Brazil's Congress Makes Enamed Exam Mandatory for New Doctors' Licenses

Brazil's Federal Senate approved, on October 15, 2026, a bill that makes the Exame Nacional de Avaliação da Formação Médica (Enamed) a mandatory requirement for medical graduates to obtain their professional registration, completing the measure's passage through Congress, according to the Senate's official news service and O Povo.

The approved text, a Bill of Conversion (PLV), converts Provisional Measure (MP) No. 1.370/2026 — issued by the executive branch in June 2026 — into permanent legislation. The measure now goes to President Luiz Inácio Lula da Silva for sanction, according to the Senate and to O Povo.

What the new rule requires

Under the approved text, reaching a minimum proficiency level in the Enamed becomes a condition for registering with a Regional Medical Council (CRM), the body doctors must join to practice in Brazil, the Senate reported.

The exam is applied in three stages during the six-year medical course, with the final stage weighted most heavily in the cumulative score, according to the Senate's description of the approved version:

1. End of the 4th semester (2nd year of the course)
2. End of the 8th semester (4th year), before the clinical internship begins
3. Final stage at the end of the 12th semester (6th year), required for CRM registration

Students who do not reach the minimum proficiency level in the final stage may retake it in later testing cycles, the Senate and O Povo reported. Those who still fail can be entered in a new Medical Graduate Registry (IEM), which allows them to take part in research and scientific activities but bars them from patient care or other functions exclusive to licensed physicians, according to O Povo.

The rule applies only to students who enrolled in a medical course from June 19, 2026 — the date the provisional measure was published — onward. Students already enrolled before that date, and doctors whose diplomas were already recognized in Brazil, keep the previous rules, per the Senate and O Povo.

For physicians trained abroad, the final Enamed stage will replace the theoretical component of Revalida, the existing exam for foreign diplomas, O Povo reported. Candidates who had already passed Revalida's first stage by June 19, 2026 are exempt from the new requirement, according to the Senate's news service.

Why lawmakers acted now

The provisional measure was issued in June 2026 after poor results in an early edition of the exam showed several schools with failing average scores, prompting the government to step in, O Povo reported.

The bill's rapporteur in the Chamber, Deputy Doutor Luizinho (PP-RJ), has described the measure as a kind of 'OAB da Medicina' — a reference to the bar exam Brazilian lawyers must pass — intended to curb what he called an 'epidemic' of new medical courses opening across the country, CNN Brasil reported. Luizinho said that under current rules, no medical course had been shut down due to legal challenges despite oversight by the Ministry of Education.

According to the Senate's official news service, the number of medical courses offered in Brazil grew from 181 in 2010 to 467 in 2024 — an increase of 158% — with private institutions accounting for 73.3% of enrollment in 2024. O Povo reported that this expansion, especially in the private sector, was not matched by satisfactory exam results.

Under the approved bill, the Ministry of Education gains expanded authority to monitor medical schools based on their students' Enamed pass rates and to open supervisory procedures against underperforming institutions, according to O Povo and CNN Brasil. Schools must publish results from their three most recent exam editions, and the data must remain publicly available for at least ten years, O Povo reported.

The law also creates a National Commission for Medical Education Assessment with eight members — four from the Federal Council of Medicine (CFM), two from the Ministry of Education and two from the Ministry of Health — with rotating annual leadership, per O Povo. Medical schools must also direct up to 2% of net revenue toward support for Brazil's public health system (SUS), in financial, care-delivery, structural, educational or scientific form, O Povo reported.

Opposition in Congress

The measure did not pass without dissent. Senator Alan Rick objected that foreign-trained doctors would still face a practical exam stage under Revalida while Brazilian graduates take only the Enamed, calling it a non-equal rule, according to the Senate's news service.

Senator Astronauta Marcos Pontes called the measure 'illogical, inopportune and incorrect,' objecting to the executive branch bypassing ongoing legislative debate on the issue, the Senate reported. Pontes, Alan Rick and Deputy Bia Kicis voted against the proposal.

Hiran Gallo, president of the Federal Council of Medicine, backed the exam structure, arguing that an identical theoretical test for both groups of graduates ensures equal evaluation criteria, the Senate reported.

What happens next

With the Senate's approval on October 15, 2026, Congress completed its review of the text, which now goes to President Lula for sanction, according to the Senate and O Povo. The underlying provisional measure had been set to lose validity on October 16, 2026, which is why the vote was treated as urgent, the Senate reported.