Graduating neurology residents’ experience with use of intravenous tPA for acute ischemic stroke
Background: Intravenous tPA was approved as a treatment for acute ischemic stroke in 1996. One potential barrier to increased use of tPA has been lack of experience and training among neurologists. To date, there has been no formal assessment of neurology residents’ experience with tPA during their training. Methods: A 12 item survey was sent in March 2000 to all graduating neurology residents as identified by AMA-GME files. Follow-up surveys were sent in April and May to non-responders. Survey items established residents’ experience and confidence with assessment of the acute stroke patient and use of tPA. Responses were assessed using a 5 point Likert scale. Presence of a dedicated stroke team, ongoing stroke clinical trials, and post-residency career plans were also assessed. Results: Of 398 graduating residents for whom addresses were available, 287 (72%) responded. 80% of respondents had personally treated a patient with tPA; 33% had done so without direct faculty supervision. 12% had neither treated nor observed a patient being treated with tPA. 89% had cared for an acute stroke patient in the first hours after administration of tPA. 73% felt comfortable independently treating acute stroke patients with tPA. 65% of residents had formal NIHSS training. Nearly all residents felt confident in their ability to identify hemorrhage (99%) and early infarct signs (94%) on CT. Residents whose institutions had a stroke team were more likely to have provided post-tPA care (93% vs 71%, p<0.001), to have had formal NIHSS training (69% vs 44%, p<0.001), and to feel comfortable independently treating patients with tPA (75% vs 62%, p=0.08). There was no association between career plans (academics vs private practice) and any survey items. Conclusion: One fifth of graduating neurology residents had never personally treated an acute stroke patient with tPA; one in ten had never seen tPA administered. One quarter did not feel comfortable independently treating with tPA. Experience with current treatment for acute stroke should be considered an essential part of neurology residency training. Stroke teams may be helpful in accomplishing this goal.