Introdução: Em Reprodução Assistida toda a equipe compartilha com o casal o árduo caminho composto pelas fases do tratamento, porém, o presente estudo deteve-se a experiência do médico. Objetivos: Investigar o Imaginário Coletivo de médicos que atuam em Reprodução Assistida sobre as situações de difícil manejo em sua prática profissional. Métodos: Foram feitas entrevistas únicas individuais, utilizando o Procedimento de Desenho-Estória com Tema como instrumento dialógico. A partir das entrevistas foi criada uma narrativa transferencial ficcional preservando elementos essenciais da dramática humana estudada. Os registros foram interpretados à luz do método psicanalítico buscando a criação/encontro de campos de sentido afetivo-emocional. Resultados: Foram encontrados os seguintes campos: \"Não deu certo!?\", que organiza-se ao redor da ideia de que não alcançar o objetivo pretendido seria o equivalente a fracassar, mesmo diante de situações incertas; \"Engole o choro!\", que organiza-se mediante a crença de que é preciso conter os sentimentos diante de determinadas situações, não deixar-se emocionar; \"Fora do comum\", que organiza-se por meio da crença de que quem está em posição de cuidador é e/ou precisa ser excepcional. Conclusões: Para a formação e à prática médica é preciso incluir, além da visão científica-tecnológica, a abordagem da subjetividade. É necessária a criação de enquadres diferenciados que auxiliem o médico a aproximar-se emocionalmente de seu trabalho, facilitem a superação de dissociações, promovam a saúde mental, contribuindo para que o exercício da profissão seja gratificante e dotado de um sentido genuíno / In Assisted Reproduction the whole team shares with the couple the hard journey through the phases of the treatment, however, this study is about the doctor\'s experience. Objectives: To investigate the Collective Imaginary of doctors working in Assisted Reproduction on some difficult situations in their professional practice. Methods: Individual interviews were conducted using the Thematic Story-Drawing Procedure as dialogical instrument. From the interviews a fictional narrative transference were created preserving essential elements of the human drama studied. The records were interpreted in light of the psychoanalytic method seeking the creation / gathering of affective-emotional sense fields. Results: The following fields were found: \"It did not work!?\", which is organized around the idea that not reaching the target would be equivalent to failing, even due to uncertain situations; \"Swallow your crying!\", Which is organized by the belief that one must contain the feelings before certain situations, not allowing themselves to get emotional; \"Out of the ordinary\", which is organized by the belief that who is in the position caregiver is and / or needs to be exceptional. Conclusions: For the training and medical practice is necessary to include, beyond the scientific-technological view, the approach of subjectivity. It is necessary to create different framings that help the doctor to approach their work emotionally, facilitate the overcoming of dissociations, promote mental health, this way contributing to the exercise of the profession so it can be rewarding and endowed with a genuine sense

Submitted by JOSIANE SANTOS DE OLIVEIRA (josianeso) on 2018-08-14T13:53:07Z No. of bitstreams: 1 Daiane Baldasso Böhm_.pdf: 1286054 bytes, checksum: 502a9d545ea8a3ec5b352f21f9ebe9b7 (MD5) / Made available in DSpace on 2018-08-14T13:53:07Z (GMT). No. of bitstreams: 1 Daiane Baldasso Böhm_.pdf: 1286054 bytes, checksum: 502a9d545ea8a3ec5b352f21f9ebe9b7 (MD5) Previous issue date: 2018-03-23 / CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / PROSUP - Programa de Suporte à Pós-Gradução de Instituições de Ensino Particulares / Os/As pacientes têm o direito de escolher a alternativa mais apropriada dentre os tratamentos de saúde disponíveis (TOERIEN et al., 2011), e precisam ser informados/as sobre as opções de possíveis tratamentos e exames diagnósticos especializados para que possam alcançar a autonomia necessária para tomar sua decisão. (LANDMARK; GULBRADSEN; SVENNEVIG, 2015; WESSELS; KOOLE; PENN, 2014). Para tanto, almeja-se o provimento de todas as informações necessárias e existentes sobre essa possível próxima etapa com certo grau de neutralidade, a fim de reconhecer a autonomia e o conhecimento do/a paciente. (LANDMARK; GULBRANDSEN; SVENNEVIG, 2014; DREW; HERITAGE, 1992). Recomendações realizadas de forma a priorizar uma opção em particular representam a autoridade deôntica do/a profissional. (STEVANOVIC; PERÄKYLÄ, 2012). Há uma lacuna em estudos interacionais na área da saúde com interações naturalísticas, i.e., “[...] dados advindos de situações cotidianas e que acontecem (e aconteceriam) com ou sem a presença de um pesquisador” (OSTERMANN; MENEGHEL, 2012, p. 14) em língua portuguesa que observem as recomendações médico/a-paciente e o processo de tomada de decisão. Ressaltamos, contudo, que ao se desenvolver uma pesquisa sob essa temática, toda uma classe profissional pode se beneficiar dos resultados. Esse tipo de análise pode contribuir para a formação de profissionais que atuam em áreas em que recomendar/tomar decisões é prática recorrente. Esta dissertação visa a analisar de que forma é realizada a sequência de recomendações médicas a pacientes grávidas (gestações de médio e alto risco) em consultas de Aconselhamento Genético (AG). Nas consultas, um médico geneticista recomenda a realização de testagem genético-fetal envolvendo procedimentos (i.e., amniocentese ou cordocentese) para posterior análise do cariótipo fetal. Ambos são procedimentos invasivos e não são livres de risco. O estudo objetiva (1) identificar a Organização Estrutural Geral (OEG) dos segmentos em que há recomendações (nível macro estrutural de análise das interações); (2) descrever as fases das recomendações nas consultas analisadas; (3) analisar as características linguístico-interacionais das sequências de recomendações (nível microinteracional de análise); (4) investigar, de uma perspectiva analítica interacional (SACKS, 1992), como (e se) a autoridade deôntica do profissional emerge nessas sequências, e sua relação com o domínio epistêmico dos/as participantes. Para tanto, a análise dos dados foi realizada sob a perspectiva teórico-metodológica da Análise da Conversa (SACKS; SCHEGLOFF; JEFFERSON, 1974; CLIFT, 2016), que permite uma análise minuciosa e retrospectiva dos turnos de fala que compõem sequências interacionais. O contexto de pesquisa é um hospital do Sistema Único de Saúde (SUS), localizado no sul do Brasil, que oferece consultas de AG a pacientes grávidas com gestações de médio e alto risco. Este estudo insere-se em um projeto maior coordenado pela Profa. Dra. Ana Cristina Ostermann, chamado A mobilização do saber e do fazer: episteme e deonticidade na fala-em-interação institucional e na conversa cotidiana, bem como as interações aqui analisadas advêm desse mesmo projeto. / Patients have the right to choose the most suitable among the different alternatives of health treatment (TOERIN et al., 2011), and thus need to be informed about the choices of possible treatments as well as of more specialized diagnostic exams so that they can reach the necessary autonomy to make a decision. (LANDMARK; GULBRANDSEN; SVENNEVIG, 2015; WESSELS; KOOLE; PENN, 2014). For this reason, professionals are supposed to provide patients with the necessary and existing information about the possible next step with some degree of neutrality, recognizing patients’ autonomy and knowledge. (LANDMARK; GULBRANDSEN; SVENNEVIG, 2014; DREW; HERITAGE, 1992). Non-neutral (biased) recommendations for a specific treatment or medical exam might represent an explicit stance of the professional’s deontic authority. (STEVANOVIC; PERÄKYLA, 2012). There is a lack of health interactional studies with naturalistic interactions i.e., “[…] data from daily situations which happen (and would happen) with or without the researcher presence” (OSTERMANN; MENEGHEL, 2012, p. 14, our translation) in Brazilian Portuguese language that observe physician-patient recommendations and the decision-making process. We highlight, however, that developing a research concerning this theme, a whole professional class must be beneficiated from the results. This kind of analysis may contribute for the formation of professionals who work in areas in which recommending/making decisions is current practise. The present master’s dissertation analyzes how the medical-pregnant patients’s (medium and high risk pregnancies) recommendation sequence is done in Genetic Counselling (GC) consultations. Along the consultations, a geneticist recommends the foetal-genetic test involving procedures (i.e. amniocentesis or cordocentesis) for further foetal karyotype analysis. Both procedures are invasive and not free risk. This study consists of (1) identifying the Overall Structural Organization (OSO) of the segments in which there are recommendations (macro structural level of interactional analysis); (2) describing the recommendation phases in the analysed consultations; (3) analysing the linguistic-interactional features of recommendation sequences (micro structural level of analysis); (4) investigating, from a conversation analytical perspective (SACKS, 1992), how (and if) the professional deontic authority takes shape in these sequences, and its relation with the participants epistemic domain. In order to do so, the data analysis was done under Conversation Analysis (CA) theoretical-methodological approach (SACKS; SCHEGLOFF; JEFFERSON, 1974; CLIFT, 2016), which enables a meticulous analysis and turns of talk retrospective that make interactional sequences. The research context is a public hospital in the south of Brazil, which offers GC consultations for pregnant patients with medium and high risk pregnancies. This study consists of a subproject of a larger project coordinated by Profa. Ana Cristina Ostermann, named A mobilização do saber e do fazer: episteme e deonticidade na fala-em-interação institucional e na conversa cotidiana, as the analysed interactions also come from the same project.

Introdução: Em Reprodução Assistida toda a equipe compartilha com o casal o árduo caminho composto pelas fases do tratamento, porém, o presente estudo deteve-se a experiência do médico. Objetivos: Investigar o Imaginário Coletivo de médicos que atuam em Reprodução Assistida sobre as situações de difícil manejo em sua prática profissional. Métodos: Foram feitas entrevistas únicas individuais, utilizando o Procedimento de Desenho-Estória com Tema como instrumento dialógico. A partir das entrevistas foi criada uma narrativa transferencial ficcional preservando elementos essenciais da dramática humana estudada. Os registros foram interpretados à luz do método psicanalítico buscando a criação/encontro de campos de sentido afetivo-emocional. Resultados: Foram encontrados os seguintes campos: \"Não deu certo!?\", que organiza-se ao redor da ideia de que não alcançar o objetivo pretendido seria o equivalente a fracassar, mesmo diante de situações incertas; \"Engole o choro!\", que organiza-se mediante a crença de que é preciso conter os sentimentos diante de determinadas situações, não deixar-se emocionar; \"Fora do comum\", que organiza-se por meio da crença de que quem está em posição de cuidador é e/ou precisa ser excepcional. Conclusões: Para a formação e à prática médica é preciso incluir, além da visão científica-tecnológica, a abordagem da subjetividade. É necessária a criação de enquadres diferenciados que auxiliem o médico a aproximar-se emocionalmente de seu trabalho, facilitem a superação de dissociações, promovam a saúde mental, contribuindo para que o exercício da profissão seja gratificante e dotado de um sentido genuíno / In Assisted Reproduction the whole team shares with the couple the hard journey through the phases of the treatment, however, this study is about the doctor\'s experience. Objectives: To investigate the Collective Imaginary of doctors working in Assisted Reproduction on some difficult situations in their professional practice. Methods: Individual interviews were conducted using the Thematic Story-Drawing Procedure as dialogical instrument. From the interviews a fictional narrative transference were created preserving essential elements of the human drama studied. The records were interpreted in light of the psychoanalytic method seeking the creation / gathering of affective-emotional sense fields. Results: The following fields were found: \"It did not work!?\", which is organized around the idea that not reaching the target would be equivalent to failing, even due to uncertain situations; \"Swallow your crying!\", Which is organized by the belief that one must contain the feelings before certain situations, not allowing themselves to get emotional; \"Out of the ordinary\", which is organized by the belief that who is in the position caregiver is and / or needs to be exceptional. Conclusions: For the training and medical practice is necessary to include, beyond the scientific-technological view, the approach of subjectivity. It is necessary to create different framings that help the doctor to approach their work emotionally, facilitate the overcoming of dissociations, promote mental health, this way contributing to the exercise of the profession so it can be rewarding and endowed with a genuine sense

This research project addresses the following: how topical talk operates in the organisation and management of MSE interactions; and how topical talk operates in the co-ordination of specific service requests and service provisions. It draws on a corpus of audio-recorded and transcribed interactions between general practitioners and persons seeking general medical services in suburban clinics in Brisbane, Australia. The corpus comprised a total of 67 medical service events (henceforth MSEs), audio-taped with the full informed consent of the participants. Many contemporary medical sociological accounts of the operation of topical talk in MSEs, typified by the work of Mishler (1981, 1984) and Waitzkin (1991), remain anchored to the 'professional dominance' thesis (Freidson 1970a; 1970b), arguing for the fundamental conflict between two perspectives - lay and professional. Topical talk has been formulated as one expression of this conflict in 'doctor-centred' communicative 'styles' (Byrne and Long 1976; Silverman 1987). Within such accounts, familiar interactional patterns in MSEs, including the content and structure of topics, have been theorised as instruments of power and control whereby the dominance of specialised medical knowledge and expertise are established and maintained. Mishler's (1984) characterisation of the conflict between a biomedically oriented 'voice of medicine' used by professional physicians (henceforth GPs) and a 'voice of the lifeworld' used by persons seeking medical services (henceforth Ps) is an expression of the 'professional dominance' thesis. The voices are characterised as attesting to a fundamental, theoretically problematic, asymmetry of power relations between GPs and Ps, thereby reinforcing the ideological status of professionals in general and the medical profession in particular. Further, recommendations regarding correctives to 'professional dominance' centre on advice GPs to attend to the primacy of Ps' talk on their experiences of illnesses rather than apparently 'ignoring' or transforming these topics into biomedical accounts of disease. This research project critiques this formulation of topical talk and the traditional theoretical and empirical bases on which it has drawn. This critique arises from the application of ethnomethodological approaches to the study of MSEs. Such approaches, as outlined in Chapters 2 and 3, are characterised by a number of conceptual and analytic premises: First, particular social structural features of social activities and the institutional contexts within which activities occur should not be assumed to be the primary criteria for judging the import and adequacy of situated action. Second, the parties to situated social events mutually constitute those events in the real world. Third, issues of agency are collaborative situated accomplishments such that the management of everyday social activities is accomplished by the people involved who show one another the rationalities of their actions as they assemble the familiar scenic features of those same institutional events (Garfinkel 1967; Sacks 1992a, 1992b). These assumptions have been applied in ethnomethodological analyses of social action, including the analysis of professional service encounters that have critiqued the 'professional dominance' thesis (Eglin and Wideman 1986; Sharrock 1979). The novelty of this study is the analysis of the operation of topic organisation as a phenomenon of order. This study also draws on recommendations within Ethnomethodology (Hester & Eglin 1997b; Watson 1997) that sequential and categorial organisations are mutually informative in the analysis of the rationality of situated social action. One of the particular contributions of this thesis is that it not only jointly applies both conversation analysis and membership categorisation analysis but also extends this recommendation to the inclusion of topic analysis as was originally provided for by Sacks (1992a , 1992b) and Garfinkel and Sacks (1970). Within this study a model of analysis has been constructed that has enabled the analytical consideration of four dimensions of social organisation: local sequential, extended sequential, topical and categorial organisations. The theoretical and empirical concepts of ethnomethodogical analysis have thus been developed and extended within this project. The central findings of this study are that in institutional service events, the 'service topic' is both significant and consequential, and that persons constitute themselves as bona fide incumbents of the categories GP or P by attending to their actions as topically organised. The local adequacy of any particular interactional move (such as questioning-answering, greetings, the design of a topic proposal, etc) is shown to be referenced to the service topic. This study found no evidence of potential or actual "struggles" between the 'voice of the life-world and the voice of medicine'. Rather, this study finds routine recognition on the part of both Ps and GPs of the centrality of the service topic and, thereby, the service task, and no evidence of orientation to distinctive biographical contributions staged in competition with biomedically relevant service topics. It is found that Ps' biographical references were made in the context of an assembled service topic such that particular service tasks, however conventional, were constituted as both relevant and reasonable as medical goods and service for the specific service recipient and provider. At the most general level, it is concluded that the service topic operates as a phenomenon of order in MSEs where order, as defined by Garfinkel and Weider (1992: 202), refers to all of the rationalities evident in the generic features of institutional events and settings, that is, the situated logic and intelligibility as well as the procedures whereby they are constituted as recognisable social events. The thesis concludes with a discussion of the implications of the findings for the theorisation, policy-making, medical education, and practices of GPs and Ps within MSEs. Overall, the significance of this work for researchers into medical interactions is that the relevance of the service topic and its pervasive organisational consequences need to be considered analytically. A major outcome of this thesis is the establishment of a new order of interest within the study of institutional interactions. The project demonstrates the pervasive consequences of service topics and thus provides a step forward in the study of institutional service interactions and ways of theorising their rationality, a step that extends beyond social structural pre-theorisations of power and domination and also beyond interactional accounts of the primary relevance of turn taking structures.

No description available.

Nous cherchions à explorer les compétences que les intervenants du service des urgences (SU), des médecins et des infirmières travaillant en équipe dans des rôles complémentaires, ont développées dans la divulgation d‘un décès, pour éclairer l‘apprentissage de cette compétence de « Communicateur ». Nous avons utilisé des entrevues semi-dirigées et un échantillonnage non probabiliste de 8 intervenants. Nous avons analysé les entrevues à l‘aide de méthodes qualitatives reconnues. Le nombre total de présences de nos intervenants à une divulgation est estimé supérieur à 2000. Notre analyse a démontré qu‘ils utilisent une structure de divulgation uniforme. Néanmoins, ils repoussaient l‘utilisation d‘un protocole, parce que jugé trop rigide. La flexibilité et l‘empathie se sont révélées des qualités essentielles pour les intervenants. Nous représentons la visite de la famille comme un épisode de désorganisation/dysfonction qui se résorbe partiellement durant le séjour au SU. Nous proposons un modèle pédagogique qui est basé sur nos résultats. / We explored the competencies that Emergency Department (ED) healthcare providers (HPs), physicians and nurses working as team members with complementary roles, have developed through notifications of death, to inform the teaching of this ‘Communicator‘ competency. We used semi-structured interviews on a non-probabilistic sample of 8 HPs. We analyzed the interviews using recognized qualitative methods. The total self-estimated number of death notifications attended by our HPs is superior to 2000. Analysis showed that experienced HPs use a uniform structure to death notification in ED. In spite of this, the use of a protocol for notification was considered inappropriate because it was deemed too rigid. Flexibility and empathy emerged as essential qualities for HPs. We submit that the family‘s ED visit is an episode of disorganization/dysfunction that gets partially resolved during their stay. Based on our results, we propose an educational model for teaching delivery of news of death in the ED.

Fragestellung und Zielsetzung: Ausgehend von dem Ziel, kommunikative Fähigkeiten von Studierenden der Humanmedizin objektiv zu messen, sollte in dieser Studie untersucht werden, ob eine ins Deutsche übersetzte Kurzversion des „Calgary-Cambridge Observation Guide for the Medical Interview“ (CCOG) von Kurtz und Silverman (1996) valide und reliabel ist und sich damit die Kommunikationsfähigkeit von Studierenden der Medizin bewerten lässt. Methode: Eine Auswahl von Ärzten, wissenschaftlichen Mitarbeitern und Studierenden des klinischen Studienabschnittes evaluierten im Abstand von mindestens drei Monaten fünf Anamnese-Videos mittels der ins Deutsche übersetzten „CCOG-Kurzversion“. Die Videos bestanden aus je einem Gespräch zwischen einem Studierenden des ersten klinischen Semesters in der Rolle des Arztes bzw. einer approbierten Ärztin und einem Schauspielpatienten – in unterschiedlicher Kommunikationsqualität. Die Auswertung erfolgte deskriptiv nach folgenden Kriterien: Bewertungszeitpunkt, Geschlecht bzw. Gruppe der Rater, Qualität der Videogespräche. Darüberhinaus wurden eine explorative und eine konfirmatorische Faktorenanalyse berechnet und die Retest-Reliabilität (Intra-Rater-Reliabilität) sowie die Intra-Class-Correlation (Inter-Rater-Reliabilität) bestimmt. Ergebnisse: 30 Rater beteiligten sich an der Studie, davon drei als sog. „Goldstan-dard“. Die Gesamtbewertung aller fünf Anamnese-Videos zeigte eine geringfügige Verbesserung in der Notenvergabe beim zweiten Bewertungszeitpunkt. In der Benotung waren professionelle Rater generell etwas strenger als Laien, Ärzte etwas strenger als Studierende und weibliche Rater etwas strenger als männliche. „Gold-standard“ und übrige Rater unterschieden sich bei einzelnen Items bis zu 1,6 Notenpunkten (z.B. beim Item „verbale/nonverbale Unterstützung des Patienten“). In der Originalversion enthält der CCOG 28 Items, die in sechs Skalen (mit jeweils 3 bis 7 Items) zusammengefasst sind. Diese Struktur ließ sich in der hier gerechneten Faktorenanalyse nur bedingt abbilden. Gemäß Eigenvalue > 1 genügten 5 Faktoren zur Abbildung bzw. Aufteilung der Items. Darüber hinaus zeigte sich eine andere Skalenzuordnung als im Original und über die Hälfte der Items (15/28) lud auf demselben Faktor. Auch die Inter-Rater-Übereinstimmung in der Beantwortung einzelner Items war nicht optimal (ICC-Range: 0,05 bis 0,57). Schlussfolgerungen: Die CCOG-Kurzversion zeigte relativ gute Übereinstimmun-gen bei der Retest-Reliabilität. Schwierigkeiten zeigten sich bei der Benotung einiger Items im Vergleich zwischen dem „Goldstandard“ und den übrigen Ratern. Die Skalen-Struktur der Items und die Inter-Rater-Reliabilität sind nur bedingt akzeptabel. Vielleicht hätte eine dreistufige Bewertungsskala oder eine homogene Rater-Gruppe oder auch eine bessere Schulung das Ergebnis der ICC verbessert. Es sollten einige Items gestrichen, sprachlich trennschärfer formuliert oder anders zusammengefasst, neue Items hinzugefügt und Skalen neu strukturiert werden.

Diss. (sammanfattning) Stockholm : Karol. inst., 2003. / Härtill 4 uppsatser.

Thesis (Ph. D.)--Kent State University, 2004. / Title from PDF title page (viewed on Apr. 27, 2006). Includes bibliographical references (p. 175-209).

INTRODUÇÃO: O modelo epistemológico humanista na Medicina redefine o bom médico como um profissional que detém tanto excelência técnica quanto traços humanísticos. Os currículos médicos tiveram que se adaptar e se preocupar com projetos pedagógicos que dessem conta de promover o ensino/aprendizagem desses traços humanísticos. Esses projetos têm tentado resgatar a Educação Liberal nos currículos de Medicina através da introdução das Humanidades Médicas. Essa introdução tem sido tentada ao redor do mundo nos últimos 40 anos e requer cada vez mais novos projetos pedagógicos. Essa tese propõe o uso de uma atividade instrucional específica no campo das Artes Cinemáticas (enquanto Humanidade Médica) com a finalidade de mediar junto aos alunos a consecução de objetivos humanísticos pertinentes à Educação Médica. OBJETIVOS: Pretendeu-se analisar o filme And the band played on, produzindo possibilidades interpretativas sobre ele, justificando-as e comunicando-as através de uma síntese elucidativa; identificar aspectos de relevância médica cujo ensino/aprendizagem pode ser mediado pela discussão estruturada do filme como atividade instrucional; compilar esses aspectos em termos de objetivos educacionais humanísticos e de sua alocação a uma das taxonomias de objetivos educacionais nas Humanidades Médicas e prover exemplos concretos de possibilidades de ensino/aprendizagem relacionadas a essa atividade instrucional. METODOLOGIA: A análise fílmica abordou a obra nos seus aspectos narratológicos (como personagens e convenções de ponto de vista e narração) e estilísticos específicos do cinema. Observou os vários eixos que geram significação no cinema (linguagem verbal, linguagem escrita, visualidade, ruídos e música). Foi macro-analítica (analisando a obra como um todo), mas necessitou de momentos de micro-análise (seqüências e planos específicos). Envolveu a análise descritiva e formal da obra e sua interpretação através da análise interna (aspectos inerentes como iconografia e simbolismo) e externa (sistemas referenciais externos como teorias psicológicas) de sentido. Os aspectos de relevância médica passíveis de ensino/aprendizagem através dessa atividade instrucional foram procurados e alocados nos campos das grandes taxonomias que organizam os objetivos educacionais (Taxonomia de Objetivos Educacionais, Campos de Significado e Competências). RESULTADOS: Descreveram-se possibilidades de uso do filme de duas maneiras instrucionais: assistência do filme inteiro e assistência de excertos, em ambos os casos com posterior discussão. Em relação ao filme como um todo, duas propostas interpretativas diferentes foram geradas com base no seu potencial uso no ensino/aprendizagem em Medicina. A primeira baseia-se na narrativa romanesca da crise vocacional vivenciada pelo protagonista e a segunda centra-se na análise da instância narrativa e seus dispositivos. Em relação aos excertos, pinçaram-se algumas seqüências para ilustrar alguns de seus possíveis usos instrucionais. CONCLUSÕES: O filme pode ser usado instrucionalmente com vistas à abordagem educacional de objetivos humanísticos. Esses objetivos são pertinentes a diversas áreas do conhecimento, entre as quais citam-se os Domínio Afetivo e Emocional, os Campos Ético e Sinoético, e as Competências Adaptativa, Contextual, de Identidade Profissional e Motivação para Aprendizagem Continuada. Esses objetivos abordam áreas de conteúdo relevantes, como a relação médico-paciente, a vocação médica, o contar notícias ruins, a persona médica, o arquétipo do médico ferido, a comunicação humana e a identidade profissional médica, entre outras. / INTRODUCTION: The humanist epistemological model in Medicine redefines the good physician as a professional that has technical excellence, but also wields humanistic traits. Medical curricula have had to adapt themselves and make efforts to generate pedagogical projects that could foster the teaching/learning of these traits. These projects have attempted to address a Liberal Education in medical curricula by means of the introduction of the Medical Humanities. This introduction has been attempted worldwide in the latest 40 years and is still in need of new pedagogical projects. This thesis proposes the use of a specific instructional activity in the Cinematic Arts (as Medical Humanity) so as to provide mediation to the accomplishment by students of humanistic objectives. OBJECTIVES: The objectives of this thesis were to analyze the film And the band played on, producing interpretative possibilities about it, justifying them and communicating them by means of an elucidative work of synthesis; to identify aspects of medical relevance, whose teaching/learning could be mediated by the structured discussion of the film as an instructional activity; to compile these aspects in terms of humanistic educational objectives and their allocation to one of the taxonomies for educational objectives in Medical Humanities; and to provide concrete examples of teaching/learning possibilities related to this instructional activity. METHODS: Film analysis approached the movie through narratological (characters and conventions of narration and point of view) and cinema-specific stylistic aspects. The several axes that generate meaning in cinema have been considered (verbal language, written word, visuality, sounds and music). The analysis was macro-analytic (approaching the film as a whole), but contemplated micro-analysis (specific sequences). It involved the descriptive and formal analysis of the film and its interpretation in the light of internal (inherent aspects such as iconography and symbolism) and external (external referential systems such as psychological theories) analysis of meaning. The aspects of medical relevance were allocated to and searched for in the fields of the great taxonomies that organize educational objectives (Taxonomy of Educational Objectives, Realms of Meaning and Competences). RESULTS: Two instructional uses of the film were described: projection of the whole film, as opposed to the projection of excerpts. In both cases, a discussion should follow. In the first case, two different interpretative proposals were generated, based on their potential use in teaching/learning in Medicine. The first is based on a romanesque narrative about the vocational crisis experienced by the protagonist, whereas the second one focuses on the narrating instance and its dispositions. In terms of the excerpts, some sequences were pinpointed to illustrate some of their possible instructional uses. CONCLUSIONS: The film may be used instructionally within the educational approach to humanistic objectives. These objectives pertain to several areas of knowledge, among which, the Affective and Emotional Domains; Ethics and Synnoetics (Realms of Meaning); and Lifelong Learning, Professional Identity, Adaptative and Contextual Competences. These objectives comprehend relevant contents, such as the physician-patient relationship, medical vocation, breaking bad news, the medical persona, human communication and medical professional identity, among others.