Processo avaliativo dos residentes em medicina de família e comunidade

Abstract

Introduction: In order to be effective and resolutive, Primary Health Care requires the training of qualified primary care specialists. Different factors influence medical training, including the evaluation process. Objective: To identify and analyze the evaluation process adopted by the Family & Community Medicine Residency Programs (PRMFC) based in the southeastern macroregion of Brazil. Methodology: The study involved three steps: documentary evaluation to relate the PRMFCsin terms of Brazilian macroregion and number of vacancies offered; identification of the active PRMFCs in 2018, in the southeast, by institutional contact; field research with the coordinators/supervisors of the active programs, to identify which evaluation processes are adopted in the training of residents. In the field research, the inclusion criteria for the PRMFCswere to be registered and authorized by the National Committee of Medical Residency and to be based in the southeast region. The exclusion criterion was not having any residents in 2018. Data were analyzed through descriptive statistics based on measures of central tendency and separatrices for the number of vacancies, and absolute frequencies and proportions. This study has been approved by the Ethics Committee, Opinion No. 2,474,161. Results: The PRMFCs cover all Brazilian macroregions. The southeastern region has the highest concentration of programs (43.2%) and vacancies (42.9%). Of the 114 PRMFCs in the southeast, 74 (64.9%) were active. Among these, 51 (68.9%) participated in the study. All PRMFCs assess their residents and adopt from one (8.3%) to twelve (100%) mandatory evaluation instruments among those presented in the research questionnaire, with an average of 5.80 (± 2,088) instruments per program. Among the mandatory instruments/methods, the following stand out: structured feedback (74.5%), self-assessment (74.5%), multiple choice tests (64.7%), and structured direct observations of the appointments (64.7%). Most programs do not carry out clinical audits (62.7%) and portfolio (58.8%). 94.1% do not rely on OSLER (Objective Structured Long Examination Record), and 62.7% do not rely on OSCE (Objective Structured Clinical Examination). 45.1% of the programs have created their own evaluation tool. Almost all (90.2%) follow the Competence-Based Curriculum of the Brazilian Society of Family and Community Medicine (SBMFC) as theirguidelines. Regarding the mandatory external evaluation of residents, 25.5% of the programs have their professional team carry out the evaluation, and in 11.8% the services are evaluated by users. The residents evaluatetheir preceptors (56.9%) as well as the program as a whole (74.5%, but not their coordinators (58.8%). Conclusions:The PRMFC evaluate theirresidents through different instruments/methods. Most adopt the SBMFC Competency-Based Curriculum as the guiding principle of the evaluation process and resort to multiple methods, which allows the realization of both summative and formative assessments. As for the PRMFCs that created their instruments, we suggest their validation so that they can be tested for their real capacity to evaluate Family and Community Medicine competencies. This could contribute to reduce or narrow the current gap related to the scarcity of specific evaluative instruments in the area in Brazil.