Improving the Quality of Residency Programs in Family and Community Medicine

Ribeiro, Lucas Gaspar; Cyrino, Eliana Golbfarb; Pazin-Filho, Antônio

doi:10.11606/s1518-8787.2023057004822

Brasil

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Original Article • Rev. Saúde Pública 57 • 2023 • https://doi.org/10.11606/s1518-8787.2023057004822 linkcopy

Improving the Quality of Residency Programs in Family and Community Medicine

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

OBJECTIVE To develop and present an instrument to evaluate and monitor the quality of medical residency programs in residencies in family and community medicine (FCM) based on preceptors and residents, considering the insertion of the health network program.

METHOD The instrument was developed in three stages: 1) interview with the preceptors of FCM; 2) literature review; and 3) production, adequacy, and approval of the evaluation instrument by renowned professionals of the Brazilian FCM. The third stage included 9 people and used the Delphi technique with 80% agreement. For the qualitative results, Bardin’s Content Analysis was used.

RESULTS In all, there were five evaluation cycles to adapt the proposed recommendations, with the elimination of one item and weighting, with a results analysis methodology of 10 resulting items, reaching an expected matrix for organizing residency programs in the health network, divided into 3 domains: Organization of the Unit, Human Resources, and Preceptor-resident relationship.

CONCLUSION An instrument for evaluating and monitoring residency programs in family and community medicine can be a tool to facilitate program managers and allow evaluation and monitoring, continuously qualifying them.

Family and Community Medicine; Boarding and Residency; Evaluation of Research Programs and Instruments

Desirable matrix in the program	How to organize and evaluate the criterion	Note
Hiring professionals already with a minimum period of assistance prior to preceptorship work (“flight hours”).	Number of family and community medical professionals with at least 3 years of experience before becoming a preceptor.	Excluded in cycle 2, 44.4% of the judges agreed to maintain this criterion, thus, it was excluded for not reaching 80% agreement to maintain. Also suggested to take out in the comments due to the low number of professionals specializing in FCM in 2021.

Desirable matrix in the program	How to organize and evaluate the criterion	Number of evaluation cycles (1–5) and weighting defined by the judges (8–10)
A. 1. Adequacy of the unit’s physical space for work.
A.1.1 Number of offices suitable for the entire team in service, without the need for rotations during the periods that the resident is in consultation. Considering that they also has activities outside the office.	At least one office per professional and/or no need for rotations.	4 cycles and reaching a weighting of 9 points.
A.1.2 Rooms and materials for procedures in the unit (activities proposed by the Competency-Based Curriculum – CBC).	Room to carry out training procedures for the specialty based on the CBC, whether in the reference unit or in another space that guarantees training (such as another unit).
If these activities are not available in the unit, the resident has spaces on the grid to perform in other training spaces.
A.2. Improving the organization of the agenda and demand for primary care services in the context of school-units, considering the social context and vulnerability of the defined population.	Residents have a protected agenda to attend and discuss cases. In addition, they have spaces for home visits, procedures, community groups.	3 cycles, reaching a weighting of 9 points.
(Note: both the preceptor and the resident must have protected spaces for adequate training of the professional in training/preceptor, considering the uniqueness of FCM (home visits, collective activities, unit meetings, theoretical agenda, among other specific demands of each program). The unique contexts of each program should also be considered: academic, in the SUS network and in the private network).		3 cycles, reaching a weighting of 9 points.
A.3. Qualification and better interrelation between service management and medical residency so that the unit remains a school-unit.	Management cooperates with the organization of the unit so that adequate training is obtained, agreeing on goals and promoting feedback spaces for the unit’s professionals and users with medical residency.	3 cycles, reaching a weighting of 8 points.

Desirable matrix in the program	How to organize and evaluate the criterion	Number of cycles (1–5) and weighting defined by the judges (8–10)
B.1. Encourage and give preference to hiring professionals for the position of preceptorship with a degree and/or residency in family and community medicine with desire/training in preceptorship.	All professionals are FCM experts.	2 cycles, with 10 points of final value.
B.2. Continuous improvement of these professionals through.
B.2.1. In-service education based on permanent education strategies and demands: the unit, the service portfolio, and the residency program.	Training process of the preceptor based on the demands of the service, residency and unit, having a protected space in the agenda for this.	3 cycles and 9 weighting points.
B2.2. Continuing Education of the preceptor through preceptorship courses, health education, continued clinical training, case matrix support, among others. Also the inclusion of permanent education in teams that have residents and preceptors, with a protected agenda.	Release of the preceptor for health department courses, external courses, continuing education through the program, matrix support with other professionals, among others.	3 cycles and 9 weighting points.
B.3. Provide ongoing training to professionals (preceptors, residents and residency unit staff) on the specialty, its updates and characteristics, so that everyone has the same discourse and can advance as the specialty advances.	Are residents, preceptors and staff systematically presented with information and training on the specialty?	5 cycles and 9 weighting points.
B.4. Financial support for preceptors, with supplementary salary or preceptorship scholarship.	Evaluate whether the preceptor has a differentiated salary for the position compared to exclusive assistant physicians (salary supplementation).	3 cycles and 10 weighting points.

Desirable matrix in the program	How to organize and evaluate the criterion	Number of cycles (1–5) and weighting defined by the judges (8–10)
C.1. Careful observation of the number of residents per preceptor to have an adequate training moment in accordance with the organization of the program based on the conformation of the team.	Presence of a maximum of 3 residents per preceptor, adding 1st and 2nd year residents (40h).	4 cycles and 9 weighting points.
C.2. Observation of the overload of “learners” per preceptor at the undergraduate and residency levels.	The maximum number is 5 students (undergraduates and residents). *It may be suitable depending on the possibility of the team, space, agreements with educational institutions (not generating preceptor overload).	5 cycles and 9 weighting points.

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[TFN3] FCM: family and community medicine.