Monographs or Articles as Bachelor End‐of‐Course Work: One Brazilian Nursing Experience

Scientific production in the Global South can be challenging, even more so in countries like Brazil and, specifically, in Nursing. Brazil has suffered a significant drop in academic production in recent years, much due to the decrease in the contribution of financial resources [1]. Another factor that also impacted this production was the COVID-19 pandemic, which prevented field studies and restricted the possibilities of data collection given the isolation restrictions, and, in some cases, in the underestimation of scientific knowledge in the face of the growing appreciation of “fake news” and obscurantism experienced in the pandemic [2]. In addition, in areas such as Nursing, where technical learning of healthcare is privileged, and there is a high demand in the labor market for recent graduates, it can be challenging to stimulate students' interest in research and increase the stimulus to producing scientific knowledge; especially in undergraduate studies. The unique mandatory experience with research production in undergraduate Nursing courses in Brazil is executing end-of-course work, ECW [3] or also generically named monograph. The ECWs are characterized by academic research carried out as a criterion to complete the graduation, usually individual and presented as a monograph. There are no regulations on how these should be. In the literature, there is also no consensus on the technical term that best defines these ECWs, and depending on the country, it is possible to find Bachelor's thesis, Bachelor's end/final project/paper, Bachelor's dissertation or final work/project. The terminology of ECW, which is most used in Brazil (“Trabalho de Conclusão de Curso” in Portuguese), will be adopted here. The terminologies, methodologies, form of presentation, structure, types, and requirements are also very diverse and free among Brazilian courses, with few studies describing these characteristics and how the conception of ECWs occurs. In Nursing, some experiences in this sense have shown a higher prevalence of descriptive and qualitative studies focused on the healthcare area in ECWs [4, 5]. In the undergraduate course evaluated in the present study, the ECW is mandatory from the course foundation. The student only graduates if he defends the ECW. Despite this, historically, these ECWs were not published as article, and when they were, they were, for the most part, published in annals of events as short or expanded abstracts and full articles. Starting in the pre-pandemic period and maintained over the present years, an internal campaign in the course, carried out by the course coordination, the discipline of “End-of-Course Work”, and an internal Research Commission of the course itself, raises awareness and encourages the adoption of the presentation in the form of an article already published. The article must already have been published or accepted without the need for revisions or in press. It may have multiple authors, but it must have an advisor, professor, and the student as author regardless of the author's order in the article. Only one student can use the article as an ECW. The empirical observations of the commission and the course coordination indicated that these stimuli seemed to have had an effect, given the increasing presence of defenses in the form of published articles. These stimuli were enhanced by the pandemic, a time when most students were unable to maintain their field studies and were restricted to their homes. Coincidentally, some Brazilian institutions and funding agencies encouraged the adoption of alternative studies instead of face-to-face data collection during the pandemic. In this context, this study aimed to describe the change in behavior in the end-of-course works (replacement of monographs by scientific published articles) of a Brazilian undergraduate nursing course and its relationship with the COVID-19 pandemic. The evaluated course is located in the inner of Brazil, in the state of Minas Gerais, in the city of Uberlândia. It is a public course, offering 40 semester vacancies; double qualification in Bachelor and Licentiateship, with completion in 10 semesters. The student must compulsorily present an ECW at the end of the course, preferably in the ninth semester. Despite this, ECWs can be defended at any undergraduate course time, starting in the second semester; and even after having completed all the subjects of the course after the 10th semester. It can be presented as a monograph (traditional model) or an already published scientific article (alternative model). If presented in the form of an article, it must have been published (accept or in press without revision needs) during the course time and have as an author a professor from the university (in the role of advisor as in traditional model). The article can be published in one semester, and the ECW can be defended in same or other semesters. As stimulus and benefits to adopting the alternative model, if the ECW is present as an article, the student already receives 70 points out of 100 referring to the written part and must only make the public defense of the ECW, which is evaluated at 30 points. The monograph model evaluates both the written part and the presentation (70 and 30 points, respectively). In the article format, it must have a B degree or strata in any area of knowledge of “Qualis Sucupira”, a Brazilian classification system of journals. A journal receives a degree classification in this system when at least one article from this journal was published by a graduate school in the evaluation interval, included in database, evaluated, and for this, receives a degree in the temporal reference interval (https://sucupira-legado.capes.gov.br/sucupira/public/consultas/coleta/veiculoPublicacaoQualis/listaConsultaGeralPeriodicos.jsf). This system classifies Journals into three strata: A, B and C (or importance ranking categories). Strata A and B can be subdivided into 3 to 5 levels, depending on the period evaluated. The importance of classifications is greater, following from A (higher impact) to B (lower impact) and from levels 1 (higher impact) to 5 (lower impact). Stratum C is considered as “inadequate” literature without ranking (sometimes similar to predatory journals). All additional ECW rules can be accessed on the institution's website (https://famed.ufu.br/graduacao/enfermagem/saiba-mais/tcc). All ECW data used here are public and can also be accessed in the institution's repository (https://repositorio.ufu.br/handle/123456789/19179). The ECW has a mandatory public defense session and deposit in the institution's repository. For this reason, the present work was not submitted to the Human Research Ethics Committee. No personal, private, or sensitive information was collected from the ECW's authors. Since 2017, all ECWs have been analyzed and checked whether they were presented as articles or monographs, stratified by academic semester and in the phases of the COVID-19 pandemic. The year 2017 was the first year that the deposit of ECWs in the institutional repository became mandatory, allowing data collection. Six academic semesters were included in the pre-pandemic phase, seven in the pandemic phase (one semester was excluded because there was no defense and approval), and four in the post-pandemic phase. The response variable was if the ECWs were presented as an article (assuming 1) or given as a monograph (assuming 0). We calculated the probability of defense in the article format for each semester and phase of the pandemic. For the analyses, we adopted the phase of the pandemic (pre-pandemic, pandemic, and post-pandemic) as an independent variable, and each academic semester was nested in the phase as a random factor. We adjusted the data for generalized linear mixed models (GLMM) with Binomial distribution and logit link functions in package glmmTMB v.1.1.4 [6]. Overdispersion and models' validation were conducted by simulating the residuals 1000 times using the package DHARMa v.0.4.5 [7]. We assessed the models' significance using chi-square tests. We adopted the Tukey test in package emmeans v.1.8.4.1 for pairwise comparisons The model-adjusted means (predicted) and their confidence interval at 95% were obtained by back-transformation from tested models using the package geffects v.1.1.5 [8]. The figures were constructed in ggplot2 v.3.4.1 [9]. The analyses were performed in R software v. 4.2.2 [10]. A total of 362 ECWs defended since 2017 were evaluated, of which 291 were presented in the form of monographs and 71 in the form of articles. In the pre-pandemic period, when the intervention to encourage change in the behavior of ECWs (replacement of monographs by scientific published articles) began, the probability of presenting an article was 0.0247 (95% CI: 0.0087–0.0681; 4 articles in 150 ECWs). In the pandemic period, the probability of presenting an article was 0.2786 (95% CI: 0.1861–0.3948; 36 articles in 121 ECWs). In the post-pandemic period, the probability of presenting an article was 0.3367 (95% CI: 0.2206–0.4765; 31 articles in 91 ECWs) (Figure 1A). The probability of presenting the ECW with an article differed between the three phases of the pandemic (Chi-square = 23.51, d.f. = 2; p < 0.0001); and the probability of defending with an article was equal in the pandemic and the post-pandemic period (p = 0.7705); with both differing from the pre-pandemic phase (p < 0.0001; Figure 1A). The probability of the Bachelor's end-of-course work being defended in the format of an article replacing the monograph format in a Brazilian undergraduate nursing course according to the phases of the COVID-19 pandemic. (A) Probability of being defended in the form of an article presented for the three phases of the pandemic. The filled points and line segments indicate predicted probabilities and 95% Confidence Interval, respectively. The empty points are the raw data plotted with jitter. Means followed by different letters differ based on the Tukey test (p < 0.0001). (B) Box-plot of the probability of being defended in the form of an article presented for each academic semester by phases of the pandemic. The bars represent the minimum and maximum. The filled points are the raw data plotted with jitter. The probabilities tend to increase as the semesters go on. The post-pandemic phase presented the highest probabilities of defense in the form of an article per academic semester (Figures 1B and 2). The growth trend was not evaluated by civil semester, given that the academic semesters presented different periods due to adjustments in the academic calendar, made according to the Dean of Education's guidance to minimize the pandemic's temporal impact. Ignoring the fact of the time difference of the semesters and adopting the order of the semesters as an independent variable, the first semester as time one (one), and the absence of intercept, the growth rate per academic semester was 0.0224 of increase in the probability of defense in the form of an article per academic semester (y = 0.0224x; R2 = 0.6782, Figure 2). The temporal trend probability of the Bachelor's end-of-course work will be defended in the format of a published article replacing the traditional format of monograph in a Brazilian undergraduate nursing course. Bachelor's end-of-course works, master's dissertations, and doctoral theses presented in the traditional monograph format are still an essential part of the knowledge production process in Brazil. Despite this, these, as they are mostly reviewed internally in institutions (usually by an evaluation committee), have received less attention and are avoidable as a source of scientific evidence; given the possibility of changes in the final products (e.g., chapters or articles from these monographs) or non-inclusion of the corrections suggested by the evaluation committee. Many institutions have fostered and encouraged academic papers at the end of the course, regardless of the academic level, to be presented in the form of articles already published or collections of articles characterizing an alternative format (see [11]). No studies evaluated this strategy's form of delivery of the ECW or its impact on graduation were founds in the literature. The development and publication of scientific articles improve the institution's scientific production indicators and minimizes the chances of monographs abandonment in the post-defense period. Such abandonment or the non-publication of the derived paper is a prevalent factor observed in the course evaluated here, in which most of the monographs produced before 2017 were never published, or if they were, it was due to the interference or submission made by the advisors; usually late in the defense. There are no known ECWs already defended in the format of articles before that date of 2017; although they are already allowed by the course rule. The course has approximately 1500 graduates, but historically, it has about 500 articles published by the effective Nursing staff of the faculty (personal observation). This initiative to encourage the production of an alternative format to the monograph showed an effect on the probability of defense in the form of an article. This initiative or stimulus was not systematized but included guidance to students in scientific methodology discipline, encouragement to teachers to adopt the format, interventions with individualized conversations with students about guidance, and resolution of specific doubts to students and professors. Ideally, there should be training programs for undergraduate research since these have reflected in the construction of identity in research and the sense of belonging of this community [12], which could reflect, in our case, greater engagement in research at the end of graduation. These programs have also been reflected in greater productivity and access to graduate studies in health students, for example [13], demonstrating the need to implement such strategies early in undergraduate courses. This campaign or intervention and constant encouragement to defend articles instead of monographs has been perceived informally in the discourse of the students of the course. In addition to the ease of defense, many students have seen this alternative as a tool to improve their professional curriculum and as a facilitator for competitions and selection processes for residency, graduate (master programs), and the job market. In informal conversations, it has been noticed that most students are already trying to plan to defend their ECWs in the format of articles, and many professors are already demanding defense in this format. This is reflected in the high probability of defense in the form of an article in the last semesters evaluated here (about 50%). We have also noticed an increase in the number of defenses of monographs, which have already been submitted to journals but have not received final acceptance. Another relevant factor in changing this culture was the awareness and flexibility of the type of article to be presented; there has been an increase in formats such as experience reports, case studies, or alternative formats to primary quantitative and qualitative works. Another behavior observed is the defense in the form of articles of “simpler” works developed in the undergraduate course. At the same time, experimental or more rigorous works have been the focus of scientific initiations for subsequent publication in journals of more significant impact, given the need for more time for completion and publication. This behavior may reflect the academic productivism that is so present nowadays, which favors article numbers instead of the quality of the manuscript, and it is necessary to include qualitative indicators of scientific production when it is evaluated [14]. Campaigns will still be needed to improve the quality of the course's publications, as a whole, but the change in culture from monograph to article is already evident. Other delivery formats also need to be discussed. For example, there is the request for permission to release the defense as a book chapter, but this format has not yet been included, largely due to the difficulty of evaluating its quality or standardization criteria. Many researchers and associations have fought against academic productivism, where quantity is prioritized over quality. But this struggle is incipient and still demands the creation of more solid bases for evaluating the production itself. The impact of science or a paper cannot be explained by the volume of publications or metrics alone [15]. Paying publication fees is prevalent among Nursing journals in Brazil and guarantees open access to readers and journals' administrative costs. Indexing in internationally recognized databases is much more restricted in Nursing Brazilian journals (e.g. [16]). This scenario makes Brazilian researchers look for journals well-positioned in these indexers at a national or international level. At this point, they will face more extended evaluations and response times coupled with high no-accept rates. Sometimes, these researchers prefer paid journals with high or low publication fees but with short acceptance times and high acceptance rates. Eventually, these journals adopt an inadequate peer-review evaluation. These traits increase the risk of Brazilian researchers' publications in predatory journals, in special in the Nursing. In the present study, the impact and quality of the publications were not evaluated, that is, whether they were published in indexed journals or predatory journals. This point deserves to be assessed in future studies. However, in this context, it is essential to highlight the low funding in Brazil for undergraduate publications, which may reflect in the choice of easily accessible journals, mostly in “open access” journals with low publication prices (fee, page and article processing charges), without adequate peer review and, often, with high acceptance rates. Despite this, it is still necessary discussions about the fundamental concept and criteria to characterize a journal with low scientific impact or predatory. The determination of the minimum stratum of Qualis to be B is not sufficient to avoid publication in predatory journals. We have observed the common change from some Journal's from A or B strata to C strata in different Qualis evaluation periods. Perhaps this is why there is a tendency for this evaluation model to be abolished by Brazilian research funding agencies. Peer review evaluation has demonstrated a clear barrier to publication in high-impact journals in excluded groups, such as the Global South or non-English-speaking countries [17]. In this sense, for example, deans of medical courses in Central and South America have shown less scientific production than in Northern continents [18], a fact that could also happen in Brazilian Nursing and in the course studied here. This reflects the greater difficulty of publication in the area and access to indexed journals without costs. Many authors have no option to publish their works given article contexts of impact, internationalization, or even local interest and and one of the few for these authors is the adoption of accessible journals. articles or in may also not be the most to final since they are and the number of per paper has It is necessary to include these criteria in the evaluation In our case, this evaluation of articles with multiple authors is by the review from the presentation of the published article. We observed that the pandemic and the change in some of ECWs as face-to-face or also with other not evaluated here. There is a change in depending on the type of ECW, the form of presentation, and even the in the discipline with the ECW. There is still a need to these in future Despite this, it is clear how the to defend in the form of an article and the COVID-19 pandemic the culture of ECWs in the and course evaluated. our study is we are not to the effect of the of the course from the effect of the pandemic. We that the stimulus to the defense of ECWs as articles instead of monographs was adequate and that the pandemic to have this change in behavior in the undergraduate nursing course evaluated. the impact of the production has not been evaluated, this change to defense in the form of an article already reflects an to and with more quality. 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