Perception of Interns and Doctors Recently Graduated from the Medicine Course of PUC-SP on Their Training to Work in Primary Health Care

ABSTRACT Background The School of Medical Sciences and Health (FCMS – Faculdade de Ciências Médicas e da Saúde) at the Sorocaba campus of the Pontifical Catholic University of São Paulo (PUC/SP – Pontifícia Universidade Católica de São Paulo) began to reform the curriculum of the Medical course in 2006, introducing a new educational project based on the 2001 Brazilian National Curricular Directives (DCN – Diretrizes Curriculares Nacionais) for Medical Degree Courses. In this curriculum, Health Care Practice is a horizontal module with its six disciplines studied from the first to the sixth year, in various practical scenarios, but with a focus on primary health care in the Unified Health System (SUS – Sistema Único de Saúde), with learning based on practice and problem solving as central educational strategies. Objective To assess whether medical students and new graduates consider themselves prepared to work in primary health care, identifying the strengths and weaknesses of their training in order to propose the adjustments required to improve the Medical course and training of graduates from the FCMS of PUC/SP. Methods A questionnaire with four open questions and five multiple choice questions using the Likert scale was answered by 66 interns and 8 new graduates. Results More than 70% of the participants consider that they are well prepared or very well prepared to work in primary health care as general practitioners, in a person-centred, critical and reflective manner, with the skills to perform activities in health prevention, promotion and rehabilitation in accordance with the DCN and the priorities of the SUS, while valuing multiprofessional work. Participants consider as curriculum strengths: involving the student in primary health care from the beginning of the course, favouring a person-centred approach in the doctor/patient relationship, and the understanding and management of the most prevalent diseases. The weakest points reported were: little medical care was provided to patients during the course, home visits were conducted without the tutor, and Primary Health Care is undervalued in professional life. Conclusions Interns at the end of the course and new graduates from the Medical course of FCMS at PUC/SP feel themselves prepared and confident to work in primary health care as general practitioners in the SUS in the way specified in the DCN and offer critical suggestions to improve teaching/learning in this scenario.摘要 **背景**：圣保罗天主教大学（Pontifícia Universidade Católica de São Paulo, 缩写PUC/SP）索罗卡巴校区的医学与健康科学学院（Faculdade de Ciências Médicas e da Saúde, 缩写FCMS）于2006年启动医学专业本科课程改革，以2001年巴西医学本科专业国家课程指导方针（Diretrizes Curriculares Nacionais, 缩写DCN）为核心依据，推出全新教育培养方案。该课程体系中，「医疗实践」作为横向模块，涵盖6门核心学科，贯穿本科一至六年级的多类实践场景，核心聚焦于统一健康系统（Sistema Único de Saúde, 缩写SUS）内的初级卫生保健（primary health care）工作，将实践学习与问题解决作为核心教学策略。 **研究目标**：评估医学生与应届毕业生是否认为自身具备从事初级卫生保健工作的能力，识别其培养过程中的优势与不足，进而为优化PUC/SP FCMS的医学专业课程体系、提升毕业生培养质量提供决策依据。 **研究方法**：本研究采用包含4道开放式问题（open questions）与5道李克特量表（Likert scale）选择题的调查问卷，共回收66名实习医学生与8名应届毕业生的有效答卷。 **研究结果**：超过70%的受访者认为，自身已具备以患者为中心、兼具批判性与反思性思维的全科医生（general practitioners）执业能力，能够依照DCN要求与SUS优先发展方向，开展健康预防、健康促进与康复相关工作，并重视多专业协作（multiprofessional work）。受访者认为当前课程体系的优势包括：从本科入门阶段即让学生参与初级卫生保健实践、助力构建以患者为中心的医患关系、掌握常见疾病的诊疗与管理能力。被指出的主要短板包括：课程期间参与临床诊疗的实践机会不足、无导师陪同开展家庭访视、初级卫生保健在职业发展规划中未得到足够重视。 **研究结论**：PUC/SP FCMS医学专业的高年级实习医学生与应届毕业生，均认为自身已具备按照DCN要求在SUS体系内从事全科型初级卫生保健工作的能力与信心，并针对该场景下的教学与学习活动提出了针对性改进建议。