Curricular reform and the professional intention of medical specialization

Chehuen, José Antonio; Ferreira, Renato Erothildes; Andrade, Andressa Carvalho Quinet de; Oliveira, Jonas Munck de; Bresser, Matheus; Apolinário, Matheus Magalhães; Barros, Pedro Murari de

doi:10.1590/1983-80422019274347

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RESEARCH • Rev. Bioét. 27 (4) • Oct-Dec 2019 • https://doi.org/10.1590/1983-80422019274347 copy

Curricular reform and the professional intention of medical specialization

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

The reform determined by the National Curricular Guidelines of the Medical Graduation Course established primary health care as the axis of the teaching-care model. However, the option of specialization may be influenced by individual, cultural and socioeconomic factors. The objective of this study was to evaluate the factors that motivate students in their career choice, and the impact of the curricular reform on this decision. This was a cross-sectional, descriptive and quantitative research. It consisted of questionnaires applied through the internet to 1,006 medical students from the five regions of Brazil. It was concluded that there was little interest in family and community medicine (1.5%; n=15), gynecology and obstetrics (3.1%; n=31) and pediatrics (4.7%; n=47). Affinity for the field was the main factor in this choice, being considered “very important” by 91.1% (n=916) of the students, followed by the intended lifestyle (56.8% n=571).

Medicine; Curriculum; Primary health care

	Unimportant		Of little importance		Important		Very important
	n	%	n	%	n	%	n	%
Lifestyle, quality of life (working hours, shifts, salary)	7	0,7	64	6,4	364	36,2	571	56,8
Affinity with specialty, personal/ professional satisfaction	1	0,1	0,0	0,0	89	8,8	916	91,1
Contact with the specialty during graduation, exposure to the area during the course	8	0,8	162	16,1	568	56,5	268	26,6
Knowledge of teacher/advisor who has aroused interest in the specialty	34	3,4	293	29,1	475	47,2	204	20,3
Family influence	432	42,9	434	43,1	110	10,9	30	3,0
Social trend/commitment	94	9,3	284	28,2	419	41,7	209	20,8
Urgency to earn money/short residency time	221	22,0	467	46,4	262	26,0	56	5,6

Questões/categorias	Escala	n	%
Currently undergraduate	1st to 4th	375	37,3
	5th to 8th	458	45,5
	9th to 12th	173	17,2
What region of the country does your college belong to?	North	114	11,3
	Northeast	211	21,0
	Midwest	126	12,5
	South	140	13,9
	Southeast	415	41,3
Percentage of public and private institutions	Public	746	74,2
Percentage of public and private institutions	Private	260	25,8
Upon entering medical school, had you already decided on a medical specialty?	Yes	264	26,2
	No	742	73,8
At this point in the course, have you defined a specialty in one of the major areas?	Yes	488	48,5
	No	518	51,5
In which of these major areas does your specialty best fit?	No answer	517	51,4
	Surgery	208	20,7
	Medical clinic	188	18,7
	Gynecology and Obstetrics	31	3,1
	Family medicine	15	1,5
	Pediatrics	47	4,7
At this point in the course, have you ruled out any of the major areas?	Yes	858	85,3
	No	148	14,7
Which one?	No answer	146	14,5
	Surgery	201	20,0
	Medical clinic	29	2,9
	Gynecology and obstetrics	205	20,4
	Family medicine	228	22,7
	Pediatrics	197	19,6
Why have you already ruled out this area?	Not ruled out	152	15,1
	Affinity	656	65,2
	Lifestyle	154	15,3
	Family influence	3	0,3
	Little contact	11	1,1
	Relationship/knowledge	11	1,1
	Trend	13	1,3
	Financial	6	0,6
Would you be a family medicine professional with a federal public career plan?	Yes	507	50,4
	No	499	49,6
Do you consider choosing a specialization in primary health care?	Yes	450	44,7
	No	556	55,3
Why?	Not ruled out	450	44,7
	Affinity	375	37,3
	Lifestyle	126	12,5
	Family influence	3	0,3
	Little contact	14	1,4
	Relationship/knowledge	18	1,8
	Trend	10	1,0
	Financial	10	1,0
Do you have doctors among your close relatives (father, uncle, grandfather)?	Yes	318	31,6
	No	688	68,4
Are you supportive of the workload related to primary health care subjects in your college curriculum?	Yes	545	54,2
	No, I would like it bigger	165	16,4
	No, I would like it smaller	296	29,4
Are you in favour of establishing two years of service in family and community medicine as a requirement upon graduation?	Yes	176	17,5
	No	830	82,5

Explanatory variable	Total	Basic cycle 1st to 4th		Clinical cycle 5th to 8th		Internship cycle 9th to 12th
Explanatory variable	Total	n	%	n	%	n	%
Did you decide on the specialty before entering college?
Yes	264	116	43,9	105	39,8	43	16,3
No	742	259	34,9	353	47,6	130	17,5
p <0.030
Have you decided at this point in the course?
Yes	488	150	30,7	219	44,9	119	24,4
No	518	225	43,4	239	46,1	54	10,4
p <0.0001
The chosen specialty fits in:
Not defined yet	517	225	43,5	238	46,0	54	10,4
Surgery	203	74	36,5	82	40,4	47	23,2
Medical clinic	188	42	22,3	94	50,0	52	27,7
Gynecology/obstetrics	36	9	25,0	21	58,3	6	16,7
Family medicine	15	3	20,0	7	46,7	5	33,3
Pediatrics	47	22	46,8	16	34,0	9	19,1
p <0.0001
Have you ruled out any areas at this time?
Yes	858	284	33,1	409	47,7	165	19,2
No	148	91	61,5	49	33,1	8	5,4
p <0.0001
Which area did you rule?
Have not ruled out yet	146	90	61,6	48	32,9	8	5,5
Surgery	201	55	27,4	97	48,3	49	24,4
Medical clinic	29	9	31,0	10	34,5	10	34,5
Gynecology/obstetrics	205	69	33,7	99	48,3	37	18,0
Family medicine	228	96	42,1	101	44,3	31	13,6
Pediatrics	197	56	28,4	103	52,3	38	19,3
p <0.0001
Why did you rule it out?
Have not ruled out yet	152	94	61,8	50	32,9	8	5,3
Affinity	656	225	34,3	324	49,4	107	16,3
Lifestyle	154	41	26,6	62	40,3	51	33,1
Others*	44	15	34,1	22	50,0	7	15,9
p <0.0001
Do you consider choosing a specialization in primary health care?
Yes	450	199	44,2	190	42,2	61	13,6
No	556	176	31,7	268	48,2	112	20,1
p <0.0001
Do you agree with the workload of primary health care disciplines?
Yes	545	224	41,1	240	44,0	81	14,9
No, I wish it were bigger	165	69	41,8	67	40,6	29	17,6
No, I wish it were smaller	296	82	27,7	151	51,0	63	21,3
p <0.001
Do you agree with internship in family medicine?
Yes	176	91	51,7	72	40,9	13	7,4
No	830	284	34,2	386	46,5	160	19,3
p <0.0001

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