IntroductionMechanical thrombectomy (MT) has transformed the treatment of ischemic stroke. However, patient access to MT may be limited due to a shortage of doctors specifically trained to perform MT. The studies reported here were done to (1) develop, operationally define, and seek consensus from procedure experts on the metrics which best characterize a reference procedure for the performance of an MT for ischemic stroke and (2) evaluate their construct validity when implemented in a virtual reality (VR) simulation.MethodsIn study 1, the metrics for a reference approach to an MT procedure for ischemic stroke of 10 phases, 46 steps, and 56 errors and critical errors, were presented to an international Delphi panel of 21 consultant level interventional neuroradiologists (INRs). In study 2, the metrics were used to assess 8 expert and 10 novice INRs performing a VR simulated routine MT procedure.ResultsIn study 1, the Delphi panel reached consensus on the appropriateness of the procedure metrics for a reference approach to MT in ischemic stroke. Group differences in median scores in study 2 demonstrated that experienced INRs performed the case 19% faster (P=0.029), completed 40% more procedure phases (P=0.009), 20% more steps (P=0.012), and made 42% fewer errors (P=0.016) than the novice group.ConclusionsThe international Delphi panel agreed metrics implemented in a VR simulation of MT distinguished between the computer scored procedure performance of INR experts and novices. The studies reported here support the demonstration of face, content, and construct validity of the MT metrics.

The overall experience was positive. In terms of the primary thesis of this study, the STs thought that they were well prepared by the teaching staff to take part in these teaching sessions.

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Handover of patient care is a time of particular risk and it is important that accurate and relevant information is clearly communicated. The hospital discharge letter is an important part of handover. However, the quality of hospital discharge letters is variable and letters frequently omit important information. The Cork Letter-Writing Assessment Scale (CLAS) checklist is an itemized checklist developed to improve the quality of discharge letters. The CLAS checklist, with an inbuilt scoring system, is available as the CLAS mobile application. Mobile applications offer an exciting opportunity for ‘point of practice' knowledge acquisition and are widely used by medical students. Content quality is integral to the success of educational mobile applications. In a recent study, the CLAS checklist improved the quality (content, structure and clarity) of discharge letters written by medical students. Though retention of these skills into the work-place and effects on patient safety have yet to be demonstrated, the development of standardized electronic discharge letters allows faster and safer transfer of information between healthcare providers and is a welcome advance. Using Near Field Communication for mobile applications to seamlessly transfer discharge letters between devices is another important feature.

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