“Você precisa criar vínculos com quem você treina”
Misturando culturas epistêmicas no treinamento de residência médica
DOI:
https://doi.org/10.48006/2358-0097/V9N1.E9109Palavras-chave:
educação médica, cultura epistêmica, profissionalismo, padronizaçãoResumo
Este artigo aborda a reforma contemporânea da educação médica de pós-graduação que visa padronizar o treinamento. As reformas são orientadas por intervenções de políticas públicas para aumentar a qualidade do atendimento, objetivar o desempenho e preparar os residentes para as mudanças nas necessidades de assistência médica. Este artigo se baseia em estudos etnográficos feitos nos Países Baixos, estudando como novos padrões de treinamento foram incorporados ao treinamento diário de residência em ginecologia e cirurgia. Percebendo a ciência da Educação como uma nova cultura epistêmica ao lado da cultura epistêmica tradicional, baseada na autoridade profissional, o artigo examina como ambas as culturas epistêmicas se entrelaçaram, fabricando uma nova cultura de treinamento que reúne tanto elementos tradicionais quanto “novos”.
Referências
BECKER, HS; BLANCHE, G; HUGHES, EC; STRAUSS, AL. 1961. Boys in white: Student culture in medical school, New Brunswick and London: Transaction Publishers .
BOSK, CL. 2003 [1979]. Forgive and remember: Managing medical failure, Chicago, IL: University of Chicago Press. DOI: https://doi.org/10.7208/chicago/9780226924687.001.0001
BOSK, CL. 1992. All God’s mistakes: Genetic counseling in a pediatric hospital, Chicago: University of Chicago Press.
BUSCHER, M; GOODWIN, D; MESMAN, J. 2010. Ethnographies of diagnostic work, Basingstoke: Palgrave Macmillan. DOI: https://doi.org/10.1057/9780230296930
COMMISSIE LEGRAND. 2003. De zorg van morgen: flexibiliteit en samenhang (Tomorrow’s care: flexibility and cohesion), Den Haag.
COMMISSIE MEYBOOM. 2002. De arts van straks: een nieuw medisch opleidingscontinüum (Tomorrow’s doctors: a new medical education continuum), Utrecht: KNMG.
FITZGIBBONS, JP; BORDLEY, DR; BERKOWITZ, LR; MILLER, BW; HENDERSON, MC. 2006. “Redesigning residency education in internal medicine: A position paper from the association of program directors in internal medicine”. Annals of Internal Medicine 144, p.920–926. DOI: https://doi.org/10.7326/0003-4819-144-12-200606200-00010
FOX, R. 1957. “Training for uncertainty”. In: MERTON, RK; READER, GG; KENDELL, PL (eds) The student-physician: Introductory studies in the sociology of medical education, Cambridge, MA: Harvard University Press.
FRANK, JR; DANOFF, D. 2007. “The CanMEDS initiative: Implementing an outcomesbased framework of physician competencies”. Medical Teacher 29(7), p.642–644. DOI: https://doi.org/10.1080/01421590701746983
HAFFERTY, FW. 2000. “Reconfiguring the sociology of medical education: Emerging topics and pressing issues”. In: BIRD, CE; CONRAD, P; FREMONT, AM (eds) Handbook of medical sociology, New Jersey: Prentice Hall.
HAM, C; ALBERTI, K. 2002. “The medical profession, the public, and the government”. BMJ 324(7341), p.838–842. DOI: https://doi.org/10.1136/bmj.324.7341.838
KELLOGG, KC. 2009. “Operating room: Relational spaces and microinstitutional change in surgery”. American Journal of Sociology 115(3), p.657–711. DOI: https://doi.org/10.1086/603535
KNORR CETINA, K. 1999. Epistemic cultures: How the sciences make knowledge, Cambridge, MA: Harvard University Press. DOI: https://doi.org/10.4159/9780674039681
KNORR CETINA, K. 2001. “Objectual practice”. In: SCHATZKI, TR; KNORR CETINA, K; VON SAVIGNY, E (eds) The practice turn in contemporary theory, London and New York: Routledge.
LAVE, J; WENGER, E. 1991. Situated learning: Legitimate peripheral participation, Cambridge: Cambridge University Press. DOI: https://doi.org/10.1017/CBO9780511815355
LEVAY, C; WAKS, C. 2009. “Professions and the pursuit of transparency in health care: Two cases of soft autonomy”. Organization Studies 30(5), p.509–27. DOI: https://doi.org/10.1177/0170840609104396
LUDMERER, KM; JOHNS, MM. 2005. “Reforming graduate medical education”. JAMA 294(9), p. 1083–1087. DOI: https://doi.org/10.1001/jama.294.9.1083
LURIE, SJ; MOONEY, CJ; LYNESS, JM. 2009. “Measurement of the general competencies of the accreditation council for graduate medical education: A systematic review”. Academic Medicine 84(3), p.301–309. DOI: https://doi.org/10.1097/ACM.0b013e3181971f08
MOREIRA, T. 2005. “Diversity in clinical guidelines: The role of repertoires of evaluation”. Social Science & Medicine 6(9), p.1975–1985. DOI: https://doi.org/10.1016/j.socscimed.2004.08.062
MOREIRA, T. 2012. “Health care standards and the politics of singularities: Shifting in and out of context”. Science Technology & Human Values 37(4), p.301–331. DOI: https://doi.org/10.1177/0162243911414921
NETTLETON, S; BURROWS, R; WATT, I. 2008. “Regulating medical bodies? The consequences of the ‘modernisation’ of the NHS and the disembodiment of clinical knowledge”. Sociology of Health & Illness, 30(3), p.333–348 . DOI: https://doi.org/10.1111/j.1467-9566.2007.01057.x
ORWELL, G. 1949. Nineteen eighty-four. London: Secker and Warburg.
POWER, M. 1997. The audit society: Rituals of verification. Oxford: Oxford University Press.
PRENTICE, R. 2007. “Drilling surgeons: The social lessons of embodied surgical learning”. Science Technology & Human Values 32, p. 534–53. DOI: https://doi.org/10.1177/0895904805303201
RIGSTED, C; HANSEN, TL; DAVIS, D; SCHERPBIER, A. 2006. “Are some of the challenging aspects of the CanMEDS roles valid outside Canada?”. Medical Education 40(8), p. 807–15. DOI: https://doi.org/10.1111/j.1365-2929.2006.02525.x
SANDERS, T; HARRISON, S. 2008. “Professional legitimacy claims in the multidisciplinary workplace: The case of heart failure care”. Sociology of Health & Illness 30(2), p.289–308. DOI: https://doi.org/10.1111/j.1467-9566.2007.01052.x
SCHEELE, F; TEUNISSEN, P; VAN LUIJK, S; HEINEMAN, E; FLUIT, L; MULDER, H; MEININGER, A; WIJNEN-MEIJER, M; GLAS, M; SLUITER, H; HUMMEL, T. 2008. “Introducing competency based postgraduate medical education in the Netherlands”. Medical Teacher 30(3), p. 248–53. DOI: https://doi.org/10.1080/01421590801993022
SHEM, S. 1995 (1978). The house of God, New York: Dell.
SINCLAIR, S. 1997. Making doctors: An institutional apprenticeship, Oxford and New York: Berg.
SMITH, A; GOODWIN, D; MORT, M; POPE, C. 2003. “Expertise in practice: An ethnographic study exploring acquisition and use of knowledge in anaesthesia”. British Journal of Anaesthesia 91, p. 319–28. DOI: https://doi.org/10.1093/bja/aeg180
STRAUSS, A. 1987. Qualitative analysis for social scientists, Cambridge: Cambridge University Press. DOI: https://doi.org/10.1017/CBO9780511557842
SZYMCZAK, JE; BROOK, JV; VOLOPP, KG; BOSK, CL. 2010. “To leave or lie? Are concerns about a shift-work mentality and eroding professionalism as a result of duty-hour rules justified?” Milbank Quarterly 88, p. 350–81. DOI: https://doi.org/10.1111/j.1468-0009.2010.00603.x
TEN CATE, O; SCHEELE, F. 2007. “Competency-based postgraduate training: Can we bridge the gap between theory and clinical practice?”. Academic Medicine 82(6), p.542–547. DOI: https://doi.org/10.1097/ACM.0b013e31805559c7
THÉVENOT, L; BOLTANSKI, L. 2000. “The reality of moral expectations: A sociology of situated judgment”. Philosophical Explorations 3(3), p.208–231. DOI: https://doi.org/10.1080/13869790008523332
TIMMERMANS, S; BERG, M. 1997. “Standardization in action: Achieving local universality through medical protocols”. Social Studies of Science 27, p. 273–305. DOI: https://doi.org/10.1177/030631297027002003
TIMMERMANS, S; BERG, M. 2003. The gold standard: The challenge of evidence-based medicine and standardization in health care, Philadelphia, PA: Temple University Press.
TIMMERMANS, S; CHAWLA, N. 2009. “Evidence-based medicine and medical education”. In: Brosnan, C, Turner, BS (eds) Handbook of the sociology of medical education, London and New York: Routledge.
VAN LOON, E; ZUIDERENT-JERAK, B. 2014. “Diagnostic work through evidence based guidelines: Avoiding gaps between development and implementation of a guideline for problem behavior in elderly care”. Science as Culture 23(2), p. 153–76. DOI: https://doi.org/10.1080/09505431.2013.809411
WALLENBURG, I. 2012. The modern doctor: Unraveling the practices of medical training reform, PhD thesis, VU University Amsterdam.
WALLENBURG, I; DE BONT, A; HEINEMAN, MJ; SHEELE, F; MEURS, P. 2013. “Learning to doctor tinkering with visibility in residency training”. Sociology of Health & Illness 35(4), p. 44–59. DOI: https://doi.org/10.1111/j.1467-9566.2012.01512.x
WALLENBURG, I; POLS, J.; DE BONT, A. 2015. ‘‘You need to bond with the ones you train’: mixing epistemic cultures in medical residency training”. Evidence & Policy, v. 11, n. 3, p. 397-414. DOI: https://doi.org/10.1332/174426415X14381764831055
WALLENBURG, I; VAN EXEL, J; STOLK, E; SCHEELE, F; DE BONT, A; MEURS, P. 2010. “Between trust and accountability: Different perspectives on the modernization of postgraduate medical training in the Netherlands”. Academic Medicine 85(6), p.1082–1090. DOI: https://doi.org/10.1097/ACM.0b013e3181dc1f0f
ZUIDERENT-JERAK, T. 2007. “Preventing implementation: Exploring intervention with standardization in healthcare”. Science as Culture 16, p. 311–29. DOI: https://doi.org/10.1080/09505430701568719
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