Stroke Simulation Enhances Resident'S Confidence In Acute Stroke/Tia Management

OBJECTIVE: The goal of this study was to determine if clinical simulation improved resident9s confidence in delivering Acute Stroke(AS)care including patient interaction in acute setting,rapid neurological assessment including NIHSS and ABCD2 and medical decision making. BACKGROUND: AS management is time dependent and obviously frightening for new residents,ways to overcome this apprehension needs to be looked at. DESIGN/METHODS: Between 2010-2012, a total of 9 neurology residents participated in AS simulation by the end of PGY-1 year before starting stroke calls. Four different case scenarios using standardized patients were used – TIA, Intraparenchymal hemorrhage, acute ischemic stroke within 3 hours (1st case) and within eight hours (4th Case) over 60 days with set time limit for each encounter. The simulation was video & audio taped. Historic controls consisting of PGY2 residents without simulation were used. Pre & post simulation survey, SP comments and debriefing was done for each scenario. RESULTS: Residents reported 100 % satisfaction with quality of demonstrations and hands-on learning experience. The accuracy and timing of decision making-IV thrombolytic, No Thrombolytic or catheter based reperfusion was significantly better to historic control and from 1 st to the 4 th case scenario. Significant improvement was also seen in patient interaction, utilizing NIHSS and ABCD2 score in decision making, indications and contraindications to thrombolytic, utilization of resources including CT & CTA, CT perfusion and MRI of brain, door to needle time and consulting Neurointerventionalist. CONCLUSIONS: Simulation training using SP9s is a superior teaching method in the management of AS/TIA and helps to manage real life patients better. Residents felt that this way of learning was superior to classroom didactics. Acute stroke simulation can be utilized for other time critical diagnoses- MI, seizure and Trauma. It may be a useful teaching tool for smaller hospitals where patient volume is low, in addition to being utilized as an annual competency test. Disclosure: Dr. Uppal has nothing to disclose. Dr. Sandhu has nothing to disclose. Dr. Vellipuram has nothing to disclose. Dr. Sanders has nothing to disclose. Dr. Phillips has nothing to disclose. Dr. Nanda has nothing to disclose. Dr. Lardizabal has received personal compensation for the speakers bureau for UCB pharmaceutical and Cyberonics, Inc. Dr. Singh has nothing to disclose.