Curriculum Innovation: A Multicenter Feasibility Study of a Consensus-Based Brain Death Simulation Curriculum

Area of Science:

• Medical Education
• Neurology
• Critical Care

Background:

• Competency in brain death/death by neurologic criteria (BD/DNC) determination is a critical milestone for neurology residents and neurocritical care fellows.
• Trainees often have limited clinical exposure and inconsistent training in BD/DNC determination across institutions.
• Simulation offers a standardized, safe method for teaching and assessing BD/DNC, but multi-institutional implementation has not been studied.

Purpose of the Study:

• To evaluate the feasibility of implementing a consensus-based BD/DNC curriculum across multiple institutions.
• To assess the impact of this simulation curriculum on trainee confidence and self-assessed competency in BD/DNC determination.

Main Methods:

• A consensus process developed 3 simulation cases addressing BD/DNC confounders, implemented in high- and low-fidelity settings.
• Neurology residents and neurocritical care fellows from 6 US academic centers participated.
• Pre/post surveys assessed confidence in 4 BD/DNC domains; data were analyzed using Wilcoxon signed-rank and Mann-Whitney U tests.

Main Results:

• Nineteen participants showed significant improvements in median confidence scores across all BD/DNC domains (p < 0.001).
• Effect sizes for confidence improvement were large (Wilcoxon r = 0.79–0.88).
• No significant differences in confidence improvement were observed between high- and low-fidelity simulation groups; 68% self-assessed as Level 4 or 5 competency post-curriculum.

Conclusions:

• A consensus-based, multi-institutional BD/DNC simulation curriculum is feasible and effectively enhances trainee confidence.
• Standardizing core practices while allowing for local variability and using adaptable curricula are key lessons learned.
• Simulation provides a viable method to improve BD/DNC determination competency, even with limited prior clinical experience.