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Neurocritical Care

, Volume 23, Issue 3, pp 401–408 | Cite as

Testing Confounders in Brain Death Determination: A New Simulation Model

  • Sara Hocker
  • Donna Schumacher
  • Jay Mandrekar
  • Eelco F.M. Wijdicks
Original Article

Abstract

Introduction

Given the rarity of brain death in clinical practice, trainees may complete their training without ever performing a brain death exam. Little is known about the performance of trainees in the evaluation of brain death. The accuracy of brain death determination can be audited and improved through simulation models.

Methods

A simulated brain death scenario was designed to incorporate numerous potential confounders. We utilized a SimMan 3G mannequin, registered nurse, simulation technician, and a facilitator. Critical care and neurology trainees were evaluated using a 24-point checklist based on the AAN guidelines. Trainees rated their confidence (5 point scale with 1 = novice, 3 = competent, and 5 = fully confident) in the evaluation of brain death and apnea testing before and after completing the scenario. Following the simulation, trainees participated in debriefing sessions involving a review of the checklist and playback of simulation videos.

Results

Forty-one trainees completed the simulation. Trainees successfully completed 352/492 (71.5 %) tasks pertaining to the evaluation of prerequisites and 262/369 (71.0 %) tasks pertaining to the clinical examination. Trainee confidence in the evaluation of brain death (2.12 ± 0.74 vs 3.29 ± 0.62, p = 0.0001) and apnea testing (2.10 ± 0.74 vs 3.59 ± 0.77, p = 0.001) significantly improved.

Conclusions

We successfully tested a new simulation model which emphasized training in crucial pitfalls. More than one in four trainees performed poorly in the evaluation of prerequisites and the clinical examination. Few trainees considered the possibility of drug or alcohol ingestion. Simulation training improved clinical performance and trainee confidence in the evaluation of brain death.

Keywords

Brain death Simulation Medical education Curricular milestones Error in medicine 

Notes

Conflict of interest

The authors declare that they have no conflict of interest.

Disclosure

Dr. Hocker, Donna Schumacher, Dr. Mandrekar, and Dr. Wijdicks report no disclosures.

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Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Sara Hocker
    • 1
  • Donna Schumacher
    • 2
  • Jay Mandrekar
    • 3
  • Eelco F.M. Wijdicks
    • 1
  1. 1.Division of Critical Care Neurology, Department of NeurologyMayo ClinicRochesterUSA
  2. 2.Department of Nursing EducationMayo ClinicRochesterUSA
  3. 3.Department of Biomedical Statistics and InformaticsMayo ClinicRochesterUSA

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