Academic Transition from High School to an Undergraduate Medical Program Using Active Methodologies Within an Integrated Curriculum One Qualitative Research

doi:10.21203/rs.3.rs-3218682/v1

Download PDF

Research Article

Academic Transition from High School to an Undergraduate Medical Program Using Active Methodologies Within an Integrated Curriculum One Qualitative Research

https://doi.org/10.21203/rs.3.rs-3218682/v1

This work is licensed under a CC BY 4.0 License

Version 1

posted

You are reading this latest preprint version

Introduction: When transitioning from high school to an undergraduate medical program that uses active teaching methodologies, students often encounter clear obstacles in their first semester, such as breaking down disciplinary barriers, adapting to the dynamics of different curricular components, adjusting to an evaluation process that is different from what they are used to, as well as a lack of understanding of the program’s pedagogical proposal.

Objective: This study aims to understand the challenges faced by medical undergraduate students in their first semester, specifically in relation to the use of active teaching methodologies within an integrated curriculum.

Method: A qualitative study was conducted through interviews with 15 students from a private medical school who started in the first semester of 2018. The data was categorized and subjected to discourse analysis.

Results: The interviewees reported difficulties in understanding the educational proposal. Although they viewed the experience of adapting to the course's methodology positively, they found it challenging. They reported that there was insufficient explanation about the evaluation processes and proposed that clearer educational objectives be established for the students.

Conclusion: The need for a more comprehensive explanation of the pedagogical project and its teaching strategies, the importance of valuing practical training in health services, and the clarification of evaluation processes and educational objectives were highlighted by the interviewed students as key pillars for a successful transition from high school to medical education.

Medical Education

Problem-Based Learning

Medical Students

Teaching

Curriculum

There is a significant misalignment between the educational strategies used in Brazilian high schools and those employed in the medical undergraduate course in the context of Problem-Based Learning (PBL). This misalignment makes it difficult for students to transition from high school to college, especially due to the controversial shift in the center of the educational process from the teacher and content to the students. However, this is not the only discomforting difference for students, as the evaluations they undergo and the way in which disciplines are integrated are also different from what they typically experience in high school^1–19.

The evaluation mechanisms for students preparing for the selection processes of higher education institutions conflict with those recommended for the medical course. This requires students to restructure their study methods and their approach to the evaluation process ^3,8,13.

Currently, in academia, it is considered essential to develop the ability to mobilize knowledge from different areas in order to train a generalist medical professional who is ready to work in healthcare attention, management, and education in a critical and reflective manner. This has led to the development of educational proposals with integrated curricula. However, breaking down disciplinary walls can create confusion for students who have predominantly been exposed to educational approaches of an inductive-deductive nature, based on an epistemology of analysis (breaking down and dividing)^6,8.

Given these reasons, although considering the role of the higher education institution in easing the academic transition by clarifying potential doubts regarding the pedagogical proposal, the feasibility of the educational strategy with an integrated curriculum in PBL ultimately depends on students' perspective regarding their introduction to the medical course. Therefore, it is crucial to value the teacher's support in the student's adaptation process to the employed methodology^6,11,14,17..

Studying students' perceptions of the transition to higher education is important. The scarce literature on this subject often focuses only on issues related to the physical structure of institutions, but it is important to also consider that the activities involved in PBL - a pedagogical approach that emphasizes meaningful learning through problem-solving in small groups, guided by a tutor, combined with the study of medical humanities, clinical skills, laboratory activities, and service-learning - are vastly different from the previous experiences of most students in a school environment. This can lead to difficulties in learning due to a lack of understanding of the role of each curricular component in student development^{10,11,13–16,19}.

Given the format presented by Brazilian high school education, the transition to medical school using PBL (Problem-Based Learning) implies a consistent methodological change. Therefore, the objective is to analyze the students' perspective regarding the integrated curriculum in medical education and how they cope with the educational proposal of the course during the first months, including the evaluation of competencies, skills, and attitudes⁶.

This is an exploratory study with a qualitative approach that uses discourse analysis to understand the perception of undergraduate medical students regarding the academic transition from high school to an integrated medical curriculum with active learning methodologies.

We adopted the paradigmatic current of Foucauldian discourse analysis, which aims at teaching researchers to investigate not "what is behind" texts and documents, nor "what was meant" by them, but rather to describe the conditions of existence of a certain discourse^20-22.

The inclusion criteria were as follows: being a first-semester student in the undergraduate medicine course, regularly enrolled, attending academic activities for up to 60 days, and not having studied at another higher education institution. Inadequacy to these criteria was considered the sole reason for exclusion. Therefore, 15 (fifteen) participants were selected from a total population of 70 (seventy) students.

The participants, who were intentionally and deliberately sampled, are presented in Table 1. They were selected into subgroups based on their sex, age, and time elapsed since high school completion.

Table 1 – Research participants

Interview	Age (years)	Sex	Time elapsed since high school completion
1	18	Female	Less than 1 year
2	18	Male	Less than 1 year
3	19	Male	Between 1 and 2 years
4	19	Female	Between 1 and 2 years
5	19	Female	Less than 1 year
6	19	Male	Less than 1 year
7	19	Female	Between 1 and 2 years
8	18	Female	Less than 1 year
9	18	Female	Less than 1 year
10	18	Female	Less than 1 year
11	18	Female	Less than 1 year
12	17	Female	Less than 1 year
13	19	Female	Less than 1 year
14	19	Female	Less than 1 year
15	19	Female	Less than 1 year

Source: Prepared by the authors (2023).

Data collection was carried out through semi-structured interviews guided by open-ended questions. The questions were related to potential barriers that students might encounter in their first semester, as well as the aspects they considered while reflecting on their academic transition, such as active methodology, integrated curriculum, and learning assessment. All interviews were recorded and transcribed in full.

The extracted material from the interviews was individually coded by each researcher and then analyzed collectively until agreement was reached for the definitive labeling of themes.

This protocol has been approved by the Ethics and Research Committee of the State University of Pará, based on good practices criteria in qualitative research ^23-24.

The procedural steps of the methodology are presented in Table 2.

Table 2 – Procedural Steps.

Steps	Description
1. Obtain data in its "raw" form.	Full audio recordings and transcripts.
2. Delve deeply into each record.	Separate listening sessions and readings, with the goal of identifying the core meanings in the responses from the participants.
3. Perform categorization.	Researchers determine the categories based on their own analysis.
4. Identify the themes or types mentioned within each category.	After each interview has been analyzed by the researchers, the responses deemed representative are emphasized based on the central idea identified.
5. Encode or label the data	Label the themes listed to each category.
6. Organize and display the themes and types of statements on a table.	The table presents the results in a clear and concise manner, facilitating interpretation.

Fifteen interviews were conducted from a population of 70 students, with 12 female and 3 male participants, between the ages of 17 and 19. The interviewees' speeches revealed four recurring themes, which are useful in developing an effective strategy for enrolling students in the medicine undergraduate program. These themes are in presented in Table 3.

Table 3

– Themes.
Themes	Interviews	Results
Teaching method and how it operates	Interview 5: "At the beginning of the course, everybody - including me - found it very difficult to understand how everything worked. There was no help, so only those who were friends with the senior students were able to help us to understand how things worked here." Interview 6: "I don't understand why there's no anatomy class. How am I supposed to become a doctor without it?" Interview 9: "[...] I have faced many obstacles in this course, especially regarding the amount of content. In the past, the test only covered what the teacher taught. Now it's different, which is a big change from high school [...]". Interview 14: "[...] I was jumping from one topic to another because many are related, but I'm not sure if I'm studying correctly or if I should be less curious and more focused on my study plan [...]".	It is observed that the interviewees have a poor understanding of curriculum integration, the proposed methodology, and the learning objectives. They also lack comprehension of the teacher's role as a learning facilitator. Students usually prefer to turn to their peers from later semesters to clarify their doubts about what and how they should study. By doing so, they highlight the shortcomings of the guidance provided by the medical school during the introductory and welcoming period for students, as well as the lack of communication between students, teachers, and course administrators. Students consider that interacting with other students from later semesters is more effective.
Evaluation processes	Interview 4: "I think that during the freshman week, the lectures are informative, but I believe there should be some moments dedicated to explaining the evaluation process. Additionally, I think that receiving proper guidance on how to approach scientific work is highly important, as my professor only provided such guidance two weeks before. This is an aspect that could be improved. Subsequently, exams followed, which were difficult, especially the objective clinical examination structure in stations. It was challenging as we did not have any formal rehearsal for it." Interview 5: "[...] the scientific work that we were required to complete was very complex, as we were not provided with a clear explanation of how it should be done. The literature review task was given to us with insufficient instructions, leaving us to struggle through it. Then, when it came time for grading, the evaluation was strict [...]." Interview 6: "I believe that there should be more guidance for completing the assignments we are asked to do. I did not understand how my work would be evaluated or on what criteria." Interview 8: "The exam is very challenging, as we score well in the tutor evaluations, but then the theoretical exam is made more difficult [...]." Interview 10: "[...] furthermore, the tutor gives the same grade to the entire group, which I believe is unfair." Interview 11: "I do not appreciate self-evaluations. When my tutor asked me how much I thought I deserved, I answered with 5, but was given a 4. This leaves me questioning why I was asked in the first place [...]".	The participants express discontent with the way they are evaluated as they do not understand the criteria used. Self-evaluation is uncomfortable for students and achieving a "good grade" remains a central objective for the interviewees.
Valorization of healthcare service learning	Interview 1: "[...] because, from the first semester, which is great, we have practical activities within the medical context to become familiar with our reality and experience the profession [...]." Interview 2: "[...] from the beginning, we learn how to interact with patients, how to deliver difficult news, and how to handle the various situations that doctors will face in life. This is very important [...]." Interview 7: "[...] I think it's essential to have on-the-job training because it allows us to see the reality that we will face in the future. So, it's very important and very good for our learning, unlike the morphofunctional laboratory, which is more distant from day-to-day practice." Interview 8: "[...] I think it's positive to work on clinical thinking and patient relationships from the beginning of the course [...]." Interview 15: "[...] learning by doing is wonderful [...]."	According to the interviewees, the healthcare service teaching activity was the most easily adaptable among all the curriculum components. The reasons pointed out include learning by doing, practicing the doctor-patient relationship, and being close to the reality of the profession.
Educational objectives and factors that interfere with learning	Interview 1: "[...] the absence of a clear definition of the boundaries between the subjects is a significant problem for us. I believe that it would be beneficial to define the morphofunctional outline and to make the objectives of the tutoring explicit, which is not always the case." Interview 5: "[...] It is possible to make connections between physiology, anatomy, and clinical skills, but without guidance, it can be complicated. The chapters in the textbooks are extensive, and if I were to study everything from all subjects, I would not be able to learn what is important at the moment." Interview 8: "[...] we cannot study a subject as presented in the textbook because it feels like a jigsaw puzzle with everything separated." Interview 12: "[...] it is better to study the anatomy of the heart, the histology of the heart, and the physiology of the heart together. It would be worse if we were studying the anatomy of the heart and the physiology of the brain. Integrating the subjects is better [...]" Interview 15: "[...] the harmonization of the morphofunctional objectives with those of the tutoring has been crucial."	The interviewees state that they are unsure of how far they should delve into a specific topic and highlight the lack of clarity in defining the studied themes as a significant problem. The combined study of anatomy, radiology, histology, and pathology of a particular region is regarded as a facilitator for comprehending the proposed subjects. However, since each disciplinary approach is extensive in its own right and becomes more complex when integrated, students struggle with the absence of a defined limit to avoid unnecessary deepening of their studies at the early stages of the medical course. In the speeches, another obstacle is mentioned: the disconnect between the recommended books and the proposal for an integrated curriculum. This is because the majority of the literature is disciplinary in nature, although some recent publications have aimed at integrating approaches in medical education.

The present study shows that difficulties in the academic transition from high school to college are associated with several factors, particularly students' lack of understanding about the course methodology, student evaluation, and educational objectives.

The interviewees, although satisfied with their first semester of the course, face discomfort in the academic transition from high school to the medicine program, reporting difficulties in understanding the educational approach used. This is expected due to the gap between the educational proposals of the two stages.^4,6.

Starting the first semester of a course usually brings great satisfaction, reflecting positively on how students deal with the challenges of adaptation. However, this does not mean that the difficulty of transitioning from high school to medical school is not an obstacle to learning, particularly if the introduction of a new educational approach for incoming students is poorly executed¹⁷.

The interviewed students have a clear understanding of the benefits of using active methodologies in their medical education. They express that this approach motivates them to acquire a more comprehensive understanding of the subject matter and to develop the ability to apply their knowledge to various situations that arise in different curriculum components. However, they feel disoriented by the lack of disciplinary boundaries, a phenomenon that has been identified in other studies^8,13,18.

The participants of the research recognize that adapting to the PBL method has been challenging due to inherited conceptions from high school, where a strong disciplinary structure impedes the mobilization of knowledge. Additionally, the central role of the teacher and the method of dividing content are so deeply entrenched in the students that, despite understanding that they are in a new phase where the demands of medical training require different approaches, they do not feel confident in confronting the paradigm shift they experience in higher education.

For students who are accustomed to a school experience based on a disciplinary curriculum and are used to being guided by a teacher who is the central figure in the teaching process, setting clear limits on the content to be learned, the absence of a well-defined field of study can be a cause of insecurity.

Peer teaching, a central element of the learning process in medical courses, is not mentioned by the student participants in the research. This may be because as first-semester students, they are still in the process of building trust with one another, although some seek guidance from students in higher semesters regarding how problem-based learning (PBL) operates. There is also no mention of problems related to the institution's infrastructure, which is a key factor in studies that examine the challenges of transitioning from high school to university education in Brazil¹⁹.

It is also noted that upon enrollment in the program, students were not properly instructed about its operation, especially in terms of the absence of boundaries between subjects and the evaluations they would undergo. There is difficulty in understanding the integrated curriculum, as disciplinary teaching materials are used in a compartmentalized manner, generating in the student the idea of division, to the point of treating the main themes or modules as subjects. This type of confusion has already been mentioned in other studies^8,18.

Even if we consider the extreme view of the student's central role, which is not recommended, the responsibilities of the educational institution in promoting adequate communication and structuring a support network for the newly enrolled student, welcoming demands arising during their adaptation to the course, cannot be seen as something secondary.

As the teaching methodology is new for students, they often feel disoriented when facing evaluation processes in the first semester of the medical course. They may resent the lack of consistent and equal guidance due to the diversity of paths that each group of students can follow with their respective tutor. This is despite pre-tutorial meetings being held to align the conduct of these sessions and ensure the successful execution of these activities.

Students become extremely anxious when they enter medical school, bringing with them the previous experience of high school education, which prioritizes obtaining good grades as the main objective, often at the expense of complete and consistent learning. Generally, they only study what they believe to be most relevant to the exams, often incorrectly, without considering the importance of a thorough understanding of the subject matter³.

The first-semester students struggled with executing scientific assignments due to their lack of experience in developing techniques and insufficient guidance in completing these tasks. They also expressed anxiety regarding the evaluation of their texts.

The students also reported difficulties with practical exams, such as the structured clinical skills exam. They claimed that there was a lack of clarity in the explanations about the evaluation process, as they had never had an activity that simulated what the exam would be like. Additionally, there was a lack of alignment in the content taught by different teachers, which exacerbated the problem. According to the students, this created conflict regarding how they performed during the evaluation, and how their grades were assigned.

The feedback moment has not been valued by students as an opportunity for learning to the extent that modern educational theories assign positive value to learning from mistakes.^9,10,16.

The assessment in the tutorial meeting lacks clear criteria for students, as it is considered subjective and at the personal discretion of the tutor. Additionally, self-assessment and peer assessment are not well-received by students. This could be due to their limited experience in handling criticism positively, as well as evaluating themselves and others. The idea of judgment appears to have a distinctly negative connotation for the interviewed students.

Students show satisfaction with the experience of healthcare service learning provided by the Interaction, Teaching, Service, Community and Management (Interação, Ensino, Serviço, Comunidade e Gestão - IESCG) central theme, as they can have early contact with various situations in health clinics, preparing themselves for future professional challenges. This is a positive tool for understanding how interdisciplinary and transdisciplinary aspects can be objectively experienced, demonstrating the positive impact of educational strategies in which the student performs care^2,11,15.

According to students' reports, the experience of working with patients, understanding the health issues in the periphery of cities, observing the reality of professional practice, and the opportunity to interact with the family health strategy are fundamental elements for the development of meaningful learning that align with the national guidelines for the medical course^5,6.

The students assert that IESCG is the primary setting where they can apply the knowledge provided by all central themes in an integrated manner. However, they do not refer to the morphofunctional laboratory as an agent for knowledge mobility and interconnection between basic sciences to promote the development of medical reasoning. This contrasts with a study involving students in later semesters⁸.

The morphofunctional laboratory appears to be regarded by students as a place to acquire knowledge rather than to apply it. It is viewed as a supporting activity to strengthen the closing tutorial session and students perceive the other central themes as being exceptionally theoretical. As a result, IESCG is considered the main hub of learning by the interviewed students.

Although not explicitly stated, the application of the principles of medical humanities is evident in the activities of the interviewees at IESCG, as seen in the genuine involvement expressed by the students with their patients during consultations.

Understanding the educational objectives to be achieved is another central issue to be discussed. The students' concern seems not to be focused on studying too much or too little, but on studying ineffectively, that is, on material that is not pertinent to the moment. As stated in the interviews, they recognize that knowledge learned in greater depth will ultimately be beneficial, but they fear losing sight of what is fundamental at their present stage in medical education. They attribute this problem to a lack of clear limits in the educational objectives.

If educational objectives are not well-specified, achievable, realistic, and perfectly understood by students, the inherent difficulties of the first semester of a medical course may be amplified^{13, 22}.

We understand that there is sufficient evidence in the results to allow us to affirm the existence of a failure in the student support service, a lack of welcoming, and a lack of clarification regarding the student's role in relation to the applied methodologies. In this context, to facilitate the academic transition, it is necessary for the course management not to fully transfer the responsibility for the student's adaptation to the newly enrolled student, and instead be actively involved in promoting the understanding of the tutor's role and the active methodology itself. Placing the student at the center of the learning process does not mean leaving them adrift. The dissatisfaction expressed by the interviewed students indicates not only a difficulty in adapting to a new method but also highlights an internal problem in the course planning, where the support provided to students is insufficient in their perception.

When students express appreciation for healthcare service learning, they point out that the educational objectives of the morphofunctional curriculum component and tutorials are not clear. This prompts us to reflect on whether the value placed on the activity in the healthcare unit (third central theme) is due solely to the fact that students are getting closer to the reality of the medical profession, as stated by several interviewees, or if there is more support, assistance, and humanization for them as students in that setting than in other curriculum components.

To make the start of medical school more attractive and stimulating for incoming students, it is essential that professors, with the support of course management, find ways to facilitate students' adaptation so that the teaching and learning process is successful from the initial stage. For this purpose, medical education professors should promote the educational process by stimulating students' critical thinking regarding their new status as medical students, using diverse methodologies, creating a dynamic teaching environment, planning activity execution, defining learning evaluation strategies, and applying a partnership model in the educational process. These measures are potentially useful for a successful academic transition from high school to medical school²⁵.

Students feel that it is necessary to actively take responsibility for the learning process, which was previously centered on the school. At this point, they are defining their study goals and the way in which they are achieved, particularly with regard to study time management. However, due to their inexperience and lack of familiarity with the methodological approach, even though they are aware of the importance of their central role, they may feel the lack of independence. This can make them feel lost and helpless as they have to deal with situations that are not consistent with their previously acquired knowledge.

The training of medical professionals requires a higher level of demand than what the student is used to, in relation to both behavior and performance of academic and extracurricular activities. Thus, the student needs to learn how to handle the new situations proposed to them, including adapting to a new teaching methodology. This is to avoid potential difficulties that could lead to frustration and thoughts of dropping out of the course. The lack of guidance from the higher education institution to help new students navigate the different curriculum components, as well as the feeling that the evaluation process is not fair, can further complicate the learning process.

The higher education institution's care for newly enrolled students is fundamental for a successful academic transition. This care should include offering effective support, clarifying doubts, providing detailed explanations of the methodological proposal and evaluation processes, carefully monitoring students' adaptation, offering psychological and pedagogical support, and keeping communication channels open between the incoming class and the course coordinator.

The need to improve how the curriculum and method are presented to students, the appreciation of service learning as an opportunity to integrate students into the academic environment in an exciting, encouraging, and positive way, the detailed clarification of evaluative processes, with continuous improvement of evaluation techniques, as well as the need for educational objectives to be clear to the student, constitute the pillars of a strategy aimed at facilitating the transition from high school to medical education, according to the viewpoint of the interviewed students. This proposal for a strategy to facilitate the transition from high school to medical education is outlined in Diagram 1.

As this study was conducted at a single institution with students from a single semester, possible generalizations may be limited.

Ethical approval and consent to participate

This research was granted exempt status by the Ethict comitee of brazilian plataforma at Centro Universitário da Amazônia (UNIFAMAZ) Review Board (CAEE number 89579818.0.0000.5701). Informed consent was obtained from all participants, and/or their legal guardian(s), before participation in the study. All methods were carried out in accordance with relevant guidelines and regulations.

Consent for publication

Not applicable.

Availability of data and materials

The datasets used and analyzed during the current study are available from the corresponding author upon reasonable request.

Funding

This study was supported by the authors

Competing interests

The authors declare no competing interests.

Author’s Contribution

A.S wrote the main manuscript

J.Q made the review about the project

E.S colected all the data and made the interviews

Acknowledgements

Not applicable.

Figueiredo, AM, McKinley, DW, Massuda, A, Azevedo, GD. Evaluating medical education regulation changes in Brazil: workforce impact. Human Resources for Health. 2021; 19(1):1-12. doi: 10.1186/s12960-021-00580-5
Dos Santos RA, Nunes MDPT. Medical education in Brazil. Medical teacher.2019; 41(10): 1106-111. doi: 10.1080/0142159X.2019.1636955
Damiano RF, Oliveira IN, Ezequiel OS, Lucchetti AL, Lucchetti G. The root of the problem: identifying major sources of stress in Brazilian medical students and developing the Medical Student Stress Factor Scale. Braz J Psychiatry. 2021;43(1):35–42. doi: 10.1590/1516-4446-2019-0824
Trullàs, JC, Blay C, Sarri E, Pujol R. Effectiveness of problem-based learning methodology in undergraduate medical education: a scoping review. BMC medical education.2022; 22(1):104. doi: 10.1186/s12909-022-03154-8
Barros R, Monteiro AR, Moreira JAM. Aprender no ensino superior: relações com a predisposição dos estudantes para o envolvimento na aprendizagem ao longo da vida. Revista Brasileira de Estudos Pedagógicos. 2014; 95(241): 544-66. doi: 10.1590/S2176-6681/305811495
Brasil. Ministério da Educação. Conselho Nacional de Educação. Câmara de Educação Superior. Resolução nº 3, de 20 de junho de 2014. Diário Oficial da União. Brasília, 23 jun. 2014; Seção 1, p. 8-11.
Salmon M, Williams D, Rhee K. Refocusing medical education reform: beyond the how. Academic Medicine. 2015; 90(2): 136-38. doi: 10.1097/ACM.0000000000000466
Silva AF, Domingues RJS, Kietzer KS, Freitas JJS. Percepção do Estudante de Medicina sobre a Inserção da Radiologia no Ensino de Graduação com Uso de Metodologias Ativas. Rev bras educ med. 2019; 43(2):95–105. doi:10.1590/1981-52712015v43n2RB20180126
Boelt AM, Kolmos A, Holgaard JE. "Literature review of students’ perceptions of generic competence development in problem-based learning in engineering education." European Journal of Engineering Education. 2022;47(5): 1-22. doi:10.1080/03043797.2022.2074819
Farias PAM, Martin ALAR, Cristo CS. Aprendizagem ativa na educação em saúde: percurso histórico e aplicações. Rev. Bras. Educ. Med. 2015; 39(1):143-58. doi: https://doi.org/10.1590/1981-52712015v39n1e00602014
Florentino JA, Rodrigues LP. Disciplinaridade, interdisciplinaridade e complexidade na educação: desafios à formação docente. Educação por Escrito. 2015; 6(1): 54-67. doi: 10.15448/2179-8435.2015.1.17410
Heptonstall NB, Ali T, Mankad K. Integrating radiology and anatomy teaching in medical education in the UK- The evidence, current trends, and future scope. Academic Radiology. 2016; 23(4): 521-26. doi: 10.1016/j.acra.2015.12.010
Virk A, Mahajan R, Singh T. Conceptualizing problem-based learning: an overview. International Journal of Applied and Basic Medical Research. 2022; 12(1):1-3. doi: 10.4103/ijabmr.ijabmr_827_21
Connolly C, Logue PA, Calderon A. Teaching about curriculum and assessment through inquiry and problem-based learning methodologies: an initial teacher education cross-institutional study. Irish Educational Studies. 2022; 1-18. doi: https://doi.org/10.1080/03323315.2021.2019083
Singh S, Khan, AM, Dhaliwal U, Singh N. Using the health humanities to impart disability competencies to undergraduate medical students. Disability and Health Journal. 2022; 15(1) 101218. doi: 10.1016/j.dhjo.2021.101218
Steiner-Hofbauer V, Holzinger A. How to cope with the challenges of medical education? Stress, depression, and coping in undergraduate medical students. Academic psychiatry. 2020; 44, 380-387.
Budakoğlu I, Coşkun Ö, Kıyak, YS, Uluoğlu, C. Teaching rational prescribing in undergraduate medical education: a systematic search and review. European journal of clinical pharmacology. 2023; 79(3) 341-48. doi: 10.1007/s00228-022-03448-2
Korpi H, Peltokallio L, Piirainen A. Problem-Based learning in professional studies from the physiotherapy student`s perspective. Interdisciplinary Journal of Problem-Based Learning. 2019; 13(1). doi: 10.7771/1541-5015.1732
Pinho APM, Dourado LC, Aurélio RM, Bastos AVB. A transição do ensino médio para a universidade: um estudo qualitativo sobre os fatores que influenciam este processo e suas possíveis consequências comportamentais. Revista de Psicologia. 2015;6(1): 33-47.
Fischer RMB. Foucault and discourse analysis in education. Cad Pesqui. 2001; 114:197-223. doi: 10.1590/S0100-15742001000300009
Alves TM, Vaz TRD, Silva MAC, Fonseca WDS. Análise de discurso e Michel Foucault: caminhos para a pesquisa em educação. Perspectivas em Diálogo: Revista de Educação e Sociedade. 2022; 9(21) :151-164. doi:10.55028/pdres.v9i21.16177
Naz Z. Foucault and Complexity Theory. In: Politics of Quality Improvement in English Further Education. Springer, Cham; 2023. https://doi.org/10.1007/978-3-031-24008-9_
Nicolaci-da-Costa AM. O campo da pesquisa qualitativa e o Método de Explicitação do Discurso Subjacente (MEDS). Psicol Reflex Crit. 2007;20(1):65–73. doi: 10.1590/S0102-7972200700010000
Fontanella BJB, Luchese BM, Saidel MGB, Ricas J, Turato ER, Melo DG. Amostragem em pesquisas qualitativas: propostas de procedimentos para constatar saturação teórica. Cad. Saúde Pública. 2011;27(2): 389-94. doi: 10.1590/S0102-311X2011000200020
Freitas R, Guimarães A, Menezes G. As competências do professor na educação superior para a aprendizagem dos Millennials e seus sucessores. Revista Lusófona de Educação. 2019; 45(45): 239-56. doi: 10.24140/issn.1645-7250.rle45.16

No competing interests reported.

Download PDF

Version 1

posted

You are reading this latest preprint version

Academic Transition from High School to an Undergraduate Medical Program Using Active Methodologies Within an Integrated Curriculum One Qualitative Research

Status:

Version 1

Abstract

Figures

INTRODUCTION

METHODS

RESULTS

DISCUSSION

CONCLUSION

Declarations

References

Additional Declarations

Status:

Version 1