A Simulation-based Mastery Learning Curriculum to Assess and Ensure Competency in Brain Death/Death by Neurological Criteria Determination: Preliminary Results
Nicholas Morris1, Amjad Elmashala2, Matthew Bevers3, Galina Gheihman4, Jamie LaBuzetta5, Tracey Fan6, Shivani Ghoshal7, Justine Cormier8, Casey Albin9, Brittany Lachance10, Melissa Pergakis1, Matthew Hoerth11, Nina Massad12, Jenna Ford13, Jon Rosenberg14, Hera Kamdar15, Hannah Kirsch16, Lauren Koffman17, Xin Zhou17, Sarah Wahlster18, Sean Marinelli19, Stefanie Cappucci20, Rachel Beekman21, Reem El-Ghawanmeh22, Ariane Lewis23, David Greer24, William McGaghie13, Daniel Harrison22
1Neurology, University of Maryland School of Medicine, 2The University of Iowa Hospitals & Clinics, 3Brigham and Women's Hospital, 4Brigham & Women's Hospital, 5UC San Diego Health, 6Neurology, University of Chicago, 7Columbia University Medical Center, 8Neurology, University of Connecticut School of Medicine, 9Emory Healthcare, 10Chest Medicine Associates, 11Mayo Clinic Arizona, 12University of Miami, 13Northwestern Feinberg School of Medicine, 14Westchester New York Medical College, 15Ohio State University Wexner Medical Center, 16Stanford University, 17Temple University Hospital, 18University of Washington School of Medicine, 19University of Washington, 20Yale School of Medicine, 21Yale New Haven Medical Center, 22Boston Medical Center, 23NYU Langone Medical Center, 24Boston University School of Medicine
Objective:
To evaluate if simulation-based mastery learning (SBML) can achieve uniform competency among neurology trainees in brain death / death by neurological criteria (BD/DNC) determination.
Background:
The ACGME Milestones suggest that neurology trainees should be able to properly perform BD/DNC determination by graduation. Data on physician knowledge, comfort, and competency with performing BD/DNC determinations demonstrate opportunities for improvement. We hypothesized that SBML could close the gap between ACGME expectations and practice in BD/DNC determination.
Design/Methods:
In August 2025, we began enrolling in an ongoing multicenter pretest-posttest study of SBML. We randomized neurology trainees to one of three simulated cases of BD/DNC determination as a pretest, followed by didactic training (the Neurocritical Care Society online Brain Death Determination course). We assessed participants using a different randomly selected simulated case immediately after taking the course, and again after deliberate practice. We scored performance using a checklist derived from a Delphi process involving authors of 2023 BD/DNC Guidelines with a minimum passing score (MPS = 89%) derived from Angoff standard setting determined by members of UCNS and ACGME Neurocritical Care examination committees. We performed repeated measures ANOVA for comparison among those that completed the curriculum.
Conclusions:
SBML achieved near uniform competency in BD/DNC determination skills among neurology trainees that completed the SBML curriculum.
Disclaimer: Abstracts were not reviewed by Neurology® and do not reflect the views of Neurology® editors or staff.