Use of Cognitive Aid Methods in the Management of Status Epilepticus

Status epilepticus (SE) is a neurological emergency requiring rapid recognition, timely escalation of therapy, and coordinated team-based management. Delays in treatment initiation and deviations from evidence-based algorithms are associated with increased morbidity and mortality. In high-stress emergency settings, healthcare trainees may experience cognitive overload, impaired situational awareness, and reduced adherence to treatment protocols. Cognitive aids have been increasingly incorporated into crisis resource management strategies to support clinical decision-making and reduce omission of critical steps during time-sensitive emergencies.

The present study is designed as a simulation-based educational intervention investigating the impact of cognitive aids on the management of status epilepticus among sixth-year Emergency Medicine interns. The study specifically examines whether the availability and format of cognitive aids influence crisis management performance in a standardized simulated environment.

• Inclusion Criteria Being a sixth-year Emergency Medicine intern, Willingness to participate in the study
• Exclusion Criteria Previous participation in simulation studies involving cognitive aids, Prior involvement in the development of the cognitive aids used in this study

The cognitive aids used in the study will be developed according to contemporary evidence-based recommendations for status epilepticus management. Their content and clinical appropriateness will be reviewed by an expert panel consisting of emergency medicine specialists, neurologists and intensive care specialists. Both paper-based and digital-format cognitive aids will contain identical clinical content and treatment algorithms.

All participants will receive standardized baseline instruction on status epilepticus management before participation in simulation activities. Simulation sessions will be conducted approximately one month after the didactic training in order to evaluate retention and practical application of knowledge rather than immediate post-lecture recall.

Simulation scenarios will be conducted in a high-fidelity simulation environment using predefined case scripts, standardized patient progression, and uniform learning objectives. Scenarios will involve dynamic clinical deterioration requiring participants to recognize ongoing seizure activity, initiate first-line therapy, escalate treatment appropriately, assess reversible causes, and manage airway and hemodynamic complications. Simulation conditions will be standardized across all groups to minimize variability in scenario delivery.

The study will be conducted as a prospective, simulation-based, controlled educational intervention study involving sixth-year Emergency Medicine interns. Participants will be allocated into three study groups:

Intervention Group A: Participants will be provided with a paper-based cognitive aid consisting of a status epilepticus management checklist/algorithm during the simulation scenario.

Intervention Group B: Participants will be provided with a digital-format cognitive aid consisting of a status epilepticus management checklist/algorithm during the simulation scenario.

Control Group: Participants will manage the simulated patient without the use of any cognitive aid and will rely solely on their existing knowledge and clinical reasoning skills.

Participants assigned to cognitive aid groups will receive a brief orientation regarding the practical use of the aid before the simulation session. This orientation will focus solely on usability and navigation of the tool and will not include additional clinical instruction.

Performance assessment will include both technical and non-technical domains. Technical performance will be evaluated using structured scenario-specific checklists derived from guideline-based management steps. Non-technical performance will be assessed using validated crisis resource management assessment principles, including leadership, communication, situational awareness, task prioritization, and decision-making behaviors.

Simulation encounters will be video recorded for assessment purposes. Evaluators responsible for scoring participant performance will use standardized assessment tools and predefined scoring criteria to improve scoring consistency. Structured debriefing sessions will be conducted after completion of the scenarios to facilitate reflective learning and reinforce evidence-based management principles.

The study is expected to provide evidence regarding the educational effectiveness of cognitive aids in emergency medicine simulation training and may contribute to the development of future crisis resource management strategies in time-critical neurological emergencies. In addition, findings from this study may help clarify whether digital or paper-based cognitive support tools provide advantages in clinical performance, workflow integration, and cognitive workload management during acute emergency scenarios.