Talai Afsaneh, Freedman Daniel A, Albert Dara V F
From the Division of Pediatric Neurology (A.T.), Department of Pediatrics, University of Texas Southwestern Medical Center at Dallas and Children's Medical Center of Dallas; Department of Neurology (D.A.F.), Dell Medical School, Austin, TX; and Division of Child Neurology (D.V.F.A.), Nationwide Children's Hospital, Columbus, OH.
Neurol Educ. 2023 Dec 28;3(1):e200111. doi: 10.1212/NE9.0000000000200111. eCollection 2024 Mar.
Psychogenic nonepileptic seizures (PNES) are difficult to differentiate from epileptic seizures (ES) even for neurologists who see these conditions frequently. This difficulty is due to overlapping semiologic findings between the 2 diagnoses. Previous studies have shown that trainees, including neurology trainees, are not accurate in differentiating PNES from ES. Neurologists often find the communication of PNES difficult. Despite these challenges, most programs do not have formal curricula for teaching PNES, and there are no standards for residency curricula in this topic. The aim of this study was to understand the gaps in resident education on PNES.
This study was accomplished through a needs assessment of current pediatric neurology residents and residency program directors (PDs). Two unique surveys were distributed, 1 for child neurology trainees and 1 for PDs. Questions were designed to understand trainees' self-reported knowledge, confidence, current education received, and desired teaching. Similarly for PDs, questions were designed to assess the state of education on PNES at their programs, sufficiency of education, and their desire for standardized curriculum.
Sixty-eight trainees and 21 PDs responded to the survey. Approximately one-quarter of trainees reported neutral to low levels of confidence and 38% reported neutral to low levels of knowledge in caring for patients with PNES. Trainees reported that directing patients with PNES to appropriate management was the most challenging aspect of care, followed by communicating the diagnosis, with 60% and 46% reporting difficulty, respectively. Only 21% of residents felt their current PNES education needs no improvement. One-fifth of PDs felt their current PNES education is not sufficient, and all reported they would incorporate a standardized curriculum. Trainees reported preferring to learn about this topic through lectures and simulation, while PDs preferred online modules and simulation.
While residents and PDs report high confidence and knowledge in treating pediatric patients with PNES, respondents felt improvement is needed to their curricula regarding this topic. Multiple learning methods are preferred, with emphasis on communicating the diagnosis and management of patients once the diagnosis has been made. PDs desire a standardized curriculum and would incorporate one into their programs. Findings of this study could be used to create a national curriculum.
即使对于经常诊治这些病症的神经科医生而言，心因性非癫痫性发作（PNES）也很难与癫痫性发作（ES）相区分。这种困难源于这两种诊断在症状学表现上存在重叠。既往研究表明，包括神经科住院医师在内的实习生在区分PNES和ES方面并不准确。神经科医生常常觉得PNES的沟通很困难。尽管存在这些挑战，但大多数培训项目并没有关于PNES教学的正式课程，而且在这个主题的住院医师培训课程方面也没有标准。本研究的目的是了解住院医师在PNES教育方面的差距。
本研究通过对当前儿科神经科住院医师和住院医师培训项目主任（PD）进行需求评估来完成。发放了两份独特的调查问卷，一份针对儿童神经科实习生，另一份针对PD。问题旨在了解实习生自我报告的知识、信心、当前接受的教育以及期望的教学内容。同样，针对PD的问题旨在评估其所在项目中PNES的教育状况、教育的充分性以及他们对标准化课程的期望。
68名实习生和21名PD回复了调查问卷。约四分之一的实习生报告信心处于中等至较低水平，38%的实习生报告在护理PNES患者方面知识处于中等至较低水平。实习生报告称，将PNES患者引导至适当的管理是护理中最具挑战性的方面，其次是传达诊断结果，分别有60%和46%的实习生表示有困难。只有21%的住院医师认为他们目前的PNES教育无需改进。五分之一的PD认为他们目前的PNES教育不充分，并且所有PD都表示他们将纳入标准化课程。实习生报告更喜欢通过讲座和模拟来学习这个主题，而PD更喜欢在线模块和模拟。
虽然住院医师和PD报告在治疗患有PNES的儿科患者方面有较高的信心和知识，但受访者认为在这个主题的课程方面仍需改进。多种学习方法更受青睐，重点是在做出诊断后传达患者的诊断和管理。PD希望有标准化课程，并会将其纳入他们的项目中。本研究的结果可用于创建全国性课程。
