The Analysis of Critical Pathways as a Tool for Integrating Teaching and Service in Health

Isabel Schuster Argenton Romualdo de Lima Pilecco Carolina Dolinski Cássia Regina Gotler Medeiros About the authors


The integration of teaching and service is considered by Ministry of Health and Education as an important strategy for training professionals, according to the principles and guidelines of the Unified Health System (Sistema Único de Saúde – SUS). This article reports on an experience of integration between medical students and a Family Health Strategy (FHS) team, carried out based on the analysis and discussion of users’ clinical pathways. The clinical pathways were designed based on Home Visits (HV) to families who had been followed up by the students. These clinical pathways were then discussed with the professionals of the FHS. The pathways evidenced a worsening of chronic diseases, the use of a mixture of public and private health services, and the search for care only when symptoms appear. The health team confirmed the difficulties reported by the users in relation to specialized care, access to surgical procedures, and the performance of some diagnostic tests. On the other hand, the professionals also reported care that is not known to the users, such as obtaining medical consultations in the FHS and the care given by the nursing team. It was observed that many users perceive Primary Care (PC) as an extension of Emergency Care, and do not understand level-of-care assignments. This situation, together with the difficulty of the team in promoting health and home visits, contributes to the frustration of the FHS workers. This analysis enabled the students to identify the difficulties of users in accessing health, and the difficulties of the FHS team in promoting comprehensiveness of healthcare. In addition, there was a certain distance between public policies and work processes, despite the health workers’ efforts to meet the needs of users, also showing failures in health care management and network. The importance of this method for inter-professional training in health was apparent, as it promotes an analysis of situations encountered in the daily life of the health team.

–Clinical Pathways; –Medical Education; –Patient Care Team; –Primary Health Care

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