Related Experiment Video
Updated: Sep 11, 2025
Simulator Training for Endovascular Neurosurgery
Published on: May 6, 2020
Curriculum Innovations: How Real Is Real Enough?: A Pilot Study Comparing Standardized Patients vs Manikin Simulators
Catherine S W Albin1, Emil Petrusa1, James A Gordon1
1From the Department of Neurology (C.A.), Emory University School of Medicine, Atlanta, GA; Departments of Surgery (E.P.), and Emergency Medicine (J.A.G.), Massachusetts General Hospital, Harvard Medical School, Boston; MGH Learning Laboratory (E.P, J.A.G), Massachusetts General Hospital, Boston; Department of Neurology (D.M.), University of Toledo, OH; and Department of Neurology (S.F.Z.), Massachusetts General Hospital, Harvard Medical School, Boston.
Background And Objectives:
Simulation training has been increasingly adopted in neurology as an engaging way to promote active learning in a safe environment while offering a reproducible platform for real-time feedback. However, despite the increase in simulation programs, there remains uncertainty about which type of high-fidelity platform would best promote trainee knowledge and confidence acquisition. The objective of this study is to investigate whether increases in resident knowledge and confidence differ when a simulation course for acute neurology emergencies uses a standardized patient vs a manikin-video format. We also investigated trainees' management deviations from the treatment guidelines.
Methods:
Over 5 sessions, 20 junior neurology residents participated in a simulation training course in which they managed 3 neurologic emergencies: right middle cerebral artery stroke, status epilepticus, and pontine hemorrhage causing coma. Residents in the standardized patient group interacted with a live actor for the cases in which the patient was conscious. Residents in the manikin-video group interacted with a manikin for all 3 cases. Before and after the course, residents completed a 40-question multiple-choice test and a survey about their self-perceived confidence in handling 15 neurologic emergencies. To create an element of internal validity, 9 items were represented in the course curriculum and 6 were not. During the simulation, a detailed behavior checklist was used to assess decision-making and guideline adherence. All residents answered items about the educational quality of the simulation sessions.
Results:
Residents had significantly higher scores on the knowledge assessment after the training session (pre: 49% vs post: 72%, p < 0.001, effect size 91%). There was no statistically significant difference between the 2 groups-each increasing 23% (p = 0.977). Regardless of group assignment, the median self-reported confidence score improved by 1 point on a Likert scale across the topics taught in the course. The behavior checklist demonstrated significant variations in treatment practices and provided targeted areas for feedback and teaching.
Discussion:
This pilot study suggests that trainees' knowledge and confidence in the management of neurologic emergencies increase after simulated encounters, regardless of whether a live actor or manikin simulation platforms is used. The use of a behavior checklist uncovered important variations in guideline adherence among novice physicians.
