García, Juan C. Considerações sobre o marco teórico da educação médica. [Considerations affecting the theoretical framework of medical education.] In: Nunes, Everardo D. (org). Juan César García: pensamento social em saúde na América Latina. [Juan César García: social thought concerning health in Latin America.] São Paulo: Cortez, 1989. p. 179-188.
Objectives: To describe the different theoretical positions that arose at the beginning of the 1970s concerning medical education and to propose certain considerations for the development of an alternative theoretical framework for such education.
Methodology: Descriptive and analytic.
Results: The author analyzes the different theoretical frameworks that have influenced medical education in Latin America. At the end of the 1970s, it was postulated that medical education mirrors medical practice and the organization of healthcare services. From this viewpoint, medical education lacks autonomy and capacity to transform medical practice. Through later discussion of this thesis, observers noted that the university enjoys a certain degree of autonomy in the organization of its activities. From this perspective, some universities developed medical education in accord with the demands that professionals would face in actual practice, while other universities proposed new professional profiles, thereby calling into question the existing model of professional practice.
Prior to the articulation of these positions, the dominant concept concerning the social transformation of educational institutions was anchored in thepositivism of educational thought. This theoretical construct proposed that society encompassed different subsystems (health, education, politics, social forces); when actions affected one subsystem, changes occurred in the others. The socioeconomic crisis of the late 1960s showed the fallacy of these propositions. Such interpretations of the capacity for change began to be questioned; these interpretations recognized that both education and medicine produce some unintended, opposite effects. The author describes in some detail the Marxist and phenomenological concepts that generated these debates and theoretical positions and also provides his own criticism.
Conclusions: The author proposes that any theoretical framework devised to rethink medical education must begin by considering the social, political, and economic context of which it forms a part. He points out that the university possesses a certain degree of autonomy with which to organize its activities and reinterpret social needs. Similarly, he emphasizes that the production of scientific knowledge and the provision of medical care must also be reinterpreted in light of the needs of society as a whole.
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