To pilot cases of Brain Death/Death by Neurologic Criteria (BD/DNC) for a novel simulation-based mastery learning curriculum, evaluating feasibility of implementation across high- and low-fidelity simulation environments and effects on participants’ confidence in performing BD/DNC.
BD/DNC determination requires uniform mastery, yet many trainees have limited clinical exposure and receive inconsistent training, compounded by variability in institutional protocols.
We developed three cases simulating common challenges to BD/DNC determination. Cases were piloted across six American academic institutions over a six-month period, using the level of simulation fidelity available at each site. Participants completed one of three cases, received debriefing, and completed a pre/post-survey assessing confidence via Likert scale (1-not confident to 5-very confident) across four domains: “Set up and Counseling,” “Prerequisites,” “Neurological Examination,” and “Apnea Test and BD/DNC Declaration.” Pre vs. post composite domain scores were compared using Wilcoxon signed-rank test. Domain-specific score changes were compared between high- and low-fidelity groups using Mann-Whitney U test.
Nineteen participants were enrolled; most (79%) had five or fewer BD/DNC exposures. Ten used high-fidelity simulators, and nine used low-fidelity simulators. Piloting informed curriculum design by defining divergent expectations for trainees with critical care training, exposing variability in institutional practices, highlighting unintended participant prompts (such as pitcher of ice water for oculovestibular testing), and revealing threats to interrater reliability. Median (Interquartile Range) pre-post composite confidence scores improved across all domains (p<0.005): “Set-up and Counseling,” 4 [3.5-4] to 4.5 [4-5]; “Prerequisites,” 4 [4-5] to 4.5 [4-5]; “Neurological Examination,” 4 [4-4] to 4.5 [4-5]; and “Apnea Test and BD/DNC Declaration,” 3 [3-4] to 5 [4-5]. There were no significant differences in magnitude of improvement between high- vs low-fidelity groups.
This pilot demonstrated feasibility of implementing a BD/DNC simulation curriculum across institutions with varying resources. Lessons learned informed refinements to case design and implementation for a simulation-based mastery learning curriculum.