To create an educational intervention to prepare neurology residents for telestroke encounters. 

Telemedicine has become increasingly common in the post-COVID era and is now a part of most clinical practices. There is a need for residency training programs to incorporate telemedicine teaching into their curriculum. Telestroke is a well-established practice and way to bring neurovascular clinical expertise into settings where an in-person stroke specialist may not be available. Skills and professionalism important in a remote telestroke consult apply to all types of telemedicine encounters.

Our telestroke OSCE (objective structured clinical examination) case was developed by our neurology faculty in conjunction with a simulation specialist. Two standardized actors were trained to impersonate an acute stroke patient and a bedside provider in an emergency room setting. The neurology resident learner was in a separate room and acted as a stroke specialist, communicating with the standardized actors and conducting an NIHSS using a live video interface. Following the encounter, immediate feedback was given by a faculty observer and the standardized actor rated resident performance using a checklist. After OSCEs were completed, the residents were debriefed in a group setting and a learner feedback survey was collected (1-5, least-most).

Out of 15 resident participants, 8 completed the learner survey (53%). They reported feeling fairly well-prepared for the OSCE (4±0.5) and rated their performance overall well (4.3±0.5). Many learners identified instructing the standardized remote provider in the NIHSS virtually as the most challenging aspect in the encounter. All learners indicated that this OSCE should be repeated for future residency classes. 

We demonstrated that a telestroke simulation is a useful tool to directly observe residents, offer immediate feedback and review telemedicine best-practices. It is a feasible, valued and important part of our dynamic neurology residency curriculum.