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Curriculum Innovations: High-Fidelity Simulation of Acute Neurology Enhances Rising Resident Confidence: Results From
Zahari N Tchopev1, Alexis E Nelson1, John C Hunninghake1
1From the Department of Neurology (Z.N.T., A.E.N., K.C., M.K.C., M.C.J.) and Department of Critical Care Medicine (J.C.H.), Brooke Army Medical Center, Ft. Sam-Houston, TX.
Introduction & Problem Statement:
The matriculation from internal medicine to neurology residency can be challenging. The most cogent approach to address this transition has yet to be identified. Studies show that simulation is highly effective at reinforcing knowledge and skills while improving learner confidence. We present the design and outcomes of an annual acute neurology simulation program.
Objectives:
We hypothesized that incoming neurology residents would (1) report improved confidence with managing acute neurologic emergencies, (2) cite a high degree of educational value with the program, and (3) demonstrate improvement in their technical knowledge.
Methods & Curriculum Description:
Our military, level 1 trauma institution's simulation laboratory and staff were used to develop and execute simulations for rising neurology residents based on the Accreditation Council for Graduate Medical Education neurology milestones. Three simulations were designed including a case of acute ischemic stroke (AIS), status epilepticus (SE) in an austere environment, and brain death evaluation with family counseling. Residents completed matched pre- and post assessments to gauge confidence, technical knowledge, and perceived educational value.
Results & Assessment Data:
Over 3 years, 15 rising neurology residents from 2 training programs completed 3 high-fidelity acute neurology cases. Self-reported confidence with acute neurology skills improved after each simulation. Confidence ratings included assessing for and identifying contraindications to tissue plasminogen activator, identifying AIS, identifying clot retrieval candidates, identifying clinical and electrographic SE, diagnosing and treating SE, identifying contraindications to and confounders of brain death diagnosis, performing the examination, and delivering bad news to families (all p < 0.05). Technical knowledge also statistically improved in the stroke (p = 0.046) and brain death simulation (p = 0.039), but not the SE simulation (p = 0.296). Participants reported an average perceived personal value of 4.8, 4.3, and 4.7 (out of a maximum of 5) for AIS, SE, and brain death simulations, respectively.
Discussion & Lessons Learned:
High-fidelity simulation of neurologic emergencies enhances confidence and knowledge of rising neurology residents. Satisfaction with the simulation cases was high. Academic hospitals can consider incorporating acute neurology simulations into their residency training.
