Enhance neurology resident comfort in diagnosing brain death through simulation education.

Uniform experience in diagnosing brain death is not guaranteed in residency training. Previous literature describes simulation training as a supplement to brain death education by demonstrating improvement in knowledge and confidence with clinical examination and apnea testing performance as well as diagnosis disclosure. To address educational gaps, we implemented brain death simulation education for senior neurology residents to standardize training and improve knowledge and comfort. 

19 adult neurology residents (PGY3 and 4s) participated. Residents were provided educational materials and asked to complete a pre-test, which included 20 knowledge-based and 15 comfort-based questions (scale 1 to 5, 1= very uncomfortable, 5= very comfortable) on key aspects of diagnosing brain death. A neurointensivist mentored each session and covered all phases of brain death testing: pre-requisites, physical examination, apnea testing, ancillary testing, and communication of findings. Following a debrief session, residents were instructed to complete a post-test (identical to pre-test). 

Knowledge scores improved from 9.6/12 to 10.8/12 for 95% of participants (n=18). Average comfort score improvement was statistically significant (p<0.05) for ensuring all pre-requisites for brain death testing are met (3.5/5 to 4.3/5), identifying/correcting confounding factors (3.3/5 to 4.2/5), brain death physical examination 3.4/5 to 4.5/5), apnea testing (2.5/5 to 4.1/5), and determining need for ancillary testing (3.1/5 to 3.9/5). There was non-significant improvement in determining eligibility for testing (3.7/5 to 4.1/5, p = 0.21) and communication of findings (3.2/5 to 3.6/5, p = 0.23).

Simulation education is a powerful tool for building skills in the determination of death by neurologic criteria during neurology residency. It not only improves resident knowledge but also comfort across the core competencies of diagnosing brain death.