Abstract TP375: Using Simulation to Improve Medical Student Knowledge and Comfort in Early Management of Acute Stroke

Abstract

Introduction: Given the narrow time window, high acuity, and growing complexity, medical student experience with early management of acute stroke (EMAS) is often limited. However, all medical students need experience recognizing and treating acute stroke regardless of their eventual specialty. Simulation-based education has been demonstrated to improve knowledge acquisition without compromising patient safety. We utilized simulation as part of an educational quality improvement initiative to address a gap in medical student experience and comfort in EMAS. Methods: In the 2017-2018 academic year, 104 third year medical students participated in stroke code simulation during the neurology clerkship. Stroke fellows led groups of ten students through two cases: right M1 occlusion requiring intravenous alteplase (IV tPA) and mechanical thrombectomy (MT) and left thalamic intracerebral hemorrhage complicated by status epilepticus. In each case, students identified and triaged stroke syndromes, performed the NIH Stroke Scale, interpreted CT and CTA images, and formulated treatment plans utilizing IV tPA and MT as well as blood pressure and antiepileptic medications. All participants completed pre- and post-simulation tests targeting clinical knowledge of EMAS (score range 0-7). Additionally, 45 students completed an anonymous post-simulation survey on subjective feelings of confidence managing acute stroke and seizure (Likert scale of 1-5). Results: Mean EMAS test score improved from 4.85 (SEM 0.089) pre-simulation to 5.25 (SEM 0.101) post-simulation (p<0.01). Students demonstrated significant improvement on questions assessing the role of supplemental oxygen in EMAS (p<0.01) and lacunar stroke syndromes (p<0.05). Subjectively, 77.8% of participants reported that simulation was the best form of acute stroke instruction they received, and 73.4% agreed or strongly agreed that the simulation improved their level of comfort with EMAS. Conclusion: Simulation improved medical student knowledge and level of comfort with EMAS. All medical school graduates should be trained to recognize signs and initiate management of acute stroke.

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