Epilepsy Education: Recent Advances and Future Directions

Abstract

Purpose of Review

The goal of this review is to survey the current literature on education in epilepsy and provide the most up-to-date information for physicians involved in the training of future doctors on this topic. We intended to review what opportunities exist to enhance our current teaching practices that may not be well-known or widely used, but may be adapted to a broader audience.

Recent Findings

Many new techniques adopting principles of education (e.g., retrieval practice and spaced learning) or new technologies (e.g., pre-recorded lectures, computer-enhanced modules, and simulation practice) have been trialled to enhance medical education in epilepsy with some success. Many of these techniques are currently adaptable to a wider audience or may soon be available.

Summary

The use of these opportunities more broadly may allow expansion of educational research opportunities as well as enhancing our ability to pass on information. As the knowledge base in epilepsy continues to dramatically expand, we need to keep evaluating our teaching techniques to ensure we are able to pass along this knowledge to our future providers.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.

    England MJ, Liverman CT, Schultz AM, Strawbridge LM. Epilepsy across the spectrum: promoting health and understanding. Washington, DC: National Academies Press; 2012.

    Book  Google Scholar 

  2. 2.

    Carter JL, Ali II, Isaacson RS, Safdieh JE, Finney GR, Sowell MK, et al. Status of neurology medical school education: results of 2005 and 2012 clerkship director survey. Neurology. 2014;83(19):1761–6.

    PubMed  PubMed Central  Article  Google Scholar 

  3. 3.

    Education ACfGM. The Neurology Milestone Project. 2015. http://www.acgme.org/portals/0/pdfs/milestones/neurologymilestones.pdf. Accessed 15 April 2019.

  4. 4.

    Daniello KM, Weber DJ. Education research: the current state of neurophysiology education in selected neurology residency programs. Neurology. 2018;90(15):708–11.

    PubMed  Article  Google Scholar 

  5. 5.

    Oto MM. The misdiagnosis of epilepsy: appraising risks and managing uncertainty. Seizure. 2017;44:143–6.

    PubMed  Article  Google Scholar 

  6. 6.

    Reuber M, Fernandez G, Bauer J, Helmstaedter C, Elger CE. Diagnostic delay in psychogenic nonepileptic seizures. Neurology. 2002;58(3):493–5.

    CAS  PubMed  Article  Google Scholar 

  7. 7.

    Benbadis SR. The tragedy of over-read EEGs and wrong diagnoses of epilepsy. Expert Rev Neurother. 2010;10(3):343–6.

    PubMed  Article  Google Scholar 

  8. 8.

    Education ACfGM. ACGME program requirements for graduate medical education in neurology. 2017. https://www.acgme.org/Portals/0/PFAssets/ProgramRequirements/180_neurology_2017-07-01.pdf. Accessed 15 April 2019.

  9. 9.

    London ZN, Khan J, Cahill C, Schuyler E, Wold J, Southerland AM. 2017 Program director survey: feedback from your adult neurology residency leadership. Neurology. 2018;91(15):e1448–e54.

    PubMed  Article  Google Scholar 

  10. 10.

    Schuh LA, Adair JC, Drogan O, Kissela BM, Morgenlander JC, Corboy JR. Education research: neurology residency training in the new millennium. Neurology. 2009;72(4):e15–20.

    CAS  PubMed  Article  Google Scholar 

  11. 11.

    Tatum WO. How not to read an EEG: introductory statements. Neurology. 2013;80(1 Suppl 1):S1–3.

    Article  Google Scholar 

  12. 12.

    Cohen AS, Izzy S, Kumar MA, Joyce CJ, Figueroa SA, Maas MB, et al. Education research: variation in priorities for neurocritical care education expressed across role groups. Neurology. 2018;90(24):1117–22.

    PubMed  Article  PubMed Central  Google Scholar 

  13. 13.

    Desai SV, Asch DA, Bellini LM, Chaiyachati KH, Liu M, Sternberg AL, et al. Education outcomes in a duty-hour flexibility trial in internal medicine. N Engl J Med. 2018;378(16):1494–508.

    PubMed  Article  Google Scholar 

  14. 14.

    Cooke M, Irby D, O’Brien B. Educating physicians: a call for reform of medical school and residency. Hoboken: John Wiley & Sons; 2010.

    Google Scholar 

  15. 15.

    Flexner A. Medical education in the United States and Canada: a report to the Carnegie Foundation for the advancement of teaching. Bulletin number four. New York: The Carnegie Foundation for the Advancement of Teaching; 1910.

    Google Scholar 

  16. 16.

    Nasca TJ, Philibert I, Brigham T, Flynn TC. The next GME accreditation system--rationale and benefits. N Engl J Med. 2012;366(11):1051–6.

    CAS  PubMed  Article  Google Scholar 

  17. 17.

    Lomis K, Amiel JM, Ryan MS, Esposito K, Green M, Stagnaro-Green A, et al. Implementing an entrustable professional activities framework in undergraduate medical education: early lessons from the AAMC core entrustable professional activities for entering residency pilot. Acad Med. 2017;92(6):765–70.

    PubMed  Article  Google Scholar 

  18. 18.

    Prober CG, Heath C. Lecture halls without lectures — a proposal for medical education. N Engl J Med. 2012;366(18):1657–9.

    CAS  PubMed  Article  Google Scholar 

  19. 19.

    Schaefer SM, Dominguez M, Moeller JJ. The future of the lecture in neurology education. Semin Neurol. 2018;38(4):418–27.

    PubMed  Article  Google Scholar 

  20. 20

    •• Le TT, Prober CG. A proposal for a shared medical school curricular ecosystem. Acad Med. 2018;93(8):1125–8. This paper provides an exciting vision for a shared “ecosystem” of curricular elements that would be available to all medical schools, in formats that could be adapted to the specific purposes of each individual curriculum.

    PubMed  Article  Google Scholar 

  21. 21.

    Anderson J, Mader JE, Gutierrez A, Oliva A. EEG and sleep team-based learning. MedEdPORTAL. 2015;11:10071.

  22. 22.

    Barratt D, Mader E Jr, Gutierrez A, Oliva A. EEG and sleep team-based learning. MedEdPORTAL. 2015;11:10071.

  23. 23.

    Moeller JJ, Farooque P, Leydon G, Dominguez M, Schwartz ML, Sadler RM. A video-based introductory EEG curriculum for neurology residents and other EEG learners. MedEdPORTAL. 2017;13:10570.

  24. 24.

    Reid J, Stone K. Pediatric emergency medicine simulation curriculum: seizure scenario. MedEdPORTAL. 2014;10:9794.

  25. 25.

    Lau KHV, Lakhan SE, Achike F. New media, technology and neurology education. Semin Neurol. 2018;38(4):457–64.

    PubMed  Article  Google Scholar 

  26. 26

    • Lau KHV, Farooque P, Leydon G, Schwartz ML, Sadler RM, Moeller JJ. Using learning analytics to evaluate a video-based lecture series. Med Teach. 2018;40(1):91–8. This paper demonstrates how analytic information from a web-based educational tool can be used for curriculum evaluation and improvement.

    PubMed  Article  Google Scholar 

  27. 27.

    Moeller JJ, Fawns T. Insights into teaching a complex skill: threshold concepts and troublesome knowledge in electroencephalography (EEG). Med Teach. 2018;40(4):387–94.

    PubMed  Article  Google Scholar 

  28. 28.

    ten Cate O. Entrustability of professional activities and competency-based training. Med Educ. 2005;39(12):1176–7.

    PubMed  Article  Google Scholar 

  29. 29.

    Jones LK Jr, Dimberg EL, Boes CJ, Eggers SD, Dodick DW, Cutsforth-Gregory JK, et al. Milestone-compatible neurology resident assessments: a role for observable practice activities. Neurology. 2015;84(22):2279–83.

    PubMed  Article  Google Scholar 

  30. 30.

    Jones LK Jr. Assessment in neurologic education. Semin Neurol. 2018;38(4):471–8.

    PubMed  Article  Google Scholar 

  31. 31

    • Larsen DP. Planning education for long-term retention: the cognitive science and implementation of retrieval practice. Semin Neurol. 2018;38(4):449–56. This is a helpful review of retrieval practice and its potential applications in medical and neurological education.

    PubMed  Article  Google Scholar 

  32. 32.

    Larsen DP, Butler AC, Aung WY, Corboy JR, Friedman DI, Sperling MR. The effects of test-enhanced learning on long-term retention in AAN annual meeting courses. Neurology. 2015;84(7):748–54.

    PubMed  PubMed Central  Article  Google Scholar 

  33. 33.

    Larsen DP, Butler AC, Lawson AL, Roediger HL 3rd. The importance of seeing the patient: test-enhanced learning with standardized patients and written tests improves clinical application of knowledge. Adv Health Sci Educ Theory Pract. 2013;18(3):409–25. 10.1007/s10459-012-9379-7.

    PubMed  Article  Google Scholar 

  34. 34.

    Larsen DP, Butler AC, Roediger HL 3rd. Comparative effects of test-enhanced learning and self-explanation on long-term retention. Med Educ. 2013;47(7):674–82.

    PubMed  Article  Google Scholar 

  35. 35.

    Green ML, Moeller JJ, Spak JM. Test-enhanced learning in health professions education: a systematic review: BEME guide no. 48. Med Teach. 2018;40(4):337–50.

    PubMed  Article  Google Scholar 

  36. 36.

    Deng F, Gluckstein JA, Larsen DP. Student-directed retrieval practice is a predictor of medical licensing examination performance. Perspect Med Educ. 2015;4(6):308–13.

    PubMed  PubMed Central  Article  Google Scholar 

  37. 37.

    Venkatraman A, Kumar N. The impact of 1 month of intensive training on a resident’s EEG interpretation skills. J Grad Med Educ. 2016;8(2):281–2.

    PubMed  PubMed Central  Article  Google Scholar 

  38. 38.

    Chau DF, Bensalem-Owen MK, Fahy BG. The effectiveness of an interdisciplinary approach to EEG instruction for residents(r). J Clin Neurophysiol. 2010;27(2):106–9.

    PubMed  Article  Google Scholar 

  39. 39.

    Bensalem-Owen M, Chau DF, Sardam SC, Fahy BG. Education research: evaluating the use of podcasting for residents during EEG instruction: a pilot study. Neurology. 2011;77(8):e42–4.

    PubMed  Article  Google Scholar 

  40. 40

    • Fahy BG, Vasilopoulos T, Bensalem-Owen M, Chau DF. Evaluating an interdisciplinary EEG initiative on in-training examination EEG-related item scores for anesthesiology residents. J Clin Neurophysiol. 2018:1. This study is the most recent of a series of publications outlining a successful innovative approach to teaching EEG to anesthesia residents using an interdisciplinary approach.

  41. 41

    • Weber D, McCarthy D, Pathmanathan J. An effective automated method for teaching EEG interpretation to neurology residents. Seizure. 2016;40:10–2. This study demonstrated that engagement with an automated platform improved resident performance in EEG interpretation, and can be a useful tool in supplementing resident learning.

    PubMed  Article  Google Scholar 

  42. 42.

    Godbole NR, Delaney PF, Verkoeijen PP. The spacing effect in immediate and delayed free recall. Memory. 2014;22(5):462–9.

    PubMed  Article  Google Scholar 

  43. 43.

    Wijdicks EFM, Hocker SE. A future for simulation in acute neurology. Semin Neurol. 2018;38(4):465–70.

    PubMed  Article  Google Scholar 

  44. 44

    •• Malakooti MR, McBride ME, Mobley B, Goldstein JL, Adler MD, McGaghie WC. Mastery of status epilepticus management via simulation-based learning for pediatrics residents. J Grad Med Educ. 2015;7(2):181–6. This study demonstrated the deliberate practice in a high-fidelity simulation setting allowed pediatrics residents to achieve mastery and increased self-efficacy in the management of children with status epilepticus.

    PubMed  PubMed Central  Article  Google Scholar 

  45. 45.

    Dworetzky BA, Peyre S, Bubrick EJ, Milligan TA, Yule SJ, Doucette H, et al. Interprofessional simulation to improve safety in the epilepsy monitoring unit. Epilepsy Behav. 2015;45:229–33.

    Article  Google Scholar 

  46. 46.

    Gaspard N, Hirsch LJ, LaRoche SM, Hahn CD, Westover MB, Critical Care EEG Monitoring Research Consortium. Interrater agreement for critical care EEG terminology. Epilepsia. 2014;55(9):1366–73.

    PubMed  PubMed Central  Article  Google Scholar 

  47. 47.

    Halford JJ, Shiau D, Desrochers JA, Kolls BJ, Dean BC, Waters CG, et al. Inter-rater agreement on identification of electrographic seizures and periodic discharges in ICU EEG recordings. Clin Neurophysiol. 2015;126(9):1661–9. 10.1016/j.clinph.2014.11.008.

    CAS  PubMed  Article  Google Scholar 

  48. 48.

    Fernandez A. Personal Communication. 2018.

  49. 49.

    Scheuer ML, Bagic A, Wilson SB. Spike detection: inter-reader agreement and a statistical Turing test on a large data set. Clin Neurophysiol. 2017;128(1):243–50.

    PubMed  Article  Google Scholar 

  50. 50.

    Roy S, Kiral-Kornek I, Harrer S. Deep learning enabled automatic abnormal EEG identification. Conf Proc IEEE Eng Med Biol Soc. 2018;2018:2756–9.

  51. 51.

    Swisher CB, Sinha SR. Utilization of quantitative EEG trends for critical care continuous EEG monitoring: a survey of neurophysiologists. J Clin Neurophysiol. 2016;33(6):538–44.

    PubMed  Article  Google Scholar 

  52. 52.

    Lamberink HJ, Boshuisen K, Otte WM, Geleijns K, Braun KPJ, TimeToStop Study G. Individualized prediction of seizure relapse and outcomes following antiepileptic drug withdrawal after pediatric epilepsy surgery. Epilepsia. 2018;59(3):e28–33.

    PubMed  Article  Google Scholar 

  53. 53.

    Lamberink HJ, Otte WM, Geerts AT, Pavlovic M, Ramos-Lizana J, Marson AG, et al. Individualised prediction model of seizure recurrence and long-term outcomes after withdrawal of antiepileptic drugs in seizure-free patients: a systematic review and individual participant data meta-analysis. Lancet Neurol. 2017;16(7):523–31.

    PubMed  Article  Google Scholar 

  54. 54.

    van Diessen E, Lamberink HJ, WOM O, Doornebal N, Brouwer OF, Jansen FE, et al. A prediction model to determine childhood epilepsy after 1 or more paroxysmal events. Pediatrics. 2018;142(6).

  55. 55.

    Bao EL, Chao LY, Ni P, Moura L, Cole AJ, Cash SS, et al. Antiepileptic drug treatment after an unprovoked first seizure: a decision analysis. Neurology. 2018;91(15):e1429–e39.

    PubMed  Article  PubMed Central  Google Scholar 

  56. 56.

    Glick TH. How best to evaluate clinician-educators and teachers for promotion? Acad Med. 2002;77(5):392–7.

    PubMed  Article  Google Scholar 

  57. 57.

    Vasilopoulos T, Chau DF, Bensalem-Owen M, Cibula JE, Fahy BG. Prior podcast experience moderates improvement in electroencephalography evaluation after educational podcast module. Anesth Analg. 2015;121(3):791–7.

    Article  Google Scholar 

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Correspondence to Daniel J. Weber.

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Daniel J. Weber and Jeremy J. Moeller each declare no potential conflicts of interest.

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Weber, D.J., Moeller, J.J. Epilepsy Education: Recent Advances and Future Directions. Curr Neurol Neurosci Rep 19, 35 (2019). https://doi.org/10.1007/s11910-019-0946-7

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Keywords

  • Epilepsy education
  • Graduate medical education
  • Technology in education