Inserção da atenção primária à saúde (APS) no ensino de graduação em medicina: revisão integrativa

Abstract

Transformations in Medical Education over time demonstrate the new demands of professionals in relation to society and the job market. Medical Education seems to move from a purely biomedical model to one that values the development of skills and competences as well as technical-scientific knowledge. Since the publication of the Flexner Report in 1910 until the current National Curriculum Guidelines for medical schools in 2014, we have observed changes in the structure of medical courses. In Brazil and in the world, medical schools express concern about social responsibility and the quality of the post graduate medical or community-based curriculum changes. This study aims to analyze how Primary Health Care (PHC) is inserted in medicine post graduate curriculum in Brazil and in the world and what are influences on the development of skills and competences. We used as methodology an integrative literature review in four journals: Academic Medicine, Medical Education, Medical Teacher and Brazilian Journal of Medical Education for five years (2013-2017). We looked for expressions related to the subject to select articles. As a result, we present an overview of the tendency of publications over the period studied. We observe that there are several modalities of insertion, from the theoretical and punctual forms, to the longitudinal and integrated forms that are presented in detail in this study. The skills cited as more developed as consequences of these insertions were: skills to work in interprofessional group and in community, cultural competence and theoretical-practical knowledge on health determinants, among others. The most used teaching-learning methodologies was Problem-Based Learning (PBL), monitoring of teacher-supervised clinical care, and immersion in Primary Care services and community through small groups. The PHC has great potential to contribute to Medical Education and can be used in different ways according to the pedagogical objectives. We are aware of the need to transform medical education. The conventional model is no able to offer adequate medical training. The health problems of the population need to be solved and doctors need to be prepared for professional life. The solution is the progressive inclusion of PHC in curriculum of medical courses in Brazil and in around the world.