A gestão da integração ensino serviço nas escolas médicas do Paraná
Data
2021-05-14
Autores
Zarpelon, Luis Fernando Boff 
Orientadores
Batista, Nildo Alves
Tipo
Tese de doutorado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Para superar os desafios da educação médica, a integração com o sistema de saúde deve estar no centro do desenho curricular da formação, da mesma forma que a organização do trabalho em saúde deve prever a incorporação de processos formativos permanentes em todos os níveis. Suportar a complexa rede resultante dessa integração, caracterizada por relações interinstitucionais, policêntricas, de natureza horizontal e interdependentes, requer novos modelos de gestão. O objetivo deste trabalho foi analisar os processos de gestão da integração ensino serviço comunidade nas escolas médicas do Paraná, apreendendo as concepções dos gestores sobre o tema, conhecendo as práticas de integração produzidas no território, identificando os fatores determinantes dessas relações, analisando os modos e processos de avaliação utilizados e as características gerenciais/operacionais existentes. Trata-se de um estudo transversal, qualitativo, exploratório, descritivo e explicativo conduzido entre coordenadores de curso de escolas médicas com ao menos um ciclo formativo completo e gestores do SUS dos seus respectivos territórios. O conjunto final foi composto por 9 escolas médicas (75% do total elegível), sendo 4 públicas, 3 filantrópicas e 2 de fins lucrativos, correspondendo respectivamente a 80%, 75% e 100% das escolas elegíveis em cada segmento. O grupo de gestores foi formado por 4 secretários municipais e 3 diretores de regional de saúde das regiões de maior densidade populacional e com maior número de equipamentos de saúde do Estado, além de um representante da Comissão Estadual de Integração Ensino Serviço Comunidade. Os dados foram produzidos pela aplicação de entrevistas semi estruturadas em cinco eixos temáticos a partir de questões norteadoras que buscavam alcançar os objetivos estabelecidos e submetidos a análise de conteúdo de Bardin, na modalidade análise temática. Os resultados demonstram que os processos de integração configuram uma rede gestora de política e se expressam em termos dos efeitos produzidos por estas relações; que as práticas produzidas no cotidiano resultam de uma governança que não considera as características intrínsecas de uma rede gestora; que os fatores determinantes destas relações estão ligados ao arcabouço jurídico vigente, a capacidade em alinhar-se ao mesmo e aos mecanismos gerenciais envolvidos; que os processos avaliativos são frágeis, baseados em percepções, inconstantes, pouco priorizados e raramente utilizados para subsidiar as decisões; e que os processos gerenciais existentes não dão conta de atender as complexidades de um sistema em rede. A integração ensino serviço no território pesquisado, embora compreendida como uma rede gestora de política, não é gerida como tal. Disso resultam práticas inadequadas de integração, que inviabilizam o aprimoramento dos sistemas avaliativos, comprometem a formação consentânea e sobrecarregam em demasia o sistema de saúde. Os novos requisitos da formação médica, para além dos aspectos regulatórios, exigem uma formação que transcenda o aparato escolar e repouse sobre todo sistema de saúde, reclamando novos e complexos arranjos de governança entre escolas e serviços, para os quais o entendimento das redes gestoras de política é indispensável.
To overcome the challenges in medical education, integration between medical schools and health systems should attend a central position in the curriculum design. In the same way, the organization of the health system must allow the inclusion of education processes at all levels. Supporting the complex network resulting from this integration, characterized by inter-institutional, polycentric, horizontal, and interdependent relations require new management models. The objective of this work was to analyze the management processes of teaching service community integration in medical schools in Paraná State. Apprehending the managers' conceptions on the theme, knowing the integration practices produced in the territory, identifying the determining factors of these relationships, analyzing the ways and processes of evaluation used and managerial characteristics concerned. It is a cross-sectional, qualitative, exploratory, descriptive, and explanatory study of which participated deans of medical schools with at least one complete training cycle and managers of the health system of schools’ territories. The final set consisted of 9 medical schools (75% of the total eligible), 4 of which are public, 3 are philanthropic, and 2 are for-profit, corresponding to 80%, 75%, and 100%, respectively, of the eligible schools in each segment. The group of health system managers had 4 municipal health secretaries and 3 regional health directors who represented the regions with the highest population density and the largest number of health equipment in the State. In addition to a representative of the State Commission Integration Teaching Community Service. Data produced by the application of semi-structured interviews in five thematic axes based on guiding questions that sought to achieve the objectives established. Then submitted to content analysis by Bardin, in the thematic analysis modality. Results show that the integration processes between medical schools and the health systems configure to a policy management network and are expressed in terms of the effects produced by these relationships. Practices produced in quotidian result from governance that does not consider the intrinsic characteristics of a management network. The determinants of these relationships correlated to the legal framework, the ability to align with it, and the management mechanisms involved. Evaluation processes are fragile, based on perceptions, inconstant, slightly prioritized, and rarely used to support decisions and current management processes are not able to answer the complexities of a networked system. Integration between medical teaching and the health service, in the researched territory, although be understood as a policy management network, is not managed as such. Results in inadequate integration practices, which hinder the improvement of evaluation systems, hamper the appropriate training, and overburden the health system. The new requirements of medical education, in addition to regulatory aspects, require training that transcends the school apparatus and lies on the entire health system, demanding new and complex governance arrangements between schools and services, for which the understanding of policy management networks is indispensable.
To overcome the challenges in medical education, integration between medical schools and health systems should attend a central position in the curriculum design. In the same way, the organization of the health system must allow the inclusion of education processes at all levels. Supporting the complex network resulting from this integration, characterized by inter-institutional, polycentric, horizontal, and interdependent relations require new management models. The objective of this work was to analyze the management processes of teaching service community integration in medical schools in Paraná State. Apprehending the managers' conceptions on the theme, knowing the integration practices produced in the territory, identifying the determining factors of these relationships, analyzing the ways and processes of evaluation used and managerial characteristics concerned. It is a cross-sectional, qualitative, exploratory, descriptive, and explanatory study of which participated deans of medical schools with at least one complete training cycle and managers of the health system of schools’ territories. The final set consisted of 9 medical schools (75% of the total eligible), 4 of which are public, 3 are philanthropic, and 2 are for-profit, corresponding to 80%, 75%, and 100%, respectively, of the eligible schools in each segment. The group of health system managers had 4 municipal health secretaries and 3 regional health directors who represented the regions with the highest population density and the largest number of health equipment in the State. In addition to a representative of the State Commission Integration Teaching Community Service. Data produced by the application of semi-structured interviews in five thematic axes based on guiding questions that sought to achieve the objectives established. Then submitted to content analysis by Bardin, in the thematic analysis modality. Results show that the integration processes between medical schools and the health systems configure to a policy management network and are expressed in terms of the effects produced by these relationships. Practices produced in quotidian result from governance that does not consider the intrinsic characteristics of a management network. The determinants of these relationships correlated to the legal framework, the ability to align with it, and the management mechanisms involved. Evaluation processes are fragile, based on perceptions, inconstant, slightly prioritized, and rarely used to support decisions and current management processes are not able to answer the complexities of a networked system. Integration between medical teaching and the health service, in the researched territory, although be understood as a policy management network, is not managed as such. Results in inadequate integration practices, which hinder the improvement of evaluation systems, hamper the appropriate training, and overburden the health system. The new requirements of medical education, in addition to regulatory aspects, require training that transcends the school apparatus and lies on the entire health system, demanding new and complex governance arrangements between schools and services, for which the understanding of policy management networks is indispensable.
Descrição
Citação
ZARPELON, Luis Fernando Boff. A gestão da integração ensino serviço nas escolas médicas do Paraná. 2021. 194 f. Tese (Doutorado Interdisciplinar em Ciências da Saúde) - Instituto de Saúde e Sociedade, Universidade Federal de São Paulo, São Paulo, 2021.