Work-up and Counseling of First-of-lifetime Seizure: A Simulation-based Educational Tool and Embedded Learning Results
Luke Massaro1, Greer Waldrop2, Michelle Bell1, Carl Bazil1, Alison Pack1, Shivani Ghoshal1
1Columbia University Medical Center, 2UCSF
Objective:
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. 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.
Background:
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 management.
Design/Methods:
Simulations were conducted at Columbia University Irving Medical Center, with learning outcomes collected with IRB approval. The 25-minute simulation presented a patient with first-of-lifetime seizure, with further structural and electrographic work-up suggesting a diagnosis of epilepsy, followed by a structured debriefing. A six-month embedded learning survey repeated the simulation case and critical action questions as a brief questionnaire.
Results:
12 adult neurology residents participated in the simulation and 10 completed a post-simulation survey. During the simulation, though all residents accurately interpreted the diagnostic results and initiated an anti-seizure drug regimen, only 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 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 who had participated in the simulation were higher than those who had not (7 vs 5.5 out of 8).
Conclusions:
Approach to first-of-lifetime seizure is a key educational milestone, 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. This simulation is feasible and effective, and may be incorporated to epilepsy curricula for neurology trainees.