with minimal exposure to health policy and management (HPM). This study aimed to assess Portuguese medical students’ exposure to, attitudes toward, and preferences for HPM education. Methods We conducted a cross-sectional survey of 483 medical students across 10 Portuguese medical schools. The questionnaire assessed prior exposure to HPM education, self-perceived knowledge of the national health system, curricular preferences, and civic participation. Results Only 29.2% of participants (n = 141; 95% CI 25.1–33.2) reported any previous HPM training, and those with exposure were more likely to demonstrate higher institutional literacy and greater confidence in understanding health system governance. Overall, 94.8% supported the inclusion of HPM in the medical curriculum, and 64.4% supported making it compulsory, with stronger support among civically engaged students. Conclusion Portuguese medical students had limited formal exposure to HPM but expressed strong demand for structured training in this area. These findings highlight a misalignment between current curricula and students’ perceived needs and support the introduction of a mandatory HPM course in Portuguese medical schools to better prepare future physicians for leadership and governance roles within the health system. Keywords: curriculum development, governance, health policy, medical education, Portugal

Study methods

This was a cross-sectional, web-based survey of medical students enrolled in Portuguese medical schools during the 2024/2025 academic year (years 1–6). The survey was administered using Google Forms® and was open between 21 May and 5 July 2025. Eligible participants were students aged 18 years or older enrolled in an accredited undergraduate medical degree program in Portugal. Participants were unpaid, voluntary, and anonymous, and electronic informed consent was obtained before accessing the questionnaire.

Limitations

This study has certain limitations that should be taken into account when interpreting the findings. First, the cross-sectional design does not allow for causal inferences to be made about the relationship between exposure to HPM training, institutional literacy, and attitudes toward curricular reform. Second, participation was based on a voluntary web survey, which may have introduced selection bias by over-representing more motivated or civically engaged students. Although the sample included students from 10 out of the 11 accredited Portuguese medical schools and all academic years, the distribution of respondents was highly uneven across institutions, with almost 60% of participants coming from just two faculties; consequently, under-represented schools may not be adequately reflected, and the generalizability of the findings to all medical schools should be considered with caution. Third, as all variables were self-reported, there is a possibility of recall and social desirability bias. However, anonymity and careful item wording were used to mitigate these effects. Finally, as the study focused on students’ perceptions and self-perceived knowledge rather than objective measures of competence or longitudinal outcomes, future research should complement these results with evaluative designs that assess the impact of specific HPM curricular interventions over time.

A 90-day district inquiry

Days 1–15 · Appraise. Read the source methods, recruitment, comparator, outcomes and limitations. Record how the study setting differs from your district and which claim the design can support.
Days 16–30 · Design. Select one recurring district decision. Publish the decision owner, evidence requirements, consultation process and appeal route; test the process on a bounded low-risk decision. Agree participation, privacy protections, baseline and stopping rules before starting.
Days 31–60 · Observe. Collect the pre-agreed measures, keep a log of implementation changes and invite confidential voluntary feedback. Preserve existing support for staff and learners.
Days 61–90 · Decide. Track decision time, unresolved objections, documented reasons, appeals and access differences. Review whether the process changes who can participate and who carries the burden. Make a dated decision to stop, revise or extend the inquiry.

Board decision brief

Present the local problem, source setting, evidence limits, intervention, responsible owner, total cost, measured changes and uncertainty. Separate staff perceptions, implementation measures and student learning outcomes.

Attribution and reuse

Francisco Goiana-Da-Silva; Duarte Tude Graça; Miguel Peliteiro; Juliana Sá; Tiago Martins; Joana Praia; Inês Guerreiro; Alexandre Alves Rodrigues; Mario Amorim Lopes; Francisco Sousa Vieira; Tomás Pessoa-e-Costa; Fernando Correia; Alexandre Lourenço; Eduardo Costa; Alexandre Morais Nunes; Alexandra Bento; João Breda; Conceição Calhau; Jaime Branco; Maria Amélia Ferreira; Hutan Ashrafian; Maria Do Céu Machado; Ara Darzi. Strengthening medical education through health policy and management training: a cross-sectional study among Portuguese medical students. Frontiers in Public Health (2026-03-04). https://doi.org/10.3389/fpubh.2026.1726073

Prepared 2026-11-07. Source authorship and DOI are preserved. The abstract and source passages are attributed extracts; this editorial guide is offered under the same CC BY 4.0 license.