Community Health course load before clerkship in Brazilian medical schools

Abstract: Introduction: The limits of the Community Health (CH) course load (CL) before medical clerkship (MC) in undergraduate medical courses are not defined neither in the National Curriculum Guidelines nor in other documents, and have not been investigated in a comprehensive way in national studies. Objective: To analyze the community health course load before clerkship in Brazilian medical schools. Method: Cross-sectional study of schools acknowledged by the Ministry of Education, which started activities until December 31, 2017. The sites of the 323 existing schools were accessed and the schools that had their curricula available in the internet with details of the CH CL before MC were included. The variables were school geographic region and administration type, medical course CL and CH CL before MC, also including epidemiology, biostatistics and occupational health course loads. Data were analyzed using descriptive statistics, Pearson chi-square (Ӽ2) for categorical variables and Mann-Whitney-U (U) and Kruskal Wallis Ӽ2 tests for continuous variables. Results: Out of 323 existing medical schools, 222 were included (68.7%). Among the included schools, 83 were tuition-free (37.4%) and 139 were not (62.6%). The median of the CH CL before MC was 440.0 hours (P25-75 = 300.0 - 640.0), equivalent to 5.4% (P25-75 = 3.5 - 7.8) of the medical course CL. The median of the CH CL before MC in hours in private and municipal schools was, respectively, 480.0 (P25-75 = 330.7 - 679.2) and 576.0 (P25-75 = 360.0 - 766.0), and of state and federal schools, respectively, 337.0 (P25-75 = 281.2 - 524.2) and 370.0 (P25-75 = 300.0 - 480.0), Ӽ2(3) = 11.48, p = .009. The median of the total CH CL in non-tuition-free schools was 500.0 hours (P25-75 = 336.0 - 690.0) and in the tuition-free schools, it was 364.0 hours (P25-75 = 285.0 - 504.0), U = 4.259.0, z = -3.26, p = .001. The median of epidemiology and biostatistics CL in hours before MC in the 124 schools was 88.0 (P25-75 = 60.0 - 120.0), whereas the occupational health CL in 63 schools was 40.0 (P25-75 = 33.0 - 60.0). Conclusions: The CH CL before clerkship varies widely, being higher in non-tuition-free medical schools.

摘要：引言：本科医学课程中，临床实习（Medical Clerkship, MC）前的社区健康（Community Health, CH）课程学时（Course Load, CL）上限，既未在国家课程指南中明确规定，也未在其他相关文件中提及，且国内尚未有研究对其开展全面调研。研究目的：分析巴西医学院校临床实习前的社区健康课程学时情况。研究方法：本研究为横断面研究，纳入2017年12月31日前已启动办学活动、经巴西教育部认可的医学院校。研究人员检索了现有323所医学院校的官方网站，将可公开完整课程计划且明确标注临床实习前社区健康课程学时详情的院校纳入研究。收集的变量包括院校所在地理区域、办学性质、医学专业总学时、临床实习前社区健康课程学时，以及流行病学、生物统计学与职业卫生课程学时。数据分析采用描述性统计方法：分类变量采用Pearson卡方（χ²）检验，连续变量采用曼-惠特尼U（U）检验与克鲁斯卡尔-沃利斯χ²检验。研究结果：现有323所医学院校中，最终纳入222所，纳入率为68.7%。其中83所为免学费院校（37.4%），139所为非免学费院校（62.6%）。临床实习前社区健康课程学时的中位数为440.0小时（四分位距P25-75=300.0~640.0小时，占医学专业总学时的5.4%（P25-75=3.5%~7.8%）。按办学性质分层分析显示：私立与市政院校临床实习前社区健康课程学时中位数分别为480.0小时（P25-75=330.7~679.2）与576.0小时（P25-75=360.0~766.0），州立与联邦院校的对应数值分别为337.0小时（P25-75=281.2~524.2）与370.0小时（P25-75=300.0~480.0），组间差异具有统计学意义（χ²(3)=11.48，P=0.009）。非免学费院校临床实习前社区健康课程学时中位数为500.0小时（P25-75=336.0~690.0），免学费院校对应中位数为364.0小时（P25-75=285.0~504.0），组间差异具有统计学意义（U=4259.0，z=-3.26，P=0.001）。在124所公开相关课程数据的院校中，临床实习前流行病学与生物统计学课程学时中位数为88.0小时（P25-75=60.0~120.0）；63所公开职业卫生课程数据的院校中，该课程学时中位数为40.0小时（P25-75=33.0~60.0）。研究结论：临床实习前社区健康课程学时差异显著，非免学费医学院校的该课程学时普遍更高。