ABC | Volume 114, Nº1, January 2019

Original Article Aimoli & Miranda STEMI Management by Recently Graduated Physicians Arq Bras Cardiol. 2020; 114(1):35-44 Figure 4 – Bars graph showing performance of recently graduated physicians in each of the six items of the checklist directly related to diagnosis and management of the patient’s tranfer during practical evaluation in the simulated station of STEMI medical care. 80 60 40 20 0 80 60 40 20 0 80 100 60 40 20 0 20 10 30 40 0 60 40 20 0 80 60 40 20 0 Assesses pain duration Recognizes the need of immediate transfer for reperfusion Insists on transfer even in the absence of hospital bed Adequately informs the patient about the disease and treatment Waits for necrosis markers to start therapy Recognizes the diagnosis of STEMI Percentage (%) Percentage (%) Percentage (%) Percentage (%) Percentage (%) Percentage (%) Yes No Yes No Yes No Yes Parcialmente Parcialmente Parcialmente No Yes No Yes No in an Emergency Care Unit of the Brazilian National Health System (SUS) by a recently graduated doctor than by a specialist in the field. Therefore, in order to increase the proportion of patients with STEMI receiving reperfusion therapy in Brazil, it is necessary to encourage and improve the teaching of this disease during undergraduate courses in medicine. Another study carried out in Brazil, in which 97 patients victims of acute myocardial infarction were interviewed, found that only 33% managed to get immediate hospitalization, whereas 67% of the patients went through up to five units until they could be admitted. Among the main reasons for the lack of hospitalization was the fact that the physician referred the patient back home due to no identification of this diagnosis. 11 Ghanem et al. , 12 using standard questionnaires applied to medical students, found that only 22% of them knew how to aid patients with myocardial infarction. 12 Little et al. 13 s howed that only 61% of the students in the last year of medical training recognized the electrocardiographic diagnosis of inferior wall STEMI. 13 Realistic simulation was the methodology employed in this assessment. This is an important assessment tool of health professionals, because it enables the performance of different evaluations within the same systematic framework, ensuring uniformity, which would be impracticable in a real scenario. On the other hand, it tries to reproduce directly the environment where this assistance usually occurs, allowing for knowledge, skills and attitude assessment. 14 We consider this simulation as highly reliable, since it was performed inside a hospital environment, with duly trained professional actors and the psychological aspect of the emotional stress involved in the performance of an evaluation, similar to that found in a real situation of emergency assistance. Therefore, the use of this methodology is a strong point of this study which deserves to be highlighted, because it presents greater validity, when compared with the application of standard questionnaires, for instance. This methodology is widespread worldwide and employed in most Brazilian medical schools. Thus, most applicants are familiar with this type of evaluation, which is not a particularity of our institution. In spite of the greater performance in some items, the answer pattern of the applicants graduated in our institution was quite similar to that of the remaining applicants. Simulation is an active learning methodology. In this study, it was used to evaluate the applicants, but it can also be used in medical teaching. We find it important to develop a realistic simulation standard scenario of STEMI assistance, adjusted to 40