The Experience of Family Medicine Interns Conducting McGill ILLNESS Narrative Interview with Non-Compliant Chronic Patients

Abstract

Despite several governmental policies with the purpose of changing medical training in Brazil, it is still predominantly hospital-centered, and the learning process is focused on diseases. We conducted a study in a traditional medical school, in which the students carried out an interview focused on the illness experience assessing chronic patients with compliance difficulties in the treatment of hypertension and/or diabetes in primary care. Fourteen medical students during the Family Medicine Internship at the Federal University of Rio de Janeiro were trained to carry out the McGill Illness Narrative Interview (MINI) and identify the modes of understanding and attribution of meaning to the illness and treatment experience. Before and after the completion of the set of 35 interviews, the students were listened to individually regarding their understanding of the compliance phenomenon and the experience with the MINI. The 35 interviews conducted by the students were analyzed with respect to the objectives of each section, in addition to interviewer’s general objective of offering a position of expertise to the patient in their report of the case. We sought to investigate the consistency of the student’s experience with this script to obtain the narrative of illness using conceptual topics – prototypes and explanatory models – and the emerging topics identified according to the technique described by Bardin for content analysis. In the analysis of the interviews conducted by the researcher with the interns at the beginning and the end of their internship, the content analysis consisted of two main themes: clinical understanding and experience with the non-compliance phenomenon, and the appreciation of performing the MINI in the context of medical training. The students considered the MINI a useful tool for understanding and exploring the individuals’ illness and their treatment experiences in their socioeconomic and cultural context. By recognizing the importance of the MINI, the interns usually reported few learning opportunities while providing care for patients. Although the students had previously recognized the importance of listening and the development of bonds, they did not know how these issues could be built, and the experience increased their confidence in the healthcare provided to patients in their medical daily life. The students noticed that non-compliance involved multiple factors, which did not usually emerge during regular medical appointments. In fact, there was more understanding about the compliance phenomenon.

A abordagem da medicina narrativa no processo de ensino-aprendizagem nas graduações das profissões da saúde

“…A MN é considerada como uma metodologia de ensino que apenas apresenta resultados subjetivos aos estudantes envolvidos. De fato, a grande maioria dos artigos avaliados nesta revisão refere-se a estudos qualitativos 17,[23][24][25]29,34,35 .…”

“…Fundamentadas nisso, surgem pesquisas como a de Bastos et al 35 que buscam entender os impactos do uso de entrevistas semiestruturadas tanto para a abordagem de doenças crônicas quanto para a formação de 14 internos em rotação de medicina de família e comunidade da Universidade Federal do Rio de Janeiro (UFRJ). Observou-se que, segundo os estudantes que utilizaram a MINI, a estratégia foi útil para entender o processo de adoecimento, adesão e tratamento desses indivíduos, bem como para desenvolver habilidades voltadas à abordagem do sujeito adoecido.…”

Tornando-se médicos e médicas na comunidade

“…Estudos sobre a escrita reflexiva 223 e o uso da medicina narrativa 224 para acessar a dimensão contextual do cuidado 225 são exemplos do uso de abordagens qualitativas em pesquisas no internato médico, e tem sido cada vez mais utilizados em pesquisa em educação médica no Brasil 226 , embora nesta revisão parte expressiva dos estudos seja de momentos anteriores ao internato 227,228,229 . Ao explorar as narrativas reflexivas e os diálogos nos grupos focais, esta tese é pioneira em uma abordagem interpretativa da experiência de aprendizado e socialização no ambiente de trabalho dos internos em um internato integrado e longitudinal na APS brasileira, em especial após as mudanças instituídas pelas Diretrizes Curriculares Nacionais para o curso de medicina de 2014.…”