Abstracts

Rationale: As one of the few true neurologic emergencies, status epilepticus has a relatively well established and widely accepted treatment algorithm. Emergent treatment of this condition can be anxiety provoking for new learners because of the often dramatic presentation and dynamic progression of the condition. Simulation-based learning allows trainees to gain experience in treating acute conditions without the risk of causing harm to actual patients. The use of simulation is being actively used as learning tool in medical specialties such as cardiology and critical care, to develop a learner s clinical skills in simulated critical situations. Currently, limited simulation protocols have been established for acute neurological emergencies, including status epilepticus.Methods: Protocols have been developed utilizing SimSuite software and the SimMan mannequin for status epilepticus for use in the Simulation Center at Mayo Clinic in Arizona. These protocols have been tailored for multiple purposes and incorporate fundamentals of status epilepticus management. The simulation allows for changes in the trainee s decisions to change the clinical outcome. For example, if adverse an adverse drug reaction to intravenous phenytoin was to be simulated, blood pressure parameters would decrease as the drug was being infused. In addition, ACGME Core Competencies have been incorporated into the protocols. An example of this would be having the learner establish code status with a simulated family member (actor) as the patient deteriorates. Pre-simulation and post-simulation surveys are administered to learners to establish effectiveness of the protocols.Results: Initially protocols have been established for objective structured clinical examination (OSCE) evaluation of first and second year neurology residents. The evaluation protocols are approximately 30 minutes in length and are intended to assess resident knowledge/competence. The protocols are then modified to provide an instruction/experience for brand new neurology residents, internal medicine residents, and medical students. These 15 minute protocols are not meant to assess, but to teach. All protocols are followed by two debriefing sessions, one with the trainee (for performance feedback) and one between the instructors and simulation center technicians (for quality improvement). Each protocol is easily modifiable, even during an active simulation with regards to clinical course and outcome. The pre- and post-simulation surveys are used also for quality improvement.Conclusions: Giving trainees simulated experiences in treatment of status epilepticus provides a controlled environment for learning. Simulation allows learners to gain experience without any patient risk. Instructors also gain a better assessment of skills, being able to observe performance in actual clinical situations. All of this can translate into better patient outcomes when exposed to real life situations.