Shaping Tomorrow's Doctors: The Impact of Socioeconomic and Institutional Factors on Medical Education Quality in Brazil

Abstract Background. Education has a transformative power in society, promoting economic and social development. In medical education, the quality of training results in the graduation of well-prepared doctors and directly influences the care provided to the population. In Brazil, the quality of medical training is assessed through the National Student Performance Exam (Enade). This study aims to analyze the institutional, social, and economic determinants of the quality of medical education in Brazil. Methods. An ecological study was conducted with 933 Brazilian higher education institutions participating in the Enade for the Medicine course from 2007 to 2019. Public government websites were used to analyze institutional, social, and economic aspects of medical training quality. Group comparisons and a multivariable logistic regression model were conducted to examine the associations between geographic and institutional characteristics with the Enade score, categorizing institutions into high and low score groups. Results. The average Enade score of medical schools in Brazil was 2.7, with the highest proportion of high scores in the South (62.4%) and Central-West (57.3%) regions, and low scores in the North (76.4%), Southeast (64.1%) and Northeast (52.6%) regions. The proportion of medical schools with high Enade scores increased over time (p < 0.001), and they demonstrated significantly higher performance in general knowledge tests (+ 10.6%; 64.4 vs 58.20) and specific knowledge tests (+ 16.0%; 65.4 vs 56.4). Geographic location was a determining factor of Enade results. Factors associated with better student performance in Enade included a well-rated didactic-pedagogical organization (OR: 1.62 [CI: 1.10–2.40]), a more qualified faculty in terms of academic degrees (OR: 1.81 [CI: 1.27–2.59]), and being publicly administered (OR: 5.74 [CI: 3.44–9.95]). Conclusion. This study highlights significant variations in training quality among medical schools nationwide, with the Center-South region showing a higher proportion of institutions achieving high Enade scores compared to more socioeconomically vulnerable regions. Institutional characteristics such as a well-rated didactic-pedagogical organization, a highly qualified faculty, and public administration are associated with better exam performance.