A comprehensive simulation curriculum for neurology residents - preparing for future challenges in neurology (P4.188)

OBJECTIVE: To determine if a neuro-simulation curriculum improves knowledge, skill levels, and comfort in neurology trainees. BACKGROUND: Advances in stroke and neuro-critical care management have created unique challenges for neurology training programs. While classic didactics serve to expand the knowledge base, medical simulation allows residents to master basic skills along with exposure to real-life management emergencies, while minimizing patient risk. METHODS: We designed five sessions, three focused on procedures including lumbar puncture, line placement and neuro-ophthalmology skills. Two sessions were focused on patient management, the first simulated an acute stroke code in an ER setting and the second involved management of neuro-critical care emergencies on a human patient simulator capable of continuous hemodynamic and cerebral monitoring. Residents learnt direct and indirect ophthalmoscopy and the utility of Maddox rods and prisms in the eye exam in the neuro-ophthalmology session. Residents were given evaluation forms to test objective knowledge as well as self-assessment of knowledge, competency and comfort level on a 10-point scale before and after each session. Results were analyzed using independent t-tests as forms were anonymous. RESULTS: We observed 29 neurology residents in various levels of training. There was a significant gain in self-assessment of knowledge (means on 10-point scale; stroke pre-4.4, post-7.7, p-value<0.001; critical care pre-3.97, post-6.35, p-value<0.001; neuro-ophthalmology pre-2.2, post-6.23, p-value 0.04), competency (stroke pre-2.8, post-6.4, p-value<0.001; critical care pre-3.4, post-5.9, p-value<0.001). Residents also reported an improvement in their comfort level with various skills (stroke pre-3.4, post-7.4, p-value 0.006; critical care pre-3.2, post-6.2, p-value 0.02; line-placement pre-4.5, post-7.1, p-value<0.001; neuro-ophthalmology pre-2.3, post-6.3, p-value<0.001). CONCLUSIONS: Our study demonstrates that integrating simulation in classical neurology didactics not only improves the knowledge base but improves competency and execution of high-risk time sensitive decisions in an emergency setting. Disclosure: Dr. Sabharwal has nothing to disclose. Dr. Saba has nothing to disclose. Dr. Szyld has nothing to disclose. Dr. Czeisler has nothing to disclose. Dr. Ishida has nothing to disclose. Dr. Lord has nothing to disclose. Dr. Rucker has nothing to disclose. Dr Balcer received personal compensation from Biogen Idec and consulting for Biogen Idec, Vaccinex and Genzyme. She is on a clinical trial advisory board for Biogen-Idec., Dr. Sander has nothing to disclose. Dr. Galetta has received personal compensation for activities with Biogen Idec, Genzyme, and Vaccinex.