Curricular Guidelines and Medical Education: Expectations of First Year Medical Students at a Higher Education Institution

ABSTRACT Students’ perspectives, disappointments and achievements significantly affect their learning process and the way they perceive the profession. This study evaluates the relationship between the New National Curricular Guidelines for Medicine Courses, implemented in 2014, and the expectations of first year students of a Medicine course of a private Higher Education Institution in the state of Minas Gerais, Brazil, regarding their medical training. The study was carried out using quantitative and qualitative methods, based on the application of questionnaires that addressed aspects such as the student’s profile, initial motivations and expectations of their academic training, futures plans and projects in relation to the profession, and knowledge about The National Curricular Guidelines for the Medicine Course. The results for the profile of these students indicated a predominance of female students, from the interior of the state of Minas Gerais, in the 18 to 20 year age group, who entered the institution through the vestibular exam having previously taken the National Secondary Education Examination (ENEM). The main motivations for choosing medicine as an undergraduate course included personal and vocational skills, and the opportunity for personal fulfillment. The expectations of the academic training included working in a hospital context during the initial years of the course, and the desire to practice at different levels of health care, promoting recovery and rehabilitation. The postgraduation projects of the students included medical residency, professional competence, work-life balance, and becoming medical specialists/subspecialists. In terms of overall vision, the students declared that they were satisfied with their graduation course, pointing out just a few areas where the learning/teaching process was lacking. The majority of students in the first period (56%) were unfamiliar with the DCNs of 2001 and 2014, and the majority of the students in the second period (54.8%) reported knowing only the 2014 guidelines, with the college being indicated as the main source of information on the new DCNs. The students’ expectations were, on the whole, in line with the principles, fundamentals and purposes of the medical training provided for in the new DCNs of the course in terms of the main competences and general abilities of the medical training, such as Integral Health Care, Health Education, and Health Management, as well as on the new dimensions addressed in these guidelines. However, some points of disagreement were observed, such as the lack of intention to become general practitioners or to focus their training on primary care, which is recommended in the guidelines; the intention to take care of their own mental health, also recommended in the new guidelines; and a certain resistance to the inclusion of new disciplines and new active learning methodologies as opposed to valuing traditional teaching methods.摘要：学生的认知、困惑与学业收获，对其学习过程及职业认知路径均具有显著影响。本研究针对巴西米纳斯吉拉斯州某私立高等教育机构医学专业一年级学生展开，旨在评估该国2014年实施的医学专业国家新版课程指导纲要（New National Curricular Guidelines for Medicine Courses）与学生医学培养预期之间的关联。本研究采用定量与定性结合的研究方法，通过问卷调查收集数据，问卷内容涵盖学生个人背景、学业初始动机与预期、职业相关未来规划与设想，以及对医学专业国家课程指导纲要的认知情况。学生背景特征分析结果显示，样本主体为来自米纳斯吉拉斯州内陆地区、年龄介于18至20岁的女性学生，她们多通过巴西大学入学考核（vestibular exam）考入本校，且此前均参加过全国中等教育考试（ENEM）。学生选择医学专业的主要动机包括个人禀赋与职业使命感，以及实现自我价值的契机。学生对学业培养的预期包括：在课程初期于临床医疗机构参与实践，以及希望在不同层级的医疗照护体系中从业，助力患者康复与功能重建。学生的毕业后规划涵盖医学住院医师规范化培训、职业能力提升、平衡工作与生活，以及成为专科/亚专科医师。从整体认知来看，学生表示对本校医学专业培养方案感到满意，仅指出了少数学习与教学环节存在不足。一年级第一学期学生中多数（56%）对2001版与2014版医学专业国家课程指导纲要（DCNs）并不熟悉；而一年级第二学期学生中多数（54.8%）表示仅了解2014版纲要，且多数学生提及本校是其获取新版DCNs相关信息的主要渠道。整体而言，学生的学业预期与新版DCNs中规定的医学培养原则、核心要义与目标相符，尤其在医学培养的核心能力与通用素养方面，例如整合式医疗照护（Integral Health Care）、健康宣教（Health Education）与健康管理（Health Management），以及纲要中新增的相关维度。但研究也发现了若干与纲要要求相悖的倾向：例如多数学生无意成为全科医师，也未计划将培养重心放在纲要推荐的基层医疗领域；学生虽关注自身心理健康（这也是新版纲要所倡导的方向），但对纲要中新增的课程科目与主动式学习教学法存在一定抵触，更倾向于传统授课模式。