Curricular transformations in medical school: an exploration of the promotion of change in Brazil

Context Curricular transformation is complex and involves many interrelated and influential factors. The idiosyncratic nature of the time-frame in which curricular change takes place makes it difficult to study these factors systematically. In 2002, the Brazilian government established the Programme of Incentives for Curricular Changes in Medical Schools (PROMED). Nineteen schools participated in the programme and were given resources to finance curricular reforms in an effort to align their course structures with the tenets of the government proposal. This study analyses reforms in coursework among the schools in this cohort in an effort to better understand the impact of such incentive programmes and factors that might influence the degree of impact across institutions. Methods We compared data on the schools before and after their participation in PROMED. To facilitate comparison, we used a scheme of axes and vectors to classify the schools according to the profundity of the curricular changes, ranging from the most conservative to the most innovative. The data used for the classification were obtained through document analysis, interviews and focus group discussions. Results Different trends were observed for each axis. Important changes were noticed in the pedagogic approach axis, particularly in terms of pedagogic changes, which called for the adoption of active teaching and learning methods. The practice scenarios axis also underwent considerable changes, specifically in terms of primary health care. The vector related to production of knowledge pertaining to health system needs showed fewer changes; none of the schools reached stage 3 (effective fulfilment of an educational innovation). Conclusions The PROMED initiative provided considerable support for implementing and consolidating curricular reforms that placed greater emphasis on the needs of society and the health care system. The different trends observed revealed the complexity behind curricular transformation and highlighted the need for the collective construction of curricula with the participation of all groups involved.