Can a brief stroke simulation course help junior doctors perform as well as senior trainees?

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Simulation bootcamps are used to onboard neurology trainees, but whether they produce competency in acute ischemic stroke (AIS) was unknown.

This prospective, single-center pre-post educational intervention study used the Angoff standard setting method to determine a Minimum Passing Score (MPS) and a Mastery Score for 2 AIS simulations. Junior neurology residents completed precourse knowledge and confidence assessments and received traditional didactic teaching. A week later, each resident completed the first scored AIS simulation. Each then practiced stroke care in an unscored simulation. Two to 8 weeks later, each resident was evaluated in an unannounced AIS simulation, the post-test.

Senior residents in postgraduate year (PGY)-3 adult neurology also completed a knowledge and confidence assessment, but were scored only on the AIS post-test case. The abstract reports using independent and paired t tests, respectively, to compare junior residents’ retention-test performance with their baseline assessment and with senior residents’ performance.

Thirteen junior residents participated: 9 PGY-2 adult neurology residents and 4 PGY-3 child neurology residents. Initially, only 3 juniors (23%) achieved the MPS in the first AIS simulation. After the course, 9 juniors (69%) achieved the MPS threshold. No junior achieved mastery. Their mean simulation performance score increased from 10.3 (SD 2.8) before the intervention to 15.7 (SD 2.6) afterward (p < 0.001). Their mean confidence score increased from 3.3 (SD 1.9) to 4.9 (SD 1.2; p < 0.001, d = 1.7).

Eight PGY-3 adult neurology residents were scored on the AIS post-test. Five reached the MPS (63%), and 1 demonstrated mastery. Postcourse simulation scores were similar for juniors and seniors: mean 15.7 (SD 2.6) versus 16.0 (SD 2.5), respectively (p = 0.793).

The authors conclude that a brief AIS simulation course may improve junior residents’ performance and confidence to a level comparable with senior residents, although not to mastery.