Abstracts

Rationale: The Accreditation Council of Graduate Medical Education's (ACGME) fellowship programs are designed to prepare trainees for independent practice. For the clinical neurophysiology fellowship, EEG exposure can vary widely between institutions due to each hospital's characteristic clinical landscape. The goal of this study was to provide a description of a clinical neurophysiology fellow's EEG experience after one year in the ACGME fellowship in order to serve as a basis for comparison for subsequent studies and to identify deficiencies so that future trainees may be better prepared for clinical practice. Methods: The ACGME clinical neurophysiology fellowship at Miami Children's Hospital, a tertiary care pediatric center, consists of 9 months of EEG reading: 6 months of video EEG (seizure monitoring unit, ward, PICU, CICU and NICU patients) and 3 months of routine EEG (all non-video EEG patients). An opportunity to read adult video EEG studies exists in the remaining 3 months of the academic year. Descriptive data for each EEG was recorded at the time of reading by the fellow and reviewed daily with 1 of 5 staff epileptologists. Findings were inputted into a secured database with pre-defined variables. Secondary review of the database was completed to account for any missing variables or input errors; source data was revisited to make corrections. At the time of submission, secondary review of the database was ongoing; therefore, a random sample of 486 of 895 completed EEG studies was generated for primary analysis. Intraoperative electrocorticography and intracranial video EEG studies were not included. Results: Four hundred eighty six EEGs studies (78% video, 20% routine inpatient and 2% routine outpatient) were randomly selected for analysis out of 895 EEG studies from 2013-2014. The sample population comprised 59% males (286/486). Mean age, 9.3 years (range: 0 days - 86 years) and median age, 6.6 years. Neonates (<44 weeks corrected gestational age or <30 days old) comprised 6.4% (31/486) of the sample population. No prior diagnosis of epilepsy existed in 49.4% (240/486) of patients and epilepsy history was unavailable in 0.8% (4/486) of patients. Etiologies in those with epilepsy consisted of 25.5% (124/486) unknown, 15.6% (76/486) structural/metabolic, 7.8% (38/486) genetic and 0.8% (4/486) provoked. Primary findings on EEG were classified as 35.8% (174/486) normal, 20% (97/486) ictal activity, 19.8% (96/486) interictal epileptiform activity, 19.5% (95/486) background abnormality, 3.3% (16/486) electroclinical diagnosis, 1.4% non-epileptic event (7/486) and 0.2% (1/486) indeterminate. Conclusions: This clinical neurophysiology fellow was exposed to a wide variety of EEG findings mainly through video EEG. Neonatal EEGs and the presence of electroclinical syndromes comprised a small proportion of the encountered studies. Future investigations can evaluate parity in training by comparing this sample to EEGs encountered at other training institutions. Program directors should be aware of the deficiencies in clinical EEG exposure so learning can be supplemented by other mechanisms.