Surgery course load in Brazilian medical schools

Abstract: Introduction: Surgery is an important curricular component of undergraduate medical courses. This study was conducted because the surgery course load in Brazilian medical has not been systematically explored at the national level. Objective: To analyze the surgery course load in Brazilian medical schools. Method: A cross-sectional, descriptive study was carried out with Brazilian medical schools acknowledged by the Ministry of Education, which had begun their activities prior to December 31, 2017 and, as of September 2018, had their curriculum matrix and/or political-pedagogical project with the surgery course load available on the internet. The variables studied were total medical curriculum course load and surgery course load before and during clerkship, as well as the schools’ geographic region and fee status. Data analysis was performed using descriptive statistic Student t-test, analysis of variance, and Mann-Whitney U and Kruskal-Wallis tests, with the null hypothesis rejected for p < .05. Results: The study included 205 of the country’s 323 existing medical schools, of which 175 had available information on the surgery course load during the clerkship, 157 before the clerkship, and 129 had information on course load before and after the clerkship. The median total surgery course load in hours was 815.0 (P25 - 75 = 677.5 - 992.0; minimum = 340.0 h; maximum =1,665.0), while the mean surgery course load before clerkship in hours was 268.7 (SD = 140.3; minimum = 32.0; maximum = 780.0), with no difference between geographic regions or fee status. During the clerkship, the median course load was 540.0 hours (P25 - 75 = 400.0 - 712.0; minimum = 170.0 h; maximum = 1,410.0), with no difference between geographic regions, but with higher values in medical schools with no tuition fees. Regarding the total curriculum course load, the mean percentage of the surgery course load before clerkship was 3.2% (SD = 1.7), the median percentage during the clerkship was 6.4% (P25 - 75 = 5.0 - 8.2), the median percentage of the total surgery course load was 6.4% (P25 - 75 = 5.0 - 8.2%, and the median percentage of surgery course load (both periods) was 9.7% (P25 - 75 = 8.3 - 11.8%). Conclusions: Despite the considerable variation in the surgery course load limits, the median of total surgery and the mean of surgery course load before clerkship were similar across geographic regions and fee statuses. The median surgery course load during clerkship was also similar across regions but higher in tuition-free medical schools. The values found in this study can help schools’ administrators to assess and plan the surgery course load in their institutions.

摘要：
引言：外科学是医学本科课程的重要组成部分。本研究开展的原因在于，巴西医学教育中的外科学课程学时尚未在国家层面得到系统性研究。
目的：分析巴西医学院校的外科学课程学时情况。
方法：本研究为横断面描述性研究（cross-sectional descriptive study），研究对象为经巴西教育部（Ministry of Education）认可、且于2017年12月31日前启动办学、截至2018年9月可在互联网公开渠道获取其课程大纲及政治-教育学课程方案（political-pedagogical project）中外科学课程学时相关信息的巴西医学院校。本研究考察的变量包括医学专业总课程学时、临床实习前及临床实习阶段的外科学课程学时，以及院校所属地理区域与收费属性。数据分析采用描述性统计、Student t检验（Student t-test）、方差分析、Mann-Whitney U检验（Mann-Whitney U test）及Kruskal-Wallis检验（Kruskal-Wallis test），以p<0.05作为拒绝原假设（null hypothesis）的判定标准。
结果：本研究最终纳入巴西现有323所医学院校中的205所，其中175所提供了临床实习阶段的外科学课程学时数据，157所提供了临床实习前的相关数据，129所同时具备临床实习前后的完整课程学时信息。外科学总课程学时的中位数为815.0小时（四分位距P25-P75=677.5-992.0；最小值=340.0小时；最大值=1665.0小时）；临床实习前外科学课程学时的均值为268.7小时（标准差SD=140.3；最小值=32.0小时；最大值=780.0小时），该指标在不同地理区域及收费属性的院校间均无显著差异。临床实习阶段的外科学课程学时中位数为540.0小时（P25-P75=400.0-712.0；最小值=170.0小时；最大值=1410.0小时），不同地理区域间无显著差异，但免学费医学院校的该指标数值显著更高。就总课程学时占比而言，临床实习前外科学课程学时占总课程的平均占比为3.2%（SD=1.7）；临床实习阶段的占比中位数为6.4%（P25-P75=5.0-8.2）；外科学总课程学时占总课程的中位数占比为6.4%（P25-P75=5.0-8.2%）；两个阶段外科学课程学时总和占总课程的中位数占比为9.7%（P25-P75=8.3-11.8%）。
结论：尽管外科学课程学时的区间范围存在较大差异，但临床实习前外科学课程总学时的中位数及均值在不同地理区域及收费属性的院校间均无显著差异。临床实习阶段的外科学课程学时中位数在不同地理区域间亦无显著差异，但免学费医学院校的该数值更高。本研究所得结果可为院校管理者评估与规划本校外科学课程学时配置提供参考依据。