Abstracts

Rationale: Epilepsy is the most common neurological disorder in children. EEG is an essential test that is used in the diagnosis and management of seizures and epilepsy. Learning the basics of EEG reading and interpretation is a requirement of child neurology (CN) residency training, however, there is a lack of specifics on how to accomplish this goal. There are currently no standardized methods of teaching EEG interpretation in neurology residency programs. The conventional method of teaching and learning to read and interpret EEGs consists of didactic lectures, self-directed reading, and in a one-on-one learning setup with the attending epileptologist. EEG misinterpretation can lead to erroneous diagnosis of epilepsy and the consequences can be serious, including side effects of anti-seizure medications, social stigma, and in teenagers and adults, loss of privileges such as driving and independence. Unfortunately, misdiagnosis of epilepsy is common and is reported in 30-40% of patients admitted to epilepsy monitoring units with a diagnosis of epilepsy. There is a need for a quality improvement study to determine the best methods of teaching EEG interpretation to child neurology residents and to determine the average number of supervised EEGs that a resident needs to read to develop competence.

Methods: We developed a structured, self-paced, and comprehensive curriculum addressing the basics of EEG using a flipped learning method. In this pilot program, at the beginning of their 4-week EEG rotation, the residents took a pre-test and then reviewed a series of teaching videos with instruction on basics of EEG. A post-test was taken 6-9 months after their EEG rotation. The data was collected and analyzed, allowing for assessment of effectiveness and for curriculum changes to be made as needed.

Results: Eleven residents (2^nd& 3^rd years of CN) took the pre-test. Eight of eleven (72%) residents took the post-test. The pre-test and post-test scores were similar at 66% and 67% respectively. The most frequently missed questions in both tests were related to benign variants and artifacts. They were consistently misclassified as pathologic findings. There was an improvement in understanding of the basic electronics of EEG, highly abnormal patterns such as burst-suppression and status epilepticus in the post-test.

Conclusions: This small pilot study supports the benefit of a structured EEG curriculum for CN trainees for understanding of basic principles and clinically relevant abnormal EEG patterns. However, a striking gap was noted in identification of benign variants and artifact which has enormous clinical relevance to patient care.

The data from the pilot program can be used for a larger multi-center study involving child neurology residency programs across the country. Based on a larger study, specific guidelines can be established for minimum EEG training in terms of methods, and quality and quantity of exposure to EEG reading during child neurology residency training. Another area of study is the assessment of delivery of a longitudinal curriculum vs a single 4-week block rotation in retention and developing competency in EEG reading and interpretation.

Funding: Please list any funding that was received in support of this abstract.: None.