Students: From the students’ responses we found that to improve teaching-learning in PC, instructor training needed to be prioritized, as this was cited in 91 responses (40%) of the 237 obtained. A lack of instructor training was deemed the most pressing issue, being cited in 83 responses (35%). Other responses were randomly distributed through simple random sampling and were not nearly as prevalent as the above two responses . The open-ended question was not answered with the option "other", indicating a different opinion.
Relationships between the medical schools across respective periods, including the absolute and relative number of students who completed the questionnaire and their respective options, are shown as priorities in Table 1.
Teachers: Our study of instructors' perceptions revealed several tensions in terms of PC, lacking instructor specialization in Family Health and PC, an inadequate planning of activities performed, and excessively large class sizes. The professionals pointed out a lack of continuing education activities as a barrier to PC teaching-learning improvement.
Table 2 shows the main issues raised by the instructors from the 3 medical schools (UNIFESO, UFF and UFT) in response to the question chosen for this study. UFV did not participate in the study of instructors.
The instructors’ responses frequently cite issues related to "planning" and "instructor qualifications.”
We held workshops (Supplemental Digital Appendix F) on the following clinical issues relevant to BHFU students and instructors and to daily BHFU practices: Is physical activity beneficial for those who have already had an Acute Myocardial Infarction (AMI)?
We found that of the tools available, the Evidence-Based Health Portal offered the best research resources for tutors and students via 12 databases and the Atheneu Library.
The portal offers 3 databases Evidence-Based Health (SBE): Dynamed, Pro Quest and the British Medical Journal (BMJ)) deemed by the students and instructors to be excellent sources of information on clinical studies based on (clinical) systematic reviews.
Approximately 20 workshops were carried out with 2 groups of 5 interns (G1 and G2) and with their respective BHFU instructors with the Secretary of Health of Teresópolis, RJ during the first semester of 2013.
A list of workshops held, and respective themes and considerations is shown in Table 3.
After the workshops, we verified the following results on pre- and post-acquired portal information: 67% (40/60) of the instructors had used information in the pre-application research phase, and 92% (55/60) achieved this after applying the tool; 62% (220/325) and 76% (247/325) of the G1 and G2 groups, respectively, achieved this in the pre-application phase, and 92% (300/325) and 84% (272/325) of the G1 and G2 groups, respectively, achieved this in the post-application phase. These results may signal a greater degree of knowledge acquisition, as the higher the post-test score obtained, the greater the likelihood of enhancing knowledge (Table 4).
Regarding the open-ended question on perceptions of the use of Internet tools, we identified the following focuses: "knowledge expansion," "applicability in practice," "the rate of information dissemination" and "updating", with no distinctions between answers given by interns from groups G1 and G2 in both the pre- and post-application phases. The instructors focused on one of the students’ answers: “the acquisition of knowledge."
We then verified studies on this subject listed in the Virtual Health Library (BVS). This database was selected due to its academic representation of teaching in the Brazilian health care field; representation within the BVS Network, which covers 30 countries of the Americas, the Caribbean, Africa and Europe; and quality through its certification by Latin American and Caribbean Center on Health Sciences Information (BIREME)/Pan American Health Organization (OPAS)/ World Health Organization (OMS).
For our study, we used 3 fundamental terms: "instruction," "training" and "basic care". The term "tutoring" was also used rather than "instruction" as a term already classified as a descriptor of health. The results presented here are based on 175 documents, including 171 articles and 2 theses. We chose to narrow our results by applying "tutoring" as a search term (leaving 90 documents) and then applying the "complete text" limitation, leaving 24 national and international documents (23 articles and 1 thesis). To better analyze these results, we summarize the content of certain studies in Table 5.