Aprendizagem social no interior da residência multiprofissional em Saúde da Família e comunidade de Fortaleza-CE sob a perspectiva da teoria de comunidades de prática

Abstract

This study focuses on the processes of social learning and their interaction among health workers. The long time experience of the Brazilian Policy of Continuing Education of Health Professionals has revealed a growing demand for nurturing new models of professional action within the Brazilian Family Health Strategy. These models must reinforce principles such as comprehensive care; focus on population needs and health responsibility over the catchment territories, as well as establishing relationships in order to provide health care and foster teamwork. This study happens in a context of government investment in Multiprofessional Residencies in Family Health and the strategy of the Family Health Support multiprofessional teams that were designed to assist Family Health Teams. This inquiry has as its object of study the Multiprofessional Residency in Family and Community Health (MRFCH) of Fortaleza, Ceará, Brazil. The general aim was analyzing and understanding how the processes of social learning within this program emerged from of the participants’ practices, using the theory of Communities of Practice as the theoretical frame. At the moment of our research, the MRFCH consisted of a schedule of in-service training of 28 residents in two years (R1 and R2) in six health professions: nursing, dentistry, physiotherapy, psychology, nutrition and social work. The subjects of this study were residents, health profession tutors and territory tutors. The methodology consisted of focal groups with R1, R2 and tutors, as well as field observations of the interactions between residents and tutors within Family Health Centers. The theoretical frame of reference for our analysis was the theory of Communities of Practice by Etienne Wenger. This theory encompasses aspects of social learning that are supported by social practice and describes the building of such communities. From this perspective we divided the results in four analytical dimensions: 1. Learning as belonging: the power of community; 2. Learning as becoming: the power of identity; 3. Learning while doing: the power of practice; and 4. Learning from experience: the power of meaning. As results, it was clear that the MRFCH constitutes itself as a Community of Practice, since it presents with shared repertoires, mutual engagement and joint enterprises that were based in the Family Health Strategy. The varied trajectories from the community participants in this context presented as a dialogical temporal relationship that reinvented several forms of acting and daring in the Residency. The products from the Residency were often nominated by their participants as elements of creation, synthesis and solidity of their own practice while action-reflection subjects. These different products encompass different accomplishments, from activities that were achieved in the interaction with users and other health professionals to conceptions about health that were brought to new dimensions with practice. Interprofessionality and interdisciplinarity were stressed as possible local solutions for health problems that happen in practice. Last, we observed that the places within the MRFCH are largely dialogic, with meaning negotiations that emerge in all encounters between learning partners and within the limits and frontiers of this Community of Practice.