Perception and manifestation of collaborative competencies among undergraduate health students*

Objective: to analyze the perception and manifestation of collaborative teamwork competencies among undergraduate health students who experienced the curricular internship’s integration module from the perspective of interprofessional education. Method: qualitative study, developed with the intervention research strategy. Twenty-eight students from five undergraduate health courses participated. Data were collected in three focus group interviews conducted with the undergraduate students at the end of each semester. For data analysis, the technique of intervention research and dialectical hermeneutics adopted was based on the theoretical framework of interprofessional education in health. Results: uniprofessional culture, the experience of integration of different fields of knowledge and collaborative competencies were manifested by the students in their reports and in the actions developed by the multidisciplinary team with individuals and families, during the experience of the curricular internship’s integration module. Conclusion: the experience of integration of the curricular internship from the perspective of interprofessionality favored the perception and manifestation of collaborative competencies that are necessary for teamwork among the students.


Introduction
The health education model in Brazil happens in a hegemonic, uniprofessional and disciplinary way, based on the regulations of professions related to market restraints, and focused on the pathophysiological conception of life (1)(2)(3) . This model is reproduced in the work process of these professionals, with isolated practices that do not favor teamwork, subjectifying individuals/patients and creating a hierarchy of actions in health, in growing disagreement with the complex needs of the increasingly interconnected contemporary world (3)(4)(5)(6) .
The competency-based training model emerges at the beginning of the twentieth century due to a demand from the labor market (10)(11) , in an attempt to qualify professionals to solve unexpected problems, promoting learning competencies and mobilizing knowledge, attitudes and expanded and plastic skills that are able to address the numerous and different needs of society (11) . Moreover, the development of competencies is associated with meaningful learning, whereby individuals build emotional memories experienced in their learning process (10) , which requires revising the teaching-learning process focused on the student and on practical applications of knowledge (3,(10)(11)(12)(13) .
IPE is conceptualized as integrated and interactive learning between two or more health professions, allowing a greater understanding of the specific roles of each professional and enhancing the development of collaborative teamwork competencies (14)(15)
IR uses specific concepts to understand the social reality studied, deconstructing the practices and discourses established, in a process of mobilization and * Interprofessional Education Collaborative (19) -This document may be reproduced, distributed, publicly displayed and modified provided that attribution is clearly stated on any resulting work and it is used for non-commercial, scientific or educational -including professional development -purposes. If the work has been modified in any way all logos must be removed transformation of reality (26)(27) . This IR was developed in two sequential moments, as described in Figure 2.
The IR's development in two moments aimed to mobilize the different actors (professors, health professionals, students), encouraging them to reflect upon and discuss the model of professional training in health to build a collective instructional proposal, integrating teaching and service, so that its implementation in the course's curricula and in the practice of the services would not happen in a vertical and decontextualized manner (3,9) .   holders (12) and volunteers (16) . As inclusion criterion, the  and Biological Sciences (BSS), followed by numbers indicating the sequence of insertion in the study.

Results
The socio-demographic profile of the students revealed that 93% lived in municipalities of Pernambuco.

Discussion
The uniprofessional model is naturalized in the training and work process of health professionals. The initial apprehension experienced by the students is characteristic of this model of disciplinary training, in which specific competencies are highly valued (1,3,6,(12)(13) , The ideal time for interprofessional experience is not a consensus. Some authors recommend it takes place at the beginning of the course, in order to reduce prejudiced stereotypes (3,12,(14)(15) ; other authors recommend it takes place at the end, given that by then the specific competencies of each course have already been consolidated, enabling greater interaction between the students from different areas, who better understand their own professional role and that of others (31) . However, it is understood that the experience of interprofessional education should be offered according to the possibilities of effective integration between students, considering the characteristics of each institution (3,(12)(13)(14)(15) . In this research, the moment of the curricular internship was perceived as viable and effective for the integration between the different courses, due to the HEI's infrastructure.
Developing altruistic attitudes is related to the sense of implication, of putting oneself in another's place (35) . The proposal of centering care on the family's reality stimulated the shift of focus from specialized care to extended care, as predicted by the researchers (18)(19) . In the reports presented, the students perceive the patients' needs beyond their specific competency, developing an understanding of the social role that health professionals should assume, as highlighted by the CICH and IPEC panels (18)(19) .
Values and ethics as competency for collaborative interprofessional practice also becomes evident when focusing care according to IPEC's core principles (19) .
The recognition of the roles and responsibilities involved in collaborative practice was evidenced in several reports of the students of this research. The development of respect for the other professionals in training through the experience of learning together favors the elimination of stereotypes (16,(32)(33)(34)(36)(37)(38) . In the students' reports, the perception of their own professional role and that of the others was present, corroborating the proposal of IPE (14)(15) and the studies that have shown the development of this competency in the interrelationships between professionals from different areas (12)(13)(14)(15)(16)(17)(18)(19)(29)(30)(31)(32)(33)(34)(36)(37)(38) . Interprofessional communication is essential for collaboration, and is present in professional-professional and professional-patient/family interactions, being necessary to develop effective and understandable exchanges in different fields of action, and also to resolve conflicts, promoting harmony in the team (40)(41)(42) .

Not
Knowing how to speak, how to listen and how to respect differences was an attitude experienced by the students during the curricular internship's integration module. exchanges with patients and their families, corroborating studies that highlight this importance (41)(42) .
The interprofessional teamwork competencywhich relates to team dynamics and functioning, aggregating the other competencies and interrelating them -is developed according to the literature, during training and in the continuous practice of interprofessional collaboration, in a progressive process of apprehension and sharing of common goals (3,(14)(15)(18)(19)(43)(44) .
The teamwork dynamics was experienced and built in the visits to the patients, and it was noted, in the students' reports, that learning to work together was a process that was mutually developed by all the teams in collaborative actions, in the different scenarios and families. These experiences promoted the students' learning and integration, with IPE having also been observed outside the intervention scenarios, allowing the continuous sharing of ideas through social networks, similarly to other studies (3,15) .
The students' collaborative action was developed by combining different knowledge and practices for the construction of the integrated care plan, with the sharing of common and specific competencies and manifestation of collaborative competencies in a procedural and continuous way. It was noted that the team acquired better resourcefulness over the period of the experience, and also that the nursing student frequently assumes a leadership role, which is recognized and allowed by his/her colleagues. This research, using IR as significant methodological strategy for the implication and involvement of different social actors, has also corroborated the viability of the institutional proposal of IPE in pedagogical projects, for insertion of the integration module in the curricular matrix of each undergraduate health course in the reality studied.