Abstract

Introduction

The impact of Covid-19 disease on medical education

The need to revisit the academic education of health professionals has never been more pressing and necessary. The health crisis caused by the pandemic of Covid-19 has highlighted the response capacity of health professionals in the face of numerous adversities. As part of overloaded teams, and facing complex clinical and social situations¹1 Frenk J, Chen L, Bhutta ZA, Cohen J, Crisp N, Evans T, et al. Health professionals for a new century: transforming education to strengthen health systems in an interdependent world. Lancet. 2010; 376(9756):1923-58. of patients, the professionals and students working in the care actions were challenged to exercise communication, management, and collaborative work skills, in addition to technical competencies. The process of confronting an extremely dynamic reality and new health needs, put in check medical education providing an opportunity to reflect on the formation of competencies for professional work in uncertain contexts.

The emergence of the pandemic, social distancing measures resulted in the suspension of classroom activities in medical schools²2 Brasil. Ministério da Educação. Portaria nº 343, de 17 de Março de 2020. Dispõe sobre a substituição das aulas presenciais por aulas em meios digitais enquanto durar a situação de pandemia do Novo Coronavírus - COVID-19. Diário Oficial da União. 18 Mar 2020; sec. 1, p 39. and destabilized educational structures, requiring reorganization and new pedagogical strategies to support the continuity of academic training³3 Gordon M, Patricio M, Horne L, Muston A, Alston SR, Pammi M, et al. Developments in medical education in response to the COVID-19 pandemic: A rapid BEME systematic review: BEME Guide No. 63. Med Teach. 2020; 42(11):1-14.^,44 Santos BM, Cordeiro MEC, Schneider IJC, Cecconi RF. Educação Médica durante a Pandemia da Covid-19: uma Revisão de Escopo. Rev Bras Educ Med. 2020; 44 Suppl 1:e139. Doi: https://doi.org/10.1590/1981-5271v44.supl.1-20200383.
https://doi.org/10.1590/1981-5271v44.sup... . Academic managers were forced to make decisions regarding different aspects, such as the relevance of content to be taught, the use of digital technologies for pedagogical purposes, teacher education to facilitate adjustments, and review of the evaluation culture of the institution. In addition, it put on the agenda the mental health of the students and the role of the professor in the face of unprecedented teaching processes. Although these issues were already under debate, the sense of urgency brought on by the pandemic demanded immediate solutions.

Since the end of the last century, there has been a consensus in favor of overcoming the traditional teaching model - predominantly biomedical⁵5 Lampert JB. Na transição paradigmática da educação médica: o que o paradigma da integralidade atende que o paradigma flexneriano deixou de lado. Cad ABEM. 2004; 1(1):23-5. - towards a more appropriate model to train professionals to provide health care with a comprehensive, interdisciplinary, and multiprofessional approach, considering the particularities of the biopsychosocial context¹1 Frenk J, Chen L, Bhutta ZA, Cohen J, Crisp N, Evans T, et al. Health professionals for a new century: transforming education to strengthen health systems in an interdependent world. Lancet. 2010; 376(9756):1923-58.. The biomedical model presented itself as limited and scarcely useful to prepare professionals to face “the challenges of the rapid transformations in society, in the labor market, and in the conditions of professional practice”⁶6 Brasil. Ministério da Educação. Conselho Nacional de Educação. Parecer CNE/CES nº 116, de 3 de Abril 2014. Diretrizes curriculares nacionais do curso de graduação em medicina. Diário Oficial da União. 6 Jun 2014; sec. 1, p. 17. (p. 17). The limitations arouse from the pedagogical characteristics of this model, such as the curricular structure divided into basic and clinical cycles with fragmented subjects and the teaching-learning process centered on the teacher, added to the insufficient, as well as alienated from social reality participation on the part of the students¹1 Frenk J, Chen L, Bhutta ZA, Cohen J, Crisp N, Evans T, et al. Health professionals for a new century: transforming education to strengthen health systems in an interdependent world. Lancet. 2010; 376(9756):1923-58.^,66 Brasil. Ministério da Educação. Conselho Nacional de Educação. Parecer CNE/CES nº 116, de 3 de Abril 2014. Diretrizes curriculares nacionais do curso de graduação em medicina. Diário Oficial da União. 6 Jun 2014; sec. 1, p. 17.

7 World Health Organization. Department of Human Resources for Health. Framework for action on interprofessional education and collaborative practice [Internet]. Genebra: WHO; 2010 [citado 12 Maio 2019]. Disponível em: http://www.who.int/hrh/nursing_midwifery/en/
http://www.who.int/hrh/nursing_midwifery... ^-88 Brasil. Ministério da Educação. Resolução nº 3, de 20 de Junho de 2014. Diretrizes curriculares nacionais do curso de graduação em medicina [Internet]. Brasília, DF: Ministério da Educação; 2014.

International documents¹1 Frenk J, Chen L, Bhutta ZA, Cohen J, Crisp N, Evans T, et al. Health professionals for a new century: transforming education to strengthen health systems in an interdependent world. Lancet. 2010; 376(9756):1923-58.^,77 World Health Organization. Department of Human Resources for Health. Framework for action on interprofessional education and collaborative practice [Internet]. Genebra: WHO; 2010 [citado 12 Maio 2019]. Disponível em: http://www.who.int/hrh/nursing_midwifery/en/
http://www.who.int/hrh/nursing_midwifery... aligned with innovative proposals⁹9 Venturelli J. Educación médica: nuevos enfoques, metas y métodos [Internet]. Washington: OPAS; 1997 [citado 1 Ago 2019]. Disponível em: https://www.imperial.ac.uk/media/imperial-college/administration-and-support-services/library/public/vancouver.pdf
https://www.imperial.ac.uk/media/imperia... advocated that contemporary medical education should focus on student learning and be based on problems, incorporating active teaching-learning methodologies and experiences in diversified practice settings. Several Brazilian movements, articulated with a set of initiatives, in line with innovative proposals resulted in the approval of the National Curricular Guidelines for Undergraduate Medical Education (DCN in the Portuguese acronym)⁸8 Brasil. Ministério da Educação. Resolução nº 3, de 20 de Junho de 2014. Diretrizes curriculares nacionais do curso de graduação em medicina [Internet]. Brasília, DF: Ministério da Educação; 2014. , aiming to better adapt the education to the Brazilian reality and the work in the Brazilian National Health System (SUS). Based on the DCNs, undergraduate medical education should include not only the acquisition of cognitive and technical aspects, but also the incorporation of competencies that allow future physicians to transform their knowledge into actions that promote integral health, through multidisciplinary cooperation and interdisciplinary practices. Curricular structures integrating the basic and clinical cycles, centrality of teaching in primary care, programmatic adequacy to the health needs of the population, increase of internship hours, student-centered pedagogical project (and teacher as a mediator of the process), emphasis on continuing education and faculty development constitute fundamental guidelines for change in Brazil⁸8 Brasil. Ministério da Educação. Resolução nº 3, de 20 de Junho de 2014. Diretrizes curriculares nacionais do curso de graduação em medicina [Internet]. Brasília, DF: Ministério da Educação; 2014..

In 2019 we conducted a quanti-qualitative survey with teachers and students of the undergraduate medical course of a public Brazilian university, with the objectives of knowing the perceptions of students and teachers about the educational environment, as well as identifying the impasses and needs for effecting changes. The pandemic and the social isolation measures caught us by surprise in the middle of the data analysis, and we were invited to follow the course reorganization from the vantage point of our role as professionals working in the medical school under study, as well as to participate in discussions in collegiate forums about the impacts and developments verified in our institution and in other medical schools.

This study aimed to recognize the changes that were being required in medical education due to the outbreak of the health crisis and to identify the perception that teachers had about these issues. It is worth noting that many issues emerging in the pandemic period had been on the agendas for change for some years, and were therefore already reflected previously in the discourses of teachers, managers, and students. We observed that the data collected in 2019 allowed us to understand our present environment as well as the impact in the face of necessary changes. In light of past experience, we tried to identify the educational initiatives to be strengthened toward the pressing demands and future transformations.

Methodology

This article is part of a larger study of a qualitative nature about teachers’ and students’ perceptions of the educational environment. The results of the latter are articulated with the empirical reality at the time of the outbreak of the pandemic, recorded through an ethnographic study. All research took place in a public university, of traditional curricular organization.

The initial stage occurred between 2016 and 2019 and was carried out through focus groups with students from the various grades of the medical course and in-depth interviews with professors. It should be noted that the present article uses data coming solely from interviews with professors, due to the centrality of this category for the processes of changes in educational practices⁸8 Brasil. Ministério da Educação. Resolução nº 3, de 20 de Junho de 2014. Diretrizes curriculares nacionais do curso de graduação em medicina [Internet]. Brasília, DF: Ministério da Educação; 2014.^,1010 Behrens MA. A prática pedagógica e o desafio do paradigma emergente. Rev Bras Estud Pedagog. 1999; 80(196):383-403.. These followed a semi-structured script addressing issues concerning the educational environment. We interviewed 11 professors, four from the basic cycle and seven from the clinical/internship cycle with outstanding performance in the undergraduate course, six of them female and five male. The sample size was defined according to the saturation criterion and the average duration of the interviews was 1h30m, conducted by the researcher-authors. The collected material was recorded and transcribed in full.

The textual material was analyzed using the WebQda software for qualitative data analysis, following these steps: reading and re-reading to have a notion of the whole and the particularities; data classification according to the emerging meanings; cutting and pasting of the text; interpretative synthesis in articulation with the data from the literature and the ethnographic study¹¹11 Taquette SR, Borges L. Pesquisa qualitativa para todos. Petrópolis: Vozes; 2020.^,1212 Minayo MCS. O desafio do conhecimento. 13a ed. São Paulo: Hucitec; 2013..

In the second stage, data were collected through participant observation during the year 2020, already in the midst of the Covid-19 epidemic, and aimed to deepen questions and understand the transformations that were taking shape. Observations and notes from discussions of weekly meetings by the research group supported the task of describing and discussing the elements of the field, without naturalizing them¹³13 Damatta R. O ofício de etnólogo ou como ter Anthropological Blues. In: Nunes E, organizador. Aventura sociológica. Rio de Janeiro: Zahar; 1978. p. 23-35.. Contextualized to the new teaching-learning environment by the ethnographic study, we identified the themes in evidence during the pandemic and revisited the data collected in 2019 in the interviews with teachers, from a more detailed plan of categorizations.

For the analysis of this stage, we listed four subcategories derived from general perceptions of the educational environment and that were on the agenda in the discussions in the medical education forums, namely: use of information and communication technology; definition of content relevance for academic education; importance of collaborative work; attention to student mental health.

Finally, we established a dialogue between the teachers’ perceptions, the literature and the empirical reality that presented itself, intending to deepen the understanding of the challenges and to glimpse alternatives for the required changes.

This study was ethically cleared by the Pedro Ernesto University Hospital Ethics Research Committee - University of the State of Rio de Janeiro (CAAE) nº 53535915.2.0000.5259, opinion nº 1.542.111.

Results and Discussion

What is relevant to learn? Questions about educational planning

Defining the essential contents for medical education has been an item on the agenda since the last century, due to the realization that it is impossible for the undergraduate course to contemplate the entire volume and detail of medical science. Since the DCNs, the teaching of Primary Health Care has gained centrality as a longitudinal curricular component and the internship time has been extended, demanding curricular reorganizations from the schools.

In compliance with Brazilian national guidelines, the studied institution proceeded with a curricular reform project by holding meetings between the undergraduate coordination, students and teachers, with the main objective of defining programmatic content that would allow greater integration of disciplines and increase the time allotted to the internship. The issue related to the definition of contents had been debated in the institution before the health crisis; however, the pandemic required resuming the discussion under a new context, giving to it an urgent character. The prospect of teaching in remote modality for an indeterminate period, the uncertainties regarding the maintenance of the school calendar and the need to comply with the deadlines for graduation of interns, forced us to ask: what, in the universe of theoretical and practical content should be prioritized?

In the research conducted in 2019 in the school under study, we found that the debate is complex and its resolution depends on several factors. There is a lack of consensus about the programmatic objectives and competencies to be achieved by the student, which results in educational planning centralized in the figure of the subject coordinator and in teachers teaching subjects that are poorly integrated. Moreover, even when the degree of importance or detail of the contents are defined by the discipline, they often follow criteria that are disconnected from the general education plan:

The definitions regarding content relevance, teaching-learning methods, scenarios for practical activities, or forms of student assessment require agreements among professors that contemplate the school’s pedagogical project, but they also require an environment within the disciplines and departments themselves that allows for debate and conciliatory movements. However, conservative medical schools are guided by hierarchical relationships¹⁴14 Rego S. A formação ética dos médicos – saindo da adolescência com a vida (dos outros) nas mãos. Rio de Janeiro: Fiocruz; 2003.^,1515 Feuerwerker L. Mudanças na educação médica e residência médica no Brasil. São Paulo: Hucitec, Rede Unida; 1998. which compromise the possibility of collective construction in discipline planning, as the teacher’s report indicates:

Teachers emphasize that there is also resistance from their own peers regarding more innovative proposals for evaluative processes:

The impasses seem far from being solved. However, during the pandemic, the need for shared solutions affirmed the importance of expanding discussion spaces for joint educational planning and collective construction of the necessary adaptations.

Use of Information and Communication Technology: teacher-student relationship, motivation, and faculty development

Emergency remote teaching was the solution found by schools to adapt to measures of social isolation by offering synchronous, asynchronous, or other digital media classes³3 Gordon M, Patricio M, Horne L, Muston A, Alston SR, Pammi M, et al. Developments in medical education in response to the COVID-19 pandemic: A rapid BEME systematic review: BEME Guide No. 63. Med Teach. 2020; 42(11):1-14.. Information and Communication Technologies (ICT) have represented a trend to renew content and methods in higher education since 1998¹⁶16 UNESCO. Organização das Nações Unidas para Educação, Ciência e Cultura. Declaração Mundial sobre Educação Superior no Século XXI: visão e ação. Comunicado. Paris: UNESCO; 1998. , and have gained greater application in recent years¹⁷17 Goudouris E, Struchiner M. Aprendizagem híbrida na educação médica: uma revisão sistemática. Rev Bras Educ Med. 2015; 39(4):620-9. Doi: http://dx.doi.org/10.1590/1981-52712015v39n4e01642014.
https://doi.org/10.1590/1981-52712015v39... . In the studied institution, there was already an institutional platform belonging to the medical school, but underutilized by the undergraduate course, as the professor commented:

The establishment of a virtual teaching-learning space with more advanced resources and the offer of training for the teaching staff to use this technology was possible after the health crisis. This was a need that came to meet the desires of teachers who had already observed the importance of greater technological investment in the educational sector:

The use of ICTs as a pedagogical tool was necessary and can be best experienced under conditions of social isolation. The digital media provided an extensive volume of information about the pandemic, rekindling questions about the role of the teacher in contemporary times that were already on the agenda before:

The emergence of the pandemic found teachers in Brazilian schools faced with little or no infrastructure offered by institutions for online learning¹⁸18 Rodrigues BB, Cardoso RRJ, Peres CHR, Marques FF. Aprendendo com o imprevisível: saúde mental dos universitários e educação médica na pandemia de covid-19. Rev Bras Educ Med. 2020; 44(1):1-5.; moreover, the introduction of remote learning brought challenges to teachers who were uncertain about the task of dealing with digital technologies, leading them to demand help from students who were more familiar with the use of media. Welcoming the unknown as a learning opportunity means that the teacher establishes a horizontal relationship with the student, in which both act in the construction of knowledge “in such a way that both become, simultaneously, educators and learners”¹⁹19 Freire P. Pedagogia do oprimido. Rio de Janeiro: Paz e Terra; 2005.. Overcoming the teacher-student contradiction is a great challenge in traditional schools¹⁹19 Freire P. Pedagogia do oprimido. Rio de Janeiro: Paz e Terra; 2005.^,2020 Feuerweker L. Gestão dos processos de mudança na graduação em medicina”. In: Marins JJN, Rego S, Lampert JB, Araújo JGC, organizadores. Educação Médica em transformação – instrumentos para a construção de novas realidades. São Paulo: Hucitec; 2004: p.17-39. as the teacher observed:

Teachers were positively surprised by the potential for teaching improvement facilitated by the partnerships established with students for the operationalization of digital media, which corroborate the use of ICTs as an important innovation in adult learning because, in addition to allowing greater autonomy to the student, they facilitate interactions by encouraging collaborative learning²¹21 Ruiz JG, Mintzer MJ, Leipzig RM. The impact of e-learning in medical education. Acad Med. 2006; 81(3):207-12. Doi: https://doi.org/10.1097/00001888-200603000-00002.
https://doi.org/10.1097/00001888-2006030... .

Nevertheless, there are some issues to consider in the current context: very long classes - as is common in medical education - have become more exhaustive in the online modality, raising questions about the motivation required for the student to perform tasks individually and isolated from his class. In face-to-face activities before the pandemic, educational planning with varied methodological strategies respecting students’ singularities and encouraging meaningful learning was described as a successful model to motivate students:

Using teacher’s creativity to employ multiple resources aligned to the students’ interests seems fundamental to make the pedagogical activities more stimulating, whether these activities are face-to-face or remote. However, in the studied institution we observed difficulties in the methodological renovation or in the search for new references, although the teachers perceived the inadequacy of old practices in a changing world. The teacher’s speech corroborates the finding that most teachers who work in higher education tend to reproduce the methodologies they have experienced in their educational process¹⁰10 Behrens MA. A prática pedagógica e o desafio do paradigma emergente. Rev Bras Estud Pedagog. 1999; 80(196):383-403.:

The discourse that predominated until the outbreak of the pandemic pointed to a demotivation of teachers and students, at various levels. The lack of meaningful learning for students and a not very motivating institutional environment for teachers, associated with an inflexible curricular structure, seemed to contribute to the situation. The pandemic affirmed the importance of institutional investment in teacher development, an ongoing process that is especially necessary in times of rapid change. Today it is expected that teachers to be updated in the use of computer tools and that, besides the specific knowledge of their areas, they know how their subjects interact with other subjects. In the field of values, they must transmit to the students a humanistic knowledge, encompassing an ethical and emotional awareness, and a cultural competence, which allow for a collaborative practice based on critical thinking and with abilities to solve problems in creative and innovative ways¹⁶16 UNESCO. Organização das Nações Unidas para Educação, Ciência e Cultura. Declaração Mundial sobre Educação Superior no Século XXI: visão e ação. Comunicado. Paris: UNESCO; 1998. ^,2222 Kereluik K, Mishra P, Fahnoe C, Terry L. What knowledge is of most worth: teacher knowledge for 21 st century learning. J Digital Learn Teach Educ. 2013; 29(4):127-40.. Faculty development programs in medical education have increased significantly in the last two decades²³23 Steinert Y, Mann K, Anderson B, Barnett BM, Centeno A, Naismith L, et al. A systematic review of faculty development initiatives designed to enhance teaching effectiveness: a 10-year update. Med Teach. 2016; 38(8):769-86.. In the studied institution, the participation of teachers in the collective construction of the Objective Clinical Structured Examination (Osce), promoted dialogue between disciplines and enabled the updating of knowledge, allowing the teacher to move out of his disciplinary territory.

The collective construction of the Osce assessment by the faculty members put collaborative work into action, promoting dialogue across disciplines and showing to be a promising avenue for future teacher development programs.

Collaborative work and the importance of communication skills

In health education processes, the emphasis on educating professionals for work collaboratively is a strategic recommendation for professionals and health systems to achieve greater resolutivity. A large percentage of medical errors and iatrogenesis occur mainly due to failures in the organization of care flows, when the patient is treated by several specialties that communicate little with each other²⁴24 Kohn LT, Corrigan JM, Donaldson MS. To err is human: building a safer health system [Internet]. Washington, DC: National Academies Press (US); 2000 [citado 20 Out 2020]. Disponível em: http://www.nap.edu/catalog/9728.html
http://www.nap.edu/catalog/9728.html... .

During the pandemic, the participation of student volunteer and intern student groups in health care units highlighted the importance of academic education emphasizing the teaching of communication, management, and collaborative work skills, in order to value students’ leading role and develop competencies for interdisciplinary and collaborative work. In the studied institution some of these competencies were already being worked on within the scope of some disciplines in collegiate meetings, or through practical activities in simulated situations,

In the health actions during the pandemic, adaptations in terms of so-called ‘light’ or ‘soft’ technologies²⁵25 Merhy E, Feuerwerker L. Novo olhar sobre as tecnologias de saúde: uma necessidade contemporânea. In: Merhy EE, Baduy RS, Seixas CT, Almeida DES, Slomp, H, organizadores. Avaliação compartilhada do cuidado em saúde: surpreendendo o instituído nas redes. Rio de Janeiro: Hexis; 2017. v. 1, p. 59-72. were implemented, such as communication between staff and families via telephone or online calls. Health teams had to reinvent themselves, and it is undeniable that the ability to communicate and the flexibility to create new ways of dialoguing, were central axes of these changes. Addressing bioethical issues that emerged in this context, such as patient eligibility for hospital admission and elective use of patient support equipment, challenged teams in shared ethical decisions. In addition to the adversities of care, the intense exposure to others’ suffering and the witnessing of farewells and anticipatory grief (previously restricted to palliative care spaces, and now becoming frequent in the ward settings) undoubtedly led health care teams and students to experiment severe physical and emotional wear and tear.

The Mental Health of the Medical Student

The stress and exhaustion of health professionals and students during the pandemic have shown that attention to the integral health of these subjects is essential. The context of uncertainty reached medical students, considered a vulnerable population to mental health problems. The emotional overload expressed in reports of increased symptoms of anxiety, depression, loss of sleep quality, increased drug use, and psychosomatic symptoms, was verified both in our experience of clinical care to students and in studies conducted in the period²⁶26 Santos WA, Beretta LL, Leite BS, Silva MAP, Cordeiro GP, França EM. The impact of the COVID-19 pandemic on the mental health of healthcare workers: integrative review. RSD Res Soc Dev. 2020; 9(8):1-29. Doi: http://dx.doi.org/10.33448/rsd-v9i8.5470.
https://doi.org/10.33448/rsd-v9i8.5470... .

The high prevalence of depression and suicide among medical students²⁷27 Rotenstein LS, Ramos MA, Torre M, Segal JB, Peluso MJ, Guille C, et al. Prevalence of depression, depressive symptoms and suicidal ideation among medical students: a systematic review and meta analysis. JAMA. 2016; 316(21):2214-36. is scarcely discussed in medical schools, even though professors at the studied institution recognize the influence of the educational environment on students’ mental health:

Some teachers at the institution under study attribute greater importance to the influence of contemporary social factors than to the pressures experienced in the educational environment in the causality of the students’ psychic symptoms

Nevertheless, studies have observed that there is a culture in medical schools that considers psychological suffering as an inherent part of the educational process and even necessary for the formation of a good professional²⁸28 Slavin SJ. Medical student mental health: culture, environment, and the need for change. JAMA. 2016; 316(21):2195-6..

The approximation of teachers and students and the importance of a careful look at the unique ways of facing academic or personal adversities seem to be a good step to overcome difficulties, as observed by the teacher in her contact with students prior to the pandemic:

The context of uncertainties about the social, political, and economic directions in Brazil were constant concerns of students in this period¹⁸18 Rodrigues BB, Cardoso RRJ, Peres CHR, Marques FF. Aprendendo com o imprevisível: saúde mental dos universitários e educação médica na pandemia de covid-19. Rev Bras Educ Med. 2020; 44(1):1-5., but the study showed aggravating factors directly related to the educational environment, such as the lack of digital accessibility, difficulties for online education and the acquisition of content in this format, as well as insecurities about the acquired learning and future insertion in the professional market. The pandemic has highlighted the importance of mental health care for students; therefore it can urge medical schools to denaturalize the causes of mental suffering and invest in protection strategies and social support on an ongoing basis.

What can we strengthen toward change?

Brazilian medical schools had the opportunity, in the midst of the health crisis, to revisit the guidelines previously recommended⁸8 Brasil. Ministério da Educação. Resolução nº 3, de 20 de Junho de 2014. Diretrizes curriculares nacionais do curso de graduação em medicina [Internet]. Brasília, DF: Ministério da Educação; 2014. and verify their legitimacy to effect changes in academic training.

In the analysis of the interviews with professors, we verified that in the institution under study, before the outbreak of the pandemic, traditional teaching practices had been renewed by innovative initiatives, but only occasionally.

In the curriculum reform undertaken at the institution in 2018, the debate conducted on the relevance of content did not show advances within the disciplines after the new curriculum was established. There were issues of academic hierarchy and institutional importance that seemed to get in the way of the evolution of this debate. The destabilizations of curriculum planning caused by the social distancing affirmed the importance of the revision of the fundamental contents to be practiced systematically and frequently in the institution. Even before the pandemic, the professors identified the need for institutional incentive for faculty development programs, so that they could update themselves methodologically and talk about more subjective aspects of the educational practice, such as the role of the teacher in contemporary times and the relationship with the students. Educational planning activities carried out before the pandemic that required a joint planning of teachers (such as the Osce, for example), were perceived as facilitating the integration of disciplines and provided opportunities for updates, functioning as a useful strategy for teacher development.

The health crisis has accentuated the need for educational planning that is adequate to the general plan of formation. The readjustment of assessment processes implies the recognition of the teaching/learning process established and demands the inclusion of the participating subjects (students and teachers), constituting an “essential basis for the construction and consolidation of new work practices”²⁹29 Ribeiro ECO. Ensino/aprendizagem na escola médica. In: Marcondes E, Gonçalves E, organizadores. Educação médica. São Paulo: Sarvier; 1998. p. 40-9. (p. 49). In this sense, the perspective of a permanent dialogic exercise between the student body and the faculty may favor the changes, being necessary that they are negotiated and agreed upon between academic managers, discipline coordinators, departments and students. It was verified that the professors wish to establish more horizontal relations with the students, occupying a position more consistent with what is required in contemporary times about the teacher’s role, in agreement with Freire’s conceptions¹⁹19 Freire P. Pedagogia do oprimido. Rio de Janeiro: Paz e Terra; 2005.. The use of active teaching-learning methodologies has the potential to redefine roles and catalyze new changes²⁰20 Feuerweker L. Gestão dos processos de mudança na graduação em medicina”. In: Marins JJN, Rego S, Lampert JB, Araújo JGC, organizadores. Educação Médica em transformação – instrumentos para a construção de novas realidades. São Paulo: Hucitec; 2004: p.17-39. and, in virtual environments it could lead to an increase in motivation for both students and teachers, strengthening the bonds of partnership and work. The need to diversify the methodological strategies that place the student at the center of the teaching-learning process was emphasized by teachers. We found that some courses seem more aligned with Fair³⁰30 Harden RM, Laidlaw JM. Be FAIR to students: four principles that lead to more effective learning. Med Teach. 2013; 35(1):27-31. Doi: https://doi.org/10.3109/0142159X.2012.732717.
https://doi.org/10.3109/0142159X.2012.73... principles(^f(f)Applying the Fair principles - providing feedback to the student, engaging the student in active learning, individualizing learning to the student’s personal needs, and making learning relevant - can lead to more effective learning.) (acronym for Feedback, Activity, Individualization, Relevance), developing feedback practices, actively engaging students in course planning, and emphasizing meaningful learning with respect for the singularities and learning needs of each student. However, despite the efforts made, there is still resistance to its widespread implementation within the disciplines themselves.

The collaborative and interdisciplinary work to face complex issues in assistance was scarcely promoted in educational practices before the pandemic. The predominance of a competitive culture among students and among teachers seems to be an obstacle to the advancement of partnerships and agreement upon outcomes, but collaborative practices introduced gradually can solve the difficulties of this training.

The incidence of psychological distress among medical students during their academic training is a phenomenon recognized³¹31 Jamal F, Fletcher A, Harden A, Wells H, Thomas J, Bonell C. The school environment and student health: a systematic review and meta-ethnography of qualitative research. BMC Public Health. 2013; 13(1):798. Doi: https://doi.org/10.1186/1471-2458-13-798.
https://doi.org/10.1186/1471-2458-13-798... and perceived by the professors in the studied institution. Even though there is no consensus among the teachers about the causality of its symptoms, it has revealed the need to better understand the diversity of the students and its idiosyncrasies, through a teacher-student approach that allows moments of reflection, dialog and sharing.

Final considerations

The present study, even limited to the universe of a public medical school with a still traditional teaching model, allowed us to get an overview of the issues in the educational environment that gained relevance due to the emergence of the pandemic. The teachers’ perceptions already made clear the need for changes in the traditional medical education model, which the social isolation caused by Covid-19 showed to be unavoidable. The analysis of the teachers’ perceptions enabled us to identify initiatives to be strengthened in order to make changes. We verified that pedagogical practices more in line with the current imperatives have been gradually implemented in the daily routine of the disciplines of the institution studied, and, although isolated in their disciplinary territories, they produce effects of questioning an outdated model of teaching. Innovative discourses and practices need to be valued and shared in the academic community, and this work encourages research to uncover and promote the legitimacy of these practices.

Medical schools are now challenged to convene the largest possible number of teachers and students to build together an agenda for discussion about the impacts and changes that have occurred, evaluating the possible incorporation of innovations. It is necessary, however, that schools link to medical associations, establishing a network of cooperation and collaboration to discuss and strengthen initiatives.

Investing in empirical research and critical reflection of the practices in progress, opening the field to new subjects, creating spaces for dialoguing, can trigger changes and catalyze transformations in the discourses and educational practices for the education of physicians.

References

Publication Dates

History