Title : Teaching neurological emergencies through simulation
Abstract:
Introduction: Simulation is considered an effective teaching strategy for medical students. In literature, neurology-themed simulation remains limited and less prominent in comparison to other specialties. Simulation provides students a chance to emulate real-world scenarios they will encounter in their clinical practice in a safe environment. High-fidelity simulation aims to replicate these real world situations through replication of the environment and resources that are available.
In UK medical schools, a phenomenon of ‘neurophobia’ has been coined by medical educators, with students often expressing fears around neurology. Recognising this challenge, coupled with the knowledge of the benefits simulation provides to medical students, we developed a novel ward-based simulation training programme with a focus on three common acute neurology presentations.
Methods: Scenarios were developed in conjunction with a neurology registrar and utilised current national guidelines. The scenarios were designed to replicate the workings of a hospital, hence required a vast array of equipment. Third-year medical students were recruited to act as the patient and were given a brief. The scenarios were aimed at the foundation year 1 doctor level (equivalent to first year intern) for fifth-year medical students to practice as. Each scenario ran in parallel, with three actors on a mock ward in the simulation centre. We collected a pre-simulation questionnaire asking students about their confidence and skill level in neurological assessment and management on a Likert scale rating. This was compared with post-simulation ratings alongside data collection on comfort and free-text opinions on simulation.
Results: In the first round of simulation, 16 students took part. The Likert scale used considered 1 as strongly disagree and 5 as strongly agree. There was a significant difference in reported confidence in recognising acute neurological deterioration and deficit prior to the simulation (M=2.625, SD=0.93) after the simulation (M=3.875, SD=0.70); t(15)=-5.84, p=0.00003. All students agreed or strongly agreed that simulation is a good way to learn. Further, there was a significant improvement in confidence when managing neurological emergencies before the simulation (M=2.375, SD=0.72) and after the simulation (M=3.8125, SD=0.66); t(15)=-6.45, p=0.00001.
Discussion: Whilst the data set shows improved self-rated confidence in neurological assessment and management, free text reviews suggested students would want more of these simulations in their learning and that it improved their confidence. We tried to create an environment which is true to the UK medical system, with CT scans requiring vetting from on-call radiology and nurses being unavailable to help. In teaching hospitals, ward-based simulation provides increased likeness to working in resource-depleted systems and encourages professionals to rely on bedside examination and tests over imaging and blood results.
The data set is a small sample size and we are continuing to provide this simulation, collecting more data from students. Further, assessing confidence in neurological management when these students start working, sometime after the simulation would provide better quality data on the long-term impact of this teaching. This project is also limited to one centre and would benefit from reaching wider audiences. Further data is required to assess the true impact of ward-based simulation.
