A "necessidade social" de uma nova escola médica : análise no contexto regional.

Abstract

This thesis presents a study on the social needs for new medical schools in regional environment. We talk about the human resource training policy for the SUS (public health services) and its materialization in a particular region in the interior of State of Rio Grande do Sul. We point out assumptions and contradictions in the arguments of Higher Education Institutions, the medical representative bodies and the Federal Government regarding the justification of social need (or not) of more doctors in several Brazilian cities. We show that it is possible to justify opening or not a medical school depending on the creativity of someone speech in the same context and based on the concept of social needs. The problem under analysis was synthesized in one question: how the implementation of a medical school can solve the challenges and contradictions that comes from training and provision of medical services for the SUS in its coverage area? Using an evaluative research, our purpose was (1) highlight the contradictions and interests involved in the definition of what is social need in the context of opening a new medical school; (2) to analyze the relevance of opening a medical school in the formation and distribution of medical professionals in its coverage area; (3) analyze the contradictions, opportunities and challenges that come from the implementation of a new medical school in the regional context, from the justification of "social needs". Using quantitative and qualitative data from the questionnaires, interviews and document analysis, we carried out a thematic analysis of the data, focusing the research sometimes in the health field and sometimes in education field but always noting the interdisciplinary connections between them; this is the social reality: synthesis of multiple determinations, along time and space, configured from subjects, alive and dialectically changeable. Anchored in the evaluation methodology by triangulation methods, we defined sources and possible indicators to understand our object of study - the medical school - assuming its condition of social project. It was defined indicators for the evaluation of the structures, processes and results, in this case, the formation of new doctors and the relationships established with government training policies, as well as the regional approach to professional practice. We emphasize that the opening of the medical school generates expectation in the municipalities of its area. However, most services are done only in the county where the course is based. At least half of the graduates don't intend to work in the region because, among other reasons, most of the students comes from municipalities of other regions and returns to there. However, an important fact is the significant increase in the number of doctors and the number of health facilities in the region, after the opening of a medical school, especially when the project of the same is also related to the provision of medical residency programs and qualification services of a teaching hospital. Analysis of the "social need" for a new medical school in the regional context should consider this school deployment phenomenon as a social project, set in a network of relationships and the midst of contradictions and possibilities.