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 2 – Comparison between the groups with greater performance (general score > 7) and lower performance (general score ≤ 7) in the simulated practice regarding STEMI medical care Characteristic General score Relative difference p-value > 7 n = 363 ≤ 7 n = 408 Demographic Age, mean ± DP 26 ± 7 26 ± 5 0.99 Age, years; median(19) 25 (24-27) 25 (24-27) Male sex, n(%) 189 (52) 255 (63) -11% 0.0034 Medical Graduation Time from conclusion, years; median(19) 0 (0-1) 0(0-1) > 0,05 Private institution, n(%) 99(27) 155(38) -11% 0.0016 Public institution, n(%) 259(71) 250(61) +10% 0.0032 Region of origin, n(%) 0.792 Southeast 245(67) 254(62) +5% Northeast 72(20) 101(25) -5% South 24(07) 24(06) +1% Central-West 16(04) 9(02) +2% North 3(01) 7(02) -1% Checklist Items, yes; n(%) Recognizes need for transfer 363(100) 125(31) +69% < 0.0001 Adequately informs the patient 201(55) 63(15) +40% < 0.0001 Recognizes STEMI 323(89) 207(51) +38% < 0.0001 Insists on tranfer in the absence of bed 162(45) 31(08) +37% < 0.0001 Requests venous access insertion 245(67) 193(43) +24% < 0.0001 Assesses pain duration 300(83) 244(60) +23% < 0.0001 Administers SL nitrate 274(75) 232(57) +18% < 0.0001 Administers IV morphine 293(81) 258(63) +18% < 0.0001 Administers P 2 Y 12 inhibitors 318(88) 298(73) +15% < 0.0001 Requests ECG monitoring 318(88) 323(79) +9% 0.0018 Administers acetylsalicylic acid 355(98) 377(92) +6% 0.0006 Waits for necrosis markers to start therapy 00(00) 32(08) -8% < 0.0001 SD: standard deviation; ECG: electrocardiogram; STEMI: ST-segment elevation myocardial infarction; SL:sublingual; IV: intravenous. the particularities of the Brazilian health system, as performed in this study, because it can be reproduced in other medical schools and used in the teaching process when approaching this major cardiac disease. An important issue that should be highlighted during the education of graduate students concerns the insertion of patients within the hierarchical network of the SUS because, in addition to establishing the adequate pharmacological treatment available in the place of care, it is important to promote an integration with the urgency and emergencies network for the prompt transfer of these patients to reference centers capable of performing the reperfusion therapy. Most students remembered to administer antiplatelet agents but, on the other hand, a significant proportion did not reinforce the need for the patient's immediate and adequate transfer, as expected in these situations. The lack of well-organized assistance networks 14 to refer STEMI patients from emergency care units to reference hospitals, makes the primary service doctor to have a central role in this transfer management. Only 25% of the applicants insisted on the transfer even in the non-availability of hospital bed. Therefore, it is important to raise the discussion about integrated clinical scenarios with management aspects, such as the Resolution N°. 2,077/14 of Federal Medicine Council on urgencies and emergencies, which addresses the concept of “zero vacancy”. It is extremely important that graduate students in Medicine courses understand that the treatment of this disease is time-dependent, and that it is possible to change the natural history, when treatment is set up early and, for this reason, they must insist on transfer of patients suffering from this disease to a center capable of providing reperfusion therapy, even in the absence of hospital beds. 41