BRAIN-SIM: Leveraging Simulation for Neurocritical Care Education with an Innovative Multidisciplinary Approach

Abstract

Background and ObjectivesEarly recognition and response are paramount in the treatment of neurologic emergencies. Due to its complexity, neurocritical care continues to provoke unease for practitioners and trainees. Simulation provides a realistic opportunity for learners to detect an acutely deteriorating neurologic patient and make rapid-fire treatment decisions. A multidisciplinary simulation-based learning environment may improve trainee confidence when caring for the neurocritical care patient population.MethodsNine simulation lab sessions were performed with a multidisciplinary team including medical students, residents, critical care medicine fellows, advanced practice providers (APP), critical care pharmacy residents, and neuroscience unit nurses. High fidelity manikins capable of reproducing acute neurologic and physiologic emergencies were used. After the simulation, participants completed a survey utilizing Likert scale responses regarding simulation logistics, faculty competence, and pre- and post-simulation confidence levels managing specific acute neurologic emergencies and performing neurocritical care procedural skills.ResultsNine simulation lab sessions were conducted, and thirty-eight surveys were completed. Mean learner confidence levels in managing patients improved from pre- to post-simulation in patients with coma [3.18 ± 0.51 versus 4.32 ± 0.25 (P < .001)], status epilepticus [3.23 ± 0.55 versus 4.36 ± 0.29 (P < .001)], acute ischemic stroke [3.75 ± 0.59 versus 4.63 ± 0.43 (P < .001)], intracerebral hemorrhage [3.25 ± 0.74 versus 4.63 ± 0.43 (P < .001)], intracranial hypertension [3.25 ± 0.74 versus 4.63 ± 0.43 (P < .001)], respiratory failure [3.5 ± 0.77 versus 4.63 ± 0.43 (P = .0016)], and procedures such as central lines [2.2 ± 0.56 versus 3.8 ± 0.56 (P = .003)], intubations [2.25 ± 0.39 versus 3.63 ± 0.62 (P < .001)], and bronchoscopies [2 ± 0 versus 3.2 ± 0.56 (P = .004). Consistently, learners strongly agreed that faculty were knowledgeable, well-informed, and thorough. Learners commented that the simulation experiences were realistic and allowed them to identify areas for improvement.DiscussionSimulation training can be an effective method to improve neurocritical care education by increasing clinician confidence in managing neurologic emergencies and procedures while providing opportunities for multidisciplinary collaboration. Further evaluation of the effectiveness of simulation education in this patient care setting is warranted.

Keywords: coma; confidence; critical care; education; multidisciplinary critical care; neurocritical care; simulation; status epilepticus; stroke.

Figure 1.

Structure of our multidisciplinary approach to simulation education in neurocritical care.

Figure 2.

Learners engaging with the simulation experience. A. Care team responding to a cardiac arrest after failing to recognize intracranial hypertension secondary to thrombolytic-related ICH. B. Neurocritical care APP facilitator explaining the equipment and procedural skills involved in central line placement. C. Neurocritical care APP facilitator demonstrating preoxygenation techniques and video guided laryngoscopy.

Figure 3.

Learner confidence before and after case-based simulation sessions. Learner reported scores range from 1 (lowest) to 5 (highest). Error bars represent standard deviation.

Figure 4.

Learner confidence before and after procedural skill simulation sessions. Learner reported scores range from 1 (lowest) to 5 (highest). Error bars represent standard deviation.