Abstract

This work aimed to analyze graduates’ profiles, education’s effects, and the professional trajectory of those who completed lato sensu courses at Fiocruz. A total of 1,620 graduates participated in 79 courses completed in the 2013-2020 period. A questionnaire was applied before the course and after its completion. A description of the absolute and relative frequency of the variables was realized. A binary logistic regression model was developed to identify variables associated with the positive impact of the course. The odds ratio and its 95% confidence interval were the measures used. Among graduates with a positive impact from the course, those with black/brown skin color are 40% more likely to have a positive impact from the course than those with white skin color; those who have other academic education before the course are 1.5 times more likely than those who have no previous education; those who changed their professional activity as a result of the course are 3.3 more likely than those who were not working; those who reported that the course was closely related to their professional activity were 5.7 more likely than those who reported that the course had poor or no relationship. Every one-year increase since graduation increased the likelihood of the course’s positive impact by 14%.

Key words:
Lato sensu course; Specialization; Graduates; Evaluation; Health education

Introduction

Analyses of education processes within Brazilian postgraduate studies have become more frequent in recent decades, driven by strategic institutional interests and those of the Ministry of Education in knowing the impact of higher education on academic and professional life¹1 Andriola WB. Estudo de egressos de cursos de graduação: subsídios para a autoavaliação e o planejamento institucionais. Educar Rev 2014; 54:203-219.

2 Engstrom EM, Hortale VA, Moreira COF. Trajetória profissional de egressos de Curso de Mestrado Profissional em Atenção Primária à Saúde no Município de Rio de Janeiro, Brasil: estudo avaliativo. Cien Saude Colet 2020; 25(4):1269-1280.

3 Hortale VA, Leal MC, Moreira COF, Aguiar AC. Características e limites do mestrado profissional na área da Saúde: estudo com egressos da Fundação Oswaldo Cruz. Cien Saude Colet 2010; 15(4):2051-2058.

4 Nuto SAS, Vieira-Meyer APGF, Vieira NFC, Freitas RWJF, Amorim KPC, Dias MSA, Vasconcelos MIO, Machado MFAS. Programa de Pós-Graduação em Saúde da Família no nordeste brasileiro: repercussões no exercício profissional dos egressos. Cien Saude Colet 2021; 26(5):1713-1725.^-55 Lima LA, Andriola WB. Acompanhamento de egressos: subsídios para a avaliação de Instituições de Ensino Superior (IES). Avaliacao 2018; 23(1):104-125.. However, undergraduate studies predominate, and graduate studies are the focus of analysis⁶6 Moreira ML, Velho L. Trajetória de egressos da pós-graduação do Instituto Nacional de Pesquisas Espaciais: Uma ferramenta para avaliação. Avaliacao 2012; 17(1):257-288.^,77 Maciel CA, Escarce AG, Motta AR, Teixeira LC. Percurso acadêmico e competências profissionais na percepção de egressos de Fonoaudiologia. Codas 2021; 33(4):e20200130. only to a lesser extent. Such studies are a practical opportunity to increase transparency about institutional results for the academic community and society. Furthermore, the continuing development of new professional skills assumes a strategic role in the agenda of postgraduate education institutions in the country. It gains prominence in the 2011-2020 National Postgraduate Plan (PNPG)⁸8 Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (Capes). Relatório Final da Comissão Especial de Acompanhamento do PNPG-2011-2020: Brasília: Capes; 2016.^,99 Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (Capes). Proposta de Aprimoramento do Modelo de Avaliação da PG. Documento Final da Comissão Nacional de Acompanhamento do PNPG 2011-2020 - 10/10/2018. Brasília: Capes; 2018. implementation monitoring process. Thus, graduates are a strategic analytical category, whether for “follow-up” studies, which prioritize following some cohorts over time, or cross-sectional studies, which allow the analysis of the formative path seen from the present moment¹⁰10 Santos JS. Atuação profissional e participação no desenvolvimento do campo científico em Ciência da Informação: estudo dos egressos do Programa de Pós-graduação em Ciência da Informação da UFMG, 1992-2005 [dissertação]. Belo Horizonte: Universidade Federal de Minas Gerais; 2006..

Some aspects related to graduates’ academic and professional trajectory stand out among the different aspects of evaluating the Brazilian postgraduate education processes. While yet to be detailed, guidelines on the follow-up of graduates are found in the lato and stricto sensu education assessment agencies’ instruments. Recently, the Coordination for the Improvement of Higher Education Personnel (CAPES) established in its stricto sensu program evaluation form a question about investing in graduate studies. The MEC evaluation indicators are distributed over five main axes within the lato sensu, where the “Professional Development” axis includes indicators such as “Graduate follow-up actions policy” and “Performance of the institution’s graduates in the socioeconomic environment”.

When well conducted, the follow-up of graduates allows an understanding of the social and professional effectiveness of the knowledge acquired throughout the formative trajectory⁵5 Lima LA, Andriola WB. Acompanhamento de egressos: subsídios para a avaliação de Instituições de Ensino Superior (IES). Avaliacao 2018; 23(1):104-125.^,1111 Meira MDD, Kurcgant P. Avaliação de curso de graduação segundo egressos. Rev Esc Enferm USP 2009; 43(2):481-485.. It is impossible to infer a linear cause-and-effect relationship between education and incorporation into the labor market or professional performance. It is essential to analyze the socioeconomic contexts that affect the market, public administration management policies, trajectory, opportunities, and individual interests. In Specialization courses, this public is often already inserted in the world of work and faces complex situations in their daily lives that lead them to seek new education. Thus, confronting the competencies developed during the course with those required in the professional practice can generate substantial subsidies for adjustments in the pedagogical structure, reviving intervening aspects of this process and, ultimately, providing transformations in the professional world.

As the leading non-university Brazilian health teaching institution, the Oswaldo Cruz Foundation (Fiocruz) plays a vital role in training highly specialized staff for the Science, Technology, and Innovation system and contributing to meeting the needs of the Unified Health System. It completed 120 years of existence in 2020 and has collaborated to train health staff throughout its history. It started offering public health education courses in 1908¹²12 Fundação Oswaldo Cruz (Fiocruz). Plano de Desenvolvimento Institucional da Fiocruz (PDI-Fiocruz 2016-2020). Brasília, Rio de Janeiro: MS, Fiocruz; 2016. and expanded and diversified its activities, broadening its operations in the national territory¹³13 Fundação Oswaldo Cruz (Fiocruz). Plano de Desenvolvimento Institucional da Educação da Fiocruz (PDIE-Fiocruz 2021-2025). Brasília, Rio de Janeiro: MS, Fiocruz; 2020. over the decades.

The institution has been following the trajectory of its graduates in the context of postgraduate studies, although these records have been given by specific studies²2 Engstrom EM, Hortale VA, Moreira COF. Trajetória profissional de egressos de Curso de Mestrado Profissional em Atenção Primária à Saúde no Município de Rio de Janeiro, Brasil: estudo avaliativo. Cien Saude Colet 2020; 25(4):1269-1280.^,33 Hortale VA, Leal MC, Moreira COF, Aguiar AC. Características e limites do mestrado profissional na área da Saúde: estudo com egressos da Fundação Oswaldo Cruz. Cien Saude Colet 2010; 15(4):2051-2058.^,1414 Conde MVF, Araujo-Jorge TC. Modelos e concepções de inovação: a transição de paradigmas, a reforma da C&T brasileira e as concepções de gestores de uma instituição pública de pesquisa em saúde. Cien Saude Colet 2003; 8(3):727-741.^,1515 Hortale VA, Moreira, CO, Bochner R, Leal MC. Trajetória profissional de egressos de cursos de doutorado nas áreas da saúde e biociências. Rev Saude Publica 2014; 48(1):1-9.. In an institutional dimension, in 2019, Fiocruz established a regular mechanism to monitor the training process when it conducted a first survey of information with graduates. The proposal involved two significant phases. The first aimed to perform a survey of the situation of graduates from 2013 to 2019. The second focused only on graduates from 2020 and started by testing data collection strategies, instruments, and logistics for processing data and knowledge accumulated in the first phase to propose a system for continuous monitoring of graduates of a similar nature integrated into the academic management system. Such a system will generate easily accessible information and indicators to be used by managers in the field of education and will allow greater visibility for society, with integration with the T&IS Observatory and Fiocruz Virtual Campus. This study aims to analyze the profile of graduates, the effects of training, and the professional trajectory of those who completed face-to-face courses in Fiocruz lato sensu specialization.

Methods

Population

The study is nested in a universe of 3,514 graduates of 79 classroom specialization courses at Fiocruz completed between January 2013 and July 2020 and distributed in 15 Units of the institution in the country. The lists of graduates from each course/Unit were obtained through Fiocruz academic management system and updated after exhaustive verification with each academic secretariat.

A total of 1,620 graduates participated in this study, equivalent to 46.1% of the total number of guests at this course level at Fiocruz. The courses were organized under three significant areas of knowledge: (1) “Collective Health”, which involves Law and Health, Primary Care Management, Public Health Planning and Budget, Public Health, and Health Surveillance courses; (2) “Medicine, Clinical, Biomedical, and Biotechnological Practices”, which includes the Nursing courses in Infectious and Parasitic Diseases, Neonatal Nursing, Infectology for Foreign Doctors, and Clinical Nutrition applied to Infectious Diseases; and (3) “Education, Information, and Communication”, with courses in Communication and Health, Dissemination and Popularization of Science, Health Education, Biosciences and Health Education, and Academic Management.

Measures used

A questionnaire was applied digitally using the Lime Survey software, which is an open-source software used for elaborating and applying online questionnaires. Based on the software’s functionalities, each graduate received an access link by email that allowed them to access their questionnaire through an individual access key. A broad campaign was undertaken to publicize the research on the websites of the Units, Fiocruz Virtual Campus, social networks, WhatsApp lists, and by publishing in the Revista Radis of the National School of Public Health Sergio Arouca/Fiocruz.

New invitation emails were sent weekly for about three months to those who still needed to answer the questionnaire. Monitoring the percentage of respondents from each unit allowed the deputy directors of education to redouble their efforts to contact and mobilize graduates. Sensitization strategies were also undertaken by coordinators and advisors who personally contacted their former students. A specific email communication channel was created with former students and those interested in the research.

The questionnaire included variables in the literature on evaluating graduates and was prepared from discussions with program and course coordinators at the institution. The preliminary questionnaire version was submitted to a group of teaching management and evaluation experts. It reached its final version, which was pre-tested and applied to a sample of 10% of the graduates from a Unit selected by convenience. On this occasion, there was a good understanding of the questions and a good completion time, ranging between 10 and 15 minutes.

The questionnaire consisted of 42 multiple-choice questions, divided into six thematic blocks: identification of the course graduates, professional activity before joining the course, professional activity and expectations right after finishing the course, employment status at the time of answering the questionnaire and effects of education, and evaluation of the educational trajectory. The questionnaire was publicized and made available for free access by Fiocruz institutional repository (ARCA) (https://www.arca.fiocruz.br/handle/icict/36744).

The following variables are studied in this paper: (1) graduate profile: gender; age; self-reported skin color; disability; inclusion by quota; country and state of residence; undergraduate education area per international classification¹⁶16 Instituto Nacional de Estudos e Pesquisas Educacionais Anísio Teixeira (Inep). Classificação Internacional Normalizada da Educação: áreas de formação e treinamento 2013 (Cine-F 2013): descrição das áreas detalhadas. Brasília: Inep; 2017.; having another academic background at the time of entry and expectations when completing the course; and (2) professional inclusion before entering the course and after completion: if working; occupation area; workplace; hiring regime; salary increase; the relationship of the professional activity with the course and the Specialization title effect.

A measure of the “course positive impact” was created from the variable “effect of the title on professional life”, where a positive response to any of the following items was considered: “the course qualified for a better performance of the activities that they already exercised or for different activities” or “the course increased the prestige and recognition of the work before colleagues and superiors”.

Data analysis

Initially, the authors described the absolute and relative frequency of the profile and professional inclusion variables performed before entering the course and after its completion. Subsequently, simple logistic regression models were employed to evaluate the relationship of variables related to professional inclusion after the end of the course by sex, skin color, and areas of knowledge of the Specialization courses, comparing the proportions through the chi-square association test at a significance level of 5%.

The analyzed sample consisted of 1,521 graduates who self-declared white, brown, and black and those who completed the course between 2013 and 2018 to identify the variables associated with the course’s positive impact. This option was due to the small number (1.9%) of participants who self-identified as yellow or indigenous, which would hamper statistical analysis, and the difficulty in aggregating them to other ethnic-racial profiles. Moreover, the 2019 and 2020 graduates were not asked to answer questions about professional inclusion because they had just left the course and had yet to express their impact on their professional careers. A binary logistic regression model was performed with the automatic selection Backward Stepwise Likelihood Ratio method. The following independent variables were considered: gender (man; woman); age (≤30 years; 31-50 years; >50 years); skin color (white; black, or brown); significant areas of knowledge of the course (Collective Health; Medicine, Clinical, Biomedical and Biotechnological Practices; Education, Information and Communication); course completion time (in years); any postgraduate education (professional qualification/improvement or specialization or residency or professional/academic master’s or doctorate; no); work contract regime after completion of the course (Consolidated Labor Laws (CLT) or temporary contract as an individual/cooperative, commissioned or self-employed position, or scholarship holder; Single Legal Regime or temporary contract as a legal entity or own company); number of jobs (none; one or more); area of expertise (care; management; education; research - yes; no; not working); work activity place (public; private; self-employed or third sector; not working); change of professional activity (yes; no; not working); relationship of the professional activity with the course (strong relationship; reasonable relationship; poor relationship or not related; not working); and salary increase after completing the course (yes; no; not working). Initially, all variables were tested from a significance level of 25%, and only the significant variables were used for the logistic analysis. The odds ratio and its respective 95% confidence interval were used. All analyses were performed using the IBM© SPSS© Statistics software, version 24.

Ethical precautions - confidentiality

This study was designed as a survey at a management level. The data used are from a public database, thus waiving its submission to the Research Ethics Committee. However, it should be noted that all ethical precautions aimed at confidentiality and participation autonomy were assured under the current Resolutions of the National Health Council.

Results

Table 1 presents the profile of the participating graduates, most of whom are female (77.5%), aged 31-40 years (44.2%), self-declared white (52.4%), with no disability (97.5%) and residing in Brazil (98.2%), predominantly in the State of Rio de Janeiro (59.5%). Seventeen graduates (1.1%) entered the Specialization course through quota, ethnicity, or disability criteria. “Health and wellness” is the graduation area of half of them (50.0%), where nursing (16.4%) stands out, followed by social assistance (9.9%), psychology (9.3%), pharmacy (6.4%), and medicine (5.9%). As an academic background, even before starting the course, 46.9% already had another Specialization course, and among those who had other education, 22.7% took the course at Fiocruz. Working in the public service in a more qualified way (45.9%) and continuing studies (40.0%) are the expectations most desired by graduates as soon as they complete the course.

Table 2 shows the characteristics of the professional inclusion of graduates before entering the specialization course and after its completion. Most are engaged in professional activity, either before (83.0%) or after the end of the course (93.9%). Also, most work in care (28.8%) and management (25.9%); and the public institution is the prevailing workplace before (61.5%) or after the course (64.8%). The Consolidated Labor Laws (CLT) (22.3%) stands out among the work regimes of graduates upon entering the course, while the single legal regime (26.6%) stands out after having completed it. Furthermore, 21.6% of graduates claim to have had a salary increase after completing the course, significantly an increase of up to 25% (13.4%); 19.8% of the graduates changed their professional activity as a result of the course, and 48.8% said their current work is closely related to the course (against 5.6% who reported no such relationship).

In general, the comparative findings between the stage before the course and after its completion reveal a more significant number of graduates with increased income and work conditions after completing the course, which is evidenced by the lower number of unemployed; greater inclusion in management, education, and research; work prevailing in the public service and with a single legal regime employment relationship.

The analysis of professional inclusion after course completion by gender, skin color, and area of knowledge identified that more women were out of the labor market after finishing the course (17.9% against 10.8% of men). More men (12.4%) changed activity and institution after the course (against 9.2% of women). They also worked mainly in the same professional activity and institution where they worked before joining the course (66.0% against 57.7% of women). Change of institution and professional activity did not show a statistically significant difference by skin color and areas of knowledge of the courses (Tables 3 and 4).

Complementarily, Table 3 shows the marked difference between sexes regarding the number of jobs after the end of the course, where more women were currently unemployed (12.7% against 8.5% of men) and, conversely, more men had two or more jobs. Concerning the area of knowledge, we have more unemployed among “Education, Information and Communication” (19.1%) course graduates than in other areas (15.6% in “Collective Health” and 15.3% in “Medicine, Clinical, Biomedical, and Biotechnological Practices”). In contrast, more graduates with two or more jobs come from “Medicine, Clinical, Biomedical, and Biotechnological Practices” (34.8%) and “Collective Health” (24.3%) courses (Table 4). There is no statistically significant difference in the number of jobs by skin color.

The “Collective Health” area stands out among the graduates of courses closely related to the current professional activity (60.8% against approximately 56.0% of the other areas). On the other hand, “Medicine, Clinical, Biomedical and Biotechnological Practices” is the field that most appears as a lack of relationship between the course and professional work (11.5% against 7.5% for “Education, Information, and Communication” and 4.7% of “Collective Health”).

Table 5 shows the result of the logistic regression that seeks to identify the variables associated with the positive impact of the course among graduates, evaluated for better performance in activities and prestige/recognition. Initially, all variables studied in the multiple model showed statistical significance at the 25% level, except for gender and primary areas of knowledge of the course, not included in the following analysis. The final model shows the following profile among graduates with a positive impact from the completed Specialization course: those with black or brown skin colors are about 40% more likely to have a positive impact from the course than those with white skin color; those who have another academic background before joining the course are 1.5 times more likely than those who have no other previous education; those who changed their professional activity due to the course are 3.3 more likely than those not working; those who reported that the course was closely related to their professional activity are 5.7 times more likely than those who reported that the course had little or no relationship; and each one-year increase in the time since graduation increases by 14% the likelihood of the course’s positive impact.

Discussion

The more significant female presence probably reflects the predominance of women in health services⁷7 Maciel CA, Escarce AG, Motta AR, Teixeira LC. Percurso acadêmico e competências profissionais na percepção de egressos de Fonoaudiologia. Codas 2021; 33(4):e20200130.^,1717 Santos LS, Souza TE, Souza CE, Monteiro MC, Prado MRMC, Prado-Junior PP, Ayres LFA, Passos CM. Perfil social-profissional de enfermeiros e médicos da Atenção Primária à Saúde de uma microrregião geográfica. Enferm Bras 2019; 18(4):552-560.

18 Lima EJF, Lima PJSF, Andrade PHA, Castro LM, Fernandes AS. Perfil e trajetória dos egressos de programas de residência das áreas básicas: um corte transversal. Rev Bras Educ Med 2021; 45(1):e9405.^-1919 Maciel ELN, Figueiredo PF, Prado TN, Galavote HS, Ramos MC, Araujo MD, Lima RCD. Avaliação dos egressos do curso de especialização em Saúde da Família no Espírito Santo, Brasil. Cien Saude Colet 2010; 15(4):2021-2028., corroborated by previous education in “Health and wellness”. Historically, some professions, such as those in Education and some in Health, are characterized by female work. According to Estevam and Guimarães²⁰20 Estevam HM, Guimarães S. Avaliação do perfil de egressos do Programa de Pós-graduação stricto sensu em Educação da UFU: impacto na formação docente e de pesquisador (2004-2009). Avaliacao 2011; 16(3):703-730., when a profession or course becomes feminized, it tends to be accepted as an extension of women’s work. It begins to occupy a less privileged position than other professions. Gender inequalities, such as the fact that more women are out of the job market after finishing the course, were observed in this study. Furthermore, the predominance of white graduates highlights the importance of investing in quota policies to reduce racial inequalities and the effects of structural racism²¹21 Artes A, Rocoldi AM. Acesso de negros no ensino superior: o que mudou entre 2000 e 2010. Cad Pesqui 2015; 45(158):858-881..

The results of this study align with previous findings regarding the predominant public nature of the bond of Fiocruz graduates²2 Engstrom EM, Hortale VA, Moreira COF. Trajetória profissional de egressos de Curso de Mestrado Profissional em Atenção Primária à Saúde no Município de Rio de Janeiro, Brasil: estudo avaliativo. Cien Saude Colet 2020; 25(4):1269-1280.^,1515 Hortale VA, Moreira, CO, Bochner R, Leal MC. Trajetória profissional de egressos de cursos de doutorado nas áreas da saúde e biociências. Rev Saude Publica 2014; 48(1):1-9.. In general, the relationship between professional activity and the course subject is evident in all areas of knowledge, showing good alignment between the training offer and professional practice.

The work and education association is also highlighted in the main expectations listed by the survey respondents. Also, most graduates already have some educational background at the lato or stricto sensu postgraduate level when they enter the course. This situation reflects the need perceived by those specializing in seeking new knowledge in the face of complex and constant changes that require a continuous education process consistent with state-of-the-art and in tune with societal needs. New technologies emerge daily in Health, and as in other areas of human activity, we live under continuous innovation. Aciole²²22 Aciole GG. Rupturas paradigmáticas e novas interfaces entre educação e saúde. Cad Pesqui 2016; 46(162):1172-1191. reminds us of characteristics of contemporary society, such as multiculturalism and interdisciplinarity. It highlights current pillars of education as a human development element, which makes it a permanent need and not just a stage of life marked by the school environment.

In this sense, some studies point to various favorable aspects regarding postgraduate education for developing skills and work qualifications. A common element is high satisfaction with the training, the application of knowledge in the work universe, the satisfaction with the personal and professional growth arising from experience, and, on the other hand, the negligible impact on wages²2 Engstrom EM, Hortale VA, Moreira COF. Trajetória profissional de egressos de Curso de Mestrado Profissional em Atenção Primária à Saúde no Município de Rio de Janeiro, Brasil: estudo avaliativo. Cien Saude Colet 2020; 25(4):1269-1280.^,2020 Estevam HM, Guimarães S. Avaliação do perfil de egressos do Programa de Pós-graduação stricto sensu em Educação da UFU: impacto na formação docente e de pesquisador (2004-2009). Avaliacao 2011; 16(3):703-730.. Generally, a negligible effect is perceived in remuneration, and more significant repercussions are described in professional education, the networks of established relationships, and personal and professional growth.

As for the higher likelihood of a positive impact of Specialization courses on black or brown graduates, we can hypothesize that, given the significant social and educational disadvantages of black people in educational access and school trajectory, from Primary Education, the provision of quality education and educational policies have a more significant influence on this population than white people, with lower accumulated disadvantages²¹21 Artes A, Rocoldi AM. Acesso de negros no ensino superior: o que mudou entre 2000 e 2010. Cad Pesqui 2015; 45(158):858-881..

Other factors identified as being more likely to have a positive impact on the course are strongly related to the graduates’ education path and professional experience, such as having another academic background before joining the course, those who changed their professional activity due to the course, those who reported that the course was closely related to their professional activity, and a longer time since graduation.

A limitation would be that generalization of the findings is not assured, despite having achieved a satisfactory response rate, especially concerning online surveys. The exclusion of yellow and indigenous participants from the logistic analysis indicates the need to apply other methodological approaches to ethnic-racial minority groups to deepen socio-cultural peculiarities. In contrast, the study brings unprecedented reflections on the subject in the country, using well-designed methodological strategies in a poorly studied group and with the approach of a relatively sufficient period after the end of the study. This setting allows for a longer-term follow-up and raises hypotheses that can guide the improvement of postgraduate education in the country and support the decision-making of teachers and education managers.

Acknowledgments

The authors are grateful to the Vice-Presidência de Educação, Informação e Comunicação (VPEIC/Fiocruz) for the general coordination of the study and the Coordenação Geral de Gestão de Tecnologia de Informação (COGETIC/Fiocruz) for the vital support in conducting the research.

References

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