Non-mandatory internship in occupational therapy: reality of students at a public university

Abstract

Introduction  The professional internship is the first contact that occupational therapy students have with the job market. It is related to higher education as it allows for deepening in different areas of practice, emphasizing practical experience. It is an opportunity to experience occupational therapy practice and acquire the skills and competencies specific to professional action.

Objective  To investigate how the relationship between professional practice and the learning process of occupational therapy students in non-mandatory internships has developed, as well as their hiring conditions.

Method  A qualitative study, of a descriptive-exploratory nature, that conducted semi-structured interviews with eight occupational therapy students from a public university in the Central-West region of Brazil. Data analysis was based on content analysis.

Results  The participants identified as female and were aged between 18 and 24 when they started their non-mandatory internship, with five of them attending up to the fifth semester of the program. For most of them, the motivation for seeking a non-mandatory internship was the desire to gain more practical experience. However, the reports reveal a process of job precarization and the transformation of the internship into a form of underemployment. The interns find themselves without support and vulnerable to situations of abuse, role distortion, and overload.

Conclusion  The reality is perceived as incompatible with the primary educational and formative objective, pointing to the urgency of a more careful approach to these activities.

Keyword:
Higher Education; Teaching; Professional Training; Students; Work

Resumo

Introdução  O estágio profissionalizante é o primeiro contato de estudantes de terapia ocupacional com o mercado de trabalho. Está relacionado com a formação no ensino superior pela possibilidade do aprofundamento em diferentes campos de atuação, dando ênfase à experiência prática. É a oportunidade de vivenciar a prática em terapia ocupacional e adquirir competências e habilidades próprias da ação profissional.

Objetivo  Investigar como tem se dado a relação entre a prática profissional e o processo de aprendizagem de estudantes de terapia ocupacional em estágio não obrigatório, bem como suas condições de contratação.

Método  Estudo de abordagem qualitativa, do tipo descritivo-exploratório, que aplicou entrevistas semiestruturadas com oito estudantes de terapia ocupacional de uma universidade pública da região Centro-Oeste do Brasil. A análise dos dados teve como referência a análise de conteúdo.

Resultados  As participantes se identificaram pelo sexo feminino, tinham idades entre 18 e 24 anos quando ingressaram no estágio não obrigatório, e cinco delas estavam cursando até o quinto semestre. Para a maioria delas, a motivação para a busca pelo estágio não obrigatório foi o desejo de ter mais experiência prática, entretanto, os relatos revelam um processo de precarização do trabalho e transformação do estágio em subemprego, as estagiárias encontram-se sem amparo e vulneráveis a situações de abusos, desvio de função e sobrecarga.

Conclusão  A realidade é percebida como incompatível com o objetivo prioritário educativo e formativo, apontando para a urgência de um olhar mais cuidadoso para estas atividades.

Palavras-chave:
Ensino Superior; Atividades de Formação; Formação Profissional; Estudante; Trabalho

Introduction

The professional training in occupational therapy was established in Brazil in 1965 through Curso Técnico em Reabilitação, at Escola de Reabilitação of Rio Janeiro (EERJ) and in 1958 by Instituto Nacional de Reabilitação, affiliated to Hospital das Clínicas of the Universidade de São Paulo. This was driven by the international rehabilitation movement developed by the United Nations (UN), the International Labour Organization (ILO), the World Health Organization (WHO), and the United Nations Educational, Scientific and Cultural Organization (UNESCO) (Reis & Lopes, 2018), initiating the expansion of the market and the formation of new professions in emerging countries (Lopes, 1991). The regulation of the field as a profession, alongside Physiotherapy, occurred through the Decree-Law of October 13^th, 1969 (Brasil, 1969), which regulated the interventions of these professions and laid the foundation for the organization of the Federal Council of Physiotherapy and Occupational Therapy (COFFITO) in 1975. This council operates as a federal public agency responsible for standardizing and overseeing the professional practice of physiotherapists and occupational therapists.

Currently, according to data from the Ministry of Education, e-MEC System, there are seventy-four (74) authorized face-to-face undergraduate occupational therapy courses in Brazil and sixteen (16) in the distance learning modality (Brasil, 2024). The course structures are organized by the National Curriculum Guidelines for the Undergraduate Course in Occupational Therapy (DCNs) (Brasil, 2002), and the workload, currently a minimum of 3,200 hours, is regulated by Resolution No. 06 of April 2009 from the National Council of Education and the Higher Education Chamber (CNE/CES) (Brasil, 2009).

The DCNs establish a professional profile for graduates with a generalist, humanist, critical, and reflective training, based on the historical, philosophical, and methodological foundations of occupational therapy and its different intervention models, grounded in scientific and intellectual rigor (Brasil, 2002). The contents are organized in a theoretical-practical way and are crucial for the training of occupational therapists. Together with extension activities and curricular internships, they indicate a qualified understanding of the profession (Bertossi et al., 2023). These activities align with the recommendation of the World Federation of Occupational Therapists for 1,000 hours of supervised practice for training (World Federation of Occupational Therapists, 2016).

Specifically regarding professional internships, the DCNs establish in Article 7 the minimum workload of 20% of the total course hours for curricular internships (Brasil, 2002). According to Resolution No. 452 of 2015, these activities are characterized as the insertion of students into the job market:

[…] a supervised educational act, developed in various practice settings, in the context of the teaching-service articulation, in the work environment, aiming at training for the productive work of students attending regular higher education institutions (IES)... aiming at learning, acquisition of competencies and skills specific to the professional activity, and the student's development for work and citizenship (Brasil, 2015).

Professional internships are divided into mandatory and non-mandatory types. The mandatory internship is part of the curriculum and is foreseen in the course's political-pedagogical project, whose completion is a requirement for approval and obtaining the diploma. On the other hand, the non-mandatory internship is an optional activity that complements the regular and mandatory training hours (Brasil, 2008).

Regarding the non-mandatory internship in occupational therapy, the focus of this study, COFFITO specifies the requirements for students wishing to participate in this modality. These include: being enrolled from the sixth semester or third year of the course and completing up to 30 hours per week; receiving direct supervision by the occupational therapist from the granting unit; receiving supervision by the occupational therapist educator from the educational institution, with both responsible for the internship in coordination with the Regional Council of Physiotherapy and Occupational Therapy (Crefito) in their location (Brasil, 2015).

In accordance with the legislation established by Law No. 11,788 of September 2008, carrying out a non-mandatory internship involves the signing of a commitment agreement between the student, the granting entity, and the educational institution (Brasil, 2008). According to the regulations of the university referenced in this research, in addition to the Internship Commitment Agreement, the student must receive a scholarship or another form of compensation for services as agreed with the company; receive transportation assistance; have personal accident insurance; have a 30-day break; and renew the contract up to two years. The workday cannot exceed six (6) hours per day and 30 (thirty) hours per week (Universidade de Brasília, 2022).

It is important to highlight that the practice of non-mandatory internships has legal backing and can be a beneficial activity for student training, as it involves tasks related to their academic formation and may also provide a remuneration. However, considering contexts such as the training environment during the COVID-19 pandemic and the social vulnerability conditions faced by occupational therapy students (Borba et al., 2020), this activity became a reliable source of income for these students and, in some cases, even the main and sole source of personal income – or even for their families.

In this sense, and expanding the discussion to the post-pandemic context, non-mandatory internships have become, in recent years, a resource for students to maintain financial stability during their time at university, as the assistance provided by Higher Education Institutions (HEI) and scholarships for scientific initiation and extension, for example, do not meet the needs of students or do not serve all those who require them.

The search for other activities that can generate income ends up taking precedence over the basic demands of the course, such as studies, extension and research activities, practical activities, and responsibilities related to the semester's courses (Maia et al., 2020), which contributes to the overload of students, impacting their academic routine (attendance in classes, discipline in studies, and academic performance), but also affects personal matters, such as healthy and regular eating, self-care, good sleep quality, among other aspects. The remunerated non-mandatory internship, in light of these factors, provides students with the experience of entering the professional field and all the contradictions that exist within the education-work relationship, particularly regarding the precariousness arising from austerity policies imposed over the last decades.

National studies on internships, both mandatory and non-mandatory, reveal the predominance of a market-oriented perspective and labor precariousness, visible in the replacement and implementation of low-cost labor, at the expense of the pedagogical training of internships with a curricular nature, i.e., the commitment to practical learning connected to theoretical propositions, which in many cases happens without the guidance of supervisors, through a fragile and often nonexistent legal bond with the institutions and owners of the granting entity (Linhares et al., 2021; Reis, 2012), characterizing a relationship based on precariousness in the dynamics of salaried labor.

In the context of occupational therapy, the shortage of professionals capable of providing assistance to populations in need of occupational therapy interventions pressures occupational therapists towards “productivity, problem-solving, and effectiveness of the practices undertaken” (Mângia & Almeida, 2003, p. 1). Coupled with precariousness and the fragility of labor rights assured to interns, the precarization of labor and the exploitation of the workforce intensifies, causing the pedagogical formation to become secondary. For Valeriano (2009, p. 3), “[…] the central issue of the precariousness of the intern's work is the evasive legislation that defines its nature”, meaning that interns are subjected to all the duties of a hired professional but do not share in their labor rights.

Thus, this research aimed to investigate the relationship between professional practice and the learning process of occupational therapy students in non-mandatory internships, as well as their employment and working conditions.

Method

This study was approved by the Research Ethics Committee of the Faculty of Ceilândia, under opinion number 114290/2023 and CAAE: 74646923.0.0000.8093, and complied with all ethical aspects involving research with human beings, as per Resolution No. 466 of December 12, 2012, from the National Health Council.

This research is based on a qualitative, descriptive-exploratory approach. Creswell (2010) states that qualitative research uses investigative strategies such as narratives, phenomenologies, ethnographies, theory-based studies, or theory-driven studies grounded in reality. According to Gil (2017), descriptive studies aim to analyze the characteristics of the population (age, gender, origin, education level, physical and mental health status, etc.) or phenomenon, as well as the establishment of relationships between variables. When combined with exploratory research, the descriptive type provides greater familiarity with the problem and aims to improve ideas and lead to new discoveries.

The study was conducted at Faculdade de Ceilândia (FCE), Universidade de Brasília (UnB). The Ceilândia campus was inaugurated in 2008 as part of the support program for the Restructuring and Expansion Plans of Federal Universities (Reuni), as a result of social movements from the local community advocating for access to free university education and the challenge of expanding and establishing health-related courses, including nursing, pharmacy, physiotherapy, speech therapy, public health, and occupational therapy (Universidade de Brasília, 2024), being the only course offered by a public Higher Education Institution (HEI) in the Central-West region. The FCE/UnB course has a workload of 3,510 hours and is offered in person, during the day (full-time), with a maximum duration of 8 to 12 semesters (Universidade de Brasília, 2023).

Participants were recruited by convenience, characterized by the recruitment of accessible individuals who met the inclusion criteria outlined in the research project. Turato (2013) asserts that this selection method helps the researcher understand the research question, with participants providing valuable data that are rich in meaning regarding the researcher's object of study.

Data collection took place in December 2023 with eight (8) students from the occupational therapy course, i.e., students who were enrolled during the research year and had experienced or were experiencing the non-mandatory internship experience. Students engaged in home-based activities and those who had withdrawn from the course during the research period were excluded from the study.

For participant recruitment, information was requested from the internship committee of the occupational therapy course at FCE regarding which students had been participating in non-mandatory internships until the time of data collection, with active enrollment in the Integrated System of Academic Activities Management (Sigaa) and having signed the Non-Mandatory Internship Commitment Term, as per the terms of Law 11788/2008. Fourteen (14) eligible students were identified for participation in the research. Of these, eight (8) were interviewed, comprising the final sample based on saturation, which occurs when new participants are no longer needed due to data repetition, marking the saturation point of the sample. This was also influenced by the theoretical framework used and the homogeneity of the study population (Fontanella et al., 2008).

The research instrument used was the semi-structured interview technique, which encourages participants' opinions and promotes interaction to capture the viewpoints, beliefs, and representations of the research subjects in relation to the object of analysis (Flick, 2004). A script was used to guide the interviews, developed by the researchers based on national literature on the subject, covering sociodemographic data, participants' perceptions of non-mandatory internships, the influence of this internship activity on students' daily lives, as well as the process of hiring and labor relations in the internship environment.

For data collection, the research was promoted through social media platforms and virtual groups, considering the ones most accessed or used by students, aiming to reach the largest number of students who had experienced non-mandatory internships. The researcher contacted students who expressed interest in participating in the study and were selected based on the inclusion and exclusion criteria.

Interviews were scheduled on days and times according to the availability of participants who voluntarily agreed to take part in the research. A location on the university campus was reserved for the individual, one-time meetings, with an average duration of 30 minutes. It is important to note that before the interview began, the research and its objectives were explained, and any doubts were clarified to ensure the students' continued interest in participating after gaining more knowledge about the study. All participants who agreed to take part in the study signed the Informed Consent Term. Finally, the interviews were audio-recorded and later transcribed to obtain the data in its entirety, preserving its originality as much as possible, considering the differences in recording. The data from the research, including the interview transcriptions, were kept under the responsibility of the principal investigator.

The data analysis was based on Bardin's content analysis, which emphasizes, through systematic and objective procedures, breaking down the text into units, into indicators formed from the investigation of the main themes emerging from the discourse, allowing the inference of information and knowledge. The content analysis technique proposed by Bardin (2011) is structured in three phases: 1) pre-analysis; 2) material exploration, categorization, or coding; and 3) treatment of results, inferences, and interpretation. The content analysis technique allows for exploring and interpreting the contents of the speech and its meanings through a systematic and objective analysis, enabling categorical classification (Bardin, 2011).

Results and Discussion

The study included the participation of eight (8) students, who self-identified as female, aged between 18 and 24 years old, most of whom were single (n=6), without children (n=7), who self-identified as white (n=5), with a family income of up to two minimum wages¹ (n=5) and who lived, at the time, with their parents and/or relatives (n=6).

The majority of participants (n=5) reported that when they entered the non-mandatory internship they were studying up to the fifth semester, and, for most of them, the motivation for seeking the non-mandatory internship was the desire to have more practical experience. The profile data of these students are described in Table 1, below:

Table 1
Profile of research participants.

Participant	Sex	Course semester	Reason for seeking internship	Working hours	Income (R$)	Audience served
P1	Female	Sixth	Finance and experience	16h	520,00	Children with autism spectrum disorder
P2	Female	Third	Finance	12h	600,00 – 1.000,00	Children
P3	Female	Fourth	Experience	28h	1.100,00	Children with autism spectrum disorder
P4	Female	Sixth	Finance and experience	23h	1.100,00	From baby to adult, motor, sensory and cognitive aspects
P5	Female	Fifth	Experience	16h	600,00	Autism spectrum disorder
P6	Female	Fourth	Finance	16h	890,00	Children with autism spectrum disorder
P7	Female	Quinto	Experience	20h	1.088,00	Children with autism spectrum disorder
P8	Female	Seventh	Experience	12h	690,00	Children with high abilities, children with autism spectrum disorder

• Source: Research data.

It is noteworthy that one student was in the seventh semester (4^th year), and two were in the sixth semester (3^rd year), all three eligible to undertake this type of internship according to current regulations (Brasil, 2015). Two students were in the fifth semester (3^rd year), two were in the fourth semester, and one was in the third semester (2^nd year), with more than half of the research participants having undertaken their internships irregularly. According to Resolution No. 452 of the Federal Council of Physiotherapy and Occupational Therapy - Conselho Federal de Fisioterapia e Terapia Ocupacional (Brasil, 2015), although it lacks updated and more robust definitions, non-mandatory internships can only be undertaken by students who are in at least the sixth semester of the course or the third year of the undergraduate program, while respecting the 30-hour weekly workload. This already points to the precariousness of this practice, where informality in hiring and supervised guidance required as part of the educational action involving practical experiences in internships, are not fully realized.

A key point regarding the motivation for undertaking the internship is that most students cited gaining experience, while some also mentioned financial reasons. This finding is in line with the study by Lima et al. (2021), which revealed that interns seek financial support through non-mandatory internships to maintain their enrollment in higher education. This reflects the reality of some university students who need to balance work and study to support themselves and their families, with non-mandatory internships seen as a way to meet financial demands.

According to Freitas et al. (2020), in full-time courses that require all-day academic activities, non-mandatory internships provide a legal means of generating income while allowing students to perform functions related to their training, through flexible hours when possible. However, this practice may prioritize income over educational functions, as occurred during the pandemic, when increased unemployment in many families led students to intensify their search for paid activities, including internships.

Another point to highlight is that the population served by the participants in this study mostly consists of children with neurodevelopmental disorders, in private practices. This suggests that this may be one of the main groups served by occupational therapists in the region studied. The services provided by these interns are exclusively in private clinics, focusing on areas such as early stimulation, development and learning, integrated rehabilitation, multidisciplinary rehabilitation, and care for children with autism. It is worth noting that the functions performed by the interns included: monitoring and/or assisting in occupational therapy treatments for children with autism, Down syndrome, Attention Deficit Hyperactivity Disorder (ADHD), and other syndromes; supervised care performing desensitization activities (tactile, olfactory, gustatory), food selectivity, body awareness, fine motor skills, daily living skills training, early stimulation, patient guidance; creating therapeutic resources; preparing the environment and materials, recording data, and tracking progress in patient records; and weekly supervision with an occupational therapist.

In this context, the analysis of data from the students' narratives revealed four categories: a) The significance of non-mandatory internships in the daily and academic activities experienced by occupational therapy interns; b) Contractual relationships and the precariousness of labor ties by companies and universities; c) Intern or professional? Working conditions and the role played by the intern; and d) Teaching and learning for interns during non-mandatory internships.

Significance of non-mandatory internships in the daily and academic activities experienced by occupational therapy interns

Occupational therapy students in internships have the opportunity to link theory and practice, teaching and learning, and develop new roles by applying what they have learned in theory to practical situations. However, the demands placed on these students often overwhelm them to the point of compromising their daily and academic activities, as the internship requires them to confront multiple and complex tasks (Zbuinovicz & Mariotti, 2021).

These interactions are generally situated at two levels: institutional and individual. At the institutional level, the daily life of an intern is shaped by academic activities such as attending classes, taking exams and assignments, participating in extension projects, tutoring, and research, facing new learning challenges, and maintaining social relationships with peers and professors. At the individual level, basic self-care activities, such as hygiene, bathing, eating, cleaning the house, and doing laundry, as well as leisure, sleep, and rest, are also involved (Taylor, 2017).

It is noticeable that as the course progresses, the responsibilities and demands inherent to the educational process increase, with the internship being one of the most significant activities in the professional formation of these students (Thew et al., 2023; Silva & Teixeira, 2013). In the following accounts, the students express how they understand their daily activities and academic performance after beginning their non-mandatory internships:

I can't even be bothered to take a shower. I get so tired that I get in the shower and think, “Oh my God, I still have to wash my hair? I have to choose between eating and sleeping...” (Participant 2).

Yes, we get very overwhelmed, especially since I have to take care of the house. So, when I get home, I still have to do things around the house and I'm already exhausted, and then I get stressed because I had to maintain my posture all day, so when I get home, I'm bursting with stress. So it's hard to balance things. You end up leaving other things, you know... some demands, right? [...] you end up not being able to rest, because on the day you have to rest, you have to do what you couldn't do during the week (Participant 6).

The non-mandatory internship is developed as an optional activity, added to the regular and mandatory workload (Brasil, 2008), and it may not be well-managed, becoming a factor of overload due to its complementary nature. As a result, the student ends up dealing with both mandatory academic requirements and simultaneous non-mandatory tasks. Additionally, it is emphasized that the participants were enrolled in a full-time program, requiring greater organization on the part of the students to balance their personal, academic, and professional demands.

Considering this context, such overload can be a risk factor for the suffering of occupational therapy students. From Hirsch et al.’s (2018) perspective, the lack of time to be with family, rest, or engage in leisure activities leads to stress overload and consequently to physical and emotional exhaustion.

Thus, the organization of the student's routine is a point that needs to be problematized, as changes in it can affect both academic performance and health and well-being. It is possible to notice the overload that the interns experienced in their daily lives, as highlighted in the following statements:

So, I wasn't very organized [...]. But I think we always focus more on the internship than on college, at least that was the case for me. It was one of the reasons I wanted to stop the internship, because I realized I was kind of leaving college aside (Participant 5, our emphasis).

I wasn't very organized. I think that was one of the things that made me practically explode at some point, because I did whatever I could on the day. So, sometimes, the demands of the non-mandatory internship ended up filling more than necessary, like, more than I could handle. It was always a bit unbalanced (Participant 4, our emphasis).

At times, the overload experienced by the interns had repercussions on aspects of their mental health, evidenced by symptoms of psychological distress, such as anxiety, depression, among others. One of the participants reported the effects on her health:

There was a time when I was doing 20 hours of non-mandatory [internship], plus the [mandatory] internship, and it was until the next semester, when I had a very heavy schedule. At the clinic, very severe patients [arrived], one after the other, aggressive, anyway, I felt like crying, like I couldn't stop, couldn't breathe, like, I would get home and cry every day (Participant 6).

I definitely feel anxious. That's the main thing, it's a lot of anxiety, and overload... I had anxiety attacks twice, no, three times, last month, and I hadn't had anxiety attacks for a year (Participant 3).

[...] a little bit of anxiety, because we're in an environment where people don't even talk to each other, they don't talk, where you don't know if you're being honest, you're working there, pretending to be a trained person (Participant 7, emphasis added).

According to Rudnicki & Carlotto (2007), the internship scenarios and contact with patients tend to increase anxiety due to the demands of this period, which require interns to adopt a professional posture and integrate what was learned in theory with practice. Furthermore, the reports reveal the need for closer support for the intern regarding the monitoring of their activities.

The last report addresses the lack of supervision, which, in addition to being an essential element to ensure good professional practice for those in training, is especially mandatory according to Article 2 of Resolution No. 452, of February 26, 2015, from COFFITO. Supervision helps the intern reflect on their performance, which can even contribute to reducing anxiety caused by work overload and the insecurity of not having someone to share with, in an illusory scenario where interns are positioned as if they were already fully qualified professionals. This need for professional support on the part of the interns is also evident when Participant 7 states that “[…] they are working there, pretending to be a qualified person”, since, due to the absence of a qualified professional to supervise her, she may not feel comfortable enough to openly express that she is in a training process and, consequently, may make mistakes at times. This absence, combined with the pressure to take on responsibilities for which she is not properly trained – and for which she does not receive appropriate compensation – increases the anxiety and self-monitoring levels of the students during the internship, practices that also have negative consequences for their personal lives.

Studies suggest that internships, in light of the market demands imposed on these positions, may be far removed from their originally intended pedagogical purpose, especially when they serve as an opportunity to hire low-cost labor for companies (public and private). Given that much of the work performed is of low demand and performance and lacks supervision (Amorim, 1995; Lima et al., 2021), hiring interns may cause insecurities, fears, and anxiety in the interns, who, as the research points out, also seek these jobs as a source of income.

Above all, what the data presented brings to this reflection is an important issue regarding the appropriate timing, the way it is conducted, and the actual role that the non-mandatory internship fulfills in professional training. It should be carried out in a way that provides complementary, productive, and qualified learning. However, when poorly planned and lacking adequate supervision, the internship can overload the student, deviating from the pedagogical purpose of the internship and turning into a need for cheap labor, to the detriment of qualified professional development. Therefore, it is essential to question whether the internship, under these conditions, contributes to the student’s training or if it ends up functioning as a factor of exploitation and wear, distancing itself from its educational and ethical objectives.

Contractual relationships and the precariousness of labor links by companies and the university

From the data obtained, it is clear that entry into non-mandatory internships diverges from the mandatory regulations that should be followed for the hiring and performance of interns, as outlined by Law 11,788 (Brasil, 2008), which protects the intern’s practice in their work environment. Thus, this study questioned the participants about the hiring process and the signing of the Term of Commitment at the start of the internship:

Actually, I went to sign for now, but as soon as I entered, I didn't sign anything, I couldn't get the university to sign. So what did they do? They changed the contract, they signed our work card, but it's not [registered there] as an intern, it's as a “therapeutic assistant”, let's say (Participant 6).

I didn't sign any contract. Is there a contract? Is there one? And then I started to see that it really wasn't good for me, because [I] didn't have my rights, when they fire me, I'll never even be able to prove that I worked there, right? (Participant 3).

In these reports, it is understood that the interns faced challenges in their hiring processes, such as the failure of the higher education institution (HEI) to sign the internship agreements, as required by Law 11,788 (Brasil, 2008). As pointed out in Table 1, five of the eight participants in the study were in their third to fifth semesters, which, according to Resolution No. 452 from the Conselho Federal de Fisioterapia e Terapia Ocupacional (Brasil, 2015), should not occur, as these are the early semesters of the course, making the institution's signature on the internship agreement legally invalid. This led the host company to modify the intern’s role to “therapeutic assistant” or “monitor”, or, even worse, not formalize the hiring process.

Nelson et al. (2020) state that the term of commitment must be signed before the internship begins, and the absence of this written agreement or its irregular creation changes the nature of the internship from an educational activity to an employment contract. This means that a student who starts an internship without signing the term of commitment is considered an employee and, due to the principle of the continuity of the employment contract, cannot have the internship relationship retroactively validated by a later commitment term. The requirement for signing the term aims to prevent the use of interns as a way to replace workers protected by labor laws.

I didn't sign either of the two [documents]. Well, I did it at the first [clinic] and I stayed there for 4 months. And then, at the second [clinic], I think I stayed for 6 months. I think it was a little less than 6 months, and then at the first one, I didn't sign anything. Then, I signed as a monitor, if I'm not mistaken, which was the contract, it was a freelance contract, as a monitor and at the second one, I never signed anything (Participant 5)

The above account exposes the divergence of the internship's purpose as an educational formation, which, according to Palmeira Sobrinho (2008), represents the illegal exploitation of the intern's labor with the aim of reducing the costs of reproducing the workforce in a precarious manner. The relationship between non-mandatory internships and education tends to highlight contradictions in the dynamics of the educational and formative process, as the internship ends up being converted into a wage relationship, with responsibilities for institutional demands beyond those provided by internship legislation, but without the costs related to labor issues (Linhares et al., 2021).

The precarization of labor can be attributed to the fact that relationships have presented themselves in different forms, such as partial work contracts, temporary work, contingent or intermittent work (Nogueira & Carvalho, 2021), and, as in the case of this research, internship contracts.

With the progressive rise of these forms of work, the types of work considered precarious have increased, characterized by insecurity, lack of predictability of the future, economic vulnerability, and possibly the loss of social rights (Barbier, 2005). When the intern is exposed to forms of hiring where the institution does not support the internship practice, they become vulnerable to situations of precariousness and abuse, as the intern is not identified as a formal worker, thus having no employment relationship and lacking labor rights (Valeriano, 2009).

One point that deserves attention is related to the rights and duties of the interns. When asked about their knowledge of Law 11,788 (Brasil, 2008) and Resolution No. 452 (Brasil, 2015), the participants demonstrated little or no knowledge, which impacted the services provided, given their acceptance of abusive situations and hiring practices in non-compliance with the law, as they are unaware of the rights that should be guaranteed and the role of the institutions involved in the hiring process. Of the eight interviewees, only two demonstrated knowledge of the Resolution and the Law.

Yes, I have had contact with it. (Participant 1).

I have had contact with it, but I won't say that I know everything (Participant 8).

No, I've never even seen it (Participant 2).

It is important to emphasize that the Class Council is responsible for overseeing the professional practice of occupational therapists, including those doing internships in this area, and does not cover other forms of practice, such as those revealed in the narratives of the participants in this study: co-therapist, monitor, or therapeutic assistant, for example. However, the practice of the occupational therapy profession by an unqualified person – without a degree in occupational therapy and without registration in the class council – is considered a criminal offense, as per Article 47 of the Offenses Law (Decree-Law 3,688/41), and the case is referred to the police.

In this sense, the importance of discussions within occupational therapy programs, as well as in higher university bodies, is highlighted. These discussions should involve the creation of strategies that increase dialogue about these practices and the current regulations on internships and other related matters with students, and especially with the councils. The need arises to foster debates and discussions that enhance and update policies, guidelines, and regulations, ensuring that non-mandatory internships maintain an educational, ethical, and complementary nature in relation to the mandatory activities in the students’ education. It is believed that the closer relationship between the university and the Class Council, through dialogues, technical visits, project partnerships, support, and participation in events, among others, can be a viable and powerful path.

Intern or professional? Working conditions and the role played by the intern

One of the obligations of the internship provider is outlined in Article 8, paragraph of Resolution No. 452 (Brasil, 2015), which mandates the provision of appropriate facilities, materials, and resources, as well as personal protective equipment (PPE) for the interns, to ensure the quality of occupational therapy assistance. It is understood that the existence of adequate space, resources, and working conditions enables the professional and/or intern to achieve their goal of providing care for the person being treated, i.e., the work environment needs to offer facilities that are compatible with the practice. When the participants were asked about the working conditions at their non-mandatory internship sites, they responded:

They filled the schedule, hiring a bunch of interns randomly, and that same room where two people used to work, ended up having, like, six, six or five appointments at the same time, sharing [the room]. Sometimes, people would go to the physiotherapy room, where it wasn't being used, but there were times when I was, like, stressed out and stuff, because of the noise, right? Imagine the child (Participant 4).

Now it's better, but before, there was a lack of resources. So you have to invent things, bring them from home. Regarding the environment, it improved because they moved to a new clinic, like a space, so everything is brand new, there's even air conditioning in the room. But before there wasn't even a fan. The problem is more resources. If you want something new, you buy it. Then you bring your own, you invent things, because there are few (Participant 6).

When I was there, I worked with children. It was really bad, because the classrooms were tiny. The resources were terrible. They were like egg cartons, used shoes, tiny paints, brushes, and that was it, you know? If I really wanted to do something of quality, I would take it out of my own pocket and buy it, or I would have to go out in the middle of the activity to get, well... toys, borrowed resources, because people also wanted to use them and it was a struggle. There was a period when I actually took money out of my own pocket and bought some basic things, but it was what I could afford (Participant 7).

The student's search for a non-mandatory internship involves the expectation of deepening the specific content of a given area of ​​activity, in addition to being able to experience, during this experience, opportunities for practice, teaching and extension, which are important for the consolidation of knowledge in their educational process. The routine reported by the research participants in relation to the performance of activities as interns shows a non-educational practice that is almost never supervised:

So, we see patients alone, right? There is a supervisor, but no. He doesn't monitor the appointments. At the clinic, it takes 30 minutes to see patients. And that's about 8 children, if they all go, right? So that's it (Participant 6).

I worked every morning. It was during the pandemic, [...] I saw 6 patients, I think there were 35 in total. The session lasted 40 minutes. At the end of the session, I had to make a schedule saying what I had done with them, and that was it, that was it, that was it for the first month. In the second month, I had to keep writing the children's reports, you know? So, there were several reports for the children who had health insurance. And then I was the one who wrote the reports to send to the health insurance, or some school report, [...] something like that for the pediatrician who asked for an evaluation (Participant 7).

[...] I saw 8 patients per shift… But, for example, Saturdays were 8 patients… it was the most tiring day… There were days when I couldn’t go to the bathroom, because there was no one to look after my child, that’s about it. Like, I couldn’t go to the bathroom and there was no snack time, there was nothing. So I think that at the very beginning there were breaks, they were 10 minutes long and then they took the breaks away too (Participant 5).

Yes, it happens a lot that there’s a gap and you have to go to an area that’s not yours, like, I don’t know, I was going to see someone as a physiotherapist, not that I’m going to do what [in] physiotherapy [is] done, right? But, like, I’m in his place, so it happens a lot that there’s a gap and you have to cover a schedule that’s not your specialty as an intern, right? (Participant 6).

Companies have adopted measures to replace workers hired under the labor laws with interns, considering that interns do not incur costs related to labor legislation. As a result, the intern performs tasks like a professional without the necessary qualifications required by their respective Council and without labor rights. The intern bears the responsibilities imposed by the execution of tasks that are not included in their working hours, such as planning that needs to be done at home. In this way, the intern seeks to complement their education beyond the conditions offered by the university and the host company, or they must deal with the weaknesses arising from these elements (Reis, 2012; Demschinski & Flach, 2022).

From the perspective of Reis & Monte (2014), this is a legally disguised way of absorbing cheap labor, under contract, to perform the tasks of workers, but without labor rights, reinforcing the logic of the precarization of the student in non-mandatory internships.

It is observed that the large number of internship opportunities can be canceled in favor of hiring a qualified professional to carry out the required tasks. However, from a market standpoint, it becomes more costly than hiring interns for the same roles, thus distorting the legally established relationship. Demschinski & Flach (2022) assert that by taking on professional roles, interns contribute, often unknowingly [and/or without much ability to change the scenario at a national level], to the devaluation of the profession and the reduction of contracts for workers with salaries anchored in the profession’s minimum wage.

The following accounts address how interns were presented in their workplaces and reveal how the intern’s work is transformed into that of a “professional”:

I introduce myself and have always introduced myself as an intern, but in one specific [clinic], they introduced me as a professional (Participant 2).

As an intern. Until, after a while, they started calling me a co-therapist, so as not to signal, I think, kind of to camouflage it… [...] but it was kind of to camouflage that we were interns working as therapists [professionals]. So, the parents didn't always recognize that we were interns, after they found out, some were a bit like that, others didn't accept it (Participant 4).

As a co-therapist. It's so they don't call us an intern (Participant 5).

When an intern performs tasks and assumes roles as a professional, this is characterized as the illegal practice of the profession, as specified by the Code of Ethics and Deontology of Occupational Therapy (Brasil, 2013), which states that, for the practice of occupational therapy, registration with the Regional Council is mandatory to act in accordance with current legislation. In order to register with the Regional Council, the graduate must present supporting documentation, such as a diploma or proof of course completion.

Although the internship emerges as a learning opportunity for the student, serving as a form of employability and a bridge between university education and a professional career, it is possible to identify, beyond appearances, the facets of the exploitation of labor and the worker (Linhares et al., 2021). In this sense, the findings of this research reveal that the internship job market has an open and disguised character of underemployment, with conditions that foster situations of abuse and exploitation, affecting the health of the intern and the quality of the work provided. This impacts not only the students' education but also the precariousness that reflects the illegality and the lack of hiring of qualified professionals.

Teaching and learning of interns in the development of the non-mandatory internship

According to Iriart et al. (2008), HEIs plays a role in the student's learning, aiming to minimize, through joint participation, the precarization of the internship bond and its distortion into an employment relationship. In this context, the participants were asked about the process of professional supervision in the field and the support provided by the institution's professors:

In this signed contract, I didn't have any professor who supervised me, no, like, I had the name, I had a supervisor title, but I never had supervision (Participant 2).

Not the professor, no professor. In fact, I even avoided talking to the professors. Not me, because I felt like every time I spoke, the professor would look at me like that, because I understand that they have this idea that we have to be exclusive to the university, that we have to dedicate ourselves to our studies, but I needed to work (Participant 1).

I had a supervisor, but she didn't give me much support. When I started, I think she talked to me about twice, but I was trained by another intern, not by her (Participant 5).

[...] Like, you know there's that supervisor, but he doesn't supervise, you know? There's a supervisor, like, he exists, but he doesn't actually supervise. (Participant 6).

Through the participants’ statements, it is possible to perceive the fragility of the teaching process in non-mandatory internships, lacking supervisors from both the educational institution and the granting units, which directly impacts the student's learning. This is because guidance and exchanges about practice do not occur, which further leads to the precarization of the work and the service offered.

Article 9 of Law No. 11,788 (Brasil, 2008) specifies that private legal entities and public administration bodies, including direct, autonomous, and foundational entities, as well as higher-level liberal professionals, may offer internships, provided they meet the legal requirements related to the signing of the commitment term, offer adequate conditions for carrying out the internship, supervise the intern, provide insurance for the intern, and send a report on the intern’s activities to the educational institution at least every six months, among other requirements. Additionally, Article 2 of Resolution No. 452 of Conselho Federal de Fisioterapia e Terapia Ocupacional (Brasil, 2015) cites the above-mentioned law and emphasizes the need for direct supervision by an occupational therapist from the granting unit and the monitoring by a faculty occupational therapist from the educational institution. It is important to follow the proportional relationship between occupational therapists and the number of interns, as established by Article 6 of the same resolution, where each professional can supervise up to two interns, maintaining the proportionality (Brasil, 2015).

It is important to highlight that in internship contexts, the presence of the supervisor is not only mandatory but also crucial for supporting the execution of the intern's practice. It has an educational and formative character, ensuring proper care and therapeutic conduct. Barros et al. (2022) explain that the internship allows for the exchange of knowledge in the daily work setting, combining the intern's knowledge with the professionals' experience in practice scenarios.

It is also essential to emphasize that, regarding some of the cases mentioned by the participants, the educational institution did not sign the internship term due to non-compliance with Article 1 of Resolution No. 452 of the Federal Council of Physical Therapy and Occupational Therapy (Brasil, 2015), which refers to the minimum period for entering a non-mandatory internship (the sixth semester or third year of the course).

Seeking to deepen the dialogue with the participants regarding their motivation to undertake non-mandatory internships, six out of the eight interviewees pointed to the search for professional experience as one of the main reasons, as the curricular practices were deemed insufficient. Additionally, they had experienced remote learning, where practical experiences were limited due to the COVID-19 pandemic (Borba et al., 2020). The search for income was also one of the factors for entering the job market in the non-mandatory internship modality. Specifically regarding practical experiences, the participants reported the following:

So, half of my undergraduate degree was during the pandemic, and my class is also very large. So, even for practical issues, we barely had any practical experience. Practical classes, you know? It was more just intervention, so I wanted that practical experience and salary issues too (Participant 5).

If it weren't for the pandemic context, I know we wouldn't have the same practical experience, because we only start having it in the sixth semester of intervention, right? So, I wanted to really see what OT does, because it's not something that's accessible to everyone. Because it takes a long time for us to really see the profession, to really practice it, to evaluate it and everything else... we do the evaluation discipline there, but we'll only evaluate the same intervention when we have contact. (Participant 8).

[...] nowadays I know a lot of things that I wouldn't have learned in college, I know how to deal with a lot of things, I know how to care in different ways and I know the job market today, which I wouldn't have known if I hadn't done an optional internship. So, from that point of view, it's actually really good. I'll leave with a different perspective, but otherwise I don't recommend it (Participant 2).

[...] everything I saw in college was not even 1/3 of what I saw in the internship. So, what I see in college is very little to prepare me for the job market. (Participant 3).

Considering this scenario, the desire to experience professional practice and the concerns regarding the lack of practical experience during education are evident. According to research by Linhares et al. (2021), the search for non-mandatory internships is motivated by the desire for experience in the field, a fact observed in this study. The reports suggest that the experience of students in non-mandatory internships can bring benefits to their education by bringing them closer to the practical reality of the profession. However, the recognition of this experience, in order to be successful, must comply with current regulations that ensure the necessary protection of rights for students who choose to engage in these activities.

It is reiterated that the pandemic context restricted students' activities and practical experiences, which weakened their education and the deepening of professional activities that should have been part of the teaching and learning relationship in both mandatory and non-mandatory internships, as well as in the practices foreseen in the occupational therapy undergraduate courses.

The occupational therapy program offered at the university that is the focus of this study has a minimum duration of eight semesters. The fourth and fifth semesters are divided into curricular components dedicated to evaluation processes and the organization of therapeutic resources, respectively. The sixth semester includes curricular components focused on intervention processes, when students actually encounter practice, working with target populations before the mandatory curricular internship. The last two semesters are dedicated to mandatory internships (Universidade de Brasília, 2023).

Additionally, it is noted that the curriculum of the occupational therapy program at this university underwent a reformulation, and one of the main changes refers to the inclusion of extension activities (Brasil, 2018), which is believed to impact students' education by allowing greater involvement in practical activities from the first semester of the program.

The movement of articulating teaching and service presents itself as a tool for integrating theory and practice, stimulating reflection on reality, and enabling students to develop critical thinking and seek solutions for problems they encounter, with commitment and respect for the patient (Campos et al., 2001). According to Pimentel et al. (2015), practice settings are a strategy for curricular transformation, as they bring students closer to the everyday life of the population and allow them to develop a critical perspective on societal problems, enabling them to learn and experience as many healthcare settings as possible.

However, it is noted that there are cases where students seek non-mandatory internships for exclusively financial reasons, whether for self-maintenance at the university, especially for those from other states or cities, to assist with family expenses, or to cover course-related costs, among other factors. This highlights the importance of support policies for students’ continued enrollment at the university, which may not be sufficient in terms of availability, value, and reach.

Despite the situations experienced in non-mandatory internships by the participants of this research, they pointed out that internship activities played an important role in their educational journey. However, as Demschinski & Flach (2022) note, it is important to highlight that the lack of effective supervision and monitoring can lead to precarious internship conditions, diverting from its main objective: the educational and professional teaching and learning process.

It is possible to recognize the fragility between education and non-mandatory internships because, in the search to fill gaps in practical experiences through internships or for financial reasons, it was observed that the intern participants in this research often face a work practice that diverges from their education due to the absence or limited contact with professionals who can provide guidance and monitor practices. Therefore, they must adapt and seek knowledge on their own. Nevertheless, despite the challenges they faced, doing a non-mandatory internship allows them to make contact with the job market and provides a foundation for learning professional conduct.

Final Considerations

Reflection on non-mandatory internships is a key topic, as it is a recognized valuable resource. However, students face a lack of supervision, remaining in a context with many weaknesses in the ethical, educational, and competency development areas, which are necessary for professional practice. Despite the Internship Law specifying the intern's role, internships have deviated from their educational nature and transformed into a work relationship that circumvents labor and educational legislation, as well as Resolutions No. 452 and No. 425 from COFFITO.

It became evident that interns face contractual weaknesses when entering internship scenarios. Although there is an internship agreement to fulfill the requirements of the law, in practice, students often work without supervision from a professional responsible for the educational institution or the granting institution. They are sometimes assigned functions that are not educational in nature, take on roles meant for qualified professionals, and are placed in precarious working conditions.

The study revealed that interns lack adequate work facilities, professional supervision, and labor rights. It also highlighted an overload felt by the interns, which impacts their daily lives, affecting their performance in academic activities and even their basic daily activities such as bathing, sleeping, and leisure. In this research, this overload was found to have significant effects on the interns' mental health, such as anxiety, stress, and sadness.

It also became clear that students need to be aware of the laws and resolutions regarding non-mandatory internships, understand the scope and responsibility of the work performed by an occupational therapist, and that educational institutions need to invest more in these topics during the occupational therapy program from the initial semesters. These and other issues raise concerns that provoke new reflections and actions on the processes of labor precarization, with non-mandatory internships being at the interface.

The limitation of this study lies in its regional scope and the involvement of only one occupational therapy university in the Midwest region. Therefore, future research is suggested to include other universities, both public and private, from different regions of the country, with a different methodological design, for a broader mapping of the issues discussed in this study.

It is emphasized that non-mandatory internships are a potential tool for bringing students closer to professional practice, as long as they are able to experience this opportunity within the established regulations, emphasizing learning in education. Above all, they should not be solely related to market-driven and productive concepts that do not promote the professional recognition of occupational therapy, but rather result in precarious working relationships and indirectly hinder the creation of new job opportunities for those currently in training to truly act as professionals.

• 1
  The value of R$1,302.00 is considered the minimum wage in force in 2024.
• How to cite:
  Rodrigues, D. S., Cavalcante, B. G., Lins, S. R. A., Santos, J. E., & Barreiro, R. G. (2025). Non-mandatory internship in occupational therapy: reality of students at a public university. Cadernos Brasileiros de Terapia Ocupacional, 33, e3844. https://doi.org/10.1590/2526-8910.ctoAO396238442

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Edited by

• Section editor
  Profa. Dra. Ana Paula Serrata Malfitano

Publication Dates

• Publication in this collection
  19 May 2025
• Date of issue
  2025

History

• Received
  03 May 2024
• Reviewed
  03 Nov 2024
• Accepted
  03 Jan 2025