Abstract

The scope of this study was to analyze the narratives of health professionals about their experiences on courses aimed at the development of knowledge and practices in health education. Two analytical categories formed the basis of this study: experience and temporality. In the analysis, narratives constructed based upon the educational experiences of health professionals in postgraduate courses were used, in order to give substance to their reflections in relation to given learning trajectories. These courses are based on articulated activities that simulate practices and performances in realistic scenarios. In analytical terms, the focus is on the structural components of the narrative (contexts, scenarios, storylines and actors), as well as the articulation between these components and the theoretical principles of the study. Among the results obtained, the highlight is on the active methodologies that are the central players in the storylines, thereby providing an opportunity to consider health training in a way that is different from traditional approaches. Among other aspects, the conclusion reached is that these narratives provide new possibilities such that, in addition to the cognitive domain and theoretical understanding, this practice may be valued and exploited as a historical and social construction based on both words and actions.

Key words
Narratives; Educational processes; Health

Foreword

The scope of this study was to analyze the narratives of health professionals about their experiences on courses aimed at the development of knowledge and practices in health education. Since health educational processes may be understood from different theoretical benchmarks, in this paper, these processes were considered on the basis of a socio-constructivist or interactionist theory of education. According to this theory, students are seen as subjects who construct knowledge in an active form, and the educator, as the person who serves as the facilitator and mediator between the subject and the object¹1 Becker F. Educação e construção do conhecimento. 2ª ed. Porto Alegre: Penso; 2012.. From this perspective, it is understood that “men/women are constituted as such [through] their interactions and are seen, therefore, as those who transform and are transformed in relationships generated in a given culture”²2 Rego TC. Vygotsky: uma perspectiva histórico-cultural da educação. Rio de Janeiro: Vozes; 1995..

In this sense, the narrative is understood to be both the object and the method of study, as well as a way used to organize the experiences and memories of human events³3 Bruner J. The narrative construction of reality. Critical Inquiry 1991; 18(1):1-21.. Narratives are constructions created from the standpoint of those who narrate them and are accepted by convention, rather than by empirical or logical findings³3 Bruner J. The narrative construction of reality. Critical Inquiry 1991; 18(1):1-21.. By telling stories, narrative structures are built in the relationship between narrator-listener, with narrative strands that weave the universal, cultural and individual levels of the human experience⁴4 Bury M. Illness narratives: fact or fiction? Sociology of Health & Illness [periódico na Internet]. 2001 [acessado 2007 Ago 02]; 23(3):263-285. Disponível em: http://www.blackwell-synergy.com/toc/shil/19/1
http://www.blackwell-synergy.com/toc/shi... .

The ideas of Ricoeur⁵5 Ricoeur P. Tempo e narrativa. Campinas: SP: Papirus; 1994. Tomo I., Kristeva⁶6 Kristeva J. O gênio feminino: a vida, a loucura, as palavras. Rio de Janeiro: Rocco; 2002. v.1., Burke⁷7 Burke P. A escrita da história: novas perspectivas. São Paulo: Editora Unesp; 1992. and Schutz⁸8 Schutz A. Sobre fenomenologia e relações sociais. Petrópolis: Vozes; 2012. (Coleção Sociologia).^,99 Castro FF. A sociologia fenomenológica de Alfred Schutz. Ciências Sociais Unisinos 2012; 48(1):52-60. were explored as the theoretical/conceptual aspects of this study, The aim was to find elements that would reveal mediation between discussion and action, structure and events⁷7 Burke P. A escrita da história: novas perspectivas. São Paulo: Editora Unesp; 1992., and memory and political action¹⁰10 Onocko Campos RT, Furtado JP. Narrativas: utilização na pesquisa qualitativa em saúde. Rev Saude Publica 2008; 42(6):1090-1096. ‒ that would indicate the displacement from theoretical knowledge representation (that which is known) to practical knowledge (that which is done)¹⁰10 Onocko Campos RT, Furtado JP. Narrativas: utilização na pesquisa qualitativa em saúde. Rev Saude Publica 2008; 42(6):1090-1096..

This research study was based on two analytical categories: experience and temporality. The experience and the action – related actions – are the result of different minds that interact within the social process⁹9 Castro FF. A sociologia fenomenológica de Alfred Schutz. Ciências Sociais Unisinos 2012; 48(1):52-60.. Individuals construct their experiences based on the relationships that they have established with other individuals, which form an intersubjective world that precedes the life of every person; based on stored experiences¹¹11 Schutz A. El problema de la realidade social. Buenos Aires: Amorrurtu; 2008. (Biblioteca de sociología)..

With regards to temporality, “time becomes human time when it is articulated in a narrative form, and that a narrative obtains its full meaning when it becomes a condition of temporal existence”⁵5 Ricoeur P. Tempo e narrativa. Campinas: SP: Papirus; 1994. Tomo I.. In narrative time, the past, present and future are linked together. Thus, in temporality, an ontological paradox may be established: “how can time be, if the past is no longer, if the future is yet to come and the present is not always present?”⁵5 Ricoeur P. Tempo e narrativa. Campinas: SP: Papirus; 1994. Tomo I..

Context of the study

The context of this study were two courses staged in training sessions¹²12 Lima VV, Pereira SMSF, Oliveira MS, Oliveira JM, Padilha RQ. Processos educacionais na saúde: ênfase em avaliação de competência. São Paulo: Ministério da Saúde, Instituto Sírio-Libanês de Ensino e Pesquisa; 2016.: Educational processes in health: emphasis on active methodologies of learning (Preceptor-EPES) ‒ involving the training of facilitators to form preceptors in the SUS¹³13 Oliveira JM, Lima VV, Padilha RQ, Pereira SMSF, Petta HL, Ribeiro ECO, Gomes R. Processos educacionais na saúde: ênfase em aprendizagem significativa. São Paulo: Ministério da Saúde, Instituto Sírio-Libanês de Ensino e Pesquisa; 2016. – and Educational processes in health: emphasis on meaningful learning experiences (Regional-EPES) ‒ involving the training of facilitators for different specialization courses with a focus on health management, in different regions of the country¹⁴14 Lima VV, Feuerwerker LCM, Padilha RQ, Gomes R, Hortale VA. Ativadores de processos de mudança: uma proposta orientada à transformação das práticas educacionais e da formação de profissionais de saúde. Cien Saude Colet 2015; 20(1):279-288.. These courses – with the same theoretical-methodological principles – were developed within the scope of the Institutional Development Support Program of the Unified Health System – SUS (PROADI-SUS) and carried out in partnership with the Ministry of Health (MS) and the Sírio-Libanês Hospital (HSL), in 2016.

Health professionals were trained by instructors as trainee-facilitators to go on to train other health professionals, providing qualifications in different educational initiatives¹³13 Oliveira JM, Lima VV, Padilha RQ, Pereira SMSF, Petta HL, Ribeiro ECO, Gomes R. Processos educacionais na saúde: ênfase em aprendizagem significativa. São Paulo: Ministério da Saúde, Instituto Sírio-Libanês de Ensino e Pesquisa; 2016.^,1414 Lima VV, Feuerwerker LCM, Padilha RQ, Gomes R, Hortale VA. Ativadores de processos de mudança: uma proposta orientada à transformação das práticas educacionais e da formação de profissionais de saúde. Cien Saude Colet 2015; 20(1):279-288.. Both teachers and facilitators act as instructors, whereby the latter are called trainee-facilitators (Figure 1).

The actions of the teachers in the training process of the trainee-facilitators consists of simulated and real practical and reflexive actions. One of the strategies used to explore situations that have occurred in real life was the construction of narratives, which were used as one of the educational resources in the portfolio activities, such as “the trajectory of each person in the course, highlighting abilities and difficulties in learning and in the development of a competency profile”¹⁴14 Lima VV, Feuerwerker LCM, Padilha RQ, Gomes R, Hortale VA. Ativadores de processos de mudança: uma proposta orientada à transformação das práticas educacionais e da formação de profissionais de saúde. Cien Saude Colet 2015; 20(1):279-288..

The portfolio activity was developed during the interactions between teachers and trainee-facilitators and between these facilitators and other trainees, depending on the educational activity in which they were involved. Face-to-face meetings or distance meetings were focused on sharing experiences and encouraging reflections on the practice, in the light of the competency profile within the context of the Unified Health System (SUS).

One of the inputs of the narrative analysis was that it made it possible to gain a better understanding about the displacements experienced by the facilitators during the course of the training process. What were their expectations when they arrived at the course? How did the process affect them? What were their feelings about the experience they had as a result of these courses?

Another possible input relates to the organization and development of the curriculum during the course. The courses are based on given intentions in mind and, in line with these, strategies are elaborated and implemented. By dint of understanding the narratives, a triangular perception of the narrators may be revealed about the dialogue established regarding what was expected, how this developed and what was achieved.

Since these are lato sensu specializations, those participating in these courses worked individually on their Course Conclusion Papers (TCCs), as one of the academic requirements for certification.

In the case of the EPES courses, one of the components of the TCCs consisted of a reflexive narrative that represented:

Using a reflexive narrative of the learning trajectory to compose the TCC was not an innovative idea introduced by the project in question, since it also appears in the 2006 educational project of the Brazilian federal university undergraduate course in medicine¹⁵15 Universidade de São Carlos (UFSCar). Projeto Político Pedagógico: Curso de Medicina, 2007. [acessado 2017 nov. 27]. Disponível em: http://www.prograd.ufscar.br/cursos/cursos-oferecidos-1/medicina/medicina-projeto-pedagogico.pdf
http://www.prograd.ufscar.br/cursos/curs... .

Although the TCC could explore a theme related to the course content, for the purpose of this investigation, only a reflexive narrative was used as a study source. Reflexive narratives should include the following documents as an appendix: “a professional trajectory overview: a record of expectations formulated at the beginning of the course and a profile questionnaire for the admission duly filled out”¹³13 Oliveira JM, Lima VV, Padilha RQ, Pereira SMSF, Petta HL, Ribeiro ECO, Gomes R. Processos educacionais na saúde: ênfase em aprendizagem significativa. São Paulo: Ministério da Saúde, Instituto Sírio-Libanês de Ensino e Pesquisa; 2016..

Method of analysis

In 2016, 320 facilitators were trained, approximately one-third being from the Preceptor–EPES course and two-thirds from the Regional-EPES course¹⁶16 Lima VV, Pereira SMSF, Oliveira JM, Ribeiro ECO, Petta HL, Oliveira MS, Padilha RQ. Processos educacionais na saúde: ênfase em tecnologias educacionais construtivistas. São Paulo: Ministério da Saúde, Instituto Sírio-Libanês de Ensino e Pesquisa; 2017.. In order to guarantee a representative sampling of reflexive narratives, a selection was made of 10% of the certified works per course, rounding up the number to the next decimal point in the event of an incomplete percentile. In order to do this, lots were drawn using the www.random.org site, by selecting the “True Random Number Generator” function, which made it possible to obtain a sequence of randomly drawn numbers, with no interference from the researcher. During this drawing of lots, the only action taken by the researcher was to include the interval of numbers to be drawn, for the purpose of maintaining the proportion of works drawn per course, as mentioned previously. Based on these guidelines, a random sampling of 30 TCCs were obtained, seven being from the Preceptor-EPES and 23 from the Regional-EPES.

Each TCC was evaluated by two coordinators from the specialization courses involved in the sample, taking the following aspects into consideration: (a) reflexive trajectory; (b) articulation of the narrative with the areas of competency; and (c) rationale and aspects related to the outline. Based on this evaluation, a convenience sample was formed for this study, based on the indication of the reflexive narratives that were awarded the highest scores by the two evaluators. Based on this inclusion criterion, the sample consisted of 14 TCCs, four being from the Preceptor-EPES and 10 from the Regional-EPES.

The 14 reflexive narratives were analyzed from the perspective of a qualitative research approach, herein understood to be a set of interpretative practices that seek to investigate meanings that the subjects attribute to the phenomena and the set of relationships in which they are included¹⁷17 Denzin NK, Lincoln YS. Introduction: the discipline and practice of qualitative research. In: Denzin NK, Lincoln YS, editor. Handbook of qualitative research. London: Sage; 2000. p. 1-29..

The analysis that was used was based on the theoretical-methodological references systematized by Gomes and Mendonça¹⁸18 Gomes R, Mendonça EA. A representação e a experiência da doença: princípios para a pesquisa qualitativa em saúde. In: Minayo MCS, Deslandes SF, organizadores. Caminhos do pensamento: epistemologia e método. Rio de Janeiro: Editora Fiocruz; 2002. p. 109-132.. After repeated readings of the narratives, an attempt was made to acquire a better understanding of both the narrators and the context of the narratives. After that, the following steps were taken: (a) identification of the excerpts of these accounts that are related to the components of the narratives (scenarios, personalities and story-lines); (b) identification of the central ideas present in each excerpt of the components of the narrative; (c) a comparison of the ideas of these accounts in each of their components, thus, establishing similarities and differences; (d) a description of the findings of each component of the narratives; (e) articulation between the findings and the results of other studies on the subject where applicable; and (f) preparation of the interpretative summary, describing components of the narratives and theoretical principles of the study.

About the narrators

The distribution of the 14 narrators in relation to: gender, age groups, geographic location of their area of work, graduation and stricto sensu post-graduation may be seen in Table 1.

All the professionals who took part in this sample worked for the public sector, mainly in the central administration of municipal and state health departments. Most had taken post-graduate courses with non-traditional methodologies. One worked at a Basic Health Unit and another was a university professor. This information was obtained from the appendix of the narratives. Since some of the narratives did not include an appendix, it was not possible to obtain all the information needed to characterize some of the narrators.

Context of the narratives

In order to understand the context of these narratives, it was necessary to use the two perspectives put forward by Thompson¹⁹19 Thompson JB. Ideologia e Cultura Moderna: teoria social crítica na era dos meios de comunicação de massa. Petrópolis: Vozes; 1998.: social institutions and the field of relationships. The institutions that served to frame these narratives – either implicitly or explicitly – were the Ministry of Health and the Sírio-Libanês Hospital. The courses that are focused on here, had specific rules to nominate participants for post-graduate projects.

In this respect, the texts herein analyzed were produced, to some extent, to heed these rules, which can be understood based on the ideas of Burke⁷7 Burke P. A escrita da história: novas perspectivas. São Paulo: Editora Unesp; 1992. in relation to the narration of events. The author in question highlights the relationship between events and the structure of the narrative texts, seeing the structure as being a social and culturally constructed dimension. When considering some of the elements related to the structure, it should be stressed that the texts could also have been drafted taking into consideration the group of relationships into which the courses are inserted: teachers-facilitators; professional-facilitators; professional-members of the administration of their place of work, among other relationship pairings.

Some narratives could have been constructed to meet the criteria of the educational institutions, since the construction of a narrative takes into account the audiences to which they are directed²⁰20 Good BJ. Medicina, racionalidade y experiência: uma perspectiva antropológica. Barcelona: Bellaterra; 2003.. In addition to this, it should be highlighted that these narratives – even if these have been freely developed – were digitalized and not verbalized for an interviewer, and this can change the narration (style of narrative), since the code of the written language follows rules that oral language does not have. This narrative framework should be taken into consideration when interpreting this material. However, this does not necessarily represent an impediment to the use of these narratives for research purposes.

The scenarios and story-lines of these experiences

The scenario can be understood as a space where the meanings of experiences were constructed by the narrators, being configured as the world of the narrated action.

Some narrators situated their experiences anchored in these groups. The two specializations, such as one of the methodological aspects, worked on the educational activities in two groups. One of these, known as “affinity” (GAF), included participants involved in the same type of service or reality intervention project; and another, called “diversity” (GD), was made up of professionals with different placements in the workplace. All trainees took part in both of these two groups, at different times.

Some of the narrators considered that the experience of participating in these groups challenged them to understand other realities, in order to reach a collectively constructed experience. Here, inter-professionality may be considered as a common characteristic to both types of groups involved. Regarded as an educational strategy to boost the process to build knowledge and practices¹³13 Oliveira JM, Lima VV, Padilha RQ, Pereira SMSF, Petta HL, Ribeiro ECO, Gomes R. Processos educacionais na saúde: ênfase em aprendizagem significativa. São Paulo: Ministério da Saúde, Instituto Sírio-Libanês de Ensino e Pesquisa; 2016.^,1414 Lima VV, Feuerwerker LCM, Padilha RQ, Gomes R, Hortale VA. Ativadores de processos de mudança: uma proposta orientada à transformação das práticas educacionais e da formação de profissionais de saúde. Cien Saude Colet 2015; 20(1):279-288., the “inter” perspective proposed in the activities analyzed, is in line with the idea of constructing a meta-standpoint in the interaction between the participants²¹21 Morin E. O método 3: conhecimento do conhecimento. Porto Alegre: Sulina; 2008..

Health work has increasingly become organized into multi-professional teams and is thus connected to the new demands of the working environment. Campos²²22 Campos GWS. Apoio matricial e equipe de referência: uma metodologia para gestão do trabalho interdisciplinar em saúde. Cad Saude Publica 2007; 23(2):399-407. stresses that the work of a health team requires a willingness and the freedom to share different views, values, knowledge and practices and points out that this is not the prevailing standard seen in interactions established in competitive organizational environments.

At the same time, in the educational field, an “inter” perspective is also not recognized as a predominant pattern. Morin²³23 Morin E. A religação dos saberes: o desafio do século XXI. Rio de Janeiro: Bertrand Brasil; 2002. stresses that there was a period, particularly in the twentieth century, when a narrowly-focused approach was used, that placed emphasis on the storage of ever-increasing specialized knowledge, thereby\ making it difficult to contextualize and articulate disciplines in order to better face the problems of this practice.

In this way, interaction between people and between them and the world, represents the bedrock for the reconnection²³23 Morin E. A religação dos saberes: o desafio do século XXI. Rio de Janeiro: Bertrand Brasil; 2002. of disciplinary knowledge, by means of sharing and reflecting on the events experienced. Maturana²⁴24 Maturana H. Emoções e linguagem na educação e na política. Belo Horizonte: Editora UFMG; 2005. points out that, in the interaction process with others, all those involved should be respected and seen as having their own legitimate points of view. As observed by Castro⁹9 Castro FF. A sociologia fenomenológica de Alfred Schutz. Ciências Sociais Unisinos 2012; 48(1):52-60., for Schutz, experience and action, as related acts, result from the connection that is established between different minds that interact in the social process and are not the outcome of only one mind that produces meanings.

According to Gomes et al.²⁵25 Gomes R, Brino RF, Aquilante AG, Avó LRS. Aprendizagem baseada em problemas na formação médica e o currículo tradicional de medicina: uma revisão bibliográfica. Rev Bras Educ Med 2009; 33(3):444-451., in courses that use learning based on problems, the group is paramount to enable previous knowledge to be discussed, thereby making it easier to develop critical reasoning, communication abilities and an understanding of the need for life-long learning.

The difficulties related to inter-professional work were not seen as an impediment to course participation. On the contrary, some statements said that the groupings created during the course was a factor that bolstered their ability to face the hardships of given municipal situations.

The scenarios mentioned are not merely physical. These are meaningful spaces that remind us of “constructions of social niches where specific personal and inter-personal relationships are called into action”²⁶26 Ribeiro AK, Lira MCDP. O processo de significação no tempo narrativo: uma proposta metodológica. Estudos de Psicologia 2008; 13(1):67-73.. These spaces began to have different meanings after the start of the course. Certainly, group participation had already occurred during the narrator’s training, but this activity, which followed their active methodology experiences, began to represent a space where new meanings were given to previous insights and where new knowledge and practices were constructed by means of interaction.

With regards to the storyline, here understood to be a sequence that gives order to the story, giving a certain meaningful direction and intention to the account²⁶26 Ribeiro AK, Lira MCDP. O processo de significação no tempo narrativo: uma proposta metodológica. Estudos de Psicologia 2008; 13(1):67-73., in general, represented processes interlaced with feelings and emotions. Some feelings became differentiated from those experienced prior to the course.

In other cases, part of the emotions that began with the course still persisted after the process.

While recognizing the value of the emotions that are interwoven into these storylines, it was noticed that emphasis was given to the organic basis in the concept of emotions and its constitutive presence in mental processes²⁷27 Vygotsky LS. A formação social da mente: o desenvolvimento dos processos psicológicos superiores. São Paulo: Martins Fontes; 1999.. Although several authors similarly consider reason-emotion integration as an intrinsic part of the learning process²⁸28 Fridja NH. The psychologists' point of view. In: Lewis M, Haviland-Jones JM, Barret LF, editors. Handbook of emotions. 3rd ed. New York: Guilford Press; 2008. p. 68-87.

29 Goleman D. Emotional intelligence: issues in paradigm building. In: Cherniss C, Goleman D, editors. The emotionally intelligent workplace. San Francisco: Jossey-Bass; 2001. p. 13-26.^-3030 Damasio A. O Erro de Descartes. Emoção razão e o cérebro humano. 2ª ed. São Paulo: Companhia das Letras; 2006., the positivist approach of education and science strives to neutralize aspects considered to be irrational in the production of knowledge. Based on objective procedures, positivism seeks “the truth” and does not value any experience that is groundless³¹31 Arantes VA. A afetividade no cenário da educação. In: Oliveira MK, Souza DT, Rego T, organizadores. Psicologia, educação e as temáticas da vida contemporânea. São Paulo: Moderna; 2002. p. 159-174..

The possibility of arousing and processing emotions during educational activities, raises the production of knowledge and practices to another level, reconnecting science and culture. The construction of rationalities as being logical that aim to negate or justify feelings and preferences²⁴24 Maturana H. Emoções e linguagem na educação e na política. Belo Horizonte: Editora UFMG; 2005., reveal, to a great extent, the parameters produced by the culture and history of society.

In the storylines studied, emotions impregnated the narrative texts, and in tandem with the traditional and innovative rationalities highlighted in the field of health education, gave direction and intentionality of the individuals to their accounts.

Active methodologies as central players in the experiences

Different characters have been mentioned, either tangentially or in greater depth. However, the so-called active methodologies were by far personified as the central players in the narratives. The construction of this character occurred far more often based on a dimension of affection rather than through the perceptions that conceptualized or characterized it.

The character in question summarized different feelings attributed by the narrators, such as “meaningful learning,” “problem-based learning,” “constructivist methodology,” “a process centered on the student,” and “autonomy and respect for individuals who construct their own story.” Active methodologies can be considered as those “technologies that promote engagement on the part of the trainees in the educational process and which favor the development of their critical and reflexive capacity, in relation to what they are doing”³²32 Lima VV. Metodologias ativas de ensino aprendizagem: desafios da inovação. In: Lima VV, Padilha RQ. Reflexões e inovações na educação de profissionais de saúde. Rio de Janeiro: Atheneu; 2018., in the sense that they promote commitment, ties, collaboration and cooperation between participants³³33 Bonwell C, Eison JA. Active learning: creating excitement in the classroom. Washington: George Washington University; 1991..

Active methodologies were also associated with educational strategies that are not inherently exclusive to them. However, to prepare a portfolio, carry out an evaluation and participate in a group task, within the framework of these methodologies, began to have different meanings from those constructed in the process experiences described by the narrators as “traditional teaching.”

Also, in the narratives, an antagonist was detected – repeatedly – as being opposed to active methodologies. This involves “traditional teaching.” It is interesting to observe that, while central players are always mentioned in the plural, the antagonist is always described in the singular. The construction of this antagonist, differs, in part, from aspects that are almost exclusively related to knowledge.

The reports analyzed contrast prior experiences with those that occurred during the courses. In the confrontation between the antagonist (in the singular) and the central players (in the plural), it may be inferred that, in relation to the former, the experiences outside the courses were condensed, while the latter was seen as a summary of various possibilities of change in the educational training of health professionals.

Based on the benchmark of the propositions put forward by Bachelard³⁴34 Bachelard G. A formação do espírito científico: contribuição para uma psicanálise do conhecimento. Rio de Janeiro: Contraponto; 1996. with regard to the training of the scientific spirit, it should be highlighted that, when faced with a new experience or new knowledge, “it is impossible to cancel out, in one fell swoop, all habitual knowledge” (…) “when the spirit is introduced to scientific culture, it is never young … in fact, it is very old, because it is as old as its prejudices”³⁴34 Bachelard G. A formação do espírito científico: contribuição para uma psicanálise do conhecimento. Rio de Janeiro: Contraponto; 1996.. In this confrontation, receiving prior knowledge may be considered to be a critical factor in the construction of new meanings.

However, according to Bachelard³⁴34 Bachelard G. A formação do espírito científico: contribuição para uma psicanálise do conhecimento. Rio de Janeiro: Contraponto; 1996., if epistemology is historic and has evolved by means of ruptures and discontinuities resulting from the evolution of scientific thought, according to Fleck³⁵35 Fleck L. Gênese e Desenvolvimento de um Fato Científico. Belo Horizonte: Fabrefactum; 2010. – who likewise believes in the historical determination of the production of knowledge – some dimension of prior knowledge remains in the construction of new meanings. In this respect, Fleck³⁵35 Fleck L. Gênese e Desenvolvimento de um Fato Científico. Belo Horizonte: Fabrefactum; 2010. points to a less uneven scientific evolution and highlights how important it is to recognize the socio-cultural interactions that are involved in the production and dissemination of knowledge.

Notwithstanding the fact that experiences with traditional and active teaching-learning methods have primarily been exploited by means of the emotions that these provoke, the narratives reveal changes both in the store of knowledge⁸8 Schutz A. Sobre fenomenologia e relações sociais. Petrópolis: Vozes; 2012. (Coleção Sociologia). in the educational processes, as well as in the sentiments of the individuals who have experienced these processes.

When considering the relationship between events and structure⁷7 Burke P. A escrita da história: novas perspectivas. São Paulo: Editora Unesp; 1992., it is worth pointing out that, although the National Curriculum Guidelines for graduation in the area of health were published at the beginning of the twenty-first century and recommend the introduction of active and problematizing methodologies in education, for practically all the careers in this field³⁶36 Almeida M. Diretrizes Curriculares Nacionais para os cursos universitários da área da saúde. Londrina: Rede UNIDA; 2003., it is still not a hegemonic practice. The force of the inertia that maintains the conventional teaching tradition lies in the challenges resulting from (the):

In this respect, the courses in question provided experiences that revealed tensions between hegemonic and counter-hegemonic knowledge. When describing what educational knowledge and practices experienced during the courses had crossed the boundaries of the interactions established therein, thereby invading the daily work processes as well as personal territory and their private lives, this trend may be considered to be on the increase. It may indeed be considered negligible in relation to what is expected and the structure of the work organizations to which the participants are linked and the schools from which they graduated.

According to Onocko Campos and Furtado¹⁰10 Onocko Campos RT, Furtado JP. Narrativas: utilização na pesquisa qualitativa em saúde. Rev Saude Publica 2008; 42(6):1090-1096., the narratives may be considered methodological tools that make it possible to permit in-depth “discourse-action relationships” and occasional events and structural questions relating to daily work in the health sector. These authors also stress the fact that this narrative opens itself up to:

Interpretative synthesis

The narratives analyzed revolved around events experienced by health professionals based on their activity as facilitators of educational processes. The narrators had not taken a course on active methodologies, but rather experienced the latter in a course environment. Paraphrasing Schutz⁹9 Castro FF. A sociologia fenomenológica de Alfred Schutz. Ciências Sociais Unisinos 2012; 48(1):52-60., it may be seen that these methodologies only became meaningful because they were consciously learned and were cognitively constituted. They began to form part of a store of experiences that can define the situations of the authors of the narratives and guide their conduct. On the other hand, the fact that they appear repeatedly in the narratives may arise from the claim made by Schutz that the experience is not the result of an isolated mind, but the result of interaction. It was through the interaction of the authors of the narratives that active methodologies were constructed as experiences and not as information.

According to Schutz¹¹11 Schutz A. El problema de la realidade social. Buenos Aires: Amorrurtu; 2008. (Biblioteca de sociología)., reflection is translated by the change in an impression of a given moment, inscribed in the world of temporal-space by evoking prior experiences, since “it is only from a retrospective point of view that very distinct experiences exist”⁹9 Castro FF. A sociologia fenomenológica de Alfred Schutz. Ciências Sociais Unisinos 2012; 48(1):52-60.. In addition, the author observes that, by means of this evocation, interferences are possible that complete or evaluate the current situation. In this respect, the active methodologies are located in the midst of the storylines as a construct that is the outcome of events experienced and as an option to think about health training in a way that differs from the traditional approach.

This tension between active methodologies (centered on the subjects who learn) and traditional teaching (centered on the reproduction of knowledge) occurs both as a break between a “before” and an “after” as an option to perceive counterpoints and displacements in the educational proposals and initiatives for health professionals.

If this tension were to be transformed into a paradox between the traditional teaching experienced and the active methodologies experienced during the course, or to be experienced after the course, the present of the elaboration of the narrative may dissipate them. As Ricoeur³⁷37 Ricoeur P. Interpretação e Ideologia. Rio de Janeiro: Francisco Alves; 1990. observes, the paradox of temporality (the past that is not the present, the present that will be the past and the future that is not yet present) can be consolidated in the present (past-present, present-present and future-present). In this respect, in the confrontation between traditional teaching (already experienced) and active methodologies (experienced or to be experienced), the act of narration is the present that makes it possible to project a possible future (giving continuity to the active methodologies) by means of a redefinition of the past (traditional teaching).

It is possible to attribute certain innovation to the narratives focused on here. This innovation does not focus so much on active methodologies; because these, in a certain way, have already been the subject of discussion for years within the scope of health education. However, if one uses the analysis put forward by Fernandes³⁸38 Fernandes SMMR. Identidade narrativa e identidade pessoal: uma abordagem da filosófica de Paul Ricoeur. Philosophica 2008 [acessado 2018 Mar 27]; 33:75-94. Disponível em: http://repositorio.ul.pt/retrieve/69992/Philosophica%2033-4.pdf.
http://repositorio.ul.pt/retrieve/69992/... , based on Ricoeur, innovation is involved in the act of the narrative itself with regards to the active methodologies that make it possible to create a (new fictional) world, that is very distinct from the hegemonic educational strategies and has the potential to alter the world of educational experiences and, in this way, transcend them and propose new models to act and exist educationally.

In addition to being reflexive, because they are textualized, the narratives revealed – as underlined by Ricoeur³⁷37 Ricoeur P. Interpretação e Ideologia. Rio de Janeiro: Francisco Alves; 1990. – an understanding about the appropriation of a constructed work, since the text can be a mediation for self-understanding. What is adopted is an approach that it “is not found behind the text, like some sort of hidden intention, but that which comes ahead of it, such as what the work unveils, discovers, reveals”³⁷37 Ricoeur P. Interpretação e Ideologia. Rio de Janeiro: Francisco Alves; 1990.. And what it reveals is that it is possible to train health professionals, in which people coexist with or counter a way of teaching that has a vertical relationship between those who teach and those who learn.

Although explanations for choosing an emancipatory form of education instead of one that reproduces the status quo, have not been examined in depth, or densified, as claimed by Burke⁷7 Burke P. A escrita da história: novas perspectivas. São Paulo: Editora Unesp; 1992., the narrators’ interest for such changes was strongly revealed.

It is in the field of interest that the emergence of feelings of passion and appreciation for life and independence on the part of the narrators of this research stands out. This consequently harks back to the association established by Kristeva⁶6 Kristeva J. O gênio feminino: a vida, a loucura, as palavras. Rio de Janeiro: Rocco; 2002. v.1. with respect to the work by Hannah Arendt that shows experience as action that articulates thought, sensorial emotions and affection. According to Arendt³⁹39 Arendt H. A dignidade da política: ensaios e conferências. Rio de Janeiro: Relume-Dumará; 1993., these experiences are revealed in narratives written in the form of biographies:

With respect to the construction of biographies in a post-modern context, Fontes⁴⁰40 Fontes I. Júlia Kristeva e o tempo sensível. Pulsional Revista de Psicanálise [periódico na internet] 2000 [acessado 2017 nov. 29]; XIII(139):23-28. Disponível em: http://www.editoraescuta.com.br/pulsional/139_03.pdf.
http://www.editoraescuta.com.br/pulsiona... highlights the work “Proust and the Sense of Time” by Kristeva, in which the author describes how much the psychic space is being reduced, subsumed by conditions that ultra-dimensionalize technology, images and speed.

When encountering narratives full of sentiments and emotions, it becomes possible to recognize the potential of narrated interactions for having provided the opportunity to construct new meanings and new sensations, as words that reveal sensorial acts of psychic significance and representation. In this sense, the potential for transformation of the subjects themselves, their knowledge and practices as narrated, express the experiences of agents of history, especially of those histories that represent biographies.

Final considerations

The use of reflexive narratives about the learning trajectory involved in educational projects as part of the TCC demonstrated a marked potential in the sense of providing visibility to the knowledge and practices constructed by the narrators. This opened up space so that, in addition to the cognitive dominion and theoretical knowledge, this practice – through events experienced – could be valued and explored as a historical and social construction based on actions and on words. This, in a certain way, breaks away from the position held in the health area, which reduces education merely to the transmission of information.

Furthermore, it was found that the narratives, even though these reflect only a moment in the life of professionals, can influence the trajectory of these individuals, in the sense of perceiving management or care in the area of health as an educational space, which is open to transformation. Thus, when exploring the categories of experience and temporality in the narratives, the possibility of the emergence of emotions and rationalities becomes apparent, such that interests and values can be worked upon in conjunction for the production of new knowledge, in a dialogue between culture and science. However, the project undertaken here, which is to analyze the narratives of health professionals in relation to their experiences during courses on the development of educational capabilities, should be understood within given limitations. The first of these is that this analysis does not set out to evaluate the effectiveness of courses centered on active methodologies, even though the narratives have been produced as a course completion paper. In this respect, a secondary interpretation was proposed. In essence, an interpretation was constructed of the interpretations of the narrators who place active methodologies as the central player in their experiences, within the scope of the interactions experienced in the educational activities studied.

Another limitation is that the analysis conducted here did not focus on empirical elements to check the changes narrated in relation to the practices performed by the narrators; after all, as advised at the beginning of this article, the acceptability of a narrative is defined by convention, and not by verification. However, by means of these, it is possible to infer that – implicitly or explicitly – it was stated that there is a possibility of coexistence between movements of reproduction and of transformation of knowledge and practices of the individuals themselves and, therefore, of reality per se.

Lastly, it should be pointed out that while the narratives are seen as a creation of the imagination of narrators, that which is fictional has a concrete effect on the world of the narrators, even though on a possible plane yet to come.

References

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