Objective:

To enhance knowledge and confidence in managing acute strokes and transient ischemic attack (TIA) for frontline internal medicine (IM) residents.

Background:

Across the United States, stroke patients are primarily cared for by IM physicians. IM residents, however, often lack formal stroke care training, which may impact their confidence and patient outcomes as trainees and future faculty.

Design/Methods:

This ongoing single-site observational cohort education study involves IM residents at an urban VA Medical Center. The study team created a lecture on acute stroke recognition, work-up, and treatment, along with pre- and post-intervention confidence and knowledge questionnaires. The confidence questionnaire uses Likert scales from “no confidence” to “high confidence,” while the knowledge questionnaire is based on IM board examination content. A PGY3-4 neurology resident leads a one-hour Zoom lecture during noon-conference for PGY1-3 IM residents, who complete anonymous questionnaires via Microsoft Forms. In this interim analysis, pre- and post-lecture confidence was summarized using descriptive statistics, and pre- and post-lecture knowledge scores (out of five) were compared with t-tests.

Results:

From October 2023 – October 2024, 14 sessions were conducted. Responses were recorded for first-time attendees and varied for pre-intervention confidence (n=75) and knowledge (n=63), as well as post-intervention confidence (n=46) and knowledge (n=53). Average knowledge scores rose from 45% pre-test to 71% post-test (p<0.001). Participants reporting at least “moderate level of confidence / may act independently” increased in all domains: acute stroke recognition (pre: 24%; post: 81%), work-up (pre: 33%; post: 78%), and treatment plan (pre: 12%; post: 70%). TIA recognition (pre: 19%; post: 76%), work-up (pre: 21%; post: 76%), and treatment plan (pre: 15%; post: 66%).

Conclusions:

Preliminary results from 14 near-peer IM resident curriculum sessions demonstrated improved knowledge and confidence in managing acute stroke and TIA. Such models can enhance IM residency training and stroke patient care in hospitals without in-house neurology.