Editors' Note: Simulation-Based Assessment of Graduate Neurology Trainees' Performance Managing Acute Ischemic Stroke. (17th May 2022)

• Record Type: Journal Article
• Authors: Ganesh, Aravind; Galetta, Steven
• Editors: Galetta, Steven; Ganesh, Aravind; Lewis, Ariane; Siegler, James E.
• Is Part Of: Neurology. Volume 98:Number 20(2022)
• Page Start: 862
• Page End: 862
• Publication Date: 2022-05-17
• Subjects: Neurology -- Periodicals; Neurology -- Periodicals; Neurologie -- Périodiques; 616.8
• DOI: 10.1212/WNL.0000000000200692
• Languages: English
• ISSNs: 0028-3878

Abstract

Abstract : In a prospective, observation, single-center simulation-based study, Dr. Pergakis et al. assessed the performance of 53 trainees (including 31 graduate neurology trainees) and 5 attending physicians, independently of a multidisciplinary stroke team, in the management of a mock patient involving acute ischemic stroke, tissue plasminogen activator (tPA)–related hemorrhage, and cerebral herniation syndrome. They found that graduate trainees performed well in the initial management of acute ischemic stroke but frequently made errors in the treatment of hemorrhagic transformation after thrombolysis—with only 55% reversing tPA according to guidelines—suggesting the need for more education for this low-frequency but high-acuity event. In response, Dr. Das notes that the Laerdal SimMan 3G mannequin used in this study is unable to demonstrate sensorimotor deficits, limiting its fidelity in stroke simulation, and indicating a potential role for more innovative mannequins or alternative approaches like immersive virtual reality. He also suggests that periodic assessment with high-fidelity simulations, similar to those used for advanced cardiac life support certification, should be considered in the maintenance of stroke scale certifications. Noting that there were disparities in performance of specific critical action items, he suggests using peer coaching strategies in which neurology trainees work closely with their critical care counterparts. Responding to these comments, the authors add that few trainees performed a comprehensive neurologic examination in their study, potentially in part due to limitations in current simulation technology in assessing the neurologic examination. They also suggest that innovative technologies like improved robotics, haptic feedback, or virtual reality–based simulation may help bridge the gap for teaching more nuanced aspects of the bedside stroke assessment like the HINTS (head impulse, nystagmus, test for skew) examination for posterior circulation stroke. This exchange highlights both the potential for simulation to enhance training and assessment in neurology and the limitations of conventional simulation technology in replicating key aspects of the neurologic bedside assessment. It will be interesting to track technological advancements in this educational space in the coming years.