A National Survey of Simulation Use, Limitations, and Future Directions in Neurocritical Care Fellowship Training

OBJECTIVE: Details regarding the use and implementation of simulation-based medical education (SBME) among neurocritical care fellowship programs are limited. The objective of this study was to describe the current use of SBME in neurocritical care fellowship education and to assess perceived barriers to SBME growth in both programs currently using simulation and those that are not. METHODS: We surveyed neurocritical care fellowship program directors using email addresses listed in the San Francisco Match directory using a Qualtrics-based survey platform. Survey questions addressed current utilization of SBME and barriers to SBME growth. RESULTS: Thirty-nine of 72 (54%) program directors responded to our survey. Of the respondents, 95% (37/39) report using SBME in their neurocritical care fellowship training programs. Most (94%, 34/36) programs create their own simulation cases. SBME was most frequently used for trainee education and trainee assessment, and rarely used for quality improvement. The most reported SBME case topics included fundamentals in neurocritical care, vascular neurology, serious illness communication, and interprofessional team dynamics. Simulations rarely focused on headache management or neuro-infectious disease, and simulations on healthcare disparities and implicit bias were not reported among survey respondents. Eighty-two percent (32/39) of responding institutions reported wanting to increase the amount of simulation training offered. Reported barriers include faculty protected time, funding, and mentorship. DISCUSSION: SBME has been embraced by most responding programs; however, the content of simulation curricula varies. Fellowship directors report interest in expanding SBME at their institutions, though are commonly limited by faculty time constraints, financial support, and mentorship. Future collaboration across institutions and application of SBME in learner assessment and quality improvement may improve simulation growth and innovation in neurocritical care fellowship training.