O Pró-Saúde no curso médico da UFPE: as influências do movimento político de mudanças na formação a partir da proposta de integração ensino-serviço.

Abstract

Concern with education and student practices appears to go hand in hand with the ideals of many activists who call for a more equitable and accessible healthcare system. Rethinking and diversifying the settings for learning/teaching may be an important tool for broadening conceptions of the health-disease process learnt by students, given that, on the one hand, change of setting throughout education does not per se guarantee a rethinking of a health service rationale geared towards the interests of the market. Based on policies aiming to promote change in education, the National Program for Reorientation of Teaching in Health (Pró-Saúde) is organized around three axes: theoretical orientation; practical settings and pedagogical orientation. The present study restricts itself to the second of these and aims to investigate the process of adoption of Pró-Saúde by the Federal University of Pernambuco (UFPE) Medicine Course and its repercussions for the dialogue between academia and health services. The methodological steps involved a review of literature on the subject, consultation of official and non-official documents on policies and initiatives that envisage closer ties between academia and the health services network, and the construction of a timeline to help understand and chronologically and politically map relevant events. The primary source was 24 semi-structured interviews with university and health service stakeholders and a roundtable conversation involving 21 UFPE medical students. Data analysis was then organized around three themes: 1) the effects of policies prior to Pró-Saúde in relation to teaching-service integration 2) ties/pacts between academia and management to effect Pró-Saúde and 3) the effects of Pró-Saúde on practical settings in the light of integral health care. The results show that the PROMED and Pró-Saúde proposals have many points in common, since, while the first version of the PNEPS had low permeability at local level, it did influence Pró-Saúde more in terms of concepts and theories than in the adoption of operationalization strategies. Pacts between academia and health services have posed challenges regarding partisan politics, the need for training of network tutors, and conflicts between Brazilian National Health Service principles and the interests of the market. In terms of repercussions for integral care, the incidence of the Program indicates the opportunities created during its implementation and those missed by the Medicine Course, showing that there is a need for integration of teaching and services to be institutionally supported by the actors involved in forging these links beyond incentivizing tools such as Pró-Saúde.