Objective:
Medical education innovation with stroke code simulation sustainably prepares neurology residents for participation in the actual stroke code process. 

Background: 
Didactic lectures on acute stroke do not prepare neurology residents for nuances of leading a stroke code in high stress environments, multidisciplinary team member interactions, and correct order entry. Simulation technology is increasingly available for resident education, but underutilized in neurology. 

Design/Methods: A goal-based stroke code curriculum was implemented through 4 scenarios enacted by a standardized patient, nurse, CT technician, stroke fellow, and junior neurology resident at the institution's simulation center. Residents alternated leading or observing simulated codes, followed by group debriefing sessions to review learning goals. Immediate effect of simulation was measured with a pre- and post- multiple-choice quiz and thematic coding of open-ended resident written feedback. Long-term impact of simulation was surveyed with a 5-point Likert scale at 1 year and free text comment box. 

Results: Between July 2016 and July 2017, 22 junior adult and pediatric neurology residents completed stroke code simulation. Quiz grades improved from 67.5% to 78.3% after simulation. Common feedback themes reference comfort with code logistics, imaging order entry, team member roles, benefit of realistic scenarios, and desire for more scenarios. The residents perceived simulation would relieve the stress of stroke call. At 1 year, all residents continued to feel comfortable with codes including tPA criteria and orders and NIHSS exam. 100% agreed simulation had sufficiently prepared them for stroke call. 83% agreed scenarios reflected their real-life experience. One resident commented stroke simulation was better than any didactic teaching for call preparedness.


Conclusions:
Medical education innovation with stroke code simulation improves junior neurology resident comprehension of the acute stroke code process and has sustained benefit on preparedness for stroke call at 1 year. Simulation is a valuable tool for neurology resident education.

Neurology Resident Education With Acute Stroke Simulation Improves Code Readiness