Inconsistencies Identified Across EEG Neurology Education Tactics


The findings showed that 64% of EEG education programs did not utilize objective measures to assess EEG milestones.

Fabio Nascimento, MD

Data from a recently published study identified a lack of consistency in teaching and evaluating residents on electroencephalograms (EEG) during residency and presented EEG education barriers alongside possible solutions.

Fabio Nascimento, MD, and Jay Gavvala, MD, MSCI, surveyed 47 program directors (PDs) of adult neurology residency programs in the US, most of them academic (89%), and found that the average number of EEGs read during a typical EEG rotation varied from more than 40, in about one-third of programs, to 0–10, in about 14% of programs.

Nascimento, an EEG/epilepsy clinical fellow at Massachusetts General Hospital, told NeurologyLive, “From our experience, myself as a recently graduated adult neurology resident 6 months ago, and Dr. Gavvala, who is a seasoned academic EEG’er, we felt as though adult neurology residents do not receive optimal EEG education throughout their training. This has been a widespread known fact among centers and residents.”

The mean number of 1-month EEG rotations required to graduate was 1.7 (range, 0–4; median, 1.75). Furthermore, 91% and 70% of programs had EEG rotations involved the inpatient and outpatient settings, respectively.

The average number of EEG readings between 11 to 20 and 21 to 30 both occurred in 20% of programs, whereas only 11% had between 31 to 40 average number of EEG readings.

There were inconsistencies with answers about requirements for successful completion of EEG rotations, which ranged from completion of rotation to oral examination and interpretation of 30 EEGs.

In total, 55% of PDs reported that 815 to 100% of their residents met EEG level 4 milestones by graduation. Nearly 27% of PDs reported that 61% to 80% of their residents met level 4 milestones and 18% of PDs reported less than 61% of residents meeting level 4 milestones.

When asked about how he would change the systems, Nascimento stated, “mandate further EEG training after neurology residency for someone to be able to read in clinical practice setting. Option 2 would be to continue with the current system where any neurologist can read EEG without having further training, but really harp on improving the EEG education in neurology residency.”

Nascimento’s findings showed that 64% of programs did not utilize objective measures to assess EEG milestones. The objective measures that were used in programs varied significantly, and included EEG tests/quizzes, oral examinations, Residency In-service Training Examination (RITE), Self-Assessment Examination (SAE), American Epilepsy Society (AES) examination, direct assessment from faculty, evaluation of EEGs logged by residents, and number of EEGs read during the rotation.

The 2 educational methods utilized by 95% and 93% of programs, respectively, were didactics given by attending, fellows, and/or residents throughout the year, and teaching EEG during EEG rotations by fellows and/or attendings.

Teaching during epilepsy clinic (66%), beside teaching during inpatient rounds (52%), and didactics given by attendings, fellows, and/or residents that are concentrated in a 1- to 2-month protected course directed at residents (30%) were all among additional educational methods.

Notably, 16% of PDs reported overnight EEG reading on senior night float and utilizing online EEG teaching platforms as methods used in their program.

In terms of barriers associated with teaching EEG, 41% of PDs reported an absence of any barriers, while insufficient EEG exposure and ineffective didactics were reported by 32% and 11% of PDs, respectively.

The authors listed a number of possible solutions to the most commonly reported barriers to EEG education. To increase exposure, they suggested either to (1) increased length/number of rotations, (2) create rotation devoted exclusively to EEG, without clinical duties, and (3) implement EMU rotation.

To optimize teaching and learning, they suggested to:

  • Increase supervision/oversight
  • Increase reading time with faculty
  • Increase responsibility/accountability to read EEGs during rotation
  • Utilize online modules to supplement education
  • Utilize case-based teaching, online and/or in-person
  • Encourage that faculty has time to read EEGs and teach
  • Implement regular EEG conferences
  • Increase EEG emphasis on inpatient services

To optimize measures of learning and evaluation, Nascimento and Gavvala suggested to (1) require a minimum number of EEGs read during rotation, and to (2) implement tests/quizzes, written and/or oral, online and/or in-person.

"I’m guilty myself. We published a lot about residents not knowing enough about EEG, but I’m one of them… Again, especially based on this study, it’s not just a problem in my residency program, but virtually all of them. Despite my bias in this field, there still needs to be improvement for sure,” Nascimento explained.

Nascimento FA, Gavvala JR. Education research: neurology resident EEG education: a survey of US neurology residency program directors. Neurology. Published online December 11, 2020. doi: 10.1212/WNL.0000000000011354
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