O ensino do lidar com a morte no contexto da atenção primária à saúde no curso de graduação em medicina

Abstract

Along time, progress in science and in the biomedical technology was increasingly expanded, contributing to the false idea of a possible control and domination of death. Death is an interdicted theme, avoided both in the lay society and in the dialogue between physicians and patients, as it is considered a professional failure in the health field. Teaching how to deal with death in the medical education has been the object of attention of some authors, but changes in the medical education to deepen this theme have occurred in a very slow pace. The aim of this research was to understand the trajectories of teaching how to deal with death within the context of Primary Health Care (PHC). It is a qualitative study based on the collaboration of teachers from the undergraduate medicine course at the Federal University of Paraíba (UFPB), who were chosen among the teachers involved in curriculum experiences within PHC. Two techno-methodological strategies were combined: in-depth interviews following a script and workshops using projective “scenes”. Gadamer’s Hermeneutic was used for the analysis and interpretation of the discourses. We have identified in the results that, to the teachers, dealing with death can be conceived according to four roles or competences in the search for a humanized care: trying to save, promoting quality of death, being present until the end, and enhancing the dimension of spirituality. For the teachers, teaching how to deal with death should be based on a multidimensional approach, along the whole medical education. In spite of the existence, in the PHC pedagogical practices, of an active teaching-learning proposal, based on the problematization of concrete situations, aiming to shorten the distance between technical and human education, the teachers have expressed that teaching how to deal with death in UFPB is, in general, insufficient and mostly technicist. Thus, limits of the PHC curriculum spaces to teach how to deal with death are: technified, fragmented teaching practices with traditional evaluation and methodologies; the need for greater pedagogical depth and integration in the undergraduate medical curriculum; and the weaknesses of the PHC services. Strengths of the PHC curriculum spaces to teach how to deal with death were: closeness to the dynamics of the illness process and fights of the population; and the construction of more dialogical practices, aimed to the enhancement of the students’ protagonism and the interdisciplinary work. This way, PHC can contribute to the implementation of more integrated, continuous, longitudinal, contextualized, and person-centered pedagogical practices. At the same time, the teaching-service relationship, concerned with the improvement of the care in the illness process and in dying, can qualify and strengthen PHC