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September 2022; 1 (1) Research ArticleOpen Access

Curriculum Innovations: How Real Is Real Enough?

A Pilot Study Comparing Standardized Patients vs Manikin Simulators in a Neurologic Emergencies Training Course

Catherine S.W. Albin, Emil Petrusa, James A. Gordon, Deepa Malaiyandi, Sahar F. Zafar
First published September 26, 2022, DOI: https://doi.org/10.1212/NE9.0000000000200004
Catherine S.W. Albin
From the Department of Neurology (C.A.), Emory University School of Medicine, Atlanta, GA; Departments of Surgery (E.P.), and Emergency Medicine (J.A.G.), Massachusetts General Hospital, Harvard Medical School, Boston; MGH Learning Laboratory (E.P, J.A.G), Massachusetts General Hospital, Boston; Department of Neurology (D.M.), University of Toledo, OH; and Department of Neurology (S.F.Z.), Massachusetts General Hospital, Harvard Medical School, Boston.
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Emil Petrusa
From the Department of Neurology (C.A.), Emory University School of Medicine, Atlanta, GA; Departments of Surgery (E.P.), and Emergency Medicine (J.A.G.), Massachusetts General Hospital, Harvard Medical School, Boston; MGH Learning Laboratory (E.P, J.A.G), Massachusetts General Hospital, Boston; Department of Neurology (D.M.), University of Toledo, OH; and Department of Neurology (S.F.Z.), Massachusetts General Hospital, Harvard Medical School, Boston.
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James A. Gordon
From the Department of Neurology (C.A.), Emory University School of Medicine, Atlanta, GA; Departments of Surgery (E.P.), and Emergency Medicine (J.A.G.), Massachusetts General Hospital, Harvard Medical School, Boston; MGH Learning Laboratory (E.P, J.A.G), Massachusetts General Hospital, Boston; Department of Neurology (D.M.), University of Toledo, OH; and Department of Neurology (S.F.Z.), Massachusetts General Hospital, Harvard Medical School, Boston.
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Deepa Malaiyandi
From the Department of Neurology (C.A.), Emory University School of Medicine, Atlanta, GA; Departments of Surgery (E.P.), and Emergency Medicine (J.A.G.), Massachusetts General Hospital, Harvard Medical School, Boston; MGH Learning Laboratory (E.P, J.A.G), Massachusetts General Hospital, Boston; Department of Neurology (D.M.), University of Toledo, OH; and Department of Neurology (S.F.Z.), Massachusetts General Hospital, Harvard Medical School, Boston.
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Sahar F. Zafar
From the Department of Neurology (C.A.), Emory University School of Medicine, Atlanta, GA; Departments of Surgery (E.P.), and Emergency Medicine (J.A.G.), Massachusetts General Hospital, Harvard Medical School, Boston; MGH Learning Laboratory (E.P, J.A.G), Massachusetts General Hospital, Boston; Department of Neurology (D.M.), University of Toledo, OH; and Department of Neurology (S.F.Z.), Massachusetts General Hospital, Harvard Medical School, Boston.
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Citation
Curriculum Innovations: How Real Is Real Enough?
A Pilot Study Comparing Standardized Patients vs Manikin Simulators in a Neurologic Emergencies Training Course
Catherine S.W. Albin, Emil Petrusa, James A. Gordon, Deepa Malaiyandi, Sahar F. Zafar
Neurol Edu Sep 2022, 1 (1) e200004; DOI: 10.1212/NE9.0000000000200004

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Abstract

Background and Objectives Simulation training has been increasingly adopted in neurology as an engaging way to promote active learning in a safe environment while offering a reproducible platform for real-time feedback. However, despite the increase in simulation programs, there remains uncertainty about which type of high-fidelity platform would best promote trainee knowledge and confidence acquisition. The objective of this study is to investigate whether increases in resident knowledge and confidence differ when a simulation course for acute neurology emergencies uses a standardized patient vs a manikin-video format. We also investigated trainees' management deviations from the treatment guidelines.

Methods Over 5 sessions, 20 junior neurology residents participated in a simulation training course in which they managed 3 neurologic emergencies: right middle cerebral artery stroke, status epilepticus, and pontine hemorrhage causing coma. Residents in the standardized patient group interacted with a live actor for the cases in which the patient was conscious. Residents in the manikin-video group interacted with a manikin for all 3 cases. Before and after the course, residents completed a 40-question multiple-choice test and a survey about their self-perceived confidence in handling 15 neurologic emergencies. To create an element of internal validity, 9 items were represented in the course curriculum and 6 were not. During the simulation, a detailed behavior checklist was used to assess decision-making and guideline adherence. All residents answered items about the educational quality of the simulation sessions.

Results Residents had significantly higher scores on the knowledge assessment after the training session (pre: 49% vs post: 72%, p < 0.001, effect size 91%). There was no statistically significant difference between the 2 groups—each increasing 23% (p = 0.977). Regardless of group assignment, the median self-reported confidence score improved by 1 point on a Likert scale across the topics taught in the course. The behavior checklist demonstrated significant variations in treatment practices and provided targeted areas for feedback and teaching.

Discussion This pilot study suggests that trainees' knowledge and confidence in the management of neurologic emergencies increase after simulated encounters, regardless of whether a live actor or manikin simulation platforms is used. The use of a behavior checklist uncovered important variations in guideline adherence among novice physicians.

Glossary

AHA=
American Heart Association;
ASA=
American Stroke Association;
group MV=
manikin with video supplement group;
group SP=
standardized patient group;
ICP=
intracranial pressure;
MCA=
middle cerebral artery;
NeuroICU=
neurologic intensive care unit;
NIHSS=
NIH Stroke Scale;
PGY=
postgraduate year;
tPA=
tissue plasminogen activator

Footnotes

  • Go to Neurology.org/NE for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • Submitted and externally peer reviewed. The handling editor was Roy E. Strowd, III, MD, MEd, MS.

  • Received April 14, 2022.
  • Accepted in final form July 29, 2022.
  • © 2022 American Academy of Neurology

This is an open access article distributed under the terms of the Creative Commons Attribution License 4.0 (CC BY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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