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Teaching and learning, based on theories and practices of Primary Health Care (APS) at the Faculdade de Medicina da Universidade de São Paulo (FMUSP), provide the institution's students with a broad, active and critical experience, so that everyone is prepared to face the challenges imposed by the labor market.

Currently, the practical classes of the FMUSP Primary Care Program are offered to students in the last years of Undergraduate and/or Graduate. The activities are carried out in 10 Basic Health Units (UBSs), located in the city of São Paulo, with the participation of 180 students and 21 academic supervisors. The courses that normally include Primary Health Care as an internship field are: Process Health, Illness and Care – first year; Outpatient Practices – third year; APS Pre-Internship – fourth year; and APS Internship – fifth year. Medical students from the first to third year of Undergraduate courses have been taking classes in the online modality. “Due to the need for social distancing, the teaching-learning process was readjusted to minimize potential damages imposed by the replacement of practical internships by remote learning”, explains Dr. Mariana Eri Sato, Technical-Administrative Supervisor of the Primary Care Program at FMUSP

In 2020, common and specific contents about different professional categories were produced with the capture of images and videos made at UBSs by academic supervisors, for pedagogical purposes. This project was planned by the FMUSP APS Teaching Subcommittee, under the coordination of Profa. Ana Carolina Basso Schmitt, from the Department of Physiotherapy, Speech Therapy and Occupational Therapy. In total, 13 videos were completed and made available for distance classes, which show the practice and processes of health professionals in PHC, covering the work of the community health agent, social assistance, nursing consultations, medical consultations, work of the physiotherapist, management and others. The interdisciplinary work of content production for distance learning relied on collaboration between professors, academic supervisors and teaching professionals from the UBSs.

Another initiative of the PHC Teaching and Research Subcommittee was the holding of three optional virtual forums for students and health professionals, with the themes: "Possibilities of interprofessional work in the context of the pandemic", "Anti-racism in health care" and "The practice of the national health policy for the black population”.

In the context of the Covid-19 pandemic, it is evident that the health area needs multidisciplinary teams, technological tools and whose knowledge is shared, in order to promote an improvement in the quality of life and excellence in the care of people. The demand is for qualified professionals with high capacity to solve the most prevalent health problems in the population, who work with access, integrality, longitudinality and coordination of care. “Above all, that they have an attention focused on the person, aligned with a greater degree of resolvability and sustainability, with effective use of available resources. In view of this, FMUSP makes practical teaching possible in the municipal network of the Unified Health System (SUS), guided by the attributes of the PHC”, says Dr. Mariana Sato.

In the FMUSP Academic Health System and Hospital das Clínicas (HC), which is the oldest Brazilian university health system and the largest in Latin America, the main objective is to offer teaching, research, assistance and cultural and extension activities, with emphasis on multidisciplinarity and multi-institutionality. The specialized units of the Extension Service for the Care of HIV/AIDS Patients, the Escola Butantã Health Center and the Basic Health Units provide care with a view to primary care. Medium complexity cases, categorized as secondary care, are carried out at the University Hospital of USP. And, tertiary/quaternary care is developed at the Hospital das Clínicas at FMUSP, which is also a reference in severe cases.

Structuring and expansion of PHC teaching at FMUSP

At the Faculdade de Medicina at USP, teaching PHC has a solid and long-standing foundation. In 2003, an interdepartmental and cross-curricular program was established, with the adhesion of the Departments of Preventive Medicine, Internal Medicine, Pediatrics, Gynecology and Obstetrics, for the creation of a pedagogical project for the Teaching of Primary Health Care in the institution. Since then, different strategies have been developed to provide practical PHC internships in the SUS municipal health network.

In 2016, the APS Teaching Subcommittee, created by the FMUSP Board of Directors, was regulated as an instance linked to the Undergraduate Committee. Also this year, FMUSP's Board of Directors implemented the Primary Health Care Program, responsible for operationalizing practical teaching activities in UBSs in line with the deliberations of the PHC Teaching Subcommittee. Initially, the PHC Program at FMUSP was composed of the supervisor, management assistant and five teaching and research professionals responsible for organizing the internships and academic supervision. “Later, the strategy of linking certain physicians from health units with FMUSP scholarships was adopted. This process ensured the expansion of the PHC Program team and represented an advance in the integration between the Faculty of Medicine and the services", said Dr. Mariana Sato. She also adds: “this process guaranteed the expansion of the PHC teaching platform and represented an advance in the integration between the Faculty of Medicine and the services”.

 A partnership was established between USP and the Municipal Health Secretariat (SMP) of São Paulo, in 2017, through the signing of the Public Education-Health Action Organizational Contract (COAPES), which aimed to strengthen the integration between education and assistance in SUS health services. In January 2020, at the request of the SMP for the University of São Paulo to be represented on the COAPES Municipal Management Committee, the COAPES USP Management Committee was regulated, composed of members appointed by the Graduate Committees of all units of the University that offer internships in the municipal health network. Since then, it has been chaired by Prof. Itamar de Souza Santos, from the Department of Clinical Medicine at FMUSP, and linked to the Dean of Graduation. This committee holds monthly meetings and works to promote integration and alignment between the units, with the purpose of forming an institutional representation competent in strengthening relations with the city hall and developing integrated actions between teaching and assistance.



                                                                                      Creation of management bodies for structuring the APS teaching at FMUSP

"The functioning of the Teaching and Research Subcommittee and the APS Program, the consolidation of the partnership with the City of São Paulo from the effective participation in COAPES (initially via the regional committee and later via the municipal committee, through USP representation) and the investment in human resources for technical supervision provided the expansion of the practical teaching of APS at FMUSP, says Dr. Mariana Sato. In fact, the FMUSP PHC Program received a positive evaluation by the Federal Council of Medicine, during the Accreditation System for Medical Schools (SAEME), carried out in 2020. The PHC internship field was considered useful and of good quality, in addition to receive the recommendation for the extension of the workload.



                                                                                      Expansion of the PHC Teaching Platform at FMUSP






                                                                                         Dr. Mariana Sato, Technical-Administrative Supervisor of the Primary Care Program at FMUSP