Construção de instrumento de avaliação das habilidades comportamentais em simulação realística na graduação em medicina

Abstract

Introduction: Adequate training of the technical, and non-technical medical students skills is required, especially in a medical emergency situation, since training suitable professionals how to conduct serious cases significantly reduces the occurrence of mistakes and damages to the patient. Real-simulation-based learning allows the trainee to be prepared on how to deal with critical situations before contacting actual patients, particularly during the emergency context. Some non-technical or behavioral skills can be especially hard to be taught and trained. For this reason, the use of specific tools like behavioral checklists or scripts, become relevant to favor this task. It is crucial to mention that such tools should also be linked to the student's reality. However, as such tools are currently unavailable in our teaching institution, we have chosen to build one, based on existing scales in the literature. Objective: The aim of this study was to create a behavioral checklist applied to the realistic simulation environment of the urgency and emergency module from CESUPA medical course. Methods: For this reason, a literature review was carried out on the undergraduate competences and currently validated scales in the health area that addressed the main behavioral skills of the medical professional. From then on, the checklist developed was evaluated by four judges and applied to the students of the boarding school in Emergency and Emergence of CESUPA. The analyzed data was treated using descriptive statistics, expressed as median, interquartile range, percentiles and 95% Confidence Interval. Results: The generated checklists have been filled by a total of 30 students, from which 28 have been selected. Attitudes related to 'communication' skills have been significantly more frequent than those related to 'teamwork'; when students' performance involved 'airways' (p = 0.0195),' polytrauma '(p = 0.0011) and 'acute coronary syndrome' (p = 0.0490). In simulated cases of 'thoracic drainage' the frequency of ‘leadership’ behavior have shown to be significantly higher than those of ‘teamwork’ (p = 0.0022). Conclusion: 1. Communication, leadership and teamwork were considered three essential behavioral skills to be applied in our tool (checklist), in order to aid realistic high fidelity simulation activities at the urgent and emergency internship of CESUPA’s medical school. 2. The checklist built as a product of this work will be used as an auxiliary tool in our scenarios for analysis and behavioral discussion during debriefing and it may also be modified, adapted and improved for posterior use in different activities in our institution. 3. We believe those studied behavioral skills might have their anticipated training in related activities through in diverse contexts in order to provide greater mastery from our students.