Abstract WP192: Mobile Stroke Unit Simulation Builds Systems Confidence and Competence in Stroke Trainees

Introduction: Mobile Stroke Units (MSUs) provide unique opportunities for prehospital acute stroke care, yet exposure during training remains limited. Simulation-based education may bridge this gap by preparing stroke trainees to manage real-time diagnostic and therapeutic challenges in the field. Objective: To evaluate the impact of MSU simulation on stroke trainees’ confidence in clinical decision-making and systems navigation, and to assess their post-simulation performance in comparison with graduating trainees. Methods: A structured MSU simulation curriculum was administered to 4 new vascular neurology trainees. Confidence across 12 skill domains, including clinical decision-making and systems coordination, was assessed pre- and post-simulation using Likert-scale surveys. Pre- vs. post-simulation changes were analyzed using Wilcoxon signed-rank tests and effect sizes (Cohen’s d). Post-simulation performance was then compared with 4 graduating trainees using Mann-Whitney U tests. Results: The trainees’ systems confidence post-simulation was significantly higher than pre-simulation (mean summed score 17.5 (2.4) vs 10.0 (1.2), d =4.01, 95% CI [1.4, 6.6]). The simulation showed a strong positive effect on clinical confidence (mean summed score 36.5 (3.1) vs 29.5 (4.9), d=1.7, 95% CI [–0.02, 3.3]). Key skill improvements included telemedicine utilization (mean Likert-scale score 4.3 (1) vs 2.0 (0.0)), coordination with crew (mean Likert-scale score 4.3 (0.5) vs 2.8 (0.5)), and escalation of concerns (mean Likert-scale score 4.5 (0.6) vs 2.5 (0.6)). There were minimal differences between post-simulation and graduating trainees across clinical and systems domains (mean summed score; clinical confidence: 36.5 (3.1) vs. 39.3 (1.0), d=1.2, 95% CI [-0.4, 2.7].; systems confidence: 17.5 (2.4) vs. 18.3 (1.3), d=0.4, 95% CI [–1.0, 1.8]). Conclusion: MSU simulation markedly enhanced systems-based confidence and clinical readiness among stroke trainees. Following the simulation, new stroke trainees achieved performance comparable to graduating peers, underscoring the simulation as a powerful tool to accelerate MSU competency and ensure preparedness for real-world prehospital stroke care.