To determine if near-peer debriefing results in resident performance outcomes that are non-inferior to those of residents debriefed by experienced faculty educators in a simulated status epilepticus case.

Limited faculty time is a barrier to implementing simulation training in neurology. Using near-peer facilitators has been proposed as a strategy to mitigate this challenge. However, whether learners debriefed by near-peers have similar outcomes to those debriefed by faculty is a gap in the literature.

This is a pre-specified interim data analysis of a multicenter, randomized control trial. Participants were junior neurology residents (adult PGY2 or pediatric PGY3) recruited from four academic centers. Following pre-briefing, residents’ performance was measured on a critical action checklist from a previously reported simulated status epilepticus case (the “pre-test”). Participants were randomized to receive one-on-one debriefing by a near-peer (intervention group) or faculty member (control group) using Debriefing with Good Judgement. Participants engaged in distraction learning before managing a second case of simulated status epilepticus (the “post-test”). The primary outcome was the change in percent of critical actions completed correctly from the pre- to the post-test.

Sample size calculation yielded a required 46 participants for 80% power to detect non-inferiority with a margin of 10%. After one year of recruitment, 27 junior neurology residents were enrolled. After debriefing, participant performance improved by 6.4% (p=0.011) in the intervention group and by 11.5% (p<0.001) in the control group. The improvement in performance in the intervention group was not non-inferior to the improvement in the control group (difference of the means 5.1%, CI -11.8% - 1.6%).

Improvement in checklist-based performance fostered by near-peer debriefers was not non-inferior to improvement fostered by faculty debriefers. The interim analysis is likely underpowered to detect non-inferiority; enrollment is ongoing. Our methodology, investigation, and analysis may inform future multicenter randomized control trials in neurology education.