UNIVERSIDADE FEDERAL FLUMINENSE
FACULDADE DE ODONTOLOGIA
CONTRIBUIÇÕES DO PRÓ-PET SAÚDE PARA A
FORMAÇÃO DE ESTUDANTES DO CURSO DE
GRADUAÇÃO EM ODONTOLOGIA
Niterói 2016
UNIVERSIDADE FEDERAL FLUMINENSE
FACULDADE DE ODONTOLOGIA
CONTRIBUIÇÕES DO PRÓ-PET SAÚDE PARA A
FORMAÇÃO DE ESTUDANTES DO CURSO DE
GRADUAÇÃO EM ODONTOLOGIA
LUANA GONÇALVES
Tese apresentada à Faculdade de Odontologia da Universidade Federal Fluminense como requisito do Programa de Pós-Graduação, Nível Doutorado, em Odontologia.
Orientador: Prof. Dr. Cresus Vinícius D. de Gouvêa Coorientador: Marcos Antônio Albuquerque de Senna
Niterói 2016
FICHA CATALOGRÁFICA
G635 Gonçalves, Luana
Contribuições do PRÓ-PET Saúde para a formação de estudantes do curso de graduação em Odontologia / Luana Gonçalves; orientador: Prof. Cresus Vinícius Depes de Gouvea, co-orientador: Prof. Marcos Antonio Albuquerque de Senna. – Niterói: [s.n.], 2016.
58 f.: il.
Tese (Doutorado em Odontologia) – Universidade Federal Fluminense, 2016.
Bibliografia: f. 43-46.
1. Diretrizes curriculares 2. PRÓ-PET Saúde. 3. Odontologia. I. Gouvea, Cresus Vinícius Depes de [orient.].II. Senna, Marcos Antonio
Albuquerque de [co-orien.]. III. Título.
BANCA EXAMINADORA
Prof. Dr. Marcos Antônio Albuquerque de Senna Instituição: Universidade Federal Fluminense
Decisão: _______________________ Assinatura: ______________________
Profa. Dra. Andrea Neiva da Silva
Instituição: Universidade Federal Fluminense
Decisão: ________________________ Assinatura: _____________________
Profa. Dra. Márcia Pereira Alves dos Santos
Instituição: Universidade Federal do Rio de Janeiro
Decisão: _______________________ Assinatura: ______________________
Prof. Dr. Sileno Corrêa Brum
Instituição: Universidade Severino Sombra
Decisão: _______________________ Assinatura: ______________________
Profa. Dra. Renata Rocha Jorge
Instituição: Universidade do Estado do Rio de Janeiro
DEDICATÓRIA
Dedico este trabalho a vocês que estão sempre ao meu lado nos dias de alegria e nos dias de tristeza... minha família.
AGRADECIMENTOS
Ao professor Cresus Vinícius Depes de Gouvêa pela confiança depositada em mim, possibilitando a realização deste sonho.
Ao amigo e professor Marcos Antônio Albuquerque de Senna pelo carinho com que me acolheu há alguns anos atrás... pelo respeito... pela confiança... por todas as portas abertas... por acreditar em mim... por ter me entendido quando, em determinado momento da minha vida, decidi abrir mão do doutorado... por ter me conhecido e me aceitado de volta para a realização desse sonho... pelo apoio incondicional... e principalmente, por proporcionar o resgaste da minha autoestima profissional. Você foi fundamental para esse processo. Seres humanos como você são cada vez mais raros nesse mundo. Muito obrigada por tudo, meu amigo!
A amiga e professora Andrea Neiva da Silva, pelo carinho de sempre... por toda ajuda, incentivo e apoio incondicional na realização desse sonho... te admiro muito. Seres humanos como você são cada vez mais raros nesse mundo. Muito obrigada por tudo, minha amiga!
Ao Cesar Luiz pela generosidade. Sem você não teria concluído este doutorado. Muito obrigada!
RESUMO
Gonçalves, L. Contribuições do PRÓ-PET Saúde para a formação de estudantes do curso de graduação em Odontologia. [tese]. Niterói: Universidade Federal Fluminense, Faculdade de Odontologia; 2016.
O presente estudo teve como objetivo analisar as contribuições do programa de incentivo as mudanças curriculares no Brasil, PRÓ-PET Saúde, para a formação dos estudantes do curso de graduação em Odontologia da Universidade Federal Fluminense. Para a construção desta análise foram investigados tutores, preceptores e estudantes do curso de Odontologia que participaram do programa PRÓ-PET Saúde nos anos de 2012 a 2015. Como instrumento de pesquisa foram utilizados questionários semiestruturados para cada grupo de sujeitos. Os resultados foram avaliados de forma quantitativa e qualitativa descritiva. O programa possibilitou o contato precoce destes estudantes com profissionais e usuários da rede de saúde, a troca de saberes através de uma atuação interdisciplinar e multiprofissional, contribuindo assim para a formação de um profissional mais humanizado, ético, com uma visão mais integral do paciente e mais preparado para atuar no SUS.
ABSTRACT
The aim of this study was to assess the contribution of the Program of Incentives for Curricular Changes PRÓ-PET Saúde in Brazil to the formation of undergraduate Odontology students from a Federal Fluminense University. Tutors, preceptors and Odontology undergraduate students who were participants of the program PRÓ-PET Saúde from 2012 to 2015 were surveyed. Semi-structured questionnaires were the research instruments applied to each subject group. The results were evaluated quantitatively and qualitatively descriptive. The program enabled the early contact of these students with professionals and users of the healthcare system, such as the knowledge exchange through an interdisciplinary and multiprofessional approach. The program contributed to the formation of well-prepared professionals to act at SUS (Unified Health System), considering their ethic, humanization and integral view of the patients.
1. INTRODUÇÃO
O Sistema Único de Saúde (SUS), criado no Brasil no ano de 1988, pela promulgação da Constituição Federal, como resultado do movimento de reforma sanitária, vem promovendo uma reorientação do sistema de saúde brasileiro. Baseado nas diretrizes e princípios deste novo sistema, a saúde, sob a responsabilidade do Estado, passou a ser um direito de todos os cidadãos, onde as especificidades dos indivíduos devem ser consideradas, para que todos possam ter a igualdade de oportunidade na sua utilização (PAIM & SILVA, 2010).
Esta mudança no modelo de atenção à saúdebusca mudar o foco da doença para um conceito mais ampliado de saúde, onde o ser humano deva ser visto como um todo, considerando sua história de vida, o meio em que ele vive e suas relações com o mesmo, seu próprio modo de viver. O cuidado à saúde passou então a ser pensado através de ações integradas de promoção, prevenção, recuperação e reabilitação (PAIM & SILVA, 2010).
Como consequência desta reorientação do sistema, houve a necessidade de mudanças na prática profissional. Os profissionais devem estar aptos a atuar de forma integral, considerando os aspectos biológicos, sociais e subjetivos do ser humano, de forma individual e coletiva; devem estar preparados para acolher, ouvir o outro, considerando nesta relação à subjetividade destes sujeitos. Devem procurar trabalhar de forma articulada, a fim de garantir a continuidade do cuidado nos diferentes níveis de atenção; lidar com diferentes saberes e atuar em equipes multidisciplinares, possibilitando uma visão mais integral do indivíduo; assim como buscar parcerias intersetoriais para o enfrentamento de situações que impliquem em menos saúde e menos qualidade de vida para todos (BRASIL, 2004).
Para que este profissional de saúde seja capaz de entender e atuar dentro destas novas perspectivas é necessário que tenha uma formação adequada para o desenvolvimento destas competências, e, de modo geral, a formação acadêmica tradicional não tem acompanhado as propostas de transformação do modelo proposto pelo SUS (COSTA & BORGES, 2015).
A formação odontológica tradicional e hegemônica no Brasil, teve como base o modelo médico científico que se institucionalizou a partir do relatório Flexner. Os elementos deste novo modelo se baseavam no mecanicismo, biologicismo, individualismo, especialização e tecnificação (MENDES, 1986).
Dessa forma, a odontologia brasileira – odontologia científica ou flexineriana - se estruturou tendo como base a universalidade biológica, orientada para a cura ou alívio das doenças ou para restaurações de lesões, pela natureza individual de seu objeto, pela concepção mecanicista do homem, pela utilização e valorização de tecnologias de alta investimento de capital, pela dominância da especialização e pela seletividade de sua clientela (MENDES, 1986).
Tendo em vista a necessidade de mudanças na formação em saúde o Ministério da Educação (MEC) reestruturou as Diretrizes Curriculares Nacionais dos Cursos de Saúde (DCN), à luz dos princípios e diretrizes do Sistema Único de Saúde (SUS). Em 2002, foi aprovada a Diretriz Curricular Nacional do curso de graduação em Odontologia, que definiu os princípios, fundamentos, condições e procedimentos da formação a serem implantados nas instituições de ensino superior do país (BRASIL, 2002).
Esta DCN, definiu o perfil do formando egresso/profissional, o Cirurgião Dentista. Este deveria ter uma formação generalista, humanista, crítica e reflexiva, para atuar em todos os níveis de atenção à saúde, com base no rigor técnico e científico. Deveria estar apto ao exercício de atividades referentes à saúde bucal da população, pautado em princípios éticos, legais e na compreensão da realidade social, cultural e econômica do seu meio, dirigindo sua atuação para a transformação da realidade em benefício da sociedade (BRASIL, 2001).
As DCNs valorizam e utilizam metodologias pedagógicas de ensino-aprendizagem que estimulam a participação ativa do estudante na construção do conhecimento, em diferentes contextos e cenários, possibilitando a vivência em diferentes situações de vida, da prática e do trabalho em equipe multiprofissional. Valoriza ainda a integração ensino-serviço vinculada às necessidades sociais da saúde e a inserção precoce deste estudante em atividades práticas que propiciem uma interação do mesmo com os usuários e profissionais de saúde desde o início de sua formação, de modo a lidar com problemas reais e assumir responsabilidades ainda durante sua formação. Propõe “a formação de um profissional ético, humanista, crítico, reflexivo, com valores de cidadania, com boa formação geral, e que atue de forma integral nas dimensões biológicas, psicológicas, sociais e ambientais, através de ações de promoção, prevenção, proteção e reabilitação da saúde, tanto a nível individual quanto coletivo” (BRASIL, 2001).
Uma nova dimensão de atuação profissional odontológica, dada pela possibilidade de se construir saúde de uma outra maneira, de se estabelecer outras/novas relações entre as diferentes profissões da saúde e entre os profissionais e a comunidade passou a ser valorizada e incentivada, exigindo assim, um esforço das instituições de ensino para readequar as propostas pedagógicas dos cursos de Odontologia.
Diante deste desafio e cumprindo o papel de ordenar a formação de profissionais de saúde, o Ministério da Saúde, por intermédio da Secretaria de Gestão do Trabalho e da Educação na Saúde (SGTES), institui em 2005 o Pró-Saúde. Este programa tinha como objetivo a integração ensino-serviço, assegurando uma abordagem integral do processo saúde-doença e visando à reorientação da formação profissional com a finalidade de ofertar à sociedade profissionais capazes de atender as demandas da população e do trabalho no SUS (ALBUQUERQUE et al., 2008)
Como estratégia para amplificar o PRÓ-Saúde, foi instituído em 2010 o Programa de Educação pelo Trabalho para a Saúde (PET-Saúde) (BRASIL, 2009).
A organização no PET-Saúde se dava através de grupos formados por um tutor, seis preceptores e 30 estudantes e inicialmente tinha como local de atuação o Programa Saúde da Família (BATISTA et al., 2015).
Este programa teve como objetivo fomentar a formação de grupos de aprendizagem tutorial em áreas estratégicas para o Sistema Único de Saúde (SUS), caracterizando-se como um instrumento de qualificação em serviço dos profissionais da saúde, bem como de iniciação ao trabalho e vivências dirigido aos estudantes das graduações em saúde, de acordo com as necessidades do SUS. Tendo como foco principal a integração ensino-serviço-comunidade, o programa vem estimulando a parceria entre as universidades e o serviço de saúde (BRASIL, 2010).
Em 2011, a SGTES, a partir dos processos de avaliação e acompanhamento dos PET anteriores, que indicaram a necessidade de articular PRÓ-Saúde e PET-Saúde, decidiu por um Edital conjunto PRÓ-Saúde/PET-PET-Saúde, o PRÓ-PET Saúde (BATISTA et al., 2015).
A Universidade Federal Fluminense, há mais de 30 anos, promove uma articulação entre os cursos da área da saúde e a rede de saúde pública do município de Niterói, por entender a importância da integração entre ensino e rede de serviços para a formação profissional e fortalecimento das relações com a comunidade. Essa
articulação ocorreu inicialmente através da inserção de docentes e estudantes na rede de saúde do município para a realização de práticas de disciplinas, projetos de extensão e pesquisa e prosseguiu através da participação nos programas de integração ensino-serviço propostos pelo Ministério da Saúde (ABRAHÃO et al, 2011).
O PRÓ-PET Saúde, desenvolvido pela Universidade Federal Fluminense e pela Secretaria de Saúde de Niterói, iniciou suas atividades em abril de 2012, tendo como objetivos: fortalecer os mecanismos de cooperação entre gestores da rede local de saúde e a Instituição Federal de ensino, visando ampliar os cenários de aprendizagem; intensificar, na formação, a abordagem integral do processo saúde-doença e da promoção da saúde; favorecer a adoção de metodologias ativas de aprendizagem e educação permanente do trabalhador envolvido na relação trabalho e ensino; ampliar as experiências de trabalho em equipe multidisciplinar na formação dos profissionais de saúde, possibilitando a construção de novos mecanismos de atenção na rede de saúde local; fortalecer o processo de regionalização e territorialização como instrumento de ampliação da resolutividade e da integralidade da atenção efetivada pela Estratégia de Saúde da Família (BRASIL, 2010).
Estudos realizados a partir de experiências do PET-Saúde e PRÓ-PET-Saúde tem demonstrado a importância desses programas de governo para incentivar as mudanças necessárias e contribuir para a formação de um profissional mais capacitado a atuar no modelo de saúde proposto pelo SUS (BATISTA et al., 2015; MADRUGA et al., 2015; FERREIRA et al., 2015; FORTE et al., 2015; FREITAS et al., 2013).
Dentro deste contexto, pretende-se analisar as contribuições do programa de incentivo as mudanças curriculares no Brasil, PRÓ-PET Saúde, para o processo de formação dos estudantes do curso de graduação em Odontologia da Universidade Federal Fluminense.
2. METODOLOGIA
2.1 Características da pesquisa
A metodologia utilizada para analisar a importância do programa de incentivo as mudanças curriculares no Brasil, PRÓ-PET Saúde, para o processo de formação dos estudantes do curso de graduação em Odontologia da Universidade Federal Fluminense foi quanti-qualitativa do tipo descritiva.
O universo amostral foi constituído por 25 estudantes do curso de graduação de Odontologia, 7 preceptores e 5 tutores que participaram do PRÓ-PET Saúde realizado pela Universidade Federal Fluminense e pela Secretaria de Saúde de Niterói, durante os anos de 2012 a 2015.
Os critérios de inclusão utilizados nesta pesquisa para seleção dos sujeitos de estudo foram: estudantes que cursavam graduação em Odontologia e que participaram do programa PRÓ-PET Saúde por no mínimo um ano; preceptores que trabalharam com estudantes do curso de odontologia por no mínimo um ano; tutores que orientaram estudantes do curso de odontologia por no mínimo um ano.
A coleta dos dados ocorreu por meio da aplicação de questionários semiestruturados, contendo perguntas abertas e fechadas, diferenciados para cada um dos sujeitos (estudantes, preceptores e tutores) (ANEXO 1, ANEXO 2 e ANEXO 3, respectivamente). Os questionários foram enviados e respondidos via email.
As variáveis pesquisadas foram: importância dos preceptores e tutores no programa; participação ativa no planejamento e desenvolvimento de atividades; importância da proximidade com os profissionais da rede para a formação; trabalho multiprofissional; impacto do programa para a formação ética humanista dos estudantes; impacto do programa para a formação em Odontologia. Estas variáveis foram pesquisadas de forma seletiva para cada um dos sujeitos da pesquisa. (QUADRO 1)
QUADRO 1: Variáveis pesquisadas de acordo com os questionários aplicados aos sujeitos da pesquisa
VARIAVEIS ESTUDANTE PRECEPTOR TUTOR
Importância dos preceptores e tutores no programa x x x Participação ativa no planejamento e desenvolvimento de atividades x x x
Importância da proximidade com os profissionais da rede para a
formação
x
Trabalho multidisciplinar x x
Impacto do programa para a formação ética humanista dos
estudantes
x x
Impacto do programa para a formação em Odontologia
x x x
2.2 Análise dos resultados
A análise quantitativa dos dados foi realizada através do Programa SPSS 17.0, onde foram analisadas as frequências numéricas. Os dados obtidos foram apresentados por meio de tabelas.
A análise qualitativa dos dados foi realizada por meio da Análise de Conteúdo, pois este método permite qualificar as vivências do sujeito, assim como suas percepções sobre determinado objeto ou fenômeno. A análise de conteúdo busca descrever o conteúdo emitido no processo de comunicação, seja ele por meio de falas ou de textos. Esta técnica é composta por procedimentos sistemáticos que proporcionam o levantamento de indicadores (quantitativos ou não) permitindo a realização de inferência de conhecimentos (BARDIN, 1977). Para a realização da análise de conteúdo, os temas foram previamente definidos, considerando os eixos de orientação do PRÓ-PET Saúde e embasamento teórico.
2.3 Aspectos Bioéticos
Observando as questões éticas inerentes a pesquisa com seres humanos, de acordo com a Resolução 466/2012 do Conselho Nacional de Saúde/ MS, o projeto desta pesquisa foi previamente submetido para apreciação do Comitê de Ética e Pesquisa da Universidade Federal Fluminense (CEP/UFF), que autorizou realização da mesma sob o número 25021913.4.0000.5243 (ANEXO 4).
Todos os sujeitos de estudo participantes desta pesquisa (estudantes, preceptores e tutores) receberam e assinaram um Termo de Consentimento Livre e Esclarecido (TCLE), previamente ao preenchimento do questionário, concordando com sua participação nesta pesquisa, assim como uma autorização permitindo a divulgação dos dados obtidos (ANEXO 5).
3. ARTIGO PRODUZIDO (Será submetido ao periódico Interface: comunicação, saúde e educação)
PRÓ-PET SAÚDE CONTRIBUTIONS FOR THE GRADUATION OF PRE-DOCTORAL DENTAL STUDENTS.
Luana Gonçalves, DDS, MSc1 Cesar Luiz, DDS 2
Marcos Antônio de Albuquerque de Senna, DDS, MSc13*
Cresus Vinícius Depes de Gouvêa, DDS, MSc14
1
Federal Fluminense University, Niterói, Rio de Janeiro, Brazil
2
Federal Fluminense University, Niterói, Rio de Janeiro, Brazil
3
Department of Health and Society, Federal Fluminense University, Niterói, Rio de Janeiro, Brazil
4
Department of Technique Dentistry, Federal Fluminense University, Niterói, Rio de Janeiro, Brazil
*Corresponding author: Dr. Marcos Antônio de Albuquerque de Senna - Universidade Federal Fluminense /Faculdade de Odontologia - Rua Mário Santos Braga, nº 30 - Campus Valonguinho, Centro, Niterói, RJ, Brazil - CEP 24040-110 - Phone: 55 21 2629-9832 - Fax: 55 21 2622-5739 - email: marcosenna@globo.com
ABSTRACT
Gonçalves, L. PRÓ-PET Saúde contributions for the graduation of pre-doctoral dental students. [thesis]. Niterói: Universidade Federal Fluminense, Faculdade de Odontologia; 2016.
The aim of this study was to assess the contribution of the Program of Incentives for Curricular Changes PRÓ-PET Saúde in Brazil to the formation of undergraduate Odontology students from a Federal Fluminense University. Tutors, preceptors and Odontology undergraduate students who were participants of the program PRÓ-PET Saúde from 2012 to 2015 were surveyed. Semi-structured questionnaires were the research instruments applied to each subject group. The results were evaluated quantitatively and qualitatively descriptive. The program enabled the early contact of these students with professionals and users of the healthcare system, such as the knowledge exchange through an interdisciplinary and multiprofessional approach. The program contributed to the formation of well-prepared professionals to act at SUS (Unified Health System), considering their ethic, humanization and integral view of the patients.
1. INTRODUCTION
The Unified Health System (SUS) created in Brazil in 1988 by the Federal Constitution, as a result of the health reform movement, has been leading the reorientation of the Brazilian health system. Based on the guidelines and principles of this new system, the health as a responsibility of the State, became a right of every citizen. The specificities of these individuals must be considered in order to provide equality of opportunity in the use if this health system (PAIM & SILVA, 2010).
This reorientation in the health care model aims to switch the focus from the disease itself to a wide concept of health. The human being is considered as a whole-person and a wide range of settings as the life history, the community where he lives, his relation with this community and the way he lives are relevant. Then the healthcare was based on the integration of promotion, prevention, recovery and rehabilitation actions (PAIM & SILVA, 2010).
Because of the system reorientation, the change of professional practices was necessary. The professionals should be able to perform an integral approach, considering biological, social and subjective factors of the human being in individual and collective spheres. The ability to admit and listen to these patients taking into account subjective factors was also necessary. These professionals should also accomplish an articulated approach in order to guarantee the care continuity in the different attention levels; deal with a range type of knowledge and act in multidisciplinary teams, enabling the whole person view; such as to seek intersectoral partnerships to the resolution of the situations that involve the decrease of health and life quality of all. (BRASIL, 2004).
In order to prepare the health professional to understand and act according to these new perspectives, the formation of this professional must provide de development of these competences. In general, the traditional academic formation has not been aligned to the transformation proposed by SUS (COSTA & BORGES, 2015).
The traditional and hegemonic Odontology academic formation in Brazil was based on the medical-scientific model institutionalized by the Flexner Report. The elements of this new model were found in mechanicism, biologicism, individualism, specialization and technicization (MENDES, 1986).
Thus, the Brazilian odontology – scientific or flexnerian dentistry – presents the biological universality as foundation. It is oriented to the diseases healing or relief or to damage restoration due to the individual nature of its object, to the mechanicist conception of man, to the utilization and appreciation of high cost technologies, to the dominance of the specialization and to the custom selectivity (MENDES, 1986).
Regarding the need of changes in the formation of healthcare professionals, the Brazilian Ministry of Education (MEC) restructured the National Curriculum Guidelines of education for health (DCN), under the perspective of the Unified Health System (SUS) principles and guidelines (SUS). The National Curriculum Guidelines of the graduation in Odontology was approved in 2002. It set principles, fundamentals, conditions and formation procedures that should be introduced in higher-level education institutes of the country (BRASIL, 2002).
This DCN determined the profile of the graduate student/professional, the Dental Surgeon. This professional should present a generalist, humanist, critical and reflexive formation to act in all levels of attention to health, based on technical-scientific accuracy. The professional should be able to develop activities related to the population oral health, based on ethic and legal principles and the understanding of social, cultural and economic conditions of the population. His performance should lead to the transformation of the reality of that community (BRASIL, 2001).
The DCN enriches and uses teaching-learning pedagogical methods that encourage the students to actively participate in the knowledge construction in varied contexts and scenes, enabling them to experience different practical and multi professional teamwork situations. Also, the DCN values teaching-service integration related to social healthcare needs and the early insertion of the student in practical activities that allow his interaction with healthcare users and professionals. The student is exposed to deal with real problems and responsibilities during his formation. The proposal of DCN consists in “the formation of an ethic, humanist, critical and reflexive professional, with values of citizenship, good general formation and able to act integrally in biologic, psychological, social and environmental dimensions, through health promotion, prevention, protection and rehabilitation in individual and collective levels” (BRASIL, 2001).
A new dimension in the performance of the dentistry professional arises due to the possibility of building health in a new way and to establish other/new relations between the different healthcare professions. The integration of the community of
health area professionals is encouraged and indispensable, thus requiring an effort of educational institutions to readjust the educational proposals of Dentistry courses.
Before this challenge, the Ministry of Health through the Division of Management of Work and Education in Health (SGTES), established the Pró-Saúde in 2005. This program was created to fulfill the responsibility of instructing the formation of health care professionals. The teaching-service integration was the purpose of this program, ensuring the integral approach on the health-disease process and to rearrange the professional formation with the goal to provide to the population health care professionals enabled to attend the population requests and the work at SUS (ALBUQUERQUE et al., 2008).
In order to amplify PRÓ-Saúde, the Program of Education for the Work for Health (PET-Saúde) was regulated in 2010 (BRASIL, 2009).
The organization of PET-Saúde consisted in groups composed by one tutor, six preceptors and thirty students. The acting place was primarily the Family Health Program (BATISTA et al., 2015).
This program aimed to promote the formation of tutorial learning groups in areas considered strategic by the Unified Health System (SUS). This program was characterized as a qualification tool in the services of health professionals such as the initiation to the work and experiences directed to undergraduate students of health careers, according to SUS needs. The main focus of this program is the integration teaching-service-community and the program nurtures the partnership between universities and the health service (BRASIL, 2010).
In 2011, the assessment and follow up of previous PET showed the need to interlock Saúde and PET-Saúde. So, they created a set notice PRÓ-Saúde/PET-Saúde, the PRÓ-PET Saúde (BATISTA et al., 2015).
The Federal Fluminense University for over 30 years promotes a linkage between the health care courses and the public health network of the city of Niterói, understanding the importance of integration between teaching and service network for professional training and strengthening relations with the community. This articulation occurred initially through the insertion of teachers and students in the municipal health network for conducting courses practices, extension and research projects and continued through participation in integration programs teaching service proposed by the Ministry of Health (ABRAHÃO et al, 2011).
The PRÓ-PET Saúde, proposed by a Federal Fluminense University and the Health Division of Niterói started in April, 2012. Its goals were to: strengthen the cooperation mechanisms between managers of the local health system net and the Federal Education Institute, magnifying the apprenticeship; deepen the integral approach of health-disease and promotion of health during the formation; foment the introduction of active learning methods and permanent education of the professionals related to the work and teaching processes; expand the experience of work in a multidisciplinary team in the formation of health care professionals, enabling the construction of new mechanisms of attention in the local health system; strengthen the regionalization and territorialization as a tool to enlarge the resoluteness and integrality of fulfilled by the Strategy of Family Health (BRASIL, 2010).
Studies based on the experiences of PET-Saúde and PRÓ-PET-Saúde show the importance of these governmental programs to encourage the necessary changes and contribute to the formation of professionals enabled to act in the health care model proposed by SUS (BATISTA et al., 2015; MADRUGA et al., 2015; FERREIRA et al.,2015; FORTE et al., 2015; FREITAS, et al., 2013).
Hence, intend to analyze the contributions of the Program of Incentives for Curricular Changes PRÓ-PET in Brazil to the formation process of undergraduate Odontology students from a Federal Fluminense University.
2. METHODS
2.1 Features of the research
To assess the importance of the Program of Incentives for Curricular Changes PRÓ-PET in Brazil on the formation of undergraduate Odontology students from a Federal Fluminense University, quantitative and qualitative methods were performed in this descriptive study.
The sampling universe consisted in 25 undergraduate Odontology students, 7 preceptors and 5 tutors who were participants of PRÓ-PET Saúde offered by a Federal Fluminense University and the Health Division of Niterói, from 2012 to 2015. The inclusion criteria applied in this study for subject selection were: undergraduate Odontology students participants of PRÓ-PET Saúde for at least one year; preceptors who worked with undergraduate students for at least one year; tutors who had tutored undergraduate Odontology students for at least one year. The general register of the Ministry of Health was used to the selection of subjects of this study (Division of Management of Work and Education in Health - SGTES).
Data collection was performed through the use of semi-structured questionnaires, formed by open and closed questions. Different questions were applied to the different subject groups (students, preceptors and tutors) (APPENDIX 1, APPENDIX 2 and APPENDIX 3, respectively). The questionnaires were sent and answered by email.
The variables studied were: the importance of preceptors and tutors in the program; active participation in the planning and development of activities; the importance of the proximity between the professionals of the net on the formation; multidisciplinary work; impact of the program on the ethic and humanist formation of the students; impact of the program on the formation in Odontology. These variables were analyzed selectively for each of the research subjects. (TABLE 1)
TABLE 1: Surveyed variables according to the questionnaires given to research subjects
VARIABLES STUDENT PRECEPTOR TUTOR
Importance of preceptors and tutors in the program
x x x
Active participation in the planning and development of
activities
x x x
The importance of the proximity between the professionals of the
net on the formation
x
Multidisciplinary work x x
Impact of the program on the ethic and humanist formation of
the students
x x
Impact of the program on the formation in Odontology
x x x
2.2 Analysis of the results
Quantitative data analysis was done by the use of the program SPSS 17.0, by the analysis of number frequencies. Data was tabled.
The qualitative data assessment was performed by the Content Analysis, so that this method provides the qualification the experience of the subject such as his perception about a specific object or phenomenon. The Content Analysis describes the content issued during the communication process, including speech and texts. This technic is composed by systematic procedures that provide the recognition of indicators (quantitative or not), allowing the inference of knowledge (BARDIN, 1977). To perform the content analysis the subject were defined considering the axis of orientation of the PRÓ-PET Saúde and theoretical basis.
2.3 Bioethical features
Regarding the ethical features related to researches involving human beings, according to the Resolution 466/2012 of the National Health Council / MH, the project of this study was approved by the Ethic and Research Committee of the Fluminense Federal University (CEP/UFF) and registered under the number 25021913.4.0000.5243 (APPENDIX 4).
Informed consent was obtained from all the study subjects (students, preceptors and tutors) before reading the questionnaire. According to the term, the participation in this study and the disclosure of the data was authorized (APPENDIX 5).
3. RESULTS
3.1 SAMPLE FEATURES
3.1.1 Students
25 (twenty-five) questionnaires were sent by email to undergraduate Odontology students from a Federal Fluminense University. These students were participants of PRÓ-PET Saúde for at least one year (from 2012 to 2015). All the questionnaires were filled and sent back to the researcher (n=25).
All the students involved in the study were part of the program PRÓ-PET Saúde and received scholarship from the Brazilian federal government for the defrayal and development of activities.
3.1.2 Tutors
25 (twenty-five) questionnaires were sent by email to undergraduate Odontology students from a Federal Fluminense University. These students were participants of PRÓ-PET Saúde for at least one year (from 2012 to 2015). All the questionnaires were filled and sent back to the researcher (n=25)
07 (seven) questionnaires were sent by email to tutors of PRÓ-PET Saúde who had tutored undergraduate Odontology students of a Federal Fluminense University for at least one year from 2012 to 2015. Only 05 (five) questionnaires were filled and sent by the tutors (n=5).
The tutors who were part of the study graduated in the following careers: nursing (1), physical education (1), psychology (1), pharmacy (1) and medicine (1).
3.1.3 Preceptors
07 (seven) questionnaires were sent by email to preceptors of PRÓ-PET Saúde who had worked with undergraduate Odontology students of a Federal Fluminense University for at least one year from 2012 to 2015. Only 05 (five) questionnaires were filled and sent by the tutors (n=5). All the questionnaires were filled and sent to the researcher (n=7).
The preceptors involved in the research had graduated in the following careers: nursing (2), social work (1), psychology (1) and medicine (3).
3.2 ROLE OF TUTORS AND PRECEPTORS
3.2.1 Evaluation of tutors by the preceptors
Preceptors assessed the participation of tutors in the program PRÓ-PET Saúde. 04 (four) of the preceptors (57%) considered it good, while 03 (three) of them (43%) considered it optimal.
Table 1. Evaluation of the participation of tutors by preceptors
OPTIMAL GOOD REGULAR BAD
43% 57% 0% 0%
3.2.2 Evaluation of tutors by the students
Regarding the participation of tutors in the program PRÓ-PET Saúde, 13 (thirteen) students (52%) considered them present, 10 (ten) students considered they present an effective participation (40%). One (1) student evaluated the participation of the tutors as casual (4%) and one (1) student (4%) e 01 (um) classified it as absent (4%).
Table 2. Evaluation of the participation of tutors by students
PRESENT EFFECTIVE PARTICIPATION
CASUAL
PARTICIPATION ABSENT
52% 40% 4% 4%
The students reported positive highlights related to the evaluation of the tutors:
“Even when absent (since the tutor does not go to with us to the work locations), the tutor actively takes part in our works through monthly virtual reports. Also, during the
group meetings, the tutor is informed about the details of the daily activities of each student. Then, the tutor shares about his opinions and reflections.” (A2)
“The tutor used to book monthly meetings for pleading, planning and results evaluation.” (A6)
“The tutor booked meetings very often to check the group productivity and to discuss about the network.” (A8)
“The tutor was always present and active in the meetings and all the activities proposed by PRÓ-PET SAÚDE.” (A13)
3.2.3 Evaluation of preceptors by tutors
Considering the participation of preceptors in the program PRÓ-PET Saúde, 03 (three) tutors (60%) classified it as good, 01 (one) tutor (20%) classified it as optimal and 01 (one) tutor (20%) classified it as regular.
Table 3. Evaluation of the participation of preceptors by tutors
OPTIMAL GOOD REGULAR BAD
20% 60% 20% 0%
3.2.4 Evaluation of preceptors by students
The students assessed the participation of preceptors in the program PRÓ-PET Saúde. 14 (fourteen) students (56%) evaluated it as present, 10 (ten) students evaluated their participation as effective (40%). Only 01 one student considered the participation of the preceptors as casual (4%).
Table 4. Evaluation of the participation of preceptors by students
PRESENT EFFECTIVE PARTICIPATION
CASUAL
PARTICIPATION ABSENT
56% 40% 4% 0%
“The preceptors are very active, showing us what we have to do (...)”. (A2)“
“In spite of being a doctor, the preceptor was always present and open to experience the knowledge exchange with the students. Hence, the community got more benefits
through the experiences and knowledge related to Odontology (student) and
Medicine (preceptor).” (A11)
“(...) the preceptor was very interested in planning and helping in projects and activities of the healthcare unit. The preceptor was always approachable and open to suggestions” (A13)
“(...) the preceptor provided new activities and allowed us to be in direct contact with the patients”. (A15)
“(...) the preceptor was always available to talk and include us daily work activities” (A20)
3.3 PARTICIPATION IN THE PLANNING AND DEVELOPMENT OF ACTIVITIES
3.3.1 Students
The students assessed their participation in the planning of the activities of the program PRÓ-PET Saúde. 20 (twenty) students reported being totally a part of the planning of the activities (80%). However, 05 (five) students reported that not participated (20%).
Table 5. Participation of students in activities planning: students report
PARTICIPANTS NOT
PARTICIPANTS
80% 20%
3.3.2 Tutors
Regarding the participation of the students in the planning of the activities developed by the group, all the 05 (five) tutors (100%) considered it effective.
The following planning strategies were highlighted: collective actions (05 tutors - 100%), team meetings (05 tutors - 100%), seminars (02 tutors - 40%), cases discussion (03 tutors - 60%) and visits to the work locations (01 tutor - 20%).
Table 6. Participation of the students in activities planning: tutors report
EFFECTIVE PARTICIPATION
100%
3.3.3 Preceptors
Taking into account the participation of the students in the planning of the actions developed by the group, 06 (six) preceptors (86%) considered it effective and only 01 (one) preceptor (14%) considered it casual.
The following planning strategies were highlighted by the preceptors: collective actions (06 preceptors - 86%), team meetings (07 preceptors - 100%), seminars (05 preceptors - 71%) and cases discussion (03 preceptors - 43%).
Table 7. Participation of the students in activities planning: preceptors report
EFFECTIVE PARTICIPATION
CASUAL PARTICIPATION
86% 14%
3.4 PROXIMITY BETWEEN THE PROFESSIONALS OF THE NETWORK DURING THE FORMATION
The students evaluated the importance of the proximity between the students and the healthcare professionals provided by PRÓ-PET Saúde. All 25 (twenty-five) students considered that this proximity improved their learning process.
“I evaluate this proximity as positive, since multidisciplinarity only brings benefits as experiences exchanges, opinions (...).” (A2)
“It allows us to have an integral view about the attention to health, to understand how multiprofessional teams may contribute to the improvement of the quality of life of the users”. (A9)
“The professionals from different healthcare areas show and teach us how the multiprofessional approach works in order to attend the population with more quality”. (A10)
“The formation becomes more humanised and integral. It goes in agreement with the national health system of the country - SUS – that depends on the multidisciplinary formation so that the professionals may be able to act according to this method”. (A13)
“Being able to exchange experiences, opinions and points of view from SUS with other areas is very enriching”. (A17)
“It is a way to look and not consider only the Odontology. PRÓ-PET Saúde promoted the approach between other healthcare areas, expanding the learning”. (A20)
“It is extremely important, considering that most Odontology students want to work for SUS. This primary contact allows the student to lead his formation (...)”. (A21) “Very important because approaches us to the healthcare service”. (A23)
“(...) it allows us to experience a different reality from the one we face at the university. Dealing with reality improves the learning process.” (A24).
3.5 MULTIDISCIPLINARY WORK
3.5.1 Tutors
Tutors were invited to share their perception about working with undergraduate students from different healthcare areas other than their own area. They considered that:
“It is a possibility for personal and professional growth, through knowledge and experience exchange.” (T1)
“Very difficult and a very, very important and crucial challenge. Building a work culture that may integrate perspectives of heterogeneous actions since the beginning of the formation course.” (T2)
“The work with students from different healthcare courses is really enriching. It provides different views of the challenges presented in the conduction of the project. I believe it improves the formation of the student.” (T4)
“It is very interesting for it enables a greater level of involvement with the teaching-learning process. The different professions offer their reflections and concerns with the problem they face in the practice.” (T5)
To assess the importance of the multiprofessional work developed during the activities proposed by PRÓ-PET Saúde, the tutors highlighted:
“It is an intense opportunity for exchange, mutual growth and knowledge expansion.” (T1)
“It is one of the greatest challenges of the program. To build logic of formation for healthcare areas less committed to professional corporatism and more willing to face concrete challenges of the national health.” (T2)
“I see this experience as a useful formation and necessary to the performance in the health area. (...) the multiprofessional feature represents one of the biggest challenges, but also is the feature that contributes more to the formation improvement.” (T4)
“It depends a lot on the involvement of the preceptors and their attempt to effectively relate to the different student healthcare areas. It also depends on their role to encourage the students to understand the duties and actions of the other healthcare areas.” (T5)
3.5.2 Preceptors
Regarding the work with students from different healthcare areas, the preceptors reported:
“It is interesting, for it enables a varied knowledge exchange, improving the treatment and the health system for the patients (...).” (P4)
“It is usually difficult, for the students come based on the prejudice and scared of the users of the health system. In the course of time, they become able to admit the users need and build partnerships in order assist them.” (P6)
“It is very good and enriching, for it promotes a multiprofessional integration. Each course has its own optics.” (P7)
The preceptors evaluated the multiprofessional work developed during the PRÓ-PET Saúde activities. They highlighted that:
“It consists in a rich and interesting experience. Especially for the students who have their first and maybe only opportunity to attend healthcare services other than those they are used to (...).” (P1)
“It is very positive. It has been interesting to deal with areas outside our routine, facing new challenges.” (P2)
“I consider this an advance motivated mainly by the interest of the participants.” (P3) “I consider the multiprofessional work of great importance, for the articulation between professional and students from different categories enables a better assistance to the users of the healthcare system and a better understanding of the concept of health.” (P4)
“It is very important, for each professional acts according to their formation and presents their point of view according to their qualification/ formation.” (P7)
3.6 THE IMPACT OF THE PROGRAM PRÓ-PET SAÚDE ON THE ETHICAL/HUMANIST FORMATION OF THE STUDENTS
3.6.1 Tutors
The tutors considered that the program PRÓ-PET Saúde influenced on the human and ethical behavior of the students who were participants of the program. All
the 05 (five) tutors (100%) reported that the program presented strong influence on the formation of the students, regarding this criteria.
Regarding the improvement in the ethical and humanist behavior of the students, 02 (two) tutors (40%) reported improvement in the relation with the users. 01 (one) tutor (20%) highlighted the concern with the users families and 04 (four) tutors (80%) highlighted a greater concern in basic health activities as change factors.
Table 8. Influence of the program PRÓ-PET SAÚDE in the ethical humanist formation of the students: tutors perception STRONG INFLUENCE SLIGHT INFLUENCE ABSENCE OF INFLUENCE 100% 0% 0% 3.6.2 Preceptors
The preceptors assessed if the program PRÓ-PET Saúde influenced on the human and ethical behavior of the students who were participants of the program. 05 (five) preceptors (72%) – considered that the program presented strong influence on the formation of the students, 01 (one) preceptor (14%) classified this influence as slight and 01 (one) preceptor (14%) reported that the program did not influence on the human and ethical behavior of the students.
Regarding the 05 (five) preceptors who considered that PRÓ-PET Saúde presented strong influence on the humanist and ethical behavior of the students, all of them (100%) highlighted the improvement in the relation with users of the healthcare system and greater interest in basic health activities as change factors.
Table 9. Influence of the program PRÓ-PET SAÚDE in the ethical humanist formation of the students: preceptors perception STRONG INFLUENCE SLIGHT INFLUENCE ABSENCE OF INFLUENCE 72% 14% 14%
3.7 THE IMPACT OF THE PROGRAM PRÓ-PET SAÚDE TO THE FORMATION IN ODONTOLOGY
3.7.1 Tutors
By evaluating the impact of the program in the formation of the student, the tutors highlighted:
“The possibility to anticipate the insertion/reality of the work process to the future professional.” (T1)
“The project enables the students to have a new perspective about SUS and the governmental healthcare system. It provides the learning of concepts that cannot be fully understood in classrooms, as bond, admission, accountability and listening. These are precious concepts to the work in the healthcare area and the traditional formation does not provide their apprehension.” (T3)
“(...) it favored the formation of the student by allowing him to have a real vision of the daily work in the governmental healthcare system and to experience the multiprofessional work, which cannot be experienced in other academic activities.” (T4)
“I believe the program impacted the formation of the students for it allows them to comprehend the real meaning of University. It is possible to apply the praxis in the professional practice from the reflections about the ideal and performed services.” (T5)
3.7.2 Preceptors
The preceptors assessed the impact of the program in the formation of the students. They highlighted that:
“It has been a positive impact with the insertion of the students in the governmental healthcare system and their participation in education activities in the healthcare units they are involved, the understanding of network procedures, the contact with
the users as advisors/ professionals in formation (...). One of the Odontology students even said that due to his participation in the program PRÓ-PET Saúde he got to understand the human being as a whole-being and not only as a beautiful smile.” (P2)
“Experiencing the program is very interesting to the students. Get to know the network where they are acting makes the difference (...).” (P3)
“It contributed to the student have the real view of what he is going to experience when he graduates. It is a previous view of the professional reality.” (P7)
3.7.3 Students
The students evaluated if the participation in the program PRÓ-PET Saúde was important to the formation in Odontology. 22 students (twenty-two) reported that it was very important (88%), 01 (one) student reported it was little important (4%) and 02 (two) students did not answer to the questionnaire (8%).
Table 10. The importance of the participation in the program PRÓ´PET Saúde to the formation in Odontology: students perspective
VERY IMPORTANT LITTLE IMPORTANT NOT ANSWERED 88% 4% 8%
The contribution of the program PRÓ-PET SAÚDE on the formation of the undergraduate Odontology students can be observed in their citations:
“It allows us to have a wide view about health”. (A1)
“In the faculty of Odontology we do not have a real view of the conditions outside the faculty. (...) The PRÓ-PET provided the practical view and the patient treated as an human being and not as a mouth. The healthcare professionals are interested in the problem origin, including where the people live, regarding their diet, their general health condition and then be able to make plans in order to actually change their lives. Through this experience I became more sensitive, more human (...).” (A2) “Nowadays the faculties are forming teeth technicians who know everything about teeth, sometimes they do not even know everything about the mouth and forget that
prior to the teeth, there is a person who needs attention. Very often the professional can solve some problems by listening to the patient. Healing diseases is very important, prevent them is better, but to promote quality of life is extraordinary. The dentist, as a healthcare professional, has the ability to do that but it is necessary to change the way of thinking and the focus on the patient healthcare. In my opinion, all the students should be part of PRÓ-PET SAÚDE, for this program has the power to change the formation and change thoughts.” (A3)
“Very positive, for it allows direct contact with the patients and other healthcare professionals.” (A5)
“It allowed me to know the point of view of the users and to learn with other professionals how to have a good relationship with the patient.” (A9)
“(...) we grow as people and as future professionals.” (A10)
“The experience that PRÓ-PET provided is greater than I expected when I entered the program. Dealing with other professionals and to understand their work view, that is usually different of mine and understand their difficulties, their limitations really improves my formation. Not only by the contact with the professionals but for the contact with the patients, their life experiences, the possibility to learn how to have an integral view and not only focused on the disease itself. I am better prepared than the people who have their clinic formation restricted to the dental office.” (A13)
“Unfortunately the formation in Odontology is generally restricted to the dental office attendance. The PRÓ-PET enabled to experience the routine and the reality of SUS, its failures and its accomplishments. The formation of a professional with humanised view and better prepared to face the market work.” (A17)
“Prepares the student to act at SUS” (A20)
4. DISCUSSION
The governmental program, PRÓ-PET Saúde, through the integration of teaching-service-community, aims to overcome the traditional formation model of health care professionals. It is based on the introduction of new pedagogical strategies enabling the student to be part of the knowledge construction process (COSTA & BORGES, 2015).
The traditional model of knowledge transmission is not applied in this program (COSTA & BORGES, 2015). The problematization method leads the learning process, encouraging the student to make choices and decisions based on the reflection about the problem. The student plays an active role in the knowledge construction (CYRINO & TORALLES-PEREIRA, 2004; MITRE et al., 2008).
The teaching-learning strategy applied is in agreement with the DCN of the course of graduation in Odontology. The DCN advocates that the pedagogical project of this graduation course must be collectively constructed. According to this student-centered model, the professor plays the role of supporting the student as facilitator and mediator in the teaching-learning process which goal is an integral and accurate formation (BRASIL, 2002). The tutors and preceptors of PRÓ-PET Saúde act as facilitators and mediators so that their function is indispensable in the formation of these health care professionals.
PRÓ-PET Saúde constitutes the formation of tutorial multiprofessional groups formed by tutors (graduation professors of different healthcare areas), preceptors (professionals from different healthcare areas who work in the health service network) and undergraduate students from different healthcare areas for the development of activities (CAMARA et al., 2015).
The tutors must plan - with preceptors and students - the activities that will be developed, follow, supervise and guide preceptors and students who are members of their tutorial group. They also must dialogue about the evaluation of activities, events schedule and continuing education (FORTE et al., 2015).
According to the problematization of the reality, besides planning the experiences and the development of activities, the preceptors admit, follow and supervise the students during their activities (FORTE et al., 2015). The preceptors are the link between the teaching and the work.
By analyzing the study results regarding the participation of tutors and preceptors in the program PRÓ-PET Saúde, one can notice that they fulfilled their functions, playing a key role in the development of activities in partnership with the students and their formation.
The traditional or Flexnerian Odontology education leads to the formation of a professional with individualistic and specialized approach; for the use of high cost sophisticated technologies, that only can be affordable to selective customs (MENDES, 1986). The profile of the professional formed according to this model is not in agreement with the reality and needs of the Brazilian population and the healthcare services (GONZALES & ALMEIDA, 2010).
In this context, the program PRÓ-PET Saúde, as a public politic of encouragement to curricular changes advocated by DCNs, promotes the articulation teaching-service-community and approaches the undergraduate Odontology students and the healthcare services (COSTA & BORGES, 2015).
The early insertion of these students in the healthcare services, in addition to the expansion of the practical sceneries, enables the student to be in touch with the socio-cultural reality of the population and the dynamic of the healthcare services during their formation (COSTA & BORGES, 2015). The student has the reality as his practical scenery and the reflection of this student is developed through real situations. The professional that is constructed under this new model is able to face the problems since the teaching-learning process occurs in the practical way based on the real needs of the population (HADDAD et al., 2012).
According to the results, most students were effectively involved in the planning of the activities. The planning was based in the problematization of the reality in the different practical sceneries, encouraging the critical thinking, the reflection and the social responsibility before the problems and experiences (BOELEN & WOOLLAED, 2009). It enables a new perspective in the professional formation, in which the knowledge construction occurs through the health and social needs of the population (FORTE et al., 2015).
The early insertion in the healthcare service enables not only the contact with the socio-cultural reality of the population, but also the contact with professional from different healthcare areas that work in the health system. These professionals play a key role in this process since they are responsible to admit and follow the students in this service, during the planning and development of the activities. These
professionals act as mediators and facilitators of the teaching-learning process. They also articulate actions and activities of the health system and are essential to the formation of the future professionals (FORTE et al., 2015).
The healthcare professionals had graduated in different health areas and perform different functions in the health system. The contact with them enlarges the view of the role of the healthcare professional to the Odontology undergraduate student sand encourages the multiprofessional team work, the dialogue and knowledge exchange between different professions. This contact also contributes to the formation of a professional who is able to perform an integral approach required by SUS (FORTE et al., 2015).
The work of multiprofessional and interdisciplinary teams is one of the competences and abilities required by DCNs for the Odontology graduation course, for the new profile of the graduating student (BRASIL, 2002).
The program PRÓ-PET Saúde, through their multidisciplinary tutorial groups, provides the interaction between students and healthcare professionals of different areas. These interactions cooperate with the knowledge exchange, the construction of knowledge and the development of activities that encourage the multiprofessional collaborative work (COSTA & BORGES, 2015; MADRUGA et al., 2015). They allow the students to understand the function and the importance of team work with professional of different healthcare areas in order to figure out the population health issues and improve the health care (FREITAS et al., 2013; MADRUGA et al., 2015).
The knowledge exchange produces a significant impact to rescue the role of the healthcare service users and their needs. It strengthens the change from an assistance approach to the integrality in the actions of healthcare (COSTA & BORGES, 2015).
The multiprofessional work is a tool for the implementation of integral attention to health. In order to achieve it, it is necessary more than gather healthcare professionals from different areas together. Their willingness and availability to interact, reflect and plan their practices in an articulate manner to valorize the team work is crucial for the success of the program (MADRUGA et al., 2015).
The interaction between the professional is extremely relevant to overcome the prejudice and stereotypes related to the different healthcare areas. The prejudice and stereotypes are strongly encouraged by the professional hierarchy culture.
Hence, this interaction contributes to a professional formation more collaborative and less hostile between the different healthcare areas (MANDY et al., 2004; BAKER et al., 2011).
The Odontology is a health science originated by the meeting of two subjects. These meetings happen in a space that sustains technological dimension of the work. While performing the oral care, the professional operates in a core formed by a dead work – the use of hard technologies (the use of instruments, machines) - and a live work in process, in the moment that it is being produced, using light technologies (relational) (MERHY & FRANCO, 2003).
The traditional model of Odontology formation supported the predominance of the dead work over the live work, with the prevalence of the use of hard technologies over light technologies. In this context, the healthcare work was limited to summary and bureaucratic relations between the subjects. Also, the knowledge of the healthcare professional was hegemonic and prevailed over the patient; the healthcare work was limited to therapeutic and prescriptive approaches (MERHY, 2002).
This fragmented formation model focused in the technical-scientific development favored the dehumanization of the assistance, by not considering the patient as an unique being who must be respected in their fullness, regarding biological, psychologic, social and spiritual features (JUNQUEIRA & RAMOS, 2007).
In this context, the DCN of the graduation course in Odontology, promotes the reorientation in the professionals formation. The DCN aims the change from the technical-scientific model (therapeutic approach, based in procedures and the use of technical-scientific protocols) to a model that provides to the dentist in formation the ability to perform according to ethical humanist bases, considering biological, social and subjective factors related to the human being. Also, according to this model, the dentist would be enabled to act in individual and collective perspectives, to admit, to listen to the patients and to consider subjectivity factors (BRASIL, 2004).
According to our results, the program PRÓ-PET SAÚDE plays an underlying role in the process of change in the professional-patient relation. It works as an activator of the changes proposed by DCN. Due to the program, the patients are identified as subjects who possess knowledge and popular practices and it enables the dialogue between the students and the community members regarding their health issues (RODRIGUES et al., 2012).
The program provides the reflection about the healthcare practice through the appreciation of the knowledge of the patient, his needs and requests. It corroborates to the demystification of the relation knowledge/power which is very common among the healthcare professionals, who usually discredit the frailty of the patient by disregarding their knowledge about their body and health (FERREIRA, et al., 2015).
The interaction teaching, service and community consists in a strategy of the program PRÓ-PET SAÚDE, is fundamental to the formation of professional committed to SUS propositions. It creates the direct contact with the population issues and provides aids to an integral approach through the development of collective actions (RODRIGUES et al., 2012).
The students experience the formative processes based on the work needs and demands. Hence, the students can experience and construct collectively a reflection about health practices and establish bonds. (FERREIRA, et al., 2015).
In opposition to professional internships, which focus on the performance of specific profession duties, the program PRÓ-PET provides the development of abilities that are common to healthcare professional of different areas. It is guaranteed by the diversification of the learning sceneries and the use of active teaching methods (COSTA & BORGES, 2015).
The use of active teaching-learning methods encourages the development of critical thinking, the reflection and the social responsibility before the problems and experienced situations (COSTA & BORGES, 2015).
The program PRÓ-PET SAÚDE brings the students closer to the various practice sceneries, enabling the knowledge development and the development of practices that will contribute to a proper formation that will reflect in their future and in the quality of services offered to the subjects, family and community (FERREIRA, et al., 2015).
