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Simulation-Based Training Improves Fellows' Competence in Brain Death Discussion and Declaration.

Patrick M Chen1,2, Aaron Trando1, Jamie Nicole LaBuzetta1

  • 1Department of Neurosciences, Division of Neurocritical Care, University of California, San Diego, CA.

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Summary

A new curriculum combining didactics and simulation improved critical care fellows' knowledge and comfort in declaring brain death. This training enhances both examination skills and family communication, addressing variability in practice.

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Area of Science:

  • Medical Education
  • Neurology
  • Critical Care Medicine

Background:

  • Variability exists in national practice regarding brain death declaration, despite established guidelines.
  • Lack of formal education is a potential contributing factor to this practice variability.
  • Effective communication with families during brain death declaration is crucial.

Purpose of the Study:

  • To develop and evaluate a targeted curriculum for brain death declaration.
  • To enhance critical care fellows' skills in performing brain death examinations.
  • To improve fellows' ability to communicate brain death diagnoses to families.

Main Methods:

  • A multidisciplinary curriculum combined didactics, case studies, and simulation-based training using a SimMan3G mannequin.
  • Fellows practiced delivering a brain death diagnosis in a standardized family scenario.
  • Pre- and post-curriculum knowledge tests and surveys assessed changes in knowledge, confidence, and comfort.

Main Results:

  • Significant improvements were observed in self-rated knowledge, perceived knowledge, confidence, and comfort with brain death exams and family discussions.
  • Objective test scores improved from 56% to 73% post-simulation.
  • Most fellows had limited prior experience with brain death declarations (0-5 cases).

Conclusions:

  • Trainees often have insufficient exposure to formal brain death education.
  • Didactic and simulation-based education effectively enhances objective knowledge and subjective comfort levels related to brain death declaration and communication.