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734: UNUSUAL CASE OF A GUILLAIN-BARRÉ SYNDROME VARIANT PRESENTING WITH ACUTE RESPIRATORY FAILURE

Learning Objectives: Nearly 12% of medical intensive care unit (MICU) patients experience neurologic complications, causing longer lengths of stay and increased mortality. Correct diagnosis in neurologic emergencies is often delayed due to improper exam technique or lack of confidence in the bedside neurologic exam. Focused bedside instruction in the neuro exam of unresponsive MICU patients, not part of the standard curriculum for internal medicine (IM) residents, is urgently needed to improve care. Methods: IM residents completed neuro exams, observed by 2 faculty members, on volunteer patients with true neuro findings as part of a clinical skills assessment program (nPACES1). Residents were evaluated in 5 domains: exam technique, identifying signs, differential diagnosis, clinical judgment and patient welfare. Residents received 10-minute post assessment teaching in the bedside neuro exam. Based on nPACES1, nPACES2 curriculum was designed to improve the IM bedside neuro exam of unresponsive MICU patients. Before the MICU rotation, residents’ attitudes, confidence, and knowledge in the neuro exam for unresponsive patients is assessed. Residents then are randomized to either 30-minute bedside teaching or standard MICU teaching arms. All residents complete post-rotation assessments and observed bedside exams on unresponsive ICU patients. Results: A total of 39 interns examined a neurologic patient under the observation of 2 faculty members in nPACES1. A total of 68 exam scores were recorded. Overall performance on the neurologic exam was lower than performance on the cardiac and pulmonary exams (neuro mean: 55%; cardiac mean: 71%; pulmonary mean: 76%). Scores for other clinical domains did not differ. Residents rated the teaching during nPACES1 positively and reported a desire for additional bedside neuro exam teaching. nPACES2 curriculum has been developed and approved by the Department of Medicine and will start in October 2018. Conclusions: IM resident performance in the neuro exam is significantly below other clinical domains. There is a desire and need for dedicated bedside neuro exam teaching in IM training. Directly observed neuro exams coupled with real-time individualized feedback are a powerful tool to improve skill and are viewed favorably by trainees. We apply this novel approach to teaching critical care neurology to IM residents using our nPACES2 curriculum. The goal of nPACES2 is to improve diagnostic accuracy when assessing unresponsive critically ill MICU patients at the bedside.