This qualitative study explored the effects of trauma as well as coping mechanisms used to deal with post-traumatic stress experienced by ILS paramedics providing emergency care services in the Gauteng Province, South Africa. It also looked at the competencies needed to cope with traumatic stress and promote biopsychosocial well-being. It is argued that it is important to look at this subject from a South African perspective since most of the published research on the sources and effects of trauma on paramedics and other frontline emergency services personnel experience comes from developed countries. It was discovered that there is minimal empirical research from South Africa on similar topics, except for a study in the Cape Town metropole. In addition to that, most published research relied on quantitative data collection methods. Through qualitative case study research this thesis draws on observations and relevant data gathered by way of semi-structured face to face interviews with eleven operational Intermediate Life Support (ILS) paramedics who work in the Gauteng province. Data is gathered on the sources of stress and coping mechanisms currently used by the paramedics. The gathered data was analysed using thematic analysis. The results show that the sources of stress for paramedics include attending gruesome scenes, extreme pressure to save lives and attending a scene where a child or a colleague is involved. It was also observed that the paramedics have a set of coping strategies to manage post-traumatic stress which are both positive and negative coping strategies. In addition to interviews with ILS paramedics from whom data is gathered on their education and training, the results in this thesis gathered insight from a panel of six experts who were engaged through a focus group discussion. These experts have demonstrable expertise in curriculum development, trauma counselling and training. The panel recommended that the training of the paramedics must be more realistic such that the paramedics are better equipped to deal with the challenges they may encounter in the work environment. It was also revealed that those who train paramedics are not well equipped to deliver the health and wellness module. It can be concluded that some paramedics are not well equipped to deal with traumatic events they encounter in the field. The researcher recommends that the health and wellness module be delivered by people who are specifically trained to deal with mental health issues. Insights gathered in this study will help the paramedics, those they help and their families.

Doctor of Philosophy (PhD) / Effective clinical reasoning and its communication are essential to health professional practice, especially in the current health care climate. Increasing litigation leading to legal requirements for comprehensive, relevant and appropriate information exchange between health professionals and patients (including their caregivers) and the drive for active consumer involvement are two key factors that underline the importance of clear communication and collaborative decision making. Health professionals are accountable for their decisions and service provision to various stakeholders, including patients, health sector managers, policy-makers and colleagues. An important aspect of this accountability is the ability to clearly articulate and justify management decisions. Considerable research across the health disciplines has investigated the nature of clinical reasoning and its relationship with knowledge and expertise. However, physiotherapy research literature to date has not specifically addressed the interaction between communication and clinical reasoning in practice, neither has it explored modes and patterns of learning that facilitate the acquisition of this complex skill. The purpose of this research was to contribute to the profession’s knowledge base a greater understanding of how experienced physiotherapists having learned to reason, then learn to communicate their clinical reasoning with patients and with novice physiotherapists. Informed by the interpretive paradigm, a hermeneutic phenomenological research study was conducted using multiple methods of data collection including observation, written reflective exercises and repeated semi-structured interviews. Data were analysed using phenomenological and hermeneutic strategies involving in-depth, iterative reading and interpretation to identify themes in the data. Twelve physiotherapists with clinical and supervisory experience were recruited from the areas of cardiopulmonary, musculoskeletal and neurological physiotherapy to participate in this study. Participants’ learning journeys were diverse, although certain factors and episodes of learning were common or similar. Participation with colleagues, peers and students, where the participants felt supported and guided in their learning, was a powerful way to learn to reason and to communicate reasoning. Experiential learning strategies, such as guidance, observation, discussion and feedback were found to be effective in enhancing learning of clinical reasoning and its communication. The cultural and environmental context created and supported by the practice community (which includes health professionals, patients and caregivers) was found to influence the participants’ learning of clinical reasoning and its communication. Participants reported various incidents that raised their awareness of their reasoning and communication abilities, such as teaching students on clinical placements, and informal discussions with peers about patients; these were linked with periods of steep learning of both abilities. Findings from this research present learning to reason and to communicate reasoning as journeys of professional socialisation that evolve through higher education and in the workplace. A key finding that supports this view is that clinical reasoning and its communication are embedded in the context of professional practice and therefore are best learned in this context of becoming, and developing as, a member of the profession. Communication of clinical reasoning was found to be both an inherent part of reasoning and an essential and complementary skill necessary for sound reasoning, that was embedded in the contextual demands of the task and situation. In this way clinical reasoning and its communication are intertwined and should be learned concurrently. The learning and teaching of clinical reasoning and its communication should be synergistic and integrated; contextual, meaningful and reflexive.

Doctor of Philosophy (PhD) / Effective clinical reasoning and its communication are essential to health professional practice, especially in the current health care climate. Increasing litigation leading to legal requirements for comprehensive, relevant and appropriate information exchange between health professionals and patients (including their caregivers) and the drive for active consumer involvement are two key factors that underline the importance of clear communication and collaborative decision making. Health professionals are accountable for their decisions and service provision to various stakeholders, including patients, health sector managers, policy-makers and colleagues. An important aspect of this accountability is the ability to clearly articulate and justify management decisions. Considerable research across the health disciplines has investigated the nature of clinical reasoning and its relationship with knowledge and expertise. However, physiotherapy research literature to date has not specifically addressed the interaction between communication and clinical reasoning in practice, neither has it explored modes and patterns of learning that facilitate the acquisition of this complex skill. The purpose of this research was to contribute to the profession’s knowledge base a greater understanding of how experienced physiotherapists having learned to reason, then learn to communicate their clinical reasoning with patients and with novice physiotherapists. Informed by the interpretive paradigm, a hermeneutic phenomenological research study was conducted using multiple methods of data collection including observation, written reflective exercises and repeated semi-structured interviews. Data were analysed using phenomenological and hermeneutic strategies involving in-depth, iterative reading and interpretation to identify themes in the data. Twelve physiotherapists with clinical and supervisory experience were recruited from the areas of cardiopulmonary, musculoskeletal and neurological physiotherapy to participate in this study. Participants’ learning journeys were diverse, although certain factors and episodes of learning were common or similar. Participation with colleagues, peers and students, where the participants felt supported and guided in their learning, was a powerful way to learn to reason and to communicate reasoning. Experiential learning strategies, such as guidance, observation, discussion and feedback were found to be effective in enhancing learning of clinical reasoning and its communication. The cultural and environmental context created and supported by the practice community (which includes health professionals, patients and caregivers) was found to influence the participants’ learning of clinical reasoning and its communication. Participants reported various incidents that raised their awareness of their reasoning and communication abilities, such as teaching students on clinical placements, and informal discussions with peers about patients; these were linked with periods of steep learning of both abilities. Findings from this research present learning to reason and to communicate reasoning as journeys of professional socialisation that evolve through higher education and in the workplace. A key finding that supports this view is that clinical reasoning and its communication are embedded in the context of professional practice and therefore are best learned in this context of becoming, and developing as, a member of the profession. Communication of clinical reasoning was found to be both an inherent part of reasoning and an essential and complementary skill necessary for sound reasoning, that was embedded in the contextual demands of the task and situation. In this way clinical reasoning and its communication are intertwined and should be learned concurrently. The learning and teaching of clinical reasoning and its communication should be synergistic and integrated; contextual, meaningful and reflexive.

Introduction: Students with disabilities are underrepresented in post-secondary education, including health professional programs. They experience higher rates of attrition and lower rates of graduation compared to their non-disabled peers. Some research indicates that educators engage in ableist practices preventing students with disabilities from successfully completing these programs. Educators report difficulty meeting the myriad of professional and educational expectations in professional programs. Rehabilitation professions provide a unique opportunity for research given their emphasis on participation and inclusion. Purpose: The purpose of this program of research was to explore the educator perspective in the accommodation of students with disabilities in professional rehabilitation programs. Method: There are three studies that constitute this thesis. The first study is a critical discourse analysis in which the most relevant texts in the accommodation process were examined. The second study is an institutional ethnography informed study, whereby university-based educators were interviewed about their actions in the accommodation process of students with disabilities. The final study is an interpretive description that involved interviews with fieldwork educators who provide disability-related accommodations to students in their work settings. Findings: The texts involved in the accommodation process revealed varied and conflicting discourses and subject positions for educators in rehabilitation programs. University-based educators identified tensions reconciling the focus on students in the post-secondary education context with the focus on clients in the healthcare context, for which they were preparing students. However, fieldwork educators were generally at ease with the accommodation process as they integrated accommodations into the broader goal of learning. Implications: This body of work provides insight into the reasons why educators may struggle with the accommodation process in professional rehabilitation programs. It also identifies potential solutions for educational programs and future directions for research. / Thesis / Doctor of Philosophy (PhD) / Students with disabilities experience difficulty entering and graduating from health professional programs, including rehabilitation. This group of students face challenges in meeting all the requirements for their programs. Through three discrete studies, this thesis explores educators’ perspectives on the accommodation process of students with disabilities. The first study demonstrated that the most relevant documents to the accommodation process require educators to take on conflicting roles. The second study showed that university-based educators struggle with the focus on students at the university, which seemed to be prioritized over the focus on clients in healthcare, the context for which educators prepare students. The final study illustrated that fieldwork educators did not experience these struggles. Rather, they accommodated students as part of the students’ learning journey. These studies help explain why educators may have difficulty with the accommodation process of students with disabilities and offer solutions for educational programs and future research.

Patient-centred care is the gold standard of health care, yet in practice, problems prevail. The use of the ‘expert patient’ in health professional education is one form of learning patient-centred care. A gap in the literature regarding how the use of ‘expert patient’ in health professional education promotes patient-centred care was acknowledged in current research. With Queen’s University Health Sciences & Affiliated Teaching Hospitals Research Ethics Board approval, a sample of Queen’s University MScOT students participated in a qualitative study with the following research question: “How does the students’ experience of interacting with the ‘expert patient' (‘XP’) relate to learning regarding client-centred practice (CCP)?” Three objectives were proposed: 1. Describe the OT students’ experience of interacting with the ‘expert patient’, 2. Describe the students’ learning regarding client-centered practice, 3. Identify the conditions particular to the ‘expert patient’ experience that led to learning regarding client-centered practice. In-depth interviews were conducted with the students subsequent to their ‘expert patient’ experience. Analysis revealed three conditions that together provided the foundation for student experiential learning regarding client-centred practice: interaction with particular persons with stable disability known as ‘expert patients’; students’ requirement to evaluate them and thus ‘experience power’; and explicit opportunities for ‘directed reflection and discussion’. Questions were raised for researchers, health care professional educators and health care professionals regarding the potentially transformative nature of engaging in unfamiliar contexts with openness to learning. The thesis allowed insight into the lived experience of OT students learning with ‘expert patients’; and the admiration, discomfort, humility and gratefulness they experienced while gaining a sense of the meaning of collaboration, respect for autonomy and recognition of expertise. Implications of the research impact all stakeholders in health professional education. / Thesis (Master, Rehabilitation Science) -- Queen's University, 2013-04-15 08:39:19.094

Background: Most treatment for people with arthritis occurs at the primary care level yet many studies have documented the need for improved arthritis management in this environment. The dissemination of clinical practice guidelines (CPGs) has been suggested as one method for improving care delivery. Getting a Grip on Arthritis, a theory and evidence-based educational program was developed to disseminate arthritis best practices based on published CPGs for the management of osteoarthritis (OA) and rheumatoid arthritis (RA). Primary care organizations were invited to enroll providers in an inter-professional workshop. Six months of reinforcement activities were offered following the workshop to support the delivery of arthritis care in their communities. Purpose: This study was designed to determine which organizational and individual level characteristics contributed to improved provider use of arthritis best practices six months following the workshops. Methods: The ACREU Primary Care Survey was completed by workshop participants at baseline and six months following the workshops in order to evaluate their use of arthritis best practices. This survey measured providers’ responses to open-ended questions that asked how they would manage the individual patients described in three hypothetical case scenarios. One point was given for each recorded best practice and totaled for each case scenario, with the highest possible score being eight for the late RA case and moderate knee OA case, and seven for the early RA case. Requests for reinforcement activities were tracked by study staff during the six months following the workshops. A practice profile was also completed by each organization. Analysis: Two models of knowledge utilization (KU) were constructed for testing. For Model 1, two-level hierarchical linear modeling (HLM) was used to determine the direct effects of provider and organizational level variables on intended use of arthritis best practices six months post-workshops, while controlling for clustering within organizations. In model 2, logistic regression was used to determine the influence of organization level factors on one specific best practice, that is, dissemination of patient educational materials during the six months following the workshop. Results: 275 providers from 131 organizations completed both baseline and six month follow-up surveys. For Model 1, total best practice scores for all three case scenarios were predicted by the discipline of the provider, the model of care in which they worked and baseline best practice scores (P<0.05). Controlling for these variables, baseline confidence in managing arthritis also predicted the six month follow-up scores for moderate knee OA (P=0.05) and baseline satisfaction with ability to manage arthritis predicted the follow-up scores for late RA (P=0.04). For Model 2, the estimated probability of disseminating patient educational materials was >82% for community health centres, primary care networks and regionally funded models of care compared to 30% for the federally funded model of care (P<0.01), and was 88% for organizations that sent multidisciplinary team members to the workshops, compared to 70% for those that did not send such a team (P=0.07). Conclusions: Use of arthritis best practices may be influenced by provider characteristics (discipline, satisfaction and confidence in managing arthritis), the model of care in which they work and the team learning experience. These results have implications for the training and education of health professionals and the design of models of care to enhance arthritis care delivery.

Background: Most treatment for people with arthritis occurs at the primary care level yet many studies have documented the need for improved arthritis management in this environment. The dissemination of clinical practice guidelines (CPGs) has been suggested as one method for improving care delivery. Getting a Grip on Arthritis, a theory and evidence-based educational program was developed to disseminate arthritis best practices based on published CPGs for the management of osteoarthritis (OA) and rheumatoid arthritis (RA). Primary care organizations were invited to enroll providers in an inter-professional workshop. Six months of reinforcement activities were offered following the workshop to support the delivery of arthritis care in their communities. Purpose: This study was designed to determine which organizational and individual level characteristics contributed to improved provider use of arthritis best practices six months following the workshops. Methods: The ACREU Primary Care Survey was completed by workshop participants at baseline and six months following the workshops in order to evaluate their use of arthritis best practices. This survey measured providers’ responses to open-ended questions that asked how they would manage the individual patients described in three hypothetical case scenarios. One point was given for each recorded best practice and totaled for each case scenario, with the highest possible score being eight for the late RA case and moderate knee OA case, and seven for the early RA case. Requests for reinforcement activities were tracked by study staff during the six months following the workshops. A practice profile was also completed by each organization. Analysis: Two models of knowledge utilization (KU) were constructed for testing. For Model 1, two-level hierarchical linear modeling (HLM) was used to determine the direct effects of provider and organizational level variables on intended use of arthritis best practices six months post-workshops, while controlling for clustering within organizations. In model 2, logistic regression was used to determine the influence of organization level factors on one specific best practice, that is, dissemination of patient educational materials during the six months following the workshop. Results: 275 providers from 131 organizations completed both baseline and six month follow-up surveys. For Model 1, total best practice scores for all three case scenarios were predicted by the discipline of the provider, the model of care in which they worked and baseline best practice scores (P<0.05). Controlling for these variables, baseline confidence in managing arthritis also predicted the six month follow-up scores for moderate knee OA (P=0.05) and baseline satisfaction with ability to manage arthritis predicted the follow-up scores for late RA (P=0.04). For Model 2, the estimated probability of disseminating patient educational materials was >82% for community health centres, primary care networks and regionally funded models of care compared to 30% for the federally funded model of care (P<0.01), and was 88% for organizations that sent multidisciplinary team members to the workshops, compared to 70% for those that did not send such a team (P=0.07). Conclusions: Use of arthritis best practices may be influenced by provider characteristics (discipline, satisfaction and confidence in managing arthritis), the model of care in which they work and the team learning experience. These results have implications for the training and education of health professionals and the design of models of care to enhance arthritis care delivery.

Submitted by Edileide Reis (leyde-landy@hotmail.com) on 2013-05-07T13:48:43Z No. of bitstreams: 1 Mariangela Matos.pdf: 2249832 bytes, checksum: 5c7afd601eed2bfda9754de2048cb99b (MD5) / Approved for entry into archive by Maria Alice Ribeiro(malice@ufba.br) on 2013-05-07T14:08:57Z (GMT) No. of bitstreams: 1 Mariangela Matos.pdf: 2249832 bytes, checksum: 5c7afd601eed2bfda9754de2048cb99b (MD5) / Made available in DSpace on 2013-05-07T14:08:57Z (GMT). No. of bitstreams: 1 Mariangela Matos.pdf: 2249832 bytes, checksum: 5c7afd601eed2bfda9754de2048cb99b (MD5) Previous issue date: 2006 / Tradicionalmente a formação profissional em Odontologia é norteada pelos pressupostos dos relatórios Flexner e Gies, os quais trazem como referência o mecanicismo, o biologismo, a especialização precoce, a tecnificação do ato odontológico e a ênfase na odontologia curativa e na assistência individual. Contrapondo-se a esse modelo, a proposta, hoje, é que se formem profissionais que dêem conta de acompanhar a complexidade da conjuntura atual do mercado de trabalho, das diretrizes das políticas públicas de saúde e da evolução dos conhecimentos científicos acerca do processo saúde-doença. Com essa perspectiva, as Diretrizes Curriculares Nacionais propõem a formação de um profissional com perfil generalista, que compreenda os determinantes sociais, culturais, comportamentais, psicológicos, ecológicos, éticos e legais; nos níveis individual e coletivo do processo saúde-doença, que possua uma sólida formação técnico-científica e ético-humanística, que sejam críticos e reflexivos, sendo capazes de trabalhar em equipes multiprofissionais e de dar respostas às necessidades sociais no âmbito da profissão. A partir dessas referencias, a dimensão ético-humanística da formação tem sido amplamente enfatizada nas políticas públicas de saúde e expressas, destacadamente, na Política Nacional de humanização cujo eixo norteador é a humanização da atenção no âmbito do Sistema Único de Saúde. Uma das orientações básicas dessa política é influenciar o aparelho formador de profissionais de saúde a reconhecer a importância das práticas humanizadoras. Nesse sentido, foi meu objetivo conhecer e analisar o perfil profissional de graduandos de dois cursos de Odontologia da Bahia, um público e um privado, buscando, destacadamente, caracterizar a dimensão ético-humanística na formação. Com essa perspectiva, foram empregadas quatro técnicas de coleta de dados: análise documental do Projeto Pedagógico dos cursos; aplicação de questionário para os alunos; entrevistas não-diretivas com professores e usuários dos serviços odontológicos oferecidos pelos cursos; e observação participante nos ambulatórios. A técnica empregada para a análise dos dados foi, destacadamente, a análise de conteúdo, usando como método de análise as abordagens quantitativa e qualitativa. Os resultados demonstram que os alunos, em sua maioria, são do sexo feminino, escolheram a profissão porque gostam da área de saúde e reconhecem as dificuldades do mercado de trabalho, elegendo o aperfeiçoamento técnicocientífico como principal mecanismo concorrencial. Mais da metade deles exerce algum tipo de atividade externa ao curso e a maioria tem afinidade com disciplinas e temas da área clínica, com um nível baixo de interesse pelas disciplinas das áreas de Ciências Humanas e Saúde Bucal Coletiva. Os Projetos Pedagógicos dos cursos explicitam a intenção de formar profissionais com referenciais ético-humanísticos consistentes e, do mesmo modo, alunos, professores e usuários têm a percepção de que essa dimensão vem sendo trabalhada nos cursos. Entretanto, o confronto carente de reflexões e mudanças, e de um esforço para diminuir a distância entre o instituído e o instituinte. Assim, a formação profissional em Odontologia nos cursos analisados parece experimentar uma transição da histórica hegemonia da tecnociência para a busca do equilíbrio entre as dimensões técnicas e ético-humanísticas, compreendidas como imprescindíveis para a caracterização de um perfil profissional competente. / Salvador

A presente tese parte das questões relativas às tensões políticas/organizativas ou de concepção, existentes historicamente entre a saúde e a educação, referentes à Educação Profissional em Saúde; busca responder até que ponto as políticas educacionais respondem às necessidades de formação dos trabalhadores técnicos da saúde no Estado do Rio Grande do Sul, como também de que forma a autonomia estadual repercute sobre as políticas de saúde e de educação na área da educação profissional em saúde, visto que o processo de descentralização se dá de forma distinta nestes dois campos. O objetivo geral do estudo foi apreender as tensões de natureza conceptual, política e legal, historicamente construídas, na relação entre as necessidades de formação técnica em saúde e as políticas educacionais, identificando implicações sobre a regulação da Educação Profissional em Saúde no Estado do Rio Grande do Sul. Esta tese sustenta-se no materialismo histórico como teoria e método. Parte das concepções marxianas sobre o trabalho constituído das relações sociais em diferentes épocas históricas, da educação formal como parte da totalidade dos processos sociais e do Estado como um complexo de relações que materializa o modo de produção capitalista da sociedade. Estas concepções teóricas subsidiaram a revisão da literatura sobre a organização do trabalho em saúde e as políticas públicas de formação dos trabalhadores do nível médio na área da saúde. O caminho metodológico percorrido partiu da análise de documentos legais e escuta dos agentes formuladores das políticas de Educação Profissional em Saúde, membros dos Conselhos de Saúde e de Educação do Estado do Rio Grande do Sul. Os resultados mostraram que as políticas de Educação Profissional, tanto do setor saúde como da educação, são ainda transversalizadas pela dinâmica da sociedade do capital, onde o Estado alinha-se na defesa dos interesses do setor privado, tanto na prestação de serviços, como na formação dos trabalhadores de saúde. Foi confirmada a hipótese de que as contradições dos campos da saúde e da educação se refletem nas políticas públicas, dificultando a transformação dos modelos de atenção à saúde e de formação dos trabalhadores do nível médio. A superação destas dificuldades poderá ser alcançada a partir de propostas de políticas públicas integradas entre os campos da saúde e da educação, sustentadas na reflexão teórica, no sentido da integração entre trabalho e ensino, para a formação dos trabalhadores de saúde do nível médio. / This thesis cares about the issues relating to the historic political/organizational tensions between health and education fields, related to Health Professional Education; it searches to answer the scope to which educational policies respond to training of the technical health workers needs in the state of Rio Grande do Sul, as well as how the state autonomy affects on health and education policies in the area of professional education in health since the decentralization process occurs differently in those fields. The overall purpose of the study is to understand the historically constructed tensions of conceptual, political and legal nature of the relationship between the need for technical health training and education policies, identifying implications for the regulation of Health Professional Education in the state of Rio Grande do Sul. This research is supported in the historic materialism as theory and method and starts from Marxist conceptions of the work as social relations in different phases of formal education as part of the totality of social processes. The study analyzes the state as a complex of relationships that materializes the capitalist mode of production in society. These concepts could support the review of literature on the health work organization and the public polices for mid-level health workers training. The methodological path followed departed from the analysis of legal documents and from listening the Professional Health Education polices formulators who are members of the Health and Education Council. The results of the research evidence that the policies of vocation, where the state lines up to defend the interests of the private sector, even in the provision of services and in health workers training. The hypothesis that the contradictions of the fields of health and education are reflected in public policies, making the transformation of health care models and workers training in the technical level was confirmed. The overcoming of these difficulties can be reached with the integration of the public polices proposals from both fields, health and education, with the support of the in theoretical reflection on the integration between work and school, for the technical health workers training.

A presente tese parte das questões relativas às tensões políticas/organizativas ou de concepção, existentes historicamente entre a saúde e a educação, referentes à Educação Profissional em Saúde; busca responder até que ponto as políticas educacionais respondem às necessidades de formação dos trabalhadores técnicos da saúde no Estado do Rio Grande do Sul, como também de que forma a autonomia estadual repercute sobre as políticas de saúde e de educação na área da educação profissional em saúde, visto que o processo de descentralização se dá de forma distinta nestes dois campos. O objetivo geral do estudo foi apreender as tensões de natureza conceptual, política e legal, historicamente construídas, na relação entre as necessidades de formação técnica em saúde e as políticas educacionais, identificando implicações sobre a regulação da Educação Profissional em Saúde no Estado do Rio Grande do Sul. Esta tese sustenta-se no materialismo histórico como teoria e método. Parte das concepções marxianas sobre o trabalho constituído das relações sociais em diferentes épocas históricas, da educação formal como parte da totalidade dos processos sociais e do Estado como um complexo de relações que materializa o modo de produção capitalista da sociedade. Estas concepções teóricas subsidiaram a revisão da literatura sobre a organização do trabalho em saúde e as políticas públicas de formação dos trabalhadores do nível médio na área da saúde. O caminho metodológico percorrido partiu da análise de documentos legais e escuta dos agentes formuladores das políticas de Educação Profissional em Saúde, membros dos Conselhos de Saúde e de Educação do Estado do Rio Grande do Sul. Os resultados mostraram que as políticas de Educação Profissional, tanto do setor saúde como da educação, são ainda transversalizadas pela dinâmica da sociedade do capital, onde o Estado alinha-se na defesa dos interesses do setor privado, tanto na prestação de serviços, como na formação dos trabalhadores de saúde. Foi confirmada a hipótese de que as contradições dos campos da saúde e da educação se refletem nas políticas públicas, dificultando a transformação dos modelos de atenção à saúde e de formação dos trabalhadores do nível médio. A superação destas dificuldades poderá ser alcançada a partir de propostas de políticas públicas integradas entre os campos da saúde e da educação, sustentadas na reflexão teórica, no sentido da integração entre trabalho e ensino, para a formação dos trabalhadores de saúde do nível médio. / This thesis cares about the issues relating to the historic political/organizational tensions between health and education fields, related to Health Professional Education; it searches to answer the scope to which educational policies respond to training of the technical health workers needs in the state of Rio Grande do Sul, as well as how the state autonomy affects on health and education policies in the area of professional education in health since the decentralization process occurs differently in those fields. The overall purpose of the study is to understand the historically constructed tensions of conceptual, political and legal nature of the relationship between the need for technical health training and education policies, identifying implications for the regulation of Health Professional Education in the state of Rio Grande do Sul. This research is supported in the historic materialism as theory and method and starts from Marxist conceptions of the work as social relations in different phases of formal education as part of the totality of social processes. The study analyzes the state as a complex of relationships that materializes the capitalist mode of production in society. These concepts could support the review of literature on the health work organization and the public polices for mid-level health workers training. The methodological path followed departed from the analysis of legal documents and from listening the Professional Health Education polices formulators who are members of the Health and Education Council. The results of the research evidence that the policies of vocation, where the state lines up to defend the interests of the private sector, even in the provision of services and in health workers training. The hypothesis that the contradictions of the fields of health and education are reflected in public policies, making the transformation of health care models and workers training in the technical level was confirmed. The overcoming of these difficulties can be reached with the integration of the public polices proposals from both fields, health and education, with the support of the in theoretical reflection on the integration between work and school, for the technical health workers training.