Objective:

We assessed third year medical student performance during acute stroke code simulations.

Background:

In many centers, non-neurology providers are at the front lines of assessing and treating stroke patients, with neurology consultation provided remotely via tele-stroke. Given that stroke is a medical emergency, it is essential for all medical providers to understand how to effectively assess and treat stroke patients. We created an experiential simulation to educate medical students on stroke codes.

Design/Methods:

We instituted a set of acute stroke code simulations for third year medical students. Prior to the simulation, students viewed a lecture on the history, exam, and relevant laboratory data to obtain during a stroke code. Preceptors had a ten-item checklist to assess performance, including obtaining a last known well, medication list, point of care glucose, weight, CT imaging, electrocardiogram and serum labs. Medical students were also asked to establish blood pressure goals and to complete a NIH stroke scale. After each simulation, students were debriefed on their performances.

Results:

Eighty-eight students participated in two sets of simulations. The mean time for the second simulation was shorter than that of the first simulation- 11 and 16 minutes respectively (p<0.0001). Students completed more checklist components during the second simulation compared to the first (88% vs 85%) and were more likely to order CT angiograms of the brain and neck during the second simulation (100% vs 69%). Students routinely misidentified blood pressure goals during both simulations, which led to inappropriate blood pressure reduction without indication. All medical students successfully identified when a patient was a thrombectomy candidate and no patients were offered thrombolytics inappropriately.

Conclusions:

We demonstrated that medical students can appropriately identify when patients are candidates for thrombectomy and that repeat simulations can improve overall performance. The simulation also identified that students needed additional education regarding blood pressure management during acute stroke.