Case Studies
Case studies showcase real-world applications of policies and innovations, offering insights into improving outcomes and efficiency. They enhance problem-solving skills, highlight best practices, and engage through storytelling for education and transparency.
Development and Dissemination of a Unique Virtual Reality Training Program to Improve Physician Skill, Knowledge and Confidence in Determining Brain Death and Family Communication
Theresa
Daly
, BS, MS
, Senior Director
, Gift of Life Institute
The Challenge
Determination of brain death (BD) is a low frequency, high-risk procedure and variability in determination of BD is well documented. Reducing this variation is key to maintaining public trust in this diagnosis, and to saving lives through organ donation. The skill to accurately perform a BD examination, and assure families understand that their family member has died, is critical in preparing families for an effective organ donation conversation. Training on determination of BD and skills necessary to communicate with families are not incorporated into most medical school education and given the low frequency of the procedure, many physicians may complete their training without ever performing a BD exam (Hocker, 2015). Studies identified 41% of residents reported never being taught how to explain BD to families (Iman N. Afif, 2021) and a survey of three academic medical centers identified lack of BD training in nearly one in four academic physicians. (Braksick SA, 2019).
The Approach
An international training center (ITC) and its affiliated organ procurement organization (OPO) partnered with a virtual solutions company to create “Determination of Brain Death and Family Communication Physician Training Program” using a scenario-based eLearning/simulation module. Simulated physician training should be easily accessible without the limitations of access to a standard simulation lab and without the labor and time intensity. Thus, the novel virtual reality tool was built to be accessible on a tablet or smartphone and does not require a headset, thereby removing the barriers that one often faces when using a traditional simulation lab. The eLearning focuses on strengthening physician communication skills to help families comprehend the BD determination process including grasping final news of death. Learners are directed to the companion application (VR) where they learn to perform a bedside neurological exam and apnea test in a virtual setting. The development team (ITC/OPO) worked with five senior neurocritical care physicians to verify the content was in line with the American Academy of Neurology guidelines and created a realistic setting and scenario. An additional 12 physicians with neurology, trauma and critical care expertise participated in the testing phases. Their feedback enhanced the medically accurate VR simulation that recreates patient responses and demonstrates use of associated medical instruments/monitoring devices. The ITC/OPO partnered with an academic medical center to assess impact/perceived efficacy of VR simulation based training through pre/post training tests.
The Results
Launched in January 2023, the program was introduced in OPO’s Donor Service Area (DSA) via online seminar by ITC and a Chief Neurocritical Care/SME to 140 physicians from 45 hospitals. Training continues to be disseminated in the OPO’s DSA and in the DSA of four additional OPOs across the US. To date, more than 700 physicians have enrolled in the OPO DSA. Preliminary data indicates 93% of learners report increased confidence in preparing families and communicating determination of BD. In addition, 93% stated the training improved knowledge of how to perform the physical act of conducting a BD exam.
Insights & Lessons Learned
The preliminary results indicate that offering training to busy physicians through this novel approach of a combination of eLearning and virtual reality, will allow physicians to gain knowledge/skills to perform BD testing and effectively communicate results with families.