Clinical Decision Making: Acute Ischemic Stroke with Large Vessel Occlusion

Area of Science:

• Medical Education
• Emergency Medicine
• Neurology

Background:

• Acute ischemic stroke affects 700,000 US patients annually.
• Timely diagnosis and management are crucial for limiting morbidity and mortality.
• Emergency medicine (EM) residents require stroke management familiarity across settings.

Purpose of the Study:

• To assess EM residents' understanding and application of acute ischemic stroke management principles.
• To evaluate resident performance using a clinical decision-making (CDM) case format.
• To identify factors influencing resident performance in stroke care.

Main Methods:

• A clinical decision-making (CDM) case simulation was administered to 39 EM residents.
• Performance was assessed using a 26-point critical action checklist.
• Structured debriefing and verbal feedback were incorporated into the assessment.

Main Results:

• The average overall score was 17.3 out of 26.
• Second-year residents (PGY-2) achieved the highest average score (18.8), outperforming third-year residents (PGY-3, 17.7).
• First-year residents (PGY-1) scored an average of 15.9.

Conclusions:

• Resident performance in acute ischemic stroke management varied.
• Higher scores in second-year residents may reflect recent, hands-on experience with stroke patients.
• The CDM case format effectively evaluated resident competency in stroke care.