Abstract W P195: Standardized Patient Simulation Can Be Incorporated Into Emergency Medicine Resident Training on Performance of the National Institutes of Health Stroke Scale

Abstract

Introduction: The National Institutes of Health Stroke Scale (NIHSS) quantifies physical impairment caused by stroke. Emergency Medicine (EM) physicians must be competent to perform the NIHSS as scale cut points are utilized to identify patients with acute ischemic stroke who may be candidates for thrombolytic therapy. Simulation is a teaching method that integrates imitation of real life scenarios into educational exercises. This study discerned if standardized patient simulation can be adopted into an educational exercise aimed at training EM residents to adequately perform the NIHSS. Methods: This preliminary study was completed with EM residents, in various years of training, from a single academic center. All residents attended a lecture on performance of the NIHSS. Each resident then performed the NIHSS on 2 patients with chronic, fixed neurological deficits. Residents were observed by a NIHSS certified healthcare professional who gave immediate feedback on examination technique. Data was analyzed with basic statistics using means and standard deviations (± SD). Results: Twenty eight EM residents, 7 NIHSS certified healthcare professionals (1 Neurologist, 5 Neurology residents, 1 nurse), and 7 patients participated in the trial. Mean certifier NIHSS score of patients was 2.7 (SD ±1.6). Resident score exactly correlated with certifier score in 11/56 examinations (20%), was within ±2 points of the certifier score in 28 examinations (50%), and within ±3 or 4 in 17 examinations (30%). Average time to complete one patient examination was 5 minutes 36 seconds (SD ±1 min 3 sec). In a post exercise survey, all residents rated this training experience as being beneficial to their medical training. Conclusions: An educational format incorporating didactic and return demonstration aimed at training a large group of EM residents to competently perform the NIHSS is practical. Immediate feedback on examination technique and a relatively short time to complete the educational exercise are advantages of this format compared to on-line training modules often used to educate physicians. Further refinement of this exercise is necessary before it can be used for the purpose of NIHSS certification.