Rationale: Commercial neurology Qbanks are widely used by U.S. adult and pediatric neurology residents for board preparation and self-assessment, including the in-service and board certification exams. Given that 8–12% of the ABPN exam focuses on “Epilepsy and Episodic Disorders,” there is a need to enhance epilepsy and EEG education during residency. This study examined the content, structure, and evidence level of epilepsy/EEG questions in two widely used Qbanks.
Methods: We reviewed BoardVitals® and Now You Know Neuro™ to identify questions related to epilepsy and/or EEG. Each was assessed for primary skill tested (recall, diagnosis, or treatment), format, difficulty level (if available), and age group (adult or pediatric). Epilepsy questions were categorized by theme: semiology, syndrome diagnosis, localization, status epilepticus, and management. Additional topics included SUDEP, PNES, autoimmune epilepsy, febrile seizures, neuromodulation, epilepsy surgery, neuroradiology, and women’s health. EEG questions were classified as addressing either benign findings (e.g., variants, sleep, artifacts) or pathological patterns (e.g., epileptiform discharges, periodic discharges, hypsarrhythmia, seizures, status). All questions were evaluated for number, type, and evidence level of references using a standard hierarchy. Descriptive analysis was conducted.
Results:
Of 2,011 BoardVitals® questions, 70 (3.4%) were epilepsy/EEG-related; only 0.7% included EEG images. Skills tested: recall (41%), diagnosis (42%), treatment (15%). Most were clinical vignettes (78%); 15.7% had images. “Hard” difficulty appeared in 31.4%. Common topics included epilepsy syndrome diagnosis (n=32), seizure management (n=21), semiology (n=18), localization (n=17), anti-seizure meds (n=19), and genetic/metabolic epilepsy (n=10). Few addressed women’s health, PNES, autoimmune epilepsy, or neuroradiology. Pediatric content predominated (68%). Most cited one reference (61%), mainly review articles (n=68) and book chapters (n=23), both Level V; only one cited Level I evidence. In Now You Know Neuro™, 148/1,422 questions (10.4%) were epilepsy-related; 100 were analyzed, including 13 EEG questions. Skills tested: recall (52%), diagnosis (27%), treatment (21%). Formats included clinical vignettes (37%) and vignettes with images (17%). Age breakdown: 20% adult, 19% pediatric, 49% unspecified. Frequent topics were syndrome diagnosis (n=21), semiology (n=18), localization (n=18), anti-seizure meds (n=42), and surgery/neuromodulation (n=9). EEG content covered normal variants (n=2), epileptiform discharges (n=3), and seizures (n=2). Most (87%) cited one reference—typically review articles (n=52) and original research (n=29); Level V was most common (n=77), followed by Level I (n=16) and II (n=10).
Conclusions: Some key areas such as such as women with epilepsy, neuroradiology, and EEG patterns were insufficiently covered. Most references were low-level evidence, indicating opportunities to improve the depth and quality of board-preparation material for epilepsy and EEG education.
Funding: None.