Stroke Simulation: A Case Study in Simulation in Medicine

Stroke Simulation: A Case Study in Simulation in Medicine

Residents on call with a stroke code

Overhead page: "Code Stroke, ED Alpha Room Seven, Code Stroke..."

It's your first night on call in the hospital as a neurology resident. You hear this page calling while you're in the room with another patient. What do you do?

The Emergency Department team members are moving along in a well-choreographed dance, and yet, they're looking to you, the neurologist, to be conductor and leader in this acute emergency. 

Residents often feel panicked in response to their first stroke code:

"This is a high stress situation."

"It's scary to be alone at night."

As a teacher, how do we equip residents to avoid panic and give the right care in this scenario?

Acute stroke codes are challenging for several reasons:

  • Very sick patient
  • Large number of team members involved in the care of one patient
  • Complex medical decision making
  • Time-sensitive treatments to prevent disability are available
  • Rapid decision making required to deliver this time sensitive medication
  • Multiple factors in patient history, exam, radiologic studies needed to make a decision for treatment

Training residents before they meet real patients

Simulation has been used in medical education for several decades. As technology and educator skills have improved, so has the ability for simulations to enhance and complement more traditional didactic teaching sessions.  With this background and thanks to the opportunities available on campus, we at the Stanford Stroke Center were able to institute a new training program using the resources at the Goodman Immersive Leaning Center.  I was the principal investigator.

We spent three months to develop the course, first creating the scenario using data from prior real-life cases, then meeting the simulationist team and reviewing the scenario with them.  Finally, a stroke neurologist trained an actor to play a standardized patient.

Here's what happened in the actual scenario:

  1. A stroke nurse interacted with trainees and carried out nursing duties.
  2. 15 residents attended two separate 4-hour training sessions with 2 different clinical scenarios.
  3. During each scenario, the residents communicated with a faculty neurologist and nurse.
  4. We debriefed the residents after each scenario to highlight key learning points from the scenario, review the goals and objectives.
  5. Trainees completed evaluations and knowledge assessments after the simulation.

Each scenario we ran took 45 minutes, plus additional time for discussion before and after the scenario.

Feedback and assessment

The simulation worked for the trainees.  They said:

“Having a real life actor was really helpful to learn how to act quickly during an emergency.”

“Realistic situation without risk--this is great for learning.”

Trainees also demonstrated 80-90% accuracy in the knowledge assessment after the simulation. The questions were focused on the multi-disciplinary teamwork, communication and neurology exam skills required to make a good clinical decision.

Everyone agreed that this program should continue. In fact, the first two years of this program was so successful that we're now looking to expand this program to include other neurological emergencies.

Have you used simulation exercises for hands-on learning? Please comment below!