A Modified Delphi Consensus-based Comprehensive Checklist and Angoff Standard for Assessment of Competency in Brain Death/Death by Neurologic Criteria Determination

ObjectiveTo develop a comprehensive checklist, define critical actions, and establish a minimal passing standard for adult and pediatric critical care clinicians as well as other providers to facilitate formative and summative assessment of brain death/death by neurologic criteria (BD/DNC) determination Design: A pre-specified three round modified Delphi consensus process to define checklist items followed by a modified Angoff standard setting process to determine critical actions and item average ratings. SettingElectronic surveys. SubjectsSelected authors of the 2023 Pediatric and Adult Brain Death/Death by Neurologic Criteria Consensus Practice Guideline, World Brain Death Project, and experts recommended by these authors (n=16) participated in the Delphi panel. Neurocritical care United Council for Neurologic Subspecialties and Accreditation Council for Graduate Medical Education examination committee members (n= 13) participated in Angoff standard setting. InterventionsNone. Measurements and Main ResultsA total of 98 unique checklist items related to assessment of prerequisites (23 items), performance of the clinical examination (28 items), apnea testing (36 items), and ancillary testing (11 items) were retained by the Delphi panel. Seven items were designated as critical actions based upon Angoff panelist consensus. The remaining 91 items were assigned item average ratings. The minimum passing score for an assessment including all items was set at 89%. ConclusionsThese guideline-concordant consensus checklist items, including critical actions and non-critical actions with their assigned item average ratings, may be applied selectively to simulated cases of BD/DNC determination for adults and children to determine a minimum passing score and readiness for independent practice, mitigating risk of inaccurate BD/DNC determination among critical care clinicians. Our process for systematically defining critical actions on a behavior checklist may be replicated for simulation-based summative assessment of learners in other critical care scenarios. KEY POINTSO_ST_ABSQuestionC_ST_ABSWhat behaviors should be included in a checklist for assessment of brain death/death by neurologic criteria (BD/DNC) determination and what level of performance is consistent with readiness for independent practice? FindingsA modified Delphi panel identified 98 checklist items which may be applied selectively to simulated cases of BD/DNC. An Angoff panel identified 7 critical actions and set average ratings for all other items. MeaningThese guideline-concordant consensus checklist items and their average ratings may be applied to assessments of simulated or real cases of BD/DNC, including those intended for summative assessment, to determine learner readiness for independent determination.