Introduction: Junior neurology residents frequently receive the first call for emergency neurological conditions, including acute ischemic stroke and intracerebral hemorrhage (ICH) (Code Stroke). Code Stroke simulations allow residents to gain experience in the evaluation and treatment of a potential stroke patient without compromising patient care. Simulations also give residents the opportunity to improve their skills through direct observation and feedback. We hypothesized that simulation training would increase junior neurology residents’ confidence, comfort level and preparedness in leading a Code Stroke.
Methodology: Ten neurology residents in their first months of training each took turns leading a Code Stroke simulation – either assessment of an ischemic stroke patient for intravenous thrombolytics, coordination of an ischemic stroke patient for embolectomy, or management of an ICH patient. Standardized patients were used in each case. Emergency medicine, vascular neurology and neurointerventional radiology attendings were active participants in the cases and gave feedback. Residents completed a survey before and after the simulation.
Results: On a 5-point Likert scale (1 – least true and 5 – most true), confidence in leading a Code Stroke significantly increased from 2.80 to 3.95 (p=0.01) and perceived preparedness for the next Code Stroke significantly improved from 2.80 to 4.30 (p<0.01). Residents reported significantly improved comfort levels in rapidly assessing the National Institutes of Health Stroke Scale score (3.35 vs. 4.25, p=0.03) and rapidly assessing a Code Stroke patient for thrombolytics (3.15 vs. 4.25, p=0.02), making the decision to give thrombolytics (2.80 vs. 4.00, p=0.02) and assessing a patient for embolectomy (3.33 vs. 4.67, p=0.03). There was a perception of enhanced mutli-disciplinary collaboration with emergency medicine providers (3.55 vs. 4.40, p=0.04) and neurointerventional radiologists (3.00 vs. 4.50, p=0.07).
Conclusion: Simulation training is a beneficial part of medical education for junior neurology residents and should be considered in addition to traditional didactics and clinical training.