Prepare first-year neurology residents to lead stroke alerts (SA) through a high-fidelity simulation using crisis-resource management (CRM) principles, a framework developed to help teams organize safe and effective care during emergencies.

Incoming residents at a large comprehensive stroke center are tasked with running SAs as early as their first day. We sought to better prepare them by creating a team-based simulation applying CRM principles including leadership designation, role clarity, communication, resource mobilization and workload distribution, while improving confidence and fostering professionalism.  

We created a scenario in which a standardized patient (SP) presented to the emergency department (ED) with an acute ischemic stroke and large vessel occlusion, within both the thrombolytic and mechanical thrombectomy windows. Roles included EMS, ED nurse, pharmacist, radiologist, CT technician, stroke fellow, endovascular team, anesthesia, SP and family member.  Residents were provided pre-learning materials and completed NIHSS and mRS certification. They completed pre- and post-assessments evaluating knowledge along with Likert scale questions gauging learner comfort and confidence navigating various aspects of the SA. Gather-Analyze-Summarize (GAS) methodology was utilized to debrief learners alongside team members participating in the scenario. Simulations will continue until completed by all PGY2 and some PGY1 residents.

Preliminary results indicate that self-reported comfort with navigating workflow, team dynamics, performing as designated leader, communicating with patient and family, and team members all increased on Likert (scale 1-5) after the simulation (n=5). Residents rated the simulation a 4.6 in usefulness, enjoyment, and willingness to participate in another simulation. Post-testing results did not demonstrate increase in knowledge of NIHSS or intervention exclusion criteria.

High-fidelity SA simulation implementing CRM is feasible and enhances comfort of neurology residents acting as leaders of a large multidisciplinary team. This pilot data will help guide further development of our neurologic emergencies curriculum to optimize transition into neurology training.