Knowledge, Confidence and Preparedness for Brain Death Determination Among Anaesthesiology and Reanimation Residents:...

Under Turkish law, brain death is determined by two physicians, one of whom is a specialist in anaesthesiology and reanimation or intensive care, a responsibility residents assume soon after qualifying. We assessed whether residents' confidence matches their accuracy, and whether the decision to initiate determination is influenced by the family's attitude toward organ donation.

Cross-sectional web-based survey of a national convenience sample of anaesthesiology and reanimation residents in Türkiye. Ten knowledge statements and three clinical vignettes combined the answer and the respondent's confidence in one choice; the primary outcome was the high-confidence error rate. In an embedded participant-blinded randomised vignette, participants were allocated 1:1 to a medically identical scenario describing the family as favourable or opposed to donation.

A total of 206 residents were analysed. They answered 80.9% of items correctly but endorsed only 64.2% with confidence; confident answers were correct in 90.8% of instances versus 63.3% of non-confident answers (p < 0.001). The mean high-confidence error rate was 5.9 ± 7.3%, yet 50.5% committed at least one such error, and these errors clustered in four domains. In this exploratory comparison, initiation of determination did not differ between arms (85.6% versus 87.4%; adjusted odds ratio 1.29, 95% CI 0.54-3.05). Only 18.0% felt prepared to serve on a determination board; in univariable and sensitivity analyses, preparedness was associated with case exposure and formal instruction but not with knowledge score.

Residents answered most items correctly and were appropriately cautious, yet fewer than one in five felt prepared; self-reported preparedness is not a measure of clinical competence. Supervised clinical exposure, correction of specific misconceptions and communication training are priorities for future intervention studies.