Abstract Details

Title Work-up and Counseling of First-of-lifetime Seizure: A Simulation-based ��ɫ��al Tool and Embedded Learning Results

Topic ��ɫ��, Research, and Methodology

Presentation(s) P2 - Poster Session 2 (11:45 AM-12:45 PM)

Poster/Presentation
Number 7-006

Objective

We created a simulation-based educational tool for adult neurology residents focused on work-up of first-of-lifetime seizure, diagnosis of epilepsy, and key components of treatment plans and counseling. Primary outcomes were six-month embedded learning and confidence in a subgroup of residents who had participated in the simulation compared to those who had not.

Background Though the work-up and counseling of first-of-lifetime seizure is a core milestone in ACGME neurology resident education, current published epilepsy-based simulations are limited to active seizure management.

Design/Methods Simulations were conducted at Columbia University Irving Medical Center, with learning outcomes collected with IRB approval. The 25-minute simulation presented a patient with first-of-lifetime seizure, with further structural and electrographic work-up suggesting a diagnosis of epilepsy, followed by a structured debriefing. A six-month embedded learning survey repeated the simulation case and critical action questions as a brief questionnaire.

Results 12 adult neurology residents participated in the simulation and 10 completed a post-simulation survey. During the simulation, though all residents accurately interpreted the diagnostic results and initiated an anti-seizure drug regimen, only 5/12 delivered a diagnosis of epilepsy to the standardized patient, 6/12 correctly counseled on the importance of regimen adherence and 6/12 on likelihood of seizure recurrence with a single-agent regimen. After debriefing, 9/10 residents reported improved learning and confidence for workup and counseling of first-of-lifetime seizure and diagnosis of epilepsy. In a six-month embedded learning survey, median scores for residents who had participated in the simulation were higher than those who had not (7 vs 5.5 out of 8).

Conclusions Approach to first-of-lifetime seizure is a key educational milestone, and simulations are lacking on this subject. Our simulation showed improved performance among participating residents for ability to diagnose and counsel for a new diagnosis of epilepsy. This simulation is feasible and effective, and may be incorporated to epilepsy curricula for neurology trainees.

Authors/Disclosures
Luke T. Massaro, MD (The Neurological Institute of New York) PRESENTER	Dr. Massaro has nothing to disclose.
Greer Waldrop, MD (UCSF)	Dr. Waldrop has nothing to disclose.
Michelle Bell, MD (New York Presbyterian Hospital, Columbia)	Dr. Bell has nothing to disclose.
Carl W. Bazil, MD, PhD, FAAN (Columbia University)	Dr. Bazil has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Medical Letter . Dr. Bazil has received publishing royalties from a publication relating to health care.
Alison M. Pack, MD, FAAN (Neurological Institute, Columbia University)	An immediate family member of Dr. Pack has received personal compensation for serving as an employee of REGENEXBIO. The institution of Dr. Pack has received research support from National Institutes of Health. Dr. Pack has received publishing royalties from a publication relating to health care.
Shivani Ghoshal, MD (Columbia University Medical Center)	Dr. Ghoshal has nothing to disclose.

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