Thought Styles in the Choice of Medical Specialty and their Correlation with Primary Care Provision Policies - A Case Study
ABSTRACT With the publication of the National Curriculum Guidelines for medical schools, in 2001, changes were implemented in medical courses with the aim of meeting the needs of the Unified Health System in terms of Primary Health Care training. One of the biggest difficulties found in the setting of Primary Health Care was that the staff was lacking both in numbers and quality of the professionals. In this context, the qualitative goal of this research was to identify the features surrounding the choice of medical specialty among graduates from UNIVALI who had effectively participated in Primary Health Care projects during their undergraduate studies. The data was collected by means of semi-structured interviews and the data analysis performed using the Thought Style category, developed by Ludwik Fleck. The results revealed the hegemony of a Thought Style with characteristics aimed at the focal expertise and with a market-oriented outlook on the profession, yet with an expanded view to addressing problem, and was therefore called the Extended Flexnerian Thought Style. In a counter-hegemonic way, another Thought Style was identified that focuses on comprehensive general practice, with an eminently public appeal, here entitled the Primary Health Care Thought Style. The hegemony of the Flexnerian Thought Style was especially justified by the force of neoliberal links, and supported by the predominantly Flexnerian curriculum structure. The complications experienced by some of the interviewees working in Primary Health Care were also considered major obstacles that hinder the consolidation of a Primary Health Care Thought Style and, consequently, the choice to work in that particular field. Inter-group movements was also show to be an important factor in the process of choosing a medical specialty, yet still under ordered according to the links. In spite of these choices, a closer approach to Primary Health Care proved to be very important in building the counter-hegemony forming the expanded view of the classic Flexnerian Thought Style, which are both important for changing the heath care model.
