Table 3 Summary descriptions of the 11 undergraduate EPAs for community medicine

EPA 1.1. First consultation to diagnose the health needs of an individual

The student, in pairs of two, performs this activity during a home visit in the territory and alternates with student partner in the roles of the executor and the observer. He or she introduces himself/herself to the person (patient), identifies the person, and documents the history of the person’s life, creating a spontaneous account guided by the classical principles of anamnesis and performing a general physical examination of the person with dexterity. Based on the information found and using clinical-epidemiological reasoning, the student develops a diagnosis of the individual’s health needs

EPA 1.2. Development and management of the Individual Therapeutic Project (ITP)

The student, in pairs of two, discusses the individual health needs diagnosis of the visited person upon his/her return to Family Health Strategy (FHS) unit. There, the two students present the case to the whole group (including the supervisor, health care team and other students), who jointly conduct a provisory ITP based on the principles of health surveillance. This ITP is discussed with the FHS team and finalized with the action plan, and tasks for follow-up are distributed. The students register the home visit and ITP plan in the patient record and with the Data Centre of the Brazilian Unified Health System (DATA-SUS).

EPA 1.3. Follow-up consultation concerning individual health needs

The student, in pairs of two, conducts home visits for follow-up consultations; this activity includes ITP implementation and discussion of the ITP with the patient and his or her family. The patient’s adherence to the ITP and the results are analysed. The student and his or her partner always collect a complementary history and re-examine the patient. They continuously monitor the ITP and are eventually accompanied by the FHS team. Because health needs are likely to change, new visits for follow-up, evaluation and reassessment of the adequacy of the proposed care plan are necessary.

EPA 1.4. Performance of procedures for individual care in health surveillance

The student conducts a defined set of general medical procedures at a primary care level upon patient request.

EPA 1.5. Management of health care support strategies

The student, in pairs of two, implements health care support strategies to provide integral, humanized care and facilitate hierarchical access.

2. Integrality of care for the health needs of the family

EPA 2.1. First consultation to diagnose family health needs

The student, in pairs of two, performs this activity during a home visit in the territory and alternates the roles of executor and observer with his or her student partner. The student is able to conduct home visits autonomously and to collect the family history and perform a general physical examination of the informant family member. He or she collects information regarding family history, interpersonal relations, educational and financial conditions, and social support networks. The student analyses the obtained information and, taking into account the evidence drawn from clinical epidemiologic data, produces a diagnosis of the family’s health needs, choosing priorities and working with the FHS team to improve dimensions of health surveillance.

EPA 2.2. Development and management of family health needs

The student, in pairs of two, performs this activity in the FHS unit. The student and his or her student partner present and discuss all family findings with the health team, make a family health needs diagnosis and, alongside the supervisor, construct a health care plan for the family that takes into account the Programmatic Actions and Care Line mandated for primary care in the municipality. The main types of care are prenatal and puerperal care; child health care until age 5; the national immunization programme; prevention of breast, uterine and prostate cancer; an anti-smoking programme; and the control of diabetes and hypertension. The family health plan is discussed, shared, assessed for adequacy and adjusted in consultation with the family members, and the student is accompanied and assessed during home visits.

EPA 2.3. Follow-up consultation on family health needs

The student, in pairs of two, performs home visits to facilitate follow-up with respect to the family health care plan. He or she performs a complementary clinical history and examination and follows the evolution of the inclusion of the family member in Programmatic Actions and the local Care Lines. The student verifies the implementation of these aspects and discusses them with the patient and his or her family. The student identifies new risky situations and family vulnerabilities. Adherence to the programme and the results are analysed. The student continuously monitors family health care needs and is eventually accompanied by the FHS team. With this interaction and community home visit practices, the student provides information to FHS, thus contributing to the accuracy of primary health care indicator identification.

3. Integrality of care for the health needs of the community

EPA 3.1. Diagnosis of health needs in the community

The student, in pairs of two, diagnoses community health needs via an interpretation of different indicators to serve as a foundation for an appropriate health care plan. Epidemiological data and clinical information related to isolated cases from the territory that forms part of the general district and community knowledge support the evidence-based diagnosis of community health needs.

EPA 3.2. Development and management of the Health Project in the Territory (HPT)

The student, in pairs of two, participates actively in community health planning. He or she discusses the diagnosis of community health needs with the team and the supervisor and subsequently participates in the planning of a broad approach that has a significant community component, which may be developed in the FHS unit or in engagement with some other social body as a Health Project in the Territory - HPT (Projeto de Saúde no Território - PST). The student promotes health education activities through the implementation of the Health in School Programme (HSP) (Programa de Saúde na Escola -PSE).

EPA 3.3. Follow-up of the Health Project in the Territory (HPT)

The student, in pairs of two, follows the implemented HPT, verifying community adherence to the community health needs care plan and analysing the results for continuous improvement and readjustment. Epidemiological data must be collected, and the HSP programme must be continued. A general overview of the territory must be maintained, and the obtained information must be entered into the DATA-SUS to store it securely.