The Medical Student’s view about the Unified Health System: the influence of education

ABSTRACT From the context of the end of the military regime and the consequent democratization of the country, with the accomplishment of the VIII National Conference of Health and the creation of the Unified Health System (SUS), proposals for changes to medical education begin to emerge in order to adapt it to this new system. Within this process, the formation of the National Interinstitutional Commission for the Evaluation of Medical Education (Cinaem) was highlighted in 1991, with the proposal to carry out a self-assessment of medical education at that time in different phases, which culminated in 2001, with the elaboration of the National Curricular Guidelines (DCN) for the medical education. Understanding that the medical education proposed by the DCN aims to train professionals with a generalist, humanist, critical and reflective profile, which contemplate the current health system, and whose formation must take place through the link with the social needs of health, with emphasis on SUS, this work aimed to identify, through a qualitative analysis, the influence exerted by the medical education in a teaching institution on the perceptions of its students and excipients about the Unified Health System. Data were collected from focus groups, carried out with students from the third to the twelfth medical period, following a flexible guiding script. The cross-sectional and horizontal reading of data based on Donabedian’s 24 “Structure, Process and Results” methodology allowed the identification of central themes present in the narratives, on which the discussion was built. Among them, the following themes were highlighted: faculty, theoretical and practical adequacy and public health. Finally, the students’ vision about the SUS system, their intentions of utilization and professional insertion in it, and some evidence of a hidden curriculum were understood. The study brought to the conclusion that medical training has a strong influence on these factors. Most of the students do not have the interest of working in the SUS nor of its use, motivated by practical experiences, by the discourse and example of the teachers.

摘要：本研究立足于军事政权终结与国家随之而来的民主化进程背景，伴随第八次全国卫生会议的召开及统一卫生系统（Unified Health System, SUS）的建立，旨在适配新体系的医学教育改革提案逐渐涌现。在此进程中，1991年成立的全国医学教育评估跨机构委员会（National Interinstitutional Commission for the Evaluation of Medical Education, Cinaem）备受关注，该委员会提议分阶段开展彼时医学教育的自评工作，并最终于2001年制定完成全国医学教育课程指南（National Curricular Guidelines, DCN）。鉴于DCN提出的医学教育目标为培养通才型、人文主义、具备批判与反思特质的专业人才，以适配现行卫生体系，且人才培养需紧密结合卫生领域的社会需求、重点围绕SUS展开，本研究旨在通过定性分析，识别某教学机构的医学教育对其学生及相关人员关于统一卫生系统的认知所产生的影响。研究数据通过焦点小组（focus group）访谈收集，访谈对象为医学专业3至12年级的学生，访谈采用灵活的引导式提纲。基于多纳贝迪安（Donabedian）的“结构-过程-结果”方法论对数据进行横断面与横向解读，得以识别叙事中的核心主题并以此展开研讨，其中突出的主题包括：师资队伍、理论与实践适配性及公共卫生。本研究最终明确了学生对SUS系统的看法、使用意愿及投身该系统的职业意向，以及隐性课程（hidden curriculum）的若干证据。研究得出结论：医学培训对上述因素具有显著影响，多数学生因实践经历、教师的言论与示范，无意在SUS系统工作，亦无使用该系统的意愿。