Assess the impact of a simulation-based mastery learning curriculum on the initial care of patients in status epilepticus

Status epilepticus (SE) is a neurological emergency requiring rapid treatment to reduce associated morbidity and mortality. Current guidelines recommend immediate benzodiazepine administration following SE onset, although studies have shown that treatment is often delayed and inadequately dosed. At academic centers, SE is commonly managed by neurology residents, making dedicated training in SE treatment essential.

A simulation-based mastery learning (SBML) curriculum was implemented at a single large academic center to train PGY-2 neurology residents to identify and treat SE. We retrospectively reviewed SE encounters from 2014–2023, comparing treatment and outcomes of patients treated by neurology residents before (2014–2017) and after (2018–2023) SBML implementation. The primary outcomes assessed were the proportion of patients in SE that received adequate benzodiazepine dosing (1) at initial administration and (2) within 10 minutes of first administration. Dosing adequacy was defined as achieving guideline-recommended thresholds (0.1 mg/kg/dose for lorazepam, maximum 4 mg/dose) or seizure cessation.

122 patient encounters (69 pre-, 53 post-SBML) met inclusion criteria. The majority of cases in both cohorts were managed by PGY-2 neurology residents. Lorazepam was used as the first-line benzodiazepine in nearly all included patients. Following SBML implementation, the proportion of patients receiving adequate first benzodiazepine dosing increased from 8.7% to 28.3% (p = 0.004). The proportion receiving adequate dosing within the 10 minutes following initial administration also increased from 24.6% to 35.8%, although this result did not achieve statistical significance (p = 0.18).

Implementation of a status epilepticus simulation-based mastery learning curriculum improved neurology resident benzodiazepine dosing adequacy during the crucial early treatment window. These findings support the role of simulation-based neurology training and warrant further study with larger cohorts to improve statistical power and investigate other clinically meaningful outcomes.