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Neurol Clin Pract. 2018 Apr;8(2):116-119. doi: 10.1212/CPJ.0000000000000435.

Stroke code simulation benefits advanced practice providers similar to neurology residents.

Author information

Division of Neurology, Neuroscience Institute (MK, OK, MDJ, JZ, RRC, WS, CH, TA, B Smith), Department of Accreditation and Regulations (TP), and Nursing Administration (TT), Spectrum Health, Grand Rapids; Department of Emergency Medicine (AO) and Department of Clinical Neuroscience, College of Human Medicine (MK, OK, MDJ, JZ, RRC, WS, CH, TA, B Smith), Michigan State University, East Lansing; Lifespan Biostatistics Core (GLB), Rhode Island Hospital; Department of Diagnostic Imaging (GLB), Warren Alpert School of Medicine, Brown University, Providence, RI; Emergency Care Specialists (RS), Grand Rapids, MI; and Department of Neurology (B Silver), University of Massachusetts Medical School, Worcester.



Advanced practice providers (APPs) are important members of stroke teams. Stroke code simulations offer valuable experience in the evaluation and treatment of stroke patients without compromising patient care. We hypothesized that simulation training would increase APP confidence, comfort level, and preparedness in leading a stroke code similar to neurology residents.


This is a prospective quasi-experimental, pretest/posttest study. Nine APPs and 9 neurology residents participated in 3 standardized simulated cases to determine need for IV thrombolysis, thrombectomy, and blood pressure management for intracerebral hemorrhage. Emergency medicine physicians and neurologists were preceptors. APPs and residents completed a survey before and after the simulation. Generalized mixed modeling assuming a binomial distribution was used to evaluate change.


On a 5-point Likert scale (1 = strongly disagree and 5 = strongly agree), confidence in leading a stroke code increased from 2.4 to 4.2 (p < 0.05) among APPs. APPs reported improved comfort level in rapidly assessing a stroke patient for thrombolytics (3.1-4.2; p < 0.05), making the decision to give thrombolytics (2.8 vs 4.2; p < 0.05), and assessing a patient for embolectomy (2.4-4.0; p < 0.05). There was no difference in the improvement observed in all the survey questions as compared to neurology residents.


Simulation training is a beneficial part of medical education for APPs and should be considered in addition to traditional didactics and clinical training. Further research is needed to determine whether simulation education of APPs results in improved treatment times and outcomes of acute stroke patients.

[Available on 2019-04-01]

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