Simulation-based training for determination of brain death by pediatric healthcare providers

Abstract

BackgroundLow competency for determination of brain death (BD) and unfamiliarity with Japanese BD (JBD) criteria among pediatricians were highlighted in previous nationwide studies. Because the JBD criteria were amended in 2010 to allow organ donation from pediatric brain-dead donors, we created a 2-day training course to assess knowledge and improve skill in the determination and diagnosis of pediatric BD.MethodsThe course consisted of two modules: a multistation round session and a group discussion session, and was bookended by a before and after 20-question test. In the multistation round session, participants rotated between stations staffed by expert faculty members. For hands-on skill development, we used the Sim Junior 3G™ simulation mannequin (Laerdal Medical, Wappingers Falls, NY, USA) for structured simulations. In the group discussion session, we implemented simulation-based role playing to practice decision making in prepared scenarios of complicated clinical situations. We investigated the participants’ impressions of the course by self-scoring and questionnaires.ResultsOf 147 pediatric healthcare providers from multiple specialties who participated in this course, 145 completed the entire process. The course was evaluated in three aspects with self-scoring and questionnaires: (1) value (4.58 ± 0.64; range 1–5); (2) time schedule (2.40 ± 0.61; range 1–3); and (3) difficulty (2.89 ± 0.43; range 1–5). Finally, participants scored the entire course program (9.64 ± 1.69; range 1–11). Various positive feedbacks were obtained from a total of 93 participants. Post-test scores (83.6 %) were significantly higher than pre-test scores (62.9 %).ConclusionThis simulation-based course represents an effective method to train pediatric healthcare providers in determining BD in Japan and may improve baseline knowledge of BD among participants.

Determination of Brain Death/Death by Neurologic Criteria

“…Determinations should be made by clinicians who are both licensed to practice medicine and trained in evaluation of BD/DNC. There are various training methods to educate practitioners about determination of BD/DNC, including online training videos and courses produced by academic institutions and simulation-based training . Additionally, the Neurocritical Care Society offers a toolkit to teach both clinicians and the public about determination of BD/DNC…”

“…There are various training methods to educate practitioners about determination of BD/DNC, including online training videos and courses produced by academic institutions and simulation-based training. [101][102][103][104][105][106][107] Additionally, the Neurocritical Care Society offers a toolkit to teach both clinicians and the public about determination of BD/DNC. 108 Clinicians should be educated during training and reeducated when they are in practice to ensure determinations are up-to-date with the latest medical standards (Supplement 10).…”

The 2023 American Academy of Neurology, American Academy of Pediatrics, Child Neurology Society, and Society of Critical Care Medicine Pediatric and Adult Brain Death/Death by Neurologic Criteria Determination Consensus Guidelines: What the Critical Care Team Needs to Know*

“…Although many of these courses (e.g., the Neurocritical Care Society's Brain Death Determination Course) require completion of written examinations, there is no universal evaluation or certification process (15). Simulation-based courses can provide valuable handson training and experience with examination techniques, and standardized patients can be used to educate about communication strategies related to BD/DNC (16)(17)(18)(19)(20). Trainees may not perform BD/DNC evaluations independently and must be directly supervised by an attending clinician.…”