‘Code Brain’- Mannequin Based Simulation Exercise to Enhance Identification, Evaluation, and Management of Cerebral Herniation for Neurology Residents.
Rameez Merchant1, Sayed Mustafa Shah1, Sarah Saleh2, Craig Williamson3
1University of Missouri, 2University of Michigan, 3University of Michigan, Neurosurgery Department
Objective:
Determine the effectiveness of a simulated patient encounter with signs consistent with herniation to train neurology residents on the clinical approach to a patient with elevated intracranial pressure (ICP) and cerebral herniation syndromes.
Background:
Cerebral herniation is a life-threatening neurological emergency that neurology residents frequently encounter, requiring prompt recognition and effective management.
Design/Methods:
A standardized simulation using a mannequin capable of dynamic pupil and vital sign changes was developed to mimic elevated intracranial pressure and cerebral herniation. Neurology residents from three training programs participated. After the simulation, they received education on the clinical approach to managing the condition. Participants completed anonymous pre- and post-simulation surveys to assess their knowledge and review the exercise, with responses recorded using a 5-point Likert scale. A paired t-test was performed to analyze the data under a 95% confidence interval.
Results:
38 Neurology residents were enrolled in the study. 57.9% of respondents reported involvement in a case where a patient was herniating. 84.2% of respondents reported receiving teaching on the topic. Following the simulation, respondents reported a significant improvement in familiarity with the signs and symptoms of cerebral herniation (3.34 vs 4.42), improved understanding of the types of cerebral herniation syndromes(2.73 vs 4.05), and understanding of the differences between elevated ICP and cerebral herniation (3.63 vs 4.45). Participants reported significant improvements in ability to initiate medical treatment in patients with elevated ICP (3.34 vs 4.34) and improvement in the ability to identify medical interventions that may worsen cerebral herniation (2.5 vs 3.84). All participants strongly agreed that the simulation provided a rapid and systematic framework to intervene on a herniating patient and that they would recommend this training to others.
Conclusions:
Simulated patient encounters were an effective tool to impart the clinical approach to elevated ICP and cerebral herniation syndromes.
Disclaimer: Abstracts were not reviewed by Neurology® and do not reflect the views of Neurology® editors or staff.