Sergio Rego

Bioética e humanização como temas transversais na formação médica

Bioethics and the humanization of health care are the strategic center of the discussions about the need for changes in medical education. In this paper the authors discuss these themes in an articulated approach, defending its insertion across the curriculum. We understand that the mere recognition of the relevance of these themes or even their presence in the curriculum are not sufficient for promoting changes in the profile of the professionals. Such changes can only be expected using an appropriate approach. The authors therefore propose the preparation of training programs directed to the teaching body (especially to those members not directly involved with ethics or bioethics teaching) and defend the importance of a judicious choice of pedagogical methods and techniques based on theoretical fundaments explaining the development of moral and ethical competence.

Preceptor, supervisor, tutor e mentor: quais são seus papéis?

The education of those who care for the health of the population has always been a matter of concern. In medical education, the figure of the experienced professional helping to educate and qualify a new generation is a constant finding. Such a professional has been given different names, preceptor, supervisor, tutor and mentor being the most common among them. Even official documents fail to clearly specify which functions, interventions, and activities each denomination entails. We thus aimed to analyze the meaning of these different denominations as used by the national and international scientific communities. Starting with the analysis of the concept each term expresses, we intend to build up a better framework for the regulation and practice of the teaching-learning process in the graduation and post-graduation courses in the health professions.

Transformação da educação médica: é possível formar um novo médico a partir de mudanças no método de ensino-aprendizagem?

The changes in medical training have long been discussed in medical schools. These attempted changes have primarily been of a methodological or pedagogical nature, with curriculum restructuring based on the introduction of problem based learning (PBL) as an underlying axis. The traditional curricular format is still predominant, with PBL emerging as the most common alternative. The aim of this article is to present this method and assessments of its results, in order to create a snapshot of how effective it is in preparing critically-minded, thoughtful and socially responsible doctors. A literature review was conducted based on searches of the SciELO (Scientific Eletronic Library Online), Pubmed (www.nlm.nih.gov) and BVS (Virtual Library in Health) databases, with the selection of articles about the subject published in the last 20 years. The results reveal isolated pedagogical change to be insufficient as a solution to provide medical training capable of combining technical and ethical and humanistic skills.

A finitude humana e a saúde pública

A morte e uma questao implicita na pratica e na formacao dos profissionais da saude. Ha, todavia, uma tendencia dos profissionais de saude de restringir sua discussao aos aspectos meramente tecnicos, seja na assistencia a saude, seja nas acoes de saude publica. Este artigo analisa a importância da adocao do cuidado de qualidade no fim de vida como norteador das praticas assistenciais e a necessidade de que o campo da Saude Publica tome esses cuidados como objeto de reflexao e de pesquisas. Por fim, aponta-se para aspectos relevantes para a formacao de profissionais de saude para que sejam respeitadores das diferencas e comprometidos com o dialogo.

Bioética para profissionais da saúde

BIOÉTICA PARA PROFISSIONAIS DA SAÚDE Lorena Mara Nóbrega de Azevêdo. Aluna do curso de graduação em Enfermagem pela Universidade Federal do Rio Grande do Norte/UFRN. Bolsista de Iniciação científica PIBIC/CNPq do grupo de pesquisa Caleidoscópio da Educação em Enfermagem da UFRN. Natal, Rio Grande do Norte, Brasil. E-mail: lorenanobregaazevedo@yahoo.com.br Aline Galúcio de Oliveira. Aluna do curso de graduação em Enfermagem pela Universidade Federal do Rio Grande do Norte/UFRN. Voluntária de iniciação científica do grupo de pesquisa Caleidoscópio da Educação em Enfermagem da UFRN. Natal, Rio Grande do Norte, Brasil. E-mail: aline_galucio@yahoo.com.br Alane de Medeiros Silva. Enfermeira. Aluna especial do Programa de Pós-Graduação em Enfermagem da Universidade Federal do Rio Grande do Norte/UFRN. Natal, Rio Grande do Norte, Brasil. E-mail: alaninhamedeiros@hotmail.com Raimunda Medeiros Germano. Professora Doutora dos cursos de graduação e pós-graduação em Enfermagem da Universidade Federal do Rio Grande do Norte/UFRN. Coordenadora do grupo de pesquisa Caleidoscópio da Educação em Enfermagem. Natal, Rio Grande do Norte, Brasil. E-mail: rgermano@natal.digi.com.br O livro Bioética para profissionais da saúde, publicado em 2009, com 159 páginas, faz parte da coleção “Temas em saúde” e foi escrito por Sergio Rego, Marisa Palácios e Rodrigo Siqueira-Batista. Os autores são médicos doutores e professores em nível de graduação e pós-graduação de ética e bioética.

Promoção e propaganda de medicamentos em ambientes de ensino: elementos para o debate

A industria farmaceutica utiliza a propaganda para a promocao de seus produtos. Os de uso controlado so podem ter a propaganda dirigida a profissionais habilitados a prescreve-los ou dispensa-los. Este artigo faz uma ampla revisao de artigos cientificos que discutem questoes eticas e legais acerca da promocao e propaganda de medicamentos em ambientes de ensino medico. Conclui-se que nao se justifica a auto-regulamentacao da propaganda de medicamentos e que existem evidencias suficientes de como o poder da industria farmaceutica e capaz de influenciar as decisoes no âmbito da relacao medico-paciente, sendo a promocao e a propaganda um de seus instrumentos. Defende-se sua total proibicao em ambientes de ensino, bem como a incorporacao da tematica na formacao dos estudantes. Como a legislacao vigente permite a propaganda de medicamentos vendidos sob prescricao apenas a medicos e farmaceuticos, destaca-se que tal propaganda e ilegal quando atinge estudantes de medicina e de farmacia.A industria farmaceutica utiliza a propaganda para a promocao de seus produtos. Os de uso controlado so podem ter a propaganda dirigida a profissionais habilitados a prescreve-los ou dispensa-los. Este artigo faz uma ampla revisao de artigos cientificos que discutem questoes eticas e legais acerca da promocao e propaganda de medicamentos em ambientes de ensino medico. Conclui-se que nao se justifica a auto-regulamentacao da propaganda de medicamentos e que existem evidencias suficientes de como o poder da industria farmaceutica e capaz de influenciar as decisoes no âmbito da relacao medico-paciente, sendo a promocao e a propaganda um de seus instrumentos. Defende-se sua total proibicao em ambientes de ensino, bem como a incorporacao da tematica na formacao dos estudantes. Como a legislacao vigente permite a propaganda de medicamentos vendidos sob prescricao apenas a medicos e farmaceuticos, destaca-se que tal propaganda e ilegal quando atinge estudantes de medicina e de farmacia.

O modelo bioético principialista para a análise da moralidade da pesquisa científica envolvendo seres humanos ainda é satisfatório

This paper discusses the application of principlism to research involving human subjects, starting from the question of its pertinence in the current situation of the paradigmatic pluralization on science and the multiplication of models of ethical evaluation in the complex societies. Highlights that the development of modern scientific medicine depended strongly on human experimentation and that up to the mid 20th century the good intention of the researcher was, theoretically, enough to justify a research morally, but that with the twofold paradigmatic transition in Science and in Ethics, occurred in the course of the 20th century, a pluralization and complexification took form in both the scientific know-how and the field of ethics applied to scientific research, which on normative level was in the uncomfortable situation of having to deal with a permanent contestation of scientific and ethic paradigms. In the field of ethics, other principles also pass to guide decisions such as the principles of protection, applicable to situations of need as they arise mainly in the case of the populations of the Third World. Finally, principlism is pertinent in its general philosophic posture and methodological value, but insufficient when applied to the moral problems of public health and in particular to research ethics in dependent countries.

Pierre Bourdieu and medical education

The contemporary discussion about the transformation of the training of health professionals has focused primarily on the change in method. This article discusses this issue in the light of Pierre Bourdieus theoretical contributions - habitus, field, symbolic capital, symbolic violence and reproduction. The conclusion is drawn that pedagogical change alone is not enough to change the profile of medical graduates.

The teaching-learning process in medical residency

The Brazilian and international scientific communities have engaged in extensive debate on the balance between scientific knowledge, clinical reasoning, development of practical skills, character-building, and professionalism. However, the teaching-learning process during medical residency has received little research attention in Brazil. This article aims to describe the relations between the science of learning and teaching during medical residency. We analyze this interface in Brazilian and international publications (1997-2007) from the field of education in general, medical education, and medical residency, demonstrating the important learning assumptions in the development of clinical reasoning, teaching of skills, and acquisition of indispensable competencies for the residents training.

Contributions to public health by the field of bioethics

Cad. Saúde Pública, Rio de Janeiro, 23(11):2530-2531, nov, 2007 In order to adequately understand contemporary bioethics and its relationship to public health, it is appropriate to trace the field’s roots. Although its origin is formally recognized in the work of Potter and Hellegers, one can reasonably situate the emergence of the reflections leading to the field of bioethics within the sphere of concerns and repercussions of research involving human beings and events more closely associated with clinical medicine, like the episode involving the creation of the Life or Death Committee, in Seattle, Washington, related to the choice of patients to be included in a renal dialysis program. In both cases the direct relationship to public health was already evident. The focus on clinical aspects in the usual analyses of these episodes may only be the result of an extemporaneous understanding of public health itself, as a field of knowledge and practices demarcated by the narrow confines of epidemiology, transmissible diseases, and preventive medicine. To the contrary, such historical milestones (among others) highlight the relevance of bioethical analysis of public health problems, in this case policymaking and health services management. The cross-disciplinary conformation and social recognition ascribed to bioethics occurred from a perspective that is much closer to the holistic concept proposed by Potter, although the principlist model developed by the Kennedy Institute of Ethics prevails in the analyses applied to clinical practice and research. It can be conceptualized as the systematic study of the moral dimensions of the life sciences and health care, employing a variety of methodologies. As applied ethics, bioethics has two indissoluble dimensions, descriptive and normative. That is, it is concerned with analyzing the moral arguments for and against certain human practices that affect the quality of life and well-being of humans and other living beings and the quality of their environments, and with basing decisions on these analyses. Considering specifically (but not exclusively) the field of public health, protection has been proposed as the underlying principle for analyses and decisions. This conception is consistent with the Universal Declaration on Bioethics and Human Rights (UNESCO). Taking as reference the core of public health, “support for health systems, elaboration of policies, and construction of models; production of explanations for health/disease/intervention processes; and, (...), the production of [health] promotion and disease prevention practices” (Ciênc Saúde Coletiva 2000; 5:219-30), one can properly state that bioethics, with its theories and methods, has contributed and continues to contribute to the development of this field, with the analysis and proposal of solutions to the moral problems inherent to collective health practices. However, in Brazil and much of Latin America as a whole, this should not become a problem, to the extent that collective health also sees itself as an interand cross-disciplinary field. Equal consideration for individual and collective interests, or the individual and collective good, is one of the public health challenges to which bioethics can make a significant contribution. The challenge is not to impose restrictions on individual freedoms, but to focus the public policymaking on collective interests, painstakingly based on the ethical point of view. Our recent history has shown that dialogue and the constant quest for understanding open the way for shaping a more just health system and its practices. Contributions to public health by the field of bioethics EDITORIAL