Curriculum Innovation: Standardized Curriculum Improves Physician and Nurse Competence and Self-Assessment in Brain...

There is less familiarity with brain death/death by neurologic criteria (BD/DNC) among medical professionals when compared with cardiac death. Targeted education should be offered to providers to improve competence and familiarity with this entity. This study was designed to evaluate the impact of a standardized curriculum on physician and nurse competence and comfort regarding BD/DNC determination. Physicians will be able to define BD/DNC, understand societal perceptions of BD/DNC, evaluate the prerequisites for determination of BD/DNC, perform a BD/DNC examination, and provide bedside counseling regarding BD/DNC. Nurses will be able to define BD/DNC, understand societal perceptions of BD/DNC, evaluate the prerequisites for determination of BD/DNC, and provide bedside counseling regarding BD/DNC.

BD/DNC curricula were developed and offered to (1) neurosciences and critical care physicians to enhance accurate declaration and discussion of BD/DNC and (2) critical care nurses to improve comfort and competence in answering family questions about BD/DNC at the bedside. Physicians underwent a formal didactic, followed by simulation-based training incorporating examination and communication skills. Critical care nurses underwent formalized didactic, followed by peer-based simulated conversations of frequently asked questions. All participants completed a precurriculum and postcurriculum survey and quiz. The Wilcoxon signed-rank test was used for analysis of quiz scores and Likert survey responses.

Forty-six neurosciences and critical care physicians (37% female) and 30 nurses (80% female) participated in their respective curriculum. Median scores on knowledge quiz significantly improved for physicians (5 [interquartile range (IQR) = 4, 6] before to 7 [IQR = 6, 8] after, p < 0.001) and for nurses (4.5 [IQR = 4, 5] before to 7 [IQR = 6, 8] after, p < 0.001). Median physician comfort in independently performing BD/DNC declaration increased (3 [IQR = 1, 5.25] before to 8 [IQR = 7, 9] after, p < 0.001). Median comfort in discussing BD/DNC with patients' family increased for both physicians (5 [IQR = 3.75, 7] before to 8 [IQR = 7, 9] after, p < 0.001) and nurses (5 [IQR = 3, 8] before to 8 [IQR = 7, 8.5] after, p < 0.001).

Formalized education on BD/DNC improves competence and self-assessment measures among physicians and nurses.