Harrison Daniel S, Elmashala Amjad, Ahmed Rashid A, DiFrancesco Matthew F, Cricco-Lizza Eliza, Blake Andrew, Vollbrecht Hanna, Zafar Sahar F, Bevers Matthew B
Department of Neurology, Boston Medical Center, MA.
Department of Neurology, Boston University School of Medicine, MA.
Neurol Educ. 2025 Jul 29;4(3):e200228. doi: 10.1212/NE9.0000000000200228. eCollection 2025 Sep.
Neurologists, especially neurointensivists, may be expected to lead cardiac arrest resuscitations. However, neurocritical care (NCC) fellows may face barriers to acquiring the necessary skills and knowledge needed for successful leadership in these scenarios. Whether a simulation course created for one group of learners and applied in a new context (a "shared simulation") could facilitate acquisition of desired outcomes among neurology learners is unclear.
In this prospective, pre-post educational intervention study, NCC fellows at 2 centers completed precourse knowledge and confidence assessments and reported barriers to resuscitation leadership. Fellows then led 2 simulated cases of cardiac arrest, initially developed for internal medicine residents with vignettes adapted to better reflect an NCC patient population. Postcourse knowledge and confidence assessments were administered immediately after the intervention and again one to 4 months later. Pre-, immediate post-, and delayed post-confidence and knowledge assessments were compared.
Thirteen NCC fellows participated in the study. Limited experience leading a resuscitation and not being preassigned the resuscitation leader role were the most highly cited barriers to leading resuscitations (n = 8/13, 61.5%). Lack of confidence and lack of knowledge were barriers for 38.5% (n = 5/13) and 22.2% (n = 2/9) of participants, respectively. Both confidence and knowledge scores improved on the immediate postassessments (5-point Likert median [IQR] 3.5 [3.1-3.9] vs 4.1 [4.0-4.7], = 0.005; mean [SD] 69.8% [8.8%] vs 88.5% [7.6%], = 0.004). No confidence or knowledge decay was observed between the immediate and delayed postcourse assessments (4.1 [4.0-4.7] vs 4.1 [3.2-4.4], = 0.50; 91.7% [6.8%] vs 81.3% [8.0%], = 0.08).
Shared simulation training improved learner confidence and knowledge in cardiac arrest resuscitation leadership and may yield similar benefits in other simulated scenarios. Low confidence, identified as a barrier to resuscitation leadership for over one-third of NCC fellows, was improved by brief simulation training.
人们期望神经科医生，尤其是神经重症医生，能够领导心脏骤停复苏工作。然而，神经重症监护（NCC）专科住院医生在获取成功领导此类复苏所需的必要技能和知识方面可能面临障碍。为一组学习者创建并应用于新环境的模拟课程（“共享模拟”）是否能促进神经科学习者获得预期成果尚不清楚。
在这项前瞻性的教育干预前后对照研究中，2个中心的NCC专科住院医生完成了课程前的知识和信心评估，并报告了复苏领导方面的障碍。然后，这些专科住院医生领导2例模拟心脏骤停病例，这些病例最初是为内科住院医生设计的，案例经过改编以更好地反映NCC患者群体。干预后立即进行课程后知识和信心评估，并在1至4个月后再次进行评估。比较课程前、干预后立即以及延迟后的信心和知识评估结果。
13名NCC专科住院医生参与了该研究。缺乏复苏领导经验以及未预先被指定为复苏领导者角色是被提及最多的领导复苏的障碍（n = 8/13，61.5%）。分别有38.5%（n = 5/13）和22.2%（n = 2/9）的参与者将缺乏信心和缺乏知识视为障碍。干预后立即评估时，信心和知识得分均有所提高（5点李克特量表中位数[四分位间距]3.5[3.1 - 3.9]对4.1[4.0 - 4.7]，P = 0.005；均值[标准差]69.8%[8.8%]对88.5%[7.6%]，P = 0.004）。在干预后立即和延迟评估之间未观察到信心或知识衰退（4.1[4.0 - 4.7]对4.1[3.2 - 4.4]，P = 0.50；91.7%[6.8%]对81.3%[8.0%]，P = 0.08）。
共享模拟培训提高了学习者在心脏骤停复苏领导方面的信心和知识，并且在其他模拟场景中可能也会产生类似的益处。超过三分之一的NCC专科住院医生将低信心视为复苏领导的障碍，而简短的模拟培训改善了这一情况。
