Abstract

Introduction

The pandemic caused by the novel coronavirus SARS-COV-2, the causative agent of Covid-19, affected the curricular activities of undergraduate dental programs. In most of them, in-person activities were totally suspended, emergency services were maintained, and theoretical activities were migrated to virtual environments¹1. Spanemberg JC, Simões CC, Cardoso JA. The impacts of the Covid-19 pandemic on the teaching of dentistry in Brazil. J Dent Educ. 2020; 84:1185-7.

2. Iyer P, Aziz K, Ojcius DM. Impact of Covid-19 on dental education in the United States. J Dent Educ. 2020; 84(6):718-22.

3. Sponchiado-Júnior EC, Vieira WA, Silva LC, Ferraz CCR, Almeida JFA, Gomes BPFA, et al. Impact of COVID-19 on dental education in Brazil. Rev ABENO. 2021; 21(1):1225.-⁴4. Silva PGB, Dias CC, Machado LC, Carlos ACAM, Dantas TS, Ximenes J, et al. Distance education in dentistry in Brazil: a critical STROBE-based analysis. Braz Oral Res. 2021; 35:e109..

In the pandemic context, remote teaching enabled the continuity of classes, and teachers accepted and mastered the use of online learning tools. However, some barriers were identified. Students’ difficulty in establishing a routine of studies while dealing with procrastination and mental healthcare, teachers’ and students’ organization of the time they had to dedicate to virtual activities, and access to electronic devices/high-quality internet service reduced learning and made students feel anxious and insecure¹1. Spanemberg JC, Simões CC, Cardoso JA. The impacts of the Covid-19 pandemic on the teaching of dentistry in Brazil. J Dent Educ. 2020; 84:1185-7.,⁵5. Zimmer R, Arossi G, Reston EG, Portella FF. Experiences and perception of dentistry students and professors regarding online classes during the Covid-19 pandemic. Rev ABENO. 2021; 21(1):1165.,⁶6. Girundi C, Aveiro MC, Uchôa-Figueiredo LR. Education for interprofessional care: redefining health practices in pandemic times. Interface (Botucatu). 2021; 25 Suppl 1:e210034. doi: 10.1590/interface.210034.
https://doi.org/10.1590/interface.210034... .

In the perspective of interprofessional education (IPE) – an educational opportunity in which students/workers from two or more professions learn together, in an interactive way, with the explicit purpose of improving collaboration and the quality of care provided for users-families-communities⁷7. Reeves S, Fletcher S, Barr H, Birch I, Boet S, Davies N, et al. A BEME systematic review of the effects of interprofessional education: BEME Guide no. 39. Med Teach. 2016; 38(7):656-68. –, initiatives carried out in practice settings of the Brazilian National Health System (SUS) are reported by the literature⁸8. Toassi RFC, Olsson TO, Lewgoy AMB, Bueno D, Peduzzi M. Ensino da graduação em cenários da atenção primária: espaço para aprendizagem interprofissional. Trab Educ Saude. 2020; 18(2):e0026798.

9. Rossit RAS, Freitas MAO, Batista SHSS, Batista NA. Construção da identidade profissional na educação interprofissional em saúde: percepção de egressos. Interface (Botucatu). 2018; 22 Suppl 1:1399-410. doi: 10.1590/1807-57622017.0184.
https://doi.org/10.1590/1807-57622017.01... -¹⁰10. Costa MV, Patrício KP, Câmara AMCS, Azevedo GD, Batista SHSS. Pro-Health and PET-Health as interprofessional education spaces. Interface (Botucatu). 2015; 19 Suppl 1:709-20. doi: 10.1590/1807-57622014.0994.
https://doi.org/10.1590/1807-57622014.09... and meet the social responsibility of education¹¹11. Esposito LI, Martínez CC, Carrasco-Labra A, Thumala JH, Kirberg RGH, Borroto DO, et al. Desafíos de la educación en odontología. ARS Med. 47(3):68-74. doi: 10.11565/arsmed.v46i4.1842.
https://doi.org/10.11565/arsmed.v46i4.18... . The pandemic brought the challenge of interaction to such initiatives, without the possibility of practice in the services. There was an adaptation to remote activities, using virtual learning environments. The continuity of teaching-service-community integration activities with an interprofessional focus allowed to put undergraduate students in contact with health teams, aiming to minimize physical distance, facilitate the understanding of the reality of the services, and create possibilities for a joint planning of health practices in the new format of interaction⁶6. Girundi C, Aveiro MC, Uchôa-Figueiredo LR. Education for interprofessional care: redefining health practices in pandemic times. Interface (Botucatu). 2021; 25 Suppl 1:e210034. doi: 10.1590/interface.210034.
https://doi.org/10.1590/interface.210034... ,¹²12. Granjeiro EM, Musse JO, Peixoto TM, Nunes IV, Soares IMSC, Silva ICO, et al. Estratégias de ensino à distância para a educação interprofissional em saúde frente à pandemia Covid-19. REVISA. 2020; 9 Esp 1:591-602..

This study aimed to understand dental students’ perception of motivations and meanings regarding interprofessional learning in the period of Emergency Remote Teaching (ERT), during the Covid-19 pandemic, at a public university located in the South region of Brazil. Motivation is understood here as a preparatory psychological process of activation and orientation of human action. It involves cognition, but it also includes an important affective-emotional component¹³13. Huertas JA. Motivación: querer aprender. 2a ed. Buenos Aires: Aique; 2006..

Methodology

This qualitative research¹⁴14. Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a32-item check list for interviews and focus groups. Int J Qual Health Care. 2007; 19(6):349-57. used the theoretical-methodological perspective of phenomenology of perception.¹⁵15. Merleau-Ponty M. Phenomenology of perception. London: Taylor and Francis e-Library; 2005.

Studied phenomenon

The studied phenomenon was the experience embodied in the teaching activity (discipline) with a focus on IPE, offered by a public university located in the South of Brazil, and carried out in Primary Health Care (PHC) practice settings. It brings the ‘absolute source’ perception of those who experience the phenomenon¹⁵15. Merleau-Ponty M. Phenomenology of perception. London: Taylor and Francis e-Library; 2005.: dental students.

The activity has been offered since 2012 and is characterized as an elective curricular component of the Dentistry course. The total number of hours is 60 (4 hours per week). Every semester, each course offers four seats to its students. For the seats to be offered, a teacher from the course must be part of the activity’s group of teachers. It is organized in activities performed in tutorship groups (2 to 3 teachers-tutors and 8 to 10 students from different courses) and theoretical activities (tutorship groups together)¹⁶16. Toassi RFC, Lewgoy AMB. Integrated health practices: an innovative experience through inter-curricular integration and interdisciplinarity. Interface (Botucatu). 2016; 20(57):449-61. doi: 10.1590/1807-57622015.0123.
https://doi.org/10.1590/1807-57622015.01...

17. Olsson TO, Dalmoro M, Costa MV, Peduzzi M, Toassi RFC. Interprofessional education in the dentistry curriculum: analysis of a teaching-service-community integration experience. Eur J Dent Educ. 2022; 26(1):174-81.-¹⁸18. Ely LI, Toassi RFC. Integration among curricula in health professionals’ education: the power of interprofessional education in undergraduate courses. Interface (Botucatu). 2018; 22 Suppl 2:1563-75. doi: 10.1590/1807-57622017.0658.
https://doi.org/10.1590/1807-57622017.06... . The theoretical-methodological framework is that of problematization and assessment of the process-product of the experience¹⁹19. Berbel NAN. A problematização e a aprendizagem baseada em problemas: diferentes termos ou diferentes caminhos? Interface (Botucatu). 1998; 2(2):139-54. doi: 10.1590/S1414-32831998000100008.
https://doi.org/10.1590/S1414-3283199800... with a focus on IPE. Three thematic axes (contents) are studied: 1. Territory/territorialization, environment and health; 2. Education and collaborative work in the health area/collaborative competencies/teamwork process in PHC; 3. Healthcare centered on people-families-community. The National Primary Care Policy is a content that is present in the three axes¹⁶16. Toassi RFC, Lewgoy AMB. Integrated health practices: an innovative experience through inter-curricular integration and interdisciplinarity. Interface (Botucatu). 2016; 20(57):449-61. doi: 10.1590/1807-57622015.0123.
https://doi.org/10.1590/1807-57622015.01...

17. Olsson TO, Dalmoro M, Costa MV, Peduzzi M, Toassi RFC. Interprofessional education in the dentistry curriculum: analysis of a teaching-service-community integration experience. Eur J Dent Educ. 2022; 26(1):174-81.-¹⁸18. Ely LI, Toassi RFC. Integration among curricula in health professionals’ education: the power of interprofessional education in undergraduate courses. Interface (Botucatu). 2018; 22 Suppl 2:1563-75. doi: 10.1590/1807-57622017.0658.
https://doi.org/10.1590/1807-57622017.06... .

Assessment is continuous and formative. The individual portfolio²⁰20. Anastasiou LGC, Alves LP, organizadores. Processos de ensinagem na universidade: pressupostos para as estratégias de trabalho em aula. 5a ed. Joinville: UNIVILLE; 2005., with partial and final deliveries - which can be in the physical or virtual format, posted on the Moodle virtual learning environment (VLE) -, is the instrument used to monitor students’ knowledge construction process, learning, and challenges. The tutor is responsible for monitoring the student during the teaching activity. They should stimulate dialog and interaction in the group and promote the problematization of experiences; in addition, they must read and provide feedback on the portfolio¹⁶16. Toassi RFC, Lewgoy AMB. Integrated health practices: an innovative experience through inter-curricular integration and interdisciplinarity. Interface (Botucatu). 2016; 20(57):449-61. doi: 10.1590/1807-57622015.0123.
https://doi.org/10.1590/1807-57622015.01...

17. Olsson TO, Dalmoro M, Costa MV, Peduzzi M, Toassi RFC. Interprofessional education in the dentistry curriculum: analysis of a teaching-service-community integration experience. Eur J Dent Educ. 2022; 26(1):174-81.-¹⁸18. Ely LI, Toassi RFC. Integration among curricula in health professionals’ education: the power of interprofessional education in undergraduate courses. Interface (Botucatu). 2018; 22 Suppl 2:1563-75. doi: 10.1590/1807-57622017.0658.
https://doi.org/10.1590/1807-57622017.06... . Instructions for the construction of the portfolio include aspects related to text structure (adequate language, synthesis skills, ethical-critical argumentation, organization of experiences, presentation of the theoretical framework with quotes and References) and to the selection, register, and analysis (theory-practice relationship) of the most significant productions, challenges related to the object of study, and ways to overcome them. Students are expected to connect such aspects with knowledge deriving from their profession and from the other professions²⁰20. Anastasiou LGC, Alves LP, organizadores. Processos de ensinagem na universidade: pressupostos para as estratégias de trabalho em aula. 5a ed. Joinville: UNIVILLE; 2005..

Up to 2019, the period before the pandemic, tutoring activities composed 80% of the number of hours and were practices conducted in the PHC services of SUS. Interaction with the team and with people-families from the territories were present. In March 2020, with the suspension of in-person activities and the regulation of ERT in the University²¹21. Porto Alegre. Universidade Federal do Rio Grande Do Sul (UFRGS). Portaria nº 2286 de 17/03/2020. Suspende atividades presenciais de ensino na Universidade. Porto Alegre: UFRGS; 2020., the IPE activity was suspended and underwent a process of pedagogical restructuring so that it could be offered, in 2021, in the remote modality. In this period, the University offered to the faculty a set of qualification activities targeted at the utilization of virtual pedagogical resources for ERT, which supported the development of the teaching plan. The activities were organized as synchronous (virtual platforms provided by the University: Teams, Meet, Mconf – 70% of the number of hours) and asynchronous (readings/tasks available in the Moodle VLE - 30% of the number of hours). Synchronous tutorship moments were maintained, preserving the logic of conversation circles for discussion and exchange of experiences, perceptions and knowledge by the professions²²22. Porto Alegre. Universidade Federal do Rio Grande do Sul (UFRGS). Faculdade de Odontologia. Plano de ensino: disciplina Práticas Integradas em Saúde I. Porto Alegre: UFRGS; 2021.. Theoretical meetings (synchronous) included contents on ‘Telehealth in PHC’ and ‘Interprofessionality and collaborative work in situations of global disasters’. Some of the synchronous meetings had the participation of management professionals (Coordinators of the Teaching-Assistance District Management - GDDA) and PHC teams (community health workers, nurses, dentists, and Collective Health residents). These workers participated in the planning and development of synchronous activities to present GDDA and the working process in PHC (territory, team, work context in the pandemic, SUS network).

During the ERT, students from 15 undergraduate programs participated in the teaching activity. The courses of Biomedicine, Physical Education, Medicine, and Public Policies could offer seats without the presence of the course teacher²²22. Porto Alegre. Universidade Federal do Rio Grande do Sul (UFRGS). Faculdade de Odontologia. Plano de ensino: disciplina Práticas Integradas em Saúde I. Porto Alegre: UFRGS; 2021.. Frame 1 presents the constitution of the tutorship groups by profession.

Participants

All the dental students who completed the IPE teaching activity in 2021, in the ERT period, were invited to participate in the study (n = 5). Three students were in different tutorship groups, and two belonged to the same group. If any of the students were on leave, had suspended their enrolment, or had dropped out of the course, they would have been excluded.

Dental students’ participation in the study is justified by the following facts: it is one of the professions that make up the PHC teams, the dental course has been present in the activity investigated here since 2012, and the revised text of the Dentistry Curricular Guidelines²³23. Brasil. Conselho Nacional de Educação. Resolução nº 3, de 21 de Junho de 2021. Institui as diretrizes curriculares nacionais do curso de graduação em odontologia e dá outras providências. Diário Oficial da União. 22 Jun 2021; Sec. 1, p. 59.recommends that the dentist must be a professional who is able to work in teams, in an interprofessional way.

Data collection and analysis

Data collection was performed between July and December 2021, when the students had already completed the remote IPE activity.

The corpus of analysis was composed of online semi-structured interviews and the students’ portfolios. The interviews were scheduled according to the students’ availability and conducted on the University’s Mconf platform. They lasted 45 to 55 minutes, were conducted by a single researcher with experience in qualitative research, recorded and subsequently transcribed. The interviews’ script had been previously evaluated by the research team when they interviewed a student who had completed the teaching activity. This student was not part of the study’s sample (Frame 2). The transcriptions were sent to the students for approval and complementation of ideas. The research team discussed whether the textual material that was produced was sufficiently dense to fulfil the research objective and, upon confirmation, finalized the data collection stage.

The material was interpreted through content analysis²⁴24. Bardin L. Análise de conteúdo. São Paulo: Editora 70; 2011.. In the pre-analysis stage (organization), the free-floating reading - inductive and open - enabled the research team to have the first contact with the data. Then, the material was classified and coded as emerging themes (units of registration). Similar themes or themes that complemented one another were gathered and generated categories of analysis²⁴24. Bardin L. Análise de conteúdo. São Paulo: Editora 70; 2011.. To protect the secrecy of information about the research participants, a sequential order was coded for interviews (E1 to E3) and portfolios (P1 to P5).

Ethical considerations

The research was approved by the Research Ethics Committee of the University that participated in the study (Opinion #3.585.711).

Results

Three students were interviewed and five portfolios were analyzed. Two students decided not to participate in the interviews.

Three categories emerged from the analysis of the interviews and portfolios, with a focus on the dental students’ understanding of motivations and meanings regarding interprofessional learning in the ERT pandemic period.

Waking to IPE: Interest in interaction and learning between professions based on the mobilization of knowledge about teamwork and comprehensive care

The students’ interest in participating in the IPE activity was influenced by the recommendation of classmates from the Dentistry course, family members who were attending another undergraduate course, and course teachers.

Such recommendation brought positive perceptions of practices performed in PHC services that the students considered motivational, despite being aware of the limitation imposed on such practices during ERT.

The proposal of students, teachers and professionals interacting and learning together, and the mobilized themes about teamwork and comprehensive care aroused the students’ interest, as they understand the importance of IPE activities in the undergraduate course.

When the students talked about the Dentistry curriculum, they expressed their perception of the distance between health courses, in view of the diversity of professions represented in the interprofessional teaching activity.

The offer of this teaching activity in the ERT format also enabled working students, whose availability to in-person activities at PHC Units is limited, to attend it. It became a facilitator for these students.

IPE mediated by information and communications technologies (ICTs): A ‘teaching while learning’ construction through collaboration

According to the dental students, participating in the IPE activity in the remote format, with interaction between different actors in the synchronous moments - connecting University and health services - and theoretical support from the recommended readings and virtual forums in the asynchronous moments (Moodle activities), stimulated the development of concepts.

New learnings emerged from the data concerning “territory/territorialization” (E1, E2, P1, P2), “care network in the SUS” (E1, P1), “multiprofessionality and interprofessionality” (E1, E2, P1, P2, P4), functioning dynamics of the Health Unit (E1, E3, P5), “catastrophes/disasters” (E1, E2, E3, P1, P2), and “telehealth/teleservice” (E1, E3, P1, P2).

To the students who were attending the final year of the course and carrying out curricular internships in the SUS, this knowledge enhanced learning.

Students’ participation and dialog with Teaching-Assistance District Managers, PHC residents and professionals in synchronous moments enabled them to learn about teamwork functioning/routine in PHC. The students were touched by these professionals’ reports on their experiences during the Covid-19 pandemic.

Although face-to-face meetings and practical activities in PHC were suspended, interaction/integration relationships and collaborative teaching-learning between different professions could be constituted in the remote IPE experience.

Groups created in a messaging application, voice calls (WhatsApp), the collective construction of the final essay on the meanings of the teaching activity, and the synchronous tutorship meetings led by teachers-tutors who stimulated students’ participation were pedagogical strategies that facilitated communication, exchanges, and learnings.

Teaching in tutorship groups, marked by exchanges, conversations/dialogs/discussions, hearing, participation, and respect for differences caught the students’ attention. They perceived it as a ‘teaching while learning’ methodology, different from what they experienced in the Dentistry curriculum.

Situations of learning with classmates from other courses were the highlight of the experience.

The relationship between IPE and care centered on the needs of people-patients was reiterated in different moments of the students’ narratives, as they recognized and strengthened the value of interprofessional communication and learning with and about other professions to avoid professional stereotypes and provide comprehensive care.

The students were able to relate interprofessional learnings to their specific practices, applying them to their profession.

Living and studying in a pandemic period of remote teaching: Virtual interaction as a challenge to IPE

The situation of living and studying in a pandemic period was frequently present in the students’ reports. Aspects like “difficult moment” (E1)/”tense moment” (P4), “the stress and anxiety that many people feel after a disaster” (P2), “life that stopped”, the “losses” with ERT (P1), and “having Covid” (E2) dialogued with the opportunity of “experiencing interprofessionality” (P4) and seeking “knowledge on our own” (P1), bringing “guidance” to students (E1) and “comfort and hope that better days will come” (P4).

The pandemic also aroused, in the students, the perception that teamwork and interprofessional learning must be present in the dentist’s education.

In spite of the recognized gains, ERT was challenging. Barriers to “access to good internet services and high-quality electronic devices (computer/mobile phone)” (E1) revealed social inequalities among students from different courses. The disease and deaths that occurred in the period also affected students’ performance and learning.

The creation of bonds in the tutorship group was a barrier observed in the ERT period.

In the end, the students recognized the importance of in-person teaching in the IPE activities, as it promotes contact with patients, experiences in healthcare spaces, and face-to-face exchanges.

Discussion

Human experiences, mainly in periods of crises like the one generated by the Covid-19 pandemic, have the potential to re-signify practices, worldviews, prejudices, values, symbols, and to produce educational reflections and changes in pedagogical actions²⁵25. Veloso B, Mill D. Distance education and remote teaching: opposition by the vertex. SciELO Preprints; Forthcoming 2022. doi: 10.1590/SciELOPreprints.3506.
https://doi.org/10.1590/SciELOPreprints.... . Without the possibility of practical activities, the remote, ‘emergency’ teaching imposed on this context allowed the continuity of the health education process, instigating theoretical-conceptual discussions about the theme of distance education/remote teaching, and showing the need to analyze what was experienced²⁵25. Veloso B, Mill D. Distance education and remote teaching: opposition by the vertex. SciELO Preprints; Forthcoming 2022. doi: 10.1590/SciELOPreprints.3506.
https://doi.org/10.1590/SciELOPreprints.... ,²⁶26. Moreira JA, Schlemmer E. Por um novo conceito e paradigma de educação digital onlife. Rev UFG. 2020; 20(26):63438..

This study contributes to the understanding of motivations and meanings, expressed by dental students, regarding the perceptual and embodied experience¹⁵15. Merleau-Ponty M. Phenomenology of perception. London: Taylor and Francis e-Library; 2005. of a remote IPE activity in the pandemic period. The participants had to adapt to the separation of the physical-geographical-corporal space in the meetings between people. In addition, there was an expansion of the use of ICTs in higher education, which required a speedy appropriation by teachers and students.

Although the students recognized the importance of in-person education within practice settings of SUS, they were receptive and willing to learn, which enabled them to experience²⁷27. Bondía JL. Notas sobre a experiência e o saber de experiência. Rev Bras Educ. 2002; (19):20-8. interprofessionality during ERT. The flexibility of the teaching and learning process enabled by the remote modality⁴4. Silva PGB, Dias CC, Machado LC, Carlos ACAM, Dantas TS, Ximenes J, et al. Distance education in dentistry in Brazil: a critical STROBE-based analysis. Braz Oral Res. 2021; 35:e109. motivated the working students and allowed them to attend the IPE activity.

To students included in a curriculum whose pedagogical strategies not always enable dialectical moments, the interaction promoted in the tutorship groups, whose focus is not the content itself, but the process of collective knowledge construction²⁰20. Anastasiou LGC, Alves LP, organizadores. Processos de ensinagem na universidade: pressupostos para as estratégias de trabalho em aula. 5a ed. Joinville: UNIVILLE; 2005., was one of the most prominent findings. In the perspective of dialectics²⁰20. Anastasiou LGC, Alves LP, organizadores. Processos de ensinagem na universidade: pressupostos para as estratégias de trabalho em aula. 5a ed. Joinville: UNIVILLE; 2005., students are given the opportunity of acquiring information and developing competencies based on interaction and exchange of ideas with classmates from different courses, teachers and health professionals, considering the personal and societal context in which they live²⁸28. Bertrand Y. Teorias contemporâneas da educação. 2a ed. Lisboa: Instituto Piaget; 2001.. Competency is understood as the students’ capacity to mobilize knowledge-skills-attitudes, using the available resources, in favor of initiatives and actions expressed in performances that are able to meet the challenges of professional practice, in different contexts of health work²³23. Brasil. Conselho Nacional de Educação. Resolução nº 3, de 21 de Junho de 2021. Institui as diretrizes curriculares nacionais do curso de graduação em odontologia e dá outras providências. Diário Oficial da União. 22 Jun 2021; Sec. 1, p. 59..

It is in this space of tutorships - marked by a diversity of professional knowledges and life histories - that students and teachers share responsibility for ‘learning to learn’ and develop respect for differences, autonomy in knowledge construction, and critical capacity⁴4. Silva PGB, Dias CC, Machado LC, Carlos ACAM, Dantas TS, Ximenes J, et al. Distance education in dentistry in Brazil: a critical STROBE-based analysis. Braz Oral Res. 2021; 35:e109.,²⁹29. Bate E, Hommes J, Duvivier R, Taylor DCM. Problem-based learning (PBL): getting the most out of your students - their roles and responsibilities: AMEE Guide no. 84. Med Teach. 2014; 36(1):1-12.,³⁰30. Luna WF, Bernardes JS. Tutoria como estratégia para aprendizagem significativa do estudante de medicina. Rev Bras Educ Med. 2016; 40(4):653-62.. The teacher, playing the role of the tutor who is responsible for facilitating learning in the virtual space, must deal with the challenges of understanding their own teaching process and learning to dialog and interact in the ERT context mediated by ICTs. Therefore, the tutorships promote learning situations in which students and teachers are involved in the learning process²⁰20. Anastasiou LGC, Alves LP, organizadores. Processos de ensinagem na universidade: pressupostos para as estratégias de trabalho em aula. 5a ed. Joinville: UNIVILLE; 2005.,³¹31. Charczuk SB. Sustentar a transferência no ensino remoto: docência em tempos de pandemia. Educ Real. 2020; 45(4):e109145..

The development of collaborative competencies, which improve the relationships between different professional categories in the dynamics of health work - especially those related to interprofessional communication and care centered on the person-patient⁷7. Reeves S, Fletcher S, Barr H, Birch I, Boet S, Davies N, et al. A BEME systematic review of the effects of interprofessional education: BEME Guide no. 39. Med Teach. 2016; 38(7):656-68.,³²32. Canadian Interprofessional Health Collaborative. A national interprofessional competency framework. Vancouver: Canadian Interprofessional Health Collabortive; 2010. - was one of the learnings identified in this study. Students problematized the applicability of interprofessionality to their clinical action as dentists. Thus, the IPE activity became an experience that marked them, touched them, and made sense in their education²⁷27. Bondía JL. Notas sobre a experiência e o saber de experiência. Rev Bras Educ. 2002; (19):20-8..

The mobilized contents about territory/territorialization, care network in the SUS, multiprofessionality and interprofessionality, functioning dynamics of the Health Unit, catastrophes/disasters, and telehealth/teleservice triggered new learnings and were connected with the obligatory curricular contents of Dentistry. The presence of managers, residents, and professionals from PHC teams in pre-established synchronous moments was a strategy that facilitated the students’ understanding of the reality of the services, teams, and needs of people-families-communities in the pandemic period⁶6. Girundi C, Aveiro MC, Uchôa-Figueiredo LR. Education for interprofessional care: redefining health practices in pandemic times. Interface (Botucatu). 2021; 25 Suppl 1:e210034. doi: 10.1590/interface.210034.
https://doi.org/10.1590/interface.210034... ,¹²12. Granjeiro EM, Musse JO, Peixoto TM, Nunes IV, Soares IMSC, Silva ICO, et al. Estratégias de ensino à distância para a educação interprofissional em saúde frente à pandemia Covid-19. REVISA. 2020; 9 Esp 1:591-602.. Students attributed meanings to the activity contents, based on their articulation with previous curricular knowledge, thus establishing a meaningful learning process³³33. Ausubel DP. Aquisição e retenção de conhecimentos: uma perspectiva cognitiva. Lisboa: Plátano; 2003..

Barriers emerged and need to be discussed. The utilization of ICTs in the investigated IPE activity was marked by inequalities concerning internet access and adequate electronic devices to remote teaching, as well as personal fragilities associated with the pandemic, which affected students’ participation and learning. The limitations concerning the creation of bonds in the tutorship groups and in activities involving teams with/in the community were also barriers to the development of IPE in ERT.

The results obtained in the experience of remote interaction between professions reinforce the students’ positive attitudes towards interprofessional learning⁸8. Toassi RFC, Olsson TO, Lewgoy AMB, Bueno D, Peduzzi M. Ensino da graduação em cenários da atenção primária: espaço para aprendizagem interprofissional. Trab Educ Saude. 2020; 18(2):e0026798.

9. Rossit RAS, Freitas MAO, Batista SHSS, Batista NA. Construção da identidade profissional na educação interprofissional em saúde: percepção de egressos. Interface (Botucatu). 2018; 22 Suppl 1:1399-410. doi: 10.1590/1807-57622017.0184.
https://doi.org/10.1590/1807-57622017.01... -¹⁰10. Costa MV, Patrício KP, Câmara AMCS, Azevedo GD, Batista SHSS. Pro-Health and PET-Health as interprofessional education spaces. Interface (Botucatu). 2015; 19 Suppl 1:709-20. doi: 10.1590/1807-57622014.0994.
https://doi.org/10.1590/1807-57622014.09... ,³⁴34. Gonçalves JRSN, Gonçalves RN, Rosa SV, Orsia JSR, Moysés SJ, Werneck RI. Impact of interprofessional education on the teaching and learning of higher education students: a systematic review. Nurse Educ Pract. 2021; 56:103212., complementing and strengthening contents of the Dentistry curriculum, especially those related to comprehensive care and care centered on the needs of people-patients⁷7. Reeves S, Fletcher S, Barr H, Birch I, Boet S, Davies N, et al. A BEME systematic review of the effects of interprofessional education: BEME Guide no. 39. Med Teach. 2016; 38(7):656-68.,⁸8. Toassi RFC, Olsson TO, Lewgoy AMB, Bueno D, Peduzzi M. Ensino da graduação em cenários da atenção primária: espaço para aprendizagem interprofissional. Trab Educ Saude. 2020; 18(2):e0026798.. Such results reveal the power of IPE initiatives that approach the role of different health professions, since the beginning of the undergraduate course, to reflect on and provide comprehensive care, and to reduce stereotyped views among health professions⁷7. Reeves S, Fletcher S, Barr H, Birch I, Boet S, Davies N, et al. A BEME systematic review of the effects of interprofessional education: BEME Guide no. 39. Med Teach. 2016; 38(7):656-68.,⁸8. Toassi RFC, Olsson TO, Lewgoy AMB, Bueno D, Peduzzi M. Ensino da graduação em cenários da atenção primária: espaço para aprendizagem interprofissional. Trab Educ Saude. 2020; 18(2):e0026798.,³⁵35. Toassi RFC, Meireles E, Peduzzi M. Interprofessional practices and readiness for interprofessional learning among health students and graduates in Rio Grande do Sul, Brazil: a cross-sectional study. J Interprof Care. 2021; 35(3):391-9..

Synchronous ERT moments preserved the possibility of learning through interaction and stimulated collaborative practices between professions, centered on patients-users-families³⁶36. Ateah CA, Snow W, Wener P, MacDonald L, Metge C, Davis P, et al. Stereotyping as a barrier to collaboration: does interprofessional education make a difference? Nurse Educ Today. 2011; 31(2):208-13.,³⁷37. White S, Lambert S, Visker J, Banez JC, Lasser B, Cichon T, et al. Public health education student stereotypes of other health professions before and after an interprofessional education program. Health Prof Educ. 2019; 5(2):120-5..

However, IPE is characterized by shared and interactive learning, according to its conception and definitions⁷7. Reeves S, Fletcher S, Barr H, Birch I, Boet S, Davies N, et al. A BEME systematic review of the effects of interprofessional education: BEME Guide no. 39. Med Teach. 2016; 38(7):656-68.. In the present study, the dental students reported learning losses due to the impossibility of interactive practices involving professionals-students-teachers-users, and IPE is not an experience characterized as distance education.

The limitations of this study intertwine with the very characteristic of IPE in the curriculum of the Dentistry course. As it is an elective teaching activity, that is, not obligatory and with a restricted offer of seats to each course, the analysis of the IPE experience during ERT involved a small number of students. Although the number of participants can be interpreted as a limitation, the richness of the empirical material enabled us to understand the meaning that students attribute to this IPE experience. Limitations concerning the utilization of portfolios as instruments to assess the teaching activity were not observed. The pedagogical mediation of the teacher-tutor with the student, with feedback on the partial delivery of the portfolio, strengthened the assessment proposal and was another interaction device between teacher and student.

Final remarks

The teaching activity of undergraduate health programs with a focus on IPE, carried out in the ERT period, was marked by interaction between students, teachers, and professionals from different areas, mediated by the use of digital platforms. The activity provided learning processes related to how to work in a team, and promoted the recognition of the importance of learning with/about other professions, interprofessional communication, and care centered on patients-users-families. Inequalities in access to internet services and to adequate ERT electronic devices, personal-familial situations related to experiencing a pandemic, and difficulties in creating bonds were the reported barriers. The inclusion of themes connected with the pandemic context, like telehealth/teleservice, was a gain that can/must be added to the activity upon return to the in-person modality.

Although the results showed contributions from ERT, IPE associated with in-person activities in practice scenarios of SUS was perceived by dental students as essential to health professionals’ education. The face-to-face experience promotes contact with people-patients and interaction in healthcare spaces, and cannot be replaced by synchronous or distance education activities.

Acknowledgements

To all the teachers, students, managers, professionals and users of SUS who believe in the proposal of interprofessional education in undergraduate programs integrated with primary care territories.

References

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