Perception of Physical Therapy students about their training to work for the Brazilian Unified Health System

Abstracts

A implantação do Sistema Único de Saúde (SUS) e a busca dos seus princípios têm suscitado mudanças nas práticas de saúde, promovendo alterações no processo de formação e desenvolvimento de profissionais da área. Nesse contexto, este trabalho teve como objetivo verificar a percepção de estudantes do Curso de Fisioterapia de uma Instituição de Ensino Superior (IES) pública, na cidade de Teresina (PI), sobre sua formação para prestação de serviços na área de atenção básica no SUS. Estudo transversal com aplicação de questionário especificamente elaborado para o estudo. A amostra foi composta por 42 dos 54 acadêmicos do Curso de Fisioterapia, matriculados do 6º ao 10º período. Os resultados mostram que 81% dos alunos afirmaram ter conhecimentos sobre o SUS proporcionados pela IES. Observou-se que somente os alunos integrantes da amostra que cursavam o 10º período (28,6%) realizaram estágio em saúde coletiva e fisioterapia comunitária. Foi verificado que 91,7% dos alunos do último ano e 43,3% dos alunos representativos dos demais períodos se julgaram aptos para atuar no sistema de saúde. Assim, constatou-se que, em sua maioria, os acadêmicos entrevistados detêm conhecimentos sobre o SUS, adquiridos em sua graduação, e acreditam estar preparados para atuar no sistema, principalmente após a realização do estágio supervisionado.

formação de recursos humanos; fisioterapia; atenção primária à saúde; Sistema Único de Saúde

ORIGINAL RESEARCH

Perception of Physical Therapy students about their training to work for the Brazilian Unified Health System

Percepción de estudiantes del curso de fisioterapia sobre su formación profesional para actuación en la atención básica en el Sistema Único de Salud

Kajena Nascimento Seriano^I; Vivianne Ramos da Cunha Muniz^II; Maria Ester Ibiapina Mendes de Carvalho^I,III

^IPhysical Therapy department of UESPI – Teresina (PI), Brazil

^IIFaculdade Internacional de Curitiba (FACINTER) – Curitiba (PR), Brazil

^IIIUniversidade Camilo Castelo Branco (UNICASTELO) – São Paulo (SP), Brazil

Correspondence to

ABSTRACT

The implementation of the Unified Health System in Brazil (Sistema Único de Saúde – SUS) and the search for its principles have led to changes in health practices, promoting alterations in the formation and development processes of the professionals of the field. In this context, this study aims to determine the perception of Physical Therapy students from a Higher Education Institution in the city of Teresina, Piauí, Brazil, on their training to provide services for SUS, by means of the application of a questionnaire specifically designed for this study. The research sample was composed of 42 out of the 54 students of Physical Therapy enrolled from the 6^th to the 10^th periods, which is also the last period of the course. The results show that 81% of academicians reported knowing something about SUS because of higher education institution. It was observed that only members of the sample attending the 10^th period (28.6%) were interns in the public health system and community physical therapy. It was found that 91.7% of students from the 10^th period and 43.3% of the students representing the other periods judged themselves to be able to work with the system. Thus, it appears that most interviewed students are aware of SUS, because of graduation, and believe to be prepared to work with the health system, especially after the supervised internship.

Keywords: human resources formation; physical therapy; primary health care; Sistema Único de Saúde.

RESUMEN

La implantación del Sistema Único de Salud (SUS) y la búsqueda de sus principios han suscitado cambios en las prácticas de salud, promoviendo alteraciones en el proceso de formación y desarrollo de profesionales del área. En ese contexto, este trabajo tuvo como objetivo verificar la percepción de estudiantes del Curso de Fisioterapia de una Institución de Enseñanza Superior (IES) pública, en la ciudad de Teresina (PI), sobre su formación para prestación de servicios en el área de atención básica en el SUS. Estudio transversal con aplicación de cuestionario específicamente elaborado para el estudio. La muestra fue compuesta por 42 de los 54 académicos del Curso de Fisioterapia, matriculados del 6º al 10º período. Los resultados muestran que 81% de los alumnos afirmaron tener conocimientos sobre el SUS proporcionados por la IES. Se observó que solamente los alumnos integrantes de la muestra que cursaban el 10º período (28,6%) realizaron pasantía en salud colectiva y fisioterapia comunitaria. Fue verificado que 91,7% de los alumnos del último año y 43,3% de los alumnos representativos de los demás períodos se juzgaron aptos para actuar en el sistema de salud. Así, se constató que, en su mayoría, los académicos entrevistados poseen conocimientos sobre el SUS, adquiridos en su graduación, y creen estar preparados para actuar en el sistema, principalmente después de la realización de la pasantía supervisada.

Palabras clave: formación de recursos humanos; fisioterapia; atención primaria a la salud; Sistema Único de Salud.

INTRODUCTION

The struggles of Brazilian social and sanitary movements were responsible for the creation of the Unified Health System (Sistema Único de Saúde – SUS), which changed management processes, social participation and the conception of health. Basic principles emerge from SUS, such as universality, equity and resoluteness, and the actions and services related to health must be developed according to these principles and guidelines from Article 198 in the Federal Constitution: decentralization, full attention to health and social participation^1-3.

The implantation of SUS and the search for its principles have raised several elaborations and propositions concerning the adopted care models, the financing logic and professional practices. Regarding professional work, there is increasing debate about the need to adjust the formation of professionals in relation to the new logic of organization in health services based on the principles and guidelines of SUS⁴.

For a long time, the graduate teaching in Brazil has been characterized by the acquisition of technical and scientific knowledge coming from inarticulate disciplines that do not integrate theory and practice. Such teaching models are not able to provide professional formation that builds the necessary profile to work in the perspective of full attention to health, including actions of promotion, protection, prevention, early attention, cure and rehabilitation^5,6.

In this context, one of the courses in the health field that goes through this change process in order to graduate professionals that are skilled to work with SUS is the Physical Therapy one. Since the profession appeared, with the goal of treating people with physical injuries caused by wars, Physical Therapy has had an essentially curative and rehabilitating character. For a long time, this point of view excluded Physical Therapy services from the public system, so the population had great difficulty to access such services^7,8.

The National Curriculum Guidelines for the graduation in Physical Therapy point out that "the formation of the physical therapist should contemplate social health needs, with emphasis on SUS". The latter should not be taken for basic attention. Its role is to provide attention to health and integrate interventions concerning health promotion, protection and recovery, however, the first level of attention is the entrance door to the system, so there should be great resoluteness, of approximately 90%, thus becoming a priority^2,7,9.

With this premise, and considering that SUS is a major employer of health workers, it is important to pay attention to the formation of Physical Therapy professionals. Such formation should stimulate critical and productive thinking, being based on the problems of the assisted population and valuing the knowledge that is daily produced in health units, articulating it with the content coming from university. Professionals with such formation who know the Brazilian health system and health policies are usually committed to this system, which is important in order to be effectively engaged in proposals to transform professional practices and the organization of the work¹⁰.

In this context of changes concerning the Physical Therapy graduation, this study aimed to analyze the perception of Physical Therapy students from a public higher education institution in Teresina, Piauí, about their formation to provide services to SUS, in order to know how students, who are the main actors in this process, see their formation in relation to SUS, as well as their expectations and knowledge regarding the Brazilian health system.

METHODOLOGY

It is a cross-sectional, quantitative and descriptive study, and the subjects were Physical Therapy students from the Center of Health Sciences at Universidade Estadual do Piauí (CCS/UESPI), located in the city of Teresina (PI).

The Physical Therapy course of this higher education institution counts on a workload of 5,220 hours/class, and 1,440 hours/class consist of supervised internship. The program is constituted of theoretical disciplines that approach collective health in the 4^th period, which are public health and community physical therapy. These add up to 120 hours/class, and all of the students analyzed in the study had already taken these disciplines. Supervised internships occur in the last year of the course, being divided into outpatient clinics and public health in the 9^th period, and hospitals in the 10^th period.

Due to the theoretical disciplines and the practical experience with SUS in the supervised internship, which enable the student to assist in basic attention, and according to resolution 139/92 of the Federal Council of Physiotherapy and Occupational Therapy (COFFITO), art. 7, item II, Physical Therapy internships can only take place "after the 6^th graduation period for being part of the professionalizing subjects"¹¹. The 9^th period did not have students regularly enrolled in the institution, so it was excluded from the study. Therefore, all of the students regularly enrolled in the 6^th, 7^th, 8^th and 10^th periods of the Physical Therapy course of CCS/UESPI were included in the study, regardless of gender and aged 18 years old or more. Those who were not in the classroom at the time of data collection were excluded.

To meet resolution 196/96 of the National Health Council, the research was approved by the Research Ethics Committee of Universidade Estadual do Piauí (UESPI), being approved and registered (n. 059/11). Participants signed two copies of the informed consent form, being one for themselves and the other for the researcher in charge. Besides, researchers took all of the precautions so that confidentiality, privacy and autonomy of the subjects could be preserved.

Data collection was performed by a questionnaire comprised of 14 questions, with open and closed items, elaborated by the authors, who included four questions on demographic data of the interviewees, two questions about the expectations in relation to SUS such as work market, seven questions about the appropriation of academic, theoretical and practical knowledge regarding SUS as to the skills to work with basic attention, and one question about the contribution of the Physical Therapy course in this context.

Subjects were recruited in the classroom and in the internship by verbal invitation. After the explanation about the research and the authorization of the professor, questionnaires were immediately answered and given to the researcher.

The software Epi Info, version 3.5.3, was used for the statistical evaluation of the collected data, by distributing frequencies, percentages, central tendency measures and dispersion.

RESULTS

Out of the 54 students enrolled from the 6^th to the 10^th period in the Physical Therapy course from the analyzed institution, 42 of them answered the questionnaire, corresponding to 80.8% of the universe of the research. The sample was sufficient, considering a margin of error of 10%, 95% confidence level and 50% level of heterogeneity.

The age of the interviewed students ranged from 18 to 28 years old, with mean of 22.2 years (±1.8). The female gender was predominant in the sample, with 30 interviewees (71.4%).

Graph 1 expresses the choice of the interviewees between the public and the private services for their professional practice after graduation.

When questioned about the higher education institution providing knowledge concerning SUS, 34 of them (81%) reported having received information of this type during their academic life.

Students answered two questions related to SUS, which assessed knowledge as to some principles of the system, expressed in Table 1.

All of the students stated that the community has something to teach the Physical Therapy student.

Table 2 shows the experience of students with the Unified Health System in a public hospital, and their experience in the basic attention and in collective health and community physical therapy internships.

When questioned about feeling prepared to work in SUS, results are demonstrated in Graph 2.

The reasons reported by the students from the 6^th to the 8^th period that revealed inaptitude to work in SUS were lack of experience and insufficient knowledge. At the same time, students in the 10^th period reported lack of experience.

DISCUSSION

The creation of SUS led to changes in health practices, imposing alterations to the process of formation and development of professionals in the field. As institutions that are essential to this process, universities should be focused on problem solving and social needs with special responsibility towards the production of new knowledge and the formation of critical and socially committed professionals. In this context, the formation of a physical therapist should not be based on specialties, but on health policies^12-14.

Some steps have been taken to form a professional profile that can meet the needs of SUS with resoluteness and quality. An initiative was the reformulation of the National Curriculum Guidelines, integrating work and teaching, practice and theory, teaching and community. Another step was the integration of public service as a practice field for teaching and research by means of visits, internships or extension projects, recognized in article 27, Law 8080/80^6,12,15.

SUS institutionalizes health services in Brazil, being considered as the largest health work market in the country¹². According to Oliveira¹⁶, the increasing positions offered in public exams, the quality of the positions, the nondiscrimination by sex, age or experience, turns this sector into a great alternative for many young people who have just left college. In the research, it was observed that 19% of the students wish to work exclusively in the public sector, and 78.6% wish to work both in the public and the private services. A similar result was found by Pinheiro et al.⁶, once 87.5% of the students revealed the desire to work for both sectors.

Students showed domain in theoretical questions related to social participation, and, especially, to the location of actions and procedures developed by SUS. A similar study was conducted with Physical Therapy students of Universidade de Fortaleza (CE), which also showed the good performance of students as to theoretical preparation for questions concerning origin, popular participation, doctrinaire and organizational principles of SUS⁶.

This situation is explained by the analysis of the program of the Physical Therapy course, which consists of theoretical disciplines that approach the matter of collective health, public health and community physical therapy in the 4^th period, and all of the students who participated in this study had already taken such disciplines.

In a study with students from the higher educational institution in João Pessoa (PA), Pimentel¹⁷ observed that, in the levels of attention to health, Physical Therapy students are less prepared for the primary level (16%), while the secondary level had the greatest expression among the answers of the students (45.46%).

As a way to keep Physical Therapy away from the paradigm of being merely a rehabilitating profession, education should be based on community, which enables the development and training of skills and abilities such as leadership, work in a multidisciplinary team, interaction with the community, problem solving, communication and planning, therefore looking for care integrality and the real and effective implantation of the principles of SUS. Thus, the domain of technical knowledge is undoubtedly indispensable, however, not enough for the model that we are trying to build. The practical learning fields are essential in this aspect. Corroborating this idea, all of the analyzed students believe that the community has something to teach to the student^13,18.

As seen in Table 2, the fields of internship in hospital environments were predominant, and this field was inserted since the 6^th period of graduation. Silva and Ros¹⁹, Gallo⁷ and Ferreira, Silva and Aguer²⁰ found a similar situation in their studies. So, they stated that the centralization of internships in hospitals and outpatient clinics makes it difficult to stimulate a broader formation, one that is more general and humanist. This demonstrates that teaching is focused on the curative and rehabilitating aspect of Physical Therapy, with little attention to the primary level.

The study found a lower proportion of students who stated having undertaken an internship in basic attention before the Mandatory Supervised Internship (Table 2), all of them from the 10^th period. This information is explained because the institution and its guidelines restrict the supervised internships to the last year of course, being divided into outpatient clinic and public health in the 9^th period, and hospitals in the 10^th period. This fact reports and justifies the findings of this study, in which outpatient and hospital formation takes place in public institutions, school hospitals that only care for users of SUS.

The late experience of students in the course observed in this study, with practices in collective health and community physical therapy, which refer to the practice of SUS in basic attention and the exercise of Physical Therapy, is in accordance with the study by Silva¹⁹, performed with Physical Therapy students from Universidade do Sul de Santa Catarina, who reported having had contact with the field of collective health only in the last year of graduation, and, in the theoretical field, they reported having isolated disciplines in the beginning of the course related to collective health addressed to SUS and basic attention to health.

Concerning the perception of the students as to their formation to work with SUS, the students in the last year of course considered they were skilled for the job, while 56.7% of the students from the 6^th to the 8^th period revealed inaptitude for such work. The reported motives were lack of experience and insufficient knowledge, which reveals that more effort is required so that the disciplines can arrange the adaptation of students to the principles and guidelines of the current health system. The analyzed institution presents isolated disciplines in the beginning of the course, without a practical relationship with the community, which only takes place in the last year of graduation, with the supervised internship, which accounts for 1,440 hours/class and only 72 hours/class approach the subject of basic attention with internship in community physical therapy.

Barbosa et al.¹³ found critical points described by the Physical Therapy professionals in their functions in basic attention, in teams of Núcleo de Apoio à Saúde da Família (NASF), among which the care and clinical formation have been mentioned as obstacles for them to adapt to the proposals of SUS, making them more dependent on technologies to work.

Facing these facts, the importance of the pedagogical formation based on the principles and guidelines of SUS is emphasized, due to its importance in the health scenery in the country, in order to operate changes in the service to be provided. It is important to develop the promotion of events involving the higher education institution (professors and students) with the community, from the beginning of the course, promoting a broader view and including Physical Therapy in the field of basic attention, besides its rehabilitating function, thus emphasizing the principle of integrality of health practices, such as collective effort, speeches and courses.

CONCLUSION

In this study, it was observed that most students aim the public service as a field for professional performance. The study showed a high percentage of right answers in theoretical questions involving SUS, and that the analyzed institution does not focus on the practice of basic care in periods prior to the supervised internship. This practice only takes place in supervised internships, which shows that only students from the last period, mostly, prove to be able to work with basic care, therefore, to SUS. The suggestion is that managers and professors of this institution have greater commitment to the practice of basic care in the initial periods of the course.

REFERENCES

• ¹
  Brasil. Constituição da República Federativa do Brasil. Brasília: Senado Federal, 1988.
• ²
  Brasil. Ministério da Saúde. A construção do SUS: histórias da Reforma Sanitária e do Processo Participativo. Brasília: Ministério da Saúde, 2006.
• 3. Machado MF, Monteiro EM, Queiroz DT, Vieira NF, Barroso MG. Integralidade, formação de saúde, educação em saúde e as propostas do SUS Uma revisão conceitual. Ciênc Saúde Coletiva. 2007;12(2):335-42.
• 4. Bispo Júnior JP. Fisioterapia coletiva: desafios e novas responsabilidades profissionais. Ciênc Saúde Coletiva. 2010;15(Suppl 1):1627-36.
• 5. Ceccim RR, Feuerwerker LCM. Mudança na graduação das profissões de saúde sob o eixo da integralidade. Cad Saúde Pública. 2004;20(5):1400-10.
• 6. Pinheiro LBD, Diógenes PN, Filgueiras MC, Abdon APV, Lopes EAB. Conhecimento de graduandos em Fisioterapia na Universidade de Fortaleza sobre o Sistema Único de Saúde. Fisioter pesqui. 2009;16(3):211-16.
• 7. Gallo DLL. A Fisioterapia no Programa Saúde da Família: percepções em relação à atuação profissional e a formação universitária [dissertação]. Londrina (PR): Universidade Estadual de Londrina, 2005.
• 8. Rodrigues RM. A Fisioterapia no contexto da política de saúde no Brasil: aproximações e desafios. Ver Perspectivas online. 2008;2(8):104-9.
• ⁹
  Conselho Nacional de Educação. Diretrizes Curriculares Nacionais dos cursos de graduação em Fisioterapia, Fonoaudiologia e Terapia Ocupacional. Brasília, 2001.
• 10. Araújo D, Miranda MCG, Brasil SL. Formação de profissionais da saúde na perspectiva da integralidade. Rev. Baiana de Saúde Pública. 2007;31(Suppl 1):20-31.
• ¹¹
  Brasil. Conselho Federal de Fisioterapia e Terapia Ocupacional. Resolução nº 139 de 28 de fevereiro de 1992. Dispõe sobre as atribuições do Exercício da Responsabilidade Técnica nos campos assistenciais da Fisioterapia e da Terapia Ocupacional e dá outras providências.
• 12. Cavalheiro MTP, Guimarães AL. Formação para o SUS e os desafios da integração ensino serviço. Cadernos FNEPAS. 2011;1:19-27.
• 13. Barbosa EG, Ferreira DLS, Furbino SAR, Ribeiro EEN. Experiência da Fisioterapia no Núcleo de Apoio à Saúde da Família em Governador Valadares, MG. Fisioter Mov. 2010;23(2):323-30.
• 14. Bispo Júnior JP. Formação em fisioterapia no Brasil: reflexões sobre a expansão do ensino e os modelos de formação. Hist Ciênc Saúde Manguinhos. 2009;16(3):655-68.
• 15. Freitas MS. A atenção básica como campo de atuação da Fisioterapia no Brasil: as Diretrizes Curriculares ressignificando a prática profissional. [tese]. Rio de Janeiro (RJ): Universidade do Estado do Rio de Janeiro, 2006.
• 16. Oliveira DA. Perfil dos candidatos e razões para o ingresso no setor público [monografia]. Porto Alegre (RS): Universidade Federal do Rio Grande do Sul, 2010.
• 17. Pimentel DM. Bases metodológicas da formação em Fisioterapia: discutindo o distanciamento entre os processos de formação e a utilização da força de trabalho [dissertação]. João Pessoa (PB): Universidade Federal da Paraíba, 2012.
• 18. Santos RB, Trelha CS. A comunidade como sala de aula: experiência de nove anos do curso de Fisioterapia em um projeto multiprofissional e interdisciplinar. Fisioter Mov. 2003;16(1):41-6.
• 19. Silva DJ, Ros MA. Inserção de profissionais de Fisioterapia na equipe de Saúde da Família e Sistema Único de Saúde: desafios na formação. Ciênc Saúde Coletiva. 2007;16(6):1673-81.
• 20. Ferreira RC, Silva RF, Aguer CB. Formação do profissional médico: a aprendizagem na atenção básica de saúde. Rev Bras Educ  Méd. 2007;31(1):52-99.

Publication Dates

• Publication in this collection
  01 Nov 2013
• Date of issue
  Sept 2013

History

• Received
  Jan 2013
• Accepted
  June 2013