Date of Award

January 2015

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

David M. Greer

Subject Area(s)

Neurosciences, Education

Abstract

Despite straightforward guidelines on brain death determination by the American Academy of Neurology (AAN), substantial practice variability exists internationally, between states, and among institutions. We created a simulation-based training course on proper determination based on the AAN practice parameters to address and assess knowledge and practice gaps at our institution. Our intervention consisted of a didactic course and a simulation exercise, and was bookended by before and after multiple-choice tests. The 40-minute didactic course, including a video demonstration, covered all aspects of the brain death examination. Simulation sessions utilized a SimMan 3G manikin, and involved a complete examination, including an apnea test. Possible confounders and signs incompatible with brain death were embedded throughout. Facilitators evaluated performance with a 26-point checklist based on the most recent AAN guidelines. One hundred eleven physicians from multiple specialties have participated in the didactic session, and 38 have completed the simulation. Pre-test scores were poor (41.4%), with attendings scoring higher than residents (46.6% vs. 40.4%, p=0.07), and neurologists and neurosurgeons significantly outperforming other specialists (53.9% vs. 38.9%, p=0.003). Post-test scores (73.3%) were notably higher than pre-test scores (45.4%). Participant feedback has been uniformly positive. Baseline knowledge of brain death determination among providers was low but improved greatly after the course. In conclusion, our intervention represents an effective model that can be replicated at other institutions to train clinicians in the determination of brain death according to evidence-based guidelines.

Comments

This is an Open Access Thesis.

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