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Journal of Interprofessional Care
ISSN: 1356-1820 (Print) 1469-9567 (Online) Journal homepage: http://www.tandfonline.com/loi/ijic20
New national curricula guidelines that support the
use of interprofessional education in the Brazilian
context: An analysis of key documents
José Rodrigues Freire Filho, Marcelo Viana Da Costa, Aldaísa Cassanho
Forster & Scott Reeves
To cite this article: José Rodrigues Freire Filho, Marcelo Viana Da Costa, Aldaísa Cassanho
Forster & Scott Reeves (2017): New national curricula guidelines that support the use of
interprofessional education in the Brazilian context: An analysis of key documents, Journal of
Interprofessional Care, DOI: 10.1080/13561820.2017.1346592
To link to this article: http://dx.doi.org/10.1080/13561820.2017.1346592
Published online: 01 Sep 2017.
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ORIGINAL ARTICLE
New national curricula guidelines that support the use of interprofessional
education in the Brazilian context: An analysis of key documents
José Rodrigues Freire Filho
a
, Marcelo Viana Da Costa
b
, Aldaísa Cassanho Forster
c
, and Scott Reeves
d
a
Master in Science Community Health Program, Department of Social Medicine, Ribeirão Preto Medical School, University of São Paulo, Monte
Alegre, Ribeirão Preto, São Paulo, Brazil;
b
Nursing Department, Campus Profa. Maria Elisa de Albuquerque Maia, State University of Rio Grande do
Norte, Pau dos Ferros, Rio Grande do Norte, Brazil;
c
Preventive Medicine, University of São Paulo, Monte Alegre, Ribeirão Preto, São Paulo, Brazil;
d
Centre for Health & Social Care Research, Faculty of Health, Social Care & Education, Kingston University & St George’s, University of London,
London, United Kingdom
ABSTRACT
The National Curricular Guidelines (NCGs) are important documents for understanding the history of
academic health professions education in Brazil. Key policies within the NCGs have helped to reorient
health professions education and have stimulated curricular changes, including active learning meth-
odologies and more integrated teaching-service environments, and, more recently, have introduced
interprofessional education (IPE) in both undergraduate and postgraduate sectors. This article presents
the findings of a study that examined the NCGs for nursing, dentistry, and medicine courses as juridical
foundations for adopting strategies that promote IPE across higher education institutions in Brazil. We
employed a comparative and exploratory documentary analysis to understand the role of IPE and
collaborative practices in NCGs for the three largest professions in Brazil. Following a thematic analysis
of these texts, four key themes emerged: faculty development; competencies for teamwork; curricular
structure; and learning metrics. Key findings related to each of these themes are presented and
discussed in relation to the wider interprofessional literature. The article goes on to argue that the
statements contained in the NCGs about adoption of IPE and collaborative practices will have an
important influence in shaping the future of health professions education in Brazil.
ARTICLE HISTORY
Received 21 November 2016
Revised 1 May 2017
Accepted 21 June 2017
KEYWORDS
Documentary analysis;
health professions; higher
education; interprofessional
education; interprofessional
learning
Introduction
The global debate concerning health workforce issues includes
as a central challenge: to align education and training pro-
cesses to initiatives that aim to strengthen health and social
care systems (e.g., Crisp & Chen, 2014). In this context, the
complex and ever-evolving health and social needs pose
demands for making effective change in systems of care.
These demands point to the direction of fostering collabora-
tion, enhancing teamwork and improving the quality of care
delivered to patients (Frenk et al., 2010).
In Brazil, the expansion of the National Unified Health
System (known by the Portuguese acronym as SUS) is based
on the values of universal and comprehensive care. These
principles reinforce the need to invest in the reorientation of
health services and health providers’training, justifying the
need to strengthen the debate on interprofessional education
(IPE)
1
and collaborative work as key foundations. Similarly,
several global recommendations point to the need to expand
initiatives to consolidate IPE and collaborative practices as
cornerstones of a new rationale for the delivery of effective
healthcare (WHO, 2010,2013).
Despite global developments that have gained momentum
from two key publications which have argued for use of IPE
(Frenk et al., 2010; World Health Organization, 2010), such
studies are still scarce in Brazil. However, recent Brazilian
experiences are beginning to make IPE a reality in both
undergraduate and post-graduate sectors. Key policies reor-
ienting health professions education have stimulated curricu-
lar changes, including active learning methodologies, more
integrated teaching environments, and the expansion of IPE
(Costa & Borges, 2015; Costa, Patrício, Câmara, Azevedo, &
Batista, 2015).
In the last 15 years, the main initiatives of this process have
been: (1) the launch of the National Curricular Guidelines
(NCGs) for health courses; (2) the National Programme for
Reorientation of Professional Training in Health (Pro-Saúde);
and (3) the Programme for Training Through Work in Health
(PET-Saúde). All these initiatives are examples of successful
practices designed to overcome the challenges of educating
health professionals. Another milestone in this process has
been the expansion of medical undergraduate courses to increase
the supply of physicians, which has resulted in the adaption of
other professional groups’curricular proposals to support these
changes. Both aspects were included in the Federal Law 12871,
approved on October 22 2013, assigning official status to the
Mais Médicos (More Doctors) programme (Brasil, 2013).
The NCGs deserve a special mention as they represent the
legal milestone of the reorientation process in health profes-
sions education, and they also provide key guidance for the
development of health education courses. In particular, they
CONTACT José Rodrigues Freire Filho joserodrigues.saude@gmail.com Pharmacist, Master in Science Community Health Program, Department of Social
Medicine, Ribeirão Preto Medical School, University of São Paulo, Av: Bandeirantes, 3900. Monte Alegre 14049-900, Ribeirão Preto, São Paulo, Brazil.
JOURNAL OF INTERPROFESSIONAL CARE
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© 2017 Taylor & Francis
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have provided an important direction for changing the tradi-
tional model of didactic training towards a more active, stu-
dent-centred approach. However, it is still unclear what role
these NCGs may have for supporting IPE in Brazil.
Background
When the nature of the NCGs is explored, it is useful to
understand the history of health professions education in
Brazil to appreciate the current context within the country’s
National Health System. Examining the NCG texts for med-
icine and nursing (published in 2001) and for dentistry (pub-
lished in 2002), they provide a detailed series of expected
profiles for future professionals as well as the competencies
essential to strengthening the Brazilian health system
(Ministério da Educação, 2001a,2001b,2002). Drawing
upon these NCG documents, Streit, Barbosa Neto, and
Lampert (2012) have helpfully highlighted key specific and
generic competencies as well as course structures, methods of
teaching, and evaluation.
This development of competencies proposed by the NCGs
aims to incorporate active learning methods which, according
to Puccini, Sampaio, and Batista (2008), will provide more
autonomous learning and encourage a more in-depth under-
standing of health in the wider societal context. This process
calls for academic, practitioner, citizen and community
knowledge, thus inducing a deeper integration between health
services and society (Stella & Campos, 2006).
For medicine, a major incentive for curricular revision was
linked to the Federal Law 12871 that created Mais Médicos
(Brasil, 2013). The Mais Médicos programme aimed to
improve the profession’s response to increasing population
health demands while also strengthening SUS’s health poli-
cies. A key area for this policy was the expansion of medical
schools and curricular changes to ensure that future physi-
cians would be educated in a way that would more appro-
priately meet the needs of SUS and the country. In some
senses, the Mais Médicos triggered the NCGs revision process
for medicine. Indeed, their legal contents provided additional
support for a new approach to medical education and stimu-
lated an updating of curricular objectives that were seen as
outmoded (Ministério da Educação, 2001a).
In 2014, the new NCGs for medicine were officially
enacted (Ministério da Educação, 2014) by decree of the
National Council for Education (a body of the Ministry of
Education). This document contained 41 articles that intro-
duced new concepts as competencies, competency areas and
competency domains as well as proposals for strengthening
teaching in primary, emergency, and mental health care. In
effect, these new NCGs reinforced the main components of
Mais Médicos. While the 2014 guidelines were founded on the
NCGs published in 2001 and 2002, they introduced new
advancements in medical education, oriented by SUS doc-
trine, with the aim of more effectively meeting Brazilian
population health needs.
This article presents the findings of a study that aimed to
explore and compare the NCGs for nursing, dentistry and
medicine courses to understand their potential for promoting
IPE in Brazil. While Brazil has 14 regulated health professions,
the focus of this article is on nursing, medicine, and dentistry:
the three largest professional groups in the country. These
professions were also selected as they form the core groups of
the national ‘Family Health’strategy in primary care.
Methods
Underpinned by social constructionism (Gergen, 2009), the
study employed a comparative and exploratory documentary
analysis to ‘describe and compare social behaviors, trends,
differences and other features’(Figueiredo, 2007, p. 105)
within the NCGs.
Data collection
The data gathered for this study (research corpus)were
obtained from the 2001 NCGs for medicine and nursing, the
2002 NCGs for dentistry and the recently approved NCGs for
medicine (Ministério da Educação, 2001a,2001b,2002,2014).
As noted above, these are important documents in informing
professions education in Brazil. Specifically, the NCGs outline
key features for curricular design as well as teaching/learning
methodologies that are used in undergraduate health educa-
tion across the entire country. Therefore, an in-depth inves-
tigation of these NCGs would constitute a key step to
understand the potential role of IPE in shaping the education
of medicine, nursing, and dentistry students.
Data analysis
The analysis of data was based on a thematic approach
described by Bardin (2009,2011). After downloading the
official documents, an initial reading was made to become
familiarised with these materials. During this phase, the NCGs
contents were examined to gather general impressions and to
compose the corpus for the analysis. In the next phase, rele-
vant text extracts from the NCGs were grouped together to
form a series of themes. Finally, data in each of themes was
summarised to allow a critical interpretation. A translation of
these materials (from Portuguese to English) was subse-
quently undertaken before writing this article.
Results
Analysing the NCGs for nursing, dentistry and medicine
undergraduate courses (Ministério da Educação, 2001a,
2001b,2002,2014), four themes (faculty development, com-
petencies for teamwork, curricular structure, and learning
metrics) emerged as key elements related to IPE. Each of
these themes is presented in this section of the article with
supporting data from the NCGs.
Faculty development
In the 2001 and 2002 NCGs (Ministério da Educação, 2001a,
2001b,2002), there was no content related to supporting the
development of educators’skills in relation to IPE facilitation.
In contrast, the 2014 guidelines (Ministério da Educação,
2014) contained an explicit section mandating that medical
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education courses include IPE faculty development.
Specifically, it was stated that faculty development should
value teachers’work, involve different faculty members in
course development activities, and provide faculty training
opportunities based on ‘interdisciplinary’
2
practices. As the
following extract illustrates:
The undergraduate course of medicine must keep a permanent
Teacher Training and Development in Health Program, aimed at
the appreciation of teacher’s work in the undergraduate degree,
the higher involvement of teachers with the course’s Pedagogic
Project and its improvement in relation to the formative proposal
contained in the document. This will be accomplished by means
of the conceptual and pedagogic domains, encompassing active
teaching strategies, based on interdisciplinary practices, so that
they take on higher commitment with the transformation of the
medical school, to be integrated to the daily life of teachers,
students, staff and users of health services (Ministério da
Educação, 2014, Art. 34).
As noted above, a key element of this NCG was the adoption
of faculty development opportunities aimed at supporting
student learning of collaborative practice. Also, importantly,
the document identified a need for faculty development activ-
ities to focus on how to integrate teachers, students, and users
of the health services.
Competencies for teamwork
Both the 2001 and 2002 NCG documents stated the need to
create a range of competencies for health providers, covering
health care delivery, decision making, communication, leader-
ship, management, and lifelong learning. Although a number
of the competencies had an implicit support for teamwork,
only the communication and leadership competencies pro-
vided an explicit reference to interprofessional interaction:
Communication: health providers must be accessible and must
keep confidentiality of the information provided to them when in
interaction with other health providers (Ministério da Educação,
Art. 4°, III, 2001a,2001b; Art. 4°, III, 2002).
Leadership: in multiprofessional teamwork, health providers must
be apt to take over leadership positions, always having in mind the
community’s welfare. Leadership comprises commitment, respon-
sibility, empathy, skills for effective and efficient decision making,
communication, and management (Ministério da Educação, Art.
4°, IV, 2001a,2001b; Art. 4°, IV, 2002).
While, as indicated above, the leadership competency state-
ment supported the notion of medical leadership over other
professional groups, the 2001 NCGs for medicine did contain
subsections which acknowledged the need for more (equitable)
competencies in interprofessional communication, involvement
of patients, family and community care, and the adoption of
teamwork:
III—communicating properly with co-workers, patients, and their
family members;
IV—informing and educating patients, family members, and commu-
nity in relation to health promotion, prevention, treatment and reha-
bilitation of diseases, using appropriate communication techniques;
XXI—acting in a multiprofessional team (Ministério da Educação,
2001b. 2001. Art. 5°)
Similarly, the 2001 NCG for nursing stated the need for
interprofessional collaboration between nurses with the
other health providers:
XXII—integrating nursing actions to the multiprofessional actions
(Ministério da Educação, 2002. Art. 5°)
In relation to the NCG for dentistry, it was stated that there
was a need for dentists to engage in teamwork with other
health providers and ensure they communicated with patients
and the wider communuty:
III—acting multiprofessionally and in an interdisciplinary and
transdisciplinary way;
XXVII—communicating with patients, health providers, and the
community in general;
XXVIII—working in interdisciplinary teams and acting as a health
promotion agent (Ministério da Educação, 2002. Art. 5°)
However, apart from these general statements for the incor-
poration of collaboration, and communication, the 2001 and
2002 NCGs offered no details on these competencies.
In contrast, the 2014 NCGs listed 22 specific competencies
which collectively provided stronger support for collabora-
tion. For example, there was an explicit focus on working in
a patient-centred manner as a member of an interprofessional
team:
Person-centered, family and community-centered care, with an
extensive interprofessional teamwork, developing horizontal,
shared relations and respecting the needs and preferences of the
person, the family and the community receiving care (…) and
common responsibilities between health professionals and users
(Ministério da Educação, 2014, Art. 5°).
The 2014 document also provided a more detailed description
of the competencies needed for the development of interpro-
fessional collaborative practice. For instance, there was more
information presented about collaboration in a number of
sections, including ‘health care’,‘care management’, and
‘health education’. The document also explicitly referred to
the need for integrating collaborative knowledge, skills, and
attitudes to enable medical graduates to work effectively in an
interprofessional manner, based on an exchange of knowledge
with other health professionals:
Learning in an interprofessional way, based on the reflection on
their own practice and the exchange of knowledge with health
professionals and other areas of knowledge, to guide the identifi-
cation and discussion of problems, stimulating the improvement
of collaboration and health care quality (Ministério da Educação,
2014, Art.7°).
Collaborative teamwork, respectful of the institutional norms in
the work environments and acting under ethical and professional
commitment to overcome the fragmentation of the work process
in health (Ministério da Educação, 2014, pp. 2–14. Art. 17).
In addition, the 2014 document stated the need for a clinical
performance linked to a shared therapeutic process that
involved an interprofessional approach. Collaborative work,
joint participation, and shared knowledge were all included as
key competencies for medical graduates:
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Use of different sources to identify problems in the work process,
including the perspective of other professionals and users and the
analysis of indicators and management model to identify risk and
vulnerability of individuals, families and social groups (Ministério
da Educação, Art 17, I-c, p. 8).
Joint participation with users, social movements, health profes-
sionals, managers of the health sector and others in the elabora-
tion of intervention plans that face prioritized problems
(Ministério da Educação, Art 17, II-a, p. 8).
Curricular structure
In relation to curricular structure issues, while the NCGs for
nursing (2001), medicine (2001), and dentistry (2002) men-
tioned the need for improving collaboration, they offered only
limited details. For example, article 12 of the 2001 NCG for
medicine stated that curricular guidelines should have a focus
on integration, interdisciplinarity, and teamwork:
IV—promoting integration and interdisciplinarity coherent with
the axis of curricular development, aiming to integrate the biolo-
gical, psychological, social and environmental dimensions;
VI—using different teaching-learning settings, allowing the stu-
dent to know and experience varied life situations, organization of
the practice and work in multiprofessional team (Ministério da
Educação, 2001. Art. 12).
However, as indicated in the above extract, there was a lack of
information about the nature of integration and level of
interprofessional interaction needed in the medical curricu-
lum. Both the 2001 NCG for nursing and the 2002 NCG for
dentistry contained similar statements on the structure of
their respective curricula in regards to promoting interprofes-
sional collaboration.
In contrast, the 2014 NCG provided better conceptual
clarity on interprofessionality. IPE was placed in a context of
strengthening and consolidating the SUS, adding new per-
spectives in the educational process:
[The curriculum aims] to promote the integrality of the Pedagogic
Project of the course using as a basis theory-practice articulation,
integration with other knowledge fields and public institutions,
SUS health services, training institutions and health care providers
to foster a flexible and interprofessional education, connected to
the main health problems of the population (Ministério da
Educação, 2014, Art. 29).
The 2014 guidelines also mandated the early integration of
students in practice settings. In doing so, it recommended that
students develop knowledge and experience of interprofes-
sional team practice related to solving real-life health pro-
blems. Specifically, this NCG required students to undertake
interprofessional clinical experiences in primary and emer-
gency care to integrate knowledge and practice. As the follow-
ing excerpt highlights:
[Section I] encouragement of curiosity and the development of
the ability to learn from everyone involved in the health work
(Ministério da Educação, 2014, Art. 20).
[Section II] identification of specific learning needs of people
under their care as well as guardians, caregivers, and family
members; use of multidisciplinary teamwork with different groups
or communities, from a significant situation and respecting the
previous knowledge and the cultural and social context of each
another (Ministério da Educação, 2014, Art. 20).
Learning metrics
In general, the 2001 NCGs for medicine and nursing and the
2002 NCGs for dentistry presented few details related to
learning metrics. Articles 13, 14, and 15 of these documents
offered similar information about the need for the assessment
of learning:
§1 The students’assessments should be based on the developed
curricular competencies, skills and contents, having the curricular
guidelines as a reference. (Ministério da Educação, 2002, Art 14).
§2 The medicine undergraduate course should use methodologies
and criteria for the follow up and assessment of the teaching
learning process and the course itself, in consonance with the
assessment system and the curricular dynamics established by
the respective Higher Education Institution (Ministério da
Educação, 2001b).
These documents did not however provide details about the
type of assessment, when/how often to assess student learn-
ing, nor did they offer any explicit mention of the assessment
of interprofessional curricular activities.
In contrast, the 2014 NCG provided more precise informa-
tion. This document demanded that the assessment of both
profession-specific and collaborative competencies was a
mandatory requirement. It stated that assessment of compe-
tencies should be formative in nature and occur every two
years until the end of a medical course:
The specific evaluation of Undergraduate Medical Course stu-
dents shall be made every two years using tools and methodolo-
gies evaluating knowledge, skills and attitudes (…) mandatory in
nature, looking at processes and context using formative meth-
ods., The results will be considered as part of the classificatory
process for the tests conducive to Medical Residency programs
(Ministério da Educação, 2014, Art. 36).
Discussion
As presented above, the analysis of the NCGs for medicine,
nursing, and indicated revealed that four themes connected to
faculty development, competencies for teamwork, curricular
structure, and learning metrics appeared to be key in the
development of IPE in Brazil. Below we discuss each of
these themes in relation to the wider interprofessional
literature.
When compared to the 2001 and 2002 NCGs, an important
advance in the 2014 NCGs was the mandate to adopt inter-
professional faculty development activities. This is a key ele-
ment needed for the success of IPE. Indeed, a number of
reports have stressed the need for faculty development to be
provided to ensure that educators can effectively facilitate IPE
to achieve core interprofessional competences (e.g., IPEC,
2011; Reeves et al., 2016). However, discussions about inter-
professionality are in their early stages in Brazil. As a result,
there is a need for an investment in processes that allow
educators to understand IPE principles. Educators in health
professions have traditionally taught using the same models
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(uni-professional) that they themselves were trained with—a
process that can legitimate conventional practices and can
hinder innovation and change (Becker, Geer, Hughes, &
Strauss, 1961).
Providing faculty development that is focused on support-
ing IPE can help educators to develop and deliver active
teaching/learning methods which can foster interprofessional
interaction and a more collaborative culture (e.g.,
Schonwetter, Hamilton, & Sawatzky, 2015; Sunguya,
Hinthong, Jimba, & Yasuoka, 2014). However, Lampert
(2008) warned that medical educators may struggle in imple-
menting the NCGs as ‘(teachers are) mainly trained in the
previous, traditional, Flexnerian model still hegemonic in the
healthcare environment [with] scarce time available to reflect
on their own role and responsibility as teachers, as guides and
facilitators of the teaching and learning process’(p. 34)—a
situation which will limit their abilities to effectively engage in
IPE facilitation. In addition, IPE faculty development activ-
ities can also be impeded by conflicting schedules and disper-
sion of facilities, and varied curricular designs that need to be
integrated when planning IPE faculty development activities
(Hall & Zierler, 2015). In this sense, the inclusion of manda-
tory faculty development programmes in the new NCGs
(Ministério da Educação, 2014) should be a powerful tool to
adopt IPE in medical courses.
As indicated above, the 2014 NCG introduced a debate of
new interprofessional concepts that were not present in earlier
guidelines (Ministério da Educação, 2001, 2002). A key con-
cept was the prerequisite to educate health professionals that
are more able to work collaboratively in teams. This shift
towards interprofessionalism should encourage higher educa-
tion institutions to give importance to interprofessional initia-
tives and to improve the qualifications of educators in line
with the NCGs requirements for faculty development.
Educators will clearly need this type of support—as recom-
mended by the WHO (2010) in their report on improving
health professions education.
Regarding competencies for teamwork, there were some
remarkable aspects in the NCGs. While the 2001 and 2001
documents were explicit in stating a need for teamwork train-
ing, the 2014 NCGs provided more refined and coherent
terminology and used concepts that supported IPE and colla-
borative practice principles. Indeed, one could see that this
text presented a number of competencies which aligned well
with the IPE literature. In particular, the ideas of Barr (1998)
who introduced a series of IPE competencies which have been
employed in later publications (CIHC, 2010; IPEC, 2011). As
a result, the 2014 NCGs offer a coherent approach as they call
for attention to interprofessional teamwork and collaboration
as well as the need to ensure patients, families, and the com-
munity are included in the centre of team-based decision-
making processes. Furthermore, these NCGs emphasised the
need for the education process to be conducive to the gen-
eration of competencies for teamwork which support a
patient-, family-, and community centred approach (e.g.,
Schonwetter et al., 2015).
Related to the curricular structure, the 2001 and 2014
versions of the NCGs share some similarity, thus showing
the continuity and relevance of the debate around teamwork
in the Brazilian context. The 2001 guidelines noted incentives
to adopt ‘interdisciplinarity’and outlined the benefits of situ-
ating students in real-life settings. The 2014 text went on to
identify the need of building curricular structures that are
linked with the macro dimensions of national health policies
(Frenk et al., 2010). Collectively, these documents also high-
light the importance of interprofessional action as the most
responsive and efficient way of addressing the health needs of
the population (WHO, 2010). Indeed, these NCGs identify the
connection and coherence related to the use of IPE and the
complex and dynamic needs of the national and international
landscape (Liu, Zhang, Liu, & Wang, 2015).
The 2014 NCG recommendation regarding the use of
active curricular methods offers a move forward for students
to meet real-life challenges and problems. In particular, it
puts students in the ‘driving seat’of their learning supported
by the teacher in the role of a facilitator (Melo & Sant’Ana,
2012;Reeves,2010).TheemphasisinthisNCGuponactive
curricular methods is a specific strength to adopt IPE, as
these methodologies are part of a wider context of integrated
health courses (e.g., Towle & Godolphin, 2013). The 2014
document also recognised the importance of IPE in encoura-
ging medical students to share learning experiences with
colleagues from other professional groups to understand
the complexity of health problems (De Los Santos,
McFarlin, & Martin, 2014). In Brazil, the construction of
the SUS demonstrates the importance of embedding key
topics in health professions education (e.g., gender and eth-
nicity, SUS principles/guidelines/policies, comprehensive-
ness of care) that demand an interprofessional approach.
The2014NCGsalsorecognisethatbothknowledgeacquisi-
tion and the building values and attitudes, according with
social and health demands are needed (Kahaleh, Danielson,
Franson, Nuffer, & Umland, 2015).
In regards to learning metrics, as presented above, the
NCGs recommended that a formative (process) approach to
assessment is needed. Learners should be informed about
their progress and given feedback related to any difficulties
encountered on a regular basis, allowing opportunities for
improvement (Caseiro & Gebran, 2010). This approach can
also stimulate active dialogue and action among between
educators and learners. The 2014 NCGs can be seen as a
step forward in establishing a stable process of assessment,
which is synergic with other pillars for change, such as faculty
development, user-centred active methodologies, and incen-
tives for shared decision making. The 2014 NCG also advo-
cated for the assessment of competence developed during the
training process, including profession-specific and collabora-
tive competencies. However, developing IPE across the
national context will demand additional efforts from all sta-
keholders. Debating the inclusion of interprofessionality in
medical education will inevitably involve a need to revisit
the traditional assessment processes to add new ways of mea-
suring values, attitudes, knowledge, and skills that support
effective teamwork centred on patients’needs (e.g., Simmons
& Wagner, 2009).
The analysis of the NCGs (Ministério da Educação, 2001,
2002, 2014) can be usefully framed by Oandasan and Reeves’
(2005) three dimensions (macro, meso, micro) needed for the
JOURNAL OF INTERPROFESSIONAL CARE 5
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implementation of IPE. At the macro level, transformations in
the policies that guide the teaching institutions need to occur;
at the meso level, curricular, programme, methodological, and
pedagogic changes need to occur; and at the micro level, there
is a need to change interpersonal and interprofessional rela-
tionships. Recognising the relevance of macro, meso, and
micro activities for the successful implementation of IPE, it
can be argued that the 2014 guidelines should play an impor-
tant role in the macro level because they can encourage major
changes in curriculum structures that will encourage reforms
to the training of health professionals in Brazil. As a legally
valid framework, the 2014 NCGs are part of the macro
dimension and bring relevance to important dimensions that
influence both the meso and the micro level in the curricular
design, in contents adoption, and in interpersonal and inter-
professional interactions.
Despite some significant advances, the 2014 NCGs still
need to overcome the conceptual confusion linked to the
interchangeable use the terms such as ‘interdisciplinary’and
‘interprofessional’. In Brazil, there are important theoretical
contributions on teamwork, using the terms ‘interdisciplinary’
or ‘multiprofessional’(Ceccim, 2004; Peduzzi, 2001; Peduzzi,
Palma, & Mendes-Gonçalves, 2000). However, in recent years,
the national literature is reinforcing the need for further
discussion and clarification on the theoretical and methodo-
logical basis of IPE (Agreli, Peduzzi, Loqueti, & Silva, 2014;
Costa et al., 2015; Peduzzi, Norman, Germani, Silva, & Souza,
2013). This view is supported in the international literature
which has emphasised the importance of overcoming concep-
tual confusion in order to ensure more robust implementation
and evaluation of IPE (Goldman, Zwarenstein, Bhattacharyya,
& Reeves, 2009; Reeves, Lewin, Espin, & Zwarenstein, 2010).
In relation to the study limitations, we only analysed three
documents (NCGs for undergraduate courses in nursing,
medicine, and dentistry). Also, possible researcher bias may
have also been introduced in the analysis of these documents.
Future research is needed to examine the adoption of IPE in
guidelines for other undergraduate health courses. Research is
also needed to describe any changes resulting from the imple-
mentation of the NCGs across the different regions of Brazil.
In addition, further research is needed to describe the efforts
of medical schools in adopting the new guidelines, showcasing
the experiences of integrating IPE in their respective curricula.
Concluding comments
As presented above, the NCGs have highlighted the need for
interprofessional competencies to shape the future of health
professions education in Brazil. The emphasis that these
guidelines have given to interprofessionality in education
and practice in Brazil supports a growth of these activities
around the world. Despite some conceptual confusion still
present in the text of the 2014 NCGs, interprofessionality is
regarded as a central foundation for reforming education and
practice in Brazil. The move towards IPE is also complemen-
tary in supporting other reforms in the country, such as the
integration between universities, health services, and the
community.
The 2014 NCGs specifically provide motivation for medical
educators to shift towards embracing shared learning pro-
cesses, drawing upon interprofessional communication pro-
cesses and collaborative patient-centred initiatives. The
guidelines encourage medical schools to reflect on the delivery
of their education content, to advance it in several critical
aspects towards producing graduates whose abilities are a
better fit to meet the needs of the Brazilian health system.
Many challenges however lie ahead with the implementa-
tion of IPE across Brazil. However, undertaking and dissemi-
nating research related to the implementation the new
guidelines will provide important evidence of this process. It
should also help create a collaborative network oriented
towards the strengthening the national health system to
become more resilient and better aligned with the health
and social needs of the Brazilian population.
Notes
1. In this article, we use the definition of IPE developed by the Centre
for the Advancement of Interprofessional Education (CAIPE), who
defined IPE as an activity which occurs when two or more health
professions learn about, from, and with each other to enable effec-
tive collaboration and delivery of patient/client care (CAIPE, 2002).
2. The NCGs documents use the terms ‘interdisciplinary’,‘interpro-
fessional’,and ‘multiprofessional’interchangeably without
acknowledging the conceptual differences related to these terms.
Declaration of interest
The authors report no conflicts of interest. The authors alone are
responsible for the writing and content of this article.
ORCID
Scott Reeves http://orcid.org/0000-0002-0573-0622
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