What should be clarified when learning the International Standards to Document Remaining Autonomic Function after Spinal Cord Injury (ISAFSCI) among medical students

The International Standards to Document Remaining Autonomic Function after Spinal Cord Injury (ISAFSCI) is a classification system to assess autonomic dysfunction after spinal cord injury (SCI). Based on feedbacks from a group of medical students who have received ISAFSCI training, our study attempted to identify the problems during ISAFSCI implementation, and to provide revision suggestion for a better instruction. We found three types of problems and provided suggestion to make further clarifications, which may facilitate a better understanding of the ISAFSCI content and more accurate ISAFSCI implementation.

• 1
  Definitions of resting hypotension, orthostatic hypotension (OH), and autonomic dysreflexia (AD) were difficult for medical students to remember, particularly regarding the inclusion or exclusion of threshold values in diagnostic criteria.
• 2
  Inconsistent descriptions for the same ISAFSCI item between the instruction text and assessment form created confusion, particularly with terms like supine hypotension versus resting hypotension.
• 3
  Nine ISAFSCI items presented confusion in choosing the appropriate answer options, including determining 'normal' autonomic control and differentiating levels of urinary and fecal incontinence.