A Multicase Simulation to Enhance Comfort in Managing Neurological Disease

Author Type(s)

Student

Document Type

Abstract

Publication Date

9-2024

DOI

10.1002/ana.27051

Journal Title

Annals of Neurology

Abstract

The clinical reasoning and management of acute neurological cases are necessary skills for neurology residents as they start their neurology residency, however most feel unprepared for this new role. In order to improve prepared-ness in this domain, we developed a simulation-based orientation program in 2013 for incoming postgraduate year2(PGY-2) neurology residents to help bridge the performance gap between the medical intern year and the first year of neurology residency. Incoming neurology residents participated in a novel interprofessional neurological simulation-based educational program as a component of their program orientation at the start of their second post-graduate year. Participants included both nurses and residents working in interprofessional teams. The program included six30-minute hands-on simulation stations covering the approach to the following topics: ( acute ischemic stroke,(2) acute hemorrhagic conversion of an ischemic stroke,(3) status epilepticus, (4) cardiac arrest (5) challenging communication (functional neurological disorder or micro-aggression), and a (6) skills station for lumbar puncture and arterial line placement. Over 7 cumulative years, were viewed 133 pre-course (90% response rate), 123 post-course evaluations (84% response rate), and 130 satisfaction evaluations (88% response rate). Before attending the pro-gram, 40% of participants expressed confidence in their approach to the various clinical scenarios explored in the program. After the program, participant confidence in their approach to the clinical scenarios increased to 67%. Resi-dents experienced the greatest improvement in confidence in the management of seizures. Residents expressed an average overall program satisfaction score of 910. This 3-hoursimulation-based PGY-2 neurology resident orientation program resulted in improved resident confidence in managing 6 clinical presentations. The residents specifically praised the program’s clinical relevance, interprofessional team training, debriefing techniques, and faculty support. This simulation-based program succeeded in easing the transition from PGY-1 internal medicine to PGY-2 neurology residency by providing them with increased confidence to competently manage various clinical scenarios. In order to further expand comfort of managing neurological dis-ease across different levels of training, we will apply this simulation-based program to medical student learners in Summer 2024.

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