Mapping academic leagues in Brazil and their impact to health studentsABSTRACT
Introduction: Academic Leagues (AL) are important student organizations in the context of public outreach during medical education, whose model has been spreading in other healthcare undergraduate degrees in recent years.
Objective: This study had as an objective to analyze the presence and impacts of the AL in the formation of various categories of healthcare professionals at the national level.
Method: A cross-sectional and descriptive study was carried out with a digital questionnaire released by e-mail to educational institutions (IE) using the snowball methodology, evaluating knowledge and perceptions about AL. Next, an exploratory and descriptive analysis of the 237 valid answers was performed. Kruskal-Wallis statistical tests and Dunn’s post-hoc tests were also performed to evaluate the differences in the response pattern of the evaluated degrees when compared to the general averages.
Results: Participants knew an average of 3.9 ± 2.8 AL based in their IE and participated in 1.6 ± 1.0 AL, with AL dedicated to interdisciplinary areas and medical specialties predominating. Participants from Medicine and Nursing degrees cited proportionally more AL based in their IE and AL of which they were members. In addition, most participants agreed that participating in AL contributed positively to their academic performance, professional training and social responsibility, although the last aspect varied as a result of the degree analyzed.
Conclusion: it was found that AL are well spread among the different healthcare undergraduate degrees, with benefits and challenges similar to those already documented for medical schools.
Keywords:
Health Education; Medical Education; Civil Society Organizations
RESUMO
Introdução: As ligas acadêmicas (LA) são organizações estudantis importantes no contexto da extensão universitária durante a formação médica, cujo modelo vem-se espalhando para outros cursos da área da saúde nos últimos anos.
Objetivo: Este estudo teve como objetivo analisar a presença e os impactos das LA na formação de diversas categorias de profisisonais da saúde em nível nacional.
Método: Realizou-se um estudo transversal e descritivo com um formulário digital divulgado por e-mail a instituições de ensino (IE) em metodologia snowball, avaliando conhecimentos e percepções sobre as LA. Em seguida, conduziu-se uma análise exploratória e descritiva das 237 respostas válidas. Foram também realizados testes estatísticos de Kruskal-Wallis e post hoc de Dunn para avaliar as diferenças no padrão de resposta dos cursos de graudação avaliados em relação às médias gerais.
Resultado: Os(as) participantes conheciam uma média de 3,9 ± 2,8 LA sediadas em suas IE e participaram de 1,6 ± 1,0 LA, sendo predominantes as LA dedicadas a áreas interdisciplinares e especialidades médicas. Participantes de Medicina e Enfermagem citaram proporcionalmente mais LA sediadas em suas IE e LA das quais foram membros. Ademais, a maioria dos(as) participantes concordou que participar de LA contribuiu positivamente para seu desempenho acadêmico, sua capacitação profissional e responsabilidade social, embora este último aspecto tenha apresentado variação em decorrência do curso de graduação analisado.
Conclusão: Verificou-se que as LA encontram-se bem difundidas entre os diferentes cursos da área da saúde, com benefícios e desafios semelhantes àqueles já documentados para os cursos de Medicina.
Palavras-chave:
Educação em Saúde; Educação Médica; Organizações da Sociedade Civil
INTRODUCTION
Academic Leagues (AL) constitute an important model of student organization in the context of public outreach in Medicine and Nursing degrees, and are traditionally defined as non-profit, non-partisan and non-religious student organizations, which aim to integrate students around an area of common interest1),(2. These organizations are managed by the own students, under faculty supervision, and regulated by statutes that describe their purpose and functioning3.
AL offer students the possibility of participating in extracurricular events, activities and projects that dialogue with all aspects of the university tripod of education-research- public outreach, enhancing university experiences4. In addition, these organizations have shown to be essential for the students’ interdisciplinary education5, benefiting them from closer contact with patients and professionals already working in the area and allowing the development of technical, social and emotional skills through active learning6.
In recent years, following the growth of the universities themselves and the curricular reforms, AL have faced a peak of growth and diversification7, spreading to other healthcare undergraduate degrees, such as Physical Therapy8, Dentistry9, Psychology10, Biomedical Sciences11 and Pharmacy12. Furthermore, the pandemic between 2020 and 2022 contributed to the digitalization of AL13, when they acted as a tool to support education in a situation in which the universities themselves were slow to adapt11.
However, most of the literature on AL outside medical schools are case studies, and there have not been, as far as we know, extensive works addressing the existence of AL in other healthcare degrees in Brazil, nor analyzing whether the contribution of these new entities to the training of health professionals of different categories is comparable to the benefits already reported among medical students. Thus, the present study aims to map the presence of AL in Brazilian public and private higher educational institutions (EIs) and the adherence of students and professionals from various healthcare degrees to this model of student organization, analyzing the contribution of AL to the academic education, social responsibility and professional qualification of its members.
MATERIALS AND METHOD
This is a cross-sectional and descriptive study. The study was carried out using an online questionnaire, published between February and October 2024, through emails directed to EIs. The sampling process was random and voluntary, following the snowball methodology, in which volunteers are encouraged to share the research with other potential participants. Due to the study method, it is assumed that dissemination via messaging apps, social networks and other means also occurred at the initiative of the involved participants.
Brazilians over 18 years of age, undergraduate students of health degrees (Medicine, Biomedical Sciences, Physical Education, Nursing, Pharmacy or Pharmacy and Biochemistry, Physical Therapy, Speech Therapy, Veterinary Medicine, Nutrition, Dentistry, Psychology, among others) or professionals who had graduated a maximum of ten years before were included in the study. Undergraduates and graduates of non-healthcare degrees and healthcare professionals that had graduated more than ten years ago were excluded. The criterion for including or excluding other degrees included by the participants in addition to the initial options was the classification of “health area” following the concept of One Health, which analyzes the interfaces and relationships between human, animal, and plant health14.
After receiving and accepting the Informed Consent Form (ICF), the participant was presented with a questionnaire divided into three parts, evaluating: 1) sociodemographic and educational information (age, gender, state of residence, ethnic-racial self-declaration according to Brazil standards, degree, undergraduate period and financing of the EI); 2) knowledge of and adherence to AL (based in their own EI or external to it); 3) self-perception about the effects of participation in AL on their academic education, social responsibility and professional qualification, with a field for comments and a degree of agreement with eight statements, measurable on a Likert scale from 1 to 5: 1 - strongly disagree, 2 - partially disagree, 3 - neither agree nor disagree, 4 - partially agree and 5 - strongly agree.
Then, an exploratory and descriptive analysis of the results was carried out, with the help of Excel® 2016 software with the supplement Real Statistics to perform statistical tests. The charts were produced in Excel® 2016 itself.
To characterize AL, a grouping was carried out in concentration areas (usually evidenced in the name of the AL) and a categorization of these areas into thematic axes: interdisciplinary areas (areas that allow the joint participation of medical professionals and other categories of healthcare professionals); industry and technology (areas related to the roles of healthcare professionals in industry); basic health sciences (subjects common to the curriculum of various degrees in the health area); and specialties of each degree. The classification of the concentration areas in each thematic axis was based on the syllabus of mandatory and elective subjects in the curriculum of the respective undergraduate degree at the university where the study took place, and the specializations registered by the respective class councils of each health professional category until the year 2025. The results were expressed in absolute and relative frequencies, corresponding to the number of times that AL in the referred concentration area were mentioned by a study participant.
To determine the average number of AL cited by participants in each degree, the results were presented as average ± standard deviation. In this stage, data cleansing was performed for greater significance of the results, through the exclusion of outliers identified with the IQR method (interquartile range). The results of one participant in Medicine, three in Veterinary Medicine, two in Biomedical Sciences, one in Pharmacy, three in Nursing and three in Psychology were excluded.
For the analysis of the participants’ self-perception of AL, the results were expressed in absolute and relative frequencies, corresponding to the result scored by each participant on the Likert scale in each statement. After verifying that the data followed a non-parametric distribution with the Kolmogorov-Smirnov test at 5%, the differences in self-perceptions were analyzed as a result of the degree, using the Kruskal-Wallis test and post-hoc Dunn test at 5% with Bonferroni correction. At this stage, only degrees with at least three participants who are or were members of AL (n ≥ 3) were considered, namely: Medicine (n = 8), Biomedical Sciences (n = 15), Nursing (n = 12), Pharmacy or Pharmacy and Biochemistry (n = 55), Physical Therapy (n = 7), Veterinary Medicine (n = 21), Nutrition (n = 4) and Psychology (n = 6)
This study was approved by the Human Research Ethics Committee of the institution where the study took place, under CAAE N. 75560523.9.0000.0067.
RESULTS
A total of 249 responses were received to the form between February and October 2024. Of these answers, two were excluded because they came from participants who did not agree with the ICF or declared to be under 18 years of age; five were excluded because they came from participants who were not attending or did not attend degrees in the health area; and five were excluded because they came from professionals who graduated more than ten years ago. Therefore, 237 valid responses remained.
Sociodemographic and educational characteristics
The participants declared mostly to be cisgender women (n = 180; 75.9%), white (n = 135; 57.0%), aged between 18 and 29 years (n = 219; 92.4%), residents of the states of São Paulo (n = 122; 51.5%) and Minas Gerais (n = 25; 10.6%). They attended public EIs (n = 191; 80.6%) and were between the 3rd and 4th year of their undergraduate studies (n = 89; 37.5%). The most frequent degrees were Pharmacy or Pharmacy and Biochemistry (n = 79; 33.3%), Biomedical Sciences (n = 36; 15.2%) and Veterinary Medicine (n = 32; 13.5%). Table 1 describes the sample characterization regarding the assessed sociodemographic and educational characteristics.
Presence and characterization of academic leagues in Brazilian higher education institutions
Most participants were familiar with the concept of AL (n = 213; 89.9%), stating that there were four or more AL based in their EI (n = 139; 58.6%). However, the majority of participants (n = 181; 76.4%) stated they did not know interinstitutional AL - that is, AL with members in their EI, but founded outside it. Regarding dissemination, most participants learned about AL through digital means, exclusively (n = 116; 48.9%).
Regarding the concentration areas, in the case of AL based in the participant’s EI, AL dedicated to interdisciplinary areas (96 mentions to 29 areas of concentration) and Medicine specialties (77 mentions to 28 areas of concentration) stood out.
Most participants are or were members of AL (136; 57.4%), in which case AL dedicated to interdisciplinary areas (63 mentions to 25 areas of concentration) and Medicine specialties (21 mentions to 12 areas of concentration) stand out.
Graphs 1 and 2 describe the thematic axes and the relative and absolute amounts of mentions to concentration areas of each of them, for AL based in the participant’s EI and AL of which the participants were members, respectively.
Number of mentions to concentration areas of each thematic axis for AL based in the participant’s EI (n = 388 mentions).
Number of mentions to concentration areas of each thematic axis for AL of which the participants were members (n = 180 mentions).
Variation in knowledge and adherence to the academic leagues in each health degree
Among the participants who knew the concept of AL (n = 213; 89.9%), the average number of AL mentioned per participant was 3.9 ± 2.8 based in their EI and 1.6 ± 1.0 AL of which they were members.
Participants who are studying or studied in Medicine and Nursing degrees proportionally cited more AL based in their EIs and AL of which they were members. The average number of known AL in the participant’s EI and the number of AL of which the participants were a member, in each undergraduate degree, are depicted in graphic 3. It should be noted that the averages were established only for degrees with a number of participants equal to or greater than three (n ≥ 3) in each situation.
Averages of the number of AL hosted in the participant’s EI and the number of AL of which the participant was a member, in each undergraduate degree.
Perceptions about the academic leagues
Regarding the self-perception statements, most participants strongly agreed that participating in AL contributed to: improving their performance in subjects of their curriculum (53; 39.0%), improving their understanding of subjects of their curriculum (55; 40.4%), building multidisciplinary knowledge (103; 75.7%), contacting students from other degrees and expanding their knowledge to other areas (71; 52.2%), deepening their knowledge of specific technical knowledge, which is not satisfactorily offered by the subjects in the curriculum of their degree (82; 60.3%), developing fundamental skills for the labor market (54; 39.7%) and developing important skills to solve social problems, expanding social responsibility (68; 50.0%). However, most participants neither agreed nor disagreed that participating in AL facilitated insertion in the professional market in their area of expertise (55; 40.4%). Graphic 4 shows the participants’ degree of agreement with each of the eight statements presented. The Kolmogorov-Smirnov test showed that all statements showed a non-parametric response distribution.
In the field available for comments on the impressions and experiences of participating in AL, 16 comments on positive aspects and four comments on negative aspects were received. Most of the positive comments highlight characteristics such as the possibility of exploring themes and subjects not presented in-depth during undergraduate studies, increasing networking and improvement of the sense of social responsibility, professional self-knowledge and interpersonal skills. The negative comments, in turn, highlight characteristics such as repetition of content already presented in the classroom (especially in the case of AL classified in the thematic axis “basic health sciences”), less social impact compared to other entities such as student unions and social collectives, lack of structuring, lack of guidance and excessive focus on the socialization of members.
Variation in perceptions about academic leagues in each health degree
The Kruskal-Wallis test showed a significant difference in the degree of agreement between health degrees only for statement n. 8, “Participating in an Academic League helped me develop important skills to solve social problems, expanding my social responsibility” (H(8) = 17.77; p = 0.023). Dunn’s post-hoc test revealed the following specific differences: positive variation for statement n. 1, “Participating in an Academic League contributed to improve my performance in subjects of the curriculum of my degree” between participants who were undergraduate students or graduates in Veterinary Medicine and the total sample (p = 0.049), with this group presenting a more positive perception of the statement; positive variation for statement n. 2, “Participating in an Academic League contributed to improving the understanding of the contents of subjects in the curriculum of my degree” among undergraduate students or graduates in Psychology and the total sample (p = 0.035), with this group attributing greater benefit to participation in AL in this aspect; and a negative variation for statement n. 8, “Participating in an Academic League helped me develop important skills to solve social problems, expanding my social responsibility” among undergraduate students or graduates in Veterinary Medicine and the total sample (p = 0.046), indicating a worse evaluation of this category regarding the contribution of AL to the evaluated competency.
DISCUSSION
The participants’ sociodemographic profile, with a prevalence of white, young, and cisgender women, is consistent with that of several studies that have collected these characteristics among students of health degrees in recent years15)-(17. However, the high percentage of participants in certain degrees compared to others, such as Pharmacy and Biomedical Sciences, and residents of the states of São Paulo and Minas Gerais, are probably due to the snowball sampling methodology. It has already been reported that this methodology, although a good alternative for recruiting participants from niches far from the researchers, is subject to variations in each niche studied due to different patterns of engagement and contribution to the dissemination of the research18. To prevent the bias of the results, literature recommends the establishment of multiple initiating points outside the initial niche19, which was done, in the case of this study, giving preference to dissemination by e-mail to several EIs in all regions of the country. However, the possibility that the results of participants in certain niches are overestimated cannot be disregarded.
The results of the measurement of the presence of AL in Brazilian higher education institutions demonstrate that this entity model, already consolidated in medical schools20, is also well disseminated by several other degrees in the health area in all regions of the country. Moreover, the notorious percentage of participants who claimed to have learned about AL through exclusively digital means confirms the recent trend of AL towards digitalization and adherence to social networks11),(13. Regarding the concentration areas, although the large number of mentions to medical specialties is an expected result in view of the history of these entities - with examples in medical schools dating back to 192021-, the presence of interdisciplinary areas as the thematic axis with the most accumulated mentions demonstrates the great potential of these organizations to provide integrative experiences throughout the teaching-learning process22, allowing the integration and exchange of knowledge between different categories of health professionals, as well as early contact with the challenges of clinical practice, which often requires multiprofessional teams23. Thus, the expansion of AL can allow students from different areas of health to improve not only professional or academic aspects, but also citizenship education, based on the development of critical thinking and social responsibility1.
In comparison with the recent literature, the results are in line with the study published by Gonsalves et al. (7 in 2024, who conducted a systematic review of 74 articles related to AL in the health area in the last two decades, finding that AL are well diversified and distributed across several areas of concentration. Quantitatively, Goergen et al.24) also reported that medical students from a university in Rio Grande do Sul participated, on average, from 3.56 ± 1.55 AL throughout their undergraduate studies - a value reasonably close to the average of 2.7 ± 1.4 found for medical undergraduate students or graduates in this study.
The agreement with the statements related to the positive impact of AL on different aspects of education (academic, professional and social) demonstrates, once again, the potential of AL as integrating education, research and public outreach tools and stimulating active learning3),(4) - this time, with results that permeate several degrees whose AL had not been studied as thoroughly as those of Medicine. Notably, the agreement with statements related to professional performance demonstrates the ability of AL to act as anticipators of professional experiences, allowing an interdisciplinary education oriented to the challenges of the profession25. The only discordant result, in this sense, is the lower degree of agreement related to the facilitation of labor market insertion, which may be linked to the difficulties of contemporary employability, including factors such as the scarcity of qualified jobs and overvaluation of previous experience in the function as a selection factor26.
On the other hand, the variation in self-perceptions due to the degree, as well as the negative comments about the AL of the thematic axis “basic health sciences”, are indications that AL basically focused on specialization, without as much impact on citizenship education or interdisciplinarity (as it has already been reported in some medical schools27), may also be a phenomenon present in other health degrees, such as Veterinary Medicine. However, it cannot be ruled out that the perceived variations (or the absence of them) are due to the small sample size for some degrees, as well as the risk of type I error in multiple comparisons, and should be interpreted with caution. Thus, specific studies for each group and with a larger number of participants would be needed to provide conclusive and significant evidence. It should be noted, in this context, that the growth and diversification of AL among medical students have already motivated discussions, including about their regulation28, showing the importance of a dialogue between students, EIs and society for the proper functioning of AL as an public outreach tool in other degrees related to the health area.
CONCLUSIONS
This study presents, in an unprecedented way, qualitative and quantitative results regarding the presence of AL in Brazilian EI and the participation and perceptions of students from various health degrees in these organizations.
It was observed that the concept of AL is known by students from various degrees in the health area and states of the country. Participation in AL was also significant, with emphasis on interdisciplinary areas and Medicine specialties. Regarding the contribution of AL to the participants’ academic education, social responsibility and professional qualification, measured through their own self-perceptions, beneficial effects were observed for most situations (although with some variation for the effects on social responsibility resulting from the degree evaluated), showing that the role of AL as a tool for integration between education, research and public outreach, already well studied among medical students, is possibly repeated in the education of several other professional categories - as well as the challenges linked to the proper organization and supervision of this model of student entity.
Finally, as future perspectives, a topic of discussion that should be explored, in addition to the analysis carried out here, is the mapping from an institutional perspective of AL, considering the official metrics of the administrative teams on the presence of AL in their EI and outreach among students, as well as perceptions and considerations that may be brought by professors and administrative staff. Furthermore, in-depth discussions should also be held regarding the impacts of AL and the initiatives for their regulation in each of the different degrees in the health area, with the purpose of widening the understanding of specific scenarios and preserving the primary objectives of this student organization model essential for academic outreach and interdisciplinary education of health professionals.
ACKNOWLEDGMENTS
The authors would like to thank all the volunteers who answered the form and helped with its dissemination, making it possible to carry out this study.
References
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Research data are only available upon request.
Source: prepared by the authors.
