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Revista Cubana de Educación Superior

versión On-line ISSN 0257-4314

Rev. Cubana Edu. Superior vol.40  supl.1 La Habana  2021  Epub 01-Nov-2021

 

Artículo original

Medical students and family relationships: tensions between expectations and performance

Estudiantes de medicina y relaciones familiares: tensiones entre las expectativas y la realidad

0000-0003-3831-7399Luciana Rios da Silva1  *  , 0000-0002-3048-6609Elaine Pedreira Rabinovich1  , 0000-0001-9943-2118Ivonete Barreto de Amorim2 

1Catholic University of Salvador, UCSAL, Salvador, Bahia, Brasil.

2State University of Bahia, UNEB, Brasil.

ABSTRACT

This article aims to present the voices of students of an undergraduate medical course about the role of families in their lives and how they perceive themselves to belong to this social group in view of the expectations of the training process and professional future. It also reveals, from the perspective of the undergraduate students, the impacts and influences of the relationships established with family agents, especially parents, based on the choice of a medical career. This is the result of a qualitative research, a case study type and the semi-structured interview was used as the collection technique. Five research collaborators, aged between 18 and 30 years old, participated in the study, and were given fictitious names of precious stones. For the construction of the theoretical basis were used the writings of Petrini (2009); Roudinesco (2002); Bourdieu, (1993); Singly (2010); Silva, Rabinovich and Amorim (2019); Rabinovich, Franco and Moreira (2012); Zittoun (2012); Berger and Luckmann (2004) and Han (2017). The results show that, while they feel pressured internally by family expectations, it is there that students find the support to overcome the challenges pertinent to the academic journey.

Key words: medical student; expectations; family; voices

RESUMEN

Este artículo tiene como objetivo dar a conocer los criterios de los estudiantes de una carrera de medicina de grado sobre el papel de las familias en sus vida y cómo se perciben a sí mismos como pertenecientes a este grupo social ante las expectativas del proceso de formación y de futuro profesional. También revela, desde la perspectiva de los estudiantes de pregrado, los impactos e influencias de las relaciones que se establecen con los agentes familiares, especialmente los padres, en función de la elección de la carrera médica. Este es el resultado de una investigación cualitativa, tipo estudio de caso, y se utilizó la entrevista semiestructurada como técnica de recolección. En el estudio participaron cinco colaboradores de la investigación, con edades comprendidas entre los 18 y los 30 años, a quienes se les dio nombres ficticios de piedras preciosas. Para la construcción de la base teórica se utilizaron los escritos de Petrini (2009); Roudinesco (2002); Bourdieu, (1993); Singly (2010); Silva (2019); Rabinovich (2019); Amorim (2019); Rabinovich, Franco y Moreira (2012); Zittoun (2012); Berger y Luckmann (2004) y Han (2017). Los resultados muestran que, si bien se sienten presionados internamente por las expectativas familiares, es allí donde los estudiantes encuentran el apoyo para superar los desafíos pertinentes al recorrido académico.

Palabras-clave: estudiante de medicina; expectativas; familia; voces

INTRODUCTION

The world is constantly in motion and evolution. Today, the contemporary «subject» is who seeks to be away from the subjugation. There is a new way of thinking, judging, relating, getting married or not, living the family, nature, culture and history. However, the contemporary subject is less capable of making affective movements. Each one lives in an individualistic way and remains in a relationship only as long as capable to extract something interesting personally. Therefore, subjectivity displays a new configuration.

The existence known as being-with-others is fraying. There is a decline in bonding that affects humanity deeply. People are investing in creating connections because they are easier to break. An unstable individual appeared, with volatile convictions and shallow commitments (Petrini, 2009), hence, it can be said that we live in a disposable society, in which exchanges are made due to a kind of saturation and the constant search for the new, causing in gradual loss of creative capacity.

Accordingly, the good management of our affective complex (emotions, feelings, passions) is a challenge, in view of excessive personal freedom. Feeling belonging to a certain order, a family, for instance, helps people to contain their impulses in view of the symbolic power that that order establishes. It consists in reinforcing the Freudian idea that the sublimation of instinct is the condition of civilization. Regarding the word «family», it should be noted that, in contemporary times, this concept can take many forms. From a social point of view, it is characterized by cooperation between the sexes and between generations and by relationships of full reciprocity (Roudinesco, 2002). Therefore, family relationships might be represented by gratuitous and unconditional reception, since only in the family is the person welcomed in its entirety and not just in part as in all other social relationships (Petrini, 2009).

From Levi-Strauss (Roudinesco, 2002), the family could be considered as a form of social organization more persistent even taking into account historical and cultural differences. The family as a mediator institution collaborates directly to establish a society once acts in the construction of personal and social identity of the subjects. Based on the understanding that the family is both immanent to individuals (as incorporated collective) and transcendent to them (Bourdieu, 1993), in order to affirm its existence, functions as a field with its relations of physical force, economic and, above all, symbolic, which might be conceived both as an objective and subjective social category, by instituting signs and symbologies that contribute to the reproduction of symbolic power (Silva, Rabinovich y Amorim, 2019).

Hence, it is common for the family to exert a powerful influence on the professional choices of their young people, as well as to set expectations on them that are anchored in a prosperous future in relation to financial and social recognition aspects, which in the family imagination can be translated through the choice to «be a doctor». Thus, the aim of the study presented here is established to display the voices of students from an undergraduate degree in medicine about the role of family in their lives and such as the awareness of belonging to this social group on the expectations of the educational and professional future process, also revealing the impacts and influences of the relationships established with family agents, especially parents, based on the choice of a medical career.

This article is the partial result of a broader research, and through the qualitative approach, developing a case study that uses semi-structured interviews as a collection technique. The study included 05 medical students, aged between 18 and 30 years, who were given fictitious names of Brazilian gemstones. The research locus was the State University of Feira de Santana (Bahia, Brazil), free public institution maintained by the state government under the autarchy regime, which began operations on May 31st, 1976.

For the construction of the theoretical basis, the writings of Petrini (2009) were used; also Roudinesco (2002); Bourdieu, (1993); Singly (2010); Silva, Rabinovich and Amorim (2019); Zittoun (2012); Berger and Luckmann (2004), Han (2017).

FAMILY AS A CONCRETE CATEGORY

Contemporary society demands an educational process that moves in favour of social, political, civil, economic and cultural rights, in order to build a less unfair society with socially equal expansion of opportunities. An educational process which meets the development of a culture in human rights, considering the role in the constitution of social subjects.

In the late nineteenth century during the modern area, the family institution began to take on another structure in the system of relations, no longer just an economic unit and going into value interpersonal relationships. In order to better delineate the household behaviour towards social procedures, Singly (2010) shows, in the period as modernity, demarcations that signal what would be, for him, the modern family 1 and the modern family 2. According to the author, urbanization and industrialization contribute to creating the modern family 1, on the other hand, the wage society, the welfare state and the power of education support the transition to modern family 2. This passage is mainly characterized by the emancipation of women, the extent to society educational capital and the market logic, proposing goods increasingly individualized.

Meanwhile, it is also important to note that the history of modern family is directly related to the history of education, and that «the economic capital gave way to school capital as an element that makes it possible, even in terms of legitimacy, the family's position in the social hierarchy» (Singly, 2010, pp. 96-97). By 1960, the families concerns became not just on leaving possessions to their heirs, but in offering the best conditions to obtain diplomas, for ever be this in the current understanding at the time, the greater chance of social mobility or maintenance of family conditions.

Although they have different characteristics relevant to the historical period in which they are located, the traditional family and modern family retain the function of contributing to the biological and social reproduction, trying to maintain or improve family position within the society. While the traditional family prioritized material goods, the greatest wealth for the modern family constituted the educational capital.

From Singly perspective (2010), it is interesting to note that the reproduction from the school component limits the family acting with their heirs, given the fact that this has good education, for example, does not ensure children's academic success, once the institution that guarantees certifications and diplomas. This form of transmission is different from the economic heritage and material goods, which can be passed across generations.

On the other hand, Bourdieu (1993) considers that the school system «is one of the most effective factors of social conservation, once provides the appearance of legitimacy to social inequalities, and sanctions the cultural heritage and the treaty social gift as a natural gift» (p. 45). In the view of researchers in vogue, this access is directly related to the social origin of individuals. This idea is justified by the following assumption: the education system an important role in the reproduction of the cultural relationship of domination and entry opportunities in higher education are directly associated with social belonging of individuals.

Assuming that to Singly (2010), education is in a strong element of social change, improvement in quality of life and expanding opportunities, and that for Bourdieu (1993), the educational process - while social reproduction mechanism - might be assumed as exclusionary, thereby, it is up to us to reflect on the democratization of admission to higher education as a promotion of inclusion and equal rights today, seeking to correct historical injustices in the educational context.

In the desire of families to provide development through educational capital is embedded the demand for the purchase of other goods not measurable and can be portrayed by Bourdieu's theory, through the cultural capital concepts, social capital and symbolic capital. The cultural capital corresponding to the set of intellectual skills produced and transmitted by the family and the schools. Social capital can be understood as the established relationships, the network of contacts that you create lifelong. The symbolic capital settles in prestige, honour, in the rituals of social recognition and can be considered a synthesis of other - cultural, economic and social.

The acquisition of this set of capital can be quite representative for the enjoyment of a range of rewards and benefits of individuals in society, including social mobility through the rise of the subjects. There is a consensus among families about the hope that education can account for what one does not have to be inherited, as well as providing social inclusion and promote the acquisition of resources that the family could not offer.

HOLDING THE WORD: MEDICINE STUDENTS

Regarding the specific context of this study, noteworthy becoming a doctor is a desire shared by students and their families. Since the choice of the course, the research collaborators generally reported receiving support family and encouragement. Only one of these collaborators joined in medical schools in order to maintain the social position and the prestige inherent in the medical profession as one of the parents already exercising this activity. The other sought to rise in the social hierarchy by having family support.

Regarding to the representativeness of being a medical student at UEFS, Ametista reveals that the pattern of change in life, especially for being one of the few members of his family to enter higher education, adds considerable social weight.

Being a medical student at UEFS is an experience that, for me, for a long time, represented ... I think that first a change in the standard of living, because of my family. I was one of the first to enter the University ..., of my mother's family I was the third, and of my father's family I was the first. So, I think that this ends up having a social and family weight for me, and, above all, for being in medical school, which was something that my family also longed for, my mother's family [...].

The student reports the desire and the satisfaction of the family by her mother, to see her enter the medical school, which was something that both craved. All over history, the family function has undergone changes that affect their working dynamics and reflect the structural changes in society in various historical moments. Noteworthily, even though undergoes considerable political, economic, social and cultural influences that cause changes in the roles and relationships, the family has a great ability to adjust to the new demands of the environment.

In historical perspective, Roudinesco (2002) highlights three major stages of evolution of the family: traditional, modern and contemporary or postmodern. The traditional family was characterized by the fact that individuals were at the service of the group. This profile was distinguished by the transmission of patrimony, by the arrangement of marriages (for people at a very young age) and by the immutable order submissive to a patriarchal authority exercised by men over women and children (Silva, Rabinovich and Amorim, 2019).

Along to the advent of the modern bourgeois family, concern is based on offering school capital and the best conditions for obtaining degrees as a way to achieve maintenance of family conditions or rise, in case the family is in a condition of low social recognition. «The conversion of family capital allowed the conservation of the family's mobilization around the production and reproduction of this new heritage» (Singly, 2010, p. 21). Therefore, the efforts of families are common to be witnessed; in to order to provide success at school to their children, as can be seen in the context presented by the students participating in the research.

My family provides me a lot of support, including for instance financial support by my mom. Additionally, structural support is furnished to me, once I have no expenses in the house; I need no washing and no cooking. (Turmalina) [...] I live alone with my parents ... they set me free of housekeeping, allowing full dedication time to study ... I am only responsible to set my room, my clothes, etc. Thus, they help me properly. They also supported me when I decided to leave the other course ... they said they would not oppose, that would help me instead [...] My father also whenever I need him to take me somewhere, he stays waiting, sometimes two hours waiting moving to one place to another without complaint. (Água Marinha)

Turmalina e Água Marinha reference to family support received to obtain success in studies that will enable them to medical training. Point out in their speeches support the objectives and resources that require financial investment, without which it would not be possible to remain in the course. Importantly, the family is an institution where the accumulation and transmission of capital under different species happens the most. Therefore, remaining together not only by the affinity of habitus, but also by common interests, both the capital and to the capital, not only economic but also symbolic (Bourdieu, 1993) and, above all, social (Silva, Rabinovich and Amorim, 2019).

Returning to the historical setting for the periods of evolution of the family, outlined by Roudinesco (2002), who highlighted that since the eighteenth century, the Western family is no longer founded on divine sovereignty father and bends to the emergence of the female. It was then from the bourgeoisie, the family turned into a biological cell and attributed maternity a centred stage (Roudinesco, 2002). Hence, a closer relationship with the mother went portrayed in the speech of four of the five students of this research. Aside from Água Marinha, all reported closer and complicity in the relationship established with the mother at the expense of paternal ties:

[...] when I decided to study medicine, I talked to my mother, she understood, and she supported me ... I was working and then left the job I had, which did not provided me much and did not make much difference. However, after had left the work, she was helping me financially and ... giving all the support for me to study, and do the cram school, and try. (Turmalina)

Oh, my mom and my godmother are two key people for me ... especially regarding the support because there are days that we think it will not be able to handle… So, they were ones, who helped me a lot in every way. ... (Rubelita)

Anyway, I even arrive and I turn to my mother, I manage to divert a little, eating out, going to a party ... I always seek for things that make me look good emotionally so I can continue on the course, you know? (Citrino)

[...] I talk a lot about the course with my mother ... once she's healthcare and works as a social worker in the Hospital… We share a lot about this issue of how we experience the suffering of others. So, this is also a positive thing for me [...]. (Ametista)

Turmalina and Rubelita exalt the maternal role regarding the support to remain on course. Refer here to the emotional support provided to host fatigue and a feeling of weakness in the face of hard formation process. Citrino also reports that refers to the mother, among other activities, in order to feel good emotionally and to continue on the course as well. On the other hand, Ametista shares specific issues of performance in the health field, given that her mother works in a hospital, thus demonstrating a relationship of empathy and complicity.

One of the elements that contributed to the decline of parental power comes from the logic of society itself, where the modern bourgeoisie had settled. The demand of the labor market has enabled the expansion of the presence of women also in the professional field, thus eliminating part of women's economic dependence, and decreasing the power of men in patriarchal marriage. Moreover, also the increase of households headed by women, where most of them are single parents. According to Roudinesco (2002), paternity also suffers many fragmentations, giving rise to a new father figure. Rubelita and Ametista report marks of the relationship with the father, highlighting the absence of the father throughout their lives, however, both signal that entering the medical course constitutes an element of influence in the paternal relationship.

My father does not help me at all. Although he says he feels very proud about me, he does not help me in anything. (Rubelita)

My father was always a person short of my life actually, so my process of rapprochement with him came after the passage of the entrance exam. (Ametista)

Rubelita verbalize that despite not work objectively and subjectively with her stay in the course, the father says he feels proud of his performance. On the other hand, Ametista explains that despite the low participation of her father throughout his life, the fact that she was passed the entrance exam for medicine enabled the approximation process. Inspired by Mafesoli, Rabinovich (2017) points out that we are leaving the homogeneity and rationality of modern society, guided by ideas of stability, to embrace the emotional heterogeneity of postmodernity. It is a design related to the decline of the patriarchal model over the emancipation of subjectivity. This fact can be observed when students are positioned in front of family support, valuing aspects intertwined with the feeling of welcoming their pain or weaknesses, which most often is the role played by the mother.

Thus, the subjectivity of the subject might be understood as being constantly carved from the established relationships, being a precondition for the production of the psychological «I». It is a primary property that can be transformed as we gain social experiences that constitute us as a person, thus creating a unique position in the world with scope for continuous reinvention (Zittoun, 2012). The choices we make can be understood as expressions of our subjectivity: they require externalization in a specific configuration in the time and space of our personal positioning.

Therefore, the emerging subjectivity is the only ways to handle every situation (Zittoun, 2012). Each memory is processed according to the cultural life of the individual, considering the present and your compass for the future. The design of the ties we have with those who are around us is reflected in the way these influence our way of acting on the everyday and the phenomena present in it. Thereby, the coming support networks of family relationships appear to be critical to the successful adaptation of students to the university and from this conflict, as can be seen in the report below;

Emotional support, because this final part of the course is very exhausting ... you sleep very little, and when you sleep little, your emotional liability is very large. Sometimes we do not eat well, and when together with other contexts like, colleague, teacher [...] So this emotional part has been very heavy at the end, and my parents have been very present with me because of that. (Água Marinha)

Água Marinha is the only of the students referred to parents without distinguishing the roles of father and mother, showing balance of influence and participation of both. In a comprehensive way, we relate things or similar events or not, at different times, from the traces they left in our bodies and minds. The marks left in each of us have different ways because we are unique. Brothers who live or have lived in the same family background hold different brands of the same experiences, confirming the idea that people will never have the same experience twice, neither the same memory, knowledge or hope. Each event is unique and can reverberate more or less time in the course of our lives.

My father and mother are separated ... I ended up living with my father. Moreover, my father is a very aggressive person, a person of hard living. Then, my first year of college, was marked by very personal problems related to live with him... My performance improved in college ten times after I left his house. I went back to live with my mother, I ended up settling with my stepfather and now I live with my mother. (Rubelita)

The speech of the student portrays the conflicts in the relationship established with her father and the consequences of this link on your academic performance. Her report legitimizes the idea that, in Piaget's perspective, the role of affection is functional for intelligence, since it is a source of energy for the full development of cognitive (Piaget, 1986), thus the fact of experiencing «personal problems» may have caused the low academic performance, to which it refers. That also reveals that marks originating from established relationships and links can reflect objectively and subjectively throughout our life path.

This combination of factors probably reflects on health, it affects the quality of life and more risky for causing stress and even depression situation (Zonta, Robles and Grosseman, 2006). Regarding this, Ametista presented the following situation:

[...] the family situation turned out to be the trigger for a problem I had in college. However, my family has always supported me in general, yes. Especially when they realized that actually the situation had worsened [...] I came to my mother and said, "Look, you know what happened? Just had a module test, the teacher came to deliver the notes. He had the insanity to deliver the notes from best to worst. And guess who the worst was? It was mine”. And she was like "I do not believe," I said, "Oh, so you can see how I'm wrong, I'm in need of medicine." (Ametista)

Ametista refers to a situation experienced in that conflictive issues that occurred in the family reverberated on their academic performance, affecting your emotional health as well. Hence, she addressed again the support received from family, especially the attention of his mother, who facing the manifested emotional fragility, led the student in search of help, as shown in the reproduction of maternal speech «[...] so let's , let's get help, whatever you need to do, let's do it!». (Ametista)

Therefore, the family acted as a solidarity network and kinship was valued as a protective factor (Petrini, 2009). The significance of family relationships and belonging bonds was also emphasized as elements for coping with adverse situations. In this sense, maintain strong relationships either with the family or with peers, seeking support and sharing feelings, is a strategy that provides comfort and eases the tension condition of the students, who generally feel pressured by family wishes.

an aunt from My Father ... has never been a very close person to me, although sometimes we live in a few moments as a family party and all, but I've never been close to her, and she «oh ... you are always welcome here in our home, in our celebrations »and I ...« all right »... would not do much trials (Ametista).

The student points out that, once again, the course proved to her as aggregator element, which enabled an approach in this case involuntary on her part towards his family members. However, in their perception, the way Aunt addressed it may be representative of the expectations she have about the medical training. It is worth remembering that in the paternal family, to which this aunt belongs, there is no tradition of entering studies in higher education, a fact that attributes even more weight to the title won by Ametista. Remaining in this line of reasoning, the students say that:

[...] the rhythm of study I had, everyone was with that expectation, you know? It was huge that I passed the entrance exam. So, it was an immense joy for everyone... (Rubelita)

[...] sometimes, people expect so much from us that we better not externalize some things ... are family expectations, right? (Ametista)

[...] Moreover, we have a family charge ... the family expects a lot from us. (Turmalina)

[...] I think my family does not even know what I am going through, you know? (Citrino)

Externalize in their speech the weight of expectations about the results that they feel obliged to submit. Families expect and want for their children what is best, but not always, their expectations match. People live with various realities. Although there is a supposedly mainstream reality of everyday life, it is possible to perceive the existence of others. Thus, explaining the origins of many of the conflicts, for what may be fundamental for the individual it is not to society (Berger and Luckmann, 2004), as well as what is essential for some may not be for others. This is the postulate of a plural society.

However, in addition to being plural, the society in which we live is that of performance (Han, 2017), which stimulates and deposits in the individual the idea of high productivity, which calls him at all times to produce and feed your positivity through the numerous tasks performed at the same time, thus affirming existence and unlimited power. This stance hyperactive prevents the individual from accepting boredom as the production stage, leading to an exhaustion, a chronic fatigue that afflicts own constitution as being, making it difficult to be-with-others. Subjectivity is born of the person interactions and it is pertinent that the same to experience pleasurable experiences, as well as tensions, anxieties and frustrations, to be structured as a subject, and it is also pertinent clearly have that when the family finds it difficult to fulfill satisfactorily its basic tasks of primary socialization and support to its members, they create situations of vulnerability (Petrini, 2009), which may relate directly to the development of the subject in the training process.

FINAL CONSIDERATIONS

Regarding student success in the development of the course, family expectations can be anchored on two fronts presented throughout this analysis. In sociological bias that seeks social recognition and full range of benefits from this there, including the accumulation of economic capital, cultural and social, and psychological aspect, as regards the search for well-being condition, emotional balance and personal fulfillment. Both are intertwined and complement each other, however, it is necessary to feed the positive imagery of contemporary family, based on the fact that, this does not set up a space defined by the sense of discipline, patriarchal rigidity and allow its members to reconcile their common belonging to the uniqueness of each one. Hence, to Singly (2010), as well as Rabinovich (2017), a good family is a group which allows small and large a particular type of recognition: a personal concern and support from significant others, accompanied by care. Feel care is a feature that eases to students, the burden imposed by the condition they occupy.

Thus, while internally they feel pressured by family expectations, students find support to overcome the challenges relevant to academic journey. It is not only support and assistance in the objective sense, because they are financially dependent families but also of subjective questions, because, especially the mother figure in the opinion of four of the five participants, constitutes a safe haven and source of comfort and welcome loving.

BIBLIOGRAPHICAL REFERENCES

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Received: February 01, 2021; Accepted: June 01, 2021

* Corresponding author: luciana-uefs@hotmail.com

The authors declare that there is no conflict of interest.

Luciana Rios da Silva: originated the idea and developed the theoretical and methodological design of the research, from the work experience with students at the institution locus of the study.

Elaine Pedreira Rabinovich: worked in the construction and development of the theoretical conception of the article as well as in the selection of specialized bibliography of recognized authors.

Ivonete Barreto de Amorim: collaborated in the construction and development of methodological and structural design of the article, as well as the analysis of data.

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