America has continued to be increasingly diverse in culture and ethnicities. As such, these diverse populations require those in health and mental health fields to adjust to the cultural differences that arise. Central to these conversations is the impact of the acculturation process on immigrant populations. Researchers posit the stress of immigration and the acculturation process leads to increased rates of mental illness (Lang, Munoz, Bernal and Sorenson 1982; Masten, Penland and Nayani 1994; Neff and Hoppe 1993). Assuming that the acculturation process impacts first generation immigrants most, this study investigated U.S. born Blacks with and without Caribbean descent and Caribbean born Blacks residing in the U.S. to determine if nativity status and generational status impacts rates of mental illness. Using the National Survey of American Life (NSAL) dataset which is one of three research projects conducted from 2001 to 2003 by the Program for Research on Black Americans (PBRA), as part of the Research Center for Group Dynamics project, analyses were conducted to determine if relationships existed for these groups. Results indicated that mental illness is dependent on country of origin and U.S. born Blacks do self-report mental illnesses significantly more than Caribbean Blacks. Caribbean Blacks who are first generation in the U.S. are significantly less likely to report mental illness than second generation Caribbean Blacks. Differences in gender, work, number of years living in the U.S., age at immigration and wealth and poverty indicators all show some relationships with mental illnesses. / Ph. D.

Moral distress in the healthcare field includes feelings of frustration, anger, guilt, anxiety, depression, despair, and powerlessness to carry out ethically appropriate actions to patients in line with personal values in the setting of external constraints. Psychiatry residents are particularly vulnerable to experiencing moral distress due to the coercive aspects of psychiatric treatment, constraints in the medical system, and the internal conflicts caused by a resident’s identity as a trainee physician and competing duties to an individual patient, healthcare organizations, health care professionals, and society. Psychiatrists make complex assessments that often cannot be made with absolute certainty, but regardless, they are tasked with the duty to identify and ultimately act on their risk assessments. These unrealistic societal expectations are especially difficult for psychiatry residents who have not yet had the experience to grow their knowledge and confidence in their decision-making skills yet still must make difficult decisions in their new role as physicians. Ethical decision-making can be used to alleviate moral distress, and a consistent utilization of an ethical decision-making framework can help guide decisions that are both objective and thoughtful. The ethical framework proposed includes considerations of the patient's capacity to consent or refuse medical treatment, the urgency of the medical condition, the feasibility of the actions needed to address the medical condition, and the countertransference of the treatment team. This framework helps guide clinicians by ensuring they understand and address the ethical considerations involved in treating patients and the moral distress that arises from these difficult choices. / Urban Bioethics

Within the framework of ethnography, an inquiry was made into the many dimensions of psychological treatment and training in a psychiatric hospital, with particular reference to State Patients. Ethnography is the study of an intact cultural or social group based mainly on observations over a prolonged period of time in which the researcher is a participant. The multicultural aspects of the therapeutic community were also inquired into. Ethnographic data was collected and processed over a period of 16 years in three psychiatric hospitals, the main source of data gathered from Weskoppies Hospital in Pretoria. The ecosystemic psychotherapeutic perspective was used as a meta-model to describe eight therapeutic approaches in which intern-psychologists were trained. The hospital is described as a therapeutic community in which rehabilitation is a multi-professional responsibility. Each profession, or sub-culture, has its own framework and culture in which it works within the broader system of the psychiatric hospital. Ethical considerations and recommendations are levelled at the academic and practical aspects of clinical psychology, hospital management, and different levels of government. / Psychology / D.Litt. et Phil.

A research report submitted to the Faculty of Commerce, Law and Management, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of Master of Commerce (specialising in Taxation). / There has been significant advances in the international arena with regards to global economic growth and trade, as well as enormous competition by countries to attract inward foreign direct investment from multinational enterprises (MNEs) to ensure the sustainability of their own economies. Fundamentally the contentious issue is the possibility of double taxation (DT), due to the dual residency of the MNE. The MNE operates in various markets which results in cross-border transactions, whether physical or electronic, and this ultimately means that different tax jurisdictions will become applicable and enforceable by each relevant country. These dual resident MNEs could be seen as a tax resident in both countries and thus be liable for tax obligations in both of these countries. This would therefore lead to the same income incurring DT or double non-taxation (DNT), which would have a devastating impact on that MNE. This lead to the establishment of double taxation treaties, agreements and conventions (DTA’s), between various countries which are aimed at addressing this imbalance. As technology advances at an alarming rate, so too does the possibility of abuse of tax treaties. Two important criteria are ‘the place of effective management’ (POEM) and the ‘permanent establishment’ (PE), which are critical to the determination of the correct tax jurisdiction where the dual resident MNE will incur various tax liabilities. These concepts, POEM and PE, can be confusing but are imperative, in order to prevent DT, and which could prejudice the relevant fiscus, as well as an attempt to avoid any conflict between the taxing regimes. An interesting facet of the POEM and PE conundrum is the interpretation by the Organisation for Economic Co-operation and Development’s (’the OECD’) Model Tax Convention (MTC) compared to the interpretations by the South African Revenue Service (SARS). Another area of contention for MNEs is the current enormous global focus on the concept of Base Erosion and Profit Shifting (BEPS), which is under great scrutiny, and is of great concern for the majority of revenue authorities. These authorities are intensifying their focus on improving and enforcing anti-avoidance provisions to prevent taxation leakage in their respective tax jurisdictions. This shift in priorities opposes one of a MNE’s main business objectives which is to maximize profits, by either diverting, extracting and/or distributing profits out of a high tax paying jurisdiction into a lower tax paying jurisdiction. This will consequently create an additional business risk which emphasises the need for international tax expertise. The international tax expert is a valuable business team member, as their knowledge and expertise is imperative for the mitigation of possible tax risks, correct interpretation and application of the relevant tax legislation on the business flows of the MNEs as a result of operational expansion or any cross-border transactions or activities. Key Words: Taxation, Tax Treaties, Agreements, BEPS, Conventions; Cross-border, Double Taxation; Dual Residency; International tax, Multinational enterprises; Permanent Establishment, Place of Effective Management; OECD Model Tax Convention; Tax Intelligence, Tax Jurisdictions

Anualmente, a Secretaria de Estado da Saúde de São Paulo (SES/SP) realiza o Concurso SUS-SES/SP para o preenchimento de vagas de RM oferecidas pelas instituições participantes, nas diferentes especialidades médicas. Partindo da compreensão que a decisão pela especialidade é um momento singular na trajetória da profissão médica, e que, a RM desempenha um importante papel para o sistema de saúde; este trabalho objetivou conhecer a tendência da demanda por especialidades médicas tomando como referência, o universo dos candidatos que se inscreveram no Concurso SUS, no período entre 1999 e 2004. Dentre as especialidades que contaram com aumento na procura estão a Anestesiologia, Cirurgia Cardiovascular, Cirurgia Oncológica, Cirurgia Plástica, Clínica Médica, Dermatologia, Endocrinologia e Psiquiatria. As especialidades que apresentaram queda na procura foram Cirurgia de Cabeça e Pescoço, Gastroenterologia, Oftalmologia, Pediatria e Pneumologia / Annually, the Secretaria de Estado da Saúde de São Paulo (SES/SP) opens Single Health System SES/SP Medical Residency Contest offered by participant institutions in different medical specialties. The public selection process has been held in partnership with Fundação Carlos Chagas for more than fifteen years. Currently, this process counts with almost six thousand candidates enrolled from several regions of Brazil. Assuming that making decision for specialty is a very singular moment for medical career, and that, Medical Residency conducts an important function for Health System; this research aims to point out tendencies for medical specialties, using the amount of enrolled candidates for SUS Contest, between 1999 and 2004, as reference. Therefore, the number of inscriptions raised 18% in this period, distinguishing male predominance. Considering candidates hometown, 52% lived outside Sao Paulo State in the moment of contest inscription, making evident the attractive potential for doctors from different regions of Brazil. In terms of numbers, basic specialties took part in half inscriptions in this period. In terms of numbers, basic specialties took part in half inscriptions in this period. The specialties with raised number of searching were Anesthesiology, Surgery Cardiovascular, Oncology Surgery, Plastic Surgery, General Internal Medicine, Dermatology, Endocrinology and Psychiatry. The specialties with decreased number of searching were Head and Neck Surgery, Gastroenterology, Ophthalmology, Pediatrics and Pneumology

A Residência Multiprofissional em Saúde pretende ser uma nova estratégia para políticas de educação permanente que enfoca diversas categorias profissionais da área de saúde e favorece a produção das condições necessárias para mudanças no perfil profissional para prepará-los para uma atuação na perspectiva da atenção integral à saúde. Este trabalho objetiva analisar o processo de formação do cirurgião-dentista do curso de Residência Multiprofissional em Saúde da Família (RMSF) da Casa de Saúde Santa Marcelina (CSSM), a partir da visão do egresso. Foram entrevistados os egressos da primeira turma desta residência. Os discursos foram analisados segundo a metodologia qualitativa pelo método da análise de conteúdo temática proposta por Bardin. A análise gerou quatro categorias. Na primeira A vivência no serviço preparando o residente observou-se que a articulação entre ensino e serviço na residência multiprofissional possibilitou uma imersão do egresso no campo de prática. A partir da vivência no serviço o aluno/profissional pode enfrentar as dificuldades existentes nos processos de trabalho e na organização do serviço refletindo e construindo conhecimentos importantes para sua formação profissional. Na segunda - Trabalhando em equipe multiprofissional: desafios e aprendizados observou-se as modificações que o trabalho em equipe proporcionou aos residentes que puderam refletir sobre o processo de trabalho no Programa de Saúde da Família e a interação entre essas categorias possibilitou uma nova abordagem no cuidado à saúde. Foi possível observar também que os residentes experimentaram as dificuldades que existem no trabalho em equipe. A lógica do trabalho multiprofissional impõe uma prática diferente daquela que os profissionais estão acostumados. Na terceira - Importância de dois atores no processo de formação: tutores e preceptores verificou-se que os tutores e preceptores desempenham papéis importantes na RMSF. Os tutores orientam o residente na sua formação e os preceptores exercem uma função indispensável na mediação das relações entre coordenação-residente-tutor. Foi possível observar que estes papéis não estavam bem definidos pelos atores envolvidos no processo de formação o que dificultou o enfretamento de alguns problemas vivenciados pelos residentes na prática. Torna-se evidente um melhor preparo destes profissionais para que as práticas pedagógicas aplicadas na residência sejam operadas a contento. Por fim a quarta categoria - Apresentando os nós críticos: do aluno, do serviço e do curso apontou alguns entraves encontrados no processo de formação: a imaturidade do recém formado: visão restrita da graduação em relação ao serviço público; despreparo do serviço em receber o residente e problemas estruturais e organizacionais da residência. Por fim, foi possível observar que a formação na RMSF da CSSM proporcionou aos egressos a percepção, o aprendizado, e o exercício de novos saberes, competências, habilidades e atitudes, tais como: atuação multiprofissional e interdisciplinar, promoção e educação em saúde, humanização e personalização do atendimento, concepção ampliada de saúde, novas relações entre profissionais de saúde e entre estes e a população. Pelos relatos dos egressos, esses e outros elementos, ainda que percebidos muitas vezes de forma fragmentada, foram identificados como componentes importantes de um novo modelo de atenção à saúde. / The Multidisciplinary Residency in Health aims to be a new strategy for permanent learning policies that focus on various categories of health professionals and promotes the production of the necessary conditions for changes in professional profile to prepare them for a performance from the perspective of comprehensive health care. The objective of this paper is to analyze the process of training of dentists in al Multidisciplinary Residency in Family Health (MRFH) at the Casa de Saúde Santa Marcelina (CSSM), from the perspective of the graduate. The first group of graduates of the residence was interviewed. The reports were analyzed according to qualitative methodology by the method of thematic content analysis proposed by Bardin. The analysis produced four categories. The first - The experience in service preparing the student - it was observed that the linkage between education and service to the student provided a multi-immersion of the graduates in terms of professional practice. From the experience in the service the student / professional can face the existing difficulties in work processes and organization of service reflecting and constructing knowledge relevant to their professional training. The second - Working in multi-professional teams: challenges and learning - the changes observed that teamwork provided to residents who might reflect on the process of working in the Family Health Program and the interaction between these categories provided a new approach to health care. It was also observed that students have experienced the difficulties that exist in teamwork. The logic of multi-professional work requires a different practice from what the professionals are accustomed. In the third - The importance of two actors in the process of education: mentors and tutors - it was observed that tutors and mentors play important roles in the MRFH. Tutors guide the student in his training and have a crucial role in mediating the relationships between coordination-student-tutor. It was observed that these roles were not well defined by the actors involved in the training process making it difficult to confront with some problems experienced by residents in practice. It is clearly evident the better preparation of these professionals for the pedagogical practices applied to the residence to be operated satisfactorily. Finally the fourth category - Introducing the critical questions: the student, service and the course - pointing out some obstacles encountered in the training process: the immaturity of the newly formed: restricted view of the undergraduation related to public service, lack of preparation of the care service to receive the students and organizational and structural problems of the course. It was also observed that the formation of MRFH in CSSM gave the students perception, learning, and the pursuit of new knowledge, skills, abilities and attitudes, such as multidisciplinary and interdisciplinary promotion and health education, humanization and personalization of care, expanded concept of health, new relationships between professionals and between them and the population. According to the reports of graduates, these and other factors, though often perceived as fragmented, were identified as important components of a new model of health care.

Introdução: A curva de aprendizado em cirurgia é um período de sedimentação de habilidades onde procedimentos são realizados com maior dificuldade e lentidão, maior risco de complicações intra-operatórias e menor eficácia clínico-funcional devido à inexperiência do cirurgião. Nós analisamos a curva de aprendizado inicial da prostatectomia radical retropúbica realizada por médicos residentes do Setor de Uro-Oncologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Método: estudo prospectivo, envolvendo 184 prostatectomias radicais retropúbicas, realizadas por cinco residentes consecutivamente, entre 02/06/2006 e 31/01/2008. Foram considerados: o tempo operatório, sangramento transoperatório, necessidade de transfusão sanguínea, taxa de margens cirúrgicas comprometidas, complicações intra-operatórias e avaliação funcional precoce. Resultados: cada residente realizou em média 37 cirurgias. O PSA mediano foi de 9,3 ng/mL e o estágio clínico T1c em 71% dos pacientes. O estágio patológico foi pT2 (73%), pT3 (23%), pT4 (4%); o escore de Gleason na peça cirúrgica foi de 54% (Gleason <7), 33% (Gleason 7) e 13% (Gleason >7). O tempo cirúrgico mediano foi de 140 minutos, o sangramento mediano de 488 mL e a necessidade de transfusão sanguínea de 7,2%. A taxa de margens cirúrgicas positivas de 23% foi constante nos 30 primeiros casos. A avaliação funcional precoce (até 6 meses de pós-operatório) mostrou 89% de continência, 57% de disfunção erétil e 7% de recidiva bioquímica. Conclusão: Durante a curva de aprendizado da prostatectomia radical, ocorre redução significativa do tempo operatório após 20 cirurgias e tendência de redução do sangramento e da necessidade de transfusão sanguínea após 29 cirurgias. As margens cirúrgicas permanecem estáveis em 23%. / Introduction: The learning curve is a period of skills improvement. Procedures are carried through with longer operating time, high risk of surgical complications and sub optimal functional outcomes. We have analyzed the residents\' initial learning curve in open radical prostatectomy in our institution. Method: Between June of 2006 and January of 2008, 184 open radical prostatectomies have been performed in our service by five senior residents in Urology. We prospectively evaluated: operating time, blood loss, blood transfusion rate, positive surgical margins, intra-operative complications and early functional outcomes. Results: an average of 37 open radical prostatectomies was performed by each resident. Medium PSA was 9,3ng/mL; clinical stage T1c in 71% of the patients. The pathological stage was pT2 (73%), pT3 (23%), pT4 (4%) and Gleason score was 54% (Gleason <7), 33% (Gleason 7) and 13% (Gleason >7). The medium operating time was 140 minutes, medium blood loss of 488 mL and positive margins were found in 23% during the first 30 cases. Early functional outcomes (less than 6 months after surgery) revealed 89% of urinary continence, 43% of normal erectile function and 7% of biochemical recurrence. Conclusion: During the initial learning curve significant reduction in operating time occurs after first 20 procedures, blood loss and transfusion improves after 29 prostatectomies and positive margins remain stable during the first 30 patients (23%).

Made available in DSpace on 2016-04-28T20:39:41Z (GMT). No. of bitstreams: 1 Regina Alvares Biscaro.pdf: 1934284 bytes, checksum: 6349530dc7f9e3be6f79896c96e927bf (MD5) Previous issue date: 2008-02-29 / With that advance of neurosciences and psychopharmacology, psychiatry has come to great transformations, as in human being conception and as in teaching and education in medical residency. This brought an important advancement in the treatment of mental disorders, but on the other hand, the teaching of psychotherapy decreased its importance, becoming part of an ancient strategy due to the lack of advancement in psychopharmacology. Recent studies though, have retaken the importance of psychotherapy as a strategy of treatment for modifying brain circuits, anciently thought to be only privilege of medication. These discoveries have modified the vision of psychotherapy´s training into psychiatry, showing its importance. Some international works focus on the resident´s training in acquisition of skills in psychotherapy, but this necessity is questionable. The objective of this study was to evaluate a group of residents´ change of consciousness during a training of psychotherapy. A Coortes study was done and a semi-structured questionnaire was used in three moments of the training and also a semi-structured interview at the end. After the results´ evaluation and data debate, it was concluded that the residents have come to transformations during the psychiatric residency period and that the training in psychodynamic psychotherapy provides a deep transformation that even propitiating the arrival of defenses, it contributes to an important change of the resident´s consciousness in relation to one self and in relation to the patient. This transformation provides an empathic listening, a larger symbolic comprehension of symptoms and motivations and the knowledge of oneself, making the resident know a little more about the other and himself in the relationship with the patient, becoming a more humane psychiatrist with a broad approach / Com o avanço das neurociências e da psicofarmacologia, a psiquiatria passou por grandes transformações, tanto na concepção de ser humano como no ensino e formação dentro da residência médica. Isso trouxe um avanço importante no tratamento dos transtornos mentais, mas por outro lado, o ensino da psicoterapia diminuiu sua importância, passando a fazer parte de uma estratégia antiga, por falta de avanços na psicofarmacologia. Estudos recentes, porém, tem retomado a importância da psicoterapia como estratégia de tratamento por modificar circuitos cerebrais, pensado antigamente ser prerrogativa apenas da medicação. Estas descobertas têm modificado a visão do treinamento em psicoterapia dentro da psiquiatria, trazendo à luz novamente a sua importância. Alguns trabalhos internacionais focam o treino do residente em aquisição de habilidades em psicoterapia, mas essa necessidade é questionável. O objetivo deste estudo foi avaliar a mudança de consciência de um grupo de residentes durante o treino em psicoterapia. Foi feito um estudo de Coortes e, utilizados um questionário semi-estruturado em três momentos do treino e uma entrevista, também semi-estruturada, no final. Após a avaliação dos resultados e discussão dos dados, conclui-se que os residentes passam por transformações durante o período da residência em psiquiatria e que o treino em psicoterapia psicodinâmica proporciona uma profunda transformação que, mesmo propiciando o aparecimento de defesas, contribui para uma importante mudança de consciência do residente com relação a si mesmo e com relação ao paciente. Esta transformação proporciona uma escuta empática, uma maior compreensão simbólica dos sintomas e das motivações e um aprofundamento em si mesmo, fazendo com que o residente, na relação com o paciente, conheça um pouco mais do outro e de si mesmo, tornando-se um psiquiatra mais humano e com uma abordagem mais completa

Submitted by Filipe dos Santos (fsantos@pucsp.br) on 2017-03-30T12:40:12Z No. of bitstreams: 1 Dayse Andrade Bispo Silva.pdf: 5401908 bytes, checksum: 0d015ee86e642e88d61ed6c18455b577 (MD5) / Made available in DSpace on 2017-03-30T12:40:12Z (GMT). No. of bitstreams: 1 Dayse Andrade Bispo Silva.pdf: 5401908 bytes, checksum: 0d015ee86e642e88d61ed6c18455b577 (MD5) Previous issue date: 2017-03-20 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / Therapeutic Residency (TR) is one of the main strategies to reduce psychiatric beds in the Brazilian Unified Health System. They are houses for people with mental disorders or abusive use of alcohol and other drugs for those the lack of housing and social network are priority issues in their life project. They receive mainly former inmates from psychiatric hospitals. Considering the importance of this equipment for the Psychiatric Reform Movement and the network that São Bernardo do Campo has today, this study aim to research the processes of psychosocial rehabilitation performed in the daily life of these houses-services, based on a methodology that privileged the production of knowledge in a collective and participatory way between the researcher and the subjects involved in the field. Therefore, we created a participative group device based on the theoretical and methodological guidelines of participatory research, Psychodrama and Institutional Analysis. The Participatory Group device was attended by 16 professionals from TR (Therapeutic Companion) and 5 professionals from the Psychosocial Care Centre (therapeutic references of the residents of TRs), in a total of 12 meetings. The structure of these meetings privileged the work with dramatic multiplication around daily situations, followed by processing and producing texts. We started the thesis by contextualizing TRs in SBC and presenting the toolbox for the construction of our intervention: the sense of participation in intervention and cartography researches, the theoretical and methodological contribution of Psychodrama, as well as the articulation of these two methodological fields - participation and protagonism. The creation and the course of the Participative Group device are themes of the third moment of this writing. The empirical material, presented in the form of scenes, was organized in two parts. The first focuses on the tools of care in psychosocial rehabilitation as formulated by the Participatory Group, presented in five vectors: the link between TR workers and residents; the thresholds of this meeting, in the form of turbulences and crises in the TRs, the joy of being together, responsibility and the production of subjectivity in RT work. The second part discusses aspects of the work process in TR and the inseparability between modes of management and modes of care, focusing on theses vectors: work hours of the Therapeutic Companions, the role of TR’s coordinator and therapeutic references of the residents, co-responsibility care and the construction of the Singular Therapeutic Project. Our thesis is that the hybridity house-service that TRs have, intensifies the radical experimentation of mental health care, articulating the clinic of living to the agencies in the territory, positioning the Therapeutic Companion workers in an experience of multi-implication, and in a protagonism of multiple roles with the residents, the team and the city. TRs, therefore, constitute as a "particular ambience" for the experimentation of potentialities and thresholds of the Psychiatric Reform / A Residência Terapêutica (RT) é uma das principais estratégias para a redução dos leitos psiquiátricos no Sistema Único de Saúde. São casas para sujeitos com transtornos mentais ou uso abusivo de álcool e outras drogas para os quais a falta de moradia e de rede social são questões prioritárias no seu projeto de vida. Recebem principalmente ex-internos dos hospitais psiquiátricos. Pensando na importância desse equipamento para o Movimento da Reforma Psiquiátrica e na estrutura de rede que São Bernardo do Campo possui hoje, este estudo teve como interesse pesquisar os processos de reabilitação psicossocial realizados no cotidiano dessas casas/serviços, a partir de uma metodologia que privilegiasse a produção de conhecimento de forma coletiva e participativa entre o pesquisador e os sujeitos envolvidos no campo-tema. Construímos, desta forma, um dispositivo grupal participativo a partir das pistas teóricas e metodológicas das pesquisas participativas, do Psicodrama e da Análise Institucional. O dispositivo Grupo Participativo contou com a participação de 16 profissionais de RTs (Acompanhantes Terapêuticos) e com 5 profissionais do Centro de Atenção Psicossocial, referências terapêuticas dos moradores das RTs, totalizando 12 encontros. A estrutura desses encontros privilegiaram o trabalho com multiplicação dramática em torno de situações do cotidiano, seguido de processamento e da produção de textos. Iniciamos a tese contextualizando as RTs em SBC e apresentando a caixa de ferramentas para a construção da intervenção: o sentido da participação na pesquisas-intervenção e cartografia, a contribuição teórica e metodológica do Psicodrama assim como a articulação destes dois eixos metodológicos - participação e protagonismo. A montagem e o percurso do dispositivo Grupo Participativo são temas do terceiro momento da escrita. O material empírico, apresentado na forma de cenas, foi organizado em duas partes. A primeira privilegia as ferramentas do cuidado na reabilitação psicossocial tais como formuladas pelo Grupo Participativo, em cinco vetores: o vínculo entre trabalhadores da RT e moradores; os limiares desse encontro, na forma das turbulências e das crises nas RTs, a alegria de conviver, a responsabilização e a produção de subjetividade no trabalho da RT. A segunda discute aspectos do processo de trabalho na RT e a inseparabilidade entre modos de gestão e modos de atenção, focalizando os vetores: carga-horária dos Acompanhantes Terapêuticos, a função de coordenador da RT e de referência terapêutica dos moradores, a corresponsabilização do cuidado e a construção do Projeto Terapêutico Singular. Nossa tese é que o hibridismo casa-serviço das RTs intensifica a experimentação radical do cuidado em saúde mental, articulando a clínica do morar aos agenciamentos no território, posicionando o trabalhador Acompanhante Terapêutico numa experiência de multi-implicação, num protagonismo de múltiplos papéis na relação com os usuários, com a equipe e com a cidade. As RTs configuram assim uma “ambiência particular” para a experimentação das potências e dos limiares da Reforma Psiquiátrica

Esta tese se ocupa da educação dos profissionais de saúde a qual vem sendo (re)discutida, amplamente no mundo. De acordo com a Organização Mundial da Saúde, a educação dos profissionais de saúde ainda é considerada fragmentada, descontextualizada e produtora de um currículo estático ao avaliar a dinâmica de mudanças que ocorre nessa área. No Brasil, destaco o movimento da Educação Permanente em Saúde (EPS) que propõe uma mudança na formação a fim de orientar os profissionais de saúde para o trabalho no Sistema Único de Saúde. O conceito de Educação Permanente é uma proposta educativa destinada a intervir e provocar reflexões sobre o processo de trabalho direcionado a melhorar a qualidade do serviço e das condições laborais: educação no trabalho, pelo trabalho e para o trabalho. Assim, essa tese objetivou: compreender como práticas pedagógicas de EPS são utilizadas na formação de profissionais em saúde em uma Residência Multiprofissional em Saúde e analisar como o processo reflexivo-dialógico desenvolvido em uma Residência Multiprofissional em Saúde com seus preceptores gera mudanças ao longo das fases de uma Pesquisa Apreciativa.Este estudo é caracterizado como um Estudo Apreciativo Crítico porque articula a metodologia Pesquisa Apreciativa com a Teoria Crítica Social. Utilizo como orientação teórica a EPS e seus conceitos atrelados ao teórico social crítico Paulo Freire. Este estudo foi implementado no Programa de Residência Integrada Multiprofissional do Hospital de Clínicas de Porto Alegre. Os participantes essa pesquisa foram sete preceptores da referida Residência. Como estratégia para produção dos dados, foram realizados grupos de discussões com os preceptores. A metodologia foi organizada em quatro estágios que constituem um ciclo 4D: Discovery, Dream, Design e Destiny. Cada fase foi desenvolvida em um objetivo específico. A análise de dados foi realizada de acordo com Green et al (2007), Silverman (2000) e Denzin e Lincoln (2000). Como principais resultados estão a identificação das melhores práticas desenvolvidas pelos preceptores, como a consulta multiprofissional, o acolhimento dos residentes e as ações integradas entre as diferentes ênfases da Residência. Em relação aos sonhos dos preceptores, destacamos os estágios vivências, a integração da residência médica com a residência multiprofissional e a valorização financeira dos preceptores. Além disso, saliento a construção da proposta de formação pedagógica para a Residência que foi a criação de um Núcleo pedagógico de Educação Permanente em Saúde. Este estudo convidou os participantes a refletirem criticamente sobre suas práticas em seu espaço de trabalho em um processo dialógico, reflexivo e participativo, pois oportunizou que os preceptores tenham a possibilidade de tornarem-se agentes de mudança, logo, sujeitos de um processo construído coletivamente. Com este estudo, esperamos que os preceptores possam atuar de modo participativo na pesquisa, se sintam coautores e valorizados, além de ampliar o diálogo em torno da problemática da EPS contextualizando-a no espaço da residência multiprofissional. / The education of health professionals during their career is being extensively re-discussed in the world. According to the World Health Organization (WHO) the education of health profes-sionals still considered fragmented, out of the context and it is the producer of a static curricu-lum when assessing the dynamicity of changes which occurs in this area. The concept of Con-tinuing Education in Health is an educational proposal to intervene and provoke reflections on the work process aimed at improving service quality and labor conditions: education in work, education through work and for the work. This thesis aimed: understand how pedagogical prac-tices of Continuing Education in Health is used on multiprofessional residences in health and analyze how the reflexive-dialogic process generates changes throughout the phases of appre-ciative inquiry. This study is characterized as a Critical Appreciative Study because it applies the methodology of appreciative inquiry articulated in the Social Critical Theory. I appliyed the theoretical guidance the Continuing Education in Health and its concepts linked to the critical social theorist Paulo Freire. This research was conducted at Multiprofessional Residence Pro-gram, which is developed in the Hospital de Clínicas de Porto Alegre, Brazil. The participants were seven Residency preceptors. As a data collection strategy groups of discussions through meetings with these preceptors were conducted. The methodology was organized into four stages which constitute a 4D cycle: Discovery, Dream, Design e Destiny. Each stage was de-veloped in a specific objective. The data analysis was conducted according to Green et al (2007), Silverman (2000) and Denzin e Lincoln (2000). The main results are the identification of the best practices developed by the teachers, the multiprofessional consultation, the reception of the residents and the actions integrated between the different emphases of the Residence. As dreams of preceptors, they highlight the steps, the integration between the Medical Residence and the Multiprofessional Residence and also a better wage for preceptors. In addition, I High-lighted the construction of the pedagogical training proposal for the Residence: a creation of a Pedagogical Nucleus of Permanent Education in Health. During the study, the participants were invited to reflect critically on their practices in the work space in a dialogical process, Reflective and participatory process that gave the possibility of becoming agents of change, subjects of a collectively constructed process. The study points to the possibility that preceptors feel them-selves to be co-authors and valued, in addition to broadening the dialogue around the problem of Continuing Education in Health contextualizing it in the space of the multiprofessional res-idence.