Competency‐based EEG education: a list of “must‐know” EEG findings for adult and child neurology residents

Abstract

The competency-based model has been guiding medical education on an international level over the last decades [1]. This model is learner-centered and has mastery of specific knowledge and skills as its unit of progression [2]. In the realm of electroencephalography (EEG), there have been continued efforts to ensure that residents have the competence to accurately and reliably interpret EEGs by the time they complete residency training. Achieving this goal is imperative, especially in countries where EEGs are typically read by neurologists without clinical neurophysiology or epilepsy fellowship training [3,4], due to the deleterious consequences of EEG misinterpretation and epilepsy misdiagnosis [3]. In an attempt to define minimum EEG competency milestones, we herein propose a prioritized list of routine EEG findings that all adult and child neurology residents should be able to identify and interpret on completion of training. Resident EEG education is guided by well-formulated milestones proposed by organizations such as the Accreditation Council for Graduate Medical Education (ACGME) [5] and International League Against Epilepsy (ILAE) [6]. These milestones, however, are not meant to be used to determine whether a trainee is competent to graduate; additionally, the milestones do not specify particular EEG findings that should be mastered by trainees. For example, the ACGME EEG Level 3 milestone encapsulates recognition of "common EEG abnormalities"; these "abnormalities", nonetheless, are not specified. We surveyed a group of EEG/epilepsy experts to delineate a list of routine EEG findings rated by their clinical yield for adult and child neurology resident education. The authors (FN, JJ, MBW, SB) designed an online survey (see supplementary material) in which a comprehensive set of adult and pediatric routine EEG findings were listed under four major sections: normal findings, artifacts, normal variants, and abnormal findings. Neonatal EEG findings were not included. EEG/epilepsy experts were asked to rate each EEG finding on a 5-point Likert rating scale (1 = "not

Expert accuracy and inter‐rater agreement of “must‐know” EEG findings for adult and child neurology residents

“…Multiple-choice questions tested rEEG findings considered high yield by a large group of international EEG/epilepsy experts ("mustknow" rEEG findings) based on the importance for adult and child neurology residents to learn these findings during residency training. 3 Tested rEEG findings are listed in Table 1. Further methodological aspects regarding the selection of these findings from the published list of "mustknow" EEG findings 3 have been described previously.…”

“…3 Tested rEEG findings are listed in Table 1. Further methodological aspects regarding the selection of these findings from the published list of "mustknow" EEG findings 3 have been described previously. 4 Each question included a de-identified, 10-20-s epoch of EEG displayed in examples using longitudinal bipolar and common average reference montages (Figure 1).…”

“…Further methodological aspects regarding the selection of these findings from the published list of "mustknow" EEG findings 3 have been described previously. 4 Each question included a de-identified, 10-20-s epoch of EEG displayed in examples using longitudinal bipolar and common average reference montages (Figure 1). This content was obtained from two authors' (FAN, SB) personal collections, and were deemed unequivocal examples of the findings tested by five EEG experts authoring this work (FAN, RM, SR, WT, and SB).…”

“…Data were collected in two iterations. The first iteration pertained to an EEG education study 4 where the same 86%, substantial (0.762) (Brazil); 79%, substantial (0.646) (Italy); and 72%, moderate (0.496) (India). In conclusion, collective expert accuracy and IRA of "mustknow" rEEG findings are suboptimal and heterogeneous.…”

“…4 In this study, we administered the same rEEG examination to EEG experts across the globe to study expert accuracy and inter-rater agreement (IRA) of the "must-know" rEEG findings. 3…”