Barriers and Facilitators of the Teaching-Learning Process of Medical Students in Primary Care in the City of São Paulo

Moniquelly Barbosa Da Silva,Izabel Rios,Pedro Félix Vital Júnior,Andréa Tenório Correia Da Silva

doi:10.1590/1981-5271v44.2-20190175

Moniquelly Barbosa Da Silva, Izabel Rios + Show 2 more

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https://doi.org/10.1590/1981-5271v44.2-20190175

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Abstract

Abstract: Introduction: Although Primary Health Care (PHC) is essential for medical students’ training, the perceptions of primary care workers about the teaching-learning process have been overlooked, particularly in municipalities where PHC management is performed by a private organization instead of the government, such as in the city of São Paulo. Objective: to analyze the perceptions of primary care workers about barriers and facilitators of medical students’ teaching-learning process in PHC in the city of São Paulo. Method: we conducted a qualitative research. We performed in-depth interviews with 12 primary care workers from the family health teams (four physicians, four nurses and four community health workers), who worked in primary care clinics in the east region of the city and received medical students, from 1st-year to internship students. The interviews were recorded, transcribed and afterwards, they were repeatedly read. We identified thematic units following the content analysis principles. Results: the barriers to medical students’ teaching-learning process in PHC were the following: (1) excessive number of scheduled patients and scarcity of time for discussion; (2) inadequate infrastructure of primary care clinics; (3) lack of training; and (4) ineffective integration among faculty, healthcare workers, managers and the assisted population. The facilitating factors of the teaching-learning process were: (1) high quality of healthcare services; (2) integration among primary care teams, interdisciplinary teams, and students; and (3) well-trained medical preceptors. Conclusions: our results have implications for PHC professionals, educational institutions, and managers. The improvement of the integration among educational institutions, health services managers, primary care workers, and the population is a condition to reach the effectiveness in the teaching-learning process, and to ensure the development of essential competencies for PHC assistance quality. Thus, the training of health professionals, improving the primary care clinic infrastructure, and creating strategies to ensure enough time for discussion and feedback could contribute to mitigate barriers to medical students’ teaching-learning process in PHC.

Highlights

Primary Health Care (PHC) is essential for medical students’ training, the perceptions of primary care workers about the teaching-learning process have been overlooked, in municipalities where PHC management is performed by a private organization instead of the government, such as in the city of São Paulo
Guidelines (NCG) for the 2014 Medical undergraduate course recommends an increase in the workload of internships in Primary Health Care (PHC) and postulate that the essential contents of the undergraduate course in medicine should establish a dialogue with the main health needs identified in the population, allowing the early inclusion of students in practical activities, as well as the use of different teaching-learning scenarios[1]
The research subjects were chosen according to qualitative selection criteria that characterize them as good key informants, that is, people capable of expressing their opinions well and who are recognized for their role in the environment where they work

Summary

Introduction

Primary Health Care (PHC) is essential for medical students’ training, the perceptions of primary care workers about the teaching-learning process have been overlooked, in municipalities where PHC management is performed by a private organization instead of the government, such as in the city of São Paulo. Primary Health Care is a privileged teaching-learning context for the understanding of the population’s health needs and for the student to experience a set of actions associated to care, from the treatment of illnesses, disease prevention and health promotion to health management, such as teamwork, care coordination, and articulation of care networks in the Brazilian National Health System (SUS, Sistema Único de Saúde)[2,3,4] In this sense, some of PHC contributions to medical education would be: dealing with different contexts and life cycles of the assisted population, their clinical, social and cultural complexities; constituting a scenario of practices in which the integration of different fields of knowledge occurs and favoring integrated and interdisciplinary clinical practice; allowing the understanding of the intersectoral health care network; contributing to the development of cultural competence and health communication; and dealing with complex problems continuously and longitudinally[4].

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Results