Abstracts

Rationale:
Psychogenic nonepileptic seizures (PNES) are the most common conversion disorder. Of the 1% of patients diagnosed with epilepsy, 5-20% actually have PNES. Most clinicians find it challenging to deliver the diagnosis in a manner that makes the patient receptive and accepting of the diagnosis but achieving this is crucial. Teaching this skill to neurology residents is vital and can be done by simulation.
Method:
We developed a simulation case scenario of a PNES patient in the setting of the epilepsy monitoring unit (EMU) to be conducted in our simulation center. A standardized actor serves as the patient. The neurology resident is given the task of taking a history, examining the patient and formulating and delivering the diagnosis of PNES with treatment suggestions based on episodes captured in the EMU. Based on the residents approach and style of dealing with the situation, the epileptologist cues the actor to become more difficult and unaccepting of the diagnosis. The resident’s ability to circumvent the patient’s anger and maintain a calm disposition is assessed in addition to communication skills. At the end of the simulation, the epileptologist conducts a debriefing session highlighting various aspects of the resident’s approach and teaching effective ways of delivering the diagnosis while getting feedback from the resident. The simulation may be repeated after the debriefing to reinforce the skill. Pre and post simulation surveys may be given to the resident, actor and epileptologist.
Results:
This simulation method gives the neurology resident an opportunity to practice encountering difficult patients with PNES in a controlled environment and get feedback and debriefing that helps guide the right approach.
Conclusion:
PNES is a common condition encountered by neurologists and epileptologists.  Considering that 20-50 % of patients in the EMU have PNES and is as disabling as epilepsy, it is as important for neurologists to be comfortable explaining the diagnosis of PNES as epilepsy. Clinical experience suggests that the clinician’s comfort level for explaining diagnosis of somatoform disorder is likely to impact the acceptance by the patient and their family. Some studies have shown that some patients will become PNES-free with the explanation of the diagnosis alone. Studies have shown improved student performance after even a single standardized patient session.  The healthcare costs of undiagnosed and untreated PNES patients are enormous. Studies have shown that communication of the diagnosis even if they continue to experience PNES, reduces healthcare expenditure overall and specifically emergency services. Delivering the diagnosis of PNES in such a way that the patients accept the diagnosis and are encouraged to seek appropriate treatment, is an important skill for both general neurologists and epileptologists. Simulation with standardized actors can be a very useful tool to educate residents and give them a foundation to evolve this skill.
Funding:
:None