Reflections and proposals for the establishment of Family and Community Medicine Master’s Programs in Brazil

Wenceslau, Leandro David; Sarti, Thiago Dias; Trindade, Thiago Gomes da

doi:10.1590/1413-81232020254.29802019

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ARTICLE • Ciênc. saúde coletiva 25 (4) • Mar 2020 • https://doi.org/10.1590/1413-81232020254.29802019 copy

Reflections and proposals for the establishment of Family and Community Medicine Master’s Programs in Brazil

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

While Primary Health Care (PHC) and Family and Community Medicine (FCM) have expanded their space and relevance in health care and undergraduate medical courses, Brazil has no stricto sensu FCM postgraduate programs. In this paper, we analyze some aspects of the Brazilian public health field and the national stricto sensu postgraduate system that can help to explain this scenario. As a contribution to the debate on this topic, we also gathered information from international postgraduate and research experiences in FCM and devised a curriculum proposal for future national FCM master’s courses. In the end, we discussed some key strategies for the emergence of stricto sensu postgraduate courses in this discipline in Brazil, highlighting the potential of these programs for evaluation and qualification of primary care services, especially the Family Health Strategy, and the training of PHC specialists required for the consolidation of the Unified Health System (SUS) as an accessible, comprehensive and equitable health system for the Brazilian population.

Key words
Family and community medicine; Postgraduate education; Research

Items compared	International Family and Community Medicine Master's programs
Final title issued	Master of Family Medicine and Primary Care	Master of Clinical Science in Family Medicine	Master of Science in Family Medicine	Master of Science in Family Medicine	Master of Family Medicine	Master of Science in Family Medicine
Educational Institution, city and country	Cayetano Heredia University, Lima, Peru	Western University, London, Canada	McGill University, Montreal, Canada	University of Nicosia, Nicosia, Cyprus	The University of Edinburgh, Edinburg, United Kingdom	L-Università ta' Malta, Msida, Malta
Duration	2 years	2 to 5 years	2 years	1 and a half years to 4 years	3 years	1 and a half years
Target Audience	PHC Professionals	Doctors	PHC Professionals	Doctors	Doctors	Health professionals
Manuscript required for master's degree	Thesis	Thesis, research project or essay	Thesis	Research project	Research project	Dissertation
Intermediate titles	Diploma	Not included	Not included	Diploma	Certificate and diploma	Not included
Number of compulsory/optional subjects	20/0	4/2	6 (subjects) / 8 (credits)	11/2	7/0	3/0
Most recurrent subjects
FCM theoretical bases	FCM Conceptual Bases	Theoretical Foundations of Family Medicine	-	-	Foundations of Family Medicine	-
Teaching-learning (TL) in FCM	TL methods and assessment for PHC	TL in Family Medicine	-	TL in health care (optional)	-	-
Clinical Communication and Patient-Centered Care	Communication and Clinical Interview	Advanced Patient-Centered Care	-	PHC Communication and Counseling	-	-
Research Methods	Research methods	FM research methods	6 methods courses^* * McGill University Master's course methods: Foundations of Participatory Research; Applied Literature Reviews; Foundations of Research in Mixed Methods; Foundations of Epidemiology in Family Medicine; Health data Basic Analysis; Qualitative Health Research.	Research methods	Research methods	Research methods bases

Research category	Possible research topics	Research methods
Primary health care management	- Comparison between primary health care models, including workforce organization and financing models - Development and analysis of cost-effectiveness and quality indicators - Visit time, service accessibility, collaborative care, referrals between family doctors and other specialists - The role and impact of electronic medical records - PHC management training for doctors	-Research to develop primary care evaluation instruments - Longitudinal epidemiological studies on family medicine. - Comparative studies of interventions with different primary care models. - Research using mixed methods.
Patient-centered care, comprehensive approach and holistic approach	-Improvement of the concepts and competencies that define centrality in the person, scope (integrality) and holistic approach - Development of indicators and instruments for assessing these competencies and their components - Understanding of social, cultural and environmental circumstances that can affect health, considering these aspects - Perceptions, perspectives, and preferences of patients and doctors about communication, person's centrality, relationship, and shared decision-making - Evaluation of person-centered approaches, comprehensive care models, holistic approaches using clinical outcomes and also satisfaction, understanding of patients and quality of life	- Qualitative research - Research to develop indicators and instruments for measuring these competencies - Prospective and retrospective longitudinal studies - Studies of interventions geared to caring for these characteristics - Research using mixed methods
Specific problem-solving skills	- Presentation and clinical development of diseases and conditions in the context of PHC, including a rational approach to symptoms, treatment efficacy, clinical decision-making and quality of care - Research on rare hereditary/genetic conditions in primary care - Medical education and continuing education aimed at solving health problems	- Longitudinal epidemiological studies in family medicine - Pragmatic studies of clinical interventions in PHC - Survey and analysis of approaches in primary care - Research using mixed methods
Community orientation	- Analysis of the effect of different models and interventions in primary care in responding to individual health needs in the local context and community health needs, as well as possible conflicts between these two.	- Survey-type research - Observational cohort studies. - Research using mixed methods.

Compulsory subjects	Syllabus principles
Theoretical Foundations of Family and Community	Epistemologia das ciências da saúde. Epistemologia de campos interdisciplinares, teoria dos sistemas e complexidade. História da MFC moderna. MFC como campo de conhecimento e disciplina acadêmica.
Introduction to Family and Community Medicine research: epistemic selections and research methods	Temas e métodos de pesquisa em MFC. Análise de pesquisas e publicações de alto impacto em MFC. Elaboração de um projeto de pesquisa em MFC. Ética em pesquisa.
Research on clinical communication and patient-centered care	Cuidados centrados no paciente: princípios e propostas de operacionalização. Comunicação clínica: teorias e técnicas. Métodos e instrumentos de pesquisa para avaliação da centralidade do paciente.
Research in teaching-learning in family and community medicine	Educação no ensino superior no Brasil. Métodos de ensino e avaliação na formação médica. Ensino da MFC no Brasil. Avaliação de métodos e experiências de ensino-aprendizagem.
Research methodologies in family and community medicine (organization in one or more subjects)	Pesquisa epidemiológica em cenários de atenção primária à saúde; pesquisa sobre intervenções diagnósticas e terapêuticas em medicina de família; pesquisa qualitativa em saúde; pesquisas com métodos mistos; avaliação de políticas e serviços em atenção primária à saúde.
Optional subjects	Syllabus principles
Family and community medicine special research topics	State-of-the-art in research according to thematic selections of the lines of research and works of supervisors of each program.

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E-mail: cienciasaudecoletiva@fiocruz.br

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[1] Collaborations

LD Wenceslau and TD Sarti also collaborated in the design and execution of the study, and in the writing of the initial version of the manuscript. TG Trindade carried out a critical review of the first version and contributed to the final version of the work.