A Modified Delphi Consensus-Based Comprehensive Checklist and Angoff Standard for Assessment of Competency in Brain...

Area of Science:

• Medical Education
• Neurology
• Critical Care Medicine

Background:

• Accurate determination of brain death/death by neurologic criteria (BD/DNC) is crucial in critical care.
• Standardized assessment tools are needed to ensure competency among clinicians.
• Existing assessment methods may lack comprehensive criteria and defined passing standards.

Purpose of the Study:

• To develop a comprehensive checklist for BD/DNC determination.
• To define critical actions and establish a minimal passing standard for clinician assessment.
• To facilitate formative and summative evaluation of BD/DNC determination skills.

Main Methods:

• A three-round modified Delphi consensus process was used to define checklist items.
• A modified Angoff standard-setting process determined critical actions and item ratings.
• Electronic surveys were utilized with experts in BD/DNC determination.

Main Results:

• A 98-item checklist covering prerequisites, clinical examination, apnea testing, and ancillary testing was finalized.
• Seven critical actions were identified through expert consensus.
• A minimum passing score of 89% was established for noncritical items.

Conclusions:

• The developed checklist and standards can be used in simulated cases to assess clinician readiness for BD/DNC determination.
• This tool may mitigate the risk of inaccurate BD/DNC determinations.
• The methodology for defining critical actions can be adapted for other critical care simulation-based assessments.