Abstract TP237: Simulation: A Novel Modality for Improving Physician Knowledge and Confidence with recombinant tissue-type Plasminogen Activator for Acute Ischemic Stroke

Abstract

Background: Intravenous recombinant tissue-type plasminogen activator (rtPA) is the only FDA approved non-invasive medical treatment for restoring brain perfusion in acute ischemic stroke (AIS) patients, however many neurology residents will graduate with little or no experience in its use. rtPA for AIS is underutilized, in part, due to lack of physician experience and training. Inappropriate use of rtPA leads to more frequent, potentially deadly complications. Simulation is an ideal educational modality for increasing physician knowledge, skill, and experience with the management of AIS without risk to patients. Methods: 23 physicians (13 neurology, 10 emergency medicine) were interviewed to identify and prioritize learning objectives for AIS management with respect to intravenous rtPA use. A comprehensive curriculum consisting of case discussions, a standardized patient encounter, and both high and low fidelity simulated patient scenarios were designed around these objectives in the format of a half-day simulation workshop. A pilot workshop was used to refine the curriculum. Entrance and exit surveys were administered to measure changes in knowledge, skills, and attitudes. The use of rtPA for AIS was tracked before and after the intervention. Results: To date, 17 neurology and emergency medicine residents have completed the workshop. All trainees reported significantly increased confidence in AIS patient selection and management with rtPA, including its potential complications. Intravenous rtPA use increased by 75% in the 7 months after residents began participating in the workshop (no protocol violations). This increase has persisted at 13 months after the initial simulation. Conclusions: Medical simulation is an effective educational modality for the training of physicians in management of AIS and shows great promise to favorably impact physician practice and AIS patient outcome.