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Posterior Reversible Encephalopathy Syndrome and Eclampsia.

Kristina Jacomino1, Kevin Tomecsek1, Andrew Little1

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Summary

This study evaluated an oral board exam case for emergency medicine trainees, focusing on Posterior Reversible Encephalopathy Syndrome (PRES) and eclampsia. Feedback indicated the case was effective but highlighted needs for improved clarity on magnesium dosing and concurrent PRES recognition.

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Area of Science:

  • Medical Education
  • Emergency Medicine
  • Neurology
  • Obstetrics

Background:

  • Posterior Reversible Encephalopathy Syndrome (PRES) presents with diverse neurological symptoms and is often underdiagnosed.
  • Eclampsia, a hypertensive disorder in pregnancy, poses significant risks to both mother and fetus, necessitating prompt emergency management.
  • Both conditions represent critical neurological and obstetric emergencies requiring specialized knowledge for effective treatment.

Purpose of the Study:

  • To assess the effectiveness of a structured interview case simulating Posterior Reversible Encephalopathy Syndrome (PRES) and eclampsia for emergency medicine resident training.
  • To identify areas for improvement in educational materials and case design for evaluating trainees' knowledge of these critical conditions.

Main Methods:

  • An oral board exam-style structured interview case was developed and administered to emergency medicine residents and fellows.
  • A multi-institution virtual Mock Oral Boards Day facilitated the case administration and subsequent feedback collection.
  • Learners and faculty examiners provided written feedback on case difficulty, quality, and effectiveness in assessing clinical reasoning.

Main Results:

  • The educational case was rated as effective, high-quality, and intermediate-to-advanced in difficulty by both learners and faculty.
  • Learners and faculty provided feedback suggesting improvements, including clearer history details and specific guidance on magnesium sulfate dosing for eclampsia.
  • A need for enhanced instruction on the concurrent presentation of PRES and eclampsia was identified.

Conclusions:

  • The structured interview case effectively evaluated trainees' understanding of PRES and eclampsia management.
  • Further refinement of the case is recommended to address specific knowledge gaps, particularly regarding magnesium dosing and concurrent diagnoses.
  • The study underscores the importance of realistic case simulations in medical education for critical obstetric and neurologic emergencies.