Etnografia do ensino médico em um CTI

Abstract

This article discusses teaching activities and practical learning at an Intensive Care Unit (ICU) of a public university hospital in Rio de Janeiro. The professional training of physicians does not merely consist of assimilating new information, because it is in the practical internships that the student becomes a true professional. Teaching and learning have proven to be very important in ethnographic research -focusing on the process of taking medical decisions about life, suffering and the death of ICU patients. The development of a medical professional identity during ICU internships includes acquiring new ways of looking at and decoding the human body in the light of multiple knowledge and new ways of communicating, as well as ways developed by the team for managing emotions. Throughout this medical learning process, the student must learn how to position himself vis à vis ethical dilemmas, which are particularly relevant in an ICU.KEY WORDS: Medical education; intensive care unit; medical ethics.Este artigo versa sobre as atividades de ensino e aprendizagem prática em um Centro de Tratamento Intensivo Geral de um hospital público universitário do Rio de Janeiro. A formação profissional do médico não consiste apenas na incorporação de novos conhecimentos, pois é nos estágios práticos que o estudante é forjado como profissional. Em pesquisa etnográfica -centrada no processo de tomada de decisões médicas referentes à vida, sofrimento e morte dos doentes internados no CTI, as atividades de ensino e de aprendizagem revelaram-se de grande importância. A construção de uma identidade profissional médica no estágio em CTI compreende a aquisição de novas formas de ver e descodificar o corpo humano à luz de múltiplos saberes, novos modos de comunicação, como também das formas de gestão das emoções construídas pela equipe. Ao longo deste processo de aprendizagem médica, o estudante deve aprender a se posicionar diante de dilemas éticos, particularmente relevantes em um CTI.

Avaliação dos estágios extracurriculares de medicina em unidade de terapia intensiva adulto

“…Despite the high load of hours of the medical course and the intense demand of time for medicine, surveys point out that some 80 to 90% of students take on some extra-school activity related in most cases with a high level of satisfaction . (1,(11)(12)(13) To include ICM in the official curriculum of medical schools has been suggested in other works and by specialists in the field . (4-5,7) Some of our data substantiate this fact.…”

“…Furthermore, there is contact with subjects that medical students know very little about during undergraduate studies, such as encephalic death. (11,16) Regarding procedures, those most frequently observed were the most common ones in the day-by-day of the ICU (central venous access, peripheral venous access and orotracheal intubation). However, performance and assurance in carrying these out alone was higher in the procedures considered as fewer complexes (punction for arterial blood gas analysis, peripheral venous access and bag -mask ventilation).…”

“…However, these professionals are frequently not prepared for this support and/or do not want to add to the function of assistant physician that of teacher, as no financial gains are accrued. (11,17) This is another important role played by inclusion of ICM in the official curriculum of the medical schools, in an effort to balance these subjects within the academic environment, as well as to offer schooling supervised by teachers.…”

“…This reflects the interest of critical care physicians to disseminate scientific, technical, and managerial and research knowledge involving this specialty, as well as the interest of students to participate in these clerkships. (8,11) The objective of this study was to detect changes in the attitude and interest of students after these clerkships, in addition to describing the more common activities developed (procedures, assistance to patients, contact with topics related to ICM).…”

Produzindo corpo, doença e tratamento no ambulatório: apresentação de casos e registro em prontuário

“…Assim, vai se tornando mais e mais claro para ele que ser médico é algo além da simples aplicação de conhecimento científico visando intervir em um processo patológico ou lesão. E isto se dá a despeito da valorização explícita do saber técnico que se adquire na fase clínica (Menezes 2001;ronzani e ribeiro 2003). Esse algo além não passou sem ser notado pela reflexão das ciências sociais acerca da medicina.…”