Mudança curricular: construção de um novo projeto pedagógico de formação na área da Fonoaudiologia

Cambio curricular: construcción de un nuevo proyecto pedagógico de formación en el área de Fonoaudiología

Maria Cecília Bonini Trenche^I,i; Luisa Barzaghi^II; Altair Cadrobbi Pupo^III

^ISpeech Therapist; PhD in History and Philosophy of Education PUC-SP, Titular Professor. <cecilia@trenche.com.br>
^IISpeech Therapist; PhD in Applied Linguistics and Language Studies PUC-SP, Full Professor <luisa@pucsp.br> ]]> ^IIISpeech Therapist and Audiologist; PhD in Human Communication Disorders (Speech Therapy). Unifesp. PUC-SP, Associate Professor <lilapupo@pucsp.br>

Translated by Philip Sidney Pacheco Badiz
Translation from Interface - Comunicação, Saúde, Educação, Botucatu, v.12, n.27, p. 697 - 711, Out./Dez. 2008.

ABSTRACT

The first year of implementation of the new pedagogical project for the Speech Therapy course at the Catholic University of São Paulo (PUC-SP) is analyzed. The aim was not only to analyze the changes in pedagogical concepts and practices, but also to construct collective work by the social body of the course. The results indicated that the new pedagogical activities (seminars, tutorials, workshops and instructive experiences) were important tools for achieving the proposed changes in the new curricular model. Highlighted among other advances were: greater integration between basic disciplines and professionalizing activities; better comprehension by students of the importance of training based on the population's needs; greater linkage between teaching, research and extension activities; interaction among students at various levels of training, regarding health promotion and disease prevention actions; planning of supplementary pedagogical activities according to students' needs detected in educational assessments.

Key words: Pedagogical project. Curricular change. Speech therapy. Curriculum.

RESUMO

Analisa-se o primeiro ano de implantação do novo Projeto Pedagógico do curso de Fonoaudiologia da Pontifícia Universidade Católica de São Paulo (PUC-SP). O objetivo foi analisar não só as mudanças de concepção e práticas pedagógicas, mas a construção de um trabalho coletivo do corpo social do curso. Os resultados apontaram que as novas modalidades pedagógicas (seminários, tutoria, oficinas, vivências formadoras) foram dispositivos importantes para se alcançar as mudanças propostas no novo modelo curricular. Entre outros avanços, destacaram-se: maior integração das disciplinas básicas com as atividades de caráter profissionalizante; melhor compreensão do estudante sobre a importância de uma formação pautada nas necessidades da população; maior articulação entre atividades de ensino, pesquisa e extensão; interação entre estudantes dos vários níveis de formação nas ações de promoção da saúde e prevenção de agravos; planejamento de atividades pedagógicas complementares em função das necessidades dos estudantes detectadas nas avaliações formativas.

Este artículo contempla la análisis del primer año de implantación del nuevo Proyecto Pedagógico del Curso de Fonoaudiología de la Pontificia Universidad Católica de São Paulo, Brasil (PUC-SP). El objetivo ha sido el de analizar no sólo los cambios de concepción y prácticas pedagógicas sino también la construcción de un trabajo colectivo del cuerpo social del curso. Los resultados mostraron que las nuevas modalidades pedagógicas han sido dispositivos importantes para alcanzar los cambios propuestos en el nuevo modelo curricular. Entre otros avances se destacan una mayor integración de las disciplinas básicas con las actividades de caracter profesionalizante, mejor comprensión del estudiante sobre la importancia de una formación pautada en las necesidades de la población y mayor articulación entre actividades de enseñanza, investigación y extensión.

Palabras clave: Proyecto pedagógico. Cambio curricular. Fonoaudiología. Currículo.

INTRODUCTION

Over the last few years, laws, regulations, resolutions (curriculum guidelines) and ordinances have been issued by the Brazilian Ministries of Education and Health, with the aim of accelerating the changes in higher education.

In consonance with the guidelines of the Brazilian National Health System (Sistema Único de Saúde, SUS), the Ministry of Health has indicated differentiated status for healthcare professionals through defining the common profile (abilities and skills) for professionals in each field. It has recommended and encouraged curriculum changes through funding for projects (Promed, Pró-saúde) that are considered to have high priority and to be essential for implementing strategic programs such as Family Healthcare. The interlinking between the policies of the Ministries of Health and Education has contributed towards reducing the gap between professional training and the needs of the SUS.

This movement of changes to the formation of health professionals has created several spaces for dialogue and collective construction. Among these, the National Education Forum for Healthcare Professions (Fórum Nacional de Educação das Profissões na Área de Saúde, FNEPAS) can be highlighted. This was created in July 2004 and is formed by teaching associations from a variety of courses within the field of healthcare.¹ It is becoming established as a social player that is committed to transformations in health education in Brazil and has shared in the conceptualization of comprehensiveness of healthcare and healthcare training.

Within the field of Speech Therapy and Audiology², since the National Curriculum Guidelines were issued in 2002, many undergraduate courses have been making curriculum changes in order to come into line with the professional profile defined for this field. These guidelines have also been the subject of analysis by the National Higher Education Evaluation System (Sistema Nacional de Avaliação do Ensino Superior, SINAES/INEP) and have been an important topic at teaching forums organized by the Brazilian Speech Therapy and Audiology Society (Sociedade Brasileira de Fonoaudiologia, SBFa), the Brazilian Audiology Academy (Academia Brasileira de Audiologia, ABA) and the Regional and Federal Boards.

The notion of comprehensiveness presupposes expansion and development of the caregiving dimension in the workplace of healthcare professionals, among other issues. This new attitude would lead its agents to become more responsible for the results of attendance practices and more capable of welcoming and building links with the target population for healthcare actions and services.

The recommended training process shifts the axis from training centered on individual care provided in specialized services to training that is more contextualized, taking into account the social, economic and cultural dimensions of the population. It aims to form professionals so that they have the capacity to respond to the population's health problems and to stimulate interdisciplinary and multiprofessional actions within the health services. It also advocates the use of active teaching-learning methods that are developed in partnership with health services.

Feuerwerker and Sena (1999) highlighted some guiding principles for the processes of change in professional healthcare formation and emphasized that the course reforms should be sustained through curriculum integration, pedagogical models that are more interactive and the use of teaching-learning methodologies centered on students as the subjects of the learning and on teachers as facilitators of the knowledge construction process.

Therefore, this is not a question of reviewing disciplines and content material, but one of establishing a way of organizing the pedagogical work in which students (the subjects of the learning process) can prepare themselves to actively seek the knowledge needed for resolving problems encountered during professional practice. 

However, curriculum changes imply transformations that do not take place linearly and immediately. Since such changes are structural, they require a long process of planning, action and reflection. What is decided on will not always be accomplished and not everything that is achieved results from the concretization of that which was thought out. In this respect, it is essential for the new pedagogical project to include the establishment of procedures of follow-up and evaluation of the process of implementing the curriculum. Such procedures make it possible to assess whether the principles defined in the project that was approved are being followed; whether what was planned in the project, syllabus and programs of the discipline is in fact being accomplished; whether the teaching and administrative resources are sufficient and/or adequate for developing the project; and whether the way in which students are making use of the material is coherent with the teaching-learning methods used.

Sacristán (1998) understood that the curriculum was constructed at the crossing point of influences and fields of activity that were differentiated and interrelated. This author highlighted six phases or levels of constructing a curriculum model: the prescribed curriculum; the curriculum presented to the teachers; the curriculum shaped by the teachers; the curriculum in action; and the curriculum evaluated.

The process of curriculum reform for the Speech Therapy and Audiology course at PUC-SP took place in 2004/2005, within the context of the events and discussions indicated above. The design of the new curriculum did not radically break away from the traditional teaching structure in the way that, for example, some nursing and medical courses did. In these latter courses, it was decided to organize the learning activities around healthcare problems. For Speech Therapy, it was implicitly proposed to transform the old curriculum (structured according to disciplines and content material) into a new one in which the activities of teaching, research and experience of work environments would be interlinked such that they would form parts of a general course plan.

Thus, both the interdisciplinary approach and the aim of integrating theoretical foundations with clinical practices and introducing new teaching-learning methods led teachers and students of the course to define actions and strategies, to be constructed through collective work and managed by a group for structuring the pedagogical project, formed by teachers and students. During the implementation of the curriculum reform, this group had an important role in the implementation of the new pedagogical methods that were introduced into the curriculum, through contributing towards reflections on the concepts and activities, thereby resulting in changes of attitude among the teachers in relation to the project.

During the first year of implementation of the curriculum reform, which was when the new pedagogical methods for the course were planned and implemented (seminars, tutorials, technical, cultural and writing workshops and training experiences), systematizing the information on this process was sought, thus making it a study and a research subject³. 

Since the aim was to study the process of implementing the curriculum reform, a qualitative method was chosen. The study sought to concentrate on the activities, situations, procedures and interactions that could help in understanding the change process among the teaching staff. The investigation was initially characterized as a research action and was conceived and conducted in close relationship with the questions raised through implementing the curriculum, in which the researchers were involved cooperatively and participatively (Thiollent, 1987). 

For the researchers to make their objectives viable, they sought to establish a routine for the processes of evaluating the proposal. This included: analysis of the planning workshops; written questions to evaluate the suitability of the actions and their results; interviews; analysis reports on the development of academic activities; records of focal groups conducted with teachers and with students; records from meetings of the group for structuring the pedagogical project and the project for programs within the discipline. The parameters proposed by Campos et al. (2001) were also used. This enabled the initial exploration of the material used, for analysis and discussion of the process of implementing the new curriculum.

Thus, the description of the results focused on the historical process of curriculum implementation. It was assumed that recording this process and its follow-up would produce knowledge and perfect the training work developed.

Thus, the present paper reports on the experience of constructing a new pedagogical project for the Speech Therapy and Audiology course at PUC-SP within an investigative perspective and, in the final considerations, indicates the advances and challenges of the new curriculum.

The conception of the new curriculum

Regarding the conception

In 2004-2005, the Speech Therapy and Audiology course at PUC-SP underwent a process of curriculum reform. The old curriculum, which had been implemented in 1997, was run from the perspective of professional orientation strongly centered on clinical-therapeutic vocation. It was subsequently reaffirmed by national guidelines and was considered to be the basis for other possible actions, such as research and consultancy. Based on the guidance determined by the minimum curriculum proposed by MEC/SESu, the 1997 curriculum was formed by a set of disciplines organized into three training groups: the basic training group, clinical therapeutic training group and consultancy training group. Over the years following its implementation, a series of changes was proposed for higher education courses because of the implementation of the Laws of Directives and Bases (Leis de Diretrizes e Bases, LDB/1996) and the resolution regarding curriculum guidelines for Speech Therapy courses (2002). Through these, the minimum curriculum was abolished and, instead, the profile of abilities and skills for professionals and the fields of knowledge within which training should take place were defined. In turn, when the university drew up its institutional pedagogical project, it highlighted the following topics: generalist training, humanistic outlook, critical thinking, pluralism, interdisciplinarity, integration between theory and practice, indissociability of research, teaching and extension and flexibility in organizing the curriculum components.

Based on these reflections, a work group with representatives from different fields and disciplines was formed to construct the professional profile and the abilities and skills to be developed. The result from this work guided the annual academic planning. The proposals were based on the concepts of interdisciplinarity and comprehensiveness. The debates focused not only on technical-scientific abilities but also on sociocultural abilities.⁵ In addition to specialization, the need to also develop a commitment and responsibility towards improving the quality of healthcare attendance and the conditions of life of the population was identified.

In the previous curriculum, the first year of the course was basically dedicated to content material that was regarded as fundamental to clinical speech therapy, with the aim of promoting comprehension of the biopsychological-sociocultural factors within the health-disease process. Although this knowledge would be retrieved in subsequent years in clinical or consultancy situations, there was a dichotomy between knowledge passed across within the basic initial cycle and within the professionalizing cycle (when students would undertake trainee placements). With this strong separation between theory and practice within the initial cycle and the clear predominance of theory, an overvaluation of memory as the main attribute to be stimulated in evaluations applied to students within this learning cycle consequently occurred. Students' motivation to study theoretical disciplines, despite the teachers' efforts to show the importance of such knowledge in day-to-day speech therapy practice, often seemed to consist of the need to pass in the discipline.

Another change related to the concept of student learning as a dynamic process of creation and correlation and of elaboration of sense and meanings, which would direct students' logic towards constructing and participating in meaningful experiences (INEP/RIES, 2006). Consequently, among other requisites, this concept implied redesigning the syllabus such that the disciplines would not operate in an individualized manner, centered on their own content material. Students would need to take part in activities that would qualify their introduction into the world of work, either through case studies or through activities that would lead them to act responsibly, analyzing their training.

To meet the National Curriculum Guidelines, the process of the new reform of the course also implied changes towards greater flexibility of the curriculum, with an orientation towards interdisciplinary approaches, concentrating on the process of training generalist professionals. Thus, the following changes can be highlighted within this process, among others:

Restructuring of the schedule of academic activities;

Reduction of the number of classroom hours for theoretical disciplines;

Resizing of the content material worked on;

Introduction of new pedagogical methods;

]]> Introduction of students to the workplace right from the initial years;

Promotion of a broader view of clinical activities and consequently a broader view of interdisciplinary thinking and actions, in multiprofessional teams or with participation in collective projects;

Passage between theory and practice, stimulated by seeking information, reading and reflection on problem situations;

Reorientation of discipline programs as a function of the project.

Creation of the group for structuring the pedagogical project for the course

At the start of the process of implementing the curriculum reform, a group consisting of course and trainee period coordinators, one representative from theoretical disciplines and another from practical disciplines, one member from the school board, one student representative and one administrative representative was set up. This group was responsible for planning, conducting and evaluating the activities accomplished every semester. It performed the following activities:

Organization of planning workshops for academic activities, every semester;

Organization and implementation of monthly interdisciplinary seminars;

Definition and guidance for tutorial activities;

]]> Definition and orientation for workshops within the course;

Structuring for the activities of training experiences.⁶ 

Implementation of new teaching/learning methods

One of the challenges of the project was to implement new teaching/learning methods. As mentioned earlier, the curriculum reform was triggered by a set of factors, including the need to incorporate advances that had already been achieved but which were not considered within the old curriculum. There were extracurricular activities organized around study and research groups, with the aim of promoting vertical links between topics and subjects dealt with at undergraduate and/or postgraduate level. These activities formed a set of successful accomplishments that were characterized by problem-solving around interdisciplinary questions within clinical speech therapy. In evaluating the course, it was clear that these dynamics promoted interlinking between teaching, research and extension, going from encounters to conceptualization of training on the basis of the curriculum guidelines. Thus, these active learning methodologies had to be incorporated into the new curriculum by introducing them as differentiated pedagogical methods covering transverse questions about training, thereby stimulating a broader view of clinical activities and speech therapy practice.

Along these lines, the pedagogical methods planned were seminars, tutorials, workshops⁷ and training experiences. In organizing the day-to-day activities of the course, tutorials and workshops were allocated on the same classroom day throughout the course.⁸ These activities, which were weekly, gave rise to monthly seminars that enabled participation by all the students and teachers of the course. 

Seminars

In the seminars, the students were introduced to the professional field by means of a set of activities providing information and reflection on interdisciplinary and multiprofessional practices. The discussions focused on ways of understanding problems or situations, asking questions about them, conceptualizing them and intervening in the realities. The seminars had to be based on real situations, avoiding very general topics, and needed to emphasize a broad view of speech therapy practices, through active methodologies and a variety of strategies such as discussions about cases and institutional situations.

The seminar activities lasted for six classroom hours and were planned to start with a warm-up activity discussing a given topic (talks, videos or presentations), followed by work in small groups on problem situations (necessarily composed of students at different levels of undergraduate and postgraduate training), and ended with a full session in which the concepts worked on were summarized.

As a policy strategy aggregated to the proposal, the seminar topics were chosen based on a course planning workshop⁹ attended by a large proportion of the teaching staff and student representatives from all year-groups of the course. During the first year of implementation of the project (2006), seven seminars were held:

I - "The Interfaces of the Field of Speech Therapy" - This aimed to lead the students towards reflecting on and discussing the fields of knowledge that have interfaces with speech therapy, in order to seek to understand the interlinking of knowledge within these areas that is considered fundamental, with the specific fields of professional practice.

III - "Under the sign of the difference" - This topic was covered by a philosopher and by an occupational physician and aimed to lead the students to debate questions relating to the social formation of prejudice and discriminatory processes. The students then watched the film "My left foot",¹¹ and could reflect on the effects of preconceived attitudes and ideas about the capacity of different people.

IV - "The different languages of language" - This dealt with the question of different viewpoints on a given problem. In this seminar, the students discussed the question of whether language is an innate or acquired skill, based on a film (Nell). A linguist, a neurologist, a psychoanalyst and a speech therapist were invited to this discussion.

V - "Integrality as Processuality" - This was developed within the Speech Therapy Week, in which the theme was "Integrality as a principle for speech therapy practice for treating organic and psychological disorders". It involved participation by one speech therapist and two physicians: one with experience of the occupational field and the other, of implementing the Family Healthcare Program.

 VI - "Public policies for rehabilitation of disabled people: the challenge of social inclusion" - This was also developed within the Speech Therapy Week, with a set of activities involving talks and round-table discussions.

VII - "Towards new esthetics for speech therapy practice: the body of/in language" – This aimed to broaden the reference points for the world and of work, through using different languages: oral, written, dramatic and body. It sought to determine the size of work within the field of language as something that implied the presence of affectivity, perception, expression, meanings, criticism and creativity for the person concerned and in relation to other people. 

These seminars played an important role not only in interlinking the transverse topics but also for guiding the thematic discussions and activities developed in tutorials, training experiences and workshops, since the central axis of these activities was the questions covered in the seminars. The teachers who participated more actively in these activities considered that they were an important space for interdisciplinary discussion, reflection and understanding of the interlinking between the activities of the pedagogical projects. In the evaluation of the students, the seminars were perceived as points of convergence in the course, as illustrated in the following declaration from one of them:

… brilliant interaction between teachers and students from different years…. helped to give an overview of speech therapy… showed the reality of the profession… the topics covered led me to decide to continue in the profession….

Two factors relating to the process of implementing the seminars that helped in curriculum integration can be highlighted. The first concerned the interdisciplinary approach, which according to Demo (1998) implies demolition of the border between research and teaching-learning. In the curriculum reform, the seminars were planned from the perspective of summarizing content material, integrating between teaching the basics and learning professional practice. Evidence of advances could be seen from the testimonies of teachers regarding students' attitudes and the use that they made of the seminars, either through questioning or through relationships established in classroom discussions. Second, the collective process of definition of the topics and methodology used in this activity was shown to be a strategy that joined together ideas and integrated the teachers' relationships with the project.

This process followed Feuerwerker (2002), who stated that strategic planning and organized effort to construct communication channels and collective discussion are essential for conducting processes of changed. The results achieved also led the structuring nucleus to understand that, to optimize the participation of teachers and the student body, the organization and implementation of the seminars had to be delegated to them. This task was initially taken on by the didactic committee and, over time, it began to simply manage the process, seeking to anticipate the problems or difficulties and to offer support to the groups.

Although the tutorials were inspired through the characterization proposed for courses based on problem-solving methodology, they were conceived differently in the pedagogical project for the speech therapy course, with the following objectives:

To set out challenges for developing students' capacities to articulate between studies developed within the various disciplines and questions considered at the seminars;

To facilitate the educational process;

To promote actions that would result in critical-reflective attitudes;

To develop activities focusing on learning and not on teaching;

To ensure that all students participated in the study, with encouragement of the initiative of contributing toward the group discussion;

To assist in self-evaluation among students and identify the need to make better academic use of the seminars;

To stimulate processes of group integration and cooperation;

]]> To enable students to start using the methods of scientific research.

Initially, the tutorials had the basic work purpose of constructing scientific knowledge for professional training. They were based on the students' own knowledge, originating from personal experiences, common sense and topics carried in the media referring to the profession of speech therapist. Their activities were organized such that they would support participation in the seminars, as stated by one of the tutors:

…The discussion on the field of knowledge of Speech Therapy and its area of activities prepared the students for the first interdisciplinary seminar "The Interfaces of Speech Therapy". Although new to this type of activity, the first-year students participated in activities in the work subgroups and also in the composition of the final discussion table in the full session. They were able to understand Speech Therapy as an interdisciplinary field, with interfaces not only within biological and health sciences but also within human and social sciences. This made room for the group to bring up their queries relating to certain first-year disciplines, such as anthropology. At first, they did not see the point of these disciplines, since their expectations were that the course would be within the field of biological sciences. The perception that language is not just a biological factor made them understand the need to study topics covered in both disciplines… (Final evaluation report from the tutorial).

To prepare for the second seminar, the students made a monitored visit, as a training experience activity, to three places with speech therapy activities, along with interviews with speech therapists, other professionals and users.

During the tutorial activities of the first semester, the students also conducted a bibliographic survey of the topics developed as course conclusion studies, dissertations, theses and periodicals within the field of speech therapy. According to one of the tutors:

"….this activity served as a first approach to the field of scientific methodology, since the students were able to see in practice, for example, the importance of constructing a clear and concise text in the form of the abstract of the scientific study, to facilitate searches by investigators, along with the adequacy of the title and choice of key words… (Evaluation focus group/teachers).

The students evaluated the tutorials as one of the "most significant pedagogical methods" of the course:

…they made it possible to work in groups… it brought us closer to the course, the teachers and the profession… broadened our understanding of the course and the profession… enabled integration among the students… indicated the importance of continuing education… (Evaluation focus group/students).

Implementation of active methodologies was a major challenge for the teachers who had trained within the field of health. For most of them, formation had involved using traditional methodologies and they had been inserted into the curriculum according to the field of their specialization (Feuerwerker, 2002; Marins, 2004). The tutorial method¹² was considered to be an important activity for bringing students closer to the field of work of speech therapists and for developing skills and attitudes for learning to learn. Through planning resources, giving advice and following up the training experiences (described in the following), the tutors provided better conditions for significant learning.

According to Zanolli (2004), the most important point regarding adult education is to help such students to identify what they do not know and the best way to do this is to expose them to situations in which they can activate and test out their previous experiences. Moreover, this author stated that learning should take place in a contextualized manner, in real situations that the students will face during their lives. One element to be considered in implementing the curriculum relates to the practice scenarios for advancing the tutorial method in the second year of curriculum implementation. Basing clinical learning in real practice right from the start of the course imposes the challenge of bringing the course close to healthcare services. Reflection based on the results achieved by implementing tutorials (testimonies of students and teachers) and investigating the literature, elucidated that the tutorial activities allowed students not only approximation with the field of speech therapy, but also the development of a more attentive eye to the needs (healthcare and education, among others) among the population attended (living conditions, access to technologies that improve quality of life, links with healthcare services and autonomy). Extending the reflections of Zanolli (2004) on medical training to the field of speech therapy, all these points need to be considered in developing active methods for clinical teaching-learning.

Training experiences introduced the students to work environments and institutions that could qualify students' vision for professional practice. These were centralized by the tutorials and interlinked with disciplines, workshops and seminars, among others. The activities developed during the first year of the course were:

Visit to an operatic performance, as a means of broadening the students' cultural repertoire and specific discussions within the body studies discipline and in the cultural workshop.

Visits to the campus libraries of PUC-SP to perform bibliographic research, from which the resulting material was presented in a tutorial.

Participation in an event promoted by PUC-SP on World Voice Day, for healthcare promotion activities.

Monitored visits to places with speech therapy activities (private clinics, primary healthcare units and hospitals) and interviews with professionals and service users.

Observation of clinical cases connected with the disciplines of acquisition of written language, acquisition of oral language and neurology.

Visits to the Museum of the Portuguese Language and the Museum of the Person.

Filming of a dialogue relationship between a child and an adult: discipline of language acquisition and technical workshop.

]]> Visit to religious temples: activity within the discipline of Introduction to Theological Thinking.

Visit to Derdic, the institution in which the third-year training session were held.

Participation in health promotion and disease prevention activities promoted by fourth-year students (auditory screening for children aged six months to two years-old, conducted at primary healthcare units).

Participation of students in the 15^th Scientific Startup Meeting, at PUC-SP.

Organization of and participation in the 13^th Speech Therapy Week and Second Mauro Spinelli Day.

In relation to the training experiences undertaken during the monitored visits, the students' evaluation was that "…they greatly enriched the training …they were a very good idea …they helped me to confirm my choice of profession …there should be more of these…" (Evaluation focal group/students). The repercussion of these experiences on the students' training was percieved and considered to be positive, not only by the teachers who planned and monitored these experiences, but also by the teachers of the theoretical disciplines, who observed changes in the academic profile of the year-group:

 … more committed and interested, with more initiative for participating in activities that contribute towards professional training… the students are discussing general social questions and those involving speech therapy practice with greater propriety… (Evaluation focus group/teachers).

These testimonies indicate that the training experiences were pertinent to the work of sensitizing the students towards the psychological aspects of motivation for the profession and conceptualization of the professional role. According to Nogueira-Martins (2006), group experiences are fundamental for professional preparation. The creation of activities and space for discussions seems to confirm this author's presupposition that such spaces are welcoming for students and contribute towards their complete formation.

Writing workshops and cultural workshops

The cultural and writing workshops were interlinked with the other activities and proposed tasks such as: diary writing and reports on visits, among others. The aim of these workshops was to initiate a discussion on the way that students related to their writing, thereby seeking to construct a more significant and pleasurable way of relating to the written language. The students participated and reported on their stories of literacy. In these workshops, the relationship between speech therapy and the arts (in general, and literature in particular) and their importance for therapeutic work was shown. It became common practice for students to narrate the stories of books that they had read and for them to exchange books to read. According to the workshop teacher:

The workshops also sought to create the practice of reading and writing outside of the university walls. In this sense, the option of working on producing an opinion article in a nonacademic and more journalistic genre, since this would: (1) allow readers to follow and take up a position regarding polemical and controversial questions; (2) strongly mobilize the argumentative structure and other linguistic and discursive mechanisms (polyphony, intertextuality, etc) that are shared by academic genres, such as articles for scientific dissemination and academic trials; and (3) circulate in newspapers and magazines. From an argumentative point of view, discussion of the different types of argument (cause, principle, authority and exemplification) and argumentative movements (sustentation, refutation and negotiation) helped the students to understand the argumentative structures that form part of opinion articles.

Regarding the link between the seminars and writing workshops, the teacher stated:

… it was possible to focus on the characteristics of literate speech presented by speakers that could be correlated with difficulties of comprehension that this way of speaking might present… the relationship between reading, literate speech and note-taking… the importance of knowing how to define things in order to take notes from oral presentations (classes, talks, etc)… (Final evaluation report from the writing workshop).

In evaluating this pedagogical method, the students showed the reach that it had:

… it showed the importance of reading and writing clearly and correctly… dealing more critically with the text… it helped in writing better… it opened my eyes to society and culture… I started to enjoy reading and writing more… it helped in understanding the material… it helped in writing, but there were only a few activities… it added to all the material, but there was not much of it… (Course evaluation questionnaire/students).

Writing is one of the ways that lead students to have access to and produce knowledge. One of the challenges of the curriculum reform was to provide the conditions for students to be able to develop their potential and to cure deficiencies that would limit their training and future professional performance. The acts of reading, writing and learning correspond to realities that are very close and therefore indissociable. The students showed this perception, thus emphasizing the benefits brought by participation in the writing workshops, relating to construction of scientific knowledge with a critical-reflective capacity. 

Technical workshop for actions relating to child healthcare

In the second semester, according to the syllabus, the workshops aimed to provide technical capacitation for professional practice. In consonance with the work of theoretical disciplines, their aim was to work from an interdisciplinary and multiprofessional perspective on factors relating to Children's Healthcare Attendance, within the sphere of the SUS, with emphasis on the question of care for children at risk.

In evaluating this method, observation showed that it had a role in linking the topics worked on within some of the theoretical disciplines, thus enabling integration of the views of different fields that act within this cycle of life and the major general concerns of healthcare policies.

Analysis on the implementation process

In analyzing the process of implementing the course curriculum, the reference points that enabled movement towards shaping the pedagogical project for the course need to be highlighted. In this process, the pedagogical project conceptualized by the teachers (who participated in constructing the proposal and carrying out negotiations and adjustments before, during and after its approval) and the project prescribed by the institution (approved by the higher boards of the university) interacted with what was effectively being implemented.

The work methodology used in the disciplines that were introduced proved to be coherent with the principle of encouraging autonomy in the teaching-learning process, either through valuing the students' prior knowledge, put into action in all situations during the training, or in leading students to understand that professional training implies processes of learning to learn, learning to do and learning to relate to others.

Differently from fields in which there is great incentive to undertake curriculum change processes, no formal instruments for this type of evaluation have yet been developed within the field of speech therapy. In the present study, to assess the results from the changes that were achieved, the axes proposed by Campos et al. (2001) were used as a reference. The latter study was an evaluation of pedagogical projects that had been thought out within the context of healthcare training for the needs of primary care.

In view of the stage of implementation of the new curriculum (first year), it was not possible to work on all of the axes and vectors in the way that Campos et al. did. However, it is important to emphasize that they provided important parameters for analyzing the curriculum implementation in the present study. Thus, the following axes were considered in the analysis: theoretical, pedagogical approach, learning scenarios and preparation for development of the pedagogical project.

Axis of theoretical orientation

The course had a theoretical focus that allowed a broad view of clinical speech therapy, given that it was already working from the perspective of various determinants of the health-disease process, without restricting the view only to organic characteristics. However, according to the reports and analyses from the students and teachers, the new methods enabled effective practice of such viewpoints, from the first years of training onwards. According to Campos et al. (2001), analysis of this axis indicated the need for the course to bring teachers and students together, from the first years onwards and in healthcare services. It was considered that posing problems regarding situations and systemization of the analysis of the health-disease process became effective through the students' experiences on healthcare equipment.

Axis of pedagogical approach

Although the curriculum did not fully adopt the Problem Based Learning methodology (PBL), it introduced active learning methods. This allowed students to have greater integration between disciplines that were considered basic and activities of a professionalizing nature, thus enabling these to be incorporated more significantly.

The pedagogical changes were imprinted in active learning processes, with orientation from tutors, and were developed within different learning scenarios using different sources of knowledge (libraries, monitored visits to services, interviews with professionals, etc.)

Implementation of different pedagogical methods (seminars, tutorials and workshops) enabled interrelations between theory and practice. Through planning activities relating to the foundations of professional practice, the curriculum met students' training needs and improved the study and investigation conditions.

Work with the teachers for improving the student evaluation instruments was initiated. Although this is a major challenge, evaluation of the training has been the subject of many discussions at teachers meetings and is now being implemented as a means of determining the result from the proposal of each pedagogical method for the course. Consequently, the teaching plans are being worked on, in terms of students' needs and those of each year-group. This work has enabled planning for pedagogical activities (monitoring and study plans) as a function of students' learning needs detected in these evaluations.

Axis of learning scenarios

Differently from the previous curriculum, in which students had active interaction with the population and with healthcare professionals only at the start of the third year, the new curriculum allowed students to participate in health promotion and disease prevention activities from the first year onward. This allowed students to assume growing responsibilities as care-providing agents, compatible with their degree of autonomy.

The activities developed in seminars, in which questions concerning problems directly relating to speech therapy clinical practice were posed, promoted integration between the teaching staff in basic and professionalizing fields because of their interdisciplinary nature and thus enabled such questions to be dealt with. Greater closeness between the course and a community and the healthcare services of the area is desirable in order to create the conditions for student training to be more centered on the population's needs.

Axis of preparation for development of the pedagogical project

Regarding the experiences of the group for implementing the curriculum, it was observed that its participants were able to go through the process of collective production and participative planning. Although the seminar topics had been chosen previously, at the planning workshop, this group was responsible for drawing up the proposal and interlinking between the tutorial activities and preparation of the students for their participation in the seminars. In planning the seminars for the second year of the course, each member of the group coordinated the organization of the new seminars, with delegation to the teachers and students of the course. 

It is important to state that, in this process, resistance to the changes from certain teachers of theoretical disciplines also occurred; although they recognized the difficulties and limitations of teaching of more traditional type, experimentation with innovations produces disorder and rearrangement, for which not everyone is very ready. In relation to these teachers, it can be said that the modifications to the students' training had positive repercussions, producing changes that could be seen through their interest in participating in the seminars, drawing up plans for their disciplines and adopting methodologies that were more active.

In the process of analyzing the pathway that was accomplished, we agree with Veiga Neto (2003) in stating that pedagogical policy projects for a course should be considered to be an ongoing process of reflection and discussion of the institution's problems, in order to seek viable alternatives for putting the policy intentions into effect: "not descriptive or constatative, but constitutive".

In this respect, the description and analysis of the process brought out important support for decision-making as the work to implement the new curriculum continues. 

Final considerations

In this article, the start of a process of implementing a new curriculum for the speech therapy course at PUC-SP was recorded, with descriptions and analysis on the implementation of new pedagogical methods (interdisciplinary seminars, technical, writing and cultural workshops and tutorials). In drawing up the project, these activities were considered to be devices for the passage from a curriculum model structured according to disciplines to a model of academic activities structures according to a pedagogical project with programmed actions.

Among other advances, the following can be highlighted: greater integration between basic disciplines and activities of a professionalizing nature; better comprehension among students regarding the importance of training governed by the population's needs; greater interlinking between teaching, research and extension activities; interaction between students at different training levels, for health promotion and disease prevention actions; and planning of complementary pedagogical activities as a function of students' needs, detected at training evaluations.

Finally, the importance of constructing national indicators for the follow-up and evaluation of curriculum changes is emphasized. Within institutions, these may guide critical reflections and induce changes.

REFERENCES

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DEMO, P. Desafios modernos da Educação. Petrópolis: Vozes, 1998.

FEUERWERKER, L.C.M. Além do discurso de mudança na educação médica: processos e resultados. São Paulo: Hucitec; Londrina: Rede Unida; Rio de Janeiro: Associação Brasileira de Educação Médica, 2002.

FEUERWERKER, L.C.M.; SENA, R.A. Construção de novos modelos acadêmicos de atenção à saúde e de participação social. In: ALMEIDA, M.J. (Org.); Educação médica e saúde: possibilidades de mudança. Rio de Janeiro: ABEM; 1999. p. 47-83

INEP/RIES. Ministério da Educação Enciclopédia de Pedagogia Universitária, glossário vol.2. Editora chefe Marilia Costa Morosini - 2006. p. 423.

MARINS, J.J. Os cenários de aprendizagem e o processo do cuidado em saúde. In: MARINS, J.J et al.(Org.) Educação médica em transformação: instrumentos para a construção de novas realidades. São Paulo: Hucitec, 2004. p.97.

NOGUEIRA-MARTINS, M.C.F. Formação: saberes e fazeres humanizados. Boletim da Saúde. Porto Alegre. jul/dez, v. 20, n. 2, p. 110-18, 2006.

PUPO, A.C et al. Novo Projeto Pedagógico do Curso de Fonoaudiologia da PUC-SP. Revista Distúrbios da Comunicação - PUC-SP, São Paulo, 18, 1-32, 2006.

SACRISTÁN, J.C. O currículo: uma reflexão sobre a prática. Porto Alegre: Artmed.1998, p. 352.

THIOLHENT, M. Crítica metodológica, investigação social e enquete operária. 3. ed. São Paulo: Polis, 1987.

VEIGA NETO, A. Currículo e interdisciplinaridade. In: MOREIRA, A.F. (Org.). Currículo: questões atuais. Campinas: E. Papirus, 2003. p. 59-102.  

ZANOLLI, M.S. Metodologias ativas de ensino-aprendizagem na área clínica. In: MARINS. J.J.N et al (Org) Educação Médica em transformação-instrumentos para a construção de novas realidades. São Paulo: Hucitec, 2004,  p.40.

1  Teaching associations for courses within Medicine, Nursing, Dentistry, Physiotherapy, Psychology, Social Services, Speech Therapy, Occupational Therapy and Pharmacy form part of FNEPAS, along with the United Network (Rede Unida), the Brazilian Association of University and Teaching Hospitals (Associação Brasileira de Hospitais Universitários e de Ensino) and the Brazilian Association for Postgraduate Public Health Programs (Associação Brasileira de Pós-graduação em Saúde Coletiva, ABRASCO). See the website http://www.fnepas.org.br.
2 In Brazil, formation at graduation level in the Phonoaudiology Course prepares the professional to practice both in the area of language pathology and the area of audiology.
3 The teachers responsible for this received research hours from the FAP/CEPE fund of PUC-SP for conducting the work and some of this material was recorded by PIBIC/CNPq grant-holders.
4 Teaching and Rehabilitation Division for Communication Disorders (Divisão de Ensino e Reabilitação dos Distúrbios da Comunicação, DERDIC).
5 The skills for the pedagogical project of the course are described in Pupo et al. (2006) p. 16. ]]> 6 Defined in the project as activities for introducing students into the field and work settings.
7 In accordance with the syllabus, the writing and cultural workshops were held in the first and fourth teaching semesters, and the technical workshops in the second and third semesters. 
8 In 2007, the second year-group following the curriculum in question was introduced.
9 A reference statement was produced from this workshop for teachers, declaring the objective, methodology and expected results. The decision to use workshops was a strategy to get the teaching staff and students involved in constructing/implementing the new pedagogical project. The workshops were differentiated from traditional methodologies through being processes that were more horizontal and democratic, with products that depended on direct participation by all parties involved.
10 In parallel with this seminar, students made monitored visits (classified as training experiences) to speech therapy services at two hospitals, two primary healthcare units and two private clinics.
11 The film dealt with a character's processes of interaction with organic and social problems resulting from stigma. In the tutorial, aspects of the main character's communication were covered, in terms of whether this impeded the processes of interaction with the other characters in the story.
12  The tutorial method presented here differs from what is practiced in courses with integrated curriculums and problem-based learning methodologies. In the speech therapy curriculum at PUC-SP, the method not only assumes that problems from clinical practice are posed but also organizes actions and strategies for studies, research and discussions on professional practices within the field.
i Address: Rua Monte Alegre, 984 - São Paulo - SP - 05014-001 Tel. 9627-7435