Mary Anderson, MD*1;Veronica Baiamonte, BA1;Stephanie Cradick, DNP, RN, CNS, ACNS-BC, CCNS, PCCN1;Nicole Friesen1;Margaret Sande, MD2;Jennifer R. Simpson, MD1 and Dr. Darlene Tad-y, MD1, (1)University of Colorado Anschutz Medical Campus, Aurora, CO, (2)University of Colorado School of Medicine, Aurora, CO

Meeting: Hospital Medicine 2017, May 1-4, 2017; Las Vegas, Nev.

Abstract number: 21

Categories: Education, Innovations Abstracts

Keywords: , , ,

Background:  The Society of Hospital Medicine considers stroke care to be a core competency in hospital medicine.  Hospitalists must be prepared to lead inpatient stroke alerts, as neurologists may not be readily available outside of academic medical centers.  However, even graduates of hospitalist training programs may report insufficient experience in leading these complex, time-pressured, high-stakes clinical encounters.  In our Hospitalist Training Program, residents traditionally complete two 4-week Consult/Neuro rotations over their PGY2 and PGY3 years, in which they assist the neurology team during stroke alerts.  However, a focused needs assessment of recent graduates indicated that more hands-on stroke alert training would have been particularly beneficial.

Purpose:  Describe an interprofessional stroke alert simulation curriculum as an innovative educational strategy for hospitalist trainees.

Description:  We developed stroke alert simulation sessions, which were held 5 separate times over academic year 2015-2016 at the simulation center on campus.  PGY3 residents were required to complete online National Institutes of Health Stroke Scale (NIHSS) certification prior to the simulation sessions.  They participated in two 30-minute inpatient scenarios with NP/PA fellows, pharmacy residents, a standardized patient, and a nurse confederate.  The first scenario involved a patient admitted with a transient ischemic attack that subsequently developed a right middle cerebral artery stroke.  The second scenario involved a patient with a posterior circulation stroke after a total knee arthroplasty.  Each simulation was followed by a structured debriefing session with interprofessional faculty.  On a 5-point Likert Scale (1 = strongly disagree to 5 = strongly agree), residents and NP/PA fellows (n=11) reported greater confidence in their ability to elicit a focused history in a patient with suspected stroke (3.2 to 4.1), accurately perform the NIHSS (2.5 to 3.8), and initiate the appropriate evaluation for acute ischemic stroke (3.4 to 4.2) as a result of the educational intervention.  They better understood the indications and contraindications for IV tPA (3.5 to 4.3) and felt more comfortable explaining its risks and benefits to patients and families (2.1 to 4.2).  Overall, they agreed that simulation training was a valuable educational experience (4.9) and that it would enable them to function more effectively on an interprofessional stroke team (5.0) in the future.

Conclusions:  While stroke simulation scenarios exist for neurology and emergency medicine trainees, to our knowledge, none have been specifically designed for hospital medicine providers.  Our results suggest that our learners found the deliberate practice and self-reflection in a safe, controlled environment to be an effective way of enhancing their knowledge and skills around stroke alerts.

To cite this abstract:

Anderson, M; Baiamonte, V; Cradick, S; Friesen, N; Sande, M; Simpson, JR; Tad-y, D . INTERPROFESSIONAL STROKE ALERT SIMULATIONS FOR HOSPITALIST TRAINEES. Abstract published at Hospital Medicine 2017, May 1-4, 2017; Las Vegas, Nev. Abstract 21. Journal of Hospital Medicine. 2017; 12 (suppl 2). Accessed January 20, 2020.

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