IJCS | Volume 32, Nº2, May/June 2019

230 Souza-Silva et al. Simulation training for myocardial infarction Int J Cardiovasc Sci. 2019;32(3)227-237 Original Article in order to stimulate critical reflection about the simulation; (viii) summarizing of the most important topics. 25 First phase This phase was developed in Belo Horizonte, Brazil. Physicians and nurses from emergency care units and SAMUwere invited to join the training, focusing mainly on professionals responsible for the care of ACS patients. Second phase This phase was developed in Montes Claros, Brazil. It was part of a quasi-experimental study,Minas Telecardio 2 project, a three-phase study (baseline, implementation and post-implementation phases) which assessed the impact of the implementation of the myocardial infarction care system in the north of Minas Gerais state. The training reported here was part of the implementation phase. 17,26 In this region, the health system is divided into nine micro-regions, covering 89 municipalities in an area consisting of 128,000 km² and comprising a population of 1.6million inhabitants. There are 18 public hospitals in the area, but 9 of those are concentrated inMontes Claros, the mainmunicipality of the region. SAMUhas 47 ambulances (7 with doctors and 40 with nurse technicians). 26 There were two training sessions. The first one, on April 2014, was carried out in Montes Claros, and physicians and nurses from emergency services of the 18 public hospitals and ambulance services (SAMU) of the north region of Minas Gerais were invited to participate. The model and duration of the training were similar to the first phase, except for the test applied to nurses, which included specific questions about their role in the management of ACS patients. All professionals were invited to answer a feedback survey. It included questions about the participant’s clinical practice, how often they had managed chest pain in the last month and how secure they felt when performing thrombolysis (when indicated) after the course. The second training session was carried out in August/September 2014. This one took place in five different municipalities distributed throughout the region, to make it easier for professionals who lived far away from Montes Claros to participate. Physicians and nurses from the emergency services of the 18 public hospitals and ambulance services (SAMU) of the north region of Minas Gerais were invited to participate. For this one, no pre and post-tests were applied. Data about medication prescription was collected in three different moments: baseline (June 19 th , 2013 to March 31 st , 2014); post-implementation phase, just after the training sessions happened (September 1 st , 2014 to May 31 st , 2015); and eight months after the end of the Minas Telecardio 2 project (June 1 st , 2015 to January 31 st , 2016). Data on the prescription of aspirin, P2Y12 inhibitor, heparin and statin medication within the first 24 hours after admission and at discharge were collected from STEMI patients admitted to hospitals in Montes Claros. Statistical analysis The data were analyzed using the program Statistical Package for the Social Sciences, version 20.0 (SPSS Inc, Chicago, IL, EUA). The evaluation of the distribution of continuous variables was performed using the Kolmogorov-Smirnov test. The continuous variables were expressed as mean and standard deviation or median and interquartile range, as appropriate, while categorical variables were expressed as absolute number and percentage. The test questions were classified into different categories depending on the subject: diagnosis, treatment or both. This classification was used to analyze the results of both tests stratified by the subject. The results of the pre- and post-tests were compared using McNemar test. In order to evaluate the influence of workplace and years since graduation on the participants’ performance in the test, the non-parametric Spearman’s correlation coefficient was calculated. The p value considered significant was set at 0.05. Results First phase A total of 189 professionals participated in the training, of which 86 were doctors and 103 nurses. Most were females (68.0%), and there was a predominance of professionals from the emergency care units (50.8%), hospitals (29.5%) and ambulance services (17.2%). Additionally, 18.9% of them had graduated up to 1 year before, 24.6% had graduated 2 to 5 years before, 16.4% had graduated 6 to 10 years before and 38.5% had been working for more than ten years in the profession. One hundred and fifty-six professionals answered both tests, which corresponds to 82.5%of the total (Figure 3). In the comparative data analysis, it was observed an improvement in the participants’ performance in the post- test, since 66.0%of the professionals achieved better scores.