EDUCAÇÃO MÉDICA: O ENSINO DE MEDICINA PALIATIVA

(1)

EDUCAÇÃO MÉDICA: O ENSINO DE MEDICINA PALIATIVA

MEDICAL EDUCATION: THE TEACHING OF PALLIATIVE

MEDICINE

Sandra Márcia Carvalho de Oliveira !"#$#%&'%('&)*)+,%'%-)"').$/%0+)1'"#)&,&'%2'&'",3%&$%4*"'%5024 6 #,+&",$3)1')",7!8,*9:" Resumo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alavras-chave'(A465+.D&(CI435+Y(A1,#20D&Y(?634+4&0(Z+*3+$%&0Y(C#43532+(Z+*3+$%+Y(?-3+2.+0H( Abstract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eywords'(C#435+*(A465+$&2Y(A1,#203&2Y(Z+**3+$%#(?+-#Y(Z+**3+$%#(C#43532#Y(_340H(

Introdução

;#.!&$#%+,*)$+,)#%'%)+.'"+,*)$+,)#%"'3,.,<%=!'%$%")#$%>%!<%<$&!3,&$"%)<?$".,+.'%+,%1)&,%&'% ?,*)'+.'#%)+.'"+,&$#%'<%@$#?).,)#/%,#)3$#%$!%$"8,+,.$#%5AB C(4D/%EFFGH%(4IA4 4/%EFJJH%KABIL/% EFJGH% 0DC4/%JMMNH%-L0ILA;O%-4%4P;QAB4/%JMMRH%(4OO;IB/%EFFG69

4% !+)1'"#)&,&'% &'1'% #'"% $% 3!S,"% &'% ?'"<,+'+.'% :!#*,% &'% *$+@'*)<'+.$9% L% ,*'##$% ,$% *$+@'*)<'+.$% *)'+TU*$% ?'"<).'% =!'% ,#% S'",VW'#% &'% ,*,&X<)*$#% &'#<)#YU=!'<% *$+*').$#% '% ,% ?,"Y"%&,Z%*$+#."!,<%1,3$"'#%*$<$%*)&,&[$#%>Y*$#%'%*$%"'#?$+#\1'3%?'3,%*$3'Y1)&,&'%52LDI;O/% EFFJH%2A;BA;/%JMRM69

]'+#,+&$% '<% '#.,:'3'*'"% <$&'3$#% <,)#% >Y*$#% '% @!<,+)#.,#% &'% '+#)+$/% '<% EFFJ% 8$",<% @$<$3$S,&,#%?'3$% $+#'3@$%D,*)$+,3%&'%;&!*,V[$%,#%-)"'.")^'#% !"")*!3,"'#%&$%;+#)+$%(>&)*$/% #!S'")+&$%,%)+#'"V[$%&$#%,3!+$#%'<%*'+\")$#%&)1'"#)U*,&$#%'/%,##)</%$#%?'"<)Y+&$%.'"%!<%<,)$"% *$+.,.$%*$<%,#%=!'#.W'#%#$*),)#/%*!3.!",)#%'%?#)*$3_S)*,#%&$%?,*)'+.'%54K;(/%EFJR69% %L"S,+)^,V[$%(!+&),3%&'%O,`&'%5L(O6%&'#'+@$!%!<%<$&'3$%&'%)+.'"1'+V[$%'<% !)&,&$#% ],3),Y1$#%$+&'%,#%,VW'#%?,3),Y1,#%.X<%)+Z*)$%a\%+$%<$<'+.$%&$%&),S+_#Y*$/%'%$%*!)&,&$%?,3),Y1$% #'%&'#'+1$31'%&'%8$"<,%*$+a!+.,%*$<%,#%.'",?X!Y*,#%*,?,^'#%&'%,3.'","%$%*!"#$%&,%&$'+V,%5OBPb4/% EFJc69

$+8$"<'%$% _&)S$%&'%dY*,%(>&)*,%'%$#% !)&,&$#%],3),Y1$#%+$% ,?Z.!3$%b%e%A'3,V[$%*$<% ?,*)'+.'#% '% 8,<)3),"'#9% fd% 1'&,&$% ,$% <>&)*$g% 4".9% NJ9% 4:"'1),"% ,% 1)&,% &$% ?,*)'+.'/% ,)+&,% =!'% ,% ?'&)&$%&'#.'%$!%&'%#'!%"'?"'#'+.,+.'%3'S,3h9%;%+$%#'!%?,"\S",8$%`+)*$%&)^%=!'g%

D$#% *,#$#% &'% &$'+V,% )+*!"\1'3% '% .'"<)+,3/% &'1'% $% <>&)*$% $8'"'*'"% .$&$#% $#% *!)&,&$#% ?,3),Y1$#% &)#?$+Z1')#% #'<% '<?"''+&'"% ,VW'#% &),S+_#Y*,#% $!% .'",?X!Y*,#% )+`.')#% $!% $:#Y+,&,#/% 3'1,+&$% #'<?"'% '<% *$+#)&'",V[$% ,% 1$+.,&'% 'i?"'##,% &$% ?,*)'+.'% $!/% +,% #!,)<?$##):)3)&,&'/% ,% &'% #'!% "'?"'#'+.,+.'%3'S,3%5 2(/%EFJR69

(2)

O'S!+&$%,%3).'",.!",g

4% :,#'% <,)#% #_3)&,% ?,",% ,% &)1!3S,V[$% '% *$+@'*)<'+.$% &$#% !)&,&$#%],3),Y1$#%5 ]6%>%,%'&!*,V[$%&$#%8!.!"$#%?"$U##)$+,)#% &,%<'&)*)+,%,)+&,%+,%S",&!,V[$/%'%?"'8'"'+*),3<'+.'%,+.'#%&$#% ,+$#%&$%'+#)+$%*3Z+)*$%+$%,<:!3,._")$%'%+,%'+8'"<,"),9% $<% ",",#%'i*'VW'#/%$%'+#)+$%&,%*3Z+)*,%&'.><j#'%?")<$"&),3<'+.'% +,#% <,+)8'#.,VW'#% <_":)&,#% &$% *$"?$/% k#% 1'^'#% ,.>% *$<?,"Y<'+.,3)^,+&$j,#/% '#=!'*'+&$j#'% &,#% &)<'+#W'#% '<$*)$+,)#/%'#?)").!,)#%'%#$*),)#%&$%#'"%@!<,+$9%;##,%$<)##[$% ?")1)3'S),%$%#,:'"%&,%.>*+)*,%'%&,%.'",?X!Y*,%<'&)*,<'+.$#,/% $%=!'%>%"'#?$+#\1'3%?'3,%?'"&,%&$%"'3,*)$+,<'+.$%?,*)'+.'l <>&)*$/%=!'%>%$%,?,+\S)$%&,%<'&)*)+,9%52BQ0;BA;-L/%EFJm/% ?9Mn69 L%?"$a'.$%&'%'i.'+#[$%-$!.$"'#%&$%A)#$%5,?"$1,&$%?'3$%;&).,3%]AL;o%+p%Fc%&'%EFFR/%"'S)#."$% 5EcJFR9FJMJmGlEFFRjNE66%.'1'%*$<$%$:a'Y1$#%?"$?)*),"%,$#%'#.!&,+.'#%&'%<'&)*)+,%$%*$+1Z1)$% &'% <$&$% @!<,+)^,&$% *$<% ?,*)'+.'#% )+.'"+,&$#% 5@$#?).,3/% ,#)3$% '% $"8,+,.$6% ?"$?$"*)$+,+&$% 'i?'")X+*),%'%.",:,3@,+&$%,%"'3,V[$%<>&)*$j?,*)'+.'H%,.!,"%+$%&'#'+1$31)<'+.$%&,%'<?,Y,%'%&,% ,:'".!",%?,",%'#*!.,%'%$%&)\3$S$%*$<%?,*)'+.'#%'%#'!#%8,<)3),"'#%?$"%<')$%3`&)*$H%:!#*,"%"'*"),"%$% ,<:)'+.'%8,^'+&$%1)#).,#%@$#?).,3,"'#%*$<%1'#Y<'+.,#%*$3$")&,#H%3'1,"%*$+8$".$%'%,3'S"),%?,",%,#% *"),+V,#%@$#?).,3)^,&,#%e%'%#'!#%,*$<?,+@,+.'#%e%.$"+,+&$%#!,%'#.,&),%+,%!+)&,&'%@$#?).,3,"%<,)#% ,S",&\1'3H%'%"'##,3.,"%,%)<?$".q+*),%&,%@!<,+)^,V[$%'%*!)&,&$#%?,3),Y1$#/%:'<%*$<$%'#."').,"%'% ,?'"8')V$,"%,%"'3,V[$%<>&)*$j?,*)'+.'%&'#&'%$%)+Z*)$%&,%1)&,%,*,&X<)*,9

L% ?"'#'+.'% ,"YS$% .'<% *$<$% $:a'Y1$% "'3,.,"% ,VW'#% &'% 'i.'+#[$% '<% *!)&,&$#% ?,3),Y1$#% &'#'+1$31)&,#% ?$"% ,*,&X<)*$#% &'% <'&)*)+,/% +,#% '+8'"<,"),#% '% ,3,% &'% $+*$3$S),% ?'&)\.")*,% &$% C$#?).,3%&,#% 3Z+)*,#/%+$%;&!*,+&\")$%O,+.,%(,"S,")&,%'%+$%,#)3$%O[$%b)*'+.'/%,.",1>#%&$%?"$a'.$% -$!.$"'#%&$%A)#$%+$%?'"Z$&$%&'%&'^'<:"$%&'%EFFG%,%&'^'<:"$%&'%EFFM9

Metodologia

I",.,j#'%&'%!<%'#.!&$%&'%"'3,.$%&'%'i?'")X+*),%&'%,VW'#%&'%*!)&,&$#%?,3),Y1$#%"',3)^,&,#% '<%'+8'"<,"),#%'%,3,%?'&)\.")*,%&$%C$#?).,3%&,#% 3Z+)*,#/%;&!*,+&\")$%O,+.,%(,"S,")&,%'%4#)3$%O[$% b)*'+.'%?'3$%?"$a'.$%&'%'i.'+#[$%-$!.$"'#%&$%A)#$%+$%?'"Z$&$%&'%EFFG%,%EFFM9% 4#%,Y1)&,&'#%8$",<%"',3)^,&,#%+,#%'+8'"<,"),#/%:")+=!'&$.'*,#%'%,3,#%3)1"'#/%*$<%,%?"'#'+V,% &$#% ?"$U##)$+,)#% &,% #,`&'% '% ,*$<?,+@,+.'#/% '% 8$",<% &)1)&)&,#% '<% &$)#% <$<'+.$#g% "$&,% &'% *$+1'"#,%'%,Y1)&,&'#%3`&)*,#9%4%?")<')",%'.,?,%*$+.'<?3$!%,%?,"Y*)?,V[$%'#?$+.q+',%&$#%1)#).,&$#% +,%?"'#'+V,%&$#%,*,&X<)*$#j?,3@,V$#%+,%!+)&,&'9%D,%#'S!+&,%'.,?,/%$")'+.,&$#%#'S!+&$%$%+Z1'3% &'%*$<?"''+#[$/%$#%1)#).,&$#%"',3)^,",<%,Y1)&,&'#%3`&)*,#9%4##)</%,#%*"),+V,#/%,&!3.$#%'%)&$#$#/% &'#'+@,",<% '% ?)+.,",<% )<,S'+#% &'% 8$"<,% 3)1"'/% :'<% *$<$% :")+*,",<% '% #'% &)1'"Y",<% *$<% $#% <>&)*$#%?,3@,V$#9%D$#%?")<')"$#%,+$#/%5EFFG%'%EFFm6%$%S"!?$%8$)%*$<?$#.$%?$"%+$1'%,*,&X<)*$#% &$%*!"#$%&'%<'&)*)+,/%=!'%)+)*),",<%,#%#!,#%,Y1)&,&'#%"',3)^,+&$%!<,%1)#).,%?$"%<X#%,%JnF%*"),+V,#% =!'%'#.,1,<%'<%3').$#%@$#?).,3,"%)+8,+Y3/%'%,%GF%)&$#$#%&$%,#)3$%O[$%b)*'+.'/%$+&'%8$",<%'#*$3@)&,#% &,.,#%'#?'*),)#%?,",%,%?"$S",<,V[$%&$%'1'+.$/%*$<$%$%-),%&,%*"),+V,/%D,.,3%'% ,"+,1,39 4%<'.$&$3$S),%!Y3)^,&,%+$%?"$a'.$%8$)%,%]"$a'*.%K,#'&%P',"+)+S%5]KP6H%<$&'3$%&'%'+#)+$%=!'% ?'"<).'%,%,?"'+&)^,S'<%?$"%<')$%&'%?"$a'.$#%'%"'#$3!V[$%&'%?"$:3'<,#9%O'+&$%$%?"$:3'<,%8$*,3% &$%?"$a'.$%&'%'i.'+#[$%'<%=!'#.[$%,%<'3@$"),%&,%"'3,V[$%<>&)*$j?,*)'+.'%'%,%@!<,+)^,V[$%+$% ,<:)'+.'%&'%#,`&'9% L%<>.$&$%'<?"'S,&$%,.'+&'%,$#%a$1'+#%,*,&X<)*$#j?,3@,V$#/%?$)#%8,*)3).,%$%,?"'+&)^,&$% '% ?"$<$1'% <$Y1,V[$% '% )+.'"'##'9% ;#Y<!3,% *$<?'.X+*),#% '% @,:)3)&,&'#% #$*)$'<$*)$+,)#% *$<$% ,!.$+$<),/% '<?,Y,/% *$<!+)*,V[$/% *$3,:$",V[$/% '+."'% $!."$#9% 43><% &'% &'#'+1$31'"% *)&,&[$#% ,3.,<'+.'%*,?,*).,&$#/%*$+#*)'+.'#%&'%#!,#%'#*$3@,#%'%*,?,^'#%&'%,.!,"%*$<$%?"$.,S$+)#.,#%&'% suas vidas.

$<% $% '<?"'S$% &$% ]KP% 8$)% ?$##Z1'3% $% &'#'+1$31)<'+.$% &'% *$<?'.X+*),#% 1$3.,&,#% ,$% <'"*,&$% &'% .",:,3@$9% 4.",1>#% &$% !#$% &'% 8'"",<'+.,#% '% 3)+S!,S'<% =!'% $% ,*,&X<)*$% '+.'+&'% '% ,*$3@'/%*$<$%$%?"$a'.$%&'%'i.'+#[$%&$!.$"'#%&$%")#$H%=!'%*$<%#!,%8$"<,%&)8'"'+*),&,%'%,.",Y1,% ,a!&,%+,%8$"<,V[$%<>&)*,9

(3)

Procedimentos:

J9%]"$*'##$%#'3'Y1$ B+)*),3<'+.'/%+$%,+$%&'%EFFG/%8$",<%#'3'*)$+,&$#%FM%3)S,+.'#9%L%?"$a'.$%-$!.$"'#%&$%A)#$% *,?,*).$!%$#%,*,&X<)*$#%&'%<'&)*)+,%"',3)^,+&$%#'<)+\")$#/%r$"s#@$?#%'%$U*)+,#9 E9%t$"s#@$?#/%LU*)+,#%'%O'<)+\")$#9 D'#.,%'.,?,%$#%,*,&X<)*$#%&$%*!"#$%&'%<'&)*)+,%=!'%?,"Y*)?,",<%&$%?"$a'.$%-$!.$"'#%&$% A)#$/%?,##,",<%?'3$%?"$*'##$%&'%*,?,*).,V[$/%,.",1>#%&'%?,3'#.",#%=!'%,:$"&,1,<%.'<,#%,"T#Y*$#% *$<$%<`#)*,/%.',."$/%&'#'+@$/%,".'%5*&R2/%,".'#,+,.$/%<\S)*,/%&)&\Y*,%)+8,+Y3/%,".'%'<%:,3W'#%'% *,",*.'")^,V[$%'%*"),V[$%&$%?'"#$+,S'</%,%U<%&'%,a!&\j3$#%,%&'#'+1$31'"%#!,#%@,:)3)&,&'#%'<%*,&,% !<,%&'##,#%\"',#9% I,<:><%8$",<%.",:,3@,&$#%.'<,#%@!<,+Z#Y*$#%*$<$%,%,:$"&,S'<%&,#%*"),+V,#%&!",+.'%,#% 1)#).,#H%*$<$%)+.'",S)"%'<%!<%?")<')"$%<$<'+.$%*$<%$%?,*)'+.'H%*$<$%#'%*$<?$".,"%+$%<$<'+.$% &,%&$"H%*$<$%*$+.$"+,"%#).!,VW'#%,&1'"#,#/%#,:'"%,*').,"%$%f+[$h%&,%*"),+V,/%&$%)&$#$/%'%&$%,&!3.$% ,&$'*)&$%'%=!,)#%$#%*!)&,&$#%<>&)*$#%+'*'##\")$#%&!",+.'%,#%1)#).,#%@$#?).,3,"'#%'%&$<)*)3),"'#9%],",% '#.,#%,Y1)&,&'#%8$",<%*$+1)&,&$#%?,3'#.",+.'#%&,#%&)1'"#,#%\"',#%*$<$%?#)*_3$S$#/%?#)=!),.",#/% <>&)*$#/%<`#)*$#/%,.$"'#/%<\S)*$#%'%?,3@,V$#/%?'"<)Y+&$%,$#%,*,&X<)*$#%'+.","%'<%*$+.,.$%*$<% 1\")$#%?"$U##)$+,)#%'%."$*,"%'i?'")X+*),#%*$<%'3'#/%,<?3),+&$/%,##)</%,%1)#[$%&$%.",:,3@$%=!'%#'"),% "',3)^,&$9 Os R&-S0T&70%'%,#%LU*)+,#%Y1'",<%*$<$%U+,3)&,&'%,%?"'?,",V[$%&$#%'#.!&,+.'#%?,",%,% "',3)&,&'%@$#?).,3,"9%B##$%'+S3$:,%+[$%#_%$%&'#'+1$31)<'+.$%&,#%@,:)3)&,&'#%,"T#Y*,#/%=!'%#'"),<% !Y3)^,&,#%+,#%1)#).,#/%<,#%.,<:><%$%$3@,"%?,",%$%?,*)'+.'%+,%?$#)V[$%&'%8!.!"$#%<>&)*$#9%]$&'+&$/% &'##,%8$"<,/%'#.,:'3'*'"%!<,%"'3,V[$%<>&)*$j?,*)'+.'%<,)#%@!<,+)^,&,9% 4$%U+,3%&$%?'"Z$&$%&'%*,?,*).,V[$%$#%?'"#$+,S'+#%*"),&$#%'#.,1,<%'<%#)+.$+),/%,%,".'%&$% )<?"$1)#$%a\%'",%!Y3)^,&,%*$<%<,)$"%8,*)3)&,&'/%$%S"!?$%'#.,1,%!+)&$%'<%:!#*,%&$%<'#<$%$:a'Y1$% '%$#%?,"Y*)?,+.'#/%=!'%)+)*),3<'+.'%+[$%Y+@,<%+'+@!<,%"'3,V[$%'+."'%#)/%&'<$+#.",1,<%'#.,"% '<?'+@,&$#%'<%'=!)?'%?,",%$%.",:,3@$%=!'%#'"),%"',3)^,&$9 c9%41,3),V[$%&$%?"$a'.$%#'S!+&$%$%<$&'3$%&'%41,3),V[$%u)"s?,.")*s%5uBAu]4IAB u/%%E F F G 6 9% 52)S!",%J69 0<,%)<?$".,+.'%,Y1)&,&'%&'#'<?'+@,&,%?'3$#%,*,&X<)*$#%&'%<'&)*)+,%=!'%?,"Y*)?,",<% &$%?"$a'.$%-$!.$"'#%&$%A)#$/%+$%?'"Z$&$%&'%EFFG%,%EFFMH%8$)%,%&'%,1,3),V[$%&$%?"$a'.$9%;#.,%,Y1)&,&'% $*$""),%#'<,+,3<'+.'/%'%Y+@,%*$<$%$:a'Y1$%,?")<$","%$%?"$a'.$%@!<,+Z#Y*$/%,.",1>#%&,%"'v'i[$/% ?$"%?,".'%&$#%,*,&X<)*$#/%&,#%?"\Y*,#%&'#'+1$31)&,#%&'+."$%&,#%!+)&,&'#/%:'<%*$<$%?"$<$1'"%,% *,?,*).,V[$%?'"<,+'+.'%'%,%)+.'S",V[$%&$#%?,"Y*)?,+.'#/%.$"+,+&$%,#%,VW'#%1)1'+*),&,#%.,+.$%+,#% 1)#).,#%@$#?).,3,"'#%=!,+.$%+,#%&$<)*)3),"'#%*,&,%1'^%<,)#%?"$1').$#,#9 ;##'#%<$<'+.$#%'",<%!Y3)^,&$#%?,",%,%"',3)^,V[$%&'%&)+q<)*,#%'%,Y1)&,&'#%*$<?3'<'+.,"'#% =!'% ?!&'##'<% 8,*)3).,"% $% 1Z+*!3$% &'% ?,"*'"),% '+."'% $#% ,*,&X<)*$#/% '% ?,",% ,+,3)#,"% ,#% 1)#).,#% @$#?).,3,"'#%'%&$<)*)3),"'#%a\%"',3)^,&,#9%L#%,*,&X<)*$#%"'3,.,1,<%#!,#%'i?'")X+*),#/%'i?3)*).,1,<% #$:"'%,#%&)U*!3&,&'#%'+*$+.",&,#%'%#$:"'%,#%'#.",.>S),#%!Y3)^,&,#%*$<%#!*'##$/%8,^),<%#!S'#.W'#%'% *"ZY*,#/%:!#*,+&$%#'<?"'%,?'"8')V$,"%,#%?"_i)<,#%,Y1)&,&'#9 ]'"*':'!j#'%*$<%)##$/%=!'%,%=!,3)&,&'%&,#%1)#).,#%,!<'+.,1,%,%*,&,%#'<,+,/%+$1,#%'#.",.>S),#% &'%,:$"&,S'<%,$%?,*)'+.'%'",<%)<?3'<'+.,&,#%'%+$1$#%*$+@'*)<'+.$#%'",<%*$<?,"Y3@,&$#9%L% ;##4W!+5S%&'%*,&,%1)#).,%'",%)<?$".,+.'%?,",%$%S"!?$%?'"<,+'*'"%)+.'S",&$9

(4)

Figura 1:%($&'3$%&'%41,3),V[$%&'%-$+,3&%P9%u)"s?,.")*s Fonte: u)"s?,.")*s/%EFFG9

Resultados

D$%?'"Z$&$%&'%&'^'<:"$%&'%EFFG%,%&'^'<:"$%&'%EFFM%$#%,*,&X<)*$#%e%?,3@,V$#%1)#).,",<% !<%.$.,3%&'%mMF%?'##$,#%'<%,<:)'+.'%&$<)*)3),"%'%@$#?).,3,"%*$<%$%?"$a'.$%&'%'i.'+#[$%-$!.$"'#% &$%A)#$%5I,:'3,%J69%D$%.$.,3%$%+`<'"$%&'%,*,&X<)*$#%8$)%&'%cE/%+$%?'"Z$&$%&'%EFFG%e%EFFM/%#'+&$% EN%&$%#'i$%8'<)+)+$'%Fn%&$%#'i$%<,#*!3)+$%5D;b;O/%EFJm6 Tabela 1. -)#."):!)V[$%&$#%3$*,)#%&,#%,Y1)&,&'#%*$+8$"<'%$%?"$a'.$%&'%'i.'+#[$%-$!.$"'#%&$%A)#$% +$%?'"Z$&$%&'%EFFGjEFFM9

PROJETO LOCAL DE ATIVIDADE

HOSPITAL DOMICÍLIO

-L0ILA;O% -L%ABOL

;+8'"<,"),%&'%$".$?'&),%&$%C$#?).,3%&,#% 3Z+)*,# ; & ! * , + & \ " ) $% O,+.,%(,"S,")&, ;+8'"<,"),#%&'%)+8'*.$3$S),%&$%C$#?).,3%&,#% 3Z+)*,# ;+8'"<,"),#%&'%+'8"$3$S),%&$%C$#?).,3%&,#% 3Z+)*,#% 4#)3$%O[$%b)*'+.' 43,%)+8,+Y3%&,%$+*$3$S),%&$%C$#?).,3%&,#% 3Z+)*,#% ;+8'"<,"),%&$%C$#?).,3%&,% "),+V, Fonteg%]")<\"),

4% &)#."):!)V[$% &,#% ,Y1)&,&'#% ?"'?,",._"),#% &$% ?"$a'.$% #'S!+&$% $% ,+$% &'% "',3)^,V[$% ,?"'#'+.$!%S",+&'%1,"),V[$%+$%&'*$""'"%&$#%,+$#/%*$+8$"<'%)3!#.",&$%+,%US!",%E9%L:#'"1,<$#% =!'%+$%,+$%&'%EFFG%@$!1'%$%<'+$"%Z+&)*'%&'%,Y1)&,&'#%?"'?,",._"),#/%'+=!,+.$%$%<,)$"%+`<'"$% $*$""'!% +$% )+.'"1,3$% &'% EFFnjEFFM9% w!,+.$% ,$% Y?$% &'% ,Y1)&,&'#/% ,#% <,)#% ?"'1,3'+.'#% 8$",<% $U*)+,#%'%r$"s#@$?#/%*$<%+xRE%'%+xcG/%"'#?'*Y1,<'+.'H%#'S!)&,%&'%#)<?_#)$#%*$<%+xN9%

(5)

Figura 2. -)#."):!)V[$%&,#%,Y1)&,&'#%?"'?,",._"),#%&$%?"$a'.$%-$!.$"'#%&$%A)#$%#'S!+&$%$%,+$9 Fonteg%]")<\"),. % $<%$%&'#'+1$31)<'+.$%&,#%,Y1)&,&'#%$%?"$a'.$%&'<$+#."$!%?$"%!<%q+S!3$%$#%?,*)'+.'#% ,%)<,S)+,"%'%1)1'+*),"%$%@$#?).,3%#'<%*,",%&'%@$#?).,3%52)S!",%c69 !"#$%&'(%L3@,"%&$%?,*)'+.'%&!",+.'%,#%,Y1)&,&'#%3`&)*,#%&$%?"$a'.$9 Fonte: ]")<\"),9%4"=!)1$%]AL;o9 $+8$"<'%?,3,1",#%&$#%?,*)'+.'#%f$#%<>&)*$#%&'%@$a'%$3@,<%+$%$3@$%&,%S'+.'%,$%8,^'"%$% ,.'+&)<'+.$h9%;+=!,+.$%=!'%&$%$!."$%q+S!3$/%&!",+.'%,#%,Y1)&,&'#%8$)%&'<$+#.",&$%$#%,*,&X<)*$#j ?,3@,V$#%#'+&$%8$"<,&$#%?,",%#'"'<%<,)#%@!<,+$#%'%<,)#%>Y*$#%&'+."$%&,%,*,&'<),%52)S!",%N969%

(6)

!"#$%&)(&L3@,"%&$%,*,&X<)*$j?,3@,V$%&!",+.'%,#%,Y1)&,&'#%3`&)*,#%&$%?"$a'.$9

Fonteg%]")<\"),9%4"=!)1$%]AL;o9

% K'<%*$<$/%8$)%&'<$+#.",&$%+'#.'%'#.!&$%,%?'"*'?V[$%&,%)<?$".q+*),%&'%S'#.$#%#)+S'3$#% ?'3$#%,*,&X<)*$#%e%?,3@,V$#9%52)S!",%G96

!"#$%& *(& L3@,"% &$% ,*,&X<)*$j?,3@,V$% '% ,% ?'"*'?V[$% &$#% S'#.$#% #)+S'3$#% &!",+.'% ,#% ,Y1)&,&'#% 3`&)*,#%&$%?"$a'.$9

Fonteg%]")<\"),9%4"=!)1$%]AL;o9

Discussão

;#.!&$#% &'<$+#.",",<% <!&,+V,#% +,#% ,Y.!&'#% &$#% '#.!&,+.'#% ,$% 3$+S$% &,% 8$"<,V[$% ,*,&X<)*,%,?_#%,%?,"Y*)?,V[$%&$#%<'#<$#%'<%?"$S",<,#%@!<,+Z#Y*$#%5(LABD/JMMFH%];OOBDB/% EFJF69%(!&,+V,#%+,%?$#.!",%.,<:><%8$",<%$:#'"1,&,#%?'3$#%,*,&X<)*$#%?,"Y*)?,+.'#%&$%?"$a'.$% -$!.$"'#%&$%A)#$9% $+8$"<'%$%"'3,._")$%,?_#%,%,1,3),V[$%#'<,+,3/%$#%<'#<$#%&'<$+#.",",<%'#.,"% <,)#%?,*)'+.'#/%<,)#%,<$"$#$#/%<,)#%,3'S"'#/%<,)#%*"ZY*$#/%'+U<%<,)#%?"$U##)$+,)#9 4$%?,"Y*)?,"%&,#%,VW'#%&$%?"$a'.$%&'%'i.'+#[$%-$!.$"'#%&$%A)#$/%$#%'#.!&,+.'#%&'%<'&)*)+,/% &'<$+#.",",<%,!<'+.$%+,%*,?,*)&,&'%&'%.",:,3@,"%'<%'=!)?'/%8,*'%,$%<!3Y%?"$U##)$+,3)#<$%'% '#?Z").$%&'%*$3,:$",V[$%$:#'"1,&$%+,#%!+)&,&'#9% ;<%*$+#$+q+*),%*$<%$#%?"'##!?$#.$#%'#.,:'3'*)&$#%?'3,%?)$+')",%'<%*!)&,&$#%?,3),Y1$#/% -",9% )*'3y%O,!+&'"#/%=!'%,U"<,%=!'% !)&,&$%],3),Y1$%>%$%"'*$+@'*)<'+.$%'%$%,3Z1)$%&'%.$&$%$% #$8")<'+.$%&$%&$'+.'H%>%$%,?$)$%*$<?'.'+.'%'%,<$"$#$%,$#%8,<)3),"'#%&$#%&$'+.'#H%'%>%.,<:><%,% *$+#."!V[$%&'%!<,%*$<!+)*,V[$%'U*,^%*$<%$#%&$'+.'#/%8,<)3),"'#%'%*$<%$#%&'<,)#%?"$U##)$+,)#%&,% '=!)?'%&'%*!)&,&$"'#%5tCL/%EFJR6/%$#%,*,&X<)*$#j?,3@,V$#%k%<'&)&,%=!'%$%?"$a'.$%#'%&'#'+1$31),%

(7)

?'"*':),<%,%)<?$".q+*),%&$%*!)&,&$%'%&$%,<$"%,$%?,*)'+.'%+$%?"'#'+.'%'%?,",%,#%"'3,VW'#%8!.!",#9% ;%*$<$%3'<,%?,",%$%?"$a'.$%'3'#%,&$.,",<g%f$%"'<>&)$%*!",%,%&$"/%<,#%#_%$%,<$"%*!",%$%#$8")<'+.$h9% L:#'"1$!j#'%,)+&,%=!'/%+$%*$+1Z1)$%*$<%$#%?"$U##)$+,)#%&,%#,`&'/%,#%&)#*!##W'#%#'%&,1,<%'<% .$"+$%&'%*$<$%,?")<$","%,#%"'3,VW'#/%.$"+,+&$j,#%<,)#%@!<,+)^,&,#%+,#%!+)&,&'#9

Conclusões

L%?"$a'.$%,3*,+V$!%,%<'.,%&'%#'+#):)3)^,"%$#%,*,&X<)*$#%&'%<'&)*)+,%=!,+.$%k%)<?$".q+*),% &,%@!<,+)^,V[$%+,%"'3,V[$%<>&)*$j?,*)'+.'9%

D,% 8,3,% &$#% ,*,&X<)*$#j?,3@,V$#g% @$!1'% ,% ?'"*'?V[$% &'% <'3@$",% &$% =!,&"$% *3Z+)*$% &'% ?,*)'+.'#%&,%,3,%)+8,+Y3%,?_#%,%1)#).,%&$%?"$a'.$%f-$!.$"'#%&$%A)#$h9%

D,#%1)#).,#%,$#%,#)3$#%@$!1'%<!).,%."$*,%&'%'i?'")X+*),#%*$<%,%)+.'",V[$%'+."'%,*,&X<)*$#j ?,3@,V$#%'%)&$#$#9%

D$#%`3Y<$#%,+$#/%*$+*3!)!j#'%=!'%$%,<:)'+.'%@$#?).,3,"%#'%<$&)U*,1,%+$#%&),#%&'%1)#).,9% ]$&),<j#'%$!1)"%<,)#%")#$#%'%<`#)*,#9

4#% *"),+V,#% '% #'!#% ,*$<?,+@,+.'#% U*,1,<% +$#% *$""'&$"'#% $!% +,% ?$".,% &$#% =!,".$#% +,% 'i?'*.,Y1,%&$%'+*$+."$%*$<%$%S"!?$%&'%,*,&X<)*$#j?,3@,V$#9

L#%8!+*)$+\")$#%$:#'"1,1,<%$#%,*,&X<)*$#j?,3@,V$#%#'<?"'%=!'%?$&),</%'%&)#*"'.,<'+.'/% )+.'",S),<%?$"%<')$%&'%!<,%")#,&,/%$!%)+&)*,+&$%'#?$+.,+',<'+.'%!<%=!,".$%?,",%+$##,%'+.",&,9%

+,-.!/0$%120.&3-%!.

4% )<?$".q+*),% &$% &'#'+1$31)<'+.$% &'% ?"\Y*,#% @!<,+Z#Y*,#% ,.",1>#% &'% ?"$S",<,#% )+#Y.!*)$+,3)^,&$#/%*$<$%$%?"$a'.$%&'%'i.'+#[$%-$!.$"'#%&$%A)#$/%&!",+.'%,%8$"<,V[$%<>&)*,%>% S",+&)$#,9%

4%*$+#."!V[$%&$%#,:'"%*)'+TU*$%,%?,"Y"%&,%8'"",<'+.,%?"$a'.$#%5f7-&"#5,W!+0#4(*#+-232<h6% 8$)% )<?3'<'+.,&,% ?,",% ,% 8$"<,V[$% &$#% *$<?$+'+.'#% &'#.'% ?"$a'.$% &'% 'i.'+#[$% '<% *!)&,&$#% ?,3),Y1$#9% $<%$%'<?"'S$%&'#.,%<'.$&$3$S),%$#%?"$:3'<,#%"',)#%&,%*$<!+)&,&'%#[$%$%8$*$%&'% ?,"Y&,%&$%,?"'+&)^,&$9%L#%,3!+$#%,?"'+&'<%+,%?"\Y*,%'%:!#*,<%,#%#$3!VW'#9%L%*$+@'*)<'+.$% &')i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a'.$#% &'%'i.'+#[$%'+#)+,+&$% !)&,&$#%],3),Y1$#%,$#%,*,&X<)*$#%*'".,<'+.'%1)"\%,%:'+'U*),"%)+`<'"$#% ?,*)'+.'#%'%#'!#%8,<)3),"'#/%,.",1>#%&$%,3Z1)$%&$%#$8")<'+.$%'%&,%?"$<$V[$%&,%=!,3)&,&'%&'%1)&,9

Referências

4OOL B4z{L%KA4OBP;BA4%-;%;-0 4z{L%(d-B 49%4$,506,&%708&*9&%-,.&:&/0;&%-,.&/%.&/!$06$!;0.& curriculares nacionais do curso de graduação em medicina.%EFJE9%-)#?$+Z1'3%'<g|%@}?gllrrr9 ,:'<'&!*<'&9$"S9:"l?&8lGF,+$#9~%4*'##$%'<g%EF%a,+9%EFJR9

KABIIL%P9H%];ABDLIIL%49%<&7$!-=%$&=,8,&>$,8,1?,&@&.%A/0B&%&!8>,$6C-=!%&/%&7$!-D#0/,60=%& hospitalar no processo de recuperação de *"),+V,#%@$#?).,3)^,&,#9%A'1)#.,%C$#?).,3,"/%?9%EMJjcJG/% EFJG9

LDO;PCL% 2;-;A4P% -;% (;-B BD49% Câmara Técnica sobre Terminalidade da Vida e Cuidados 4%E!%FG,.(%-)#?$+Z1'3%'<g|%@}?gllrrr9?$".,3<'&)*$9$"S9:"l%~4*'##$%'<g%EF%,+9%EFJR9

0DC4/%D9H%OBPb4/%C9%Brinquedoteca: um mergulho no brincar9%O[$%],!3$g%(,3.'#'/%JMMN9%

-L0ILA;O%-4%4P;QAB4g%8A.!=%&0&>!$#06%&-%.&0-H0$8%$!%.&!-H%-F.9%-)\3$S$%(>&)*$/%1$39JE/%+9J/% ?9JFjJE/%JMMR9

(8)

2BQ0;BA;-L/%(9%<&I.6#/%-60&/0&J0/!=!-%&0&%&K!GL-=!%&08&+#!/%/,.&4%E!%FG,.M&Revista ]"\Y*, C$#?).,3,"/%,+$%bBBB/%+9%Nn/%?9Mn/%+$1l&'^9EFJm9

2A;BA;/%]9%Educação e Mudança9%%O[$%],!3$g%],^%'%I'"",/%JMRM9

2LDI;O/%L9%I/#=%1?,&-%.&=!L-=!%.&/%&.%A/0&0&-,G%.&=,-3"#$%120.&0>!.6L8!=%.9%O,`&'%'<%A'1)#.,/% ])",*)*,:,/%19%c/%+9%Gm/%?9%JGjEE/%EFFJ9%

uBAu]4IAB u/% -9% The Kirkpatrick Model/% EFFG9% -)#?$+Z1'3% '<g% @}?gllrrr9s)"s?,.")*s?,".'+"#9 *$<l<$&'3Jl9%4*'##$%'<%M%,+%EFJR9

(4OO;IIB/%(99%N,#6,$0.&/%&OF=%&/%&%E0"$!%(&B+.'"8,*'9%K$.!*,.!/%1$39M/%+9JR/%?9NGcjNGn/%<,"9l,S$9% EFFG9

(4IA4 4/%(9H%tB((;A/%Q9H%4A4LjLAQ;/%I9%Dialogia do riso: um novo conceito que introduz alegria para a promoção da saúde apoiando-se no diálogo, no riso, na alegria e na arte da palhaçaria.% )X+*%#,`&'%*$3'Y1,9%O[$%],!3$lO]/%1$39Jm/%+9JF/%?9NJERjNJcn/%EFJJ9%

(LABD/%;9%Introdução ao Pensamento Complexo9%P)#:$,g%B+#Y.!.$%]),S'./%JMMF9%

D;b;O/%O9H%LPBb;BA4/%(9H%'.%,39%Estudo sobre o ensino de uma formação médica mais humana. A'1)#.,%O'<)+,/% !")Y:,l]A/%19%cR/%+9E/%?9cMjNm/%a!3l&'^9EFJm9

];OOBDB/%P9H%K;AI4 CBDB/%P99%+#!/%$&/,&.0$&P#8%-,B&=!L-=!%M&60$-#$%&0&OF=%9%O[$%],!3$g%],!3)+,#H% 2010.

]BDC;BAL/% (9H% PL];O/% Q9% Q& !-R#L-=!%& /,& 7$!-D#0/,& -%& P#8%-!;%1?,& /%& %..!.6L-=!%& @& =$!%-1%& hospitalizada9%A'19%K",#9%;+8'"<,S'</%K",#Z3),/%19Nm/%+9E/%?9JJRjJcJ/%JMMc9

AB C(4D/%P9H%'.%,39%4,.!FG0&08,F,-&%-/&P0%E6PB&",!-"&70S,-/&6P0&-0"%FG09%C',3.@%]#y*@$3$Sy/% t,#@)+S.$+/%19%EN/%+9%N/%?9%NEEjNEM/%EFFG9

OBPb4/% 9H% 4D-A4-;/% 29H% D4O B(;DIL/% A9% +#!/%/,.& 4%E!%FG,.& :& #-/%80-6,.& 0& Q7$%-"L-=!%B& Revisão de Literatura/%A'1)#.,% )X+*),#%'<%O,`&'/%B.,a!:\/%(Q/%1$39c/%+9c/%a!3j#'.%EFJc9

t$"3&%C',3.@%L"S,+)^,Y$+9%-'U+)Y$+%$8%?,33),Y1'%*,"'H%EFFE9%-)#?$+Z1'3%'<g%@}?gllrrr9r@$9)+.l *,+*'"l?,33),Y1'l&'U+)Y$+l'+%9%%4*'##$%'<g%EF%a,+%EFJR9

A'*':)&$%'<%EN%&'%a,+')"$%&'%EFJR9 4?"$1,&$%'<%Jc%&'%<,"V$%&'%EFJR9