Context and setting The Medical School of Universidade Cidade de São Paulo (City University of São Paulo), Brazil was founded in 2003 and has a curriculum structured across 6 years. The first 4 years use problem-based learning (PBL) and are integrated, community-based and student-centred. These are followed by 2 years of internship. Following the Brazilian National Guidelines for Medical Education, the internship was designed to include rotations in paediatrics, obstetrics and gynaecology, surgery, internal medicine, mental health and public health. Since the inception of this internship, we have used Moodle as an open-source e-learning platform to design and create online courses with a high degree of interactivity in order to improve information uptake.

Why the idea was necessary The internship rotations take place in different and distant settings, from primary health care units to ambulatories and hospitals in a large metropolis with more than 19 million inhabitants. Rotations in peripheral hospitals and extended clinical attachments are becoming more important and the facilities need to keep pace with this. It would be unreasonable to expect the facilities at peripheral hospitals to match those of the central campus. In 2008, at the beginning of the internship, we realised that we required alternative methods of facilitating contact between students and teaching staff in order to provide educational materials and, mainly, to receive feedback from students for the internship evaluation.

What was done Based on the Moodle platform, an online environment was developed for internship teaching staff and students. Each batch of students has a link in the portal through which they can access the instructions for each rotation and information about their performance. Once logged in, the teacher chooses an assessment method, clicks on the name of the student, sees his or her picture and can then insert the relevant grades. Global ratings and PBL tutorial marks should be inserted weekly. Marks on written examinations and portfolios can be inserted at the end of the rotation and marks on objective structured clinical examinations can be inserted once per semester. When the teacher has inserted the grade, he or she can write comments, suggestions and feedback that will be available to the intern confidentially. The Moodle environment also allows teaching staff to post messages, queries and pedagogical information to students. The program automatically calculates a student’s final grade, but, before the student can access this final grade, he or she is required to answer an online programme evaluation survey regarding the teaching staff and the infrastructure of internship settings, at the end of each rotation (9 weeks). Students also have the option of viewing marks on their performance in each component of the final grade (i.e. global ratings, and marks on tutorials, examinations and portfolios).

Evaluation of results and impact After two semesters we observed that 100% of students accessed the internship environment and answered the evaluation survey before the end of the semester. Twice a year the assessment committee produces a report on each rotation based on the data provided by students. This information supports curriculum decision-making and feedback from students is presented to the teaching staff in a personal and confidential report. Moodle is shortening distances and helping students and educators to provide and easily access information. Programme evaluation is challenging but feasible, even if students and teaching staff are dispersed across different or distant educational settings.