Abstract WP316: Stroke Simulation Improves Resident Confidence in Acute Stroke/TIA Management

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Abstract

Objective/Background: The goal of this study was to determine if clinical simulation improved resident confidence in delivering acute stroke care including patient interaction in acute setting, rapid neurological assessment including NIHSS and ABCD2 and medical decision making.

Design/methods: Between 2010-2016, a total of 31 neurology residents participated in acute stroke simulation by the end of PGY-1 year before starting stroke calls.Five different case scenarios using standardized patients were used - TIA, Intraparenchymal hemorrhage, acute ischemic stroke within 3 hours, within eight hours and acute ischemic stroke with wake up symptoms.The simulation was video & audio taped. Historic controls consisting of PGY2 residents without simulation were used. Pre & post simulation survey, SP comments and debriefing was done for each scenario.

Results: Residents reported 100 % satisfaction with quality of demonstrations and hands-on learning experience.The accuracy and timing of decision making - IV thrombolytic, No Thrombolytic and catheter based reperfusion was significantly better to historic control and pre and post simulation competency. The decision making also improved from 1st to the 5th case scenario. Significant improvement was also seen in patient interaction, utilization of NIHSS and ABCD2 score in decision making, indications and contraindications to thrombolytic, utilization of resources including CT & CTA, CT perfusion and MRI of brain, door to needle time and consulting Neurointerventionist.

Conclusion: Simulation training using SPs is a superior teaching method in the management of acute stroke/TIA and helps to manage real life patients. Residents felt that this way of learning was superior to classroom didactics. It may be a useful teaching tool for smaller hospitals where patient volume is low, in addition to being utilized as an annual competency test.

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