How do we equip medical professionals to tackle tough cases without risk to patients? The answer is simulation.
Challenge
Diagnosing and managing focal epilepsy remains a significant challenge for neurologists across Europe due to its heterogeneous presentation, limited patient awareness, and restricted access to diagnostic tools. Treatment complexity is further increased by varied etiologies and numerous therapy options. Additionally, clinical inertia—the reluctance to adapt therapy despite evidence of suboptimal outcomes—remains prevalent, particularly in cases of drug-resistant epilepsy, leading to missed opportunities for therapeutic optimization.
Solution
A virtual patient simulation was deployed to 88 European neurologists, featuring a complex case: a young female with drug-resistant focal epilepsy and comorbid anxiety/depression, experiencing nocturnal breakthrough seizures despite prior monotherapies. The simulation was CPD-certified and allowed physicians to practice diagnosing and managing the case using a comprehensive, evidence-based platform. After each decision, participants received targeted clinical guidance (CG) grounded in best practices and current guidelines, with their performance tracked and compared pre- and post-guidance using validated statistical methods (McNemar’s test).
Impact
The intervention yielded significant improvement: accurate identification of drug-resistant epilepsy, better epilepsy management, and enhanced evaluation of psychiatric comorbidities post-guidance (all P < .01). Post-intervention, correct treatment selection (including optimized combination ASM therapy) rose from 26.1% to 48.8%. Nevertheless, inertia remained an issue, with 47.7% persisting in not changing ineffective therapies even after guidance, although this was a notable reduction from pre-guidance levels (69.3%). Rationales for incorrect management included overestimation of side-effect risk, guideline confusion, and underestimation of seizure severity.
Conclusion
The simulation uncovered substantial educational needs and validated virtual simulation as an effective tool for improving neurologists’ competence in the nuanced management of drug-resistant focal epilepsy.