ABC | Volume 114, Nº1, January 2019

Original Article Clinical Competence in ST-segment Elevation Myocardial Infarction Management by Recently Graduated Physicians Applying for a Medical Residency Program Ugo Stocco Aimoli 1 and Carlos Henrique Miranda 1 Universidade de São Paulo - Campus de Ribeirão Preto - Divisão de Medicina de Emergência do Departamento de Clínica Médica, 1 Ribeirão Preto, SP – Brazil Mailing Address: Carlos Henrique Miranda • Universidade de São Paulo Faculdade de Medicina de Ribeirão Preto - Divisão de Medicina de Emergência do Departamento de Clínica Médica - Rua Bernardino de Campos, 1000. Postal Code 14040-900, Ribeirão Preto, SP – Brazil E-mail: chmiranda@fmrp.usp.br Manuscript received October 29, 2018, revised manuscript March 05, 2019, accepted March 20, 2019 DOI: https://doi.org/10.36660/abc.20180309 Abstract Background: A significant reduction in the morbidity and mortality related to ST-segment elevation myocardial infarction (STEMI) has been achieved with the development of reperfusion therapies. Early diagnosis and correct initial management are important to ensure this benefit. In Brazil, recent graduates in medicine are responsible for a large part of the initial care provided for these patients. Objective: To assess the clinical competence in the diagnosis and initial treatment of STEMI by newly graduated physicians applying for a medical residency program. Methods: We assessed the performance of 771 applicants for the direct entry selection process of the FMRP-USP Clinical Hospital Medicine Residency Program, performed in a simulated setting of STEMI, with professional actors and medical evaluators, using a standardized checklist following the recommendations of the Brazilian Guidelines for the management of this disease . Results: The general performance score presented a median of 7 and an interquartile range of 5.5-8.0. In relation to the items assessed: 83% required ECG monitoring, 57% requested the insertion of a peripheral venous access catheter, 95% administered acetylsalicylic acid, 80% administered a second antiplatelet agent (p2y12 inhibitor), 66% administered nitrate, 71% administered morphine, 69% recognized the diagnosis of STEMI, 71% assessed the pain duration, 63% recognized the need for immediate transfer, 34% showed adequate communication skills and only 25% insisted on the transfer even in case of non-availability of beds. Conclusions: The initial diagnosis and management of STEMI need to be improved in medical undergraduate courses and inserted into the reality of the hierarchical network structure of the Brazilian Unified Health System (SUS). (Arq Bras Cardiol. 2020; 114(1):35-44) Keywords: ST Elevation Myocardial Infarction; Medical Staff, Hospital; Education, Medical; Clinical Competence; Internship and Residence. Introduction Over the last decades there has been a great development in the treatment of ST-segment Elevation Myocardial Infarction (STEMI) with an important reduction in its morbidity and mortality, especially with the emergence of fibrinolytic therapy and primary angioplasty procedures which allow for immediate recanalization of the involved coronary artery. 1 However, to reap these benefits, it is important to make an early diagnosis of STEMI, using a resting ECG and to organize the referral of these patients to tertiary centers capable of carrying out reperfusion therapy. 2 Inside the Brazilian Unified Health System (SUS), which is categorized into levels of care, this patient is usually assisted in Emergency Care Units (UPAs). Because of the lack of professional doctors dedicated exclusively to emergency care, a great deal of this healthcare is provided by recently graduated physicians. 3 The lower clinical experience of these professionals can compromise the diagnosis and initial management of these patients in this critical period, in which agility makes all the difference. 4 The objective of this study was to assess the clinical competence for the diagnosis and initial management of STEMI by recently graduated physicians applying for a medical residency program. Methods This is a single-centered cross-sectional study, which used simulation with professional actors, organized within the objective structured clinical examination system, better known as OSCE, as the evaluation method to verify the clinical competencies of recently graduated physicians in 35