Uso de simulação para o ensino de práticas colaborativas e o trabalho em equipe no internato em medicina: uma estratégia de integração ensino-serviço

Abstract

Cardiac arrest (CA) requires prompt and effective attendance by an integrated and collaborative interprofessional teamwork. The use of simulation, collaborative practice and interprofessional education are strategies capable of improving integral patient care, improving technical and human skills. This paper describes the experience of the integrated training between the last year medical student and the health team during a simulated emergency situation and aims to analyze the technical and human performance of students and nursing professionals for the collaborative practice. Methods: This is a quasiexperimental study, involving 50 students from the medical internship and 40 nursing technicians, in which the gains of technical and human performance in cardiopulmonary resuscitation (CPR) were evaluated using team assessment tool, during training workshops between October 2016 and July 2017.Two simulated stations were prepared, one of out-hospital (ECA) and the other inhospital cardiac arrest (ICA), in which the participants were grouped into pairs containing a student and a nursing technician. Results: There was a significant increase in the mean of cognitive evaluation before and after training, with 5.9 ± 2.7 and 7.5 ± 1.8, respectively, p <0.001. Similarly, performance during OSPE also showed a significant improvement in the outpatient CA station, with a media of 14,2 before and 21,6 after training (p <0.001). The mean scores observed at the ICA station were 20.8 ± 9.6 and 30.0 ± 8.9 before and after the intervention (p <0.001). The evaluation with the TOSCE showed that the human abilities presented significant improvement after the training, both individual and in the team. Individually we observed a reduction of the percentage of participants in the "below-expected" stratum (63.9% vs 36.2%, p <0.001). The same was observed for the teams (66.9% vs 37.5%, p <0.001). Conclusions: the use of the TOSCE tool was feasible when applied in a simulated emergency scenario as a formative strategy for groups assessment, being well accepted by the participants. Its use allows identify weaknesses and domains of nontechnical skills essentials to improve teamwork.