ABSTRACT #6

Impact Of Protected Eeg Reading Time On Resident Eeg Knowledge

Bryan Green

PURPOSE AND GOALS: Neurology residents are often involved in the care of patients undergoing longterm EEG monitoring, but protected time for residents to practice reading EEGs and writing EEG reports is often limited. The Mount Sinai Hospital’s adult neurology residency recently underwent a reform of its EEG curriculum to increase protected time for EEG reading while on a dedicated epilepsy monitoring unit (EMU) service block. In this study, we aimed to measure the impact of this protected time on residents’ performance on an EEG quiz.

METHODS: We distributed a survey to adult neurology residents in postgraduate years (PGY) 2-4, of whom some had been exposed to the new EMU service block (EMU residents) and some had not (non-EMU residents). Residents were presented with 20 EEG samples (10-15 second epochs presented in longitudinal bipolar montage) and were asked whether the EEG showed normal activity (including benign variants/artifact). If they scored the EEG as normal, this became their final diagnosis. If they scored the EEG as abnormal, they were asked whether the EEG was ictal or on the ictal-interictal continuum (IIC). Responses were scored against an attending epileptologist’s diagnosis (normal activity or benign variants, n=4; slowing, n=5; sporadic epileptiform discharges, n=1; IIC, n=4; ictal, n=6). For each sample, residents were asked whether they would want to call the EEG fellow/attending (which could suggest either uncertainty or urgency regarding the EEG findings). We calculated descriptive statistics and compared responses between EMU and non-EMU residents, as well as between PGY levels (no significance testing due to low sample size).

EVALUATION PLAN: Residents answers to the EEG knowledge survey were scored against an attending epileptologist’s diagnosis.

SUMMARY OF RESULTS: Thirteen residents completed the survey (10 EMU [6 PGY2, 4 PGY4]; 3 non-EMU [2 PGY3, 1 PGY4]). Residents correctly recognized normal EEGs as normal with 55% accuracy, compared to 96% accuracy in identifying ictal/IIC EEGs as abnormal. EMU residents were less likely to call for slow EEGs (31% vs. 58%) and more likely to call for ictal EEGs (90% vs. 77%).

REFLECTIVE CRITIQUE: Residents with more protected EEG reading time, despite being mostly junior residents, displayed similar accuracy for identifying normal and ictal/IIC patterns to senior residents who did not have this protected time. Future prospective comparisons of resident EEG knowledge before and after EMU service time are underway.