Tchopev Zahari N, Nelson Alexis E, Hunninghake John C, Cacic Kelsey, Cook Melissa K, Jordan Morgan C
From the Department of Neurology (Z.N.T., A.E.N., K.C., M.K.C., M.C.J.) and Department of Critical Care Medicine (J.C.H.), Brooke Army Medical Center, Ft. Sam-Houston, TX.
Neurol Educ. 2022 Nov 15;1(2):e200022. doi: 10.1212/NE9.0000000000200022. eCollection 2022 Dec.
INTRODUCTION & PROBLEM STATEMENT: The matriculation from internal medicine to neurology residency can be challenging. The most cogent approach to address this transition has yet to be identified. Studies show that simulation is highly effective at reinforcing knowledge and skills while improving learner confidence. We present the design and outcomes of an annual acute neurology simulation program.
We hypothesized that incoming neurology residents would (1) report improved confidence with managing acute neurologic emergencies, (2) cite a high degree of educational value with the program, and (3) demonstrate improvement in their technical knowledge.
METHODS & CURRICULUM DESCRIPTION: Our military, level 1 trauma institution's simulation laboratory and staff were used to develop and execute simulations for rising neurology residents based on the Accreditation Council for Graduate Medical Education neurology milestones. Three simulations were designed including a case of acute ischemic stroke (AIS), status epilepticus (SE) in an austere environment, and brain death evaluation with family counseling. Residents completed matched pre- and post assessments to gauge confidence, technical knowledge, and perceived educational value.
RESULTS & ASSESSMENT DATA: Over 3 years, 15 rising neurology residents from 2 training programs completed 3 high-fidelity acute neurology cases. Self-reported confidence with acute neurology skills improved after each simulation. Confidence ratings included assessing for and identifying contraindications to tissue plasminogen activator, identifying AIS, identifying clot retrieval candidates, identifying clinical and electrographic SE, diagnosing and treating SE, identifying contraindications to and confounders of brain death diagnosis, performing the examination, and delivering bad news to families (all < 0.05). Technical knowledge also statistically improved in the stroke ( = 0.046) and brain death simulation ( = 0.039), but not the SE simulation ( = 0.296). Participants reported an average perceived personal value of 4.8, 4.3, and 4.7 (out of a maximum of 5) for AIS, SE, and brain death simulations, respectively.
DISCUSSION & LESSONS LEARNED: High-fidelity simulation of neurologic emergencies enhances confidence and knowledge of rising neurology residents. Satisfaction with the simulation cases was high. Academic hospitals can consider incorporating acute neurology simulations into their residency training.
从内科过渡到神经科住院医师阶段可能具有挑战性。解决这一过渡问题的最有效方法尚未确定。研究表明，模拟在强化知识和技能的同时提高学习者信心方面非常有效。我们介绍了一项年度急性神经科模拟项目的设计与成果。
我们假设即将入职的神经科住院医师会（1）报告在处理急性神经科急症方面信心增强，（2）认为该项目具有很高的教育价值，（3）在技术知识方面有所提高。
我们利用军队一级创伤机构的模拟实验室和工作人员，根据研究生医学教育认证委员会神经科的里程碑，为即将入职的神经科住院医师开发并执行模拟。设计了三个模拟案例，包括一例急性缺血性中风（AIS）、在严峻环境下的癫痫持续状态（SE）以及伴有家属咨询的脑死亡评估。住院医师完成了匹配的课前和课后评估，以衡量信心、技术知识和感知到的教育价值。
在3年时间里，来自2个培训项目的15名即将入职的神经科住院医师完成了3个高保真急性神经科案例。每次模拟后，自我报告的急性神经科技能信心均有所提高。信心评级包括评估和识别组织型纤溶酶原激活剂的禁忌症、识别AIS、识别血栓取出术候选人、识别临床和脑电图SE、诊断和治疗SE、识别脑死亡诊断的禁忌症和混淆因素、进行检查以及向家属传达坏消息（所有P<0.05）。中风（P = 0.046）和脑死亡模拟（P = 0.039）中的技术知识在统计学上也有所提高，但SE模拟中未提高（P = 0.296）。参与者对AIS、SE和脑死亡模拟的平均感知个人价值分别为4.8、4.3和4.7（满分5分）。
高保真模拟神经科急症可增强即将入职的神经科住院医师的信心和知识。对模拟案例的满意度很高。学术医院可考虑将急性神经科模拟纳入其住院医师培训。
