Determining the utility of simulation-based training in assessment of the ACGME milestone for brain death determination in adult Neurology residents. 

Recent updates to the ACGME milestones require proficiency in brain death determination. Because brain death occurs rarely, there is limited opportunity to observe and perform a brain death exam during residency. Simulation-based training is a useful tool for teaching management of infrequently encountered scenarios such as brain death. Prior studies have shown simulation improves practitioner knowledge base and comfort level with diagnosing brain death. No studies have demonstrated its utility as an assessment tool.

We created a simulation using a SimMan 3G manikin for brain death determination. Using the American Academy of Neurology guidelines, we created a validated checklist scoring four categories: pre-requisites and confounders, neurologic examination, apnea test, and determination of the need for ancillary testing. Adult neurology residents completed a survey before participating in the simulation. After the simulation, residents participated in a group debriefing and completed a post-simulation survey identical to the pre-simulation survey. The ACGME milestone for determination of brain death was assessed based on participants’ scores on the simulation.

All UF neurology residents performed the brain death determination simulation and were objectively scored on the ACGME milestone. Residents reported improved comfort level with determining brain death and scored higher on knowledge-based questions after the simulation and debriefing session.

We successfully created a simulation designed to assess residents’ progress on the ACGME milestones in determining death by neurologic criteria. Variations of these scenarios exposed residents to commonly-encountered confounders, barriers to completing the exam, and situations where interventions may be required to continue testing safely. Additionally, residents reported increased comfort level and scored higher on knowledge-based questions after the simulation and debriefing.