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Introduction: In the last few decades, the rates of international medical migration have continuously risen. In Psychiatry, there is great disparity in the workforce between high and low-income countries. Yet, little is known about the 'push' and 'pull' factors and the migratory intentions of trainees. This study aims to assess the factors impacting the decisions of psychiatric trainees in Portugal towards migration. Material and Methods: A questionnaire was developed in the Brain Drain study and was distributed to psychiatric trainees in Portugal. Results: The sample consists of 104 psychiatric trainees (60.6% female). Overall, 40.4% of the trainees had prior experience of living abroad and the majority (96.9%) felt that this experience influenced their attitude towards migration in a positive way. About 75% of trainees had 'ever' considered leaving the country, but the majority (70.0%) had not taken any 'practical steps' towards migration. The main reasons to stay in Portugal were personal, while the main reason to leave was financial. The majority of the trainees (55.7%) were dissatisfied or very dissatisfied with their income, working conditions and academic opportunities. Discussion: Working conditions, salaries and academic opportunities are the main triggers for the migration of psychiatric trainees from Portugal. Conclusion: These results may inform the decisions of stakeholders in the health and education sectors and point out the necessary investments required and the impact it may have on the workforce. RESUMOIntrodução: Nas últimas décadas, a migração médica internacional tem aumentado continuamente. Na Psiquiatria, existe uma grande disparidade de recursos humanos entre países desenvolvidos e com baixo desenvolvimento económico. No entanto, pouco se sabe sobre os fatores que atraem (push) ou afastam (pull) a mobilidade e quais as intenções migratórias dos internos de psiquiatria. O objetivo deste estudo é avaliar os fatores que influenciam o processo de tomada de decisão dos internos de Psiquiatria em Portugal relativamente à migração. Material e Métodos: Um questionário foi desenvolvido no âmbito do estudo Brain Drain, e foi enviado aos internos de Psiquiatria em Portugal.Resultados: A amostra é constituída por 104 internos de Psiquiatria (60,6% do sexo feminino). No geral, 40,4% dos internos tiveram uma experiência de mobilidade e a maioria (96,9%) sentiu que esta os influenciou positivamente na sua atitude em relação à migração. Cerca de 75% dos internos já considerou emigrar, mas a maioria (70,0%) não deu nenhum passo nessa direção. A principal razão para permanecer no país prende-se com factores pessoais, enquanto o principal motivo para emigrar é financeiro. A maioria (55,7%) dos internos estava insatisfeito ou muito insatisfeito com o seu salário, condições de trabalho e oportunidades académicas. Discussão: Condições de trabalho, salários e oportunidades académicas são os principais estímulos para a emigração nos internos de Psiquiatria em Portugal. Conclusão: Estes resultados poderão apoiar a...

Accreditation of medical residency programs has become globally important. Currently it is moving from the goal of attaining minimal standards to a model of continuous improvement. In some countries, the accreditation system engages peers (physicians) to survey residency programs. The surveyors are sometimes volunteers, usually engaged in multiple clinical and education activities. Few studies have investigated the benefits of residency program evaluation and accreditation from the perspective of the surveyors. As peers they both conduct and receive accreditation surveys, which puts them in a privileged position in that it provides the surveyor with an opportunity to share experiences and knowledge and apply what is learned in their own context. The objective of this study is to obtain the perceptions of these surveyors about the impact of an accreditation system on residency programs. Surveyors participated in semi-structured interviews. A thematic analysis was performed on the interview data, and resulting topics were grouped into five themes: Burden (of documentation and of time needed); Efficiency and efficacy of the accreditation process; Training and experience of surveyors; Being a peer; Professional skills and recognition of surveyors. These categories were organized into two major themes: ‘Structure and Process’ and ‘Human Resources’. The study participants proposed ways to improve efficiency including diminish the burden of documentation to the physicians involved in the process and to increase efforts on training programs and payment for surveyors and program directors. Based on the results we propose a conceptual framework to improve accreditation systems. Abbreviations: PD: Program director