Simulation-based Brain Death Determination Training for Neurology Residents
Cesar Escamilla-Ocanas1, Gabriel Torrealba-Acosta2, Noelia Morales-Cardona3, Lintu Ramachandran3, Catherine Garcia4, Mohammad Hirzallah1
1Baylor College of Medicine, 2Department of Neurology, Duke University Medical Center, Durham, NC, 3Department of Neurology, Baylor College of Medicine, Houston Texas, 4MD Anderson Cancer Center
Objective:

We evaluated the impact of a simulation-based brain death determination workshop among second-year neurology residents, focusing on the foundational understanding of brain death as well as their proficiency conducting brain death examinations.

Background:

Brain death determination is an essential skill every neurologist should have. Despite the availability of clear guidelines for brain death determination, there is significant variability in practice both, within the United States and internationally. Previous studies have shown neurology residents have limited exposure to brain death examination and typically do not perform this task independently. However, they are expected to be proficient in determining brain death by the end of residency. We developed a simulation-based workshop for brain death determination, which aligns with the current American Academy of Neurology (AAN) guidelines.

Design/Methods:

We designed a simulation-based workshop for brain death determination for second-year neurology residents. High fidelity mannequins were used to simulate patients and five different clinical scenarios were presented. each case, a debriefing session was conducted to provide immediate feedback.  A pre- and post-workshop questionnaire was applied to each resident and mean scores were compared with a paired t-test.  Educational competencies evaluated included brain death pre-requisites, evaluating confounders, brain death neurological examination, spinal reflexes, brain death ancillary testing.  Questionnaire results had no identifiable information.

Results:

Nine neurology residents completed the brain death determination workshop. Eight out of nine demonstrated an improvement in performance following the completion of the workshop. Mean pre-workshop score was 70.94 % ± 19.90, while the mean post-workshop score increased to 93.16 % ± 9.76 (p=0.0196).

Conclusions:

The participation in a brain death determination simulation workshop among second-year neurology residents improved the foundational understanding of brain death determination. Conducting a simulation-based workshop early during neurology training might help increase the level of confidence and proficiency performing a comprehensive brain death examination prior to the completion of residency.

10.1212/WNL.0000000000206604