A pilot Tuning Project-based national study on recently graduated medical students' self-assessment of competences--the TEST study.

BACKGROUND: The Tuning Project is an initiative funded by the European Commission that developed core competences for primary medical degrees in Europe. Students' grouped self-assessments are used for program evaluation and improvement of curricula. The TEST study aimed to assess how do Portuguese medical graduates self-assess their acquisition of core competences and experiences of contact with patients in core settings according to the Tuning framework. METHODS: Translation of the Tuning's competences (Clinical Practice - CP), Knowledge (K) items and Clinical Settings (CS) was performed. Questionnaires were created in paper and electronic formats and distributed to 1591 graduates from seven Portuguese medical schools (July 2014). Items were rated in a 6-point Likert scale (0-5) of levels of competence. Exploratory factor analysis (EFA) was conducted and Cronbach's alpha was used to evaluate the internal consistency of the questionnaire. Kruskal-Wallis and Dunn's tests were used for multiple comparisons. RESULTS: Three hundred eighty seven questionnaires were analyzed, corresponding to 24% of the target population. EFA yielded an 11-factor solution for CP and a 6-factor solution for K items. The median value of CP factors was 2.8 (p25 = 2.0; p75 = 3.5) and the median value of K factors was 2.6 (2.0; 3.2). Factor scores ranged from 1.3 (Legal principles) to 4.0 (Ethical principles). Clinical presentations, psychological aspects of illness, evidence-based medicine and promotion of health showed the highest results. Lower scores were detected in medical emergencies, practical procedures, prescribing drugs and legal principles. More than 90% of graduates experienced having contact with patients in 8 CS but only 24% of graduates had contact in all 14 CS. Graduates had the least contact with patients in the emergency rooms, intensive care units, palliative, rehabilitation and anesthetic care. Significant differences (p < 0.05) among schools were detected in 8 factors and 7 settings. CONCLUSIONS: We developed a valid questionnaire supporting national SWOT analysis on the acquisition of core competences in medical education. Results suggest that Portuguese graduates are not fully prepared for clinical practice. Curricular improvements in core competences and the educational development of the transition period between undergraduate and postgraduate education ought to be considered. Outcome-based program evaluation relying on graduates' grouped self-assessments contributes to inform changes in medical education.

[Study on Portuguese Medical Schools' Learning Conditions: A National Analysis on Student Satisfaction, Student-Tutor Ratios and Number of Admissions]. / Estudo sobre as Condições Pedagógicas das Escolas Médicas Portuguesas: Uma Análise Nacional Sobre a Satisfação Estudantil, Rácios Estudante-Tutor e Número de Admissões.

INTRODUCTION: Experiences of clinical and nonclinical learning environments, as well as assessment and study environments influence student satisfaction with their medical schools. Student-tutor ratios may impact on their perception of clinical learning environments. The aim of this study was to analyze medical students' satisfaction and student-tutor ratios in relation to medical schools' number of admissions. MATERIALS AND METHODS: A questionnaire was created, regarding learning, assessment and study environments in eight medical schools. 2037 students participated in this cross-sectional study. Cronbach' alpha (internal consistency) was calculated and principal component analysis was conducted. Pearson correlations and multiple comparisons were analyzed. RESULTS: Assessment environments showed the highest satisfaction scores and clinical learning environments the lowest scores. The national student-tutor ratio in clinical rotations is 7.53; there are significant differences among schools. Institutions with higher number of admissions showed the lowest scores of overall student satisfaction (r = -0.756; p < 0.05), which decreased with progression in the medical course. High student-tutor ratios are strongly correlated with low levels of satisfaction regarding clinical learning environments (r = -0.826; p < 0.05). DISCUSSION: Clinical learning environments show the lowest satisfaction scores, which may expose the effect of high ratios in clinical rotations. Depending on the number of admissions, significant differences between medical schools were found. Quality of teaching-learning strategies and articulation with hospitals might also be important variables. CONCLUSION: Medical schools with more admissions might be more susceptible to lower scores of student satisfaction. High student-tutor ratios in clinical rotations may reduce the quality of learning experiences and inhibit the acquisition of competences.

Introdução: Os ambientes de ensino clínico e não clínico, bem como as condições de avaliação e estudo, influenciam a satisfação estudantil com as Escolas Médicas. Os rácios estudante-tutor podem ter impacto na perceção sobre o ensino em meio clínico. Este estudo tem como objetivo analisar a satisfação dos estudantes de Medicina e os rácios estudante-tutor em relação com o número de admissões das Escolas Médicas. Materiais e Métodos: Foi criado um questionário sobre os ambientes de aprendizagem, avaliação e estudo em oito Escolas Médicas, distribuído a 2037 estudantes. Calculou-se o alfa de Cronbach (consistência interna) e executou-se uma análise de componentes principais. Resultados: Condições de avaliação obtiveram os melhores resultados de satisfação, enquanto o ensino em meio clínico revelou as menores pontuações. O rácio estudante-tutor nacional em disciplinas clínicas (7,53) traduz diferenças significativas entre Escolas. Instituições com maior número de admissões evidenciam resultados inferiores de satisfação estudantil (r= -0,756; p < 0,05), com redução progressiva ao longo do curso. Elevados rácios estão correlacionados com baixa satisfação com o ensino em meio clínico (r= -0,826; p < 0,05). Discussão: O ensino em meio clínico evidencia menor satisfação estudantil, traduzindo os elevados rácios em disciplinas clínicas. Dependendo do número de admissões, existem diferenças significativas entre Escolas. A qualidade das estratégias de ensino-aprendizagem e articulação hospitalar podem igualmente ser variáveis importantes. Conclusão: As Escolas com maior número de admissões podem ser mais suscetíveis a baixos resultados de satisfação estudantil. Elevados rácios estudante-tutor em disciplinas clínicas podem reduzir a qualidade do ensino em meio clínico e inibir a aquisição de competências.