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Educação médica em Cabo Verde no contexto de pequeno Estado insular: o desafio da sua implantação
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Esta tese de doutoramento em Saúde Internacional, especialidade de Políticas de Saúde e Desenvolvimento, pretendeu analisar as condições para a exequibilidade da Educação Médica, e ser uma contribuição à reformulação da Política de Educação Médica (PEM) que oriente a modulação de uma instituição de ensino médico de qualidade, mas adaptada às condições concretas do país. Ela resulta dos trabalhos de investigação sobre os desafios à implantação da Educação Médica em Cabo Verde. Este pequeno estado insular, com seus fatores específicos, está sujeito às mudanças decorrentes da evolução rápida da Educação Médica. Esses trabalhos de investigação tiveram por base uma revisão narrativa da literatura sobre os fatores que estão a moldar os desenvolvimentos na Educação Médica mundial no século XXI e sobre as vulnerabilidades específicas e capacidade de resiliência dos Pequenos Estados Insulares como Cabo Verde.
A tese é estruturada por artigos, com três partes:
A Introdução Geral onde se expõe a situação do conhecimento atual sobre a relação entre a Educação Médica e a transformação social numa pequena nação insular;
Quatro estudos que originaram um artigo cada, que corporizam a tese;
A terceira parte é a Discussão e Conclusões onde, seguindo o quadro de referência de Janicek (2010), são analisadas as implicações dos achados da tese para a exequibilidade de um projeto de Educação Médica nacional.
A abordagem metodológica seguida é mista e a estratégia de investigação é a de estudo de caso. Os métodos e técnicas foram utilizados consoante o estudo realizado.
O Estudo 1 – Caracterização da força de trabalho médica em Cabo Verde – permitiu evidenciar as características que determinam a baseline para a implantação local da Educação Médica. É um estudo censitário feito a partir dos dados secundários dos médicos cabo-verdianos registados no Departamento de Recursos Humanos do Ministério da Saúde. Através de uma análise estatística descritiva simples, utilizando o software SPSS 20, fez-se uma caracterização detalhada dos atributos da força de trabalho médica cabo-verdiana no período estudado, que envolve o ritmo de crescimento e de especialização, os locais de formação, a sua distribuição pelo país ou a previsão da aposentação dos médicos.
O Estudo 2 – Aparecimento e expansão do ensino médico no contexto da cooperação entre os estados membros da CPLP – permitiu visualizar o quadro de apoio à formação dos médicos nacionais que Cabo Verde tem recebido e perspetivar o alargamento da parceria no processo de ensino médico local e no desenvolvimento de uma capacidade de formação especializada. É uma análise documental e uma revisão narrativa da literatura sobre a cooperação bilateral e multilateral em Educação Médica em África, particularmente nos países membros da CPLP, que realça as múltiplas dimensões dessa colaboração, como a investigação, o estabelecimento de redes colaborativas, a regulação
do ensino médico e o apoio às licenciaturas em Medicina. Além disso faz prever a conversão desta cooperação numa abordagem triangular Sul-Norte-Sul, inserida no Plano Estratégico de Cooperação em Saúde (PECS/CPLP). Essa abordagem, envolvendo os países africanos, Brasil e Portugal, pode apoiar iniciativas do ensino médico local e o desenvolvimento de uma capacidade de formação pós-graduada nos países como parte de uma importante estratégia para ajudar a reter médicos.
O Estudo 3 – Exame das perceções, apoios e resistências de diversas franjas da sociedade cabo-verdiana sobre a implantação e desenvolvimento da Educação Médica local – permitiu identificar os elementos essenciais à reformulação da política de Educação Médica em CV, reconhecida como uma política de educação e de saúde, mas formulada com o comprometimento de vários atores, organizações e instituições com responsabilidade na conceção e realização de medidas subsequentes. Os achados traduzem os apoios consensuais à instalação do ensino médico nacional, mas apelam à confirmação dos desenvolvimentos institucionais necessários para a viabilização e afirmação da Educação Médica nacional iniciada em 2015. É um estudo qualitativo que resulta da análise de entrevistas a decisores-chave, personalidades da esfera política e de áreas afins à saúde e à educação e médicos, através de entrevistas semiestruturadas, de discussões em grupos focais (GF), bem como da análise documental às notícias nos media cabo-verdianos sobre a instalação do ensino médico local.
O Estudo 4 – A opinião dos alunos do 1º ano do curso de ensino médico na Universidade de Cabo Verde (Uni-CV) – permitiu estudar as características do perfil dos alunos e identificar a sua satisfação com o processo académico, principais dificuldades, expetativas quanto à prática médica futura, informações que permitem ajustar o processo de ensino iniciado. É um estudo qualitativo, por força do início do curso de Medicina na Universidade de Cabo Verde em 2015, realizado através de um inquérito semiestruturado, dirigido aos primeiros alunos do curso. Os dados foram inseridos no Excel (2013), trabalhados pelo SPSS 23 e objeto de uma análise estatística descritiva simples.
A Discussão Geral foi feita na terceira parte da tese, seguindo o quadro de referência de Janicek (2010). Recordou-se o objetivo geral da investigação e sintetizou-se os resultados e as discussões produzidas em cada um dos artigos. Os resultados apresentados traduzem os apoios consensuais à instalação do ensino médico em Cabo Verde. Reconhecem a sua relevância. Mostram que não estão reunidas ou asseguradas todas as condições para o sucesso do ensino instalado em 2015 por essa decisão ter ultrapassado a realização das condições prévias. Apresenta-se os processos mais importantes para o tornar sustentável e apela-se à confirmação dos desenvolvimentos institucionais necessários à viabilização e afirmação da Educação Médica no contexto nacional. Identificam algumas das limitações que deverão ser corrigidas, criando condições para ir ao encontro das boas práticas identificadas noutras experiências de ensino médico em África e em pequenos estados insulares.
Palavras chave: Cabo Verde, Educação Médica, Estudantes de Medicina, Política de Educação Médica, Vulnerabilidades.
This doctoral thesis on International Health, specializing in Health and Development Policy, aimed to analyze the conditions for the feasibility of medical education in Cape Verde and to contribute to the reformulation of a Medical Education Policy (PEM) to guide the modulation of a quality medical education, but adapted to the specific conditions of the country. It results from research on the challenges to the implementation of Medical Education in Cape Verde. This small island state with its specific factors is subject to the changes arising from the rapid evolution of Medical Education. These research work was based on a narrative review of the literature on the factors that are shaping the developments in world medical education in the XXI century and about the specific vulnerabilities and resilience of small island states like Cape Verde. This thesis is structured in articles with three parts: The General Introduction exposes the current state of knowledge about the relationship between Medical Education and social transformation in small insular nations. Four studies that originated an article each, and that embody the thesis; And the third part is the overall discussion where, following the frame of reference of Janicek (2010), the implications of the findings of the thesis for the feasibility of a National Medical Education project are analyzed. The methodological approach followed is mixed and the research strategy is that of a case study. The methods and techniques were used according to the study. Study 1 – Characterization of the medical workforce in Cape Verde – allowed to highlight the characteristics that determine the baseline for the local implantation of medical education. It is a census study based on the secondary data of Cape Verdean physicians registered in the Department of Human Resources of the Ministry of Health. Through a simple descriptive statistical analysis, using the software SPSS 20, a detailed characterization of the attributes of the force Cape Verdean medical work during the study period, which involves the rate of growth and specialization, training sites, their distribution by country or predicting the retirement of doctors. Study 2 – The emergence and expansion of medical education in the context of cooperation among CPLP Member States – allowed to visualize the support framework for the training of Cape Verdean physicians and to foresee the expansion of partnerships for local medical education and for the development of postgraduate training capability. It is a documentary analysis and a narrative review of the literature on bilateral and multilateral cooperation in medical education in Africa, particularly in CPLP member countries, highlighting the multiple dimensions of such collaboration as research, collaborative networking, regulation of teaching Support for medical degrees. Also, does provide the conversion of this cooperation in a South-North-South triangular approach, set in the Strategic Plan for Cooperation in Health (PECS / CPLP). This approach, involving African countries, Brazil and Portugal, can support local medical education initiatives and the development of postgraduate training capacity in countries as part of an important strategy to help retain physicians. Study 3 – Examination of perceptions, supports and resistances of several fringes of Cape Verdean society on the implementation and development of local medical education – identified the essential elements of the recasting of medical education policy in CV, recognized as an education and health policy, but formulated with the commitment of various actors, organizations and institutions with responsibility for the design and implementation of follow-up actions. The findings reflect consensual support for the establishment of national medical education, but call for confirmation of the institutional developments necessary for the viability and affirmation of national medical education begun in 2015. It is a qualitative study that results from the analysis of interviews with key decision-makers, personalities from the political sphere and from areas related to health and education, and physicians through semi-structured interviews, focus group discussions (GF), as well as documentary analysis News in the Cape Verdean media about the installation of local medical teaching. The study 4 – The opinion of the students of the 1st year of the medical teaching course at the University of Cape Verde (Uni-CV) – allowed to study the profile of the students and identify their satisfaction with the academic process, main difficulties, expectations concerning the future medical practice, information that allows adjusting the teaching process initiated. It is a qualitative study, due to the beginning of the medical course at the University of Cape Verde in 2015, conducted by the initiating of medical school in 2015, through a semi-structured survey addressed to the first students of medical school. The data were inserted in Excel (2013), worked by SPSS 23 and object of a simple descriptive statistical analysis. The General Discussion was made in the third part of the thesis, following the reference frame of Janicek (2010). He remembered the overall goal of research and synthesized the results and discussions produced in each of the articles. The results presented reflect consensual support for the installation of medical education in Cape Verde. Recognize its relevance. Show that they are not satisfied or secured all the conditions for successful teaching installed in 2015 by that decision exceeded the fulfillment of the preconditions. Identifying the most important processes for sustainability, they call for the confirmation of the institutional developments necessary for the viability and affirmation of medical education in the national context. They identify some of the limitations that need to be addressed by creating the conditions to meet best practices identified in other medical teaching experiences in Africa and small island states. Key words: Cape Verde, Medical Education, Medical Students, Medical Education Policy, Vulnerabilities.
This doctoral thesis on International Health, specializing in Health and Development Policy, aimed to analyze the conditions for the feasibility of medical education in Cape Verde and to contribute to the reformulation of a Medical Education Policy (PEM) to guide the modulation of a quality medical education, but adapted to the specific conditions of the country. It results from research on the challenges to the implementation of Medical Education in Cape Verde. This small island state with its specific factors is subject to the changes arising from the rapid evolution of Medical Education. These research work was based on a narrative review of the literature on the factors that are shaping the developments in world medical education in the XXI century and about the specific vulnerabilities and resilience of small island states like Cape Verde. This thesis is structured in articles with three parts: The General Introduction exposes the current state of knowledge about the relationship between Medical Education and social transformation in small insular nations. Four studies that originated an article each, and that embody the thesis; And the third part is the overall discussion where, following the frame of reference of Janicek (2010), the implications of the findings of the thesis for the feasibility of a National Medical Education project are analyzed. The methodological approach followed is mixed and the research strategy is that of a case study. The methods and techniques were used according to the study. Study 1 – Characterization of the medical workforce in Cape Verde – allowed to highlight the characteristics that determine the baseline for the local implantation of medical education. It is a census study based on the secondary data of Cape Verdean physicians registered in the Department of Human Resources of the Ministry of Health. Through a simple descriptive statistical analysis, using the software SPSS 20, a detailed characterization of the attributes of the force Cape Verdean medical work during the study period, which involves the rate of growth and specialization, training sites, their distribution by country or predicting the retirement of doctors. Study 2 – The emergence and expansion of medical education in the context of cooperation among CPLP Member States – allowed to visualize the support framework for the training of Cape Verdean physicians and to foresee the expansion of partnerships for local medical education and for the development of postgraduate training capability. It is a documentary analysis and a narrative review of the literature on bilateral and multilateral cooperation in medical education in Africa, particularly in CPLP member countries, highlighting the multiple dimensions of such collaboration as research, collaborative networking, regulation of teaching Support for medical degrees. Also, does provide the conversion of this cooperation in a South-North-South triangular approach, set in the Strategic Plan for Cooperation in Health (PECS / CPLP). This approach, involving African countries, Brazil and Portugal, can support local medical education initiatives and the development of postgraduate training capacity in countries as part of an important strategy to help retain physicians. Study 3 – Examination of perceptions, supports and resistances of several fringes of Cape Verdean society on the implementation and development of local medical education – identified the essential elements of the recasting of medical education policy in CV, recognized as an education and health policy, but formulated with the commitment of various actors, organizations and institutions with responsibility for the design and implementation of follow-up actions. The findings reflect consensual support for the establishment of national medical education, but call for confirmation of the institutional developments necessary for the viability and affirmation of national medical education begun in 2015. It is a qualitative study that results from the analysis of interviews with key decision-makers, personalities from the political sphere and from areas related to health and education, and physicians through semi-structured interviews, focus group discussions (GF), as well as documentary analysis News in the Cape Verdean media about the installation of local medical teaching. The study 4 – The opinion of the students of the 1st year of the medical teaching course at the University of Cape Verde (Uni-CV) – allowed to study the profile of the students and identify their satisfaction with the academic process, main difficulties, expectations concerning the future medical practice, information that allows adjusting the teaching process initiated. It is a qualitative study, due to the beginning of the medical course at the University of Cape Verde in 2015, conducted by the initiating of medical school in 2015, through a semi-structured survey addressed to the first students of medical school. The data were inserted in Excel (2013), worked by SPSS 23 and object of a simple descriptive statistical analysis. The General Discussion was made in the third part of the thesis, following the reference frame of Janicek (2010). He remembered the overall goal of research and synthesized the results and discussions produced in each of the articles. The results presented reflect consensual support for the installation of medical education in Cape Verde. Recognize its relevance. Show that they are not satisfied or secured all the conditions for successful teaching installed in 2015 by that decision exceeded the fulfillment of the preconditions. Identifying the most important processes for sustainability, they call for the confirmation of the institutional developments necessary for the viability and affirmation of medical education in the national context. They identify some of the limitations that need to be addressed by creating the conditions to meet best practices identified in other medical teaching experiences in Africa and small island states. Key words: Cape Verde, Medical Education, Medical Students, Medical Education Policy, Vulnerabilities.
Descrição
Palavras-chave
Saúde pública Educação médica Cabo Verde
Contexto Educativo
Citação
Editora
Instituto de Higiene e Medicina Tropical