The Completion of a PGY-1 Neurology Bootcamp Leads to Increased Trainee Knowledge and Confidence in Neurologic Emergencies Management and Procedural Skills
Carol Swetlik1, A. Blake Buletko2, Robert Marquardt3, Erin Higgins4, Catherine Hassett2
1Cleveland Clinic - Neurological Institute, 2Cleveland Clinic - Cerebrovascular Center, 3Cleveland Clinic - Neuromuscular Center, 4Cleveland Clinic - Ob/Gyn and Reproductive Biology
Objective:
To evaluate the impact of an end-of-the-year, post-graduate year 1 (PGY-1) simulation-based neurology bootcamp on trainee knowledge, self-confidence, and skill independence regarding acute neurologic emergencies management and bedside procedural skills.
Background:
The post-graduate year 2 (PGY-2) neurology resident is often the first line of triage for evaluation of acute neurologic deterioration on the inpatient neurology service, requiring autonomy and responsibility. We implemented and evaluated a bootcamp prior to this critical training period.
Design/Methods:
In this prospective cohort study, 14 rising PGY-2 neurology residents attended a two-day bootcamp with a simulation-based curriculum led by neurology faculty practicing cerebrovascular, critical care, and inpatient neurology medicine. Pre- and post- bootcamp, trainees completed multiple-choice knowledge assessments and via Likert scales, self-reported confidence in managing neurologic emergencies. Faculty observed and rated trainee ability to independently perform five neurologic procedures (lumbar puncture, external ventricular drain [EVD] management, botulinum toxin injection for migraine, digital fundoscopy, and pupillometry), with residents additionally reporting their own perceived degree of independence.
Results:
Proportion of trainees demonstrating independence per faculty rating significantly increased for all five procedural skills post-bootcamp (for all, p < .05). Trainee self-reported independence of EVD management, pupillometry, and fundoscopy skills also increased post-bootcamp (for all, p < .05), with < 25% of trainees reporting total independence pre-bootcamp to 50%, 86%, and 79% post-bootcamp, respectively. Knowledge assessment scores increased from a pre-bootcamp mean of 54% of questions correct to mean 70% correct (p = 0.002), driven by increases in vascular neurologic emergency and procedural knowledge. On a 5-point Likert scale, trainee self-reported confidence in emergency management increased from median 2.5 (a little confident) to median 4 (fairly confident) (p < .001)
Conclusions:
A simulation-based, two-day bootcamp with focus on acute cerebrovascular neurologic emergencies and neurologic procedural skills showed significant improvements in trainee knowledge along with faculty-observed and self-reported confidence and independence.