Context and setting The last 2 years of the 6-year Brazilian medical undergraduate curriculum are based on a series of clinical rotations (in paediatrics, obstetrics and gynaecology, internal medicine, surgery, and public health), carried out as an internship. The goal is to consolidate knowledge and improve clinical competences through clerkships carried out under close supervision. The rotations are divided into different scenarios of practice ranging from the university hospital to numerous services representing the three levels of health care, as recommended by the National Guidelines (DCN) in 2001. The 55 students rotate in five clinical areas, for 12 weeks each, in contexts that represent 10 different health care services.

Why the idea was necessary Given that students are scattered across different departments and services, it was necessary to improve the level of supervision and provide a better tool of communication that would allow students to maintain closer contact with faculty staff. A follow-up strategy was implemented using Moodle, a platform for distance learning, which offers resources that facilitate tutoring and enable a distance electronic portfolio. The program contains five virtual rooms, focused on internal medicine, child health, women’s health, surgery and public health, respectively, which function under the guidance of one teacher per clinical area. The rooms contain forums and activities, comprising: real clinical cases, hypothetical clinical problems, records of daily activities, a virtual library with sites, PowerPoint presentations; an archive of instructional resources, and self-evaluation opportunities through high-stakes tests.

What was done A questionnaire on satisfaction with the electronic tool and supervision was administered electronically to students and supervisors. The questionnaire used Likert scale items, multiple-choice items and open-ended questions to establish students’ and supervisors’ perceptions of the strengths of the clinical experience and their opinions on areas that required improvement.

Evaluation of results and impact A total of 42 students (76%) responded to the questionnaire. Response rates ranged from 77% in surgical and internal medicine, to 59% in women’s and public health. The layout of the electronic environment was considered to be very good or good by 76% of students. In response to items on the learning activities, 45% of students evaluated the discussion of hypothetical clinical problems and the real cases of their practice, as good or very good. Approximately 56% fully or partially agreed that the discussions of the real clinical case were important in improving their clinical reasoning and nearly 66% expressed a similar opinion on the discussions of hypothetical clinical problems. These discussions helped 39% of students to discover their learning needs. After they had performed two rotations within 3 months, the students suggested that supervisors should be trained and commented on the need to increase their commitment. The provision of opportunities to discuss real cases and the close contact facilitated with course coordinators were mentioned as strengths of the virtual environment.

It is anticipated that 300 students and 20 teachers will be involved in the virtual environment for the internship by the time it reaches its second anniversary in 2010. The use of the electronic portfolio will be extended to all modules, throughout Years 1–4 of the curriculum, as well as to medical residency programmes, including multi-professional residencies in family and community medicine.