Investigate variability in U.S. neurology resident education on brain death.

A 17-question survey on brain death education was sent to program directors of ACGME-accredited neurology residency programs for whom contact information was available (146/177 programs, 83%).

Respondents (39/146 programs, 26.7%) were predominantly from established programs, defined as > 10 years of ACGME accreditation (82%), in the northeast (44%) with neurosciences intensive care units (97%) and mandatory neurocritical care rotations (95%). Neurologists (86%) and neurointensivists (80%) were authorized by hospital policy to conduct brain death testing; less commonly, programs had no specific criteria for testing (11%) or allowed residents to perform testing (9%). Lecture-based instruction was used by most programs (91%) and many integrated observed encounters (51%) and simulation (37%) as teaching tools. Brain death education included examination techniques (97%), pre-requisites (94%), findings inconsistent with brain death (94%), common mimics (85%), communication strategies for delivering the diagnosis (79%), as well as apnea testing techniques (74%), including when to abort testing (65%) and how to interpret the arterial blood gas (62%). Competence for graduation was assessed through a required observed patient encounter (41%), simulation-based encounter (21%), or resident self-reporting (24%). Few programs reported residents completing 5 or more brain death evaluations (18%) prior to graduation. The majority (78%) of programs expressed interest in shared simulation scripts.

Variability in brain death education exists amongst ACGME-accredited neurology residency programs. There is an opportunity to standardize brain death education, as well as establish techniques and standards for determination of clinical competence.