Abstract Details

Title Simulations and Brain Death: A Novel Approach to Evaluating Competency

Topic ��ɫ��, Research, and Methodology

Presentation(s) P7 - Poster Session 7 (8:00 AM-9:00 AM)

Poster/Presentation
Number 15-011

Objective To develop a checklist, define critical actions, and set a minimal passing standard (MPS) for formative and summative assessment of brain death/death by neurologic criteria (BD/DNC) determination.

Background Clinician competence in BD/DNC determination is assumed but not established. Simulation-based mastery learning supports both training and assessment but requires a checklist and MPS supported by validity evidence, neither of which exists in BD/DNC.

Design/Methods A three-round modified Delphi consensus process defined checklist items, followed by a modified Angoff process to identify critical actions and establish the MPS. Delphi panelists included authors of the 2023 BD/DNC Consensus Guideline, World Brain Death Project, and experts recommended by these authors. Angoff panelists included United Council for Neurologic Subspecialties and Accreditation Council for Graduate Medical ��ɫ�� Neurocritical Care Examination Committee members. The steering committee generated candidate items, which Delphi panelists rated on a 5-point importance scale. Panelists were allowed to suggest new items and modifications during initial rounds. Items with >80% consensus were retained. Angoff panelists estimated the percentage of minimally competent learners expected to complete each checklist item during a BD/DNC case simulation. Items rated “100%” by >80% of panelists were designated critical (“can’t miss”). All others were deemed non-critical, allowing participants to miss these items and achieve competency if the MPS was met.

Results

Ninety-eight checklist items were retained across four domains: prerequisites (23), clinical examination (28), apnea testing (36), and ancillary testing (11). Seven items were designated as critical actions. The remaining 91 items were assigned item average ratings. The minimum passing score for an assessment including all items was set at 89%.

Conclusions

This guideline-concordant, consensus-derived checklist establishes an MPS for BD/DNC assessment, distinguishing critical from non-critical actions. Selective application of the checklist to simulated cases will facilitate assessment of competence and readiness for independent BD/DNC determination.

Authors/Disclosures
Neil Dhruva, MD PRESENTER	Mr. Dhruva has nothing to disclose.
Daniel S. Harrison, MD (Boston Medical Center)	Dr. Harrison has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Glass Health. Dr. Harrison has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Diedrich & Donohue, LLP.
Jenna Ford, MD (Northwestern)	Dr. Ford has nothing to disclose.
David M. Greer, MD, FAAN (Boston University School of Medicine)	Dr. Greer has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Thieme, Inc. Dr. Greer has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for multiple. Dr. Greer has received publishing royalties from a publication relating to health care. Dr. Greer has received publishing royalties from a publication relating to health care. Dr. Greer has received publishing royalties from a publication relating to health care. Dr. Greer has a non-compensated relationship as a Treasurer-Elect with American Neurological Association that is relevant to AAN interests or activities. Dr. Greer has a non-compensated relationship as a President with Neurocritical Care Society that is relevant to AAN interests or activities.
Sarah Wahlster, MD	Dr. Wahlster has nothing to disclose.
Nikita Chhabra, DO	Dr. Chhabra has nothing to disclose.
Ariane Lewis, MD, FAAN (NYU Langone Medical Center)	Dr. Lewis has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Seminars in Neurology. Dr. Lewis has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Journal of Clinical Neuroscience.
Lori A. Shutter, MD, FCCM, FNCS, FAAN, FAAN (UPMC Dept of Critical Care Medicine)	The institution of Dr. Shutter has received research support from NIH. Dr. Shutter has received publishing royalties from a publication relating to health care.
Michael Rubin, MD, FAAN (UT Southwestern Medical Center)	Dr. Rubin has nothing to disclose.
Panayiotis N. Varelas, MD, PhD, FAAN (Albany Med-Department of Neurology)	Dr. Varelas has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for UCB. Dr. Varelas has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Astra Zeneca -Alexion - Portola. Dr. Varelas has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Annexon. Dr. Varelas has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Astra Zeneca- Alexion-Portola. Dr. Varelas has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Marinus. Dr. Varelas has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Annexon. Dr. Varelas has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Giammarco, Mullins & Horton P.C. The institution of Dr. Varelas has received research support from Marinus. The institution of Dr. Varelas has received research support from Bayer. Dr. Varelas has received publishing royalties from a publication relating to health care. An immediate family member of Dr. Varelas has received personal compensation in the range of $5,000-$9,999 for serving as a Rep to the RUC meeting with AAN. Dr. Varelas has received personal compensation in the range of $500-$4,999 for serving as a Speaker at the Annual Meeting with AAN. Dr. Varelas has a non-compensated relationship as a President - Past President with Neurocritical Care Society that is relevant to AAN interests or activities.
Katharina M. Busl, MD, MS, FAAN (University of Florida)	Dr. Busl has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Rissman Law. Dr. Busl has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Huffman Powell Baley. Dr. Busl has received personal compensation in the range of $500-$4,999 for serving as a Consultant for University Science. Dr. Busl has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for SCCM. Dr. Busl has a non-compensated relationship as a Board Member with Art in Medicine that is relevant to AAN interests or activities. Dr. Busl has a non-compensated relationship as a Associate Editor with Critical Care Explorations that is relevant to AAN interests or activities. Dr. Busl has a non-compensated relationship as a Assistant Editor with Neurocritical Care that is relevant to AAN interests or activities.
Matthew Kirschen, MD, PhD, FAAN	The institution of Dr. Kirschen has received research support from NIH.
Thomas Nakagawa, MD	Dr. Nakagawa has received personal compensation in the range of $500-$4,999 for serving as an officer or member of the Board of Directors for Society of Critical Care Medicine. Dr. Nakagawa has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for American Academy of Pediatrics. Dr. Nakagawa has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Vorys, Sater, Seymour and Pease. Dr. Nakagawa has received publishing royalties from a publication relating to health care.
Paul M. Vespa, MD, FAAN (UCLA)	Dr. Vespa has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for ceribell. Dr. Vespa has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for ceribell. Dr. Vespa has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Ceribell. Dr. Vespa has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for multiple. The institution of Dr. Vespa has received research support from NIH. Dr. Vespa has received intellectual property interests from a discovery or technology relating to health care.
Cherylee Chang, MD (Duke University)	Dr. Chang has a non-compensated relationship as a Member, Board of Directors (Council); Treasurer; President-Elect with Society of Critical Care Medicine that is relevant to AAN interests or activities.
David Bauer, MD	Dr. Bauer has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Congress of Neurological Surgeons. Dr. Bauer has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for HuffPowelBayley.
Carolina B. Maciel, MD, MSCR, FAAN	Dr. Maciel has received research support from American Heart Association. Dr. Maciel has received research support from National Institute of Health.
Michael Souter, MD (Harborview Medical Center, University of Washington)	Dr. Souter has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Teleflex. Dr. Souter has a non-compensated relationship as a Medical Director with LifeCenter Northwest that is relevant to AAN interests or activities.
Fernando D. Goldenberg, MD (University of Chicago)	Dr. Goldenberg has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Legal expert review.
Conall Francoeur, MD	Dr. Francoeur has nothing to disclose.
Thomas P. Bleck, MD, FAAN (Northwestern University Department of Neurology)	Dr. Bleck has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Ceribell. Dr. Bleck has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Marinus Pharmaceuticals. Dr. Bleck has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for iECURE. Dr. Bleck has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Acasti. Dr. Bleck has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Society of Critical Care Medicine. Dr. Bleck has received research support from NIH.
Gene Y. Sung, MD, MPH (U.S.C. Neurology)	The institution of Dr. Sung has received research support from NIH.
Sarah E. Nelson, MD, MPH, FAAN (Tufts Medical Center)	Dr. Nelson has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Neurology Journal. Dr. Nelson has received publishing royalties from a publication relating to health care. Dr. Nelson has a non-compensated relationship as a Women Leading in Neurology Program with ��ɫ�� that is relevant to AAN interests or activities.
Lauren Koffman, DO, MS (Temple University Hospital)	Dr. Koffman has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Law Firm. Dr. Koffman has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Walters Kluwer.
Evie Marcolini, MD	Dr. Marcolini has nothing to disclose.
Samuel Galvagno (University of Maryland, School of Medicine)	No disclosure on file
Christa O'hana S. Nobleza, MD	Dr. Nobleza has nothing to disclose.
Brenda Fahy, MD	Dr. Fahy has received personal compensation in the range of $500-$4,999 for serving as a Oral Board Examiner and Question Author honorarium with American Board of Anesthesiology .
Ivan Da Silva, MD	Dr. Da Silva has nothing to disclose.
Alejandro A. Rabinstein, MD, FAAN (Mayo Clinic)	Dr. Rabinstein has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Boston Scientific. Dr. Rabinstein has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Shionogi . Dr. Rabinstein has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Chiesi. Dr. Rabinstein has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Ceribell. Dr. Rabinstein has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Neurocritical care/NCS-Springer. Dr. Rabinstein has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Wolters/UptoDate. Dr. Rabinstein has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for EBSCO/DynaMed. Dr. Rabinstein has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for AHA. Dr. Rabinstein has received publishing royalties from a publication relating to health care. Dr. Rabinstein has received publishing royalties from a publication relating to health care. Dr. Rabinstein has received publishing royalties from a publication relating to health care. Dr. Rabinstein has received publishing royalties from a publication relating to health care.
Abhay Kumar, MD	Dr. Kumar has nothing to disclose.
Jordan Bonomo, MD	Dr. Bonomo has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for JBAR Consulting.
Claude Hemphill III, MD, FAAN (Zuckerberg San Francisco General Hospital)	Dr. Hemphill has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Zoll. Dr. Hemphill has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Aurenar. Dr. Hemphill has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for various legal firms. The institution of Dr. Hemphill has received research support from NIH/NINDS.
RAHUL NANCHAL, MD	Dr. NANCHAL has nothing to disclose.
Bradley Dengler (Uniformed Services University of the Health Sciences)	No disclosure on file
Nicholas A. Morris, MD, FAAN (University of Maryland Medical Center)	The institution of Dr. Morris has received research support from National Institute of Neurological Disorders and Stroke. The institution of Dr. Morris has received research support from ��ɫ��. The institution of Dr. Morris has received research support from National Institute of Neurological Disorders and Stroke. Dr. Morris has received personal compensation in the range of $500-$4,999 for serving as a Webinar Speaker with Kreg Therapeutics. Dr. Morris has a non-compensated relationship as a Editorial Board Member with ��ɫ�� that is relevant to AAN interests or activities. Dr. Morris has a non-compensated relationship as a Editorial Board Member with Neurocritical Care Society that is relevant to AAN interests or activities.

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