VCOM Carolinas Research Day 2023
Simulation and Technology
DEVELOPMENT OF STATUS EPILEPTICUS SIMULATION FOR TRAINING IN EMERGENCY MEDICAL CARE
Rebecca Dudley, OMS II; Jordan Paugh, OMS II; Paul LaPenna, DO; Jaime Foushee, PharmD; Michael Parks, MPA; Tom Lindsey, DO Edward Via College of Osteopathic Medicine, Carolinas Campus; Spartanburg, SC
Abstract # SIM-3
A unique aspect of this simulation is the creation of novel electroencephalogram (EEG) waves using the coding language Python. Throughout the simulation, an erratic, burst-suppression or normal wave will play in real-time as students order an EEG, based on the patient’s current condition. A Ceribell ® device will also be placed on the mannequin as a visual aid for students.
Simulation-based education fosters a robust set of experiences designed to prepare learners for the clinical environment. Although the breadth of simulated scenarios has grown exponentially, there is a lack of widely available training for emergent patient presentations, such as status epilepticus (SE). 1,2 SE is a dangerous complication of seizures that can lead to significant patient morbidity and mortality. Generalized, convulsive SE refers to greater than 5 minutes of a continuous seizure OR two or more discrete seizures within a 5-minute period, in which there is incomplete recovery of consciousness between episodes. The purpose of this poster is to detail the creation of a SE simulated experience based on guidelines developed by the American Epilepsy Society (AES) for the treatment of an adult patient. 3 Objective : The aim of this project is to create an efficacious simulation representing a progressive clinical case of SE that improves student knowledge and confidence in management of this emergent condition.
Figure 3. The image to the left depicts a burst-suppression EEG pattern.
Figure 4. The image to the right depicts an erratic EEG pattern.
Study Design: This project will use a within-subjects design to evaluate knowledge and confidence as part of a quality analysis and improvement project within first year osteopathic medical students. Prior to the simulation, students will be given an assessment with 5 knowledge-based questions related to status epilepticus, written in a COMLEX level 1 board style format. Students will rate statements of confidence in managing status epilepticus on a 5-point Likert scale. Following the simulation, student knowledge and confidence will be re-evaluated. To determine the difference between pre- and post-test values, a paired samples t -test will be performed.
Figure 5. The image to the left depicts a normal EEG pattern.
The authors of this poster would like to acknowledge and thank the Edward Via College of Osteopathic Medicine Carolinas Campus Simulation Center staff for their assistance and guidance in developing this simulation. Acknowledgements Conclusions : Results of this study may support the efficacy and importance of widely available training for the treatment of SE. The goal of the simulation is to enhance the confidence and knowledge of learners related to management of SE. The simulation was trialed in the spring of 2022. A preliminary assessment of mean student test score data on epilepsy questions within the pharmacology curriculum was reviewed as a quality improvement initiative. In comparing mean student test scores on epilepsy question from 2021 (before the trial of the SE simulation) and 2022 (after the trial of the SE simulation), numerical improvement was noted in 2022 for student performance on epilepsy and SE specific questions. No statistical analysis was run on this data. This data was hypothesis-generating but may support the efficacy of the SE simulation, leading to the current project initiative. Results: This study is currently still in progress; therefore, the results have not been finalized. After completion of the study, the results will reveal if there is a statistically significant increase in student knowledge and confidence related to SE management following participation in the simulation.
Figure 1 . Example knowledge and confidence assessment items Simulation Development: This simulation was developed using evidence-based guidelines for the treatment of an adult patient published by the American Epilepsy Society 3 to determine a systematic management plan. The simulation is built with three main phases based on treatment goals: stabilization, initial therapy, and secondary therapies. The simulation begins with a patient demonstrating presentation of SE with classic risk factors. In phase one, students will focus on identifying the patient’s condition and stabilizing the patient. In phase two, students will determine and deliver the first-line pharmacologic treatment option. As the patient continues to seize in phase three, the second-line pharmacologic treatment will be identified and delivered. To conclude the simulation, students will recognize the need to stabilize the airway and practice intubation. Throughout the simulation, students will be prompted with questions to facilitate active involvement. Finally, students will participate in a debriefing of the experience.
Figure 2 . Simulation template *This treatment algorithm was developed using the American Epilepsy Society’s “Proposed Algorithm for Convulsive Status Epile pti cus” 3
2 0 2 3 R e s e a r c h R e c o g n i t i o n D a y
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