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Essay on visibilities and blindness in the formative world of dentistry: part 2 - internships and online (remote) education
Essay on visibilities and blindness in the formative
world of dentistry: part 2 - internships and online
(remote) education
Cristine Maria Warmling*; Samuel Jorge Moysés**
* Doctor in Education, Coordinator of Programa de Pós-
graduação Ensino na Saúde, Faculdade de Medicina,
UFRGS
** Ph.D. in Epidemiology and Public Health, Full Professor at
PUC-PPR, Adjuncto Professor at UFPR
Received: 03/26/2021. Approved: 06/30/2021.
ABSTRACT
The essay, part 2, emphasizes the expanded use of informational technologies for virtual (remote)
teaching and the possibilities for innovations in pedagogical, technical, and political practices with
special emphasis on the praxis of curricular internships in dentistry. The focus here is on how the
pandemic scenario produced regulations by corporate bodies and in institutional spheres, for digital
management of professional and educational practices and their consequences in terms of internships
in the Unified Health System. It concludes with a critique of the ambivalent relations between the
human and the technological, in particular the concept of presence in the pandemic context, but also
inquiring about future post-pandemic horizons in the educational universe.
Descriptors: Education, Dental. Pandemics. Education, Distance. Coronavirus Infections. Syllabus.
1 INTRODUCTION caused by the pandemic opened space for the
The austerity policies and extreme search for technological solutions to allow the
commodification and privatization of higher teaching-learning continuity. At the same time,
education1, which already were in expansion, this finding allows us to experience an
advance even more by means of digital educational technological accelerationism3,4,
transformation policies and programs with which resulting in great challenges.
we live, stimulated by the closing of schools due Under the excuse of the institutional
to the need of controlling the pandemic2. responsibility for continuity of classes
The demand for the interruption of classes (emergency remote education), it also emerges
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1Essay on visibilities and blindness in the formative world of dentistry: part 2 - internships and online (remote) education
profitable plans – and, in some cases, profit- internships, developed as teaching-learning and
focused plans only – in private education care in act, if they migrate to the hybrid, partially
organizations. They attract investments with the digital format?
seal of financialization, thanks to the promises of Although it is accepted that the
educational transformation with the intensive use technological tools and virtual environments
of new technologies and contingent replacement have a great educational applicability as
of human labor for some functions and tasks. educational resources, in contexts of physical
The use of informational technologies may distance – therefore, applicable also in dentistry
not be something negative, as the technologies in its several teaching-learning activities –, these
can bring significant conveniences for the solutions have one major limitation related with
universities in terms of quality and the accessibility of many of those involved8.
differentiation. However, they are captured by The significance of science, technology,
influences from the private sector that impose and reliable scientific information, both for the
their commodification values and goals on higher academic community and the population in
education. In several educational institutions, it is general, as well as for the people served in the
evident the productive rearrangement, under an internships, becomes preponderant and involves
also neoliberal political-ideological – not only the issue of interconnectedness in present times.
technological – project bonding the Following the inquiries that are imposed, the
transformation platform of higher education question is: What type of information are we
educational infrastructures and digitization1,5. producing and conveying? What type of dental
The pandemic is a social, scientific, and education or what type of internships would be
technological challenge of such magnitude that possible in the Brazilian Unified Health System
the support to the education and health systems, (SUS) in the pandemic circumstance? What is
amongst others, becomes even more basic. Such expected for the post-pandemic?
systemic support has happened in an unequal
way, reaching in an unfair manner distinct groups 2 THE COMPLEXITY OF THE NEW
that suffer the effects of the pandemic according CHALLENGES
to their place in the society due to economic or Regarding dental education in its whole
political power, access to and capacity of and the impact of the pandemic, including in the
fulfilment of sanitary recommendations, health resolution of the internships, the questions still
conditions and labor opportunity, amongst seem to be approached in an incipient way.
others6. Following the initial news concerning the
Never ever have a responsible science and pandemic emergency that outbroke in Wuhan
a socially oriented technology been so necessary, (China), the concerns are turned predominantly
not only for our immunization and adoption of toward the production of guides and innovation
non-pharmacological measures, but also for of biosafety guidelines or methodologies making
searching solutions that include the conjuncture use of innovative informational technologies in
of educational crisis and scientific denial7 – education9-11.
affecting the internships also, given the social Beyond the interruption of the regular
contact and with the labor world made possible curricular activities, and the generic
by them. With such problematization, it emerges recommendations on the resumption of hybrid
the question of how to equate the issue of the education – partially on-site, partially remote,
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2Essay on visibilities and blindness in the formative world of dentistry: part 2 - internships and online (remote) education
with rotation of groups and reduction of human agencies published in the accountable
circulation in the teaching-learning institutional scopes an extensive set of norms
environments, everything still is quite vague in trying to guide the duties of health providers,
many institutions. Even the physical spaces still especially in the field of surveillance and
are not quite reconfigured, due to the time of biosafety. With similar intensity, concerning
construction and the financial resources available teaching, the Ministry of Education produced
for investment. It is a time interpreted as of regulations in face of the requirements for
threats and negative effects for the dental distance education. The education institutions
education, severely affecting the students12,13. A became accountable for managing the processes
study published amidst the pandemic describes in their technical, pedagogical, and political
the initiatives and concerns of over two hundred scopes and contexts. The proposals of internships
professors from the whole world regarding the and practices in a non-on-site way were
possible answers to be found for the provision of established as likely to be organized by the
clinical courses, virtual curricula, or simulation education institutions, however respecting the
laboratories in remote learning mode14. The organization recommended by the National
innovation demanded for the renovation of the Curricular Guidelines (Diretrizes Curriculares
dental education model, in view of the Covid-19 Nacionais – DCN) established in the different
pandemic, is centered on virtual technologies courses17:
applied to future dental education10. “§ 3º Regarding the professional
The issue of distance education/labor, or its practices of internships or those
virtual correlates during the pandemic, expands requiring specialized laboratories, the
the concerns of the Federal Dental Board replacement addressed in this caput must
[Conselho Federal de Odontologia – CFO] when obey to the National Curricular
regulating a range of other current topics that Guidelines approved by the National
involve the dental subsystem in Brazil (for Council of Education”.
example, the possible use of digitized images in The Brazilian Dental Education
social networks). Also, before the pandemic, the Association (Abeno) took a position, interpreting
agency had already issued a specific resolution that, according to the DCN, the dental education
forbidding the application and registration of must be restricted to the accomplishment of
students who had graduated in courses fully practical activities and on-site internships by
provided by distance education, known as EAD digital means18. Later, by means of a specific law
[distance education]15. The imbroglio expands and in face of the extension of the public calamity
when a new resolution is issued16, considering state by the Covid-19 pandemic, it legislated on
the principle of legitimacy and prohibition for the reduction of the number of school days. This
appointments by correspondence, radio, tv or made it possible for the health field courses to
similar means [sic], calling the attention of those bring forward their conclusion with 75% of the
concerned, as this is based on quite an old, pre- workload of the mandatory curricular
internet legislation (article 7 of Law N. 5081/66), internships19.
when tele-dentistry, tele-appointment, tele- In its rhythm, the pandemic imposes open-
advice, and tele-education, among other and-close movements, not only in the Covid-19
available now, had not been even conceived. surveillance and control system, but also in the
During the pandemic, the corporative legal requirements and establishments, setting
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3Essay on visibilities and blindness in the formative world of dentistry: part 2 - internships and online (remote) education
the intermittent shutdown of on-site teaching of internships, claiming that they are permeated
activities in the universities. Yet, a strategy is by simulated and actual activities by means of
promulgated calling the health students to act in ICT, and that this context already is a reality.
the front line of the pandemic, through However, the CNS reiterates that the use of
mandatory curricular internships in primary care virtual technologies must be incorporated as a
services, intermediate care services, hospital pedagogical device to assist in the education
networks and in the very communities enclosed process, not to replace the on-site teaching, but
by the public service networks – the Brazil rather to strengthen and qualify it, both in
counts on me, a strategical action of the Ministry unusual situations like the COVID-19 pandemic,
of Health20. Also, some state health departments and to consolidate its use in the future in a
called oral health teams to the front line of coherent way with quality training.
immunization itself, with the participation of The senses and emergencies of the thinking
health students, especially medicine, in some on the learning decurrent of internships in SUS
localities. are others. There are pungent lessons being
Thus, it seems contradictory to understand learned in times of much pain and rupture of
why dental students, future health professionals, social bonds. For example, the importance of the
cannot be exposed to practical activities allowed confrontation with the existential truth, the
to health providers, provided they fulfill a consideration of the vulnerability of the human
rigorous biosafety protocol. Therefore, we condition, the importance of solidarity with the
should ask how the governance and management other23. The association of technology with
systems of education and health integrated education needs to be seen with care, sensitivity,
networks have acted for the functioning of ethical grounds, and epistemological
internships in SUS during the pandemic21. surveillance (of the scientific foundations),
The recommendation from the National because while it provides training in digital
Health Council (Conselho Nacional de Saúde – means, it can also reduce the role of interpersonal
CNS) is highlighted. Following several relations in the teaching-learning process – this is
considerations, it addresses the Ministry of when the pedagogical mediation with the use of
Education requesting technical opinions from the the word is intermediated by screens24,25.
CNS itself and the mentioned Ministry22. In these
technical opinions it is considered the norms 3 ARE THERE ALTERNATIVES?
issued on internships and insertion of students PHYSICAL PRESENCE OR DIGITAL
and professors in the health services. For HOLOGRAM (META PRESENCE) IN
instance, the substitution of on-site classes by INTERNSHIPS
digital ones while the pandemic situation lasts, Quarantine. Distancing. Reclusion.
with the prerogatives of provision of courses, in Lockdown. Discontinuation of regular activities.
an exceptional character, using information and These are all are words quite used in 2020 and
communication technologies (ICT), but vetoing still repeated in 2021. People feel the fatigue
the substitution of professional practices in produced by the omnipresence of the pandemic,
internships and laboratory by the remote way. accentuated in Brazil by the current picture of
This collided with other guidance by the Ministry social-political forces that bear upon us. All of us
of Education, which emphasizes the feel a certain hangover from the current way how
development of professional practices by means life walks… That is, activities mediated by
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4Essay on visibilities and blindness in the formative world of dentistry: part 2 - internships and online (remote) education
digital technology. experience in primary care services, occasionally
There is a meme (from the Greek mimema, following a community health worker, in home
a unit of cultural information spread by imitation) interviews or program actions next to the team,
26
circulating on the Internet saying that when providing care to a bed-ridden patient or
everything that we do not want now is a second applying an analytical device to a family core in
wave of lives, but we already are immersed in this conflict, or yet, in the powerful beauty of a young
second wave, perhaps a third one. Certainly, mother walking an economic fine line to take
other torrents of webinars, tele-classes, and so- care of the offspring and participate in the Freire
called remote activities will come. It would be circle of culture, we all learn… with odors,
pertinent to ask whether this exhaustion results colors, lights, environments, landscapes, human
from the degree of confounding amidst the concreteness29.
physical isolation caused by the pandemic (at The immersion in this real changes the
least for us, who have the means to protect previous (quite often prejudicial) understanding
ourselves) or from our daily immersion in the of many of us, with the experience of the
digital devices? We have compacted time-space different contexts in which life unfolds,
in a quantic operation… And do we suffer with becoming learning scenarios with a great
the social pandemonium that affects us and the andragogic power. This is how – not by miracle,
political pandementia that depletes us27? but by gift –, the learning to know, to do, to live
In fact, there is no equivalent alternative to with the others, culminating with the learning to
teaching-learning practices like those we be, happens30. Not by chance, we always call
advocate for, that is, live education-labor, them live classes, when there is no mediated
learning in act. However, would it be possible to human interaction – except by our own senses,
create any minimally acceptable (and our innate equipment –, assigning to this
operational) alternative in the sense of experimentness the additional attribution of
competences certification? It is necessary to open learning together with sociability.
the debate to the new roles played by What to do with activities that, at the first
technologies in the mediation of many social, sight, seem hopelessly demanding concerning
professional, educational functions. One visible the presenciality (and, indeed, are demanding),
aspect is that micropower is not concentrated by demarcating the teaching-learning process? In
the professor as the exclusive holder of the the universe of health undergraduate courses, for
knowledge that will be conveyed anymore. From example, there was an exponential rise in recent
trustees of knowledge, we became mediators of publications addressing virtual education in
vast knowledge kept in simultaneously basic, clinical, surgical, and internships areas, in
reachable, globally supplied, and brought up to practically all medical (sub)specialties2,31-42.
date electronic repositories. There was even reference to the corpse virtuality
The early innovators leave ahead of the late in experiences with anatomy classes43.
ones, although assuming unknown risks. We are A few experiences, still incipient and not
holistic beings, we have physical, psychological, published, begin to be outlined in the Brazilian
social reactions, all integrated, that form our dentistry regarding exercises with online
cognitive, emotional, or motor learning – or what internships scenarios – so that we do not give up
already has been called as diverse types of of them in pandemic times. For instance:
intelligence28. In this way, in a territorial (i) Thorough geospatial scanning,
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5Essay on visibilities and blindness in the formative world of dentistry: part 2 - internships and online (remote) education
provided by digital technologies – thematic maps social presence, self-presence, copresence,
of urban neighborhoods that can be navigated mediated presence or virtual presence46,47 – and
(and explored) with the precision supplied by such polyphony/polysemy is due to the
satellite images: thus, territorialization is interdisciplinarity of the new field.
experienced in computer screens with On the other hand, we know well what the
visualization of neighborhoods, areas, micro organic sensation of presence is in its
areas, and homes. corporeality48. Presence can be the being there:
(ii) Intensive use of information immersion in the actual, on-site world, but also
systems, either from official agencies (Brazilian in movies and inspiring art in general,
Institute of Geography and Statistics – IBGE; entertainment, games, or memorial daydreams
SUS Department of Informatics – Datasus; City and recollection of trips, loves, adventures,
and State Departments) or by means of secondary anyway, the immaterial thought that makes one
data bases or online research: hence the use of to fly… And even more, the social presence
available (or constructed) indexes and indicators which is the being together in real time: it can be
for sociodemographic, epidemiological, and by phone, letters (increasingly rare), e-mails,
clinical characterization of populations chats, social networks. Or, more usual now, the
circumscribed to the operative areas of the copresence, being together in a shared
primary care services where the internships environment: face-to-face connection in a digital
happen. environment, by streaming, videoconference,
(iii) Interviews or webinars with videocalls – even because we, professors, are
managers and health teams: therefore, the becoming full time streamers.
possibility of understanding roles, attributions, Presence has already been described as the
sanitary responsibilities of the distinct health (illusory) perception of what would not be
providers working in practice/learning scenarios. mediated49. This exercise of capturing the world
(iv) Project-based education (PjBL) or (the exterior one, outside the mind) and
resolution of situation-problem, with actual internalizing it through the senses is called
family cases that many professors have in their sensorial perception, bringing the following
files of lessons/internships; discussion of order of problems: I) which neurophysiological
proposals for family approach, use of systems and processes are in the origin of the
genogram/family genogram, cycle of life, online capacity of perceiving? II) how was this
family interview under strict (bio)ethical naturally adapted until reaching the Homo
principles, amongst others, and resolution of sapiens? III) which mental processes are in the
actual cases. origin and which outcomes seem to result from
them? As explaining the physiological
4 THE CONCEPT OF PRESENCE mechanism in the origin of a certain perception
To deepen the educational potential of such is one thing, another one, quite different, is to
options, in the future it will be necessary to explain which mental state is this, its
deepen the concept of presence44,45. Despite the phenomenological content, the experience that
interest of the researchers for research on stems from this content and, also, how this
presence, there is not any well-defined and experience can be founding of knowledge – or, in
widely accept concept on what presence is yet. the present case, of teaching-learning50. Also,
There is a range of denominations – telepresence, there is presence perceived as a state of
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6Essay on visibilities and blindness in the formative world of dentistry: part 2 - internships and online (remote) education
conscience: the sensation of some external interactions are mediated. For example, we only
stimulus, of some environment, in relation to see because we have light as a means, we only
which we experience a sense of absorption, a hear because we have air as a means44.
natural and whole interaction51. Therefore, we create and act on/with the
Presence can be also thought as a technology, but we shall not forget that it, the
psychological state in which virtual, almost technology, retroacts on us. Therefore, the
authentic or authentic objects are felt like actual concept of trans humanity has already been
objects in a sensorial or not sensorial way52. discussed54. The speed of presence of the
Additionally, nowadays one fears the increased technique in our life exceeded the scale of
reality; dimensions of space (length, width, Anthropos, that is, there is an anthropological
height, depth) and time in gradual compacting. turn produced by the technique for which our
Quantic effects in a semantics web that does not evolutive equipment is not fully prepared. Our
alternatively process codes configured like 0 and emotional-cultural (reflexive) time is slow in
1 anymore, but rather simultaneously, what can front of the algorithms and artificial intelligence.
generate a scale of extra-human informational Still, would we be creating a misconception
processing! when separating virtual and real world in our
With this brief theoretical incursion on the present and immediate future? Would or would
concept of presence, it is not, therefore, curious not, now/already, our information (or digital
that our students, in on-site lessons, had the old footprints) be an integral part of our hybrid
habit of answering to the roll call saying present! identities?
Well, actually, increasingly less…, and in fact On the other hand, our trend, especially for
this does not use to represent, in recent times, those who migrate from analogic to digital, is to
much in terms of effective social presence, since believe, due to the immateriality of these
invariably many are connected with their call interactions among faceless – or with a face, but
phone53. It can be physical presence only, mediatized by technology – individuals in the
without any human interaction. There are indeterminate cyberspace55, now better
56
debates, also, on the absent-present and the designated as infosphere , (pairing with
present-absent24,25 – and this warning is also valid biosphere), experiencing not only the online, but
for professors who, even when supposedly rather more intensely the onlife – that it is
present in on-site activities, do not produce the advocated that it does not make sense anymore to
necessary cognitive-affective interchange with speak on online and offline, as our life is
their groups of students. connected the whole time57. What is the
Thus, the means can successfully provide perception of the real for a child who, in the first
to the users the sensation of proximity and year of life, touches the screen of the cell phone
privacy that usually would be felt only with (touch screen)?
physical presence. In any way, let’s not fool As Umberto Galimberti warns58, we
ourselves… Almost everything that we feel and continue to think the technique as an instrument
perceive in the so-called actual world is captured at our disposal, when it became the environment
by the human sensorial system, formed by that surrounds and constitutes us according to the
senses: sight, smell, taste, hearing and touch, rules of rationality that, mixing the criteria of
which provide us information from the world functionality and efficiency, do not hesitate in
through the environment. Therefore, even natural subordinating the requirements of the man to the
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7Essay on visibilities and blindness in the formative world of dentistry: part 2 - internships and online (remote) education
requirements of the technical apparatus. managers quickly perceived the profits of
Without knowing, we still move with the scalability, connectiveness, and economy of
typical characteristics of the pre-technological means in the digital situation propitiated by the
human, who acted in sight of a horizon sense, pandemic: the question will be to decide in the
with a set of ideas and feelings in which they future on the complementariness or substitution
recognized themselves. But the technique does of traditional forms of education.
not tend to a goal, it does not promote a sense, it h) The students, already in this
does not open the scenario of salvation, it does generation but increasingly in a greater number
not redeem, it does not disclose the truth: the in the future, will be connected – not migrants,
technique only functions or, is created to but vitally familiarized with the digital and
function. And its functioning becomes gamified world.
planetary58. What comes next, in a close horizon? The
new powers concentrated through the so-called
5 FINAL REMARKS 4.0 technological revolution, with I 5G internet
The questions of our (pandemic and post- and surrogates, the dissemination of the society
pandemic) time are many, still without clear of platforms. Then, the new generations, perhaps,
answers. For sure, we already know that: may again experience the unique experience of
a) Local and transnational distances on-site/virtual internships in SUS, having the
were breached, existing a type of time/space possibility of constructing a new world – yes, the
compacting. doors of the future are open, and it is possible!
b) We can carry through the
planetary distribution of our presence, almost as RESUMO
we had the gift of ubiquity. Ensaio sobre visibilidades e cegueiras no
c) We witness the algorithmizing of mundo formativo da Odontologia: parte 2 -
os estágios e o ensino on-line (remoto)
education with artificial intelligence. We
O ensaio, parte 2, enfatiza o uso ampliado de
recognize that we may be replicating the teaching tecnologias informacionais de ensino virtual (ou
mediation deficit in the cognitive and affective remoto) e as possibilidades de inovações nas
plan, as well as in digital education – that is, práticas pedagógicas, técnicas e políticas com
problems known in on-site education. especial destaque para a práxis dos estágios
d) The power hold by the professor curriculares em Odontologia. O foco aqui
and demonstrated in the master class of the past, debruça-se sobre como no cenário pandêmico
produziram-se, pelos órgãos corporativos e nos
based on the rhetoric of the holding of sources of
âmbitos institucionais, normativas de gestão
knowledge, is practically over, demanding now digital das práticas profissionais e educacionais e
mediation, collaboration, production of seus reflexos em se tratando de estágios no
motivation, engagement, inclusion, and student Sistema Único de Saúde. Conclui com a crítica
enchantment. sobre as relações ambivalentes entre o humano e
e) The storage, access, and recovery o tecnológico, em particular sobre o conceito de
of information are practically inexhaustible, not presença no contexto pandêmico, mas indagando
também sobre horizontes futuros pós-
being seen a limit for its online availability.
pandêmicos no universo educacional.
f) Apparently, professors will be a Descritores: Educação em Odontologia.
mid-term between teacher and streamer. Pandemias. Educação a Distância. Infecções por
g) The university executives and Coronavírus. Currículo.
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8Essay on visibilities and blindness in the formative world of dentistry: part 2 - internships and online (remote) education
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