Objective:

This Quality Improvement (QI) project evaluates adult neurology residents' knowledge and confidence in brain death testing before and after simulation-based training led by a neurocritical care attending, using the updated 2023 AAN guidelines on death by neurological criteria. 

Background:

Discrepancies in brain death testing arise from varying institutional policies and state laws. The AAN's 2023 guidelines aim to standardize brain death determination. Developing resident confidence and competence is essential, as this ACGME milestone will impact their independent practice. 

Design/Methods:

This QI project evaluates knowledge and confidence through one-on-one simulations with 11 neurology residents (PGY2-PGY4) and a neurocritical care attending at an academic medical center. A 25-question pre-test on the new guidelines was followed by a lecture and simulation sessions covering prerequisites, exam techniques, and family communication.  A post-test was administered to assess improvements in knowledge and confidence. 

Results:

The pre-test revealed that few residents had observed three or more brain death exams (4/11), and most had never performed one themselves (6/11) or witnessed a single apnea test (6/11). While 63.36% felt somewhat comfortable performing a brain death exam, only 45.45% were confident in teaching it. Interestingly, 72.72% believed they understood the prerequisites according to the new guidelines, but the average pre-test score was only 48.48%. Furthermore, there was no association between a higher level of training and test scores. Testing is ongoing, and post-test results will be presented at the conference. 

Conclusions:

This simulation-based training targets gaps in knowledge and confidence among adult neurology residents regarding brain death determination. By aligning with the updated AAN 2023 guidelines, it strengthens both practical skills and teaching abilities. The personalized simulations offer a promising approach to improving competency as they effectively recreate a high-stakes assessment in a relatively low-cost environment while providing high educational value. Post-test results will confirm the program’s overall impact on resident preparedness.