Simulation-Based Training in Brain Death Determination
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ORIGINAL ARTICLE
Simulation-Based Training in Brain Death Determination Benjamin J. MacDougall • Jennifer D. Robinson Liana Kappus • Stephanie N. Sudikoff • David M. Greer
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Ó Springer Science+Business Media New York 2014
Abstract Background Despite straightforward guidelines on brain death determination by the American Academy of Neurology (AAN), substantial practice variability exists internationally, between states, and among institutions. We created a simulation-based training course on proper
All Simulation expertise and resources including, but not limited to, simulation enhanced curricular construction, scenario design, simulator adaptation and technical support, were provided by the SYN:APSE Center for Learning, Transformation and Innovation at Yale-New Haven Health System.
Electronic supplementary material The online version of this article (doi:10.1007/s12028-014-9975-x) contains supplementary material, which is available to authorized users. B. J. MacDougall Yale University School of Medicine, New Haven, CT, USA J. D. Robinson Department of Neuroscience, Yale-New Haven Hospital, New Haven, CT, USA L. Kappus S. N. Sudikoff SYN:APSE Center for Learning, Transformation, and Innovation, Yale-New Haven Health System, New Haven, CT, USA S. N. Sudikoff Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA D. M. Greer (&) LLCI 912, Department of Neurology, Yale University School of Medicine, 15 York Street, New Haven, CT 06520, USA e-mail: [email protected]
determination based on the AAN practice parameters to address and assess knowledge and practice gaps at our institution. Methods Our intervention consisted of a didactic course and a simulation exercise, and was bookended by before and after multiple-choice tests. The 40-min didactic course, including a video demonstration, covered all aspects of the brain death examination. Simulation sessions utilized a SimMan 3G manikin and involved a complete examination, including an apnea test. Possible confounders and signs incompatible with brain death were embedded throughout. Facilitators evaluated performance with a 26point checklist based on the most recent AAN guidelines. A senior neurologist conducted all aspects of the course, including the didactic session, simulation, and debriefing session. Results Ninety physicians from multiple specialties have participated in the didactic session, 38 of whom have completed the simulation. Pre-test scores were poor (41.4 %), with attendings scoring higher than residents (46.6 vs. 40.4 %, p = 0.07), and neurologists and neurosurgeons significantly outperforming other specialists (53.9 vs. 38.9 %, p = 0.003). Post-test scores (73.3 %) were notably higher than pre-test scores (45.4 %). Participant feedback has been uniformly positive. Conclusion Baseline knowledge of brain death determination among providers was low but improved greatly after the course. Our intervention represents an effective model that can be replicated at other institutions to train clinicians in the determination of
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