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  <front>
    <journal-meta>
      <journal-id journal-id-type="publisher-id">abc</journal-id>
      <journal-title-group>
        <journal-title>Arquivos Brasileiros de Cardiologia</journal-title>
        <abbrev-journal-title abbrev-type="publisher">Arq. Bras. Cardiol.</abbrev-journal-title>
      </journal-title-group>
      <issn pub-type="ppub">0066-782X</issn>
      <issn pub-type="epub">1678-4170</issn>
      <publisher>
        <publisher-name>Sociedade Brasileira de Cardiologia - SBC</publisher-name>
        <publisher-loc>S&#227;o Paulo, SP, Brazil</publisher-loc>
      </publisher>
    </journal-meta>
    <article-meta>
      <article-id pub-id-type="publisher-id" specific-use="scielo-v3">qHGKXG4tLBXt3ysrwvVjqvd</article-id>
      <article-id pub-id-type="other">00006</article-id>
      <article-id pub-id-type="publisher-id" specific-use="scielo-v2">S0066-782X2008001700006</article-id>
      <article-id pub-id-type="publisher-id" specific-use="scielo-v1">S0066-782X(08)09100506</article-id>
      <article-id pub-id-type="doi">10.1590/S0066-782X2008001700006</article-id>
      <article-categories>
        <subj-group subj-group-type="heading">
          <subject>Artigos Originais</subject>
        </subj-group>
      </article-categories>
      <title-group>
        <article-title>Doutorado em cardiologia no Instituto do Cora&#231;&#227;o da FMUSP, de 1994 a 2004: defesa e publica&#231;&#227;o</article-title>
      </title-group>
      <contrib-group>
        <contrib contrib-type="author">
          <name>
            <surname>Marchini</surname>
            <given-names>Julio Fl&#225;vio Meirelles</given-names>
          </name>
          <xref ref-type="aff" rid="aff02"/>
        </contrib>
        <contrib contrib-type="author">
          <name>
            <surname>Caramelli</surname>
            <given-names>Bruno</given-names>
          </name>
          <xref ref-type="aff" rid="aff01"/>
        </contrib>
      </contrib-group>
      <aff id="aff01">
        <addr-line>
          <named-content content-type="city">S&#227;o Paulo</named-content>
          <named-content content-type="state">S&#227;o Paulo</named-content>
        </addr-line>
        <institution content-type="orgname">Universidade de S&#227;o Paulo</institution>
        <institution content-type="orgdiv1">Faculdade de Medicina </institution>
        <institution content-type="orgdiv2">Instituto do Cora&#231;&#227;o</institution>
        <country country="BR">Brazil</country>
      </aff>
      <aff id="aff02">
        <addr-line>
          <named-content content-type="city">Ribeir&#227;o Preto</named-content>
          <named-content content-type="state">S&#227;o Paulo</named-content>
        </addr-line>
        <institution content-type="orgname">Universidade de S&#227;o Paulo</institution>
        <institution content-type="orgdiv1">Faculdade de Medicina de Ribeir&#227;o Preto </institution>
        <country country="BR">Brazil</country>
      </aff>
      <pub-date date-type="collection" publication-format="electronic">
        <month>11</month>
        <year>2008</year>
      </pub-date>
      <volume>91</volume>
      <issue>5</issue>
      <fpage>315</fpage>
      <lpage>320</lpage>
      <history>
        <date date-type="rev-recd">
          <day>07</day>
          <month>04</month>
          <year>2008</year>
        </date>
        <date date-type="received">
          <day>11</day>
          <month>11</month>
          <year>2007</year>
        </date>
        <date date-type="accepted">
          <day>05</day>
          <month>05</month>
          <year>2008</year>
        </date>
      </history>
      <permissions>
        <license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by-nc/4.0/" xml:lang="en">
          <license-p>This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.</license-p>
        </license>
      </permissions>
      <abstract>
        <p>FUNDAMENTO: Um estudo avaliou a rela&#231;&#227;o entre defesas de tese e publica&#231;&#245;es no &#226;mbito de toda a Faculdade de Medicina da Universidade de S&#227;o Paulo (FMUSP). Questiona-se a exist&#234;ncia de diferen&#231;as entre diferentes &#225;reas do conhecimento e no dom&#237;nio do tempo. OBJETIVO: Caracterizar as publica&#231;&#245;es relacionadas &#224;s teses defendidas na p&#243;s-gradua&#231;&#227;o do Instituto do Cora&#231;&#227;o (InCor) da FMUSP. M&#201;TODOS: Realizou-se um levantamento retrospectivo junto &#224; p&#243;s-gradua&#231;&#227;o de cardiologia da FMUSP, no per&#237;odo de 1994 a 2004. Inicialmente foram coletados dados de alunos que defenderam teses nesse per&#237;odo, de seus orientadores e das pr&#243;prias teses. A seguir, cruzando informa&#231;&#245;es da Medline&#174; e Web of Science&#174;, localizaram-se publica&#231;&#245;es desses autores e dados referentes &#224;s respectivas publica&#231;&#245;es. RESULTADOS: Nesse per&#237;odo, foram defendidas 268 teses, que resultaram em 195 publica&#231;&#245;es, no per&#237;odo de at&#233; dez anos ap&#243;s a defesa. As publica&#231;&#245;es ocorreram com mediana de um ano e nove meses ap&#243;s a sua defesa, com fator impacto mediano de 2,1 e uma mediana de 4 cita&#231;&#245;es por trabalho. N&#227;o houve correla&#231;&#227;o com signific&#226;ncia estat&#237;stica em nenhum dos dados estudados. CONCLUS&#195;O: Uma porcentagem importante das teses &#233; publicada. A publica&#231;&#227;o tem ocorrido de maneira cada vez mais precoce ap&#243;s a defesa. Esse fato pode estar relacionado ao sucesso das pol&#237;ticas das comiss&#245;es de p&#243;s-gradua&#231;&#227;o e &#224; import&#226;ncia com que esse tema j&#225; &#233; debatido atualmente, contribuindo para a melhoria da qualidade da p&#243;s-gradua&#231;&#227;o.</p>
      </abstract>
      <kwd-group xml:lang="pt" kwd-group-type="author-generated">
        <kwd>Educa&#231;&#227;o de p&#243;s-gradua&#231;&#227;o em medicina</kwd>
        <kwd>fator de impacto</kwd>
        <kwd>avalia&#231;&#227;o pelos pares para publica&#231;&#227;o</kwd>
      </kwd-group>
      <pub-date publication-format="electronic" date-type="pub">
        <day>05</day>
        <month>01</month>
        <year>2009</year>
      </pub-date>
    </article-meta>
  </front>
  <body>
    <p>ARTIGO ORIGINAL </p>
    <p> EXPERIMENTAL</p>
    <p>Doutorado em cardiologia no Instituto do Cora&#231;&#227;o da FMUSP, de 1994 a 2004: defesa e publica&#231;&#227;o</p>
    <p>
      <bold>Julio Fl&#225;vio Meirelles Marchini<sup>II</sup>; Bruno Caramelli<sup>I</sup></bold>
    </p>
    <p><sup>I</sup>Unidade de Medicina Interdisciplinar em Cardiologia do Instituto do Cora&#231;&#227;o da Faculdade de Medicina da Universidade de S&#227;o Paulo, S&#227;o Paulo, SP - Brasil </p>
    <p><sup>II</sup>Faculdade de Medicina de Ribeir&#227;o Preto da Universidade de S&#227;o Paulo, Ribeir&#227;o Preto, SP - Brasil</p>
    <p>
      <xref ref-type="corresp" rid="end">Correspond&#234;ncia</xref>
    </p>
    <p>
      <bold>RESUMO</bold>
    </p>
    <p><bold>FUNDAMENTO:</bold> Um estudo avaliou a rela&#231;&#227;o entre defesas de tese e publica&#231;&#245;es no &#226;mbito de toda a Faculdade de Medicina da Universidade de S&#227;o Paulo (FMUSP). Questiona-se a exist&#234;ncia de diferen&#231;as entre diferentes &#225;reas do conhecimento e no dom&#237;nio do tempo. </p>
    <p><bold>OBJETIVO:</bold> Caracterizar as publica&#231;&#245;es relacionadas &#224;s teses defendidas na p&#243;s-gradua&#231;&#227;o do Instituto do Cora&#231;&#227;o (InCor) da FMUSP. </p>
    <p><bold>M&#201;TODOS:</bold> Realizou-se um levantamento retrospectivo junto &#224; p&#243;s-gradua&#231;&#227;o de cardiologia da FMUSP, no per&#237;odo de 1994 a 2004. Inicialmente foram coletados dados de alunos que defenderam teses nesse per&#237;odo, de seus orientadores e das pr&#243;prias teses. A seguir, cruzando informa&#231;&#245;es da Medline&#174; e Web of Science&#174;, localizaram-se publica&#231;&#245;es desses autores e dados referentes &#224;s respectivas publica&#231;&#245;es. </p>
    <p><bold>RESULTADOS:</bold> Nesse per&#237;odo, foram defendidas 268 teses, que resultaram em 195 publica&#231;&#245;es, no per&#237;odo de at&#233; dez anos ap&#243;s a defesa. As publica&#231;&#245;es ocorreram com mediana de um ano e nove meses ap&#243;s a sua defesa, com fator impacto mediano de 2,1 e uma mediana de 4 cita&#231;&#245;es por trabalho. N&#227;o houve correla&#231;&#227;o com signific&#226;ncia estat&#237;stica em nenhum dos dados estudados. </p>
    <p><bold>CONCLUS&#195;O:</bold> Uma porcentagem importante das teses &#233; publicada. A publica&#231;&#227;o tem ocorrido de maneira cada vez mais precoce ap&#243;s a defesa. Esse fato pode estar relacionado ao sucesso das pol&#237;ticas das comiss&#245;es de p&#243;s-gradua&#231;&#227;o e &#224; import&#226;ncia com que esse tema j&#225; &#233; debatido atualmente, contribuindo para a melhoria da qualidade da p&#243;s-gradua&#231;&#227;o.</p>
    <p><bold>Palavras-chave:</bold> Educa&#231;&#227;o de p&#243;s-gradua&#231;&#227;o em medicina, fator de impacto, avalia&#231;&#227;o pelos pares para publica&#231;&#227;o.</p>
    <p>
      <bold>Introdu&#231;&#227;o</bold>
    </p>
    <p>O processo de forma&#231;&#227;o do p&#243;s-graduando inclui aquisi&#231;&#227;o de conhecimento, did&#225;tica, metodologia cient&#237;fica e produ&#231;&#227;o de conhecimento inovador. O aluno deve ser capaz de realizar a coleta de dados, tabula&#231;&#227;o e exposi&#231;&#227;o de resultados, defesa e, finalmente, apresenta&#231;&#227;o dos dados &#224; comunidade de interesse. Um levantamento recente realizado na Faculdade de Medicina da Universidade de S&#227;o Paulo (FMUSP) mostrou que havia baixas taxas de publica&#231;&#227;o<sup>1</sup>. A defesa da tese n&#227;o &#233; o fim de um processo, mas sim seu in&#237;cio, gerando conhecimento a ser divulgado, al&#233;m de servir de alicerce para novos trabalhos. Um editorial desta revista, na comemora&#231;&#227;o dos 30 anos da p&#243;s-gradua&#231;&#227;o em cardiologia do Instituto do Cora&#231;&#227;o (InCor), destacou a hist&#243;ria dessa &#225;rea e sua contribui&#231;&#227;o para a produ&#231;&#227;o e exporta&#231;&#227;o de saber<sup>2</sup>. </p>
    <p>Esses dados, entretanto, s&#227;o gerais e podem n&#227;o ser verdade para &#225;reas espec&#237;ficas. Este trabalho procurou continuar essa an&#225;lise dentro da cardiologia, como destaque dentro dessa mesma faculdade. A observa&#231;&#227;o ocorreu em um per&#237;odo posterior ao previamente estudado, permitindo observar se houve tend&#234;ncia de mudan&#231;a da taxa de publica&#231;&#227;o. </p>
    <p>
      <bold>M&#233;todos</bold>
    </p>
    <p>Foram analisadas as teses em cardiologia da FMUSP apresentadas no per&#237;odo de 11 anos, de 1994 at&#233; 2004. Consideraram-se nesta an&#225;lise apenas estudantes matriculados que defenderam suas teses durante o intervalo em estudo. Foram coletados dados dos alunos de p&#243;s-gradua&#231;&#227;o, de seus orientadores e dos temas das teses defendidas. Sobre os alunos, obtiveram-se data de nascimento, ano de gradua&#231;&#227;o, data de entrada no programa de p&#243;s-gradua&#231;&#227;o e data de defesa da tese. Calcularam-se o intervalo entre a formatura e a matr&#237;cula na p&#243;s-gradua&#231;&#227;o, o tempo de perman&#234;ncia no programa e as idades na matr&#237;cula e na defesa.</p>
    <p>Sobre os orientadores cadastrados, foi obtido o n&#250;mero de teses que orientaram durante o per&#237;odo estudado.</p>
    <p>Quatro pesquisadores (dois de &#225;rea cl&#237;nica e dois de &#225;rea b&#225;sica) analisaram o t&#237;tulo das teses sem conhecimento do nome do pesquisador ou de seu orientador e classificaram, de maneira independente, cada uma delas conforme a &#225;rea de interesse: b&#225;sica, cl&#237;nica e epidemiol&#243;gica. Trabalhos n&#227;o realizados em humanos, a partir de amostras de tecidos ou em modelos, foram classificados como &#225;rea b&#225;sica. Estudos n&#227;o-experimentais, determinando preval&#234;ncia, incid&#234;ncia e progn&#243;stico, foram classificados como &#225;rea epidemiol&#243;gica, e estudos experimentais com seres humanos foram classificados como estudos cl&#237;nicos.</p>
    <p>As fontes de dados utilizadas neste estudo foram o arquivo Pubmed&#174;, dispon&#237;vel na internet pela National Library of Medicine do National Institute of Health (ncbi.nih.nlm.gov), e o Web of Science&#174;, dispon&#237;vel por meio da Coordena&#231;&#227;o de Aperfei&#231;oamento de Pessoa de N&#237;vel Superior (Capes). Por meio do t&#237;tulo da tese, do nome do orientado e de seu orientador, foi identificado se a tese foi ou n&#227;o publicada em peri&#243;dico cadastrado nessas fontes at&#233; a conclus&#227;o do presente trabalho, em fevereiro de 2008. Se o trabalho era identificado, extra&#237;a-se sua data de publica&#231;&#227;o, o peri&#243;dico em que foi publicado, seu fator de impacto no ano de sua publica&#231;&#227;o e o n&#250;mero de vezes que o artigo foi citado em outros trabalhos at&#233; o momento da an&#225;lise. Calculou-se ainda o n&#250;mero de cita&#231;&#245;es por ano desde a publica&#231;&#227;o at&#233; fevereiro de 2008. O fator de impacto utilizado foi proveniente do <italic>Journal Citation Reports</italic>&#174; da Thomson Scientific (JCR), disponibilizado pela Capes desde 2001. Para 14 publica&#231;&#245;es pr&#233;vias a 2001, o valor foi solicitado &#224;s oito revistas envolvidas ou obtido em duas publica&#231;&#245;es<sup>3,4</sup>. N&#227;o est&#227;o definidos ainda os fatores de impacto para os anos de 2007 e 2008, casos em que foi utilizado o fator de impacto de 2006. Isso ocorreu com 11 publica&#231;&#245;es. Para os peri&#243;dicos que n&#227;o est&#227;o inclu&#237;dos no JCR, foi atribu&#237;do o fator de impacto zero.</p>
    <p>A an&#225;lise estat&#237;stica foi feita com o programa Stata 9.0&#174;. Utilizou-se an&#225;lise <italic>kappa</italic> para avaliar a concord&#226;ncia na classifica&#231;&#227;o das teses em tipos. A regress&#227;o log&#237;stica foi utilizada para testar a correla&#231;&#227;o entre publicar a tese com as vari&#225;veis pesquisadas e a regress&#227;o linear multivari&#225;vel para correlacionar o fator de impacto obtido na publica&#231;&#227;o com as vari&#225;veis em quest&#227;o. O teste t n&#227;o-pareado unicaudal ou do qui-quadrado foi utilizado para compara&#231;&#227;o de grupos quando apropriado.</p>
    <p>
      <bold>Resultados</bold>
    </p>
    <p>No per&#237;odo de 11 anos, foram apresentadas 268 teses de doutorado. A idade dos alunos no momento da entrada no programa de p&#243;s-gradua&#231;&#227;o em m&#233;dia foi de 37 anos, com desvio padr&#227;o de 7,0 anos. A defesa da tese em m&#233;dia foi aos 41 anos, com desvio padr&#227;o de 6,9 anos. Noventa e sete por cento dos alunos eram m&#233;dicos. A m&#233;dia de dura&#231;&#227;o da p&#243;s-gradua&#231;&#227;o, ou seja, entre a matr&#237;cula e a apresenta&#231;&#227;o da tese, foi de 4 anos, com desvio padr&#227;o de 1,6 anos.</p>
    <p>O tempo entre a formatura e a entrada no programa foi em m&#233;dia de 13 anos, com desvio padr&#227;o de 6,7 anos. Esse per&#237;odo para quem se formou antes de 1980 foi de 23 anos, com desvio padr&#227;o de 6,15 anos, 13 anos para quem formou entre 1980 e 1989, com desvio padr&#227;o de 6,0 anos e 6 anos para quem se formou ap&#243;s 1989, com desvio padr&#227;o de 1,84 anos.</p>
    <p>Observou-se que o programa de p&#243;s-gradua&#231;&#227;o teve 47 teses defendidas na primeira metade e 221 teses na segunda metade do per&#237;odo.</p>
    <p>No intervalo de estudo, participaram 68 orientadores distintos, cada um com uma mediana de 6 alunos variando de 1 a 15 alunos.</p>
    <p>Ap&#243;s 2 anos e 8 meses de sua defesa, 50% dos alunos publicaram suas teses (<xref ref-type="fig" rid="fig01">fig. 1</xref>). Ao todo 195 (73%) foram publicadas, com uma mediana de 1 ano e 9 meses ap&#243;s a defesa, com percentis 25 e 75 de 1,1 anos e 3,1 anos, respectivamente. A publica&#231;&#227;o mais precoce ocorreu 6 anos e 4 meses antes da defesa da tese, e a &#250;ltima ocorreu 10 anos e 6 meses ap&#243;s. Cento e sete (55%) foram publicadas em peri&#243;dicos que possuem fator de impacto. Nesse grupo, a publica&#231;&#227;o ocorreu com uma mediana de 1 ano e 9 meses ap&#243;s a defesa, com percentis 25 e 75 de 0,9 anos e 2,8 anos, respectivamente. O valor mediano do fator de impacto dessas publica&#231;&#245;es foi de 2,1, variando de 0,4 at&#233; 51,3, com percentis 25 e 75 de 1,4 e 3,6, respectivamente. As publica&#231;&#245;es foram citadas com uma mediana de 4 vezes variando de nenhuma vez at&#233; 353 vezes, com percentis 25 e 75 de 1 e 11 vezes, respectivamente. As publica&#231;&#245;es obtiveram uma mediana de 1,0 cita&#231;&#227;o por ano, variando de nenhuma cita&#231;&#227;o at&#233; 49,3 cita&#231;&#245;es por ano, com percentis 25 e 75 de 0,3 e 1,9, respectivamente.</p>
    <fig id="fig01">
      <graphic xlink:href="1678-4170-abc-91-05-0315-00006-gf01.jpg"/></fig>
    <p>Quanto &#224;s publica&#231;&#245;es em peri&#243;dicos n&#227;o avaliados pelo JCR, a publica&#231;&#227;o ocorreu com uma mediana de 2 anos e 1 m&#234;s ap&#243;s a defesa, com percentis 25 e 75 de 1,2 e 3,7, respectivamente. A <xref ref-type="table" rid="tab01">tabela 1</xref> apresenta os n&#250;meros de teses defendidas e publicadas no decorrer dos anos estudados.</p>
    <table-wrap id="tab01">
      <graphic xlink:href="1678-4170-abc-91-05-0315-00006-gt01.jpg"/></table-wrap>
    <p>Foi realizado o teste do qui-quadrado comparando a porcentagem de publica&#231;&#245;es em cada ano, em rela&#231;&#227;o a uma porcentagem em que a publica&#231;&#227;o fosse fixa todos os anos. Constatou-se que a distribui&#231;&#227;o observada n&#227;o foi diferente (p = 0,99).</p>
    <p>Observou-se ainda que 16% do total de publica&#231;&#245;es ocorreram antes da defesa, enquanto 17% aconteceram depois de 4 anos desse evento.</p>
    <p>Dividiu-se o total de defesas publicadas em sua mediana, o que ocorreu em julho de 2002. A primeira metade, totalizando oito anos e meio com 98 teses publicadas e a segunda metade nos dois anos e meio restantes com 97 teses. O tempo para a publica&#231;&#227;o das primeiras 97 teses ap&#243;s a defesa apresentou uma mediana de 2 anos e 6 meses, com percentis 25 e 75 de 0,9 e 4,2, respectivamente, e nas restantes isso ocorreu com uma mediana de 1 ano e 7 meses, com percentis 25 e 75 de 1,1 e 2,4, respectivamente. Os dois grupos de valores foram significativamente diferentes (p = 0,0118) (<xref ref-type="fig" rid="fig02">fig. 2</xref>). </p>
    <fig id="fig02">
      <graphic xlink:href="1678-4170-abc-91-05-0315-00006-gf02.jpg"/></fig>
    <p>A concord&#226;ncia da an&#225;lise dos tipos de tese pelo valor <italic>kappa</italic> foi de 0,11, ou seja, uma concord&#226;ncia pobre. A <xref ref-type="table" rid="tab02">tabela 2</xref> apresenta as concord&#226;ncias por tipo de tese. Observou-se que a classifica&#231;&#227;o como tese b&#225;sica, a qual obteve a melhor correla&#231;&#227;o, foi apenas regular (entre 0,2 e 0,4) por meio do valor <italic>kappa</italic>.</p>
    <table-wrap id="tab02">
      <graphic xlink:href="1678-4170-abc-91-05-0315-00006-gt02.jpg"/></table-wrap>
    <p>Em 111 teses (41%) n&#227;o se estabeleceu uma maioria entre os classificadores sobre qual o tipo de tese. Quanto ao restante, 67 (25%) foram classificadas como estudo cl&#237;nico, 61 (23%) como estudo epidemiol&#243;gico e 29 (11%) como estudo b&#225;sico. Se os tipos epidemiol&#243;gico e cl&#237;nico forem compreendidos como uma &#250;nica classifica&#231;&#227;o, o valor <italic>kappa </italic>da concord&#226;ncia aumenta para 0,23. Nesse caso, 53 teses (19%) ficaram sem classifica&#231;&#227;o, 194 (72%) foram classificadas como cl&#237;nica e as outras 21 (7%) como estudo b&#225;sico.</p>
    <p>Buscou-se correla&#231;&#227;o entre os fatores pesquisados e a publica&#231;&#227;o da tese. As vari&#225;veis consideradas nessa an&#225;lise foram: ano de gradua&#231;&#227;o, intervalo entre a formatura e a matr&#237;cula na p&#243;s-gradua&#231;&#227;o, tempo de perman&#234;ncia no programa, idade na defesa e n&#250;mero de teses orientadas concomitantemente pelo respectivo orientador. A an&#225;lise, por regress&#227;o log&#237;stica, n&#227;o mostrou correla&#231;&#227;o com nenhuma vari&#225;vel pesquisada. A seguir, foi realizada a an&#225;lise da rela&#231;&#227;o entre o fator de impacto do peri&#243;dico no qual foi publicada a tese e os fatores pesquisados pela regress&#227;o linear multivariada. Os fatores considerados foram os mesmos. N&#227;o foi encontrada correla&#231;&#227;o entre o fator de impacto com nenhuma uma das vari&#225;veis. A <xref ref-type="fig" rid="fig03">figura 3</xref> apresenta o tempo para publica&#231;&#227;o da tese em rela&#231;&#227;o ao fator de impacto. </p>
    <fig id="fig03">
      <graphic xlink:href="1678-4170-abc-91-05-0315-00006-gf03.jpg"/></fig>
    <p>
      <bold>Discuss&#227;o</bold>
    </p>
    <p>Realizou-se um levantamento mostrando o desempenho e a evolu&#231;&#227;o da p&#243;s-gradua&#231;&#227;o em cardiologia do InCor/FMUSP. Foram buscados fatores que poderiam se correlacionar a maior probabilidade de publica&#231;&#227;o e/ou publica&#231;&#227;o em um peri&#243;dico com maior fator de impacto. </p>
    <p>O per&#237;odo de 13 anos entre a formatura e a matr&#237;cula no programa de p&#243;s-gradua&#231;&#227;o &#233; bastante extenso. Salienta-se ainda que esse tempo foi de 26 anos para quem se formou antes de 1980. Esse dado pode ser explicado em parte pela resid&#234;ncia m&#233;dica em cardiologia. Isso equivale a uma pequena fra&#231;&#227;o do tempo para quem se formou antes de 1980, mas j&#225; corresponde a 50% do tempo para quem se formou ap&#243;s 1989. A resid&#234;ncia m&#233;dica em cl&#237;nica m&#233;dica em 2 anos come&#231;ou nos anos 2000 e 2001, portanto n&#227;o est&#227;o inclu&#237;dos alunos de p&#243;s-gradua&#231;&#227;o com 4 anos de resid&#234;ncia nesta amostra. Outra possibilidade para complementar esse valor seria o tempo despendido para a prepara&#231;&#227;o do projeto de p&#243;s-gradua&#231;&#227;o, incluindo seu in&#237;cio antes da matr&#237;cula formal no programa.</p>
    <p>Encontrou-se nesse per&#237;odo de 11 anos a publica&#231;&#227;o de 195 trabalhos. Outro levantamento publicado em 2005 apontou a produ&#231;&#227;o de 204 publica&#231;&#245;es de teses no per&#237;odo de 30 anos de p&#243;s-gradua&#231;&#227;o do Instituto do Cora&#231;&#227;o<sup>2</sup>. Excluindo 42 publica&#231;&#245;es que ocorreram ap&#243;s 2005, observou-se que nos 11 anos estudados se concentram 75% das publica&#231;&#245;es realizadas nessa institui&#231;&#227;o.</p>
    <p>Esses resultados podem ser comparados com o estudo realizado por Younes e cols.<sup>1</sup>, no qual foi analisado o tempo para a primeira publica&#231;&#227;o dos doutores que obtiveram o seu t&#237;tulo na FMUSP, em todas as &#225;reas da p&#243;s-gradua&#231;&#227;o no per&#237;odo de 1990-2000. Constatou-se que em cinco anos 50% dos p&#243;s-graduandos ainda n&#227;o tinham publicado nenhum trabalho. Neste estudo, o valor encontrado para a publica&#231;&#227;o da tese por 50% dos alunos foi de dois anos e oito meses. N&#227;o temos, para o estudo anterior, uma an&#225;lise apenas dos alunos da &#225;rea de cardiologia, no entanto, ao compararmos dois subgrupos deste estudo atual (divididos pela sua mediana), observamos uma diminui&#231;&#227;o significativa do tempo para publica&#231;&#227;o da tese (<xref ref-type="fig" rid="fig02">fig. 2</xref>).</p>
    <p>A classifica&#231;&#227;o das teses conforme o tipo (cl&#237;nico, epidemiol&#243;gico ou b&#225;sico) apresentou uma concord&#226;ncia n&#227;o-satisfat&#243;ria entre os quatro pesquisadores. A melhor correla&#231;&#227;o obtida n&#227;o ultrapassou o valor <italic>kappa</italic> 0,23, que corresponde a uma concord&#226;ncia regular. &#201; poss&#237;vel que cada tese envolva aspectos que percorrem os diferentes tipos de classifica&#231;&#227;o. Por exemplo, um trabalho cl&#237;nico pode utilizar m&#233;todo de biologia molecular e tamb&#233;m conter an&#225;lise epidemiol&#243;gica dos grupos de estudo. N&#227;o h&#225; como dividir o estudo de p&#243;s-gradua&#231;&#227;o nesses tipos.</p>
    <p>N&#227;o foi encontrada nenhuma correla&#231;&#227;o entre publicar o estudo ou entre o fator de impacto com qualquer uma das vari&#225;veis estudadas por meio da regress&#227;o log&#237;stica ou linear, respectivamente. </p>
    <p>A Comiss&#227;o Federal de Educa&#231;&#227;o, em 3 de dezembro de 1965, definiu a p&#243;s-gradua&#231;&#227;o que na &#233;poca se estruturava no pa&#237;s<sup>5</sup>. Trata-se do posicionamento da universidade para a gera&#231;&#227;o de conhecimento cient&#237;fico e tecnol&#243;gico. Salienta ainda que, em contraposi&#231;&#227;o aos cursos de gradua&#231;&#227;o que devem ser abertos ao maior n&#250;mero poss&#237;vel de alunos, a p&#243;s-gradua&#231;&#227;o deve ser restrita aos mais aptos. Por isso, os pr&#243;prios programas devem manter um alto n&#237;vel com aperfei&#231;oamento cont&#237;nuo, o qual envolve conhecer suas caracter&#237;sticas, propor e realizar mudan&#231;as. Em um segundo tempo, uma nova an&#225;lise deve ser realizada comparando-se a primeira, o que permite conclus&#245;es sobre os resultados. &#201; necess&#225;rio escolher instrumentos e m&#233;todos para essa avalia&#231;&#227;o. A auto-avalia&#231;&#227;o de uma institui&#231;&#227;o pode conter conflitos de interesses na medida em que os interessados s&#227;o os pr&#243;prios avaliadores. Conhecimentos cient&#237;ficos gerados, ao serem publicados em um peri&#243;dico, s&#227;o vistos por grupos externos &#224; institui&#231;&#227;o, avaliando indiretamente a pr&#243;pria p&#243;s-gradua&#231;&#227;o pelo seu produto. A avalia&#231;&#227;o da Capes dos programas contempla esse quesito<sup>6</sup>. Ao mesmo tempo, est&#225; claro nos crit&#233;rios propostos pela Capes que este n&#227;o seja o &#250;nico fator utilizado em toda a avalia&#231;&#227;o. </p>
    <p>Um segundo n&#237;vel de an&#225;lise seria avaliar o fator de impacto das publica&#231;&#245;es obtidas. Este reflete a vis&#227;o de que um artigo &#233; de pouca utilidade a n&#227;o ser que seja utilizado e citado por outros pesquisadores. &#201; calculado por meio de uma rela&#231;&#227;o do n&#250;mero de cita&#231;&#245;es de todos os trabalhos de um determinado peri&#243;dico dos dois anos anteriores sobre todos os trabalhos publicados no mesmo per&#237;odo pelo mesmo peri&#243;dico<sup>7</sup>. Existem contribui&#231;&#245;es importantes, como sobre doen&#231;as locais, preval&#234;ncia, an&#225;lises de custos nacionais, que n&#227;o s&#227;o de interesse dos principais eixos de pesquisa mundiais, Estados Unidos e Europa, e que poder&#227;o n&#227;o ser publicadas em revistas de fator impacto<sup>8</sup>. Abordagens feitas por grupos nacionais poder&#227;o ter maior dificuldade para aceita&#231;&#227;o em peri&#243;dicos mais visados. Isso influencia negativamente esse indicador e conseq&#252;entemente seu uso, sem que necessariamente a qualidade da pesquisa seja menor. Devem ser conhecidas as limita&#231;&#245;es desse indicador para que possa ser mais bem interpretado.</p>
    <p>A pr&#243;pria avalia&#231;&#227;o da Capes, tendo incorporado an&#225;lise de publica&#231;&#245;es e tempo limite para a publica&#231;&#227;o ap&#243;s a defesa, pode ser o principal motivo para as tend&#234;ncias observadas. Al&#233;m disso, a import&#226;ncia da publica&#231;&#227;o para o programa de p&#243;s-gradua&#231;&#227;o vem sendo reconhecida pelas pr&#243;prias institui&#231;&#245;es que conferem a titula&#231;&#227;o. Algumas comiss&#245;es passaram a exigir a submiss&#227;o do trabalho como exig&#234;ncia para a conclus&#227;o do doutorado. Fica em aberto a possibilidade de repetir o estudo em um futuro pr&#243;ximo para compara&#231;&#227;o.</p>
    <p>
      <bold>Limita&#231;&#245;es do estudo</bold>
    </p>
    <p>O valor do fator de impacto para os anos 2007 e 2008 foi o de 2006, mas que representa 5% dos trabalhos. Os crit&#233;rios de inclus&#227;o exigiam ter terminado a defesa de tese. Por isso, n&#227;o consideramos os abandonos, mas, em virtude do seu n&#250;mero muito pequeno, acreditamos que os resultados n&#227;o foram influenciados.</p>
    <p>
      <bold>Agradecimento</bold>
    </p>
    <p>Ao Prof. Dr. Julio S&#233;rgio Marchini, por suas sugest&#245;es e revis&#227;o atenciosa do artigo.</p>
    <p>
      <bold>Potencial Conflito de Interesses</bold>
    </p>
    <p>Declaro n&#227;o haver conflito de interesses pertinentes.</p>
    <p>
      <bold>Fontes de Financiamento</bold>
    </p>
    <p>O presente estudo n&#227;o teve fontes de financiamento externas.</p>
    <p>
      <bold>Vincula&#231;&#227;o Acad&#234;mica</bold>
    </p>
    <p>N&#227;o h&#225; vincula&#231;&#227;o deste estudo a programas de p&#243;s-gradua&#231;&#227;o.</p>
    <p>
      <fn id="end" fn-type="corresp">
        <label>
          <bold>Correspond&#234;ncia:</bold>
        </label>
        <p> Bruno Caramelli </p>
        <p> Av. Dr. En&#233;as C. de Aguiar 44 </p>
        <p> 05403-000 &#150; S&#227;o Paulo, SP, Brasil </p>
        <p> E-mail: </p>
        <p>
          <email xlink:href="bcaramel@usp.br">bcaramel@usp.br</email>
        </p>
      </fn>
    </p>
    <p> Artigo recebido em 11/11/07; revisado recebido em 07/04/08; aceito em 05/05/08</p>
  </body>
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  <sub-article article-type="translation" id="TRen" xml:lang="en">
    <front-stub>
      <article-categories>
        <subj-group subj-group-type="heading">
          <subject>Original Articles</subject>
        </subj-group>
      </article-categories>
      <title-group>
        <article-title xml:lang="en">Doctorate in cardiology at FM-USP heart institute from 1994 through 2004: defense and publication</article-title>
      </title-group>
      <abstract xml:lang="en">
        <p>BACKGROUND: A study evaluated the relationship between the defense of dissertations and their publication within the realm of the entire Medical School of the University of S&#227;o Paulo (FM-USP). The existence of differences among different areas of knowledge and the time between defense of dissertations and their publication is questioned. OBJECTIVE: To characterize publications related to dissertations defended in graduate courses of the Heart Institute (InCor) of the University of S&#227;o Paulo Medical School (FM-USP). METHODS: A retrospective survey was carried out featuring graduate work at FM/USP for the 1994 - 2004 period. Initially, data were collected on students who defended dissertations during this period, on their advisors, and on the dissertations defended in the course of the period. Then, by crossing these data with data from Medline&#174; and Web of Science&#174;, publications by these authors and data were located that referred to the respective publications. RESULTS: During that period, 268 dissertations were defended, resulting in 195 publications within a period of up to 10 years after their defense. The median time for publication after defense was one year and nine months, with a median impact factor of 2.1, and a median of 4 citations per paper. There was no statistically significant correlation among any of the data studied. CONCLUSION: A significant percentage of the dissertations were published, and in the group studied, publication took place within increasingly short times after their defense. This fact may be related to the success of the graduate commissions' policies and to the importance currently lent to debates on this theme, all of which contribute to improvement in the quality of graduate studies.</p>
      </abstract>
      <kwd-group xml:lang="en">
        <kwd>Education, medical graduate</kwd>
        <kwd>impact factor</kwd>
        <kwd>peer review, research</kwd>
      </kwd-group>
    </front-stub>
    <body>
      <p>
        <bold>ORIGINAL ARTICLE</bold>
      </p>
      <p><undefined id="tx-body2"/>Doctorate in cardiology at FM-USP heart institute from 1994 through 2004: defense and publication</p>
      <p>
        <bold>Julio Fl&#225;vio Meirelles Marchini<sup>II</sup>; Bruno Caramelli<sup>I</sup></bold>
      </p>
      <p><sup>I</sup>Interdisciplinary Medicine in Cardiology Unit, Heart Institute of the University of S&#227;o Paulo Medical School, S&#227;o Paulo, SP - Brazil</p>
      <p><sup>II</sup>University of S&#227;o Paulo Medical School of Ribeir&#227;o Preto, Ribeir&#227;o Preto, SP - Brazil</p>
      <p>Mailing Address</p>
      <p>
        <bold>SUMMARY</bold>
      </p>
      <p><bold>BACKGROUND:</bold> A study evaluated the relationship between the defense of dissertations and their publication within the realm of the entire Medical School of the University of S&#227;o Paulo (FM-USP). The existence of differences among different areas of knowledge and the time between defense of dissertations and their publication is questioned.</p>
      <p><bold>OBJECTIVE:</bold> To characterize publications related to dissertations defended in graduate courses of the Heart Institute (InCor) of the University of S&#227;o Paulo Medical School (FM-USP).</p>
      <p><bold>METHODS: </bold>A retrospective survey was carried out featuring graduate work at FM/USP for the 1994 &#150; 2004 period. Initially, data were collected on students who defended dissertations during this period, on their advisors, and on the dissertations defended in the course of the period. Then, by crossing these data with data from Medline&#174; and Web of Science&#174;, publications by these authors and data were located that referred to the respective publications.</p>
      <p><bold>RESULTS: </bold>During that period, 268 dissertations were defended, resulting in 195 publications within a period of up to 10 years after their defense. The median time for publication after defense was one year and nine months, with a median impact factor of 2.1, and a median of 4 citations per paper. There was no statistically significant correlation among any of the data studied.</p>
      <p><bold>CONCLUSION: </bold>A significant percentage of the dissertations were published, and in the group studied, publication took place within increasingly short times after their defense. This fact may be related to the success of the graduate commissions' policies and to the importance currently lent to debates on this theme, all of which contribute to improvement in the quality of graduate studies.</p>
      <p><bold>Key words:</bold> Education, medical graduate; impact factor; peer review, research.</p>
      <p>
        <bold>Introduction</bold>
      </p>
      <p>The graduate program training process includes the acquisition of knowledge, teaching, scientific methodology, and the production of innovative knowledge. Students must be capable of carrying out data collection, tabulation, and the presentation of findings to the target community. A survey recently carried out at the Medical School of the University of S&#227;o Paulo (FM-USP) showed that publication rates<sup>1</sup> were low. The defense of a dissertation is not the end of a process, but rather its beginning. The process generates knowledge to be publicized and also serves as the foundation for new works. An editorial of this journal commemorating 30 years of graduate studies in cardiology at the Heart Institute (InCor) highlighted the history of this area and its contribution to the production and exportation of knowledge<sup>2</sup>.</p>
      <p>However, these are general data and may not be true for specific areas. In this paper we sought to continue this analysis within the field of cardiology, featuring it as a highlight within this same medical school. This observation occurred during a period following a previous period that was covered by a different study, which made it possible to note if there was a tendency toward change in the publication rate.</p>
      <p>
        <bold>Methods</bold>
      </p>
      <p>Analysis was carried out of dissertations in cardiology at FM-USP presented in the course of the eleven-year period from 1994 through 2004. This analysis took into consideration only enrolled students who defended their dissertations during the interval under study. Data were collected regarding the graduate students themselves, their advisors, and the themes of the dissertations they defended. Data regarding the students included date of birth, graduating year, graduate program entrance date, and dissertation defense date. Calculations focused on the interval between the date of graduation from medical school and enrollment in the graduate program, length of time in the program, and ages upon enrollment and defense of their dissertations.</p>
      <p>Information regarding the registered advisors consisted of the number of dissertations each one had advised in the course of the period studied.</p>
      <p>Four researchers (two from the clinical area and two from the basic area) analyzed the titles of the dissertations without any knowledge regarding the names of the authors or their advisors, and independently classified each dissertation according to the area of interest: basic, clinical or epidemiological. Works not carried out on humans, based on tissue samples or on models, were classified as basic area. Non-experimental studies, determining prevalence, incidence, and prognostics, were classified as epidemiological, and experimental studies with human beings were classified as clinical studies.</p>
      <p>The second source of data used in this study was the Pubmed&#174; archive, available on the Internet from the National Library of Medicine of the National Institute of Health (ncbi.nih.nlm.gov), and Web of Science&#174;, accessible through CAPES. By entering the title of the dissertation, the name of the candidate and of the advisor, it was possible to identify whether the dissertation had been published in any journal registered in these sources up to the conclusion date of this paper &#150; February 2008. If the paper was identified, the following data was extracted: its publication date, the journal in which it was published, its impact factor in the year of its publication, and the number of times the article was cited in other papers up to the time of its analysis. Also calculated was the number of citations per year from the publication date until February 2008. The impact factor used came from Thomson Scientific Journal Citation Reports&#174; (JCR) made available by CAPES (Coordination for the Improvement of Higher Education Personnel) since 2001. For 14 publications prior to 2001, the impact factor was requested from the eight journals involved, or obtained from two publications<sup>3,4</sup>. Impact factors for the years of 2007 and 2008 have not yet been defined &#150; a situation applying to 11 publications &#150; in which cases the 2006 impact factor was used. A zero impact factor was attributed to journals not included in the JCR.</p>
      <p>Statistical analysis was carried out using the Stata 9.0&#174; program. Kappa analysis was used to evaluate agreement in the classification of dissertations into types. Logistic regression was used to test the correlation between publication of the dissertation and the variables surveyed, and multivariate linear regression was used to correlate the impact factor obtained by the publication with the variables under study. Either non-paired single-tailed t-tests or chi-square tests were used for comparison of groups when appropriate.</p>
      <p>
        <bold>Results</bold>
      </p>
      <p>Two hundred and sixty-eight doctoral dissertations were presented within the eleven-year period of this study. The average age of students upon entrance to the graduate program was 37, with a standard deviation of 7.0 years. Students averaged 41 years of age with a standard deviation of 6.9 years upon defense of their dissertation. Ninety-seven percent of the students were physicians. The average duration of the graduate work, i.e., between enrollment and presentation of the dissertation, was 4 years, with a standard deviation of 1.6 years.</p>
      <p>The average length of time between graduation from medical school and entrance in the graduate program was 13 years with a standard deviation of 6.7 years. That same interval for those who graduated prior to 1980 was 23 years with a standard deviation of 6.15 years; 13 years with a standard deviation of 6.0 years for those who graduated between 1980 and 1989; and 6 years with a standard deviation of 1.84 years for those who graduated after 1989.</p>
      <p>We noted that 47 dissertations were defended in the first half of the graduate program period, and 221 in the second half.</p>
      <p>Sixty-eight different advisors took part in the program within the interval of this study, each advisor with a median of 6 students, ranging from 1 to 15 students advised.</p>
      <p>The dissertations of 50% of the students were published within two years and eight months of their defense (<xref ref-type="fig" rid="fig01-body2">Figure 1</xref>). In all, 195 (73%) were published with a median of one year and nine months after their defense. The 25th and 75th percentiles were, respectively, 1.1 year and 3.1 years. The earliest publication occurred six years and four months prior to defense of the dissertation, and the latest, ten and a half years after its defense. One hundred and seven (55%) were published in journals that have impact factor. In this group, the median time to publication was 1 year and 9 months after defense and the 25th and 75th percentiles were respectively 0.9 years and 2.8 years. The impact factor of these publications ranged from 0.4 to 51.3, with a median of 2.1 and 25th and 75th percentiles amounting respectively to 1.4 and 3.6. Citations of these publications per year ranged from zero to 353 with a median of 4 and respective 25th and 75th percentiles of 1 and 11 times. The publications obtained a median of 1.0 citation per year, ranging from zero to 49.3 citations per year with respective 25th and 75th percentiles of 0.3 and 1.9.</p>
      <fig id="fig01-body2">
        <graphic xlink:href="1678-4170-abc-91-05-0315-00006-gf01-en.jpg"/></fig>
      <p>As to publications not evaluated by JCR, publication occurred with a median of two years and one month after the defense, and the 25th and 75th percentiles were respectively 1.2 and 3.7. <xref ref-type="table" rid="tab01-body2">Table 1</xref> shows the number of dissertations defended and published in the course of the years studied.</p>
      <table-wrap id="tab01-body2">
        <graphic xlink:href="1678-4170-abc-91-05-0315-00006-gt01-en.jpg"/></table-wrap>
      <p>The chi-square test was carried out to compare the percentage of publications for each year with the average for the whole 11-year period studied. The comparison showed that there was no difference in distribution (p=0.99).</p>
      <p>It was also observed that 16% of the total publications occurred prior to defense of the dissertation, while 17% occurred four years after defense.</p>
      <p>Total dissertations published were divided at the median, which occurred in July 2002. The first group comprised eight and a half years with 98 dissertations published, and the second group comprised the remaining two and a half years with 97 dissertations published. The median length of time from defense until publication for the first 98 dissertations was two and a half years, with respective 25th and 75th percentiles of 0.9 and 4.2. The median for the remainder (97 dissertations) was one year and seven months with 25th and 75th percentiles of 1.1 and 2.4, respectively. The values found for the two groups were significantly different (p=0.0118) (<xref ref-type="fig" rid="fig02-body2">Figure 2</xref>).</p>
      <fig id="fig02-body2">
        <graphic xlink:href="1678-4170-abc-91-05-0315-00006-gf02-en.jpg"/></fig>
      <p>Kappa analysis of the two types of dissertations showed agreement to be 0.11, i.e., low agreement. <xref ref-type="table" rid="tab02-body2">Table 2</xref> shows agreement by type of dissertation. It was noted that kappa agreement proved to be only average (0.2 and 0.4) for dissertations classified as basic &#150; those that had shown the highest correlation.</p>
      <table-wrap id="tab02-body2">
        <graphic xlink:href="1678-4170-abc-91-05-0315-00006-gt02-en.jpg"/></table-wrap>
      <p>In 111 dissertations (41%), no majority opinion was established among the classifiers as to the type of dissertation. In regard to the remainder, 67 (25%) were classified as clinical studies, 61 (23%) as epidemiological studies, and 29 (11%) as basic studies. If the epidemiological and clinical studies are seen as one sole classification, kappa agreement rises to 0.23. In this case, 53 dissertations (19%) remained unclassified, 194 (72%) were classified as clinical studies, and the remaining 21 (7%) as basic studies. </p>
      <p>Correlation was sought between the factors surveyed and publication of the dissertations. The variables considered in this analysis were: year of graduation; interval between graduation and enrollment in the graduate program; length of time in the graduate program; age upon defense; and number of dissertations advised concomitantly by the respective advisors. Analysis by logistic regression showed no correlation with any variable surveyed. Multivariate linear regression was then used to analyze the relationship between the impact factor of the journal in which the dissertation was published and the factors surveyed. The factors taken into account were the same. No correlation was found between the impact factor and any of the variables. <xref ref-type="fig" rid="fig03-body2">Figure 3</xref> shows the time until publication of the dissertation in relation to the impact factor. </p>
      <fig id="fig03-body2">
        <graphic xlink:href="1678-4170-abc-91-05-0315-00006-gf03-en.jpg"/></fig>
      <p>
        <bold>Discussion</bold>
      </p>
      <p>A survey was carried out to show performance and evolution of the graduate program in cardiology at InCor/FM-USP. Factors were sought that might correlate the greater probability of publication and/or publication in journals featuring higher impact factors.</p>
      <p>A period of 13 years between graduation from medical school and enrollment in a graduate program is quite long. It must also be pointed out that such interval, for those who graduated prior to 1980, was 26 years. This fact can be explained, in part, by the medical residence in cardiology which was equivalent to only a small fraction of the time between graduation and enrollment in the graduate program for those who graduated prior to 1980, but corresponds to 50% of that time for those who graduated after 1989. The two-year medical residence in clinical medicine was only initiated in 2000 and 2001 and therefore does not include the graduate students with four years of residence included in this sample. Another possibility to complement this value would be the time spent on preparation of the graduate project, including beginning it prior to formal enrollment in the program.</p>
      <p>Publication of 195 dissertations was found within the 11 years covered by this study. Another study, published in 2005, pointed to the production of 294 publications of dissertations within the 30 years of graduate studies at the Heart Institute<sup>2</sup>. Excluding the 42 publications that occurred after 2005, we can see that 75% of all the publications attributed to this institution occurred within the 11 years studied.</p>
      <p>These results can be compared to the study made by Younes et al<sup>1</sup> that analyzed the first publication of PhDs who earned their doctorate at FM-USP in any graduate program area during the period of 1990-2000. They found that in five years, 50% of the graduates had not yet published any paper. In this study, the value found for publication of the dissertation by 50% of the students was two years and eight months. For the previous study, we have no analysis exclusively for students of cardiology. However, upon comparison of two subgroups of this current study (divided at their median), we noted a significant drop in the time until publication of the dissertation (<xref ref-type="fig" rid="fig02-body2">Figure 2</xref>).</p>
      <p>Classification of the dissertations by type &#150; clinical, epidemiological, and basic &#150; showed agreement among the four researchers to be unsatisfactory. Even the highest correlation obtained was no higher than kappa 0.23, which corresponds to average agreement. It is possible that each dissertation involves aspects that occur in all of the various types of classification. For example, a clinical study may use a molecular biology method and also feature epidemiological analysis of the study groups. There is no way of dividing graduate studies into such types.</p>
      <p>Logistic regression found no correlation between publication of the study and any of the variables studied, nor did linear regression reveal any correlation between the impact factor and any of the variables studied.</p>
      <p>On December 3, 1985, the Federal Education Commission defined graduate study, which was being structured in Brazil at the time<sup>5</sup>. The object was to position universities as generators of scientific and technological knowledge. The definition also points out that contrary to undergraduate courses, which should be open to the greatest possible number of students, graduate courses should be limited to the most capable students. Thus, graduate programs must uphold a high level of ongoing improvement, which involves knowing their characteristics, as well as proposing and implementing changes. Thereafter, a new analysis should be carried out, comparing it with the first and making it possible to draw conclusions regarding the results. Instruments and methods must be chosen for this evaluation. Self-evaluation of an institution may involve conflicts of interest since the parties of interest are the evaluators themselves. Scientific knowledge generated, upon its publication in a journal, is seen by groups outside the institution, and the graduate program itself is indirectly evaluated by its product. Evaluation of graduate programs by CAPES takes this fact into consideration<sup>6</sup>. At the same time, the criteria proposed by CAPES make it clear that this is not the only factor considered in the course of an evaluation.</p>
      <p>A second level of analysis would be to evaluate the impact factor of the publications obtained. This second level reflects the view that an article is of scant worth if it is not used and cited by other researchers. The impact factor is calculated by dividing the number of citations of all the works published in a certain journal for the two previous years by all the works published during the same period by the same journal<sup>7</sup>. There are some important works, such as those on local diseases, their prevalence, and analyses of national costs, that are of little interest to the main hubs of world research &#150; the United States and Europe &#150; and that may not be published in journals with high impact factors<sup>8</sup>. Studies carried out by national groups may find it more difficult to have their works published in the more renowned journals. This fact has a negative influence on the impact factor indicator, and consequently on the use of the study, without necessarily reflecting on the quality of that study. The limitations of this indicator must be understood if it is to be properly interpreted.</p>
      <p>The CAPES evaluation itself, by incorporating analysis of publications and a limited time for publication following the defense of dissertations, may constitute the main reason for the tendencies noted. In addition, the importance of publication for the graduate program is now being acknowledged by the institutions that grant doctorate degrees. Some commissions are now demanding submission of the work for publication as a requirement for conclusion of the doctorate. Candidates are allowed the possibility of repeating the study in the near future for comparison purposes.</p>
      <p>
        <bold>Limitations of the study</bold>
      </p>
      <p>The value of the impact factor used for years 2007 and 2008 (representing 5% of the dissertations covered in this study) was the same as that for 2006. Among the criteria for inclusion was the requirement that defense of the dissertation had been completed. Thus, dropouts were not taken into consideration but, in view of their very small number, we feel that the results were not influenced.</p>
      <p>
        <bold>Acknowledgement</bold>
      </p>
      <p>Our thanks to Dr. Julio S&#233;rgio Marchini, for his suggestions and careful revision of the article.</p>
      <p>
        <bold>Potential Conflict of Interest</bold>
      </p>
      <p>No potential conflict of interest relevant to this article was reported.</p>
      <p>
        <bold>Sources of Funding</bold>
      </p>
      <p>There were no external funding sources for this study.</p>
      <p>
        <bold>Study Association</bold>
      </p>
      <p>This study is not associated with any graduation program.</p>
      <p>
        <bold>References</bold>
      </p>
    </body>
  </sub-article>
</article>
