Abstracts

Rationale: Appropriate and timely treatment of status epilepticus (SE) decreases morbidity and mortality. Despite the associated high mortality, time-sensitive treatment of this emergency is often delayed due to multiple reasons, including delay in recognition and diagnosis, administration of inappropriate antiepileptic medications, or suboptimal doses that do not follow established guidelines. In most teaching hospitals, neurology residents evaluate the majority of patients with SE. Thus, it is imperative that we ensure adequate training of these physicians. At our institution, the curriculum to teach the management of SE relied on didactic lectures which included case scenarios but did not provide opportunities for practice of the skills.  We sought to develop a new approach to the delivery of our SE curriculum using simulation-based mastery learning (SBML). We hypothesized that this approach would result in improved residents’ confidence and compliance with SE protocols. Methods: All eight first year neurology residents completed the curriculum. Prior to the implementation of the new curriculum, the residents received the traditional didactic lecture at the beginning of residency. Two months later, the SBML curriculum was implemented. First, residents underwent a baseline simulation assessment (pre-test) where they were graded using a 26 item checklist developed for this curriculum and agreed on by 8 experts. Next, the residents participated in an educational session regarding the identification and management of SE including an additional one hour of deliberate practice using a high fidelity simulator with ongoing feedback from an expert. Third, 3-4 weeks later, the residents underwent a simulation-based assessment (post-test) using the same 26 items checklist. A minimum passing standard (MPS) of 88% was determined by a panel of 14 experts using the mastery Angoff approach. Any resident meeting the MPS at post testing was determined to have passed the session. Any resident not meeting the MPS was provided additional opportunities for practice and re-testing until the MPS was met. Results: None of the residents met the MPS at the pretest. After deliberate practice and feedback, all of the residents met the MPS. Fifty percent of the residents met the MPS after one session of deliberate practice; the remaining 50% met the MPS with one additional training session. The median checklist score was significantly higher in the post test compared to the pre-test (98% vs. 50%; p-value < 0.0005). Seventy five percent of the residents strongly agreed and 25% agreed that SBML is better than traditional didactics sessions. All of the residents strongly agreed that they feel more confident in diagnosing and managing convulsive SE after completing the training. Sixty three percent strongly agreed and 37% agreed that they feel more confident managing non-convulsive SE after completing the training. Conclusions: SBML is superior to the traditional approach to teaching SE. The use of SBML resulted in the learners achieving mastery in the identification and management of SE. Additionally, the residents felt more confident managing SE after completing the curriculum. Funding: None