To describe the feasibility and acceptability of a flipped classroom/simulation experience to teach neurology clerkship students a systematic approach to altered mental status (AMS) and to describe behavior trends in the pilot cohort.

It is paramount that clerkship students develop a framework for the workup and initial management of the altered patient. In the flipped classroom model, students review material in advance of an experiential learning experience like simulation, which allows the facilitator to assess the students’ the application of knowledge and can be leveraged to address gaps in knowledge or performance. 

Seventy-nine neurology clerkship students were assigned the self-paced module on altered mental status to review in the first two weeks of their clerkship. There were 40 simulated encounters over 6 dates in which students worked in pairs to elicit a history and perform a screening neurologic exam on a standardized patient that had been brought to the emergency department for “confusion” (personality changes and aphasia). A behavior checklist was completed by the faculty observers during the students’ simulations. Students anonymously completed a modified Simulation Effectiveness Tool after the simulation.

Forty-seven students (59.4%) completed the evaluation survey. Student performance during the simulation revealed that students often did incomplete mental status assessments (rarely evaluating attention or language). Many students (89%) agreed that the course helped them develop a better understanding of the approach to altered mental status. Most of students (98%) agreed that “debriefing contributed to their learning” and that “the simulation was an effective way to reinforce the approach to a patient with AMS.” 

A flipped classroom/simulation curricula emphasizing the approach to AMS revealed that medical students infrequently do a thorough mental status exam. Students nearly all agreed that simulation was an effective strategy to reinforce the importance of a systematic approach to AMS.