Incorporating Simulation Technology Into a Neurology Clerkship

Abstract

Simulation-based medical education is growing in use and popularity in various settings and specialties. A literature review yields scant information about the use of simulation-based medical education in neurology, however. The specialty of neurology presents an interesting challenge to the field of simulation-based medical education because of the inability of even the most advanced mannequins to mimic a focal neurologic deficit. The authors present simulator protocols for status epilepticus and acute stroke that use a high-fidelity mannequin despite its inability to mimic a focal neurologic deficit. These protocols are used in the training of third- and fourth-year medical students during their neurology clerkship at Penn State College of Medicine. The authors also provide a review of the pertinent literature.

Credibility, Replicability, and Reproducibility in Simulation for Biomedicine and Clinical Applications in Neuroscience

“…Currently, even the most advanced mannequins and computer-generated simulations have very limited capacity to produce a realistic focal neurological deficit or combination of signs and symptoms. Design and implementation of SBME tools is especially challenging in brain disease due to the complexity of the brain, and the variety of its responses to insult ( Chitkara et al, 2013 ; Ermak et al, 2013 ; Fuerch et al, 2015 ; Micieli et al, 2015 ; Konakondla et al, 2017 ). This complexity suggests that back-end multiscale modeling would be particularly valuable in SBME development for brain disease.…”

New Media, Technology and Neurology Education

“…NeuroLearn-online education courses offered by the American Academy of Neurology, with continuing medical education credits available 15 Computer-based teaching modules Neurological Exam Rehearsal Virtual Environmentcomputer-based virtual patient system to teach cranial nerve disorders to medical students 16 Electromyography multimodality module for residents and fellows, for independent study or to complement live training 18 Classroom/e-learning hybrids Flipped curricula Electroencephalopathy video-based lectures to complement live teaching in residency 19 Electroencephalopathy podcasts to complement live teaching in residency 21,22 Adjunctive tools external to classroom teaching High-fidelity simulations Simulations in acute stroke and status epilepticus for 3rd and 4th years medical students 23 Simulations in emergency neurology and critical care for fellows 25 Simulation in brain death determination 26 Adjunctive tools internal to classroom teaching…”

“…Outside of well-described learning approaches such as the flipped classroom, the integration of technology-based education into a learning environment requires more deliberation. For example, Ermak et al 23 developed live training simulations for third-and fourth-year medical students in a neurology clerkship using the scenarios of acute stroke and status epilepticus. The group designed this intervention as a required component of the curriculum, as it ensures that students gain experience in key clinical scenarios that they may not otherwise encounter due to heterogeneity of exposure in clinical rotations.…”

“…10,11 The wide variety of technology-assisted interventions in neurology education has been summarized previously. 12 These can be placed on a spectrum based on their relationship to traditional teaching methods, ranging from fully independent computer-based curricula as in massive open online courses (MOOC), 13,14 continuing education online curricula 15 or computer-based teaching modules; [16][17][18] classroom/e-learning hybrids as in the flipped model; [19][20][21][22] adjunctive tools external to classroom teaching as in highfidelity simulations; [23][24][25][26] adjunctive tools internal to classroom teaching as in audience response systems; 27 to adjunctive tools independent of classroom teaching as in web- 28 or mobile-based applications 29,30 (►Table 1). Due to the diversity of applications, it is difficult to establish general principles for using technology in medical education, especially to address the challenges described.…”

“…However, it may be possible to identify "minimum" standards that can be adopted by the general front line educator, which is the goal of this article. We do this by examining the commonalities of several technological applications that have stood out for high impact to neurology education, including computer-assisted learning in UME and CME, 16,21,22 high-fidelity simulation in GME, [23][24][25][26] and flipped neurology curricula in UME and CME. 33,34 Based on these exemplary neurology educational endeavors, we suggest the following recommendations for applying technology effectively to medical education in general: (1) match technology to predetermined educational objectives, (2) characterize learners in relationship to technology, (3) optimize how technological components fit into the learning environment, (4) monitor and manage learner engagement with technology, (5) perform cost analyses, and (6) explore opportunities for educational scholarship and research (►Table 2).…”