Health Professionals Training: Strategies of Sensibility to Work with the Community

This article reports a classroom experience with Sports Science and Nutrition students. The objective was to characterize the field of public health, as a process of collective building and production space of knowledge, practices, promoting a theoretical and critical reflection in relation to different educational practices used in health education. Employing different methodological strategies that not only overcome resistance to the contents, but also stimulate the students to work with communities. Experience has shown that differentiated teaching and learning processes represent more difficulty, because they demand more dedication and responsibility from both the teacher and the students, confirming the importance of searching through more interactive activities: It leads to students development as professionals and citizens.


Introduction
Nowadays, it is clear that students in the classroom have less involvement with the basic contents of the development, while the traditionally used methodologies prove to be increasingly less efficient. As a pro fessor of the health area, specifically instructing Psychology, Public Health, Health Education and Co mmunication in this area, this last two so called "service d isciplines" allow me to observe great resistance, lack of interest and motivation, on the part of students to contents related to the collective health, and it expanded to the Psychology course [1], as well. Working with Nutrit ion and Sports Science students, the strangeness was even more accentuated, besides being an underrated content by the specific development areas.
When faced to real daily problematic situations concerning the health area, the students exercise the practice-theory-practice relat ion having reality as the starting and departure point of the learning process. It's essential to search for ways to work with different p ieces of knowledge, to look at each person respecting his background and not considering ourselves as the only ones mastering all the knowledge.
The aim of these disciplines was to promote a theoretical and crit ical th in king relat ed to the Pub lic Health as a collect ive bu ild ing space and the d ifferent edu cat ion al practices used in health, as well as promoting the practice of pedagogical didact ic methodolog ies as support tools for

Transformer Education
To think o f education as transformer of practices and knowledge requires commit ment fro m the educator and his student. Education needs to move toward allo wing and facilitating the g rowth of human beings who respect themselves and others; so that they can act with responsibility and freedom [2]. To be able to act and reflect, the student needs to be aware and conscious of his presence in the world and to appropriate it and "to know himself in it" (p.16) [3].
The human being has a natural potential to learn, i.e., requires adequate resources and space to take ownership of their learn ing [4]. According to Freire, one cannot think about education without considering the man h imself in a constant constructing state, because he "knows himself and recognizes that he is unfin ished" [3], [5]. Education imp lies a search for the subject of your own education. "[...] so nobody educates anybody, but no one is self educated, men educate themselves, each other, mediated by the world." (P.28), [3] In this context of learn ing, content although significant, is in the background and success does not happen when the student learns everything he had to learn, but when he learns how to learn what he wants to know [4], [6], [ 7].
The educator as facilitator trusts the student, shares responsibility for the learning process, provides resources inherent not only fro m his attitude and experience, but also fro m the material and the systematic knowledge [4], [3].
Accepting the student "as a valid being in the present, by correcting his doings not his being. The respect for each other, a loving demeanor towards him will only occur if we see him and by seeing, accept him in his legit imacy "(p.26) [2].
Education despite some movements remains vertical, because the teacher is still a higher being and the student passively receives the knowledge, becoming the educator's depository. The teacher retains knowledge as being unique and does not seek new in formation, because it is not challenged by the students [5], [3], [8]. In this traditional view, it is thought that the more you give, the more you know, at the creativity's expense.
For all this, education must bring the student to reflect on their context, not as a mere spectator of reality, but as a subject. Therefore, he needs spaces that will provide alternatives for the develop ment of skills and potentials, enabling the intervention and the opportunity of being, of thinking and of acting, in other words, to be education' s subject, not its instrument.
The new educational proposals are for an eminently problem-based education, mainly crit ical, reflective and transformative that does not stop in the discourse, but that requires action. The new models p ro mote the exchange, changing already established schemes, creating discomfort for the student and the teacher; it is easier to o ffer what is already available, than dispose to create new information through the dialogue and acceptance of the other's knowledge; moreover to be open to challenges regarding their own practice.
The professional train ing must go beyond technique, it needs to prepare professionals with a wide backg round, with an investigative thinking that can identify and handle the market and the social demands involved in their profession and their upbringing as a person.

Reflecting the Practice
Through the experience in the classroom, the exchange, the reflection and the dialogue, the criticis m often overwhelming while rich by the students, helped build a critical view o f the pract ice as a teacher. In this sense, the assessment present in the making becomes a supportive tool and generates in the educator the possibility of having an opening in the building of the most appropriate methodologies for the group that demands your performance.
In relation to what we call " methodological strategies," the way to address the contents does not match the dynamics for merely motivating students or simp ly bringing them closer to each other, but rather, creating activities whose primary purpose is the development of skills, of inquiring thinking, creating true emotional bonds, the interaction for the achievement of collective tasks, the use of availab le knowledge, reflect ions on practice and to evaluate the work done.
By questioning real situations, the student is led to exercise the practice-theory-practice connection, having the reality as the starting and departure point of the learning process.
Fro m this thought, education is in a constant movement of change and growth that never stops; where the established and the new knowledge are in a dynamic connection that leads to the review, the reflect ion and the creation of new forms of act ion that monitor the rap id and great advances of man kind.
Innovations bring both positive and negative repercussions, not only by the characteristics and different assumptions of the new ways of teaching and learning, but also by the natural resistance to change [9].
The previously mentioned led us to reflect on the classroom experience, of disciplines that discuss new and not specific contents of the field of study. The fact that they are mandatory and not part of the specific contents of the nutritionists and sports scientists, promoting more resistance and devaluation by the professionals of different areas, as well as the students themselves, led to the search for new forms of action in these disciplines, and to identify the need to offer tools for the development of skills and competencies for health wo rk.
The objective was to advocate a theoretical and crit ical reflection regard ing the Public Health as an area of construction, and the different practices used in health education, at the same time, to pro mote the use of didactic and pedagogical methodologies as support tools for the work with the co mmunity.
We believe that in planning a course, the choice of a methodology requires the consideration of some points such as: to whom we are planning this lesson, what events have already been experienced in the approach and motivation of these students, what are their training needs and what changes can be promoted in them and their social environment.

Methodology
The courses were developed in t wo semesters; the first approached the Public Health and the second, Health Education and Co mmunicat ion Course.
The subjects worked in Public Health have been developed using different methodological techniques such as: Theoretical classes, group works, participant observation (field knowledge and diagnosis of health needs), directed studies, integration dynamics, seminars, debates, reading assignments (compulsory and complementary), among others.
There were discussions of the follo wing subjects: • The health-disease process. For the discussion in addition to reading the texts, the students were required to perform a survey among the population; in order to contrast the popular with the systematized knowledge. The chosen slogan was "what they mean by health and disease." • The discussion of the "We as health professionals" paradigm, sought to reflect on the nutritionists and sports scientists role in the field o f Public Health.
• In the field work, was discussed the participating observation theme, and an observation and interview itinerary was provided, wh ich would help them in the field work.
• Among other topics: the concept of health; the health lectures and letters; the promotion and prevention concepts, health demands and needs; the Unified Health System -(Sistema Ún ico de Saúde) SUS; the public health primary care; the Family Health Strategy -ESF; hu manization and health care; care as value; subject dimensions and comprehensiveness of care; interdisciplinary field; team work; public policies and the public health field as a collective process of construction and space for knowledge production and practices [10].
At the end of the Public Health course, a "neighborhood fair" was conducted with the purpose of socializing the observation experiences, and to know the demands and needs present in the population. The written paper was a scientific report of the visit, and the elaboration of an intervention project to be developed during the Health Education and Co mmunicat ion course At the first class meeting of this d iscipline, the field work was summarized and all the guidelines were provided, regarding the intervention project as the central work for the Health Education and Co mmunicat ion discipline. The following group work techniques were presented and experienced: workshops, group dynamics, discussion groups, experiment reports, wheel method [11] and the "problemat ic methodology" [9], among others, in order to understand each technique development process and to decide wh ich ones would be used in the community activit ies.
Among the topics discussed in this course are: • Definition o f educator, of education and of health education in order to confront the students knowledge with the systematic. The educator's posture and his social role.
• Health education in Brazil, basic concepts, limits and possibilit ies, fields of action and as a practice in primary care, which focuses on health promotion and prevention.
• Pedagogical models and approaches used in health care.
• Concepts of co mmunity, co mmun ity education, popular participation, in order to stimulate the students to work with the community.
The intervention project has been enhanced, in parallel with the different concepts discussion, and was chosen: the theme, the target population, the goals and the necessary actions to achieve it.
During the projects development, under the teacher's supervision, several presentations were made, to discuss the actions and to suggest changes.
To present the results at the end of the course, there was a workshop denominated "experiences exchange", with the goal of evaluating the experience and identifying strengths and weaknesses, and to discuss strategies for the practice optimiztion in the classroom.
There were on average 50 students per discipline, each with 15/ 4 hours meet ings, with a total of 60 hours load.

Results and Discussion
In the first day, we were faced with the fact that 92% (46) of students enrolled in the discipline, were fro m the Sports Science course and only 8% (4) were fro m the Nutrition. Is important to clarify what this course is offered in two classes with different teachers. A more balanced student distribution between the two courses was expected, but it did not happen.
In Public Health were presented and discussed the disciplines fundamental concepts. Different authors were brought in for discourses on health as a collective building and space for pro motion and prevention among the population. Activities were d irected to the theoretical discussions and the preparations for the field observation.
Earlier, students had difficulty understanding the need for the observation, complained about the distance between the neighborhoods and the school questioned the observation guidelines, and particularly, the Public Health impo rtance in Sports Science students. It was clear that students in this area have difficulty in seeing themselves as public health professionals.
During 15 meetings, with a 4 hours load, there were classroom discussions of the theoretical concepts; the last minutes of seven meetings were dedicated to the field observation planning (districts in the city of Limeira -SP). Twelve d istricts were chosen and distributed according to their locations, aiming to reach the city d ifferent sectors (downtown, suburbs and/or different social strata). The students were div ided into 5-6 students groups. For this activity an observation itinerary was provided as well as interview samples for the residents, the merchants, the health professionals, the community leaders, among others.
The observation experience allowed the students to develop skills for approaching the residents and the professionals fro m d ifferent sectors, and to understand that every situation experienced in the neighborhoods, somehow interferes with the populations health. They understood the importance of each sector within the neighborhood, and the attention to the health care and the education by area of scope.
At the end of the course, there was a "Neighborhood Fair" in an open area of the school grounds. Each group was creative in their presentations, answered questions and identified the health needs of the population visited.
Fro m the observation and presentation they were able to understand in practice, the discussions made in the classroom. According to statements by some students, "[...] gave meaning to public health;" "during the neighborhood visit and in the presentation, I realized the importance of public health and our role as health professionals." "Learning to identify the neighborhoods needs was very motivating." "In the neighborhoods presentation, we realize that the people's needs are similar, and that together we can come up with solution strategies." In the Health Education and Co mmun ication first day of class, after retrieving the Public Health work, we were faced with the fact that 21 of the students enrolled, had not attended the observation activity during the previous semester; thus requiring some adjustments and changes in the final work planning.
Among the strategies, the students were required to perform field work, to make a general presentation of their experiences in the neighborhoods and a survey of the population needs. Another strategic requirement was fo r the groups to have students from both courses, but there were some challenges and unwillingness to work together as a group. Nevertheless, during the classroom discussions, they showed great interest in contributing to improve the activities of the different g roups. Some groups chose to develop the work in the visited communit ies; while others sought institutions to perform the work.
After overcoming various difficulties, it was decided by the group to work with a specific theme in all co mmunit ies or locations chosen. The chosen theme was: " Garbage," for being a real problem in all the d ifferent places visited. As this was a theoretical and practical discipline, the focus of discussions and experiences of the techniques were around the theme and the activities preparation for the work with the population.
The Alforja [12] team, states that the techniques are tools in the training p rocess, seeking to create and recreate. But the key is not the use of participatory techniques alone, without the methodology concept that guides the process, which is based on the knowledge construction. This means they say, fro m the practical v iew, i.e., what the population knows, lives and feels in the different situations they face in their daily lives, that was the focus of the intervention projects.
Participatory techniques, to really pro mote a learn ing process, should allow both a collect ive discussion and a reflection. They enable the individual and collective knowledge to be enriched and potentialized fro m co mmon points. The participants bring their indiv idual knowledge; thus enriching and enlarging the collective experience. [5], [12], [2], [13], [14].
The activities to be held in the co mmunity were first experienced in the classroom, and changes made where it was necessary. The projects were presented at various times, and collectively discussed and agreed upon before going into the field. Th is allowed the collective creation of knowledge, where all were participants of the development and of the practical imp licat ions. The objective was to sensitize the students, to learn about what the people already own and what was brought by the group.
The project's development process demanded fro m the students various activities including: site search, target population identification, contacts, project presentation and request for authorization fro m the site's coordinator or director, preparat ion of workshops and materials, group organization fo r the tasks distribution, the projects theoretical foundation, supervisory involvement, as well as coping with the population motivation and concentration to develop the project.
This move, to a certain extent, led to the attitudes, students need to develop when planning to work with education. Maturana and Nisis [3], pred icate that the educative process is intended to guide our students in their upbringing as human beings who respect themselves and others, in a continuous configuration of a living space that promotes and makes the collective construction possible, an investigative thinking and fulfilment wish, developing responsibility attitudes, collaboration, joy and freedom to Be, Think and Do.
During the development of the discipline it was emphasized the education contribution, to the development of health actions that transform people's habits through the knowledge of the everyday and the population demands. Still, it was difficult for the students to understand that health education is part of a wider context that goes beyond the population's shift to healthier habits.
In education it is important not only to overcome the individuals' resistance, but also to encourage them to act ively participate, through his knowledge and their circu mstances [15]. At the same t ime we must recognize their knowledge [3], which causes them either improve their health or damage it. This recognition lies in the ethical principle of the respect for individual liberty [2], [4], [5], [14][16], [17].
With this view, the students visited the neighborhoods in advance for a first contact with the reality and with the people in the commun ity.
The intervention projects were performed by 11 groups, with 2 to 7 members. It was possible to return to five (5) of the neighborhoods previously visited in the Public Health discipline. The remaining groups made contact with educational institutions to develop the project. The meetings with the population were on average, 3-4 per project.
The visited sites were: elementary schools (public and private), orphanage, co mmunity centers, training center for the mentally d isabled, city central square and municipal day care. The target audience: ch ild ren, adolescents with learning disabilit ies and the general population (in the square).
All projects were aimed to educate the target population in relation to the proper management of garbage, recycling and hygiene, through fun activities and the building of toys using recycled material.
The practice of these activities and the planning of the intervention project, allo wed the students to realize that when considering the other's freedo m and autonomy; one cannot change people's habits devoid of the understanding of their reality and without their participation. According to Guenther[18], the world view is one factor that influences the perception and everyday experiences, which leads people to interpret and select what to include or ignore according to their perceptions.
In the classroom practical activit ies, the students had difficulty working with different methodologies, which demanded greater involvement, reflection and creativity. At the beginning they proved to be apathetic, resistant and had difficulty understanding the collective construction process. Toward the end o f the meetings, despite the lack of involvement in some act ivities, there were imp roved integration among them; they have become mo re participatory, crit ical, p roblematic and supportive. And the contact with the community brought about changes in attitudes toward the disciplines contents and the insights about the community.
This experience has allowed us to realize that the concepts can be worked in different ways, and it is necessary to provide enabling tools fo r the development of skills and the concepts construction through the theory -practice relation.
Here are some o f the groups' manifestations in relat ion to work with the commun ity: In "experiences exchange" students presented their productions through film, photographs, newsletters, brochures in addition to toys and utensils made fro m recyclable material. They demonstrated responsibility before the communit ies, and care in the workshops' organization and preparation.
In the course's evaluation, the students pointed out the strengths, the weaknesses and made some imp rovement suggestions. Here are the considered strengths: going fro m visualizat ion to practice through the proposed methodology; putting into practice the discipline concepts; new knowledge and learning through projects outside the classroom; departing from the classroom routine; learning to create intervention projects; dealing with the problems and challenges that arose during the activities; contrasting the same projects different approaches; counting on everybody' s participation according to the integration dynamics within the classroom; learning to cope with different social contexts; not only in exchanging experiences both in the classroom and with the community, but also learning to evaluate each other's work, which led to the work co mmit ment.
Among the weaknesses were: d ifficu lties in organizing the projects schedule; only one project of the kind for the four (4) years of college limitation; difficulties in the interaction of the two courses (Sports Science and Nutrition); the lack of experience in the neighborhoods observation (for the students new to the assignment); short time availab le for the activities; disinterest by some of the students.
Among the suggestions for imp roving the discipline development were the following: mandatory participation in field work (field knowledge); project development throughout the semester; requirement for the groups to develop with at least two age groups, to experience different challenges and solutions in the same project.

Conclusions
Despite of the difficult ies encountered, such as, large numbers of students, low interest and appreciation for the Public Health field, resistance to new strategies requiring greater involvement, dedication and responsibility fro m both the student and the teacher, the co mmunity intervention and change in attitudes by some students, confirm the importance of searching, through more part icipatory activit ies, for the mean ing of their format ion as professionals and citizens.
To offer students the opportunity to get in touch with reality and fro m it to identify situations that give meaning to their training becomes undeniably rich and challenging.
We recognize that the methodologies require some improvement; however, as an experience, it invites us to review the Public Health strengths and weaknesses and to give continuity to its work proposal.
In the training of health professionals becomes necessary to offer an opportunity to be more act ive, crit ical; with a world view that contributes to the collective construction of knowledge, and to practice in a more human manner, besides the willingness to work interdisciplinary.