Cuidados paliativos: uma proposta para o ensino da graduação em medicina

Abstract

INTRODUCTION: The deepening of the topics related to the terminality of life has been a concern of health professionals who deal with patients in this situation. The individual and family demands regarding deficiencies in the care given to patients who need palliative care lead us to reflect on the need to acquire competences in the area of Palliative Care in the training of medical undergraduates. OBJECTIVES: To propose essential competences for the teaching of Palliative Care in undergraduate medical courses. METHODOLOGICAL COURSE: The research was delineated as a descriptive and qualitative. Initially, a documentary research was done in the national and international literature on general competences in Palliative Care; in the sense of constructing a framework with suggestions of essential competences for undergraduate education in Brazil. Next, the elaborated material was presented individually to 8 professionals with specialized training in palliative care from different areas (doctor, nurse, psychologist, occupational therapist) for analysis, accompanied by an interview with three open questions: 1) What would you suggest to improve the competences in palliative care for undergaduate medical education, given the material that was delivered to you? 2) Comment on the importance of interprofessionality in teaching in Palliative Care, emphasizing the biological, psychological, social and spiritual dimensions of care and 3) Talk about obstacles to the implementation and development of the proposal in the teaching of medical graduation. In the documentary analysis and in the interviews with the professionals, the categorical thematic content analysis proposed by Bardin was used. RESULTS: The initial documentary research resulted in 5 categories (Introduction, Symptom control, Interprofessional team, Palliative Care topics, Assistance in the last moments of life), 8 subcategories and 96 units of analysis that gave subsidy to the researcher to construct the suggestions of compentences, distributed in a framework in five modules, with their respective contents. From the interviews with the professionals, after reading the material that was given to them, 6 categories emerged (Basic principles of Palliative Care, Symptom management, Ethical and legal issues, Communication and psychosocial and spiritual aspects, Teamwork and Challenges for the implementation of proposal), in addition to 12 subcategories and 168 analysis units. About the category "Challenges for the implementation of the proposal" the conceptual unfamiliarity of managers and health professionals about palliative care appears, in the units of analysis, as one of the main obstacles to be overcome. From the speeches contained in the subcategories and units of analysis, emerged suggestions for better distribution of the modules, resulting in the renaming of these modules (Basic principles of Palliative Care, Symptom management, Teamwork, Ethical and legal issues, Assistance in the last moments of life), thus emphasizing the importance of interprofessional teamwork as an essential competency to be acquired in the teaching of Palliative Care at graduation. FINAL CONSIDERATIONS: The gap in undergraduate medical education about the many aspects that involve the terminatity of life can not be ignored in the face of the growing demand in medical practice. The discussion and improvement of Palliative Care competences suggested in this study will certainly be essential during medical education forums, so that we can have more clarity than is really needed for general practitioner training.