Ações afirmativas na graduação em medicina: avaliação do perfil e do desempenho cognitivo, prático e profissional de estudantes admitidos pelo sistema de cotas e de ampla concorrência no primeiro ano do internato

Abstract

Introduction: The expansion of access to higher education through affirmative action policies has been a strategy adopted to reduce educational opportunity inequalities in Brazil. These policies aim to increase the representation of historically underrepresented groups; however, they continue to generate debate, particularly in highly competitive programs such as Medicine, regarding their impact on student profiles and academic performance. Objective: This study aimed to compare the sociodemographic and socioeconomic profiles of students admitted through regular path and those admitted through affirmative action system. Additionally, it sought to evaluate the academic performance of these groups in the fifth year of the Medical Program at the School of Health Sciences, taking into account factors associated with academic achievement. Methods: This prospective cohort study included 236 students enrolled in the Medical Program at the School of Health Sciences (ESCS) who completed the fifth year of the program between 2022 and 2024. Data were obtained from the ESCS academic system and government databases. Academic performance was assessed based on cognitive evaluations, practical assessments, professionalism evaluations, and the final year grade point average. Statistical analyses included univariate tests and multiple linear regression models. Results: Of 236 students, 102 (43.2%) were admitted through the social quota system and 134 (56.8%) through open competition. Quota students had a higher median age at admission (median [MD] = 21 years; interquartile range [IQR] = 19–24) compared to non-quota students (MD = 20; IQR = 19–21; p < 0.001), a lower proportion of selfdeclared white students (46.1% vs. 78.4%; p < 0.001), a lower frequency of parentes with higher education (44.1% vs. 94.8%; p < 0.001), lower household Human Development Index (MD = 0.813; IQR = 0.731–0.883 vs. 0.941; IQR = 0.866–0.955; p < 0.001), and lower per capita income (MD = 2.17; IQR = 1.37–3.99 vs. 7.93; IQR = 3.99–10.63; p < 0.001). Although open competition students performed better in three of the four assessments in the univariate analysis, the type of admission was not significantly associated with academic performance in the multivariate analysis. In the cognitive assessment, only age at admission showed a statistically significant association, with a negative effect on performance (β = –0.039; 95% CI: –0.065 to – 0.014; p < 0.001). In the practical assessment, none of the variables analyzed showed a significant association with performance. In the professionalism assessment, significant associations were observed with female sex (β = 0.165; 95% CI: 0.013 to 0.316; p = 0.033), being married (β = 0.589; 95% CI: 0.151 to 1.027; p = 0.009), having at least one parent with higher education (β = 0.242; 95% CI: 0.036 to 0.448; p = 0.021), and age at admission, which again showed a negative association (β = –0.033; 95% CI: –0.055 to –0.011; p = 0.003). Finally, regarding the final fifth-year grade point average, factors significantly associated with better performance included female sex (β = 0.146; 95% CI: 0.032 to 0.261; p = 0.013), being married (β = 0.376; 95% CI: 0.044 to 0.708; p = 0.0271), and younger age at admission (β = –0.032; 95% CI: – 0.048 to –0.015; p < 0.001). Conclusion: Despite the sociodemographic and socioeconomic differences identified between the groups, quota students demonstrated academic performance equivalent to that of non-quota students when contextual variables were controlled. These findings reinforce the effectiveness of affirmative action as a strategy for social inclusion and equity in higher education, without compromising the quality of medical graduation.