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An open access peer-reviewed journal in neurologic and neuroscience education
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December 2022; 1 (2) RESEARCH ARTICLEOpen Access

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

Hernan Nicolas Lemus, Barbara A. Dworetzky, Ellen J. Bubrick, Garth Rees Cosgrove, Steven Tobochnik
First published November 15, 2022, DOI: https://doi.org/10.1212/NE9.0000000000200018
Hernan Nicolas Lemus
From the Departments of Neurology (H.N.L., B.A.D., E.J.B., S.T.) and Neurosurgery (G.R.C.), Brigham and Women's Hospital, Boston, MA.
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Barbara A. Dworetzky
From the Departments of Neurology (H.N.L., B.A.D., E.J.B., S.T.) and Neurosurgery (G.R.C.), Brigham and Women's Hospital, Boston, MA.
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Ellen J. Bubrick
From the Departments of Neurology (H.N.L., B.A.D., E.J.B., S.T.) and Neurosurgery (G.R.C.), Brigham and Women's Hospital, Boston, MA.
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Garth Rees Cosgrove
From the Departments of Neurology (H.N.L., B.A.D., E.J.B., S.T.) and Neurosurgery (G.R.C.), Brigham and Women's Hospital, Boston, MA.
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Steven Tobochnik
From the Departments of Neurology (H.N.L., B.A.D., E.J.B., S.T.) and Neurosurgery (G.R.C.), Brigham and Women's Hospital, Boston, MA.
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Citation
Education Research: Evaluation of Epilepsy Surgery Education in Epilepsy and Clinical Neurophysiology Fellowship Programs
Hernan Nicolas Lemus, Barbara A. Dworetzky, Ellen J. Bubrick, Garth Rees Cosgrove, Steven Tobochnik
Neurol Edu Dec 2022, 1 (2) e200018; DOI: 10.1212/NE9.0000000000200018

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Abstract

Background and Objectives To 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.

Methods A 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.

Results There 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.

Discussion High-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.

Glossary

ABPN=
American Board of Psychiatry and Neurology;
ACGME=
Accreditation Council for Graduate Medical Education;
CNP=
clinical neurophysiology;
DRE=
drug-resistant epilepsy;
NAEC=
National Association of Epilepsy Centers

Footnotes

  • Go to Neurology.org/NE for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • Submitted and externally peer reviewed. The handling editor was Roy Strowd III, MD, Med, MS.

  • Received June 17, 2022.
  • Accepted in final form September 9, 2022.
  • © 2022 American Academy of Neurology

This is an open access article distributed under the terms of the Creative Commons Attribution License 4.0 (CC BY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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