Training Lag in FAST Response: How Well Are We at Preparing Our NCHDs for Managing Acute Stroke?

Abstract Background Non-consultant hospital doctors (NCHDs) on the general medical rota frequently assess older patients with suspected stroke, often without formal training. Early recognition and structured assessment are critical for initiating interventions such as thrombolysis. The 2023 UK and Ireland National Clinical Guideline for Stroke emphasises the use of validated tools such as the NIH Stroke Scale (NIHSS) in acute stroke assessment. While ACLS (Advanced Cardiac Life Support) is mandated for NCHDs, NIHSS certification and stroke-specific training are not. This study explored stroke confidence, training, and attitudes toward NIHSS certification among NCHDs. Methods An anonymous survey was distributed to NCHDs on the medical call rota. It captured stroke assessment experience, confidence, training history, and views on NIHSS certification. Results 43 NCHDs responded (interns: 10, SHOs: 20, registrars: 13). 81% had assessed a patient with suspected stroke. Mean confidence in stroke assessment was 2.1 on a 5-point scale (1 = not at all confident, 5 = extremely confident). 79% had not received formal stroke training, and 84% had not received stroke-specific teaching during their current rotation. 74% had never completed NIHSS certification, and 84% had not done so in the past year. Among those uncertified, 81% said they would complete it if offered during hospital induction. Reported barriers included lack of access, time constraints, and unawareness of training resources. 86% agreed that stroke training and NIHSS certification should be mandatory, similar to ACLS. Conclusion Most NCHDs assess patients with suspected stroke without structured training or NIHSS certification. Based on these findings, there is clear demand and justification for including stroke training and NIHSS certification in NCHD hospital induction. These findings support consideration by the Royal College of Physicians of Ireland to incorporate NIHSS certification into Basic and Higher Specialist Training.