A Hybrid Simulation-Based Workshop Improves Knowledge and Confidence in the Management of Hemorrhagic Conversion of...

Mechanical thrombectomy is the standard of care in acute ischemic stroke with anterior large vessel occlusion presenting within 6 hours of symptom onset, but complications do exist. We assessed the feasibility of a hybrid simulation-based workshop at a national meeting for interventional neurology trainees focused on the management of acute ischemic stroke and tissue-plasminogen activator-related hemorrhage.

In this prospective, observational, hybrid simulation-based study at a fellows' workshop at a national conference, participants were asked to manage a patient with acute ischemic stroke in the neurointerventional suite followed by thrombolytic-related hemorrhage leading to cerebral herniation during mechanical thrombectomy. We evaluated the participants' ability to complete critical actions that were developed based on best practices and relevant American Heart Association guidelines and the Neurocritical Care Society's Emergency Neurological Life Support protocols. The primary outcome was the improvement in knowledge from a precourse to postcourse test. Secondary outcomes included participant reactions.

Sixty trainees completed the simulation session in 8 groups. The mean sum of critical actions completed by trainees was 9.75/14 (70%). There was a moderate effect of the intervention on trainees' knowledge from pretest (mean 3.8, SD = 0.3) to posttest (mean 4.3, SD = 0.3). The simulation scenario was described as moderately realistic, very engaging, and extremely satisfactory. Following the workshop, all fellows endorsed an increase in proficiency and confidence in neurological emergency management.

Simulation-based workshops at national conferences are feasible and a potentially useful tool for safely educating a large audience of trainees who may not have access to high-fidelity simulation platforms at their institutions.