Health Residency Program Research Articles

(RE)THINKING CARE IN PROFESSIONAL HEALTH TRAINING: EXPERIENCE REPORT

This study focuses on the mental health of residents who worked during the Covid-19 crisis, with the primary objective of contributing to the enhancement of healthcare provided during their professional training in hospital settings. The aim of this study was to promote the care of residents in their professional training within the hospital context. In pursuit of this intention, the study drew upon the experiences of residents and analyzed the pedagogical project of a multiprofessional residency program as well as its Internal Regulations regarding caregiver care. The goal was to contribute to healthcare training programs in the state of Pernambuco, Brazil, based on the practices of residents, serving as guiding principles for clinical activities. Data collection instruments included Narrative Interviews, Document Analysis, and the Researcher's Field Diary. In the interpretation of the residents' narrative data, Gadamer's hermeneutical concept of horizon fusion in human dialogue was employed. The study participants consisted of four professionals from a Multiprofessional Residency Program in Health at a hospital in the Agreste region of Pernambuco. The sample was non-probabilistic and intentional, selecting residents of both genders who were part of the program. As a result, the study highlights the importance of exploring new possibilities and strategies to support residents in their training, transcending established norms, with the aim of promoting openness to listening to their voices, which were previously neglected. It is crucial to facilitate interactions in which their voices are heard, allowing their experiences to gain visibility and influence healthcare interventions, policies, and professional training.

Gestão de programas de residência em saúde: uma revisão de escopo

Abstract This scoping review aimed to comprehensively map various facets of managing Health Residency Programs, considering all actors and adopting the guidelines established by the JBI. Databases comprised LILACS and MEDLINE via PubMed, SCOPUS, EMBASE, CINAHL with full text, academic source or EBSCO, and Web of Science, among others. A total of 17,114 documents were identified, with 32 articles related to the management of Health Residency Programs included after duplicate removal and title, abstract, and full article reading. The management categories listed in this study resulted from mapping the analyzed articles. Highlighted aspects of people management include recruitment, resident selection, and preceptor training. Regarding organization, the emphasized aspects encompass structuring and reorganizing communication within the residency program and challenges associated with organizing activities.

Training for the Brazilian National Health System (SUS) in health residency programs: an analysis of policy effects in a state context

Este artigo analisa o contexto dos efeitos da política de residência em área profissional da saúde no estado de Pernambuco, Brasil, por meio do referencial teórico-analítico da Abordagem do Ciclo de Políticas. Trata-se de um estudo qualitativo que utilizou entrevista semiestruturada com nove atores-chave e pesquisa documental, explorada pela análise de conteúdo temática. Como resultados da política, observaram-se: fortalecimento do papel do Sistema Único de Saúde (SUS) na regulação da formação, elevada qualificação dos profissionais de saúde, qualidade do cuidado e ampliação do acesso. O investimento na implementação da política, enquanto lócus privilegiado de articulação entre ensino, serviço e comunidade, potencializa o alcance da integralidade da atenção ao mesmo tempo que contribui para avançar as mudanças necessárias na formação superior em Saúde e nas práticas de cuidado, ainda que persistam limites.

Implementation of the Family and Community Medicine and Multidisciplinary Family Health Residency programs of the Municipal Health Department of Campo Grande-MS, Brazil

Resumo Embora haja aumento do número de vagas de residência médica em medicina de família e comunidade, ainda há má distribuição. Esses programas de residência apresentam uma cooperação com a Fundação Oswaldo Cruz através de ações embasadas e aplicáveis na prática, com a inovação de tecnologias assistenciais. Resultados mostram crescimento na evolução dos atendimentos médicos, de enfermagem e odontológicos, com percentuais de 86,94%, 81,97%, 81,80% e 66,00%, respectivamente. A melhoria da qualidade do registro, a mudança do processo de trabalho na odontologia e o empoderamento da enfermagem, com protocolos assistenciais são os principais resultados.

Implementation of the Family and Community Medicine and Multidisciplinary Family Health Residency programs of the Municipal Health Department of Campo Grande-MS, Brazil

Resumen Aunque hay un aumento en el número de vacantes de residencias médicas en medicina familiar y comunitaria, todavía hay una mala distribución. Estos programas de residencia presentan cooperación con la Fundación Oswaldo Cruz a través de acciones basadas y aplicables en la práctica, con la innovación de tecnologías asistenciales. Los resultados muestran un crecimiento en la evolución de la atención médica, de enfermería y odontológica, con porcentajes del 86,94%, 81,97%, 81,80% y 66,00%, respectivamente. Mejorar la calidad de los registros, cambiar el proceso de trabajo en odontología y empoderar a la enfermería, con protocolos de atención, son los principales resultados.

Management of health residency programs: a scoping review

Resumo O objetivo do estudo foi mapear os aspectos relacionados à gestão de programas de residência em saúde considerando todos os atores envolvidos. Trata-se de uma revisão de escopo adotando as diretrizes estabelecidas pelo JBI. Foram utilizadas como fontes de informação LILACS, MEDLINE, via PubMed, SCOPUS, EMBASE, CINAHL with Full Text e Fonte Acadêmica/EBSCO e Web of Science, entre outras descritas na seção método. Com a estratégia de busca, identificaram-se 17.114 documentos, e após o processo de análise, que envolveu remoção de duplicatas, leitura de título, resumo e textos completos, 32 documentos foram incluídos na revisão, por estarem relacionados à gestão de programas de residência em saúde. A partir do mapeamento desses documentos, surgiram categorias que estavam relacionadas aos aspectos de gestão elencados nesta pesquisa. Algumas informações encontradas se destacaram. Na gestão de pessoas, observam-se aspectos relacionados a recrutamento, seleção dos residentes e treinamento de preceptores. Já na organização, destacam-se estruturação e possibilidades de reorganização de comunicação do programa de residência, bem como os desafios na organização de atividades.

Stress and residency: a study of a multiprofessional program in collective health

Multiprofessional Health Residency Programs constitute postgraduate education, with training based on the teaching-service process within a complex context of interactions and relationships. The study aimed to analyze the occurrence of stress in residents of a Multiprofessional Collective Health Residency Program at the Health Department of Recife through the application of the “Escala de Estresse no Trabalho” (EET) and a biopsychosocial questionnaire. Out of a total of 23 alternatives, 21 of them depict a higher level of stress among second-year residents, which also corresponds to the period of the COVID-19 pandemic. The stress level was perceived as high in all evaluated dimensions, with a higher occurrence in the "autonomy/control" aspect, revealing a high level of stress among the Multiprofessional Collective Health Residency Program residents. The findings emphasize the importance of taking action and reflecting on the issues and contributing to the generation of support for the development of public policies related to residency programs, particularly in recognizing and valuing the program graduates.

Health residency programs in a university hospital: a potent training setting for interprofessional collaborative practice

Resumen Este estudio reta comprender la experiencia de los residentes sobre la Práctica Colaborativa Interprofesional (PCI) en un hospital universitario (HU) en el estado de São Paulo. Investigación cualitativa a través de entrevistas semiestructuradas basadas en la Técnica del Incidente Crítico con 14 residentes de programas de residencia uni y multiprofesionales, analizadas por análisis temático de Bardin. El HU demostró ser potente para la implementación de la PCI al propiciar interacciones entre profesionales de diferentes áreas y niveles de formación. La calidad de las interacciones entre trabajadores, residentes, usuarios y familiares fue crucial para el desarrollo de la PCI. Se identificaron barreras como falta de estructura organizacional, sobrecarga de profesionales, debilidad en la provisión de educación permanente interprofesional y predominio del modelo biomédico de atención. Las acciones colaborativas mediadas por comunicación informal son el dispositivo más utilizado para el cuidado compartido.

Health residency programs in a university hospital: a potent training setting for interprofessional collaborative practice

Resumo Este estudo tem por objetivo compreender a experiência de residentes sobre a Prática Colaborativa Interprofissional (PCI) em um hospital universitário (HU) do estado de São Paulo. É uma pesquisa qualitativa realizada por meio de entrevistas semiestruturadas com base na Técnica do Incidente Crítico, com 14 residentes de programas de residência uni e multiprofissionais, analisadas pela análise temática de Bardin. O HU mostrou-se potente para efetivação da PCI por proporcionar interações entre profissionais de diferentes áreas e níveis de formação. A qualidade das interações entre trabalhadores, residentes, usuários e família foi determinante para o desenvolvimento da PCI. Foram identificadas barreiras como ausência de estruturação organizacional, sobrecarga dos profissionais, fragilidade na oferta de Educação Permanente relacionada à educação interprofissional e predomínio do modelo biomédico de Atenção à Saúde. As ações colaborativas mediadas pela comunicação informal constituem o dispositivo mais utilizado para os atendimentos compartilhados.

Resident Physician Education in the Human Trafficking Medical Safe Haven.

Human trafficking is a widespread public health problem across the United States. In recognition of the incredible need among victims and survivors of human trafficking for longitudinal, trauma-informed care, the Medical Safe Haven (MSH) was developed in 2016 through the Dignity Health Family Medicine Residency Program in Sacramento, California, and subsequently expanded to 2 other Dignity Health residency program sites. The MSH program included 3 sessions of trafficking-specific curriculum for resident physicians to prepare them to provide care for MSH patients. The current study aimed to evaluate resident physician learner confidence after participating in the MSH curriculum along with perceptions of the MSH program as a whole upon their graduation. The study was a retrospective, preassessment/postassessment design. Resident physicians completed surveys that assessed learner confidence after each of the 3 training sessions, utilizing Likert scale items. Third-year resident physicians also completed a survey that included scaled and open-ended questions. Paired t-tests were used to evaluate the data in addition to content analysis for the open-ended questions. There were significant increases in learner confidence after the training sessions on all items measured, including identifying and caring for victims and survivors of trafficking. Third-year residents responded that the MSH program helped them to more effectively communicate and care for victims and survivors and many planned to take the trauma-informed care model to their future practices. While generalizability of the study was limited due to the retrospective design, the MSH program was found to have a meaningful impact on the resident physicians who participated in the training.

Analysis of professional training in Multiprofessional Health Residency Programs in Brazil from the perspective of residents.

The aim of this study was to analyze professional training in multiprofessional health residency programs (MHRPs) in primary care from the perspective of residents from 20 programs who had completed residency in the period 2015-2019. We undertook a cross-sectional study analyzing criteria in the dimensions Pedagogical Approach and In-Service Education Settings responded using a 10-point Likert scale. The study sample consisted of 365 graduates from MHRPs in 12 Brazilian states. The highest-scoring criteria in the dimension Pedagogical Approach (Cronbach's α=0.94) were broad concept of care and professional training oriented towards comprehensive care (P50=10). The lowest scoring criteria were those involving preceptorship (P50=7). With regard to the In-Service Education Settings dimension (Cronbach's α=0.90), the main strength was group educational activities (P50=9) and the main weaknesses were adequacy of the physical structure of health facilities (P50=6), participation of residents in local health committees (P50=6), and coordination with medical residency programs (P50=5). The findings show that professional training in MHRPs is aligned with the principles and guidelines underpinning Brazil's public health system, with emphasis on comprehensiveness and prevention. However, efforts are needed to improve preceptor training and address weaknesses in practice settings.

Análise da formação em Programas de Residência Multiprofissional em Saúde no Brasil: perspectiva dos egressos

Abstract The aim of this study was to analyze professional training in multiprofessional health residency programs (MHRPs) in primary care from the perspective of residents from 20 programs who had completed residency in the period 2015-2019. We undertook a cross-sectional study analyzing criteria in the dimensions Pedagogical Approach and In-Service Education Settings responded using a 10-point Likert scale. The study sample consisted of 365 graduates from MHRPs in 12 Brazilian states. The highest-scoring criteria in the dimension Pedagogical Approach (Cronbach’s α=0.94) were broad concept of care and professional training oriented towards comprehensive care (P50=10). The lowest scoring criteria were those involving preceptorship (P50=7). With regard to the In-Service Education Settings dimension (Cronbach’s α=0.90), the main strength was group educational activities (P50=9) and the main weaknesses were adequacy of the physical structure of health facilities (P50=6), participation of residents in local health committees (P50=6), and coordination with medical residency programs (P50=5). The findings show that professional training in MHRPs is aligned with the principles and guidelines underpinning Brazil’s public health system, with emphasis on comprehensiveness and prevention. However, efforts are needed to improve preceptor training and address weaknesses in practice settings.

Resident and supervisor perception of learning climate in public health resident training in the Netherlands

The purpose of this study was to evaluate the perceived quality of the learning climate by public health residents in the Netherlands and compare residents' and supervisors' perceptions. Residents of five public health subfields, who started their residency programs in 2019 and onwards, as well as supervisors involved in the residency program, were invited to complete aweb-based survey based on an adapted version of the D‑RECT questionnaire. Answers of residents and supervisors of the same training site and public health subfield were matched to compare perceived quality of the learning climate. One hundred fourteen residents responded (response rate 50.9%). Residents' overall assessment of the learning climate showed amean score of 4.19 on a5-point-scale. Thirty-eighth supervisor-resident matches were formed. There were no notable differences in the perception of residents and supervisors. Residents' overall assessment of the learning climate was positive. Supervisors and residents' perception of learning climate is equal. Our adapted version of D‑RECT seems to be suitable to evaluate the learning climate for public health residency programs in the Netherlands. Further research is necessary to validate our questionnaire and to confirm our findings.

The New to Public Health Residency Program Supports Transition to Public Health Practice.

Training and retaining a competent public health workforce are challenging. Residency programs for new and transitioning professionals are effective in other fields but rare in governmental public health. The New to Public Health Residency Program is a residency program for professionals entering public health practice. On the basis of the Foundational Public Health Services model, the program was designed using adult learning principles and best practices from nurse residency programs. Content created by public health experts is delivered over 12 months through online course sessions that include interactive learning activities. Additional program components include monthly synchronous online discussions and support from a mentor. Residents apply their learning through implementation of an evidence-based practice project at their workplace. The program is accredited for continuing professional development contact hours. Agencies with limited resources to support new public health employees may find the New to Public Health Residency Program a vital training resource.

Relação entre território e residência em saúde: uma possibilidade de experiência decolonial?

ABSTRACT Can the presence of health residency in the territory be a way to decolonize the academy? This article addresses the possibility of decolonizing the academy through a multiprofessional family health residency program focused on rural health in the region. This is an experiential report whose epistemological basis is postcolonial and decolonial theories, especially the pedagogy of the territory, and includes elements of interdisciplinary and multidisciplinary training, the territory and health, the relationship between the territory and the health of the rural population in the Quilombola community of Estivas, in the rural region of Garanhuns, Pernambuco. The conclusion is that the multiprofessional residency, as an institute of collective spaces, allows a new look at the territory, the community and health professionals to develop their actions based on interdisciplinarity, popular education and continuous training as a practice to understand other ways of producing health and stimulate change not only in the community and health professionals, but especially in society, making an important contribution to the decolonization of the academy.

Admission of alumni from Multiprofessional Residency Programs into the SUS.

ABSTRACTINTRODUCTION:The Multiprofessional Health Residency Programs (PRMS) were set up as a strategy for training workforce for the Brazilian Unified Health System (SUS).OBJECTIVE:To investigate the proportion of alumni from Primary Health Care Multiprofessional Residency Programs admitted into the SUS and associated factors.METHODS:This is a sectional study developed with alumni from Primary Health Care Multiprofessional Residency Programs from all over Brazil, encompassing the period from 2015 to 2019. Participants answered an online questionnaire with general personal information, admission into stricto sensu graduate school, the labor market and, specifically, the SUS. We applied Pearson's chi-square test for bivariate analyses and Poisson's regression for multiple analysis.RESULTS:A total of 365 alumni from Programs from all Brazilian regions participated in the study. Of those, 80.2% reported entry into the labor market and 47.9% reported being employed in the SUS. Admission into the SUS has been associated with the professions that make up the Reference Team for Primary Health Care (PHC) (PR = 1.87; 95% CI 1.54–2.28) and non-admission into stricto sensu graduate programs (PR = 0.77; 95% CI 0.61–0.97). Regarding admission characteristics, the PHC scenario (47.4%) and work focused on health care (84.9%) were prevalent. Almost 40% of alumni who entered the SUS are working with unstable contracts. Besides, being a residency alumnus is often undervalued in recruitment (56.9%). Among those admitted into the SUS, 8.7% reported being selected to work in the Covid-19 pandemic effort.CONCLUSIONS:The results of this study reinforce the need for a policy to encourage the maintenance, creation and valorization of the PRMS. They also warn about the possibility that admission into the SUS for workers is increasingly difficult due to the current underfunding of the health system.

Reorganização do trabalho do NASF-AB no enfrentamento da pandemia COVID- 19

Objetivo: relatar a experiência das residentes do Programa de residência em Saúde da Família e Comunidade na reorganização do Núcleo de Apoio à Saúde da Família (NASF) em um território, para o enfrentamento da Pandemia de COVID-19. Método: relato de experiência. Informações coletadas em fontes oficiais e registros das vivências dos autores. Resultados: as estratégias adotadas durante a pandemia foram: teleatendimento, telemonitoramento, produção de materiais educativos, novo fluxograma de atendimento, porta de entrada de sintomáticos, suporte as equipes e testagem rápida. Conclusão: adaptação rápida e consistente para apoiar a Estratégia Saúde da Família no cuidado a população.

Interdisciplinarity and interprofessionality in teamwork: perceptions of multiprofessional residents in Hospital Care

Multiprofessional Health Residency Programs were created to further align health training with the needs of the population and, through an emphasis on teamwork, have been contributing to the consolidation of the Brazilian Unified Health System. The present study sought to understand the perceptions of a group of multiprofessional residents in Hospital Care about interdisciplinarity and interprofessionality within the scope of teamwork. This is a qualitative study that had the participation of 29 multiprofessional residents in the ‘Hospital Care’ area of concentration, all female (six psychologists, six social workers, six nurses, six physiotherapists and five nutritionists). Data were collected by means of a semi-structured interview script. The corpus was subjected to thematic content analysis. Most of the participants: (1) reported that their first contact with the notion of interdisciplinarity occurred when they were in college, which led to them assimilating it as a synonym for joint action, and (2) claimed to have no knowledge of the notion of interprofessionality, but valued the horizontalization of relations between health professionals. Additionally, important conditions concerning both interdisciplinarity and interprofessionality were not emphasized by the participants. Further studies on the subject are needed, due to its importance for public health.

Atuação do psicólogo no Núcleo de Apoio a Saúde da Família: uma experiência em um programa de residência multiprofissional

INTRODUÇÃO: A residência é uma modalidade de pós-graduação que se caracteriza pelo treinamento em serviço, tendo como base a aprendizagem pela prática cotidiana. Programas de residência multiprofissional objetivam capacitar profissionais para o exercício qualificado na Atenção Básica de Saúde, a porta de entrada principal do Sistema Único de Saúde (SUS), por meio de metodologias ativas, trabalho em equipe e cuidado humanizado. OBJETIVO: Relatar a experiência e a inserção do psicólogo, enquanto residente, em um programa de residência multiprofissional em Saúde da Família. MÉTODO: Foi realizado o relato de experiência de uma profissional da psicologia enquanto residente do Programa de Residência em Saúde da Família. A presente experiência ocorreu entre março de 2018 e março de 2020 e as seguintes atividades foram descritas: (a) matriciamento, (b) acolhimentos e atendimento individuais, (c) realização de grupos, (d) educação em saúde, (e) consultas compartilhadas e (f) visitas domiciliares. RESULTADOS: Pode-se afirmar que o processo de formação de profissionais em saúde pública constitui um desafio a gestores, educadores e trabalhadores envolvidos neste processo. Dificuldades em relação ao estímulo simultâneo de habilidades profissionais, interpessoais e humanísticas, bem como senso crítico sobre responsabilidade social são comuns. Ainda assim, a proposta de programas residência é uma oportunidade significativa de aprendizado e contato com outras áreas de saúde. CONCLUSÃO: Diversas limitações puderam ser identificadas ao longo das atividades cotidianas da residência, tal como falta de conhecimento dos profissionais sobre a estratégia de saúde da família e o papel da residência multiprofissional no serviço de saúde.

Caracterização das residências multiprofissionais em saúde do Brasil

Objetivo: Caracterizar os programas de residências multiprofissionais em saúde do Brasil. Método: Estudo quantitativo, descritivo, transversal. Os dados foram coletados na internet por arquivos cedidos pelo Ministério da Educação e dos editais dos programas de residência, de março a setembro de 2019, através de um instrumento contendo as variáveis: região geográfica, estado brasileiro, financiamento, número de vagas, ano de início do programa, área de concentração, instituição propositora, profissões existentes e cenários de prática. Resultados: Os programas de residência estão concentrados na região sudeste, destacando-se o Estado de São Paulo. São Financiados, em sua maioria, pelo Ministério da Saúde, estando concentrados em instituições públicas. A profissão de enfermagem está inserida em grande parte dos programas. O eixo de concentração na atenção básica/saúde é o mais ofertado. Conclusão: Os programas de residência multiprofissionais em saúde do Brasil são ofertados em todas as regiões do país, a maioria com bolsas do ministério da saúde, em instituições públicas, na área de concentração da atenção básica, sendo a enfermagem a profissão que está inserida em grande parte dos programas. A característica central das residências multiprofissionais em saúde é ser ensino em serviço, o que concretiza a formação interprofissional.