A integração ensino-serviço-gestão-comunidade na percepção de preceptores de graduandos na Atenção Primária à Saúde / The teaching-service-management-community integration in the perception of undergraduate students' preceptors in Primary Health Care

Resumo Orientações, normativas e incentivos nacionais como as Diretrizes Curriculares Nacionais, o Pró-Saúde e o PET-Saúde, contribuíram para fomentar um importante arranjo formativo conhecido como "integração ensino-serviço-gestão-comunidade". Nesse contexto, a preceptoria na atenção primária à saúde (APS) se destaca. Assim, é relevante conhecer, sob a ótica de preceptores, qual é a participação de cada ator desta integração e quais são as barreiras antipedagógicas e de processo de trabalho que dificultam a preceptoria. Este estudo teve como objetivo compreender fatores facilitadores e dificultadores da integração na perspectiva de preceptores de graduandos no âmbito da APS no município de São Paulo-SP. Trata-se de um estudo qualitativo, do tipo descritivo-exploratório, que utilizou entrevistas semiestruturadas com 14 preceptores, interpretadas pela análise de conteúdo temática. Como barreiras principais foram identificadas: sobrecarga de trabalho, desvalorização da saúde pública, falta de apoio pedagógico e distanciamento da comunidade no processo formativo. Entre as contribuições, destacam-se o trabalho interprofissional e a aproximação entre as instituições de ensino e a gestão quando planejam o estágio. A integração tem importantes questões a serem aperfeiçoadas ao olhar dos preceptores, tendo em vista facilitar a articulação entre os atores e transpor as barreiras formativas.

Abstract National guidelines, regulations and incentives such as the National Curricular Guidelines, Pró-Saúde and PET-Saúde, contributed to fostering an important training arrangement known as "teaching-service-management-community integration". In this context, preceptorship in primary health care (PHC) stands out. Thus, it is relevant to know, from the perspective of preceptors, what is the participation of each actor in this integration and what are the anti-pedagogical and work process barriers that make preceptorship difficult. This study aimed to understand factors that facilitate and hinder integration from the perspective of preceptors of undergraduates within the scope of PHC in the city of São Paulo-SP, Brazil. This is a qualitative, descriptive-exploratory study, which used semi-structured interviews with 14 preceptors, interpreted by thematic content analysis. As main barriers were identified: work overload, devaluation of public health, lack of pedagogical support and distance from the community in the training process. Among the contributions, interprofessional work and the approximation between educational institutions and management when planning the internship stand out. Integration has important issues to be improved from the point of view of preceptors, with a view to facilitating articulation between actors and overcoming training barriers.

Preceptorship in Family and Community Medicine: challenges and achievements in a Primary Health Care in progress. / Preceptoria em Medicina de Família e Comunidade: desafios e realizações em uma Atenção Primária à Saúde em construção.

Strengthening Primary Health Care (PHC) relies directly on training medical specialists in primary care. This text aims to report the Family Medicine training experiences in Rio de Janeiro between 2008 and 2016. It brings to reflection the development of preceptors in medical specialization through an experience report on three Family Medicine medical residency programs, namely, the Municipal Health Secretariat program, the Federal University of Rio de Janeiro program and the National School of Public Health program. The PHC reform in Rio de Janeiro created a demand for medical specialists working in networks, leading to the expansion of already established medical residency programs and the establishment of a new program sponsored by the Municipal Health Secretariat, providing new teaching positions in several health facilities within the municipal network. These three residency programs progressed through different paths to provide training to their preceptors, offering permanent courses and local actions seeking higher professional qualification and better balance between care and education responsibilities. Permanent investments to strengthen medical residency programs and preceptors training are essential to consolidate the PHC reform nationwide.

Mais Médicos no Paraná: acolhimento e o processo de trabalho na atenção básica / Mais Médicos in the state of Parana: reception and work process in primary care

Este artigo relata a experiência da tutoria e supervisão do Programa Mais Médicos no Estado do Paraná, na perspectiva de melhoria da qualidade da Atenção Básica e na capacidade dos serviços de saúde em responder de forma efetiva às necessidades dos usuários do sistema. No inicio do programa em setembro de 2015, com a chegada dos médicos nos municípios, a supervisão percebeu uma dificuldade que os serviços encontravam em relação ao Acolhimento e Processo de Trabalho nas Unidades de Saúde. Partindo desta situação os tutores e supervisores embasados nos referenciais teóricos existentes, iniciaram um processo dialógico e participativo junto aos gestores locais, estruturado a partir das visitas de supervisão, das reuniões loco regionais, dos encontros de planejamento e da execução de ações de educação em saúde, com o objetivo de garantir a acessibilidade e discutir a reorganização do processo de trabalho. Tais práticas potencializam a construção do Sistema Único de Saúde e são fundamentais para o fortalecimento da Atenção Básica.

This article reports the experience of the Mais Médicos Program tutoring and mentoring in the state of Paraná, Brazil. It focuses on quality improvement of primary health care and on health services capacity to respond effectively to users' needs. In the beginning, with the arrival of doctors in the counties on September 2015, the supervision noticed a difficulty related to reception and work process in health care units. Starting from this point, tutors and supervisors, based on the existing theoretical references, initiated a dialogic and participatory process with local managers in order to ensure accessibility and discuss the process of work reorganization. This action was based on supervisor's visits, regional meetings, planning meetings and on implementation of health education actions. Such practices influenced the construction of Unified Health System (Sistema Único de Saúde -SUS) and are essential to the consolidation of Primary Care.

Preceptorship in an international setting: Honduran nurses and American nursing working together.

An international service-learning program in a developing country that incorporates local, in-country preceptors offers a unique and valuable learning opportunity for US nursing students. Because of limited research related to the experiences of preceptors in international settings, exploring the experiences of these preceptors and their American nursing students makes a needed contribution to the literature and guides the development of international service-learning programs that meet the needs of both preceptors and students.

Implementation of a nontraditional postgraduate year 1 pharmacy residency program.

PURPOSE: The development and implementation of a nontraditional pharmacy residency program at a Veterans Affairs medical center (VAMC) are described. SUMMARY: The nontraditional pharmacy residency program at Lebanon VAMC was designed in accordance with the ASHP accreditation standard. The residency program was structured to meet staff needs without compromising patient care or significantly affecting the pharmacy services provided. The purpose statement, intended outcomes, and learning goals and objectives of the nontraditional pharmacy residency program were formulated to be equivalent to those of a traditional one-year pharmacy residency program, enabling practicing pharmacists to obtain similar overall learning experiences. The nontraditional residency program at Lebanon VAMC spans two years. The non-traditional program structure is based on a four- to six-week residency learning experience that alternates with a comparable time in the work schedule. Each required or elective learning experience ranges from four to six weeks. Longitudinal learning experiences may extend up to two years. One pharmacist was matched and began the residency in July 2012 as the inaugural nontraditional postgraduate year 1 (PGY1) pharmacy resident at Lebanon VAMC, the second institution to implement the nontraditional program within the Veterans Health Administration. The resident is expected to complete the program in June 2014 and remain committed to the Lebanon VAMC pharmacy service for a minimum of two years thereafter. CONCLUSION: A nontraditional PGY1 pharmacy residency program was successfully developed and implemented for pharmacists who aspire to complete residency training and improve their clinical, leadership, and preceptorship skills.

An international internship on social development led by Canadian nursing students: empowering learning.

BACKGROUND: A Canadian nursing student-led knowledge dissemination project on health promotion for social development was implemented with local professionals and communities in Brazil. OBJECTIVES: (a) to identify how student-interns contrasted Canadian and Brazilian cultural and social realities within a primary healthcare context from a social development perspective; (b) to examine how philosophical underpinnings, including social critical theory and notions of social justice, guided student-interns in acknowledging inequalities in primary healthcare in Brazil; and (c) to participate in the debate on the contribution of Canadian nursing students to the global movement for social development. DESIGN AND SETTING: A qualitative appraisal of short-term outcomes of an international internship in the cities of Birigui & Araçatuba (São Paulo-Brazil). PARTICIPANTS: Four Canadian fourth-year undergraduate nursing students enrolled in a metropolitan university program. METHODS: Recruitment was through an email invitation to the student-interns, who accepted, and signed informed consent forms. Their participation was unpaid and voluntary. One-time individual interviews were conducted at the end of their internships. Transcriptions of the audio-recorded interviews were coded using the qualitative software program ATLAS ti 6.0. The findings were analyzed using thematic analysis. RESULTS: Student-interns' learning unfolded from making associations among concepts, new ideas, and their previous experiences, leading to a personal transformation through which they established new conceptual and personal connections. The two main themes revealed by the thematic analysis were dichotomizing realities, that is, acknowledging the existence of "two sides of each situation," and discovering an unexpected reciprocity between global and urban health. Furthermore, the student-interns achieved personal and professional empowerment. CONCLUSIONS: The knowledge gained from the international experience helped the student-interns learn how to collaborate with Brazilian society's sectors to improve the social conditions of a "marginalized population". Student-interns became aware of their inner power to promote change by making invisible inequity visible in their own terms.

International fieldwork placements and occupational therapy: lived experiences of the major stakeholders.

INTRODUCTION: Occupational therapy students obtain a great deal of their professional preparation and experience through fieldwork placements. Although many occupational therapy students have taken part in international fieldwork placements, there is little research on this topic. As fieldwork placements are an integral part of the education of occupational therapy students, literature on the subject of international fieldwork placements is necessary. Accordingly, the aim of this study was to examine the personal and professional experiences of occupational therapy students, supervisors, and on-site staff who have taken part in an international fieldwork placement. METHODS: Qualitative interviews for this phenomenological study were administered with 14 participants who had taken part in an international fieldwork placement in Trinidad and Tobago. Data were analysed using thematic analysis. FINDINGS: Three themes emerged: collaborative learning, cultural negotiations and thinking on my own. DISCUSSION: Considering fieldwork is a critical component in the occupational therapy curriculum, it is reassuring to uncover that international placements can be of benefit to all stakeholders while achieving its primary goal of preparing students to become competent therapists. All participants developed a greater cultural awareness and appreciation, which is necessary as occupational therapists are increasingly working in diverse settings with diverse client groups. This information can also be used to enhance international fieldwork education as students continue to travel abroad to complete their mandatory fieldwork hours.

Análise discente da contribuição do preceptor e do estágio na formação do aluno de graduação da FO UERJ / Student assessment of the contribution of the instructor and internship to the training of undergraduate students at FO UERJ

O objetivo deste estudo foi analisar o impacto da contribuição do preceptor e do estágio na rede pú- blica na formação dos alunos de graduação da Faculdade de Odontologia da UERJ, através do programa Pró-Saúde. Foram analisados 95 questionários de avaliação que são distribuídos aos alunos ao final do período no qual constam as avaliações da contribuição do preceptor durante a formação do aluno, a contribuição do estágio em serviço na formação do aluno, os pontos positivos, pontos negativos e sugestões. Através das respostas obtidas podemos concluir que a realização do estágio com o suporte do preceptor aparece como recurso que contribui para ampliar a experiência e vivência do aluno, oportunizando uma aproximação significativa entre os alunos e o Sistema Único de Saúde, assim como é importante o estabelecimento da integração entre academia e serviço para o desenvolvimento de mecanismos de capacitação dos profissionais da rede através dos projetos públicos vigentes (AU).

The aim of this study was to analyze how the instructor and internship in the public healthcare system contribute to impacting the academic training of undergraduate students from the School of Dentistry, State University of Rio de Janeiro, through the "Pró-Saude" program. An analysis was made of 95 evaluation questionnaires usually distributed to undergraduate students at the end of their academic term. These questionnaires evaluate the contribution of the instructor and of the service-providing internship to the student's undergraduate training, both positive and negative aspects of the experience, and also garner suggestions. According to the replies obtained, we can conclude that the internship given with the support of the instructor was rated as a resource that contributes to broadening the student's experience. Moreover, this internship offers students a greater opportunity to develop a closer relationship with the SUS (Brazilian Unified Healthcare System), and to establish greater integration between academia and service-rendering to foster the development of training mechanisms for public healthcare professionals through the public projects currently in place (AU).

Developing a postbasic gerontology program for international learners: considerations for the process.

BACKGROUND: A private university in Chile was seeking opportunities to acquire expertise in developing distance education programs using new media technology, especially in health-related fields. An initiative was undertaken to develop a distance postbasic gerontology program for technical nurses in Chile by partnering with a Canadian school of nursing. METHOD: The instructional design process was used as a systematic approach throughout the development of the program. Attention to cultural considerations was emphasized throughout each phase of the process. RESULTS: The developed program consists of 13 self-paced print modules with web-based components and is primarily asynchronous with scheduled milestones. A 6-week preceptored clinical experience follows completion of the theory portion to support learner mastery of program outcomes. CONCLUSION: Developing international nursing education programs is an enriching experience that presents unique challenges and issues. These challenges can be overcome by using a creative, systematic approach to program development that reflects cultural considerations. Developing flexible working relationships that respect the cultural differences of international team members facilitates international initiatives.

Cambio curricular en el plan de estudios de la carrera de medicina de la Universidad de Chile / Curricular change in medical education of the Universidad de Chile

La Facultad de Medicina de la Universidad de Chile ha puesto en marcha, en el primer año 1998, cambios curriculares que consideran una mayor relevancia social de la medicina y una mayor capacidad de resolución de problemas de sus egresados. Se describe el proceso seguido para actualizar el perfil profesional, diseñar un nuevo plan de estudios que reorganiza las materias en seis subsistemas que reemplazan la organización previa de ciclos básico, preclínico y clínico, capacitar a los docentes en metodologías innovadoras, apoyar el desarrollo personal de los alumnos a través del programa de tutores y organizar y perfeccionar el campo clínico de atención primaria mediante la creación de un Departamento de Medicina Comunitaria