Introduction: Neurology led Stroke Teams are becoming imperative in recent care models of acute stroke management. Advanced Practice Providers (APP) are important members of these stroke teams. Code Stroke simulations allow (APP) to gain valuable experience in the evaluation and treatment of a potential stroke patient without compromising patient care. We hypothesized that simulation training would increase advanced practice provider confidence, comfort level and preparedness in leading a Code Stroke similar to neurology residents.
Methods: Nine advanced practice providers and nine neurology residents each took turns leading a Code Stroke simulation to determine need for intravenous thrombolysis, thrombectomy and blood pressure management on three cases with standardized patients. Emergency medicine physicians and neurologists were preceptors and gave feedback. APPs and residents completed a survey before and after the simulation. Generalized mixed modeling assuming a binomial distribution was used to evaluate change.
Results: On a 5-point Likert scale (1 - Strongly disagree and 5 - Strongly agree), confidence in leading a Code Stroke significantly increased from (2.8 to 4.5, p<0.01) comfort level in rapidly assessing a stroke patient for thrombolytics increased (3.0 vs. 4.3 p<0.001), making the decision to give thrombolytics increased (2.7 vs. 4.3, p<0.01) and assessing a patient for embolectomy increased (2.6 vs. 4.3, p<0.01); these results held for both APP and residents.
Conclusion: Simulation training is a beneficial part of medical education for advanced practice providers and should be considered in addition to traditional didactics and clinical training.