Lemus Hernan Nicolas, Dworetzky Barbara A, Bubrick Ellen J, Cosgrove Garth Rees, Tobochnik Steven
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.
Neurol Educ. 2022 Nov 15;1(2):e200018. doi: 10.1212/NE9.0000000000200018. eCollection 2022 Dec.
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.
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.
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%, = 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.
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.
评估美国癫痫与临床神经生理学（CNP）专科培训项目学员接触外科癫痫治疗及相关培训的范围。对与学员更多参与癫痫手术相关的特征进行了评估。
设计了一项包含10个问题的多项选择题调查，以描述各个专科培训项目、癫痫外科项目、学员参与情况以及学员表现评估。该调查于2021年11月至2022年4月分发给成人癫痫和CNP-脑电图方向专科培训项目的项目主任。癫痫外科手术程序包括切除性手术方法、神经刺激方式以及针对药物难治性癫痫批准的姑息性干预措施。使用Fisher精确检验评估分类变量之间的关联。
72名调查对象中共有37人回复（回复率51%）。大多数（68%）外科项目每年进行超过30例外科手术。各项目的手术范围总体相似。在大多数项目中，学员每年亲自参与1 - 10例（49%）或11 - 30例（46%）外科手术。与每年手术量≤50例的机构相比，每年手术病例数>50例的机构使学员接触超过10例/年的可能性更高（77%对33%，P = ）。学员在术前规划中的参与度最高，在围手术期和术后活动中的参与度则更具变化性。手术管理能力主要通过教员评估进行调查（97%），而较少使用口试（46%）和笔试（30%）评估。
尽管癫痫手术量大的中心也有更多专科培训岗位，但能让学员有更多接触机会。各机构在外科癫痫治疗的接触机会、学员参与度和表现评估指标方面存在差异。我们确定了各项目可重点关注的特定领域，以提高学员在癫痫外科治疗管理方面的能力。
