Teaching “Red Flags” of Primary Versus Secondary Headache: A New Simulation Case for Incoming Neurology Residents
Minali Nigam1, Erica Ratti1, Sarah Conway1, Shuhan Zhu1
1BWH
Objective:
To evaluate a simulation case on red flag symptoms and signs of headache for incoming neurology residents.
Background:
Accurately identifying the symptoms and signs of primary and secondary headache disorders is an important skill for all neurologists. Simulation-based teaching has been widely adapted for procedural skills but less commonly adapted for teaching of headache clinical history. We used a case simulation based on idiopathic intracranial hypertension (IIH) to teach incoming neurology residents the appropriate “red flags” to accurately diagnose and manage headache disorders.
Design/Methods:
We created and incorporated an IIH case into our incoming neurology residents’ annual orientation simulation course. 21 residents in groups of 3 to 4 participated in a case with a facilitator and standardized patient (SP).
The case narrative for the SP included the headache description, associated features, headache triggers and simulated physical examination findings. There were five phases of the case 1) history-taking to identify the “red flag” symptoms of secondary headache 2) physical exam with images of papilledema projected on a computer screen 3) review of brain MRI with evidence of elevated intracranial pressure 4) identification of IIH diagnosis and patient education on treatment and 5) debrief.
After the simulation, resident satisfaction of the headache simulation along with five other case simulations was assessed using a Likhert scale from 1 (unsatisfied) to 5 (most satisfied).
Results:
The course evaluation had a 66% response rate (N= 14). The headache simulation ranked highest among the six cases in the simulation course with a mean satisfaction score of 4.7 [range 3-5].
Conclusions:
Introduction of a headache simulation case was favorable among incoming neurology residents. Simulation teaching can expose residents early on to red flag symptoms and signs necessary to distinguish primary from secondary headache.