LAUSR

BACKGROUND Prompt and accurate identification of stroke victims is essential to reduce time from symptoms' onset to adequate treatment and to improve neurological outcomes, and stroke victims are most often first cared for by paramedics. Most neurologists evaluate the extent of the neurological deficit according to the National Institutes of Health Stroke Scale (NIHSS), but the use of this scale by paramedics has proven unreliable. This might be, at least in part, due to the teaching method. As the video used to teach NIHSS lacks interactivity, engaging electronic learning (e-learning) methods might improve knowledge acquisition. OBJECTIVE This study was designed to evaluate whether a highly interactive e-learning module could enhance NIHSS knowledge acquisition in paramedics. METHODS A randomized, controlled trial comparing a specially designed e-learning module with the original NIHSS video was performed on paramedics working in Geneva, Switzerland. A registration number was not required as our study doesn't come into the scope of the Swiss federal law on human research. The protocol was nevertheless submitted to the local ethics committee (Project ID 2017-00847) which issued a "Declaration of no objection". Paramedics were excluded if they had prior knowledge of or previous training in the NIHSS, or if they had worked in a neurology or neurosurgery ward. The primary outcome was the overall performance in the study quiz, which contained 50 questions. Secondary outcomes were performance by NIHSS item, time to course and to quiz completion, user satisfaction regarding the learning method, user's perception of the course duration, and probability the user would recommend the course to a colleague. RESULTS The study was completed by 39 paramedics. There was a better overall median score (36/50 vs 33/50, P=.04) and a higher degree of satisfaction regarding the learning method (90% vs 37%, P=.002) in the e-learning group. Users who had followed the e-learning module were more likely to recommend the course to a colleague (95% vs 63%, P=.02). Paramedics in the e-learning group took more time to complete the course (93 vs 59 minutes, P<.001), but considered the duration to be more adequate (75% vs 32%, P=.01). Time to quiz completion was similar between both groups (25 vs 38 minutes, P=.12). CONCLUSIONS Use of an e-learning module therefore shows promising results in teaching the NIHSS to paramedics. CLINICALTRIAL