Edward P. Sloan, MD, MPH Emergency Medicine Education in Neurological Emergencies: Where Are We? Where Do We Need to Be?

Edward P. Sloan, MD, MPH

Emergency Medicine Education Emergency Medicine Education in Neurological Emergencies:in Neurological Emergencies:

Where Are We? Where Are We? Where Do We Need to Be?Where Do We Need to Be?

Edward P. Sloan, MD, MPH

Neurocritical Care Society Neurocritical Care Society 66thth Annual Meeting Annual Meeting

Miami, FLMiami, FLOctober 24, 2008October 24, 2008

Edward P. Sloan, MD, MPH

Edward Sloan, MD, MPHEdward Sloan, MD, MPH

ProfessorProfessor

Department of Emergency MedicineDepartment of Emergency MedicineUniversity of Illinois College of MedicineUniversity of Illinois College of Medicine

Chicago, ILChicago, IL

Edward P. Sloan, MD, MPH

Attending PhysicianAttending PhysicianEmergency MedicineEmergency Medicine

University of Illinois Hospital

Chicago, IL

Edward P. Sloan, MD, MPH, FACEP

Edward P. Sloan, MD, MPH

Edward P. Sloan, MD, MPH

Thank you to Thank you to Stephan Mayer, MD and the Stephan Mayer, MD and the Neurocritical Care SocietyNeurocritical Care Society

for their support of this for their support of this programprogram

Edward P. Sloan, MD, MPH

Plenary Session:Plenary Session:Neurocritcal Care in the Neurocritcal Care in the Emergency DepartmentEmergency Department

Edward P. Sloan, MD, MPH

Neuroemergencies:Neuroemergencies:What Are Emergency What Are Emergency

Physicians TaughtPhysicians Taught

Edward P. Sloan, MD, MPH

Key QuestionsKey Questions• What do we need to know?

• (How will it improve patient care?)

• Are we taught what we need to know?

• How are we taught this information?

• What are the educational gaps?

• What are the next steps?

Edward P. Sloan, MD, MPH

What Do We Need to Know?What Do We Need to Know?• Neurological exam

• Utilization of advanced neuroimaging

• Documentation of the patient encounter

• Awareness of clinical guidelines

• Treatment of the most important neurological emergencies

Edward P. Sloan, MD, MPH

What Do We Need to Know?What Do We Need to Know?• tPA, ischemic stroke

• Hemorrhagic stroke

• Subarachnoid hemorrhage

• Seizures and status epilepticus

• CNS infections

• Traumatic brain injury

• Neuromuscular disorders

• Pediatric neurological emergencies

Edward P. Sloan, MD, MPH

What Do We Need to Know?What Do We Need to Know?• Evaluation of –AMS and coma–Headache–Seizures–Syncope–Blunt head trauma–Fever and headache–Hypertensive emergencies in neuro pts

Edward P. Sloan, MD, MPH

Are We Taught What We Need?Are We Taught What We Need?

• Hard to evaluate

• How do we assess competency?

• How do we develop a list of

“have to learn items”?

• We can only evaluate published curricula

Edward P. Sloan, MD, MPH

Are We Taught What We Need?Are We Taught What We Need?

• Hard to evaluate

• How do we assess competency?

• How do we develop a list of

“have to learn items”?

• We can only evaluate published curricula

• There are none!!

• Published info only states problem

Edward P. Sloan, MD, MPH

How Are We Taught this Info?How Are We Taught this Info?

• Stettler, Jauch et al Acad Emer Med 2005

• Survey of 126 EM Residency Directors

• 270 hours per year of didactic lectures

• 12 hours of annual neuro emerg content

• 17% of EM programs have neuro rotation

• 15% have neurosurgery rotation

• Only one offered both

Edward P. Sloan, MD, MPH

How Are We Taught this Info?How Are We Taught this Info?• Stettler, Jauch et al Acad Emer Med 2005• Half of the neuro rotations critical care• Electives for 33% of programs:–Neurology, neurosurgery, neuroradiology

• Conclusions:–Not much takes place outside of ED–Need to enhance didactics–Consider more rotations

Edward P. Sloan, MD, MPH

Educational ConferencesEducational Conferences

• ACEP, AAEM Scientific Assemblies

• SAEM Annual Meeting–Neurological Emergencies Interest Group

• NAEMSP Meeting

• Neurocritical Care Society Meeting

• ASA Meeting

• AAN Meeting

Edward P. Sloan, MD, MPH

Clinical GuidelinesClinical Guidelines

• www.guidelines.gov

• ACEP Clinical Policy Committee–Traumatic Brain Injury

–Seizures and Status Epilepticus

– Ischemic Stroke and tPA Use

Edward P. Sloan, MD, MPH

Clinical GuidelinesClinical Guidelines

Edward P. Sloan, MD, MPH

Evidence Based ReviewsEvidence Based Reviews

• Cochrane Collaboration*

• Societies

Edward P. Sloan, MD, MPH

Internet Based LearningInternet Based Learning

• ACEP, AAEM Scientific Assemblies

Edward P. Sloan, MD, MPH

Internet Based LearningInternet Based Learning

Edward P. Sloan, MD, MPH

www.ferne.orgwww.ferne.org

Edward P. Sloan, MD, MPH

OverviewOverview

Mission StatementMission Statement

–Patients with neurological emergencies deserve quality emergency care.

– Quality scientific research. – Case-oriented, evidence-based medical

education on optimal acute neurological care.– Use of technology to break down space and

time barriers.– Advocacy.

E. Bradshaw Bunney, MD

EducationEducation

Meeting Attendance and EvaluationsMeeting Attendance and Evaluations

75 FERNE meetings75 FERNE meetings

420+ Clinical Lectures420+ Clinical Lectures

15 Research Lectures15 Research Lectures

191 Different Speakers191 Different Speakers

E. Bradshaw Bunney, MD

EducationEducation

Meeting Attendance and EvaluationsMeeting Attendance and Evaluations

More than 5530 physicians in attendanceMore than 5530 physicians in attendance

10,370+ physician contact hours10,370+ physician contact hours

Content evaluated as excellent or good by 97% Content evaluated as excellent or good by 97%

of learnersof learners

Edward P. Sloan, MD, MPH

EducationEducation

Branded Product: Case-based LearningBranded Product: Case-based Learning

– Case presentation

– Key Clinical Questions

– Introduction, the clinical disease state

– Optimal ED management strategies

– Patient outcome

– References, Annotated bibliography

– Key Learning Points

– Questions and answers

Edward P. Sloan, MD, MPH

EducationEducation

Web-based Learning: Video SlideshowsWeb-based Learning: Video Slideshows

• Audio, video and slide contentAudio, video and slide content• Able to access individual slides for specific contentAble to access individual slides for specific content• MS Producer, viewable with Windows Media PlayerMS Producer, viewable with Windows Media Player

Edward P. Sloan, MD, MPH

EducationEducation

Web-based Learning: Slide LecturesWeb-based Learning: Slide Lectures

Download or view online

Edward P. Sloan, MD, MPH

EducationEducation

Web-based Learning: WebcastingWeb-based Learning: Webcasting

• Live simulcasts using Centra Symposium

Edward P. Sloan, MD, MPH

EducationEducation

Handheld Software: HandiStroke RxHandheld Software: HandiStroke Rx

HANDi Stroke Rx Available freefrom www.ferne.org

• Written at Mount Sinai, New York• Funded by a FERNE grant• NIH Stroke Scale• tPA Inclusion/Exclusion criteria• tPA dosage calculator• Continuation of care orders

Edward P. Sloan, MD, MPH

EducationEducation

Handheld Software: SeizureStatHandheld Software: SeizureStat

SeizureStat Available at www.ferne.org

• Written at UIC by FERNE• Funded by Abbott and UCB Pharma• SE Protocol• Urgent seizure meds• Seizure, SE information• Palm software summer 2008

Edward P. Sloan, MD, MPH

EducationEducation

Educational MaterialsEducational Materials

Acute Stroke Materials

• Developed a handbook and companion CD Rom

• Published Spring 2004

• Collaboration included American Stroke Association

and France Foundation

Edward P. Sloan, MD, MPH

EducationEducation

Web-based Learning: EMedHome.comWeb-based Learning: EMedHome.com

• FERNE generated contentFERNE generated content• CME can be obtained via the EMedHome websiteCME can be obtained via the EMedHome website• Slides and audioSlides and audio

Edward P. Sloan, MD, MPH

EducationEducation

Web-based Learning: Abstract SearchWeb-based Learning: Abstract Search

Topic specific abstract searches

Edward P. Sloan, MD, MPH

ResearchResearch

Directed Neurological Emergencies Research GrantDirected Neurological Emergencies Research Grant

– $ 25-50,000 per grant

– Emergency Medicine Foundation (EMF)

– Promotes new knowledge relating to the diagnosis and acute management of neurological emergencies

– Directed to Emergency Medicine researchers

Edward P. Sloan, MD, MPH

ResearchResearch

Seed Grants / Unsolicited ProposalsSeed Grants / Unsolicited Proposals

• Up to $5,000 grants

• Promote new research

• Help secure future funding

• Identify the support source

• Specific area of interest

• Available for all EM practitioners

Edward P. Sloan, MD, MPH

Neurological Emergencies EducationNeurological Emergencies Education

Edward P. Sloan, MD, MPH

Neurological Emergencies EducationNeurological Emergencies Education

Edward P. Sloan, MD, MPH

www.ferne.orgwww.ferne.org

Edward P. Sloan, MD, MPH

Other Educational MediaOther Educational Media• Textbooks• Journals• Industry, dinners• Internet• iPods, handhelds• Experience• Legal work• Research protocols

Edward P. Sloan, MD, MPH

Other Educational MediaOther Educational Media

Edward P. Sloan, MD, MPH

ConclusionsConclusions• There are neurological emergencies pts

• There is a need to know (and do!)

• There is an educational gap

• There are media that can be utilized

• There are motivated individuals

• There is an opportunity

Edward P. Sloan, MD, MPH

RecommendationsRecommendations• Develop a list of need to knows

• Develop curricula

• Develop coordinated industry and federal support for educational efforts

• Utilize technology to break down barriers to learning (inertia, space, time)

• Make the Internet work for us

• Go forth and prosper!

Thank you.Thank you.

[email protected]@ferne.org

[email protected]@uic.edu

ferne_neurocritcare_2008_sloan_education_102408_final04/18/23 12:47 Edward P. Sloan, MD, MPH, FACEP