Determining Brain Death: Neurology Residents Gain Critical Insight into a Complex Process
Summary
- The Neurology Residency Program at the University of Miami Miller School of Medicine has implemented a brain death determination simulation course in its training.
- All third-year neurology residents participated in the fall course at the Simulation Center in the Center for Patient Safety.
- The course unfolds in stages, beginning with an ungraded pre-test simulation, a one-hour video covering concepts of brain death and a hands-on, graded, deliberate practice.
Brain death determination requires clinicians to confirm the irreversible loss of all brain function while guiding decisions about ongoing care and potential organ donation and providing clarity and closure for families in the most difficult circumstances.
Recognizing the complexity and sensitivity of this process, the Neurology Residency Program at the University of Miami Miller School of Medicine and Jackson Health System has taken a proactive approach to training future neurologists in this critical area of care. While many physicians develop these skills gradually through clinical exposure, the residency program has implemented a dedicated brain death determination simulation course in its training.
“Because brain death determination is so nuanced and complex, it’s critical for neurologists to be proficient in this practice,” said Nina Massad, M.D., assistant professor of clinical neurology and neurocritical care at the Miller School. “This hands-on workshop equips residents with practical skills in brain death determination and better prepares them for independent practice after residency.”
Training to Identify Brain Death
All third-year neurology residents at UM/Jackson participated in the fall course, which serves as a pilot study in collaboration with multiple institutions. Hands-on training took place at the Simulation Center in the Center for Patient Safety, with faculty using materials from the Neurocritical Care Society.
The course unfolds in stages, beginning with an ungraded, pre-test simulation with a mannequin tailored to each resident’s case. Residents decide if their “patient” meets the criteria for brain death while assessing subtleties that can crop up when dealing with human beings. Next steps involve the residents watching a one-hour video covering concepts of brain death followed by a quiz. The residents must achieve a 100% score to complete their certification.
“When we built our residency curriculum, we made it tiered, with room for fundamentals at the beginning, such as neurologic emergencies instructed to our second-year residents,” Dr. Massad said. “For residents in their third year, we know they are ready to take on a deeper challenge, which this course will equip them with.”
A Safe Learning Environment for Neurology Residents
For the final segment of the course, residents returned to the Simulation Center for a graded, deliberate practice. The training room described a typical O.R. setting, with an interactive mannequin ready for assessment. Faculty monitored residents and their facilitators during the simulation.
“As each resident starts to diagnose, we have a checklist of components they need to perform, based on the American Academy of Neurology guidelines, such as asking for the patient’s CT, labs and medication status,” said Erika Marulanda-Londono, M.D., assistant professor of clinical neurology and associate program director of the Neurology Residency Program at the Miller School. “The goal is for each resident to pass with at least a 90% score. But if they don’t the first time, we provide them with feedback on how to better diagnose their case before they redo the simulation.”
The combination of faculty involvement and resident independence created an optimum learning landscape.
“My favorite part of the course was the safe environment provided,” said Lilian Godeiro Coelho, M.D., a third-year resident. “Here, there is no judgment, as the faculty know that we are residents starting to learn these complex techniques. The fact that they are guiding us makes me feel very comfortable to learn what we need to do.”
“Our aim is for this course to increases their confidence and comfort with brain death determination,” Dr. Massad said. “This process can be intimidating, even for physicians, because of the many moving parts involved, as well as the medical and legal implications. I hope that participants not only become more comfortable with the procedure but also strengthen their knowledge and ability to follow the established guidelines.”
Tags: Department of Neurology, Dr. Erika Marulanda, Dr. Nina Massad, neurology, residency, resident physicians, resident training, simulation-based training