Digital flashcards and medical physiology performance: a dose-dependent effect.

Use of digital flashcards promotes active recall, spaced repetition, and self-assessment academic principles. This work explores the association and dose-dependent effect of this study method and locomotor (LP) and cardiovascular physiology (CP) grades. A single-faculty cohort study of medical LP and CP students was conducted, and 155 and 676 flashcards, respectively, were created through Moodle. An exploratory analysis examined three exam results (2019), and a confirmatory study used a fourth exam (2021) in another CP cohort. Of 685 students enrolled, 558 participated in the exploratory analysis: 319 (69%) for LP and 311 (84%) for CP, of which 203 LP and 267 CP students were flashcard users. Median grades were higher among flashcard users, and the number of cards reviewed was positively correlated with grades (r = 0.275 to 0.388 for LP and r = 0.239 to 0.432 for CP, P < 0.001). Multiple linear regression models confirmed a positive dose-dependent association between results and the number of flashcards studied: for every 100 LP cards reviewed, exam grades increased 0.44-0.75 on a 0-20 scale range (P < 0.001), and for every 1,000 CP flashcards, results raised 0.81-1.08 values (P < 0.05). These findings were confirmed in the 2021 CP cohort of 269 participants, of whom 67% were flashcard users. Digital flashcard revision has a consistent positive dose-dependent association on LP and CP grades.NEW & NOTEWORTHY Implementing flashcard-based strategies is a feasible way to promote active recall, spaced repetition, and self-assessment, and students are highly adherent to these initiatives. There is a positive dose-dependent association between the number of flashcards reviewed and physiology grades. These results are consistent across different physiology subjects, under different cohorts, over short and medium terms.

O médico que eu quero ser: autoimagem profissional no Brasil e em Portugal / El médico que quiero ser: autoimagen profesional en Brasil y en Portugal / The doctor I want to be: professional self-image in Brazil and Portugal

Este estudo qualitativo avaliou a percepção de acadêmicos sobre sua autoimagem como futuros médicos e os fatores que influenciaram a construção da sua identidade profissional. Foram entrevistados 32 estudantes do sexto ano de Medicina no Brasil e em Portugal. Utilizou-se a análise de conteúdo na modalidade temática e a dramaturgia de Goffman para análise e interpretação dos dados. A autoimagem idealizada revelou-se em duas temáticas: o médico centrado em si e aquele que valoriza a relação interpessoal. Uma terceira temática mostrou a influência da universidade e de elementos trazidos a priori na identidade do médico. Os resultados indicam a influência do currículo oculto na construção da identidade profissional e reforçam a importância dos aspectos sociais e humanísticos na formação médica.(AU)

Este estudio cualitativo evaluó la percepción de académicos sobre su autoimagen como futuros médicos y los factores que influyeron en la construcción de su identidad profesional. Se entrevistaron 32 estudiantes del sexto año de medicina en Brasil y en Portugal. Se utilizó el análisis de contenido en la modalidad temática y la dramaturgia de Goffman para análisis e interpretación de los datos. La autoimagen idealizada se reveló en dos temáticas: el médico centrado en sí mismo y aquel que valora la relación interpersonal. Una tercera temática mostró la influencia de la Universidad y de elementos traídos a priori en la identidad del médico. Los resultados indican la influencia del currículo oculto en la construcción de la identidad profesional y refuerzan la importancia de los aspectos sociales y humanísticos en la formación médica.(AU)

This qualitative study evaluated the perception of academics about their self-image as future doctors and the factors that influenced the construction of their professional identity. Thirty-two sixth-year medical students in Brazil and Portugal were interviewed. Content analysis in the thematic modality and Goffman's dramaturgy were used for data analysis and interpretation. The idealized self-image was revealed in two themes: the doctor centered on himself and the one who values the interpersonal relationship. A third theme showed the influence of the University and of elements brought a priori in the doctor's identity. The results indicate the influence of the hidden curriculum in the construction of professional identity and reinforce the importance of social and humanistic aspects in medical education.(AU)

Psychiatry and mental health teaching programs of eight portuguese-speaking schools of medicine: A comparative analysis.

Background: Improvement of teaching methods in psychiatry has been the subject of permanent adaptation and innovation. Strengthening graduate education skills in psychiatry and mental health will allow physicians to have the knowledge, skills, and attitudes to carry out early diagnosis and treatment at primary healthcare settings, taking into consideration that the population should benefit from the best interventions by general practitioners. Objective: The objective of this study was to examine how the undergraduate program of psychiatry and mental health subject in the schools of medicine of the Community of Portuguese-Speaking Countries in the three continents is structured. Methods: The methods include a narrative description of the program of psychiatry, the workload, the delivery and assessment methods, and the ethical and socio-cultural aspects in psychiatry and research made by the director of the course of psychiatry in Portugal, Brazil, and Mozambique. Results: Eight schools of medicine from Portugal, Brazil, and Mozambique participated in the study. All these schools use standards which are defined by the regulatory bodies of their countries. The teaching year varied between the third and the sixth. The workload varied between 140 and 224 h. Topics were addressed in presence or virtual methods. Combined qualitative and quantitative assessment is done to encompass competencies, skills and knowledge based on clinical histories, ongoing assessment, seminars, and final written tests. Ethical and socio-cultural aspects in various strands are taught to be linked to the local reality. Research is encouraged by using grants. Conclusion: Teaching psychiatry follows global and national standards and is organized according to the reality of each country. Psychiatry departments from these three continents invest in teaching methodologies that encourage self-knowledge and the development of critical thinking, which is evaluated in a holistic context. The authors consider that the programs should have a workload according to the current burden of mental illness.

Predictors of Medical Students' Views toward Research: Insights from a Cross-Cultural Study among Portuguese-Speaking Countries.

Developing the skills and interest in scientific research of medical students is crucial to ensuring effective healthcare systems. As such, in this study, we aimed to assess Portuguese-speaking medical students' attitudes and perceptions toward scientific research and clinical practice, and how they are influenced by individual characteristics and regional indicators. A total of 455 first-year students from three medical schools in three countries (Portugal, Brazil, and Angola) participated in this study by completing a questionnaire. Portuguese students attributed the most importance to scientific skills and were the most confident in their ability to perform these skills. Angolan students were the most motivated to perform research and integrate it into the curriculum, despite having the most negative attitudes and perceiving themselves as having less ability to perform scientific skills. Brazilian students had the least positive attitudes toward science. In Portugal, attitudes depended on gross domestic product (GDP), while in Angola, they were influenced by the type of secondary school attendance. Portuguese students' perceptions of scientific skills were related to sex, GDP, type of secondary school, and participation in research. In Brazilian and Angolan students, perceptions were associated with age and research participation, respectively. The findings support the need to promote skills and positive attitudes toward scientific research in future physicians, fostering physician-scientists and improving patient care.

Reflective writing in the teaching of communication skills for medical students-A systematic review.

OBJECTIVE: To analyse the use, assessment, and measured outcomes of reflective writing (RW) in teaching communication to medical students. METHODS: Systematic search of seven electronic databases, focused on using RW in teaching communication skills. Three reviewers selected and prepared the synthesis of the studies. The synthesis was based on thematic analysis using Braun and Clarke's approach. RESULTS: We identified 1325 studies, reviewed 101 full-text articles, and included 12 articles in the analysis. The four themes identified showed that RW is not a stand-alone practice. RW is blended with other teaching strategies. Through RW, students identified structural, emotional, and relational aspects and challenges of communication. Only a few studies found a positive correlation between reflective ability and communication skills CONCLUSION: RW can be integrated with various teaching methods, at all stages of learning, to stimulate discussion of interpersonal and intrapersonal topics. Through RW, students explore theirs and their patient's emotions, values, behaviours, and needs identifying challenges and practices relevant to communication. PRACTICE IMPLICATIONS: RW can address different structural, relational, and emotional issues that are relevant to communication learning. Further educational development and high-quality empirical research on the use of RW and unique outcomes are needed to support communication skills learning.

Os desafios para o ensino de emergências de psiquiatria em desastres e conflitos armados / The challenges of Teaching Psychiatric Emergencies in situations of natural disasters and armed conflicts

Resumo: Introdução: A população moçambicana tem sido recorrentemente afectada por situações traumáticas devido a catástrofes naturais (ciclones, secas, inundações) ou provocadas pelo homem (conflitos armados), que podem levar ao desenvolvimento de perturbações mentais que, se não forem identificadas e tratadas, deixarão sequelas graves e causarão cronicidade. Objetivo: Este estudo teve como objetivo promover uma reflexão sobre a inclusão de temas psiquiátricos de emergência em desastres naturais e conflitos armados nas disciplinas ou módulos de psiquiatria, nos cursos de formação de graduação nas escolas médicas de Moçambique. Método: Trata-se de revisão narrativa da bibliografia, realizada entre abril e junho de 2021, com foco na pesquisa de artigos e documentos publicados nas plataformas virtuais Research4Life, PubMed, Hifa-pt e Google Scholar que abordam o tema desastres naturais e conflitos armados e seu ensino para estudantes de Medicina na disciplina de psiquiatria. Resultado: A inclusão das emergências psiquiátricas em desastres e conflitos armados no curso de Medicina pode proporcionar aos clínicos gerais que atuam na atenção primária à saúde conhecimentos e habilidades para que possam reconhecer emergências psiquiátricas causadas por desastres naturais e conflitos armados e trabalhar nelas, levando em consideração que o país atualmente tem poucos médicos especializados em psiquiatria. Conclusão: A adequada organização e assistência em emergências psiquiátricas à população exposta a desastres naturais e conflitos armados contribui para a resiliência e salvaguarda da saúde mental das comunidades. Neste ensaio, refletimos sobre o desafio de incorporar os temas das emergências psiquiátricas causadas pela exposição a desastres naturais e conflitos bélicos como contribuição para melhorar as habilidades dos médicos generalistas na resposta às demandas prementes de saúde mental dessa população vulnerável.

Abstract: Introduction: The Mozambican population has been recurrently affected by traumatic situations due to natural (cyclones, droughts, floods) or man-made (armed conflicts) catastrophes, which can lead to the development of mental disorders that, if not identified and treated, result in severe sequelae and cause chronicity. Objectives: To promote a reflection on the inclusion of emergency psychiatric topics in natural disasters and armed conflicts in the disciplines or modules of psychiatry in undergraduate medical school courses in Mozambique. Methods: Narrative literature review carried out between April and June 2021, focusing on the research of articles and documents published on the virtual platforms Research4life, PubMed, Hifa-PT, Google Scholar and that address the topics of natural disasters and armed conflicts and the teaching of these topics to medical students in the discipline of psychiatry. Results: The inclusion of psychiatric emergencies in situations of natural disasters and armed conflicts in the medical course can provide general practitioners who work in primary health care with knowledge and skills to recognize and act in psychiatric emergencies caused by natural disasters and armed conflicts, taking into account the fact that the country currently has few doctors specialized in psychiatry. Final considerations: The adequacy of the organization and assistance in psychiatric emergencies to the population exposed to natural disasters and armed conflicts contributes to the resilience and protection of the mental health of the communities. In this article, we reflect on the challenge of incorporating the topics of psychiatric emergencies caused by exposure to natural disasters and armed conflicts as a contribution to improving the skills of general practitioners in responding to the pressing mental health demands of this vulnerable population.

How Computer-Assisted Learning Influences Medical Students' Performance in Anatomy Courses.

Anatomy is an essential subject of the medical curriculum. Despite its relevance, the curricular time and logistical resources devoted to teaching anatomy are in decline, favoring the introduction of new pedagogical approaches based on computer-assisted learning (CAL). This new pedagogical approach provides an insight into students' learning profiles and features, which are correlated with knowledge acquisition. The aim of this study was to understand how training with CAL platforms can influence medical students' anatomy performance. A total of 611 medical students attending Musculoskeletal Anatomy (MA) and Cardiovascular Anatomy (CA) courses were allocated to one of three groups (MA Group, CA Group, and MA + CA Group). An association between the performance in these anatomy courses and the number of CAL training sessions was detected. In the MA Group (r = 0.761, P < 0.001) and the MA + CA Group (r = 0.786, P < 0.001), a large positive correlation was observed between musculoskeletal anatomy performance and the number of CAL training sessions. Similarly, in the CA Group (r = 0.670, P < 0.001) and the MA + CA Group (r = 0.772, P < 0.001), a large positive correlation was observed between cardiovascular anatomy performance and the number of CAL training sessions. Multiple linear regression models were performed, considering either musculoskeletal or cardiovascular anatomy performance as the dependent variable. The results suggest that using CAL platforms to study has a positive dose-dependent effect on anatomy performance. Understanding students' individual features and academic background may contribute to the optimization of the learning process.

Desenvolvimento docente pós-COVID-19: mudanças ou troca de cenário? / Teacher development after COVID-19: changes or just a change of scenario?

Resumo: Introdução: O mundo tem milhões de infectados pelo SARS-CoV-2, e o desfio permanece em 2021, com a vacinação e o aparecimento das novas cepas. Este é um texto sobre reflexões de como a pandemia está mobilizando as escolas médicas e se as mudanças induzidas pela emergência sanitária nos paradigmas pedagógicos serão revertidas em mudanças culturais. Desenvolvimento: A experiência de confinamento tem sido emocionalmente rica, entremeada por desafios, mergulhos pedagógicos reflexivos e muito trabalho. Analisamos o confronto entre a pandemia e as escolas médicas, com ênfase nos questionamentos a respeito das adaptações e se serão revertidas em mudanças culturais. O desenvolvimento docente não tem sido priorizado nas instituições de educação médica, e a troca do presencial para o remoto não garante mudanças. Conclusão: O docente tem papel nuclear na formação de médicos com competência, ética e humanidade. É necessário avançar, para além do brilho da hiperconectividade, com a instalação de um fórum permanente sobre desenvolvimento docente.

Abstract: Introduction: Millions of people around the world are infected with the SARS-CoV-2 virus, and the ongoing challenge in 2021 involves vaccination and the emergence of new strains. This text presents reflections on how the pandemic has mobilized medical schools, and whether the changes induced by the health emergency in our pedagogical paradigms will reverberate in cultural changes. Development: Self-isolation has proved to be an emotionally rich experience, pervaded by challenges, contemplative explorations in teaching, and a lot of work. We investigated how medical schools have tackled the pandemic, focusing on issues of the adaptations made and whether they will unfold into cultural changes. Teacher development has not been prioritized at medical schools, and the shift from the classroom to remote learning does not guarantee changes. Conclusion: The teacher plays a central role in the training of competent, ethical and humane physicians. It is necessary to move beyond the gloss of hyperconnectivity and install a permanent forum on teacher development.

Added value of assessing medical students' reflective writings in communication skills training: a longitudinal study in four academic centres.

OBJECTIVES: This study describes the development and implementation of a model to assess students' communication skills highlighting the use of reflective writing. We aimed to evaluate the usefulness of the students' reflections in the assessment of communication skills. DESIGN: Third-year and fourth-year medical students enrolled in an elective course on clinical communication skills development were assessed using different assessment methods. SETTING AND PARTICIPANTS: The communication skills course was offered at four universities (three in Brazil and one in Portugal) and included 69 students. OUTCOME MEASURES: The students were assessed by a Multiple-Choice Questionnaire (MCQ), an objective structured clinical examination (OSCE) and reflective writing narratives. The Cronbach's alpha, dimensionality and the person's correlation were applied to evaluate the reliability of the assessment methods and their correlations. Reflective witting was assessed by applying the Reflection Evaluation for Enhanced Competencies Tool Rubric (Reflect Score (RS)) to measure reflections' depth, and the Thematic Score (TS) to map and grade reflections' themes. RESULTS: The Cronbach alpha for the MCQ, OSCE global score, TS and RS were, respectively, 0.697, 0.633, 0.784 and 0.850. The interobserver correlation for the TS and RS were, respectively, 0.907 and 0.816. The assessment of reflection using the TS was significantly correlated with the MCQ (r=0.412; p=0.019), OSCE (0.439; p=0.012) and RS (0.410; p=0.020). The RS did not correlate with the MCQ and OSCE. CONCLUSIONS: Assessing reflection through mapping the themes and analysing the depth of reflective writing expands the assessment of communication skills. While the assessment of reflective themes is related to the cognitive and behavioural domains of learning, the reflective depth seems to be a specific competence, not correlated with other assessment methods-possibly a metacognitive domain.

Curricular changes: the impact on medical students knowledge of neuroanatomy.

BACKGROUND: Although neuroanatomy is considered an essential requirement in medical curriculum, its teaching has undergone many changes in recent years, with most medical schools starting to implement an integrated approach. The current paper describes the comparative evaluation of the neuroanatomy knowledge scores of medical students who attended two different pedagogic approaches of neuroanatomy in the Faculty of Medicine of the University of Porto. METHODS: Forty fourth-year medical students who attended a traditional stand-alone approach and 42 third-year medical students who attended an integrated approach completed a written test of knowledge. RESULTS: Although there were some significant differences, the results globally revealed no statistically significant difference between the neuroanatomy knowledge scores of the integrated and traditional education groups, with most students obtaining a passing score in both curricula. CONCLUSIONS: Our study is the first attempt to compare the knowledge acquired by medical students from two different pedagogical approaches to neuroanatomy. Although the integrated curricula were only implemented in the Faculty of Medicine of the University of Porto a few years ago, the students who attended these curricula obtained similar scores as those obtained by the students of the traditional curriculum. This finding suggests that an integrated curriculum can be, in light of curricular reform, an efficient approach to teaching neuroanatomy to medical students.

The assessment of personality traits and its association with learning communication skills / Avaliação dos traços de personalidade e sua associação com a aprendizagem de habilidades de comunicação

Aims: The aim of this study was to investigate the association between personality traits and attitudes toward learning communication skills in undergraduate medical students. The relation between students' attitudes and personality trait could help us identify those who those who will need more support to develop communication skills, based on their personality traits. Methods: The data was collected data from an intentional and cross-sectional sample composed of 204 students from three Brazilian universities. The students answered questionnaires containing the Communication Skills Attitude Scale (CSAS-BR) and the Big Five Mini-Markers (BFMM) for personality. Data were analyzed using frequency calculations, principal components analysis, and the multiple linear regression model. Results: Seven among 26 items of the original Communication Skills Attitude Scale (CSAS) presented factor loads lower than |0.30| and must be excluded in the CSAS -BR that showed one domain including positive and negative attitudes. The value of Cronbach's alpha of the 19-item scale was 0.894. The BFMM showed similar dimensional results with five domains with Cronbach's alpha values of 0.804 for Extroversion, 0.753 for agreeableness, 0.755 for conscientiousness, 0.780 for neuroticism and 0.668 for openness. There were positive and statically significant linear associations with the CSAS-BR and agreeableness (ß: 0.230, p<0.001), extraversion (ß: 0.150, p=0.030), and openness to experience (ß: 0.190, p=0.010). These personality factors drive social interactions and interpersonal relations, which involve the tendency to be friendly, flexible, and cooperative; to show a willing disposition; and the ability to actively engage with others. Conclusions: Based on the methods applied in this study, the results demonstrated a relation between agreeableness, extraversion and openness to experience with attitudes on communication skills in students from three Brazilian universities. Our results suggest that the evaluation of personality traits can contribute to the recognition of students for whom the establishment of special teaching strategies can improve communication skills.

Objetivos: Este estudo teve como objetivo determinar se se existe uma associação entre traços de personalidade e atitudes quanto à aprendizagem de habilidades de comunicação em estudantes de medicina. A relação entre as atitudes dos alunos e o traço de personalidade pode nos ajudar a identificar aqueles que necessitarão maior apoio para desenvolver habilidades de comunicação, a partir da identificação inicial do traço de personalidade. Métodos: Os dados foram coletados em uma amostra intencional em um corte transversal composta por 204 estudantes de três universidades brasileiras. Os alunos responderam a questionários contendo a Communication Skills Attitude Scale (CSAS-BR) e o Big Five Mini-Markers (BFMM) para personalidade. Os dados foram analisados usando cálculos de frequência, análise de componentes principais e o modelo de regressão linear múltipla. Resultados: Sete dos 26 itens do Communication Skills Attitude Scale (escala original - CSAS) apresentaram cargas fatoriais inferiores a |0.30|e foram excluídos no CSAS-BR, que mostrou um domínio contendo atitudes positivas e negativas. O valor do alfa de Cronbach na escala de 19 itens foi 0,894. O BFMM mostrou resultados dimensionais semelhantes com cinco domínios com valores alfa de Cronbach de 0,804 para extroversão, 0,753 para amabilidade, 0,755 para conscienciosidade, 0,780 para neuroticismo e 0,668 para abertura. Houve associações lineares positivas e estatisticamente significativas do CSAS-BR com amabilidade (ß: 0,230, p <0,001), extroversão (ß: 0,150, p = 0,030) e abertura à experiência (ß: 0,190, p = 0,010). Esses fatores de personalidade promovem interações sociais e relações interpessoais com tendência de serem amigáveis, flexíveis e cooperativas; bem como estarem disponíveis; e com capacidade de se envolver ativamente com as outras pessoas. Conclusões: Este estudo, com a metodologia empregada, mostrou que traços amabilidade, extroversão e abertura à experiência estiveram associados com habilidades de comunicação em acadêmicos de três universidades brasileiras. Os resultados sugerem que a avaliação dos traços de personalidade possa contribuir para o reconhecimento de alunos para os quais o estabelecimento de estratégias especiais de ensino possa melhorar as habilidades de comunicação.

Item pre-knowledge true prevalence in clinical anatomy - application of gated item response theory model.

BACKGROUND: Computer and paper examinations in our days are constructed from an item pool which is regularly updated. Given the way that exams are created, one of the major concerns is the security of the items that are being used in order to ensure a good estimation of abilities. The aim of this study is to measure the prevalence of item pre-knowledge in our medical school. METHODS: The Deterministic, Gated Item Response Theory Model (DGM) was applied to estimate the prevalence of students who have had item pre-knowledge from six multiple choice examinations of the Clinical Anatomy course at the Faculty of Medicine of University of Porto. Each examination consisted of 100 items with an average of 200 students and 20% repeated items per examination. The estimation of the sensitivity and specificity was based on a simulation study. The sensitivity and specificity estimates, and apparent prevalence were used to estimate true prevalence of cheating students in the examinations under study. RESULTS: The specificity in the DGM for different simulation scenarios was between 68 and 98%, while the sensitivity ranged from 60 to 91%. The apparent prevalence was between 0.0 and 3.4%, while the true prevalence ranged from 1.2 to 3.7%. CONCLUSIONS: The true prevalence was much lower compared to the students self-reported copying of responses from other students; however, it is important to keep monitoring the pre-knowledge prevalence in order to enforce measures in case an increase occurs.

The Role of Anatomy Computer-Assisted Learning on Spatial Abilities of Medical Students.

Currently, medical education context poses different challenges to anatomy, contributing to the introduction of new pedagogical approaches, such as computer-assisted learning (CAL). This approach provides insight into students' learning profiles and skills that enhance anatomy knowledge acquisition. To understand the influence of anatomy CAL on spatial abilities, a study was conducted. A total of 671 medical students attending Musculoskeletal (MA) and Cardiovascular Anatomy (CA) courses, were allocated to one of three groups (MA Group, CA Group, MA + CA Group). Students' pre-training and post-training spatial abilities were assessed through Mental Rotations Test (MRT), with scores ranging between 0-24. After CAL training sessions, students' spatial abilities performance improved (9.72 ± 4.79 vs. 17.05 ± 4.57, P < 0.001). Although male students in both MA Group and CA Group show better baseline spatial abilities, no sex differences were found after CAL training. The improvement in spatial abilities score between sessions (Delta MRT) was correlated with Musculoskeletal Anatomy training sessions in MA Group (r = 0.333, P < 0.001) and MA + CA Group (r = 0.342, P < 0.001), and with Cardiovascular Anatomy training sessions in CA Group (r = 0.461, P = 0.001) and MA + CA Group (r = 0.324, P = 0.001). Multiple linear regression models were used, considering the Delta MRT as dependent variable. An association of Delta MRT to the amount of CAL training and the baseline spatial abilities was observed. The results suggest that CAL training in anatomy has positive dose-dependent effect on spatial abilities.

Do reciprocal relationships between academic workload and self-regulated learning predict medical freshmen's achievement? A longitudinal study on the educational transition from secondary school to medical school.

One of the most important factors that makes the transition from secondary school to medical school challenging is the inability to put in the study time that a medical school curriculum demands. The implementation of regulated learning is essential for students to cope with medical course environment and succeed. This study aimed to investigate the reciprocal relationships between self-regulated learning skills (SRLS) and academic workload (AW) across secondary school to medical school transition. Freshmen enrolled in medical school (N = 102) completed questionnaires at the beginning and at the end of their academic year, assessing AW (measured as study time hours and perceived workload), SRLS (planning and strategies for learning assessment, motivation and action to learning and self-directedness) and academic achievement. An exploratory factor analysis (EFA) and a longitudinal path analysis were performed. According to the EFA, study time and perceived workload revealed two factors of AW: students who had a high perceived workload also demonstrated increased study time (tandem AW); and those who had a low perceived workload also demonstrated increased study time (inverse AW). Only a longitudinal relationship between SRLS and AW was found in the path analysis: prior self-directedness was related to later tandem AW. Moreover, success during the first year of medical school is dependent on exposure to motivation, self-directedness and high study time without overload during secondary school and medical school, and prior academic achievement. By better understanding these relationships, teachers can create conditions that support academic success during the first year medical school.

Do students from public schools fare better in medical school than their colleagues from private schools? If so, what can we learn from this?

BACKGROUND: Internal grade inflation is a documented practice in secondary schools (mostly in private schools) that jeopardises fairness with regard to access to medical school. However, it is frequently assumed that the higher internal grades are in fact justifiable, as they correspond to better preparation of students in private schools in areas that national exams do not cover but nevertheless are important. Consequently, it is expected that students from private schools will succeed better in medical school than their colleagues, or at least not perform worse. We aimed to study whether students from private schools do fare better in medical school than their colleagues from public schools, even after adjusting for internal grade inflation. METHODS: We analysed all students that entered into a medical course from 2007 to 2014. A linear regression was performed using mean grades for the 1st-year curse units (CU) of the medical school curriculum as a dependent variable and student gender, the nature of students' secondary school (public/private), and whether their secondary school highly inflated grades as independent variables. A logistic regression was also performed, modelling whether or not students failed at least one CU exam during the 1st year of medical school as a function of the aforementioned independent variables. RESULTS: Of the 1709 students analysed, 55% came from public secondary schools. Private (vs. public) secondary school (ß = - 0.459, p < 0.001) and whether secondary schools highly inflated grades (ß = - 0.246, p = 0.003) were independent factors that significantly influenced grades during the first year of medical school. Having attended a private secondary school also significantly increased the odds of a student having failed at least one CU exam during the 1st year of medical school (OR = 1.33), even after adjusting for whether or not the secondary school used highly inflated grades. CONCLUSIONS: It is important to further discuss what we can learn from the fact that students from public secondary schools seem to be better prepared for medical school teaching methodologies than their colleagues from private ones and the implications for the selection process.

Clinical communication skills and professionalism education are required from the beginning of medical training - a point of view of family physicians.

BACKGROUND: The Brazilian undergraduate medical course is six years long. As in other countries, a medical residency is not obligatory to practice as a doctor. In this context, this paper aims to clarify what and when competencies in communication and professionalism should be addressed, shedding light on the role of university, residency and post-residency programmes. METHODS: Brazilian family physicians with diverse levels of medical training answered a questionnaire designed to seek a consensus on the competencies that should be taught (key competencies) and when students should achieve them during their medical training. The data were analysed using descriptive statistics and correlation tests. RESULTS: A total of seventy-four physicians participated; nearly all participants suggested that the students should achieve communication and professionalism competencies during undergraduate study (twenty out of thirty competencies - 66.7%) or during residency (seven out of thirty competencies - 23.33%). When competencies were analysed in domains, the results were that clinical communication skills and professionalism competencies should be achieved during undergraduate medical education, and interpersonal communication and leadership skills should be reached during postgraduate study. CONCLUSION: The authors propose that attainment of clinical communication skills and professionalism competencies should be required for undergraduate students. The foundation for Leadership and Interpersonal Abilities should be particularly formed at an undergraduate level and, furthermore, mastered by immersion in the future workplace and medical responsibilities in residency.

Assessment in pediatrics clerkships: impact of strategies to solve item-sharing problems.

INTRODUCTION: Reusing multiple-choice questions in different examinations may lead to item sharing between students. Our aim was to analyze and solve an item-sharing problem during assessment of medical students in pediatrics clerkship. METHODS: This is a 3 years prospective analysis of 5th year medical students, submitted to an examination at the end of their Pediatrics' clerkship. In 2012, questions were reused across different clerkships. In 2013, no questions were reused in different clerkships. In 2014, no questions were reused and the review of the test was postponed to the end of the year, after all clerkships ended. RESULTS: In 2012, the mean score increased 1.36 points (in a scale of 0-20) per clerkship rotation, with the last clerkship having a difference of 9.5 points regarding the first one (P < .001). Fifty percent of this variation was due to the repetition of questions. In 2013, with a new question bank, the mean score increased 0.8 points per clerkship rotation, with a difference of 5.6 points between the last and the first rotations (P < .024). Finally, in 2014 there was no significant variation between clerkships.Tests' scores had a significant moderate correlation with students' average course grade (r = 0.39, r = 0.30, r = 0.48, for 2012, 2013, and 2014, respectively). The students' average course grade, however, did not confound the increase in tests' scores across different clerkships. CONCLUSION: The present work demonstrated an item-sharing problem among students during pediatric clerkships. An effective approach to correct this bias assessment was achieved by restricting the reuse of questions, by changing the time-point of test revision and by progressively adapting equating strategies.