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Published on: January 15, 2017
Simulation-Based Assessment of Graduate Neurology Trainees' Performance Managing Acute Ischemic Stroke.
Melissa B Pergakis1, Wan-Tsu W Chang1, Ali Tabatabai1
1From the Department of Neurology (M.B.P., W.-T.W.C., M.S.P., J.E.P., G.P., N.B., M.M., N.A.M.), Department of Emergency Medicine (W.-T.W.C.), Department of Medicine (A.T.), and Program in Trauma (M.B.P., W.-T.W.C., A.T., B.N., J.E.P., G.P., N.B., M.M., N.A.M.), University of Maryland School of Medicine, Baltimore; and Department of Neurology (D.P.L.), Lahey Hospital and Medical Center, Burlington, MA.
Neurology trainees manage acute ischemic stroke well but struggle with post-thrombolysis bleeding complications. Simulation highlights educational gaps in treating rare, critical events like hemorrhagic transformation after tissue plasminogen activator (tPA).
Area of Science:
- Neurology
- Medical Education
- Emergency Medicine
Background:
- Multidisciplinary stroke teams enhance acute ischemic stroke care.
- Potential for these teams to impede trainee education and impact future outcomes in community hospitals.
Purpose of the Study:
- Assess graduate neurology trainee performance in managing acute ischemic stroke independently.
- Evaluate trainee competence in handling tissue plasminogen activator (tPA)-related hemorrhage and cerebral herniation syndrome.
Main Methods:
- Prospective, observational, single-center simulation-based study.
- Participants managed a simulated acute ischemic stroke case with subsequent hemorrhagic conversion and herniation.
- Critical actions defined by modified Delphi approach using AHA guidelines and ENS protocols.
Main Results:
- Graduate neurology trainees achieved 68% on critical actions (15/22).
- 90% correctly administered tPA; 84% stopped infusion upon deterioration.
- Only 55% reversed tPA per guidelines; training level significantly impacted performance (p < 0.001).
Conclusions:
- Trainees excel in initial stroke management but need improved education on hemorrhagic transformation post-thrombolysis.
- High-fidelity simulation is a promising tool for assessing acute stroke management skills.
