Become capable of communicating based on theoretical foundations, including |
( theoretical frameworks and models of the Humanities, Social Sciences and Health on communication and human relationships, which include psychology and psychiatry; |
( scientific evidence on communication in health; |
( principles and guidelines of the Unified Health System (SUS)6464. Brasil. Lei nº 8.080, de 19 de setembro de 1990. Dispõe sobre as condições para a promoção, proteção e recuperação da saúde, a organização e o funcionamento dos serviços correspondentes e dá outras providências. Diário Oficial da União ; 20 set 1990. and public health policies |
( professionalism and its components5252. Medical Professionalism Project. Medical professionalism in the new millennium: a physicians’ charter. Lancet . 2002;359(9305):520-2.)-(5656. Rabow MW, Remen RN, Parmelee DX, Inui TS. Professional formation: extending medicine’s lineage of service into the next century. Acad Med . 2010;85(2):310-7.; |
( history, culture, knowledges and practices of care and healing of the different social groups that constitute the Brazilian population; |
( understanding of Metadiscourse, especially concerning the process of production, circulation and legitimation of the structured language and normative conventional beliefs that value or devalue certain social groups8585. Hyland K. Metadiscourse: what is it and where is it going? JoP. 2017;113:16-29.),(8686. Jaworski A, Coupland N, Galasinski D. Metalanguage: social and ideological perspectives. Berlin: Walter de Gruyter; 2004.; |
( concepts and characteristics of constructs related to intra- and interpersonal communication, such as emotional intelligence8787. Goleman D, Boyatzis R, McKee A. O poder da inteligência emocional. Rio de Janeiro: Campus; 2002. and social skills8888. Del Prette ZAP, Del Prette AD. Psicologia das habilidades sociais: diversidade teórica e suas implicações. Petropólis: Vozes; 2009.; |
( forms of expression of verbal and non-verbal communication and characteristics for their effectiveness6060. Fortin VI AH, Dwamena FC, Frankel RM, Smith RC. Smith’s patient centered interviewing: an evidence-based method. 3rd ed. New York: McGraw Hill; 2012.),(6161. Chou C, Cooley L, editors. Communication RX: transforming healthcare through relationship-centered communication. New York: McGraw Hill ; 2018.),(8989. Hojat M. Empathy in health professions education and patient care. New York: Springer; 2016.),(9090. Lunenburg, FC. Louder than words: the hidden power of nonverbal communication in the workplace. IJ SAID. 2010;12(1):1-5.; |
( operational levels of verbal communication8686. Jaworski A, Coupland N, Galasinski D. Metalanguage: social and ideological perspectives. Berlin: Walter de Gruyter; 2004.),(9191. Craig RT. Metacommunication. In: Jensen KB, Rothenbuhler EW, Pooley JD, Craig RT, editors. The international encyclopedia of communication theory and philosophy. West Sussex: John Wiley & Sons. 2016. Doi:https://doi.org/10.1002/9781118766804.wbiect232. https://doi.org/10.1002/9781118766804.wb...
; |
( pragmatic communication and its characteristics9292. Watzlawick P, Beavin JH, Jackson DD. Pragmática da comunicação. São Paulo: Culturix; 2010.),(9393. Bosco FM, Tirassa M, Gabbatore I. Why pragmatics and theory of mind do not (completely) overlap. Front Psych. 2018;9:1453. Doi: https://doi.org/10.3389/fpsyg.2018.01453. https://doi.org/10.3389/fpsyg.2018.01453...
. |
Search, critically evaluate the literature and prepare and write documents adequately, becoming able to |
( recognize documents used in health care, medical education and health management; The documents include consultation files / physical and electronic medical records, exam request document, prescription, transfer report, discharge summary, reference and / or counter-reference form, compulsory notification, informed consent, living will, death certificate, notification of adverse events / errors, territorialization matrix/map, projects and documents for health education, reports and minutes in health care, among others; additionally, protocols, innovation and research projects, planning and resource management spreadsheets and health management contracts, among others; and, additionally, texts, narratives, reviews, scientific articles, abstracts, portfolios, presentations, extension and research projects in medical education, among others. - write the documents, filling out the necessary fields, in a clear, structured and organized way, with coherence and cohesion, without redundancy or ambiguity, in legible handwriting (when written by hand), using correct Portuguese and appropriate medical technical terms, when relevant; - include the name of the person in charge and, in health care documents, also the signature and stamp or digital certification of the professional; - update information as soon as possible in registration documents. |
( seek, organize and file information, with the help of information and communication; technologies (ICT), select relevant information through critical reading and prepare syntheses |
( critically analyze the information posted on social media, identify false information and fake news and provide arguments about its untruth, based on evidence; |
( develop research, extension and technological innovation projects with clear, structured, organized, coherent and cohesive writing, scientifically based and in correct Portuguese of the project, the Free and Informed Consent (FIC) form and/or Free and Informed Assent (FIA) form, of the partial and final report and of articles and abstracts; |
( recognize that plagiarism is characterized as a crime of ideological falsehood. |
Develop as a person (intrapersonal communication), with improvement of self-knowledge, adaptability, critical reflection and critical thinking, becoming capable of |
( cultivate their own - presence/mindfulness; - empathy; - resilience; - creativity; - curiosity and the ability to ask questions -- in everyday life to reflect and broaden perspectives and understand relationships in complex situations; -- to critically seek and evaluate scientifically-based information for clinical reasoning and responses to clinical situations; - capacity to debate; - assertiveness1919. World Health Organization. WHO patient safety curriculum guide: multi-professional edition. Geneva: WHO. 2011. Disponível em: Disponível em: https://www.who.int/publications/i/item/9789241501958 . Acesso 10 jan. 2021. [Marra VN, Sette ML, coordenadores. Guia curricular de segurança do paciente da Organização Mundial da Saúde: edição multiprofissional. Rio de Janeiro: Pontifícia Universidade Católica do Rio de Janeiro; 2016 [acesso em 10 jan. 2021]. Disponível em: https://cdn.who.int/media/docs/default-source/patient-safety/9788555268502-por519565d3-e2ff-4289-b67f-4560fcd33b9d.pdf?sfvrsn=9e58a092_1.] https://www.who.int/publications/i/item/...
),(2626. Omura M, Maguire J, Levett-Jones T, Stone TE. The effectiveness of assertiveness communication training programs for healthcare professionals and students: a systematic review. Intern J Nurs Stud. 2017;76:120-8.),(2727. O’Connor P, Byrne D, O’Dea A, McVeigh TP, Kerin MJ. “Excuse me”: teaching interns to speak up. Jt Comm J Qual Patient Saf. 2013;39(9):426-31.; |
( recognize one’s own emotions and emotional responses, and their influence on interpersonal relationships; |
( identify situations that may trigger strong emotions and anticipate contexts that may arouse them; |
( use strategies to manage their own emotions and seek support when needed; |
( promote and preserve one’s physical and mental balance with self-care and self-compassion; |
( recognize signs of overload and changes in one’s physical and mental health, including stress, anxiety, burnout and depression, seeking strategies to mitigate their causes and treat their diseases; |
( commit to learning to learn, to do, to be and to live together and develop progressive autonomy for learning; |
( recognize one’s own strengths, limitations, desires, expectations, concerns, fears, prejudices and communication style and their influence on interpersonal relationships, strengthening potentialities and seeking strategies to overcome limitations; |
( demonstrate critical thinking; |
( demonstrate the capacity to debate; |
( identify one’s prejudices and biases in clinical reasoning, which can affect the consultation and lead to diagnostic errors; |
( request feedback and receive it openly and flexibly to change one’s knowledge and practices |
( reflect on the ethical / bioethical challenges experienced and witnessed, with ethical and legal principles as a reference; |
( reflect on shared messages and attitudes witnessed throughout the training, understanding the socio-historical aspects that perpetuate the hidden curriculum and the power relations and prejudices, identifying the values consistent with professionalism that must be incorporated into the construction of one’s professional identity; |
( be co-responsible for - promoting strategies to change messages and attitudes not consistent with professionalism; - building an academic and work environment in health that promotes respect, ethics and sensitivity; |
( differentiate between simple and complex situations that lead to uncertainties; |
( deal with high levels of complexity and uncertainty, asking for support when necessary; |
( recognize one’s limits in academic performance and health work and seek support when necessary. |
Improve interpersonal communication, becoming able to |
( express oneself in meetings and individual or group presentations, in an ethical, sensitive, respectful, inclusive and non-prejudiced manner (non-racist, non-sexist, non-capacitist, non-LGBTQIA+phobic, non-xenophobic, among others), appropriate for the age, level of schooling and other characteristics of the target audience, through - clear, organized, logical, cohesive and coherent oral verbal communication, with an appropriate flow of information and balanced use of open and closed questions - legible written verbal communication (when written by hand), organized, with a logical sequence, coherent, cohesive, without ambiguity or redundancy; - nonverbal communication consistent with the verbal communication that shows respect and attention; -- using --- written and/or illustrated educational resources (such as images, drawings, diagrams, three-dimensional models), artistic-cultural creative material and audiovisual resources in a balanced manner to motivate, improve the sensitivity and facilitate the understanding of participants; --- interactive strategies to maximize the participation of those who are interested when communicating with families, social groups and the community; --- maximize people’s participation when their communication has limitations; -- demonstrating --- mastery of the Portuguese language spoken in Brazil; --- mastery of medical technical terms used in the academic-scientific environment; --- knowledge of the Brazilian Sign Language (LIBRAS, Linguagem Brasileira de Sinais) and other forms of inclusive communication, including alternative and extended communication (CAA, alternative and augmentative communication)9494. Elsahar Y, Hu S, Bouazza-Marouf K, Kerr D, Mansor A. Augmentative and alternative communication (AAC) advances: a review of configurations for individuals with a speech disability. Sensors. 2019;19(8):1911. Doi: https://doi.org/10.3390/s19081911. https://doi.org/10.3390/s19081911...
)-(9898. Gomes CA, Rugno FC, Rezende G, Cardoso RC, De Carlo MM. Tecnologia de comunicação alternativa para pessoas laringectomizadas com câncer de cabeça e pescoço. Medicina (Ribeirão Preto). 2016;49(5):463-74. and support systems for people with alterations in expressive or receptive communication9797. American Speech-Language-Hearing Association. Augmentative and Alternative Communication [acesso em 20 em 2022]. Disponível em: www.asha.org/Practice-Portal/Professional-Issues/Augmentative-and-Alternative-Communication/. www.asha.org/Practice-Portal/Professiona...
; --- knowledge of the language used in the different ethnicities and cultures of the Brazilian population and regions of Brazil (“communication geography”); --- knowledge of at least one foreign language, ideally the one that most often conveys medical scientific information; |
( adapt interpersonal communication to the method and channel / means of communication used, covering - face-to-face communication; - distance / virtual communication through ICT management, also considering -- when communicating asynchronously, --- being careful when writing messages to avoid misinterpretation; --- a shorter presentation time; -- when communicating synchronously, also considering --- the need for cultural sensitivity, encouraging dialogue, qualified listening, encouraging questions and the expression of concerns and fears, and an empathic and supportive response; --- technical, ethical and legal aspects of telehealth (teleconsultation / telecare) and other remote medical activities (telemedicine); --- the needs of the target audience and the characteristics of information to be conveyed in the media; |
( building and maintaining rapport; |
( perform qualified listening; |
( recognize and demonstrate respect and sensitivity to cultural diversity and to values and other unique characteristics of each person; |
( recognize verbal and non-verbal signals of emotions and respond with empathy and solidarity; |
( deal with strong emotions, anticipating them when there are signs of tension, understanding their origin, managing one’s own emotions, responding with sensitivity, empathy and solidarity and taking care of one’s own safety, seeking help when they feel they may be at risk; |
( provide respectful, constructive and appreciation feedback and accept feedback respectfully and with an openness to the change in attitudes and practices; |
( understand and recognize factors that influence interpersonal relationships, including the phenomenon of transference and countertransference; |
( recognize barriers and limitations that interfere with communication, consider the possibilities for their management, including their elimination, explain their existence and say that you will try to minimize their interference, search for interpreters or use other resources, including the CAA; |
( interact in a sensitive and respectful way and value the active participation of people who use CAA in the meeting; |
( in research projects, explain the FIC and FIA forms to participants in an ethical, clear and honest way and interact respectfully and ethically with research participants when collecting information and validating their results; |
( socialize knowledges in teaching, extension (including health care and health management activities) and in research; |
( work in an interdisciplinary and interprofessional collaborative way as a member and a leader, with clear language and openness to “different opinions and respect for the diversity of values, roles and responsibilities”3232. Brasil. Resolução CNE/CES nº 3, de 20 de junho de 2014. Institui Diretrizes Curriculares Nacionais do Curso de Graduação em Medicina e dá outras providências. Diário Oficial da União; 2014. and, in health care1919. World Health Organization. WHO patient safety curriculum guide: multi-professional edition. Geneva: WHO. 2011. Disponível em: Disponível em: https://www.who.int/publications/i/item/9789241501958 . Acesso 10 jan. 2021. [Marra VN, Sette ML, coordenadores. Guia curricular de segurança do paciente da Organização Mundial da Saúde: edição multiprofissional. Rio de Janeiro: Pontifícia Universidade Católica do Rio de Janeiro; 2016 [acesso em 10 jan. 2021]. Disponível em: https://cdn.who.int/media/docs/default-source/patient-safety/9788555268502-por519565d3-e2ff-4289-b67f-4560fcd33b9d.pdf?sfvrsn=9e58a092_1.] https://www.who.int/publications/i/item/...
; - include the person under care, their family members and caregivers as part of the team1919. World Health Organization. WHO patient safety curriculum guide: multi-professional edition. Geneva: WHO. 2011. Disponível em: Disponível em: https://www.who.int/publications/i/item/9789241501958 . Acesso 10 jan. 2021. [Marra VN, Sette ML, coordenadores. Guia curricular de segurança do paciente da Organização Mundial da Saúde: edição multiprofissional. Rio de Janeiro: Pontifícia Universidade Católica do Rio de Janeiro; 2016 [acesso em 10 jan. 2021]. Disponível em: https://cdn.who.int/media/docs/default-source/patient-safety/9788555268502-por519565d3-e2ff-4289-b67f-4560fcd33b9d.pdf?sfvrsn=9e58a092_1.] https://www.who.int/publications/i/item/...
; - take responsibility for the person under care and the continuity of their care; - subordinate one’s own interests to those of the person under care and the team for shared decision-making; - be responsible for the safety of the person under care, with special attention to processes with greater safety risk such as emergencies, procedures, changes in work shifts, transfers between sectors and institutions, relying on scripts and checklists to ensure effective communication1919. World Health Organization. WHO patient safety curriculum guide: multi-professional edition. Geneva: WHO. 2011. Disponível em: Disponível em: https://www.who.int/publications/i/item/9789241501958 . Acesso 10 jan. 2021. [Marra VN, Sette ML, coordenadores. Guia curricular de segurança do paciente da Organização Mundial da Saúde: edição multiprofissional. Rio de Janeiro: Pontifícia Universidade Católica do Rio de Janeiro; 2016 [acesso em 10 jan. 2021]. Disponível em: https://cdn.who.int/media/docs/default-source/patient-safety/9788555268502-por519565d3-e2ff-4289-b67f-4560fcd33b9d.pdf?sfvrsn=9e58a092_1.] https://www.who.int/publications/i/item/...
),(9999. Agency for Healthcare Research and Quality. TeamStepps 2.0, Team Strategies & Tools to Enhance Performance and Patient Safety: Pocket guide. AHRQ Pub. No. 14-0001-2. Revised December 2013 [acesso em 10 set 2021]. Disponível em: Disponível em: https://www.ahrq.gov/sites/default/files/publications/files/pocketguide.pdf . https://www.ahrq.gov/sites/default/files...
; - manage/mediate conflicts1919. World Health Organization. WHO patient safety curriculum guide: multi-professional edition. Geneva: WHO. 2011. Disponível em: Disponível em: https://www.who.int/publications/i/item/9789241501958 . Acesso 10 jan. 2021. [Marra VN, Sette ML, coordenadores. Guia curricular de segurança do paciente da Organização Mundial da Saúde: edição multiprofissional. Rio de Janeiro: Pontifícia Universidade Católica do Rio de Janeiro; 2016 [acesso em 10 jan. 2021]. Disponível em: https://cdn.who.int/media/docs/default-source/patient-safety/9788555268502-por519565d3-e2ff-4289-b67f-4560fcd33b9d.pdf?sfvrsn=9e58a092_1.] https://www.who.int/publications/i/item/...
),(9999. Agency for Healthcare Research and Quality. TeamStepps 2.0, Team Strategies & Tools to Enhance Performance and Patient Safety: Pocket guide. AHRQ Pub. No. 14-0001-2. Revised December 2013 [acesso em 10 set 2021]. Disponível em: Disponível em: https://www.ahrq.gov/sites/default/files/publications/files/pocketguide.pdf . https://www.ahrq.gov/sites/default/files...
with assertiveness and non-violent communication7575. Rosenberg MB. Comunicação não violenta: técnicas para aprimorar relacionamentos pessoais e profissionais. 3ª ed. São Paulo: Ágora; 2006., aiming to -- reach a consensus when there are differing opinions in teamwork; -- address errors and behaviors that jeopardize the safety of the person under care; - when acting in leadership, additionally1919. World Health Organization. WHO patient safety curriculum guide: multi-professional edition. Geneva: WHO. 2011. Disponível em: Disponível em: https://www.who.int/publications/i/item/9789241501958 . Acesso 10 jan. 2021. [Marra VN, Sette ML, coordenadores. Guia curricular de segurança do paciente da Organização Mundial da Saúde: edição multiprofissional. Rio de Janeiro: Pontifícia Universidade Católica do Rio de Janeiro; 2016 [acesso em 10 jan. 2021]. Disponível em: https://cdn.who.int/media/docs/default-source/patient-safety/9788555268502-por519565d3-e2ff-4289-b67f-4560fcd33b9d.pdf?sfvrsn=9e58a092_1.] https://www.who.int/publications/i/item/...
, -- contribute to the construction and strengthening of the bond and cohesion of the team and of a collaborative environment that promotes a “team spirit”; -- agree with and clarify one’s own role and function and that of other team members; -- coordinate and facilitate the rapid and regular flow of information relevant to teamwork -- encourage the sharing of ideas, perspectives and concerns, listening carefully to everyone and agreeing on decisions; -- provide appreciation feedback and request it on a regular basis; -- organize and coordinate meetings and keep up-to-date records; -- monitor the work situation, including psychological and social aspects that influence it and balance each member’s workload; -- mobilize resources to enhance team performance; -- plan and organize team improvement/training activities. |
Additionally, in health care, the student must become able to |
( communicate in the different stages and processes of the clinical encounter at all levels, scenarios and processes of health care and dimensions of care, focusing on relationships and empowering people under care and their families / caregivers, as described in Figure 1; The scenarios include the home, outpatient clinic/office, urgent/emergency care sectors, wards, intensive care unit and palliative care, surgery and recovery room, institutional therapeutic spaces, community spaces, institutions where people with certain characteristics and needs live, such as nursing homes and orphanages, among others. The processes include consultation, embracement (both users receiving care on demand, and listening to them when referring to health services and actions), home visits, territorialization, exceptional therapeutic team project in contexts of vulnerability, matrix support (specialized technical support offered to the interprofessional team, to qualify their actions in health), coordination of health promotion groups, surgical and non-surgical procedures, health education, change of work shift, transfer of care between sectors and units, planning of advanced care, family talk and conference / medical report, risk communication and team meetings, among others. - adapt the encounter and communication to -- age group [neonatal, infants, preschool and schoolchildren, adolescents, adults and the elderly]; -- stage of the life cycle (from pregnancy and birth to aging and the dying process); -- specialty; -- cultural aspects, literacy, perspectives, needs, expectations and preferences of the person under care, their family members and/or caregivers; - approach in a respectful, ethical and sensitive manner -- meetings with people under care and with families on home visits; -- the sexuality of the person under care, conducting the meeting according to their choices and needs; -- the experiences of the person under care regarding social, ethnic, racial and cultural aspects, knowing and recognizing their perspectives and values; -- spirituality, if the person under care so desires; -- people under care who have symptoms with no organic explanation, understanding their biopsychosocial context and their possible causes; -- people in situations of violence, including bullying, neglect and physical violence, dealing with their own emotions, responding with empathy and solidarity, empowering and promoting the autonomy of the person under care, and seeking psychological and social support and taking the necessary measures; - build shared singular therapeutic projects, encouraging self-care and the “autonomy of individuals, families, groups and communities and recognizing users as active protagonists of their own health”3232. Brasil. Resolução CNE/CES nº 3, de 20 de junho de 2014. Institui Diretrizes Curriculares Nacionais do Curso de Graduação em Medicina e dá outras providências. Diário Oficial da União; 2014.; - carry out matrix support activities, considering the knowledge of each team member; |
( communicate in specific contexts (Figure 2), which encompass several processes, among them, but not exclusively, - health risk situations to the person under care; - motivational interview, to identify the stage of behavioral change of the person under care, their degree of confidence and conviction to change, as well as the potentials and challenges perceived by them; - change of habits according to the person’s willingness to change; - health risk behaviors, with their identification, approach when present and agreement on a therapeutic plan; - management of uncertainties about the diagnosis, best therapeutic option, prognosis and other aspects of care, sharing them with sincerity and sensitivity to the person under care and to family members / caregivers and team members, demonstrating willingness to seek support for decision making, recognizing one’s own emotions and responding with empathy to the emotions of the people present at that moment1919. World Health Organization. WHO patient safety curriculum guide: multi-professional edition. Geneva: WHO. 2011. Disponível em: Disponível em: https://www.who.int/publications/i/item/9789241501958 . Acesso 10 jan. 2021. [Marra VN, Sette ML, coordenadores. Guia curricular de segurança do paciente da Organização Mundial da Saúde: edição multiprofissional. Rio de Janeiro: Pontifícia Universidade Católica do Rio de Janeiro; 2016 [acesso em 10 jan. 2021]. Disponível em: https://cdn.who.int/media/docs/default-source/patient-safety/9788555268502-por519565d3-e2ff-4289-b67f-4560fcd33b9d.pdf?sfvrsn=9e58a092_1.] https://www.who.int/publications/i/item/...
; - difficult news100100. Baile WF, Buckman R, Lenzi R, Glober G, Beale EA, Kudelka AP. SPIKES-A six-step protocol for delivering bad news: application to the patient with cancer. Oncologist. 2000;5:302-11.)-(103103. Narayanan V, Bista B, Koshy C. BREAKS protocol for breaking bad news. IJPC. 2010;16(2):61-5.; - error / adverse event management, including1919. World Health Organization. WHO patient safety curriculum guide: multi-professional edition. Geneva: WHO. 2011. Disponível em: Disponível em: https://www.who.int/publications/i/item/9789241501958 . Acesso 10 jan. 2021. [Marra VN, Sette ML, coordenadores. Guia curricular de segurança do paciente da Organização Mundial da Saúde: edição multiprofissional. Rio de Janeiro: Pontifícia Universidade Católica do Rio de Janeiro; 2016 [acesso em 10 jan. 2021]. Disponível em: https://cdn.who.int/media/docs/default-source/patient-safety/9788555268502-por519565d3-e2ff-4289-b67f-4560fcd33b9d.pdf?sfvrsn=9e58a092_1.] https://www.who.int/publications/i/item/...
-- identifying areas prone to their occurrence; -- recognizing the ethical and legal issues related to its disclosure; -- meeting with the team and authorities involved to reflect and discuss what happened and why the adverse event happened, focusing on the task and not on the people; -- recording the adverse event in a specific form, with justification; -- planning measures to ensure that the mistakes that were made are not made again -- providing support to the team; -- disclosing the incident to the people under care, family members / caregivers and other people who respond for them in an ethical, respectful, sincere, objective way, without a defensive posture, demonstrating that one regrets what happened, recognizing the suffering it generated, sharing information and in clear language, without technical terms, following the process of communicating difficult news and explaining what happened and its causes, what is expected, the resources mobilized to support the affected people, how its investigation was and is being carried out and the measures being taken so that it does not occur in the future; - crises, emergencies and disasters104104. Organização Mundial da Saúde. Comunicação eficaz com a mídia durante emergências de saúde pública: um manual da OMS. Brasília: Ministério da Saúde ; 2009. [Tradução de: WHO. Effective Media Communication during Public Health Emergencies: a WHO Handbook; 2007.] [acesso em 20 jan 2022]. Disponível em: https://bvsms.saude.gov.br/bvs/ razilian o/ razilian o_eficaz_midia_durante_emergencias.pdf. https://bvsms.saude.gov.br/bvs/ razilian...
)-(111111. Secretaría Interinstitucional de la Estrategia Internacional para la Reducción de Desastres, Naciones Unidas. Vivir con el riesgo: informe mundial sobre iniciativas para la reducción de desastres. Genebra: ONU; 2004. -- act fast, effectively communicating with the health team, with responsibility for the safety of the person under care; -- plan and carry out risk communication for different audiences, recognizing and valuing the media as one of the main opportunities to communicate with the public, whose processes are well detailed in manuals and guides from international and national institutions104104. Organização Mundial da Saúde. Comunicação eficaz com a mídia durante emergências de saúde pública: um manual da OMS. Brasília: Ministério da Saúde ; 2009. [Tradução de: WHO. Effective Media Communication during Public Health Emergencies: a WHO Handbook; 2007.] [acesso em 20 jan 2022]. Disponível em: https://bvsms.saude.gov.br/bvs/ razilian o/ razilian o_eficaz_midia_durante_emergencias.pdf. https://bvsms.saude.gov.br/bvs/ razilian...
)-(111111. Secretaría Interinstitucional de la Estrategia Internacional para la Reducción de Desastres, Naciones Unidas. Vivir con el riesgo: informe mundial sobre iniciativas para la reducción de desastres. Genebra: ONU; 2004.; -- recognize signs of overload, stress and moral distress and seek support to deal with their consequences; - intensive/critical care, with frequent sharing of information, in a respectful, empathetic and sincere manner -- with the person under care, to update them on their health conditions, keep them in contact with the external reality and encourage their participation in decision-making within their reach112112. Corrêa M, Del Castanhel F, Grosseman S. Percepção de pacientes sobre a comunicação médica e suas necessidades durante internação na unidade de cuidados intensivos. Rev Bras Ter Intensiva. 2021;33:401-11.)-(114114. Scheunemann LP, McDevitt M, Carson SS, Hanson LC. Randomized, controlled trials of interventions to improve communication in intensive care: a systematic review. Chest. 2011;139(3):543-54., using CAA115115. Ju XX, Yang J, Liu XX. A systematic review on voiceless patients’ willingness to adopt high-technology augmentative and alternative communication in intensive care units. Intens Crit Care Nurs. 2021;63:102948.),(116116. Ten Hoorn S, Elbers PW, Girbes AR, Tuinman PR. Communicating with conscious and mechanically ventilated critically ill patients: a systematic review. Crit Care. 2016;20(1):1-14., when they are intubated, tracheostomized or with other barriers and limited speech; -- with family members, caregivers and loved ones at a family conference / “medical report”, preferably in a private place, encouraging their active participation in the meeting117117. Seaman JB, Arnold RM, Scheunemann LP, White DB. An integrated framework for effective and efficient communication with families in the adult intensive care unit. Ann Am Thorac Soc. 2017;14(6):1015-20.)-(119119. Brooks LA, Bloomer MJ, Manias E. Culturally sensitive communication at the end-of-life in the intensive care unit: a systematic review. Austr Crit Care . 2019;32(6):516-23.; - palliative and end-of-life care, additionally120120. Carvalho RT, Parsons HÁ, organizadores. Manual de cuidados paliativos ANCP. 2ª ed. São Paulo: Academia Nacional de Cuidados Paliativos; 2012 [acesso em 20 jan 2022]. Disponível em: file:///G:/Documents/Habilidades_comunicacao/2022/manual_de_cuidados_paliativos_ancp.pdf.)-(124124. Schrijvers D, Cherny NI. ESMO Clinical Practice Guidelines on palliative care: advanced care planning. Ann Oncol. 2014;25:iii138-iii42., -- share information about health conditions and the lack of perspective of therapeutic cure in a sincere manner, using the steps for the communication of difficult news -- when there is a transfer to a palliative care unit, explain clearly and sincerely about its reason; -- talk about what the person under care wants to talk about or address, including their desires, their spirituality, information about the dying process, and other issues brought up by their families and/or loved ones; -- coordinate the planning of advanced care, together with the person under care, their families and/or loved ones and the members of the health team, agreeing on the place where they want to be cared for, the type of care they want to receive, if the situation gets worse, and record it; - when asking about the intention to donate organs, demonstrate sensitivity and solidarity with the grieving process of family members/caregivers, responding to emotions with empathy, and showing respect and understanding when consent is denied125125. Knox K, Parkinson J, Pang B, Fujihira H, David P, Rundle-Thiele S. A systematic literature review and research agenda for organ donation decision communication. PIT. 2017;27(3):309-20.),(126126. Jacoby L, Crosier V, Pohl H. Providing support to families considering the option of organ donation: an innovative training method. PIT . 2006;16(3):247-52.; |
( effectively communicate in processes and actions aimed at collective health3232. Brasil. Resolução CNE/CES nº 3, de 20 de junho de 2014. Institui Diretrizes Curriculares Nacionais do Curso de Graduação em Medicina e dá outras providências. Diário Oficial da União; 2014., including - health promotion groups; - “health diagnosis and problem prioritization [...] by investigating the health needs of groups of people and the living and health conditions of communities, identifying their risk and vulnerability based on “the political, cultural, institutional discrimination, socioeconomic, and environmental context and of the relationships, movements and values of populations in their territory” and on “biological, psychological, socioeconomic and cultural aspects related to illness and vulnerability” and the coping strategies3232. Brasil. Resolução CNE/CES nº 3, de 20 de junho de 2014. Institui Diretrizes Curriculares Nacionais do Curso de Graduação em Medicina e dá outras providências. Diário Oficial da União; 2014.; - “discussion and construction of intervention projects in social groups [...] always considering their autonomy and cultural aspects”, encouraging the “inclusion of health promotion and education actions [...] and encouraging the “inclusion of perspective of other professionals and representatives of social segments involved in the creation of health projects” (3232. Brasil. Resolução CNE/CES nº 3, de 20 de junho de 2014. Institui Diretrizes Curriculares Nacionais do Curso de Graduação em Medicina e dá outras providências. Diário Oficial da União; 2014.; - “development of plans directed at prioritized problems” and implementation of actions3232. Brasil. Resolução CNE/CES nº 3, de 20 de junho de 2014. Institui Diretrizes Curriculares Nacionais do Curso de Graduação em Medicina e dá outras providências. Diário Oficial da União; 2014.; - “planning and evaluation of projects and actions within the scope of the Unified Health System” [...] aimed at improving collective health3232. Brasil. Resolução CNE/CES nº 3, de 20 de junho de 2014. Institui Diretrizes Curriculares Nacionais do Curso de Graduação em Medicina e dá outras providências. Diário Oficial da União; 2014.. |
Additionally, in health management, the student must become able to |
( focus on relationships when organizing, monitoring and evaluating people and actions in health work and teaching-service integration; |
( embrace users, families, social groups and the community, listening to their perspectives |
( make decisions including listening to users, families, social groups, community and health team members; |
( coordinate, create and implement intervention plans “together with users, social movements, health professionals, health sector managers and also from other sectors” (3232. Brasil. Resolução CNE/CES nº 3, de 20 de junho de 2014. Institui Diretrizes Curriculares Nacionais do Curso de Graduação em Medicina e dá outras providências. Diário Oficial da União; 2014.; |
( develop “scientific, technological and innovation development” projects, encouraging the participation and creativity of members of the interprofessional team(s) and the community3232. Brasil. Resolução CNE/CES nº 3, de 20 de junho de 2014. Institui Diretrizes Curriculares Nacionais do Curso de Graduação em Medicina e dá outras providências. Diário Oficial da União; 2014.; |
( participate “in formal spaces for collective reflection on the work process [...] and intervention plans” (3232. Brasil. Resolução CNE/CES nº 3, de 20 de junho de 2014. Institui Diretrizes Curriculares Nacionais do Curso de Graduação em Medicina e dá outras providências. Diário Oficial da União; 2014.);
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( develop the diagnosis of the territory in a participatory way, together with the team professionals, local leaders and members of the community3232. Brasil. Resolução CNE/CES nº 3, de 20 de junho de 2014. Institui Diretrizes Curriculares Nacionais do Curso de Graduação em Medicina e dá outras providências. Diário Oficial da União; 2014.; |
( disseminate the diagnosis of the territory among users, families, social groups, community and team members and agree with them on strategies to improve the reality3232. Brasil. Resolução CNE/CES nº 3, de 20 de junho de 2014. Institui Diretrizes Curriculares Nacionais do Curso de Graduação em Medicina e dá outras providências. Diário Oficial da União; 2014.; |
( develop and/or participate in existing movements and projects to improve health and social conditions, at the local, regional, national and international levels3232. Brasil. Resolução CNE/CES nº 3, de 20 de junho de 2014. Institui Diretrizes Curriculares Nacionais do Curso de Graduação em Medicina e dá outras providências. Diário Oficial da União; 2014.. |