This study examined the dissatisfaction among Chinese medical students with online medical English courses, which overemphasize grammar yet fail to provide practical opportunities related to medical situations. This study compared co-teaching’s effects, involving native and non-native instructors, with a single-instructor (traditional) model on student satisfaction in online medical English courses. Using a qualitative design, pre- and post-course interviews were conducted with 49 second-year medical students across seven classes, exploring their perceptions of instruction, curriculum, and course satisfaction. The findings indicated that the co-teaching model improved student engagement and satisfaction, not specifically due to the native English-speaking instructor but likely because of the focus on more interactive and discussion-oriented strategies. In contrast, the single-instructor model maintained the traditional grammar-focused instruction, leading to lower satisfaction levels. Both instructional models faced limitations related to their reliance on textbooks for delivering core material needed for the course’s comprehensive exam. These results suggest that the instruction design and approach, rather than the native instructor alone, was the main driver of positive outcomes in co-teaching. The study’s findings suggest a need for curriculum reforms that reduce textbook dependence and incorporate more practical, interactive learning strategies. Future research should consider applying various research techniques, such as mixed-method approaches, longitudinal studies, and experimental designs, to comprehensively assess the long-term effects of instructional strategies and curriculum innovations on student outcomes.

This paper provides a unique empirical analysis of the effects of political factors on the adoption of PPP contracts in Brazil. As such, it innovates along two different lines: first, political factors behind the adoption of PPPs have been largely ignored in the vast body of empirical literature, and second, there is scant work done on the motives of any kind behind the adoption of PPPs in Brazil. Various economic and financial reasons have been evoked to justify the use of PPPs in general. These include the goal of promoting socio-economic development in a tight public budgetary framework or of improving the quality of public services through the use of economically efficient and cost-effective mechanisms. Any possible underlying political motives, however, have been overlooked in the PPP research. And yet, there is abundant literature suggesting a link between the adoption of PPPs and the ideology of the governing body or the political cycles associated with elections. This study examines the impact of ideological commitment and opportunistic political behavior on the process of PPP contracting in Brazil, including the stages of public consultation, the publication of tender, and the signature of the contract, using federative-level data for the period between 2005 and 2022. Consistent with the outstanding literature, the two hypotheses are tested: first, conservative parties tend to celebrate more PPP contracts than left-leaning parties, and second, the electoral calendar has a significant effect in the process, allowing for opportunistic behaviors. Empirical results suggest that there is little evidence for the relevance of ideological leanings in the process of adopting PPPs in Brazil. Additionally, regardless of ideology, parties significantly choose to enter PPPs at specific points in the electoral cycle, suggesting decisions are influenced by political considerations and electoral strategy rather than by purely financial or ideological considerations. This may pose severe constraints on the efficiency and cost-effectiveness of the contracts, negatively impacting public governance and leading to protracted costs for taxpayers.