School of Medicine

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.

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% 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.

A 4-item affect scale portrayed on crosswise lines was developed and tested on medical students participating in preclinical courses with a view to measuring appeal as an educational outcome. This usage was based on assumptions that end-of-course adaptation could be derived from affect responses and should reflect the appeal of a course experience. Indeed, the results demonstrated that positive affect (pleasure, satisfaction) and negative affect (anxiety, grief) responses have substantial correlations with an independent measure of appeal: course valuing section scores of the Course Valuing Inventory. Moreover, students with various adaptation modes, as signalled by affect response patterns, showed significantly different means in course valuing scores. Significant differences were also shown in adaptation mode distribution among students finishing courses with distinct integration methods, or levels of learner control. As hypothesized, it was found that end-of-course adaptation modes differentiate between learners who do and do not volunteer for a student preceptorship in the same course. Findings suggest that affect responses can be used as a scale of course appeal to measure the effects of motivational strategies.

Summary: Summary. Does peer-tutoring affect students’ educational outcomes in problem-based learning? Students’ characteristics and outcomes were compared along 14 successive classes of a problem-based learning course in the University of Brasilia medical programme. In the first stage of this time series, 26 teacher-tutored groups were formed; in the second stage, 50 groups had both teacher- and peer-tutoring. Both groups had equivalent characteristics in stages one and two as regards membership size and composition (students’ learning style, self-confidence and motivation to learn). Results showed that scores for problem-solving tests and self-evaluation of skills were not significantly different between first and second stage groups. However, scores of meaningfulness of course experience and group work usefulness were significantly higher in the peer-tutoring stage. Significant positive correlations were found between scores of meaningfulness of course experience and both self-evaluation and group work usefulness but not between the first measure and group size or motivation to learn. The findings suggest that peer-tutoring can facilitate group work without sustained loss of cognitive achievement in long range conditions of problem-based learning experience.

A self-help group approach was used to enhance medical students' self-directed learning (SDL) skills within an elective course. The SDL task profile envisaged included personal responsibility for, self-direction, and self-monitoring of learning. Reflection and learning partnerships were supported and facilitated by discussion and exercises in a small group context. Self-assessment of SDL tasks, as well as measures of approaches to study using the Approaches to Studying Inventory, were obtained. The results showed increased level of self-efficacy regarding the SDL tasks at the end-of-course. The task self-ratings had significant relationships to measures of deep approach to study. Academic achievement (GPA) was significantly higher for students who participated in the elective experience than for controls. Among the participants, 67% showed enhancement of the SDL task profile. Reasons for lack of improvement are discussed. The findings suggest that the approach used maybenefit most, but not all students under constraining conditions.

Is the diagnostic ability of medical students — as appraised by the Diagnostic Thinking Inventory (DTI) — influenced by the learners’ characteristics, or the way they acquired basic knowledge? This question was explored in a 4-year consecutive sampling of clinical clerkship students. DTI inventory scores (flexibility in thinking and structure in memory), learners’ characteristics (learning style, self-confidence as a learner, and motivation to learn), together with knowledge scores (grade-point average and problem-solving test) were measured and analysed for their relationships and the differences between groups. Results revealed that higher scores of the DTI measures were associated with students’ high self-confidence, high motivation to learn, and abstract learning types. Correlation coefficients showed significant relationships between the DTI scores and both knowledge measures. In addition, t-tests showed that students with an integrated teaching background and problem-based learning (PBL) experience obtained significantly higher scores for structure in memory. The findings suggest that the inventory scores are sensitive to both cognitive and non-cognitive factors. The inventory may be useful in detecting subtle influences on diagnostic ability differentiation in medical students.

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.

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.

The purpose of this work was to analyze features of students' motivation in relation to academic factors after one year of medical studies, testing out a version of the Academic Motivation Scale (AMS). The AMS was administered to 299 subjects of both sexes and re-administered to a 25% sample one year later. Measures of learning perceptions and achievement representing motivational factors were also obtained. Statistical procedures were done to describe the internal and external validity, including correlation analysis between the AMS components and the motivational measures. The findings showed satisfactory levels of internal consistency, moderate temporal stability and consistent inter-correlation matrix. The profile of responses revealed a predominance of autonomous motivation and a gender effect. The relationships of the AMS components with the motivational antecedents and consequences revealed a spectrum of motivation compatible with individual and contextual influences. The results support the validity of the AMS and its usefulness in the study of academic motivation.

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% 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.

The purpose of this work was to analyze medical students` motivation features in relation to outcomes of
academic progress during undergraduate studies. The Academic Motivation Scale (AMS) was administered
in consecutive classes to a total of 285 2nd year students who graduated at the University of Brasilia.
Statistical analyses were undertaken on AMS indicators and their correlations with cumulative GPA and
peer-tutoring outcomes, as well as on outcome differences among four motivation-profile groups identified
in cluster analysis. The results showed positive, significant correlations between intrinsic motivation
components and GPA, as well as between peer-tutoring activity and a mix of intrinsic motivation and
extrinsic motivation by external regulation. Cluster analysis groups with definite autonomous motivation or
with combined (autonomous and controlled) motivation undertook more extended peer tutoring than those
with less self-determined patterns. The discussion appraises the findings in the light of the Self-
Determination Theory as related to aspects of motivation adaptation and influences of transition in
educational context. In conclusion, the results suggest that motivational features ascertained at the
beginning of the medical program have a significant, albeit small, predictive effect on the students`
achievement and peer tutoring activity. The later outcome differed significantly among students with
distinguishing motivational configurations.

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 firstyear
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%
of the variabilit y 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.

The authors analyzed Pediatrics as career choice in a study involving 877 graduates from the University of Brasilia from 1994 to 2007. Data included demographics, learning attributes, early career preference, peer-tutoring experience, academic achievement, selective training in the last semester, and choice of residency training. Contingency and logistic regression analyses were performed with the graduates grouped according to choice of Pediatrics versus all other options. Overall, 9.7% of graduates had chosen Pediatrics, of whom 44.7% had indicated early attraction to the specialty, while another 45.9% did not express interest until their clinical training. No significant trend was shown for early attraction, but a lower proportion of graduates chose Pediatrics in the last 6 years, in parallel with fewer applications for tutoring experience and selective training. Logistic regression identified five predictors of choice in decreasing order of effect size: selective training, overall achievement, reflective learning style, ranking of early preference, and time of graduation. Independent ef fects of gender and peer tutoring were not statistically significant. In conclusion, the predictors of choice of Pediatrics comprised personal and curricular features in distinct patterns of interest and influence, within an overall context of decreasing choice of the specialty in recent years.

The purpose of this study was to assess the patterns of medical students` responses to the Diagnostic Thinking Inventory (DTI) at the University of Brasilia. The inventory was administered within an 11-year timeframe to 677 students of both sexes early in their clinical experience. Statistical procedures were used to identify interrelated item sets and groups with similar response patterns, as well as differences between groups and their relationships with distinctive features. Results of the analyses revealed six salient DTI dimensions designated diligent procedure, easy grasping, flexibility of conception, comparative appraisal, abstraction of meaning, and safe play. Six student classification groups were identified based on the clustering of the dimension indexes. Students` DTI indexes and respective group affiliation were related to their insertion period in the study timeframe, early clinical achievement-gradient, self-efficacy level, and two-semester frequency of peer tutoring after the DTI appraisal. In conclusion, medical students differ in their perceptions of the diagnostic process as entailed by the DTI, and the patterns of perceptions have meaningful relationships with their learning progress and options.