O ensino da atenção primária à saúde no internato médico das universidades públicas da Região Norte
Data
2013
Autores
Silva, Flávio Dias da [UNIFESP]
Orientadores
Seiffert, Otilia Maria Lúcia Barbosa [UNIFESP]
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Desde 1996 o Brasil optou por investir na Atenção Primária à Saúde (APS) como base estruturante do Sistema Único de Saúde (SUS) através da Estratégia Saúde da Família (ESF). Esta decisão implicou em um aumento significativo da demanda de médicos generalistas. A escassez de médicos especialistas (Médicos de Família e Comunidade – MFC’s) tem feito com que boa parte dos postos de trabalho na ESF esteja sendo ocupada por recém-graduados e/ou médicos não especialistas em APS. Este cenário mostra e demanda às escolas médicas a formação de profissionais aptos ao trabalho nesta área da saúde. O objetivo desta pesquisa foi avaliar como está sendo realizado o ensino das competências necessárias para o trabalho em APS durante o Internato nas escolas públicas da região Norte do Brasil. Sete escolas públicas da região Norte participaram da pesquisa. Optou-se por uma abordagem quanti-qualitativa, que foi realizada por três métodos: pesquisa documental dos projetos pedagógicos dos cursos (PPCs) e programas de Internato; aplicação de questionário semi-estruturado aos coordenadores dos programas de Internato; e, por fim, entrevista com estes coordenadores. Os dados documentais e empíricos obtidos permitem evidenciar que o ensino das competências no Internato ainda está distante de ser adequado às necessidades do médico que trabalhará na ESF. Apesar dos PPCs revelarem que as escolas estudadas buscam formar profissionais com perfil generalista e identificados com as necessidades da comunidade amazônica, nota-se que o percurso formativo não está fortemente orientado para a APS. Os achados indicam programas de Internato com uma carga horária insuficiente para o ensino da APS; estágios em outras áreas da saúde não voltados ao ensino de competências generalistas uma vez que o enfoque ainda é em medicina hospitalar e atenção secundária ou terciária; ausência de definição de uma matriz de competências a ser desenvolvidas ao longo do Internato; não explicitação clara nos PPCs dos métodos de avaliação de competências dos internos; dificuldades de encontrar preceptores qualificados e disponíveis; estrutura precária das Unidades de Saúde; obstáculos na integração entre universidade e serviços de saúde; e a insignificante atratividade do campo da APS para o interno. Apesar destas sinalizações todos os programas de Internato estudados contemplam estágio na ESF, correspondendo no máximo a vinte por cento da carga total. Ao menos metade das escolas tem realizado estágio em municípios do interior (estágio Rural), iniciativa com potencial indutor de interiorização dos profissionais médicos. Apreende-se das manifestações dos Coordenadores que há necessidade de uma reorientação do currículo da graduação e do próprio Internato em direção a uma maior ênfase no ensino da APS. Frente aos desafios de mudanças na formação do médico no país, este trabalho culmina com uma proposta de diretrizes para orientação do internato médico para a atenção primária à saúde, ganhando especial significância com o recém-lançado Programa Mais Médicos (2013), que, entre outras ações, sugere uma maior aproximação com a APS durante a formação médica.
Since 1996, Brazil chose to invest in Primary Health Care (PHC) as a basis for organization of the Unified Health System (SUS) through the Family Health Strategy (FHS). This decision resulted in a significant increase in demand for general practitioners. The low number of specialized doctors (Family and Community Physicians – FCP’s) has made much of the jobs in the FHS is being occupied by recent graduates and/or non-expert general practitioners. This scenario demands for medical schools to train professionals able to work in this area of health. The objective of this research was to assess how it is being done teaching the skills needed to work in APS during the medical internship in the public schools of northern Brazil. Seven public schools in the northern region participated. We opted for a quantitative and qualitative approach, which was performed by three methods: desk research of the pedagogical projects (PPs) and internship programs, application of semi-structured questionnaire to the coordinators of the internship programs, and, finally, interview with these coordinators. The data obtained allow documentary and empirical evidence that the teaching of skills in the internship is still far from adequate to the needs of the physician who will work in the FHS. Despite PPs reveal that the studied schools seek to prepare students with generalist profile and identified with community needs of Amazon region, we note that the training path is not strongly oriented to PHC. The findings indicate internship programs with insufficient workload for teaching PHC ; placements in other health areas not geared to teaching generalist skills since the focus is still in hospital medicine and secondary or tertiary care; lack of definition of an array of skills to be developed during the internship; no clear explanation of the skills assessment methods; difficulties to find qualified and available preceptors ; precarious structure of the Health Units; obstacles in the integration between university and health services; low attractiveness of the field of PHC. Despite all these caveats internship programs studied include the FHS rotation, corresponding to a maximum of twenty percent of the total internship load. At least half of the schools have performed rotation municipalities (Rural rotation), initiative with the potential to induce inner country migration of medical professionals. Coordinators of internship programs said that there’s a need for a reorientation of the undergraduate curriculum and the internship itself toward a greater emphasis on teaching PHC. The challenges of change in medical training in the country, this work culminates with a proposal of guidelines for medical internship orientation to primary health care, gaining special significance with the newly launched Program ―Mais Médicos‖ (2013) , which, among other actions, suggests a closer relationship of medical training with PHC.
Since 1996, Brazil chose to invest in Primary Health Care (PHC) as a basis for organization of the Unified Health System (SUS) through the Family Health Strategy (FHS). This decision resulted in a significant increase in demand for general practitioners. The low number of specialized doctors (Family and Community Physicians – FCP’s) has made much of the jobs in the FHS is being occupied by recent graduates and/or non-expert general practitioners. This scenario demands for medical schools to train professionals able to work in this area of health. The objective of this research was to assess how it is being done teaching the skills needed to work in APS during the medical internship in the public schools of northern Brazil. Seven public schools in the northern region participated. We opted for a quantitative and qualitative approach, which was performed by three methods: desk research of the pedagogical projects (PPs) and internship programs, application of semi-structured questionnaire to the coordinators of the internship programs, and, finally, interview with these coordinators. The data obtained allow documentary and empirical evidence that the teaching of skills in the internship is still far from adequate to the needs of the physician who will work in the FHS. Despite PPs reveal that the studied schools seek to prepare students with generalist profile and identified with community needs of Amazon region, we note that the training path is not strongly oriented to PHC. The findings indicate internship programs with insufficient workload for teaching PHC ; placements in other health areas not geared to teaching generalist skills since the focus is still in hospital medicine and secondary or tertiary care; lack of definition of an array of skills to be developed during the internship; no clear explanation of the skills assessment methods; difficulties to find qualified and available preceptors ; precarious structure of the Health Units; obstacles in the integration between university and health services; low attractiveness of the field of PHC. Despite all these caveats internship programs studied include the FHS rotation, corresponding to a maximum of twenty percent of the total internship load. At least half of the schools have performed rotation municipalities (Rural rotation), initiative with the potential to induce inner country migration of medical professionals. Coordinators of internship programs said that there’s a need for a reorientation of the undergraduate curriculum and the internship itself toward a greater emphasis on teaching PHC. The challenges of change in medical training in the country, this work culminates with a proposal of guidelines for medical internship orientation to primary health care, gaining special significance with the newly launched Program ―Mais Médicos‖ (2013) , which, among other actions, suggests a closer relationship of medical training with PHC.
Descrição
Citação
SILVA, Flávio Dias da. O ensino da atenção primária à saúde no internato médico das universidades públicas da Região Norte. 2013. 150f. Dissertação (Mestrado Profissional em Ensino em Ciências da Saúde) – Escola Paulista de Enfermagem, Universidade Federal de São Paulo, São Paulo, 2013.