Education Research: Evaluation of Epilepsy Surgery Education in Epilepsy and Clinical Neurophysiology Fellowship Programs

Abstract

Background and ObjectivesTo assess the scope of surgical epilepsy exposure and training among fellows in Epilepsy and Clinical Neurophysiology (CNP) fellowship programs in the United States. Characteristics associated with increased fellow involvement in epilepsy surgery were evaluated.MethodsA 10-question multiple-choice survey was designed to characterize individual fellowship programs, epilepsy surgery programs, trainee involvement, and assessment of trainee performance. The survey was distributed to program directors of adult Epilepsy and CNP-EEG track fellowships between November 2021 and April 2022. Epilepsy surgery procedures included resective approaches, neurostimulation modalities, and palliative interventions approved for drug-resistant epilepsy. Associations between categorical variables were evaluated using the Fisher exact test.ResultsThere were 37 responses from a total of 72 survey recipients (51% response rate). The majority (68%) of surgical programs performed >30 surgical procedures per year. The range of procedures was overall similar across programs. At most programs, fellows were personally involved in 1–10 (49%) or 11–30 (46%) surgical procedures per year. Institutions with >50 surgical cases/year were more likely to expose fellows to >10 cases/y compared with institutions with volumes ≤50 per year (77% vs 33%,p= 0.017). Fellows had the greatest involvement in presurgical planning with more variable involvement in perioperative and postoperative activities. Competency in surgical management was primarily investigated through faculty assessments (97%), whereas oral (46%) and written (30%) assessments were less frequently used.DiscussionHigh-volume epilepsy surgery centers provide trainees with increased exposure despite also having more fellowship positions. There is variability in surgical epilepsy exposure, trainee involvement, and performance evaluation metrics between institutions. We identify specific areas that programs may focus on to improve fellow competency in the surgical management of epilepsy.

Finding Flourishing in Neurology

“…The first of these articles explores gaps in surgical epilepsy training for clinical neurophysiology fellows in the United States. 15 This survey-based study highlights 3 existing educational gaps including the following: (1) variability in surgical epilepsy training exposure exists, (2) fellows were most involved in preoperative planning with varied participation in perioperative and postoperative management, and (3) direct observation of fellow competence in surgical management is rare. These gaps can be the source for new innovations to identify, develop, and evaluate methods to assess fellow competence, a road map that could be used by educators in many neurologic fellowship and not just epilepsy.…”

Epilepsy Care in Latin America and the Caribbean: Overcoming Challenges and Embracing Opportunities

“…51 52 53 54 55 56 In a 2023 survey highlighting epilepsy surgery scope and training in Central America and South America, epilepsy surgery was reported in all 15 participating countries (Argentina, Brazil, Chile, Colombia, Costa Rica, Ecuador, El Salvador, Honduras, Mexico, Panama, Peru, Uruguay, Venezuela, Bolivia, and Paraguay). 57 Most surgical centers reported performing 1 to 10 procedures yearly, with several reporting 11 to 30 procedures yearly. Most programs performed resections, 55% performed depth electrode and/or subdural electrode implantation, none of them offered laser interstitial thermal therapy.…”

“…Most programs performed resections, 55% performed depth electrode and/or subdural electrode implantation, none of them offered laser interstitial thermal therapy. 57 The most common surgical procedures were cortical resections, temporal lobectomies, vagal nerve stimulation placement, callosotomies, and hemispherectomies. 56 The study highlighted substantial variability in surgical procedures performed and surgical exposure across different centers.…”

“…A more recent survey examining surgical exposure and education among trainees in epilepsy centers in Latin America revealed that one-third of the respondents reported training surgical epilepsy fellows at their institutions, with the majority reporting one to two fellows enrolled per year. 57 Among these, 36% reported fellows participating in 1 to 10 procedures annually, 31% in 11 to 30 procedures, and 33% in >30 procedures. 57 Fellows primarily utilized surgical epilepsy journals as their most common didactic resource, followed by lectures, textbooks, and online modules.…”

“…57 Among these, 36% reported fellows participating in 1 to 10 procedures annually, 31% in 11 to 30 procedures, and 33% in >30 procedures. 57 Fellows primarily utilized surgical epilepsy journals as their most common didactic resource, followed by lectures, textbooks, and online modules. Fellows' evaluation of proficiency in surgical epilepsy management primarily involved faculty and oral assessments.…”