Abstracts

Rationale: Optimizing understanding and cooperation between medical specialties and departments ultimately improves quality of care for patients. We sought to develop an educational and collaborative framework for seizure management in the emergency room between the Neurology and Emergency Medicine (EM) departments at four academic hospitals within the Mount Sinai Health System. This included developing a joint Neurology-EM seizure curriculum, formulating a set of guidelines for seizure management across the hospitals, and addressing gaps in care in the acute setting.

Methods: The curriculum on seizure management was developed by an epileptologist, a neurology resident, an EM attending and an EM resident. The same training was delivered to two Neurology residency programs (Mount Sinai Hospital and Mount Sinai West) and two EM residencies (Mount Sinai Hospital and Mount Sinai West/Morningside). The curriculum consisted of a lecture and an EM oral boards style interactive session of four cases. The lecture focused on basic definitions as well as management of first-time seizures, breakthrough seizures, status epilepticus, and nonepileptic events. The cases that followed directly corresponded to these scenarios. The lecture was delivered by either a resident or an attending. Cases were facilitated in small groups by a neurologist and an EM doctor jointly. Those facilitating the small groups were trained by the authors of the program on the highlights of each case. A pre-post exam with eight graded questions (1 point for each question) was given to assess basic seizure management knowledge before and after the educational program. We also assessed participant confidence in seizure management (“not at all”, “somewhat”, or “definitely”). Statistical comparison of pre-test and post-test groups was performed using the Mann-Whitney U and Chi-square tests.

Results: The program received a positive response at all sites. Multiple participants reported that they wished other education programs were as collaborative and interactive. The mean pre-test score (n = 92) was 3.6 and the mean post-test score (n = 36) was 5.2 (p < .0001). Of the pre-test respondents, 14% “definitely” felt confident in seizure management as compared to 39% of post-test respondents, and 16% of pre-test respondents felt “not at all” confident as compared to 3% of post-test respondents (p = .003).


Conclusions: An interdepartmental Neurology-EM program for seizure management in the emergency room was collaboratively constructed and successfully executed across multiple hospitals in the Mount Sinai Health System. A key aspect of this initiative was the development of an educational curriculum disseminated to both EM and Neurology residency programs. After completing the module, participants performed better on the assessment and felt more confident in their ability to manage seizures. The authors believe that patient care requires a shared knowledge base amongst multiple departments and that this model may be of use for multiple resident education initiatives.


Funding: None.