Building confident cohesive stroke response teams: Design, implementation and outcomes of a stroke code simulation training program for interprofessional teams in LMIC

Training in LMICs for hyperacute stroke relies on didactic methods. This study describes the development and evaluates the impact of a high-fidelity simulation-based interprofessional stroke code training course in Pakistan, aiming to improve teamwork, communication, and clinical decision-making. A quasi-experimental mixed-methods study was conducted at Aga Khan University (AKU) in September 2024. Participants encountering hyperacute stroke participated across Pakistan. A total of 25 participants completed this national-level course across 5 stroke centers. Statistical analysis revealed significant improvements in self-efficacy scores across all tasks, except for manage uncontrolled high blood pressures in patients receiving TPA ( p = 0.05583). Notable gains were observed in areas such as interdepartmental communication, prioritizing hyperacute stroke cases during triage and code activation, accurate ASPECT and NIHSS calculation, execution of the hyperacute stroke algorithm and assessment of r-tPA eligibility ( p < 0.001).Questionnaire results demonstrated enhancements across all three learning domains cognitive, affective, and psychomotor with individual learning objectives showing improvements ranging from 25% to 40%. Qualitative analysis highlighted key challenges, including the absence of standardized stroke pathways, lack of adherence to evidence-based practices, and delays in patient arrival and workflow efficiency. Participants underscored the need for structured training programs, improved interdepartmental coordination, and the creation of algorithmic workflows. This study demonstrates that high-fidelity simulation-based training enhances stroke code management skills among healthcare professionals in LMICs. Implementing structured, team-based simulation programs can improve acute stroke care and patient outcomes, thereby improving and streamlining workflows. • High-fidelity interprofessional stroke code simulation training in Pakistan significantly improved self-efficacy across cognitive, affective, and psychomotor domains, achieving 25–40% gains in critical acute stroke management competencies. • Systematic identification of context-specific barriers—including absence of standardized stroke pathways, inconsistent guideline adherence, and resource disparities—enabled targeted workflow optimization in an LMIC setting that is well equipped with CT imaging but lacks trained teams, offering lessons for reciprocal innovation in similarly high-resource yet low-skilled contexts. • Scalable, team-based simulation models have the potential to strengthen acute stroke care delivery in LMICs by enhancing interdepartmental coordination, decision-making, and team cohesion , breaking down silos, and ultimately improving patient outcomes.