Variability in Brain Death Education Across US Neurology Residency Programs
Getasha Doobay1, Erin Barnes2, Jeremy Moeller3, Emily Gilmore4, Rachel Beekman5
1Yale New Haven Hospital, 2Albany Medical Center, 3Yale University, 4Yale University School of Medicine, 5Yale New Haven Medical Center
Objective:

Investigate variability in U.S. neurology resident education on brain death.

Background:
Clinician competence is critical for accurate and consistent brain death testing. Brain death determination is a core competency of graduating neurology residents in the U.S., however, formal teaching and competency assessment during training may be limited.
Design/Methods:

A 17-question survey on brain death education was sent to program directors of ACGME-accredited neurology residency programs for whom contact information was available (146/177 programs, 83%).

Results:

Respondents (39/146 programs, 26.7%) were predominantly from established programs, defined as > 10 years of ACGME accreditation (82%), in the northeast (44%) with neurosciences intensive care units (97%) and mandatory neurocritical care rotations (95%). Neurologists (86%) and neurointensivists (80%) were authorized by hospital policy to conduct brain death testing; less commonly, programs had no specific criteria for testing (11%) or allowed residents to perform testing (9%). Lecture-based instruction was used by most programs (91%) and many integrated observed encounters (51%) and simulation (37%) as teaching tools. Brain death education included examination techniques (97%), pre-requisites (94%), findings inconsistent with brain death (94%), common mimics (85%), communication strategies for delivering the diagnosis (79%), as well as apnea testing techniques (74%), including when to abort testing (65%) and how to interpret the arterial blood gas (62%). Competence for graduation was assessed through a required observed patient encounter (41%), simulation-based encounter (21%), or resident self-reporting (24%). Few programs reported residents completing 5 or more brain death evaluations (18%) prior to graduation. The majority (78%) of programs expressed interest in shared simulation scripts.

 

Conclusions:

Variability in brain death education exists amongst ACGME-accredited neurology residency programs. There is an opportunity to standardize brain death education, as well as establish techniques and standards for determination of clinical competence.

10.1212/WNL.0000000000206169