Introduction:

Residency admission exams, although not intended to evaluate medical training, do so in an indirect way. The evaluation of the quality of the medical residency tests allows, among other things, to re-evaluate the training process itself and the skills expected of the candidates.

Objective:

To evaluate first phase exam tests of different medical residency programs in the largest Brazilian urban centers.

Method:

We evaluated 500 questions of residency admission exams in the states of São Paulo, Rio de Janeiro and Minas Gerais. The items were evaluated in terms of their origin, geographical location, area of knowledge, contextualization, context scenarios and complexity by Bloom's taxonomy.

Results:

Most of the questions presented contextualization (64.4%, n = 322), with predominant scenarios of high complexity and in hospital environment. The predominant taxonomic category was identified as recognition (41.60%, n = 208), the second most frequent was judgment, in 26% of the questions (n = 130), followed by synthesis (15%, n = 75), analysis (7.60%, n = 38), comprehension (6%, n = 30) and application (3.8%, n = 19). Considering the dichotomization between questions of theoretical and clinical reasoning, we found a balance between both (clinical reasoning: 48.9%, n = 243; theoretical reasoning: 51.4%, n = 257). The association of contextualization with clinical reasoning was high, with the relative risk of an item requiring clinical reasoning in the presence of contextualization of 26.31 (CI 11.06 – 62.59).

Final considerations:

The scenario outlined by the present research demonstrates that the different selective processes for medical residency in Brazil differ greatly in relation to the selection profile, with hospital-centered focus, favoring scenarios of high complexity in a hospital environment. Although much has been done and discussed in order to promote changes in medical education in Brazil, the selection process for Medical Residency still fails to reflect the changes advocated since the end of the last century and consolidated in the public policies of the beginning of this century. If we consider that the selected professionals are likely to remain at that institution after the end of their undergraduate studies, then we can have some understanding of the feedback cycle that is created in the programs.

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