Stroke training of prehospital providers: an example of simulation-enhanced blended learning and evaluation.

Since appropriate treatment of patients in the first few hours of ischemic stroke may decrease the risk of long- term disability, prehospital providers should recognize, assess, manage and communicate about stroke patients in an effective and timeefficient manner. This requires the instruction and evaluation of a wide range of competencies including clinical skills, patient investigation and management and communication skills. The authors developed and assessed the effectiveness of a simulation-enhanced stroke course that incorporates several different learning strategies to evaluate competencies in the care of acute stroke patients. The one- day, interactive, emergency stroke course features a simulation- enhanced, blended- learning approach that includes didactic lectures, tabletop exercises, and focused- examination training and small- group sessions led by paramedic instructors as standardized patients portraying five key neurological syndromes. From January to October 2000, 345 learners were assessed using multiple- choice tests as were randomly selected group of 73 learners using skills' checklists during two pre- and two post- course simulated patient encounters. Among all learners there was a significant gain in knowledge ( pre: 53.9% +/- 13.9 and post: 85.4% +/- 8.5; p < 0.001), and for the 73 learners a significant improvement in their clinical and communication skills ( p < 0.0001 for all). By using a simulation- enhanced, blended learning approach, pre- hospital paraprofessionals were successfully trained and evaluated in a wide range of competences that will lead to the more improved recognition and management of acute stroke patients.