To establish an evidence based and comprehensive simulation based curriculum for neurology residents during residency regarding brain death examination and breaking the news to family with aim to obtain 1) education 2) practical skills 3) confidence and 4) ability to effectively communicate with grieving family.  

Neurologist is the most common specialist called for a brain death examination. For it no formal training curriculum exists nor is it one of the clinical exercises mandated by ACGME or ABPN. This diagnosis needs accuracy and adherence to standard parameters.

Despite AAN’s clear practice parameters, a recently published study by Dr. Greer et al., reported great variation in hospital policies throughout USA and no prerequisite training / comfort was required by those. Interestingly enough when a group of practicing neurologists and neurosurgeons were evaluated about the intricacies of brain death determination, their score was only 54%.

Curriculum included following steps in sequence:

Step 1: Pre-curriculum survey.
Step 2: Self reading.
Step 3: Faculty driven lecture.
Step 4: Simulation based supervised brain-death examination followed by breaking the news 
Step 5: Gift of life staff sessions on organ donation.   
Step6: Grand round by an invited external expert.
Step7: Post-Curriculum Survey.

Ten neurology residents were studies with pre and post curriculum surveys. Each survey had 5 knowledge based questions and 5 comfort based. Results are shown in the table below.

Simulation based brain death examination is an effective, feasible and practically important curriculum for neurology residents to not only improve their short comings in this subject but also increase their confidence in performance and communication with family.