Educação interprofissional para tomada de decisão compartilhada em farmacoterapia: promovendo estratégias de justiça epistêmica por meio da pedagogia crítica.

Abstract

The development of IPE at undergraduate level is essential for the training of future health professionals capable of sharing decisions regarding drug treatment. This work aimed to understand the processes involved in the preparation, offering and evaluation of a curricular academic activity in IPE for shared decision-making in pharmacotherapy, from the perspective of the students and tutors involved. To achieve this end, this thesis was methodologically organized into three stages. In Stage I, with the aim of mapping the literature of interest, a scoping review was conducted on teaching-learning strategies in IPE for shared decision-making in pharmacotherapy, as well as the methods and instruments used to evaluate these experiences. The search was carried out in seven electronic databases, in addition to the manual search, following the recommendations of PRISMA-ScR, including 21 articles. This review identified inconsistencies in how IPE interventions are implemented, reported and evaluated and revealed a scarcity of experiences that considered the centrality of the patient in sharing the decision. These findings reinforced the importance of offering an IPE initiative with this focus. In Stage II, based on the results of the review, an academic curricular activity in IPE was planned and offered for shared decision-making in pharmacotherapy, taking into account the Brazilian health context, in light of theories of epistemic injustice and critical pedagogy by Paulo Freire. The teaching plan was prepared with a workload of 30 class hours, divided into 15 weekly meetings. The activity, offered as an option, took place in the second semester of 2022 and was attended by twenty students from five courses: Nursing (n = 5), Pharmacy (n = 6), Medicine (n = 2), Psychology (n = 4) and Dentistry (n = 3). Different active methodologies were used to achieve teachinglearning objectives, based on the development of collaborative skills and the sharing of health decisions. In Stage III, through the lens of autoethnography, we sought to understand the power dynamics involved in this interprofessional initiative from the perspective of students and tutors. The data were constructed from portfolios prepared by students, focus groups, individual interviews and participant observation, permeated by reflexivity. The Freirean critical perspective was used as a theoretical lens for analyzing and interpreting the results. The findings of this stage revealed how students participating in IPE with a focus on shared decision-making in pharmacotherapy can reproduce structural hierarchies in health, naturalized in speech, behaviors and attitudes, legitimizing the privileges of the medical category and the submission of patients. Future IPE initiatives must be careful not to paradoxically reinforce traditional stereotypes by including the theme of power explicitly in teaching programs.