Improving PM&R Resident Knowledge and Confidence About Autonomic Dysreflexia in Inpatient Spinal Cord Injury Patients

Abstract

Research Objectives To improve Physical Medicine & Rehabilitation (PMR) resident medical knowledge and confidence in diagnosing and treating Autonomic Dysreflexia (AD) in Spinal Cord Injury patients admitted to an acute inpatient rehabilitation unit. Design Pre-test-post-test design. Setting MR Residency Program at an academic medical center. Participants 24 PM&R residents. Interventions Residents received simulation training on AD in 4 different clinical presentations using separate high-fidelity manikins in a small (3-4) group setting followed by 1 hour of didactic session on AD on a separate date. Main Outcome Measures Resident confidence on diagnosis and treatment of AD measured using a pre- and post-test survey. Responses were scored using Likert scale with 1 being “not at all confident” and 5 being “very confident”. Results For the six PGY-2 residents, a comparison of survey results before simulation and after simulation yielded significant increases in the confidence of their responses to each question asked (except the question regarding understanding of the pathophysiology of autonomic dysreflexia). In a post simulation comparison of survey responses between PGY-2 residents and senior resident there was no significant difference in the confidence of responses between the different resident levels. Conclusions Our study demonstrates the benefits of utilizing simulation training to improve clinical confidence through simulated application of trainee medical knowledge. The lack of significant difference in confidence level in the post stimulation survey responses between PGY-2 and senior residents highlights the value of simulation training for new trainees in orienting them to medical management of AD. High-fidelity manikins are an innovative and interactive educational tool that should be used to augment standard didactic and bedside teaching. Author(s) Disclosures None. To improve Physical Medicine & Rehabilitation (PMR) resident medical knowledge and confidence in diagnosing and treating Autonomic Dysreflexia (AD) in Spinal Cord Injury patients admitted to an acute inpatient rehabilitation unit. Pre-test-post-test design. MR Residency Program at an academic medical center. 24 PM&R residents. Residents received simulation training on AD in 4 different clinical presentations using separate high-fidelity manikins in a small (3-4) group setting followed by 1 hour of didactic session on AD on a separate date. Resident confidence on diagnosis and treatment of AD measured using a pre- and post-test survey. Responses were scored using Likert scale with 1 being “not at all confident” and 5 being “very confident”. For the six PGY-2 residents, a comparison of survey results before simulation and after simulation yielded significant increases in the confidence of their responses to each question asked (except the question regarding understanding of the pathophysiology of autonomic dysreflexia). In a post simulation comparison of survey responses between PGY-2 residents and senior resident there was no significant difference in the confidence of responses between the different resident levels. Our study demonstrates the benefits of utilizing simulation training to improve clinical confidence through simulated application of trainee medical knowledge. The lack of significant difference in confidence level in the post stimulation survey responses between PGY-2 and senior residents highlights the value of simulation training for new trainees in orienting them to medical management of AD. High-fidelity manikins are an innovative and interactive educational tool that should be used to augment standard didactic and bedside teaching.