Stroke training of prehospital providers: an example of simulation-enhanced blended learning and evaluation.
Since appropriate treatment of patients in the first few hours of ischemic stroke may decrease the risk of long-term disability, prehospital providers should recognize, assess, manage and communicate about stroke patients in an effective and time-efficient manner. This requires the instruction and evaluation of a wide range of competencies including clinical skills, patient investigation and management and communication skills. The authors developed and assessed the effectiveness of a simulation-enhanced stroke course that incorporates several different learning strategies to evaluate competencies in the care of acute stroke patients. The one-day, interactive, emergency stroke course features a simulation-enhanced, blended-learning approach that includes didactic lectures, tabletop exercises, and focused-examination training and small-group sessions led by paramedic instructors as standardized patients portraying five key neurological syndromes. From January to October 2000, 345 learners were assessed using multiple-choice tests as were randomly selected group of 73 learners using skills' checklists during two pre- and two post-course simulated patient encounters. Among all learners there was a significant gain in knowledge (pre: 53.9%+/-13.9 and post: 85.4%+/-8.5; p<0.001), and for the 73 learners a significant improvement in their clinical and communication skills (p<0.0001 for all). By using a simulation-enhanced, blended-learning approach, pre-hospital paraprofessionals were successfully trained and evaluated in a wide range of competences that will lead to the more improved recognition and management of acute stroke patients.
Gordon
David Lee
DL
University of Miami Center for Research in Medical Education, Florida 33101, USA.
Issenberg
S Barry
SB
Gordon
Michael S
MS
LaCombe
David
D
McGaghie
William C
WC
Petrusa
Emil R
ER
D002545:Brain Ischemia / Q000175:diagnosis* / Q000628:therapy; D002983:Clinical Competence; D003198:Computer Simulation; D003479:Curriculum; D004501:Education, Medical / Q000379:methods*; D004632:Emergency Medical Services; D004634:Emergency Medical Technicians / Q000193:education* / Q000592:standards; D004638:Emergency Treatment / Q000379:methods* / Q000592:standards; D006801:Humans; D018794:Problem-Based Learning; D014481:United States