Student-selected courses in a medical school: scope and relationships.

BACKGROUND: There is a dearth of reports in the literature of school-wide appraisals of the student-selected approach in medical education. AIM: This paper appraises the scope of student-selected components in a medical programme and analyses the relationships of achievement and motivation with choices of optional courses. METHOD: The prospective study involved 247 students from seven class-cohorts. Statistics checked the differences between groups, as well as the association between the students' academic motivation and achievement with the extent of their selections between optional courses and peer-tutoring activity. RESULTS: Most students explored multiple options, including pre-clinical, clinical and non-medical subjects among the domains of learning experienced. A fifth of them earned more student-selected credits from optional courses than the requisite minimum. Twenty courses accounted for 80.2% of optional-course enrolments. Choices between optional courses and peer-tutoring activity reflected distinct learner features. Five variables-selective-credits need, achievement, intrinsic motivation to experience stimulation, and (negatively) peer-tutoring activity and intrinsic motivation to accomplish-explained 43% of the variability in optional-course credits. Nevertheless, a higher-level blend of optional-course and peer-tutoring selections related to greater cognitive achievement and intrinsic motivation. CONCLUSIONS: This work describes the variety of responses in extent and type of choices in a mix-option approach to student-selected credits. The findings suggest interrelationships of achievement and motivation toward purposeful blending of student-selected educational activities.

Medical students' reflection in learning in relation to approaches to study and academic achievement.

The purpose of this work was to appraise reflection on learning in relation to measures of learning orientation, course valuing and academic achievement. The study involved 196 second-year students of a six-year medical programme. The scales of Reflection in Learning (RLS), Course Valuing Inventory (CVI) and a version of the Approaches to Studying Inventory (s-ASI) were administered early in the third term. The RLS was reapplied in the last week of the term. The relationships between students' RLS scores, their approaches to learning and perceived learning outcomes and their academic achievement were examined. There were positive, significant relationships between RLS, CVI and s-ASI's meaning orientation. Academic achievement was significantly, albeit weakly, related to RLS. High achievers showed stability or positive change in RLS more frequently and stronger/stable personal efficacy in self-reflection. The findings suggest that a better knowledge of the reflection profile might be useful to help students' quest for self-regulation of learning.

Três casos de inovação curricular no panorama recente (1964-1988) da Educação Médica Brasileira: subsídios de um retrospecto baseado na revisão de documentos / Three cases of curricular innovation in the recent perspective (1964-1988) of the Brazilian Medical Education: an appraisal of a retrospect based on the review of documents

No intervalo de uma década (1966-1975), três escolas médicas - nas universidades de Brasília (UnB), São Paulo (USP) e Minas Gerais (UFMG) - estabeleceram novos currí-culos a fim de preparar médicos com potencial ampliado no trato de necessidades de saúde no cenário comunitário. As três escolas diferiam entre si no contexto geopolítico, na totalidade de recursos e na experiência de vida. Embora suas propostas tivessem traços em comum, cada qual definiu de forma peculiar os elementos da organização programática, dos enfoques estratégicos e da gestão do processo curricular, os quais se expressaram diferentemente na característica global de orientação comunitária, bem como no impacto de seus efeitos na formação dos médicos e no sistema de saúde. Este relato reúne informações documentais referenciadas e algumas ilações sobre os elementos básicos da inovação curricular e seus efeitos, nos três casos.

Along a decade (1966-1975), three medical schools - belonging to the University of Brasilia (UnB), University of São Paulo (USP) and University of Minas Gerais (UFMG) - established new curricula, aiming at the education of physicians with a broader capacity to deal with the health needs of the community. The three schools differed between them in their amount of resources, life experience and geopolitical factors. Although their proposals shared common features, each one peculiarly developed the elements of the program organization, the strategical approaches and the management of the curricular processes - which displayed differently in the key component of community orientation, as well as on the consequences of their outcomes on the physician education and the health system. This report brings the available documental information together and makes inferences about the basic features of the curricular innovation and its effects, in the three cases.

Influences on choice of surgery as a career: a study of consecutive cohorts in a medical school.

AIM: To examine the differential impact of person-based and programme-related features on graduates' dichotomous choice between surgical or non-surgical field specialties for first-year residency. METHODS: A 10-year cohort study was conducted, following 578 students (55.4% male) who graduated from a university medical school during 1994-2003. Data were collected as follows: at the beginning of medical studies, on career preference and learning frame; during medical studies, on academic achievement, cross-year peer tutoring and selective clinical traineeship, and at graduation, on the first-year residency selected. Contingency and logistic regression analyses were performed, with graduates grouped by the dichotomous choice of surgery or not. RESULTS: Overall, 23% of graduates selected a first-year residency in surgery. Seven time-steady features related to this choice: male sex, high self-confidence, option of surgery at admission, active learning style, preference for surgery after Year 1, peer tutoring on clinical surgery, and selective training in clinical surgery. Logistic regression analysis, including all features, predicted 87.1% of the graduates' choices. Male sex, updated preference, peer tutoring and selective training were the most significant predictors in the pathway to choice. DISCUSSION: The relative roles of person-based and programme-related factors in the choice process are discussed. The findings suggest that for most students the choice of surgery derives from a temporal summation of influences that encompass entry and post-entry factors blended in variable patterns. It is likely that sex-unbiased peer tutoring and selective training supported the students' search process for personal compatibility with specialty-related domains of content and process.

Medical students' mindset for reflective learning: a revalidation study of the reflection-in-learning scale.

The aims of this paper are to examine the measurement properties of the Reflection-in-Learning Scale (RLS) and to identify whether there are relationships between RLS scores early in the medical program and outcomes of the students' academic activity later on. The 14-item RLS was administered to second-year students (N = 275) at start and at end of the third semester, after the students had reviewed their previous learning experience with the Course Valuing Inventory. The internal consistency, temporal stability and dimensionality of the RLS scores were investigated in relation to the start-end perspectives. Furthermore, a 2-year follow-up allowed the assessment of the relationships of third-term RLS scores with sixth-term measures of both academic achievement and diagnostic reasoning as appraised by the Diagnostic Thinking Inventory (DTI). Findings indicate that RLS data have acceptable unidimensionality and consistency of measurement, notwithstanding a significant individual-context interaction. Repeated measures revealed distinct patterns of RLS scores relating to perceived self-efficacy on the ability to reflect. Third-term RLS scores were significant, albeit weak, predictors of sixth-term cognitive achievement and DTI-related diagnostic reasoning ability. In conclusion, the results do not support a major explanatory role for RLS on knowledge representation. Nevertheless, the findings appear to substantiate the construct validity of this tool as an index of the students' frame of mind as regards reflective learning. They suggest that the RLS captures a self-regulation or cognitive housekeeping dimension of the students' reflective learning. The individual pattern of such (reflective) activity is likely to vary with specific learning conditions.

Medical students' self-appraisal of first-year learning outcomes: use of the course valuing inventory.

The aims of this paper were: to appraise how medical students perceive the meaning and value of their first-year experiences in medical studies, as measured by the Course Valuing Inventory (CVI); and to identify the relationships between the CVI responses and the learners' attributes and expectations. The study involved 282 second-year students of a six-year medical programme over a four-year timeframe. Factor analysis identified five dimensions of CVI responses: worthiness of learning experience, emotional awareness, personal development, cognitive enhancement and task drive. Higher CVI scores related positively and significantly to female gender, stronger self-confidence as a learner, greater motivation to learn, meaning orientation and reflection in learning. The CVI score was the strongest independent predictor of intention to continue the studies as a motivational consequence of first-year learning experience. In addition, a separate test showed significant relationships between the dimensions of CVI responses and the DREEM score (Dundee Ready Education Environment Measure). In conclusion, CVI responses that are more positive are likely to be associated with a quest for meaning, reflection in learning and autonomous motivation, given the relevance of the educational environment for the proximal interests of the students.

Cross-year peer tutoring experience in a medical school: conditions and outcomes for student tutors.

AIMS: To examine the features of cross-year peer tutoring and to explore their relationships to learners' characteristics and educational outcomes from the student-tutor perspective. METHOD: The records of 447 final year medical students were examined to provide data on the starting terms, frequency and course targets of peer tutoring activity of student tutors. The relationships of these features with their learners' characteristics, academic achievements and selective clerkship pathways were analysed. SETTING: The medical education programme at the University of Brasilia, Brazil. RESULTS: Analysis showed that about 96% of all graduates had acted as student tutors at some time during the programme, with great variation in starting terms, numbers and types of courses tutored. The average number of tutored courses per tutor was four. Frequency and variety of tutored courses were significantly related to achievement, learning style and gender. Higher achievers acted as student tutors for many terms and explored different subjects, and there is evidence that the experience expanded their academic expertise. Specific tutoring in a clinical course also related to strength of early career preference. Furthermore, there was a significant correlation between the number of terms of tutoring undertaken in a clinical course and the proportion of students choosing selective clerkship training in the same area by the end of programme. CONCLUSIONS: The findings suggest that acting as a peer tutor can be an appealing and constructive educational opportunity to further students' academic development. Enhanced expertise seems to relate to the accumulation and breadth of tutoring experience. Moreover, clinical tutoring may help students in making decisions regarding choice of career.

What kind of motivation drives medical students' learning quests?

AIMS: To describe the patterns of medical students' motivation early in the undergraduate programme and to examine their relationships with learning features and motivational outcomes. METHODS: The Academic Motivation Scale (AMS) was administered after the first medical year to 297 students of both sexes from consecutive classes within a 4-year timeframe. Measures of learner orientation and reflection in learning were also obtained. Academic achievement and peer tutoring experience were recorded during a 2-year follow-up. Quantitative approaches included analysis of variance, correlational and classificatory analyses of the data. RESULTS: The profile of the students' responses revealed higher levels of autonomous motivation than of controlled motivation although such measures were positively related. Correlation analysis showed significant association of autonomous motivation with higher levels of meaning orientation, reflection in learning, academic achievement, cross-year peer-tutoring experience, and intention to continue with studies. Classificatory analysis identified 4 student groups with distinct patterns of motivation. Analysis of variance revealed significant and consistent differences in learning features and outcomes among such groups. CONCLUSIONS: The findings indicate that medical students portray distinct patterns of autonomous and controlled motivation that seem to relate to the learners' frame of mind towards learning as well as the educational environment. Autonomous motivation had closer relationships than controlled motivation with measures of self-regulation of learning and academic success in the context of a demanding medical programme.

Valor e significado da vivência no primeiro ano do curso de medicina: apreciação de aprendizado pessoal e contexto em uma série histórica / Value and meaning of the first-year learning experience in a medical program: an appraisal of personal learning and context in a historic series

Os propósitos do trabalho foram examinar as percepções dos alunos sobre a vivência inicial do curso de Medicina, mediante o Questionário de Valoração do Curso (QVC), bem como analisar relações entre índices do QVC e medidas de atributos pessoais e sucesso acadêmico. O estudo envolveu 609 alunos numa década. Os resultados revelaram relativa estabilidade dos escores do QVC em turmas consecutivas e diferenças significantes entre os alunos agrupados por sexo, naturalidade, categoria de preferência por carreira e semestre de acesso ao curso. Verificaram-se, também, associações significantes entre escores do QVC e medidas de autoconfiança, intenção de aprender, rendimento cognitivo e atividade de monitoria em quatro semestres seguidos. Testes do Modelo Linear Geral revelaram quatro fatores independentes principais na explicação da variabilidade do escore do QVC: intenção de aprender, autoconfiança, preferência por carreira e semestre de acesso. A discussão examina os achados em conexão com noções de contexto interno do aprendiz e ambiência educacional. Concluindo, as respostas ao QVC refletem a perspectiva de valoração do aprendizado pessoal na interação com as dimensões do contexto educacional. O instrumento tem, assim, utilidade no acompanhamento pedagógico da iniciação profissional.

The purpose of this study was to appraise how medical students perceive their first-year experiences in the medical course using an adapted version of the Course Valuing Inventory (CVI), and to analyse the relationships between the CVI scores and the students' individual attributes and academic achievements. The study involved 609 students and covered a period of ten years. The results showed relative stability of CVI scores in consecutive classes and significant differences among students when grouped by sex, place of birth, career choice, and term of enrolment in the program. Other findings were the significant relationships between CVI score and self-confidence, willingness to learn and cognitive achievement, and peer tutoring activity during four consecutive terms. GLM tests (between subjects and effects) identified four principal independent factors to explain the CVI-score variability: willingness to learn, self-confidence, career choice and term of enrolment. The discussion appraises the findings in relation to concepts of the students, internal context and educational context. In conclusion, CVI responses reflect a perspective of valuing personal learning in interaction with dimensions of the educational context. Accordingly, this tool can be considered useful for the pedagogical supervision of medical students' professional initiation.

Autodeterminação da motivação em alunos de Medicina: relações com motivos de escolha da opção e intenção de adesão ao curso / Self-determined motivation in medical students: correlations with preference reasons and the intention to pursue the medical course

O propósito do estudo foi analisar a variabilidade da autodeterminação da motivação em função dos motivos de escolha de medicina e fatores da aprendizagem, e seus efeitos na intenção dos alunos de prosseguir no curso. Aplicou-se a Escala de Motivação Acadêmica ao total de 450 alunos em seis anos, apurando-se também os fatores da escolha e as medidas da orientação e autoconfiança e do rendimento na aprendizagem. Os resultados mostraram correlações positivas e significantes entre autodeterminação da motivação e valoração do aprendizado realizado, orientação significativa na aprendizagem, autoconfiança como aprendiz e rendimento cognitivo, bem como altruísmo e busca de desafio nos motivos de escolha de medicina. Análise de regressão revelou que fatores pessoais e contextuais, incluindo motivos de escolha, explicavam 42 por cento da variabilidade de autodeterminação da motivação. Outra análise demonstrou que autodeterminação da motivação, intenção de aprender e valoração do aprendizado explicavam a parte maior da variabilidade na intenção de prosseguir no curso. Os achados sugerem a ocorrência de inter-relações significativas entre fatores pessoais e contextuais na determinação de autodeterminação da motivação e da intenção de adesão ao curso, após o primeiro ano de estudos.

The purpose of this study was to analyze the variability of self-determined motivation as refers to the reasons for choosing medicine and with respect to factors related to the learning process and their effect on the students' motivation to pursue the studies. The Academic Motivation Scale (AMS) was applied to 450 students over 6 years. The reasons underlying the choice were assessed and the value attributed to the course, learning orientation, self-confidence and learning outcome were measured. The results of the analyses indicate significant and positive correlations between self-determined motivation and course valuing, meaningful orientation, self-confidence, and first-year GPA, as well as altruism and looking for challenges as reasons for choosing medicine. Regression analysis revealed that contextual and personal variables, including choice reasons, explained 42 percent of the variability of self-determined motivation. Further analysis showed that self-determined motivation, the intention to learn, and course valuing explained the greater part of variability in the intention to pursue the studies. In conclusion, the findings suggest meaningful correlations between contextual and personal factors in shaping self-determination and motivation and the intention to pursue the studies after the first year of the medical course.

Escolha de ginecologia e obstetrícia por graduandos da Universidade de Brasília: um estudo de influências numa série histórica / The choice of obstetrics and gynecology by graduates of a medical school: a study of influences over a 13-years period

Analisa-se a escolha de residência médica em Ginecologia e Obstetrícia (GO) em função de características pessoais dos graduandos, eventos curriculares e contexto temporal da instituição. O estudo incluiu 792 egressos do curso de Medicina da Universidade de Brasília, formados no período 1994-2006. Os dados abrangeram descritores demográficos e de aprendizagem, preferência inicial por carreira, monitorias, rendimento acadêmico, estágio seletivo no internato e inscrição para residência médica ao término do curso. Análises de contingência e de regressão logística foram realizadas com os egressos agrupados segundo a escolha ou não de GO. No conjunto, 8% dos egressos escolheram GO, dentre os quais 33% manifestaram atração inicial pela área. Não houve tendência temporal consistente na escolha ou na atração inicial, mas no qüinqüênio 1997-2001 a proporção de escolha foi menor do que a de atração inicial, em correspondência a mudanças na ambiência do curso. A análise de regressão logística identificou seis fatores preditivos da escolha: estágio seletivo, monitoria e incremento de rendimento em GO, preferência inicial, sexo feminino e época de graduação. Em conclusão, fatores associados à escolha de GO numa série histórica de 13 anos incluíram características pessoais, eventos curriculares e fase da conjuntura institucional.

The authors studied the choice of Obstetrics and Gynecology (Ob-Gyn) by medical graduates, in relation to personal features, program-related features and historical context. The study involved 792 students who graduated from the University of Brasilia in the period from 1994 to 2006. Data included demographics, learning attributes, early career preference, peer-tutoring experience, academic achievement, selective training in the final semester, and choice of residency training. Contingency and logistic regression analyses were performed with the graduates grouped according to choice of Ob-Gyn or any other option. Overall, 8% graduates selected GO of whom 33% had indicated early attraction to the specialty. No significant temporal trend was observed for either choice or early attraction. However, during a 5-years period, fewer graduates than the initially attracted by the specialty chose Ob-Gyn, a fact associated with program-environment changes. The logistic regression analysis identified six independent predictive factors: selective training, peer-tutoring and incremental achievement in Ob-Gyn, early preference for the specialty, (female) gender and date of graduation. In conclusion, the study revealed that the predictors of Ob-Gyn choice in a 13-years timeframe involved personal features, curricular events and the phase of the institutional conjuncture.

Avaliação seriada versus exame vestibular: semelhanças e diferenças entre Coortes no Curso de Medicina da Universidade de Brasília / Serial evaluation versus admission exam: similarities and differences between Cohorts in the Medical Program at the University of Brasilia

O propósito deste estudo retrospectivo foi avaliar o impacto do processo de avaliação seriada, em comparação com exame vestibular, em termos de efeitos no perfil de atributos e de progresso acadêmico de alunos da Universidade de Brasília. Os sujeitos foram 415 alunos (57,8 por cento masculinos) registrados no Curso de Medicina após aprovação para ingresso mediante avaliação seriada, ou exame vestibular no primeiro ou segundo semestre, ao longo de seis anos (1999-2004). Foram comparados, entre os grupos de ingresso, os indicadores demográficos, de atitudes em face do aprendizado e de rendimento cognitivo no curso. Os resultados mostraram proporções significantemente maiores de alunos naturais do Distrito Federal e da faixa etária mais jovem no grupo da avaliação seriada. O índice de rendimento acadêmico manteve-se significativamente mais elevado nesse grupo desde o segundo ao nono período do curso. Análises estatísticas indicam que tal efeito reflete, além da forma e do ano de ingresso, outras diferenças nas características dos alunos, tais como sexo, idade e valoração do aprendizado. Os achados sugerem que a avaliação seriada privilegiou a aptidão acadêmica quanto ao rendimento cognitivo e alterou tendências na composição demográfica do alunado com efeitos no próprio rendimento estudantil.

The purpose of this retrospective study was to appraise the impact of a new admission process (serialevaluation) on the attributes and achievement patterns of medical students in comparison to the standing onetime admission test. The subjects were 415 students (57,8 percent males) enrolled in the medical program of the Universit y of Brasilia, admitted through serial evaluation or admission test in the course of six years (1999-2004). The admission groups were compared as refers to demographic data, learning attitudes and academic achievement indicators. The results showed significantly higher proportions of students born in the Federal District and of a younger age-bracket in the serial evaluation group than in comparison to the admission test group. Academic achievement was also significantly higher in this group, from the second to the ninth semester. Statistical analyses indicate that besides the year and the criteria of admission the effect on academic achievement reflected other differences such as sex, age and self-appraisal of learning outcomes in the features of the students. These findings suggest that the new admission process has favored academic aptitude in terms of cognitive achievement. It also seems to have modified the demographic composition of the student body with effects on academic achievement in itself.

Retrospectiva da cúpla de edimburgo: subsídios para a educação médica

Resumo: Um critério transcendente da qualidade da educação médica é a formação de profissionais competentes e aptos a responder às necessidades de saúde da sociedade como um todo. Nessa perspectiva, o artigo sintetiza os subsídios resultantes da Cúpula Mundial sobre educação médica, em Edimburgo -1993. Esses elementos são relacionados aos desafios correntes e a quatro estratégias globais de reorientação, as quais têm em comum tal critério de qualidade.

Summary: A transcendent criterium of quality in medical education is the training of competent professionals who are responsive to the health need of society as a whole. In this respect, the article synthesizes the propositions that resulted from the World Summit on Medical Education at Edinburgh. It relates such propositions with the current challenges facing the medical schools ant the global strategies for reorientation of medical education that have such a quality criterium in common.

Desenvolvimento de Habilidades de Aprendizagem: Estudo dos Efeitos de uma Experiência / Development of Learning Skills: A Study on the Effects of an Experiment

Resumo: O estudo se baseia em dados dos egressos do curso de Medicina no período de 1994-98. Do total de 255 egressos, 122 cursaram uma disciplina optativa visando à promoção da função educativa do aprendiz, com ênfase na melhoria de habilidades de aprendizagem autodirigida e cooperativa. Foram obtidos dados de rendimento cognitivo e de exercício de monitoria em semiologia, bem como de atributos dos egressos antes da opção de seguir ou não a optativa. Os resultados revelaram similaridade de atributos entre os grupos. Na comparação com o grupo controle, o grupo de participantes mo5trou índice de rendimento na graduação significativamente superior. A proporção de participantes que exerceram a monitoria foi também significativamente maior. Entre os participantes, o índice de rendimento na graduação mostrou relações significativas com o escore de desempenho no trabalho em equipe e o nível de autonomia na aprendizagem alcançados na disciplina. O escore de desempenho no trabalho em equipe foi significativamente superior entre os que exerceram a monitoria. A apreciação da experiência eletiva foi estreitamente relacionada ao aprendizado percebido e seu significado pessoal. Os resultados ampliam achados anteriores e sugerem a utilidade do refinamento de habilidades de aprendizagem na busca de um aprendizado mais significativo e duradouro.

Abstract: This study is based on data for medical graduates over a 5-year period (1994-98). Out of 255 graduates, 122 took an elective course promoting the educator's role and featuring the development of self-directed learning skills and cooperative learning. The academic achievement, student preceptorship in semiotics, and learners' descriptors. The results showed similarities of descriptors between the groups prior to the intervention. However the participant group had an overall grade point average significantly superior to the control group at graduation. The proportion of participants who performed the preceptorship was higher than that of controls. Among the participants, there were significant relationships between overall grade point average at graduation and both the score in teamwork performance and the level of learner autonomy attained at end-of-course. Likewise, the score in teamwork performance was significantly higher among participants who carried out the preceptorship. Participant ranking of the elective was closely related to finding personal meaning and understanding of self-directed and cooperative learning. In conclusion, the results expand previous findings and suggest the usefulness of learning skill development in the quest for meaningful and lasting learning

Eficácia Percebida por Estudantes de Medicina no Aconselhamento de Fatores de Risco / Efficacy of Risk Factor Counseling as Perceived by Medical Students

Resumo: O aconselhamento é um modo de comunicação educativa que tem um potencial crescente na prestação de serviços de prevenção. O propósito deste estudo foi examinar as percepções da auto-eficácia no aconselhamento e a relação dessas percepções com a vivência de um módulo de instrução ao paciente e com a etapa de preparação de estudantes de Medicina. Os dados foram obtidos mediante dois instrumentos: um questionário para apurar a auto-eficácia e as atitudes dos estudantes sobre o aconselhamento na redução de riscos para a saúde, e uma auto-avaliação dos resultados da aprendizagem no módulo. As percepções de auto-eficácia no aconselhamento foram moderadas em intensidade e significantemente relacionadas com os escores da auto-avaliação. Os níveis de auto-eficácia variaram entre áreas de aconselhamento tais como aboliçiio de tabagismo, redução de estresse e orientação alimentar. Não foram observadas diferenças de auto-eficácia entre estudantes com diferentes categorias de atitude sobre o aconselhamento. Em acréscimo, observou-se forte tendência para auto-eficácia crescente no papel de instrução ao paciente com etapas progressivas de preparação. Os resultados confirmam a utilidade da medida de desenvolvi­mento da auto-eficácia e reforçam a idéia da importância de práticas educativas específicas que visem à melhoria do desempenho no aconselhamento.

Abstract: Counseling is a mode of educational communication that is bound to play an increasing role in the future delivery of preventive services. The purpose of this study was to examine medical students' perceptions of their self-efficacy in counseling and the relationship of the perceptions to a patient education learning experience and the stage of undergraduate training. Data were obtained through two inventories: first a questionnaire to measure students self-efficacy and attitudes about counseling and health risk reduction, and later a self-assessment of learning outcomes from the patient education experience. Students' perceptions of self-efficacy in counseling were moderate in strength and significantly related to self-assessment of the patient-educator role. Self-efficacy levels varied across the areas of counseling, such as smoking cessation, stress reduction, and nutritional guidance. No differences were found in the distribution of self-efficacy measures between categories of attitudinal approach to counseling identified by content analysis. In addition, there was a strong trend for increasing self-efficacy in the patient-educator role with progressive stages of undergraduate training. The results confirm the usefulness of measuring the development of self-efficacy and reinforce the idea of the importancc of specific educationa/ praclices in fostering improvement of medical students' counseli.ng performance.

Desenvolvimento e Uso de Medida do Trabalho em Grupo na Aprendizagem Cooperativa Medida do Trabalho em Grupo

Resumo: Apresenta-se um estudo de desenvolvimento e de aplicação de escala de condutas de trabalho em grupo. A análise de validação foi empreendida no cenário natural de uma disciplina e mostrou índices aceitáveis de consistência interna e de estabilidade temporal. Uma dimensão de 'liderança cooperativa' foi revelada por análise de fatores. Os resultados da análise de aplicação revelaram que o escore total da escala se relaciona significantemente com medidas de auto-eficácia na cooperação em equipe e de rendimento acadêmico, bem como distingue estudantes com vivências distintas. Outros dados indicam que a dimensão de condutas implicada é uma habilidade transferível, que pode ser reforçada por experiência de tutoria ou treinamento de cooperação. Os achados do estudo sugerem que a escala é um instrumento robusto, simples e útil para avaliação global de habilidades na aprendizagem cooperativa em grupo pequeno e no acompanhamento dos estudantes.

Summary: This work presents a development study describing the construct properties and application of a scale of group work behaviors (GWB). The validation analysis was undertaken in a naturalistic setting of a course and revealed acceptable internal consistency and temporal stability. A dimension of 'cooperative leadership' was identified by factor analysis. The results of application analysis revealed that the total score is significantly related to both measures of self-efficacy in teamwork and academic achievement, and that it distinguishes students with distinct experiences. Other results indicate that the behavioral dimension is a transferable skill that can be enhanced by training or tutorship experience. The findings suggest that the GWB scale is a robust, simple and useful tool for global assessment of ability in small group cooperative learning and for monitoring of students' personal qualities.

Enfoques de Estudo de Alunos de Medicina

Resumo: Examina-se que falares afetam o enfoque de aprendizagem de alunos de Medicina, mediante a aplicação do Inventário de Enfoques de Estudo desenvolvido por Entwistle e colegas, o qual identifica três orientações de estudo: significativa, reprodutiva e estratégica. Uma versão abreviada do Inventário foi administrada a alunos de Medicina no início do terceiro semestre e no decorrer do quinto semestre do curso. Foram obtidos dados de características dos estudantes, da avaliação inicial do curso e do rendimento acadêmico no semestre da iniciação clínica, e medidas suas relações com os escores de orientação de estudo. Os resultados revelam que a escala de orientação significativa mostra escores mais elevados que as demais, diferencia grupos (segundo sexo e nível de motivação), apresenta associação significante com a escala de orientação estratégica e com medidas de avaliação do curso e de rendimento acadêmico, e tem estabilidade moderada. As implicações dos achados são comentadas. O perfil de orientação de estudo fornecido pelo Inventário utilizado pode ser útil para monitorar as dimensões de variação do enfoque de aprendizagem adotado por estudantes nos diversos contextos do ensino médico.

Summary: Which learning approach is predominant among medical students? This article addresses the question by the use of the Approaches to Studying Inventory (ASI), developed by Entwistle et al. This questionnaire identifies three study orientations: meaning, reproductive, and strategic. A short version of ASI was administered to medical students at the start of the third term and during the fifth term of the medical program. Student descriptors and measures of course evaluation and student assessments were also obtained. The results show that the scale of meaning orientation has moderate stability and higher scores than the others. The scale differentiates between groups by sex and level of motivation and shows significant association with strategic orientation and measures of course evaluation and academic achievement. ln conclusion, the study orientation profile derived from ASI may be useful for monitoring the dimensions of variation of the learning approaches adopted by students in the different contexts of their medical education.

Fatores de Influência na Escolha de Carreira de Docentes Médicos / Factors Influencing Career Choices of Medical School Faculty

Resumo: Este trabalho averigua os padrões de influência de uma variedade de fatores na escolha da área de atuação profissional por decentes de um curso de Medicina. Um questionário com 25 itens foi preenchido por 95 docentes médicos. Diversos tipos de análise estatística foram efetuados para caracterizar os atributos do instrumento e os padrões de diferença nas respostas. Os resultados mostram consciência interna e variação de influências nas respostas ao questionário. Cinco dimensões de influência foram identificadas: altruísmo e visão social, modelo de orientação, curiosidade intelectual, compatibilidade pessoal e conveniência prática. Os participantes revelaram, em conjunto, nível positivo de múltiplos aspectos de influência, mais forte para itens de curiosidade intelectual e de compatibilidade pessoal. Subgrupos com níveis de influência distintos foram identificados, especialmente em função de percepções de altruísmo e visão social e de modelo de orientação. Os padrões de respostas docente relacionam-se com vinculo à disciplina clínica, mas não com gênero, tempo de experiência ou graduação na própria escola. Os achados sugerem a utilidade do questionário na diferenciação de padrões de respostas associados ao sentido da escolha da carreira e ao perfil de orientação da escola médica.

Abstract: The purpose of this study was to analyze career choices patterns among medical school faculty; A group of 95 physician-teachers from this school answered a 25-item questionnaire. Several statistical procedures were used to define the instrument´s properties and the subjects´ response. Five dimensions of influence were identified: altruism and social outlook, role model, intellectual curiosity, personal fit, and practical convenience. Altogether the subjects showed a moderate multi-item level of positive influence that was stronger for intellectual-curiosity and personal-fit items. Subgroups with distinct levels of influence were identified especially regarding the dimensions of altruism and orientation model. The subjects´ response patterns were related to affiliation with clinical specialty but not to gender, teaching experience, or graduation from the same school. In conclusion, the questionnaire appears to be a useful tool for differentiating the response patterns associated with career choice and the school´s mentoring profile.