Comunicação clínica no internato: habilidade em interface com o currículo integrado e orientado por competência

Abstract

Introduction: Clinical Communication is an instrument for interaction between professionals and between them and users, being extremely important to ensure integral care. The complexity of the users’ biopsychosocial demands must be understood and worked through skills developed beyond the technical and biomedical knowledge, including a more extensive training in relation to the human being. In the curriculum of a medical school institution in the interior of São Paulo, Clinical Communication is a skill expected of the student in all undergraduate scenarios. During medical internship, it is important that communication practice be developed in an integrated fashion, considering the biopsychosocial aspects of the subject under care; however, the literature demonstrates that this skill is superficially explored in training, causing difficulty for its effectiveness. Thus, it can be assumed that there are different understandings about the concept of Clinical Communication and its theoretical-practical articulation between teachers and students, being necessary to analyze this educational process during internship. Objective: Thus, the objective was to question how teachers and students from a medical course internship understand the teaching-learning aspects about Clinical Communication in an integrated and competence-based curriculum. Method: This was a qualitative study, which included eleven 5th-year medical students, twelve 6th-year medical students and nine internship teachers. The interviews were semi-directed and carried out based on an interview script, which were later transcribed and submitted to the analysis of content, thematic modality. Results: Three categories emerged from the concepts and characteristics of the topics “Clinical Communication” and “Curriculum”: 1) What involves clinical communication; 2) Development of clinical communication during the undergraduate course and 3) Proposals for the training of internship students and teachers. It was observed that the participants understood the concept of Clinical Communication and its importance for the students’ training, but also that it is difficult to develop this training due to the lack of knowledge about the curriculum, student work overload and teacher devaluation. Conclusion: The study considers the development of Clinical Communication skills of internship students and the possibilities for reflection on gaps mentioned by students and teachers.

Habilidades de comunicação na relação médico-paciente: revisão da medicina atual na atenção primária à saúde

“…Essa definição ambiciosa para seu tempo, é alicerce para os conceitos adotados pela Constituição Federal de 1988 e pelo SUS (Brasil, 1990). Entretanto, é evidenciado pelos autores dessa revisão que não existe um enraizamento desses conceitos nos médicos de forma plena, principalmente por fatores na graduação e residência (Lima, 2021).…”

“…As graduações médicas brasileiras não têm em quantidade suficiente de horas-aula em disciplinas sobre HC, pois ainda tem o foco na medicina baseada na doença, indo contra o que se apresenta melhor para o paciente. Continuamente, mesmo que se o graduando tenha tido esse aprendizado do cuidado centrado na pessoa, existe chance de ele ser desvirtuado pelos médicos preceptores do internato ou da residência, que seguem esse molde retrógrado de medicina por terem se graduado em outro momento (Lima, 2021;Moura, 2019;Silva, 2020).…”