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Gustavo Salata Romão,1 Sheyla Ribeiro Rocha,2 Milton Faria Junior,1 Marina de Toledo Durand,1 Reinaldo Bulgarelli Bestetti1 1Medical Course, University of Ribeirão Preto, Ribeirão Preto, São Paulo, Brazil; 2Department of Medicine, Federal University of São Carlos, São Carlos, São Paulo, BrazilCorrespondence: Gustavo Salata Romão; Reinaldo Bulgarelli Bestetti, Email gsalata@uol.com.br; rbestetti44@gmail.comPurpose: To evaluate medical students’ perceptions about using peer teaching (PT) in the online Clinical PBL (C-PBL).Materials and Methods: The C-PBL used in the Primary care Unit (PCU) of the medical course of the Ribeirao Preto University was adapted to the virtual environment. A PT session was included to enhance students’ intrinsic motivation. This cross-sectional study applied a 14-item survey to evaluate the perceptions of 378 medical students from the first to the seventh semester about the use of PT in this context.Results: According to participants’ perceptions, the use of PT in the online C-PBL allowed the interactive participation of students and produced satisfactory knowledge acquisition. Preparing and presenting a slideshow and being taught by peers contributed significantly to their learning. The survey used to collect information presented a high internal consistency measured by Cronbach’s alpha.Conclusion: From the students’ perspectives, the use of PT in the online C-PBL was satisfactory and improved learning for peer teachers and learners. This study contributes additional evidence suggesting that PT is an effective teaching strategy in online learning and can be associated with PBL. This finding has implications for curriculum development and the health system.Keywords: peer teaching, clinical PBL, problem based learning, virtual learning, educational technology

Reinaldo Bulgarelli Bestetti,* Marina de Toledo Durand,* Lucélio B Couto, Milton Faria-Jr, Helen Figueiredo Fumagalli, Vinicius M R Silva, Gustavo S Romão, Rosemary Furlan-Daniel, Marcelo E Garcia, Sônia M N Ferri, Ana Cláudia S Reis, Salim D Jorge-Neto, Tufik Jose M Geleilete Department of Medicine, University of Ribeirão Preto, Ribeirão Preto city, Brazil*These authors contributed equally to this workCorrespondence: Reinaldo Bulgarelli Bestetti, Universidade de Ribeirão Preto, Av, Costabile Romano, 2201, Ribeirão Preto city, Brazil, 14096-900, Tel/Fax +55 16 36037031, Email rbestetti44@gmail.comPurpose: The role of marks in the University Admission Test (UAT) plus the marks from pre-university academic records in predicting academic achievement at the end of the Medicine undergraduate degree program is not completely known. This study was undertaken to compare the performance of marks in the UAT alone with those of the UAT plus marks from the National High School Exam (ENEM in Brazil) regarding students’ outcomes at the end of the Medicine undergraduate degree program.Methods: Fifty-one (51) students from the last semester (12th) of our Medicine undergraduate degree program were included in the study. They were divided into a group of those who used the marks obtained in the UAT plus the marks obtained in the ENEM (ENEM group, n=9), and those who only used the marks in the UAT (non-ENEM group, n=42). We compared the academic achievement of the non-ENEM group with that of the ENEM group regarding the mean marks obtained in the clerkship, in the Progress Test (PT), and in the Objective Structured Clinical Examination (OSCE).Results: The mean scores obtained in the disciplines of the clerkship were higher in the non-ENEM group compared to the ENEM group (7.32 ± 0.41 vs 6.98 ± 0.31, p= 0.01). Both groups obtained similar mean marks in the OSCE and in the PT. A moderate correlation was observed between the marks in the clerkship with those of the UAT from the non-ENEM group (p=0.00006; r=0.45).Conclusion: Marks of the UAT alone appear to be associated with a higher academic achievement in the clerkship than marks of the UAT plus scores obtained from the ENEM at the end of the Medicine undergraduate degree program.Keywords: problem-based learning, medical school selection, medical education, clinical competency, university admission tests

Reinaldo B Bestetti, Lucélio B Couto, Priscila Roncato-Paiva, Gustavo S Romão, Milton Faria-Jr, Rosemary Aparecida Furlan-Daniel, Tufik José Magalhães Geleilete, Salim Demetrio Jorge-Neto, Fernanda Porfirio Mendonça, Marcelo Engracia Garcia, Marina Toledo Durand Department of Medicine, University of Ribeirão Preto, Ribeirão Preto City, BrazilCorrespondence: Reinaldo B BestettiUniversity of Ribeirão Preto, Avenida Costábile Romano, 2201, Ribeirão Preto City 14096-900, BrazilTel +55 16 36036795Email rbestetti44@gmail.comPurpose: Most studies assessing the value of the university admissions test (UAT) to predict academic performance at the end of a medical course were carried out on lecture-based medical courses. However, the association between performance in the UAT with academic achievement at the end of medical course in a problem-based learning (PBL) medical hybrid curriculum remains controversial. The aim of this study was to correlate marks in the UAT with those obtained in the Organized Structured Clinical Examination (OSCE), in the progress testing (PT), and in the final marks of the clerkship (FMC).Methods: We used data from 48 medical students. A single and a multiple dependency studies were performed to assess bivariate and multiple correlation between the UAT or the essay scores (dependent variables) and the OSCE, PT, and FMC (independent variables). Pearson test, multiple linear regression, and ANOVA tests were used and a p-value < 0.05 was considered significant.Results: In the bivariate analysis, only the UAT and FMC marks were correlated (r=0.34; p=0.02). However, the multiple dependency study showed a moderate correlation among UAT, OSCE, PT, and FMC marks (r=0.46; p=0.01). No correlation was found between the essay scores and PT, FMC, and OSCE scores.Conclusion: Our study shows that UAT marks, but not essay scores, can predict academic achievement, particularly in terms of clinical competence (FMC) at the end of a medical course in a PBL hybrid curriculum.Keywords: admissions test, clinical performance, problem-based learning, Organized Structured Clinical Examination, progress testing

Gustavo Salata Romão, Reinaldo Bulgarelli Bestetti, Lucélio Bernardes CoutoDepartment of Medicine, University of Ribeirão Preto, Ribeirão Preto, BrazilWe read with great interest the excellent paper by Pruitt et al1 who presented a problembased learning (PBL) approach to system-based practice medical education. Because a PBL medical teaching approach in primary care is rare, we would like to report our experience on this strategy as well. We have been using the PBL method in our medical course before the clerkship since 2003. In view of the fact that pre-university education is deficient and totally lecture-based,2 we have had to make some changes to adapt PBL to our educational reality, mainly testing application (multiple-choice questions) before, and some lectures following, the reporting phase of tutorial sessions.3,4 However, we had not used PBL in primary care until 2016. In Brazil, the Unified Health System provides universal health coverage for more than 170,000,000 people in a public decentralized and hierarchical network of primary, secondary, and tertiary health care services. A key part of this increasing access to health care is the Family Health Program (FHP). Unfortunately, the system is underfunded, and the health professionals are not sufficiently prepared to work in such a complex health system. Because of this, we have been implementing system-based practice in our medical course in a PBL environment since 2016.View the original paper by Pruitt and colleagues.

Reinaldo B Bestetti, Lucélio B Couto, Carolina BA Restini, Milton Faria Jr, Gustavo S Romão Department of Medicine, UNAERP Medical School, University of Ribeirão Preto, Ribeirão Preto, Brazil Purpose: In our context, problem-based learning is not used in the preuniversity environment. Consequently, students have a great deal of difficulty adapting to this method, particularly regarding self-study before the reporting phase of a tutorial session. Accordingly, the aim of this study was to assess if the application of an assessment test (multiple choice questions) before the reporting phase of a tutorial session would improve the academic achievement of students at the preclinical stage of our medical course.Methods: A test consisting of five multiple choice questions, prepared by tutors of the module at hand and related to the problem-solving process of each tutorial session, was applied following the self-study phase and immediately before the reporting phase of all tutorial sessions. The questions were based on the previously established student learning goals. The assessment was applied to all modules from the fifth to the eighth semesters. The final scores achieved by students in the end-of-module tests were compared.Results: Overall, the mean test score was 65.2±0.7% before and 68.0±0.7% after the introduction of an assessment test before the reporting phase (P0.05). Students in the eighth semester scored 71.8±2.3% compared to 70±2% when they were in the seventh semester (P>0.05).Conclusion: In our medical course, the application of an assessment test (a multiple choice test) before the reporting phase of the problem-based learning tutorial process increases the overall academic achievement of students, especially of those in the sixth semester in comparison with when they were in the fifth semester. Keywords: problem-based learning, self-directed learning, medical education, undergraduates, assessment

Lucélio B Couto, Gustavo S Romão, Reinaldo B Bestetti Department of Medicine, University of Ribeirão Preto, Ribeirão Preto, Brazil We have read with great interest the paper by Kassab et al, who have essentially shown that good teachers will be good tutors in a problem-based learning (PBL) environment. We have been facing great difficulties to select tutors because there has been no tradition in PBL in our region in the preuniversity teaching. Furthermore, the majority of our teachers have been formed in a discipline-based medical curriculum. Therefore, it is reassuring to learn from the work by Kassab et al that subject-matter mastery is the powerful independent predictor of tutoring skills. View the original paper by Kassab and colleagues.