A Standardized Patient-based Simulation Study on Herpes Simplex Virus (HSV) Encephalitis in a Preclinical Neuroscience Curriculum
Nathan Schleinkofer1, Safa Kaleem1, Neel Naik2, Mikhail Goman3, Kevaughn Harvey4, Anne Connolly4, Erika Abramson2, Joseph Safdieh5, Sydney Katz2, Evan Noch6
1NewYork-Presbyterian Weill Cornell Medical Center, 2Weill Cornell Medical College, 3Hospital for Special Surgery, 4Weill Cornell Medicine Clinical Skills Center, 5Weill Medical College of Cornell University, 6New York Presbyterian Hospital, Weill Cornell Medical Center
Objective:
To administer an educational simulation to medical students in a preclinical neuroscience curriculum to improve confidence in diagnosing and managing altered mental status (AMS), Herpes Simplex Virus (HSV) encephalitis, and seizure.
Background:
Pre-clinical medical students receive limited interaction with patients with AMS. Simulations can address gaps in medical student education. We developed a standardized patient (SP)-based simulation to improve students’ confidence and competence in the neurological examination and differential diagnosis in a patient presenting with AMS.
Design/Methods:
Medical students in the preclinical neuroscience curriculum participated in a formative simulation on HSV encephalitis. During the simulation, students interviewed and examined an SP with fever, confusion, and aphasia. Students submitted five differential diagnoses and reviewed the encounter with neurology faculty and housestaff. Lastly, the SP exhibited a tonic-clonic seizure. Students were asked to stabilize the patient, administer medications, and order diagnostic tests. The simulation concluded with a debrief session explaining the results of diagnostic testing and recommendations for managing seizure and HSV encephalitis. Using a 5-point Likert scale ranging from “extremely comfortable” to “not at all comfortable”, matched pre- and post-test surveys assessed students’ comfort with examining, diagnosing, and managing patients with AMS or seizure, and working with peers in a group setting.
Results:
83 students completed the pre-test survey, 91 students completed a differential diagnosis, and 60 completed the post-test survey. A Wilcoxon signed-rank test showed that from pre- to post-test, across all domains, students felt more confident in obtaining a history, creating a differential diagnosis, and working with peers with an average increase of 0.81 points (p<0.001). Students found all three parts of the simulation useful (average 3.8/5). 54 students (59%) listed HSV encephalitis on their differential diagnosis.
Conclusions:
Simulation sessions are a valuable tool to train and build confidence in diagnosing and understanding neurological disorders for medical students.