Barriers and Facilitators of the Teaching-Learning Process of Medical Students in Primary Care in the City of São Paulo

Abstract

Introduction: Although Primary Health Care (PHC) is essential for medical students’ training, the perceptions of primary care workers about the teaching-learning process have been overlooked, particularly in municipalities where PHC management is performed by a private organization instead of the government, such as in the city of São Paulo. Objective: to analyze the perceptions of primary care workers about barriers and facilitators of medical students’ teaching-learning process in PHC in the city of São Paulo. Method: we conducted a qualitative research. We performed in-depth interviews with 12 primary care workers from the family health teams (four physicians, four nurses and four community health workers), who worked in primary care clinics in the east region of the city and received medical students, from 1st-year to internship students. The interviews were recorded, transcribed and afterwards, they were repeatedly read. We identified thematic units following the content analysis principles. Results: the barriers to medical students’ teaching-learning process in PHC were the following: (1) excessive number of scheduled patients and scarcity of time for discussion; (2) inadequate infrastructure of primary care clinics; (3) lack of training; and (4) ineffective integration among faculty, healthcare workers, managers and the assisted population. The facilitating factors of the teaching-learning process were: (1) high quality of healthcare services; (2) integration among primary care teams, interdisciplinary teams, and students; and (3) well-trained medical preceptors. Conclusions: our results have implications for PHC professionals, educational institutions, and managers. The improvement of the integration among educational institutions, health services managers, primary care workers, and the population is a condition to reach the effectiveness in the teaching-learning process, and to ensure the development of essential competencies for PHC assistance quality. Thus, the training of health professionals, improving the primary care clinic infrastructure, and creating strategies to ensure enough time for discussion and feedback could contribute to mitigate barriers to medical students’ teaching-learning process in PHC.

Percepção dos profissionais de saúde sobre a atuação de acadêmicos no contexto da Atenção Primária

“…A carência na estrutura física, com insuficiência de consultórios e espaços pequenos que comportem todos os alunos, também é vista em UBS de outras regiões brasileiras, o que impossibilita a adequada participação do acadêmico no processo de ensino-aprendizagem. Tais estudos acrescentam como dificuldade a quantidade grande de consultas no turno e o tempo disponibilizado para o atendimento e para as discussões com o acadêmico, mostrando o despreparo organizacional da integração instituiçãoprática 12,13 . Entretanto, a UBS, cenário dessa pesquisa, apresenta requisitos materiais e recursos humanos suficientes para receber acadêmicos das áreas da saúde e possibilitar a geração de conhecimento e benefícios para a população.…”

“…Isso difere dos achados dos estudos de Pimentel et al, que destacam sobre a capacitação dos recursos humanos ainda necessitar de melhoria, sendo necessária a equiparação das equipes de municípios menos desenvolvidos às equipes de municípios mais desenvolvidos no que se refere ao acesso a cursos e treinamento em saúde 14 . A falta de preparo dos profissionais de saúde para atuarem como preceptores e docentes foi descrito por outros estudos como um grande desafio, e que deveria ser abordado pelas Instituições de Educação Superior (IES), por meio de treinamento técnico e qualificação pedagógica 12,13 .…”