ABC | Volume 114, Nº1, January 2019

Original Article Aimoli & Miranda STEMI Management by Recently Graduated Physicians Arq Bras Cardiol. 2020; 114(1):35-44 Table 1 – Demographic characteristics of the recently graduated physicians who took part in the practical examin on STEMI medical care Characteristics n = 771 individuals Age (years); median (19) 25 (24-27) Male sex; n(%) 444 (58) Years from graduation; n(%) < 1 year 549 (71) ≥ 1-2 years 145 (19) ≥ 2-3 years 44 (06) ≥ 3-4 years 12 (01) ≥ 4 years 21 (03) Institution where graduated; n(%) Public 509 (66) Private 254 (33) Foreign 8 (01) Region of origin; n(%) Southeast 499 (65) Northeast 173 (22) South 48 (06) Central-West 33 (04) North 10 (01) Abroad 08 (01) When comparing the applicants who performed best (general score > 7) with those with a lower performance (general score ≤7), no differences were observed in relation to the age, mean time of graduation and geographic region of origin. However, a higher prevalence of males was observed in the group with lower performance (63% vs. 52%; p = 0.003) and a higher prevalence of graduates from public universities in the group with greater performance (71% vs. 61%; p=0.0016). When comparing their performance in each of the 12 items of the checklist, the first group presented superior results in all items. Nevertheless, the greatest differences between the groups occurred with regard to diagnosis aspects, transfer management and communication skills. The prevalence of identification of immediate transfer need was 100% vs. 31%; p < 0.0001, the percentage of adequate communication skills was 55% vs. 15%; p < 0.0001, the identification of the diagnosis of STEMI was 89% vs. 51%; p < 0.0001 and the persistence to organize the transfer even in case of non-availability of beds was 45% vs. 8%; p < 0.0001 (Table 2). When comparing the 90 candidates from our institution with all the other applicants from the remaining institutions, the following results were found: ECGmonitoring requirement (86% vs. 83%; p = 0.50), insertion of peripheral venous access device (81% vs. 54%; p < 0.0001), pain duration assessment (63% vs. 71%; p = 0.11), accurate STEMI diagnosis (76% vs. 68%; p = 0.20), acetylsalicylic acid administration (100% vs. 94%; p = 0.01), second antiplatelet agent administration (80% vs. 76%; p = 0.004), nitrate administration (72% vs. 65%; p = 0.16), morphine administration (82% vs. 70%; p = 0.01), immediate transfer requirement (82% vs. 61%; p < 0.0001), adequate communication skill (49% vs. 32%; p = 0.001), transfer requirement even in case of non-availability of beds (38% vs. 23%; p = 0.003). Discussion This study shows the need to enhance training, during undergraduate courses, on the identification of STEMI and, especially, to increase knowledge of the assistance flow in the care line of this disease. According with report data on medical demography in Brazil, in 2016, there were 18,753 new registrations in Regional Medical Councils, most of them from the Southeast region (50% of the registrations). 7 Thus, every year, there is a great number of young doctors graduating from several medical colleges in Brazil. Many of them begin medical practice by choice, or due to difficulties to enter residency programs, and even concomitantly  with these programs to complement their earnings. Due to lack of professionals exclusively dedicated to emergency care, newly graduated doctors usually take shifts in the emergency department. In Brazil, about 50% of STEMI patients are treated with reperfusion therapy, 8 reaching a percentage of 20% in public hospitals of certain regions. 9 In a Brazilian registry of acute coronary syndrome, in which 2,453 patients were included, high rates of acetylsalicylic acid use (97.6%) and P2Y12 inhibitor (89.5%) were observed in the first 24 hours, similar to the rates found in this study, but among STEMI patients, only 35.9% 38