Cidade alta, cidade baixa: as potências e os desafios da implementação de um Programa de Residência de Medicina de Família e Comunidade em Salvador

Abstract

Abstract: This essay critically examines the experience of implementing the Family and Community Medicine Residency Program of the Municipal Health Secretariat of Salvador between 2019 and 2025, analyzing its theoretical foundations, pedagogical strategies, management mechanisms, and impacts on the health network. The PRMFC-SMS-SSA is structured around a critical-reflective curricular core grounded in Paulo Freire’s emancipatory education, maintaining traditional references of the specialty, such as Person-Centered Medicine, while advancing by incorporating the transversal debates on coloniality, race, gender, and class. Its management model adopts principles of co-management and the Paideia Method, strengthened by the notion of aquilombamento as a collective strategy of care and resistance. Over the six years analyzed, the program faced structural challenges—such as an insufficient number of preceptors, precarious primary care services, and the impacts of the COVID-19 pandemic—that demanded resilience in both pedagogical and administrative organization. Among its outcomes, the program contributed to the qualification of municipal health services, as demonstrated by its role in expanding the portfolio of services; achieved national prominence in debates on curriculum, equity, and psychiatric reform; and, most importantly, trained specialists with critical depth and transformative potential regarding health care practices. The experience demonstrates the feasibility of non-outsourced municipal residency programs and reaffirms the importance of critical, territorially grounded training models committed to transforming care and confronting structural inequalities within Brazil’s Unified Health System (SUS).