O ensino da Clínica Ampliada na Atenção Primária à Saúde: a prática de professores tutores e alunos de graduação médica

Detalhes bibliográficos
Autor(a) principal: Godoy, Daniele Cristina
Data de Publicação: 2018
Tipo de documento: Tese
Idioma: por
Título da fonte: Repositório Institucional da UNESP
Texto Completo: http://hdl.handle.net/11449/154787
Resumo: The contemporaneous crisis in the medicine and the challenges to the medical education have been issue for a huge international debate in the last decades. Among those challenges, there are some highlights: practice dehumanization, the individual health care fragmentation and the inequality of access to health care. In the light of this context, it has been recommended several measures to change medical training, in order to overcome such problems, among which, a closer approximation of this training with the public health systems. The structuring of the Unified Health System (SUS) in Brazil, although late, has been producing a new reorientation schedule of professional training from programs of Ministry of Health and Education, of incentives to change the graduations of the health professions. The Faculty of Medicine of Botucatu (FMB), with a long history of medical education in the community has been participating of the before mentioned programs of incentive to the restructuring of medical education. Within this scope of changes, the University-Services-Community Interaction Program (IUSC) was created in 2003. In its development, it was structured like a set of disciplines directed to undergraduation in medicine and nursing, having as teachinglearning scenario the territory, public facilities, especially basic health units, and community institutions. The practices of these disciplines are developed guided by the problematization methodology and by the conceptions of the practice humanization and the integrality of care. This study took as a field the discipline IUSC III, given to the students of the 3rd year of medical undergraduation, whose main activity is supervised medical consultation and guided by the design of the "Expanded Clinic". To achieve its goal of "developing skills and abilities to care for and promote community health" IUSC III has as pedagogical strategies: the longitudinal link, the use of the "extended anamnesis" script, case discussions with different health professionals and the use of field diaries. This research proposes to recognize the practice of professors and students in the teaching-learning process of the Expanded Clinic in Primary Health Care, through an ethnographic study of the daily life of this discipline. The field was developed during 14 months by means of bibliographical and documentary study and participant observation with record in field diary of the following moments: introduction module, observation activity and health unit recognition by the students, supervised medical consultation, case discussion meetings, clinical supervision and coordination meetings of the discipline with the professors. From the analysis of the field diaries and the documentary and bibliographic study of IUSC III pedagogical strategies, a dense description of his daily life was elaborated through dialogue with the framework of the Expanded Clinic and studies of the medical and clinical work. The study shows the power of pedagogical strategies for the development of a broader student’s view about the health needs of the users. Besides the significant receptivity of the students to a discipline of clinical practice in which the student has an active role already in the third year, part of them are resistant to the production of narratives from clinical encounters. The clinical experience in primary care is challenging for students, faced with a demand that is placed on a border between the problems of life and the well-defined diagnosis, Abstract which adds to the ambiguity and uncertainty of knowledge itself and medical practice. The analysis of this experience of students and professors with the teaching of the Expanded Clinic in Primary Health Care, although takes just a little space in the curriculum, it is fertile for reflection on medical teaching and possible paths and strategies for graduation change.
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spelling O ensino da Clínica Ampliada na Atenção Primária à Saúde: a prática de professores tutores e alunos de graduação médicaThe expanded clinic teaching in the Primary Health Care: the practice of professors and undergraduate medical studentsAtenção Primária à SaúdeEducação MédicaEstratégias Pedagógicas para o ensinoClínica AmpliadaPesquisa EtnográficaEthnographic ResearchMedical EducationPrimary Health CareExpanded ClinicPedagogical Strategies for TeachingThe contemporaneous crisis in the medicine and the challenges to the medical education have been issue for a huge international debate in the last decades. Among those challenges, there are some highlights: practice dehumanization, the individual health care fragmentation and the inequality of access to health care. In the light of this context, it has been recommended several measures to change medical training, in order to overcome such problems, among which, a closer approximation of this training with the public health systems. The structuring of the Unified Health System (SUS) in Brazil, although late, has been producing a new reorientation schedule of professional training from programs of Ministry of Health and Education, of incentives to change the graduations of the health professions. The Faculty of Medicine of Botucatu (FMB), with a long history of medical education in the community has been participating of the before mentioned programs of incentive to the restructuring of medical education. Within this scope of changes, the University-Services-Community Interaction Program (IUSC) was created in 2003. In its development, it was structured like a set of disciplines directed to undergraduation in medicine and nursing, having as teachinglearning scenario the territory, public facilities, especially basic health units, and community institutions. The practices of these disciplines are developed guided by the problematization methodology and by the conceptions of the practice humanization and the integrality of care. This study took as a field the discipline IUSC III, given to the students of the 3rd year of medical undergraduation, whose main activity is supervised medical consultation and guided by the design of the "Expanded Clinic". To achieve its goal of "developing skills and abilities to care for and promote community health" IUSC III has as pedagogical strategies: the longitudinal link, the use of the "extended anamnesis" script, case discussions with different health professionals and the use of field diaries. This research proposes to recognize the practice of professors and students in the teaching-learning process of the Expanded Clinic in Primary Health Care, through an ethnographic study of the daily life of this discipline. The field was developed during 14 months by means of bibliographical and documentary study and participant observation with record in field diary of the following moments: introduction module, observation activity and health unit recognition by the students, supervised medical consultation, case discussion meetings, clinical supervision and coordination meetings of the discipline with the professors. From the analysis of the field diaries and the documentary and bibliographic study of IUSC III pedagogical strategies, a dense description of his daily life was elaborated through dialogue with the framework of the Expanded Clinic and studies of the medical and clinical work. The study shows the power of pedagogical strategies for the development of a broader student’s view about the health needs of the users. Besides the significant receptivity of the students to a discipline of clinical practice in which the student has an active role already in the third year, part of them are resistant to the production of narratives from clinical encounters. The clinical experience in primary care is challenging for students, faced with a demand that is placed on a border between the problems of life and the well-defined diagnosis, Abstract which adds to the ambiguity and uncertainty of knowledge itself and medical practice. The analysis of this experience of students and professors with the teaching of the Expanded Clinic in Primary Health Care, although takes just a little space in the curriculum, it is fertile for reflection on medical teaching and possible paths and strategies for graduation change.A crise contemporânea da medicina e os desafios à educação médica tem sido objeto de um grande debate internacional nas últimas décadas. Dentre estes desafios destacam-se a desumanização da prática, a fragmentação do cuidado médico individual e a desigualdade de acesso a atenção à saúde. Diante deste contexto têm se recomendado inúmeras medidas de mudança da formação médica para superar tais problemas dentre as quais uma maior aproximação desta formação com os sistemas públicos de saúde. A estruturação do Sistema Único de Saúde (SUS) no Brasil, ainda que tardiamente, vem produzindo uma nova agenda de reorientação da formação profissional a partir de programas, do Ministério da Saúde e da Educação, de incentivo à mudança das graduações das profissões da saúde. A Faculdade de Medicina de Botucatu (FMB), com uma longa trajetória de ensino médico na comunidade vem participando dos referidos programas de incentivo à reestruturação do ensino médico. Dentro deste escopo de mudanças foi criado o Programa Interação Universidade-Serviços-Comunidade (IUSC) em 2003. Em seu desenvolvimento estruturou-se como um conjunto de disciplinas dirigidas à graduação em medicina e enfermagem, tendo como cenário de ensino-aprendizagem o território, equipamentos públicos, em especial as unidades básicas de saúde, e instituições comunitárias. As práticas destas disciplinas se desenvolvem orientadas pela metodologia da problematização e pelas concepções da humanização da prática e a integralidade do cuidado. Este estudo tomou como campo a disciplina IUSC III, ministrada aos alunos do 3º ano de graduação médica, que tem como atividade principal a consulta médica supervisionada e orientada pela concepção da “Clínica Ampliada”. Para alcançar seu objetivo de “desenvolver competências e habilidades para a atenção e promoção da saúde da comunidade” a IUSC III tem como estratégias pedagógicas: o vínculo longitudinal, o uso de roteiro de “anamnese ampliada”, discussões de casos com diferentes profissionais dos serviços de saúde e o uso de diário de campo. Esta pesquisa se propõe a reconhecer a prática de professores-tutores e alunos no processo de ensino-aprendizagem da Clínica Ampliada na Atenção Primária à Saúde, mediante estudo etnográfico do cotidiano desta disciplina. O campo desenvolveu-se durante 14 meses por meio de estudo bibliográfico e documental e observação participante com registro em diário de campo dos seguintes momentos: módulo de introdução, atividade de observação e reconhecimento da unidade de saúde pelos alunos, consulta médica supervisionada, reuniões de discussão de casos, supervisão clínica e reuniões da coordenação da disciplina com os professores-tutores. A partir da análise dos diários de campo e do estudo documental e bibliográfico das estratégias pedagógicas da IUSC III elaborou-se uma descrição densa do seu cotidiano, mediante diálogo com o referencial da Clínica Ampliada e estudos do trabalho médico e da Clínica. O estudo mostra a potência das estratégias pedagógicas para o desenvolvimento de um olhar ampliado do aluno sobre as necessidades de saúde dos usuários. Em que pese a significativa receptividade dos alunos a uma disciplina de prática clínica na qual o aluno tem um papel ativo já no terceiro ano, parte deles mostram-se resistentes à produção de narrativas dos encontros clínicos. A experiência da clínica na atenção primária é desafiadora para os alunos, diante de uma demanda que se coloca numa fronteira entre os problemas da vida e o diagnóstico bem definido, a qual se soma a ambiguidade e a incerteza do próprio conhecimento e da prática médica. A análise desta experiência de alunos e professores-tutores com o ensino da Clínica Ampliada na Atenção Primária à Saúde, embora ocupe um pequeno espaço no currículo, mostra-se fértil para a reflexão sobre o ensino médico e possíveis caminhos e estratégias para a mudança da graduação. Palavras-chave: Educação Médica; Atenção Primária à Saúde; Clínica Ampliada; Pesquisa Etnográfica; Estratégias Pedagógicas para o Ensino.Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)CAPES: 024/2010-40Universidade Estadual Paulista (Unesp)Carneiro, Rosamaria GiattiCyrino, Antônio P. Pithon [UNESP]Universidade Estadual Paulista (Unesp)Godoy, Daniele Cristina2018-08-03T13:44:07Z2018-08-03T13:44:07Z2018-05-24info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/doctoralThesisapplication/pdfhttp://hdl.handle.net/11449/15478700090659733004064078P9porinfo:eu-repo/semantics/openAccessreponame:Repositório Institucional da UNESPinstname:Universidade Estadual Paulista (UNESP)instacron:UNESP2024-09-04T13:29:18Zoai:repositorio.unesp.br:11449/154787Repositório InstitucionalPUBhttp://repositorio.unesp.br/oai/requestrepositoriounesp@unesp.bropendoar:29462024-09-04T13:29:18Repositório Institucional da UNESP - Universidade Estadual Paulista (UNESP)false
dc.title.none.fl_str_mv O ensino da Clínica Ampliada na Atenção Primária à Saúde: a prática de professores tutores e alunos de graduação médica
The expanded clinic teaching in the Primary Health Care: the practice of professors and undergraduate medical students
title O ensino da Clínica Ampliada na Atenção Primária à Saúde: a prática de professores tutores e alunos de graduação médica
spellingShingle O ensino da Clínica Ampliada na Atenção Primária à Saúde: a prática de professores tutores e alunos de graduação médica
Godoy, Daniele Cristina
Atenção Primária à Saúde
Educação Médica
Estratégias Pedagógicas para o ensino
Clínica Ampliada
Pesquisa Etnográfica
Ethnographic Research
Medical Education
Primary Health Care
Expanded Clinic
Pedagogical Strategies for Teaching
title_short O ensino da Clínica Ampliada na Atenção Primária à Saúde: a prática de professores tutores e alunos de graduação médica
title_full O ensino da Clínica Ampliada na Atenção Primária à Saúde: a prática de professores tutores e alunos de graduação médica
title_fullStr O ensino da Clínica Ampliada na Atenção Primária à Saúde: a prática de professores tutores e alunos de graduação médica
title_full_unstemmed O ensino da Clínica Ampliada na Atenção Primária à Saúde: a prática de professores tutores e alunos de graduação médica
title_sort O ensino da Clínica Ampliada na Atenção Primária à Saúde: a prática de professores tutores e alunos de graduação médica
author Godoy, Daniele Cristina
author_facet Godoy, Daniele Cristina
author_role author
dc.contributor.none.fl_str_mv Carneiro, Rosamaria Giatti
Cyrino, Antônio P. Pithon [UNESP]
Universidade Estadual Paulista (Unesp)
dc.contributor.author.fl_str_mv Godoy, Daniele Cristina
dc.subject.por.fl_str_mv Atenção Primária à Saúde
Educação Médica
Estratégias Pedagógicas para o ensino
Clínica Ampliada
Pesquisa Etnográfica
Ethnographic Research
Medical Education
Primary Health Care
Expanded Clinic
Pedagogical Strategies for Teaching
topic Atenção Primária à Saúde
Educação Médica
Estratégias Pedagógicas para o ensino
Clínica Ampliada
Pesquisa Etnográfica
Ethnographic Research
Medical Education
Primary Health Care
Expanded Clinic
Pedagogical Strategies for Teaching
description The contemporaneous crisis in the medicine and the challenges to the medical education have been issue for a huge international debate in the last decades. Among those challenges, there are some highlights: practice dehumanization, the individual health care fragmentation and the inequality of access to health care. In the light of this context, it has been recommended several measures to change medical training, in order to overcome such problems, among which, a closer approximation of this training with the public health systems. The structuring of the Unified Health System (SUS) in Brazil, although late, has been producing a new reorientation schedule of professional training from programs of Ministry of Health and Education, of incentives to change the graduations of the health professions. The Faculty of Medicine of Botucatu (FMB), with a long history of medical education in the community has been participating of the before mentioned programs of incentive to the restructuring of medical education. Within this scope of changes, the University-Services-Community Interaction Program (IUSC) was created in 2003. In its development, it was structured like a set of disciplines directed to undergraduation in medicine and nursing, having as teachinglearning scenario the territory, public facilities, especially basic health units, and community institutions. The practices of these disciplines are developed guided by the problematization methodology and by the conceptions of the practice humanization and the integrality of care. This study took as a field the discipline IUSC III, given to the students of the 3rd year of medical undergraduation, whose main activity is supervised medical consultation and guided by the design of the "Expanded Clinic". To achieve its goal of "developing skills and abilities to care for and promote community health" IUSC III has as pedagogical strategies: the longitudinal link, the use of the "extended anamnesis" script, case discussions with different health professionals and the use of field diaries. This research proposes to recognize the practice of professors and students in the teaching-learning process of the Expanded Clinic in Primary Health Care, through an ethnographic study of the daily life of this discipline. The field was developed during 14 months by means of bibliographical and documentary study and participant observation with record in field diary of the following moments: introduction module, observation activity and health unit recognition by the students, supervised medical consultation, case discussion meetings, clinical supervision and coordination meetings of the discipline with the professors. From the analysis of the field diaries and the documentary and bibliographic study of IUSC III pedagogical strategies, a dense description of his daily life was elaborated through dialogue with the framework of the Expanded Clinic and studies of the medical and clinical work. The study shows the power of pedagogical strategies for the development of a broader student’s view about the health needs of the users. Besides the significant receptivity of the students to a discipline of clinical practice in which the student has an active role already in the third year, part of them are resistant to the production of narratives from clinical encounters. The clinical experience in primary care is challenging for students, faced with a demand that is placed on a border between the problems of life and the well-defined diagnosis, Abstract which adds to the ambiguity and uncertainty of knowledge itself and medical practice. The analysis of this experience of students and professors with the teaching of the Expanded Clinic in Primary Health Care, although takes just a little space in the curriculum, it is fertile for reflection on medical teaching and possible paths and strategies for graduation change.
publishDate 2018
dc.date.none.fl_str_mv 2018-08-03T13:44:07Z
2018-08-03T13:44:07Z
2018-05-24
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