Published in Neurology!
Congratulations to Dr. Kathatrina Busl on the publication of “Simulations and Brain Death: A Novel Approach to Evaluating Competency,” which appears in the June 10th edition of Neurology.
Abstract
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 Education 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.