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 Neurocritical Care Society 6 th Annual Meeting Miami, FL October 24, 2008

Edward P. Sloan, MD, MPH Edward Sloan, MD, MPH Professor Department of Emergency Medicine University of Illinois College of Medicine Chicago, IL

Edward P. Sloan, MD, MPH Attending Physician Emergency Medicine Attending Physician Emergency Medicine University of Illinois Hospital Chicago, IL Edward P. Sloan, MD, MPH, FACEP

Edward P. Sloan, MD, MPH

Thank you to Stephan Mayer, MD and the Neurocritical Care Society for their support of this program

Edward P. Sloan, MD, MPH Plenary Session: Neurocritcal Care in the Emergency Department

Edward P. Sloan, MD, MPH Neuroemergencies: What Are Emergency Physicians Taught

Edward P. Sloan, MD, MPH Key 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? 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? 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? 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? 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? 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? 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? 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 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 Guidelines ACEP Clinical Policy Committee –Traumatic Brain Injury –Seizures and Status Epilepticus –Ischemic Stroke and tPA Use

Edward P. Sloan, MD, MPH Clinical Guidelines

Edward P. Sloan, MD, MPH Evidence Based Reviews Cochrane Collaboration * Societies

Edward P. Sloan, MD, MPH Internet Based Learning ACEP, AAEM Scientific Assemblies

Edward P. Sloan, MD, MPH Internet Based Learning

Edward P. Sloan, MD, MPH

Overview Mission 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 Education Meeting Attendance and Evaluations 75 FERNE meetings 420+ Clinical Lectures 15 Research Lectures 191 Different Speakers

E. Bradshaw Bunney, MD Education Meeting Attendance and Evaluations More than 5530 physicians in attendance 10,370+ physician contact hours Content evaluated as excellent or good by 97% of learners

Edward P. Sloan, MD, MPH Education Branded 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 Education Web-based Learning: Video Slideshows Audio, video and slide content Audio, video and slide content Able to access individual slides for specific content Able to access individual slides for specific content MS Producer, viewable with Windows Media Player MS Producer, viewable with Windows Media Player

Edward P. Sloan, MD, MPH Education Web-based Learning: Slide Lectures Download or view online

Edward P. Sloan, MD, MPH Education Web-based Learning: Webcasting Live simulcasts using Centra Symposium

Edward P. Sloan, MD, MPH Education Handheld Software: HandiStroke Rx HANDi Stroke Rx Available free from 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 Education Handheld Software: SeizureStat SeizureStat Available at 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 Education Educational 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 Education Web-based Learning: EMedHome.com FERNE generated content FERNE generated content CME can be obtained via the EMedHome website CME can be obtained via the EMedHome website Slides and audio Slides and audio

Edward P. Sloan, MD, MPH Education Web-based Learning: Abstract Search Topic specific abstract searches

Edward P. Sloan, MD, MPH Research Directed 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 Research Seed 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 Education

Edward P. Sloan, MD, MPH Neurological Emergencies Education

Edward P. Sloan, MD, MPH

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

Edward P. Sloan, MD, MPH Other Educational Media

Edward P. Sloan, MD, MPH Conclusions 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 Recommendations 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 ferne_neurocritcare_2008_sloan_education_102408_final 4/27/2015 6:58 AM Edward P. Sloan, MD, MPH, FACEP