Abstract WP95: Acute Stroke Simulation Training For General Medical Trainees: Busting Clots, Myths And Fears

Abstract

Background: Acute stroke assessment and management is a time critical process. The emergency “stroke call” should include a standardised NIHSS assessment, initial observations and investigations and a decision regarding thrombolysis and thrombectomy. We found this to be daunting for trainees, and it has been documented that physician experience impacts upon door-to-needle time. Aims: The aim of our simulation training was to provide a safe environment to improve the ability and confidence of trainees in leading stroke calls with a view to improving acute stroke care and patient access to revascularization therapies. Method: We designed a one-day simulation course aimed at internal medicine trainees who are expected to lead stroke calls currently or in the immediate future. The candidates are surveyed to establish baseline confidence and complete questionnaires to assess knowledge about managing acute strokes. Here we present data from the first 18 attendees. The course is led by stroke consultants, assisted by members of the multidisciplinary team, including medical trainees, stroke specialist nurses and a paramedic. Alongside structured seminars, simulated acute stroke scenarios lead each candidate through patient handover, assessment, investigation and management decisions followed by a structured debrief. Clinical results, equipment and live monitoring are used to increase the fidelity of the simulation. Results: The course improved candidates' confidence in leading a thrombolysis call from a mean of 2.83/10 to 7.11/10, found to be statistically significant on Paired T-Test(t=9.69, p=<0.0001). Furthermore, the candidates’ acute stroke management quiz scores rose from a mean of 5.67/10 to 8.17/10 (t=5.28, p=<0.0001). Qualitative feedback included: “Good broad interactive session on a subject we get limited teaching on” and “Fantastic, clinically relevant course. I feel much more confident to attend thrombolysis calls now”. Conclusions: Simulation is an established staple of acute medical education, and has a demonstrable benefit when applied to acute stroke management training. We propose that this opportunity should be widely available if not mandatory to internal medical training.