Objective:

We hypothesized that developing standardized training for the neurological coma examination will ensure medical trainees are effectively taught the necessary skills to perform and interpret physical examinations on comatose patients.

Background:

It has been shown that medical trainees lack confidence in their physical examination skills and understanding the significance of their findings.

Design/Methods:

Twenty-eight third and fourth-year medical students rotating in the Neuro-intensive care unit (NICU) participated in a one-hour coma examination training consisting of a lecture and skills demonstration led by a neurocritical care attending. Students completed an anonymous pre/post-session survey assessing their confidence and comfortability in performing a coma examination. Survey answer options were designed on a Likert scale from 1-5 with 1 being “strongly disagree” and 5 being “strongly agree.” Statistical analysis was performed using the Wilcoxon signed ranks test.

Results:

There were statistically significant increases in self-rated comfort level and clinical competency in all areas following the training. Question 9 (“I am able to teach another student how to complete a comprehensive neurological physical examination of a comatose patient”) and question 2 (“I am able to determine a Glasgow coma score for a comatose patient”) showed the greatest improvement from pre- to post-survey responses (p-value: <0.001, Wilcoxon signed ranks test).  Half of respondents answered 5 (“strongly agree”) to question 12 (“The coma clinical skills workshop increased my confidence in my ability to perform a comprehensive neurological physical examination on a comatose patient”).

Conclusions:

Our results demonstrate that standardized neurological coma examination training in medical education is an effective teaching method. This approach should be further explored by expanding the training to include more students and learner types such as residents and nurses. Long-term efficacy may need to be determined through a follow-up survey of students at the end of their medical education after working in other ICU settings.