Simulation-Based Assessments and Graduating Neurology Residents' Milestones: Status Epilepticus Milestones

Area of Science:

• Medical Education
• Neurology
• Clinical Skills Assessment

Background:

• The Accreditation Council for Graduate Medical Education (ACGME) developed Milestones for resident assessment, but guidance on assessment methods is lacking.
• This study addresses the gap in understanding how well these frameworks translate to practical clinical skills.

Purpose of the Study:

• To evaluate graduating neurology residents' skills in identifying and managing status epilepticus (SE).
• To assess the correlation between SE management skills and ACGME Milestones assigned by clinical competency committees (CCCs).

Main Methods:

• A cohort study of 2018 graduating neurology residents from three Chicago academic medical centers.
• Simulation-based assessment using a 26-item checklist to evaluate SE identification and management skills.
• Comparison of simulation scores with resident experience, self-confidence, and assigned ACGME Milestones.

Main Results:

• Seventy-six percent of eligible residents participated; average SE checklist score was 60%.
• No significant correlation was found between simulation performance and prior SE case experience or self-confidence.
• Residents had high average Milestones for epilepsy and management (4.3/5 and 4.4/5), but these did not correlate with simulation performance.

Conclusions:

• Graduating neurology residents demonstrated inadequate simulated status epilepticus management skills.
• End-of-rotation evaluations alone appear insufficient for assigning Milestones for critical clinical skills like SE management.