Work-up and Counseling of First-of-Lifetime Seizure: A Simulation-based Educational Tool and Embedded Learning Results
Abstract number :
2.141
Submission category :
4. Clinical Epilepsy / 4B. Clinical Diagnosis
Year :
2023
Submission ID :
794
Source :
www.aesnet.org
Presentation date :
12/3/2023 12:00:00 AM
Published date :
Authors :
Presenting Author: Luke Massaro, MD – Columbia University Irving Medical Center
Greer Waldrop, MD – Chief Resident, Neurology, Columbia University Irving Medical Center; Michelle Bell, MD – Program Director of the Adult Neurology Residency Program, Neurology, Columbia University Irving Medical Center; Alison Pack, MD – Director, Division of Epilepsy and Sleep, Neurology, Columbia University Irving Medical Center; Carl Bazil, MD, PhD – Director, Sleep Disorders Center, Neurology, Columbia University Irving Medical Center; Shivani Ghoshal, MD – Assistant Professor of Neurology, Neurology, Columbia University Irving Medical Center
Rationale: Up to ten percent of the people worldwide will have one seizure in their lifetime. Though the work-up and counseling of first-of-lifetime seizure is a core milestone in ACGME neurology resident education, current published epilepsy-based simulations are limited to active seizure and status epilepticus management. In response, we created a simulation-based educational tool for adult neurology residents focused on work-up of first-of-lifetime seizure, diagnosis of epilepsy, and key components of treatment plans and counseling. Our primary outcomes were six-month embedded learning and confidence in a subgroup of residents who had participated in the simulation compared to those who had not.
Methods: Simulations were conducted at Columbia University Irving Medical Center in October 2022, with learning outcomes collected with IRB approval. Simulation case framework, critical action checklist, and standardized patient scripts were developed through a Delphi expert consensus among epilepsy educators within our institution. The 25-minute simulation presented a patient with first-of-lifetime seizure, with further work-up revealing structural and electrographic abnormalities suggesting a diagnosis of epilepsy. Each simulation was followed with 25 minutes of structured debriefing. A six-month embedded learning survey repeated the simulation case and critical action questions as an 8-point questionnaire.
Results: Twelve adult neurology residents participated in the simulation and ten completed a post-simulation survey. Six-month embedded learning results compared a subgroup of ten neurology residents participating in the simulation compared to ten that had not, with equal distribution of junior and senior residents between both groups. During the simulation, though all residents accurately interpreted the diagnostic results and initiated an anti-seizure drug regimen, less than half (5/12) delivered a diagnosis of epilepsy to the standardized patient, 6/12 correctly counseled on the importance of regimen adherence and 6/12 on likelihood of seizure recurrence with a single-agent regimen. After debriefing, 9/10 residents reported improved learning and 9/10 improved confidence for workup and counseling of first-of-lifetime seizure and diagnosis of epilepsy. In a six-month embedded learning survey, median scores for residents participating in the simulation were higher than those who had not (7 versus 5.5 out of 8). Of simulation-participating residents, 10/10 felt more confident in work-up of first-of-lifetime seizure and 8/10 felt they remembered the learning points of the simulation.
Conclusions: Approach and distinction of first-of-lifetime seizure and epilepsy are key educational milestones, and simulations are lacking on this subject. Our simulation showed improved performance among participating residents for ability to diagnose and counsel for a new diagnosis of epilepsy in an outpatient setting. This simulation is feasible and effective, and may be incorporated to epilepsy curricula for neurology trainees.
Funding: None
Clinical Epilepsy