Overall Goals and Objectives

The overall goal of our training program is to develop superb epileptologists. It is the mission of our training program to ensure that our graduates have demonstrated competency in the six core areas as designated by the ACGME. It is the goal of our program to develop life-long self-evaluation and self-improvement skill. To accomplish these goals, the fellow’s progress toward competency throughout their year of training will be evaluated both by faculty, program director, and by the fellow. At the time of each 6-month evaluation, the program director and the fellow will formulate an action plan to move towards competency and proficiency in the following areas:

Patient Care

Obtain accurate and sufficient histories to characterize seizures and to define risk factors for developing epilepsy
Review AAN practice guidelines and learn to incorporate them into the evaluation and treatment of patients with epilepsy
Demonstrate communication skills to educate patients and families regarding epilepsy diagnosis and treatment
Work with health care professionals (i.e. nursing staff, neurophysiology technologists, ancillary staff) to provide patient-focused care
Attend Epilepsy clinics, admit and manage epilepsy monitoring patients including both pediatric and adult patients
Review electrophysiological studies and apply findings to care of patients with epilepsy
Formulate patient management plans regarding appropriate diagnostic and therapeutic interventions

Medical Knowledge

Explain the recognition and treatment of status epilepticus, a medical emergency
Take a personal initiative in self-education (including perusing recent literature). This includes review of standard texts of EEG interpretation and epilepsy disorders. As includes review of teaching files of normal and abnormal EEGs
Describe the importance of neuroimaging in the evaluation of patients with epilepsy
Be able to classify seizure types and epilepsy
Verbalize rational approach to the management of epilepsy including choice of appropriate antiepileptics
Understand the mechanism of action of antiepileptics and how it relates to treatment
Explain the indications and utility of epilepsy monitoring for the evaluation of intractable epilepsy, especially the use of surgical treatment of epilepsy, and the diagnosis of spells
Characterize the unique situation of epilepsy in women of child bearing age
Understand and verbalize principles of safety for patients with epilepsy and discussing SUDEP
Electroencephalography

Describe the principles of EEG generation and recording
Achieve an orderly approach to the interpretation of EEG studies
Identify normal and abnormal EEG patterns from infancy to elderly
Describe the developmental features of EEG from infancy to the elderly
Recognize abnormal EEG findings and correlate EEG findings with clinical epilepsy syndrome and seizure types, including pediatric syndromes
Achieve skills in creating and dictating neurophysiology reports
Correlate video recordings of seizures with EEG tracing and interpret scalp EEG findings
Read and interpret intracranial EEG findings as the related to zones of interest for epilepsy surgery
Perform and interpret extra-operative mapping
Decision-making for surgery/neuro-stimulation among patients who undergo scalp or invasive EEG monitoring studies
Describe the principles of Wada testing and fMRI and implications for epilepsy surgery and cognitive outcomes following surgery.
Interpret continuous EEG recordings from adult and pediatric patients in the epilepsy monitoring and intensive care units and updating care teams of the record progress

Interpersonal and Communication Skills

Develop techniques to obtain accurate history from patients, and gain the patients’ confidence and trust
Create reports that accurately convey EEG findings and relate these findings to the clinical setting
Interact effectively with other members caring for patients including nursing and technical staff
Create clinic and hospital notes that are concise and accurate

Professionalism

Show respect, compassion, integrity and ongoing professional development
Verbalize ethical principles with adherence to confidentiality, HIPAA principles, and appropriate informed consent
Respect cultural differences on patients and colleagues creating a professional environment.
Approach sensitive patient issues with respect and compassion.
Be punctual and appropriately attired
Keep patient logs up-to-date

Practice-Based Learning and Improvement

Appraise literature to better understand epilepsy syndromes and their etiology and clinical presentation
Assess studies that evaluate treatment options for specific seizure types and epilepsy syndromes
Apply and use the International League Against Epilepsy (ILEA) website that aids in understanding epilepsy syndromes and seizure management.

Systems Based Practice

Identify the importance for proper diagnosis and treatment of epilepsy as to the effect of diagnosis on insurability and driving privileges
Assess efficiencies of the UW and VA systems regarding patients referred from other centers, and develop management plans that are effective and not redundant or wasteful of medical resources
Make decisions regarding the cost considerations of choosing appropriate antiepileptic drug therapy
Identify advocacy programs for patients with epilepsy

Clinical Training

Competence in the comprehensive diagnosis and management of all forms of epilepsy (Patient Care);
A rich knowledge base in both clinical and basic neuroscience, as well as the fundamentals of epilepsy (Medical Knowledge);
Competence in obtaining an appropriate medical history (including sensitive issues such as sexual history) in a professional and humane manner (Interpersonal and Communication Skills, Professionalism);
Competence in communicating diagnosis and treatment plans, and competence in communicating potentially sensitive information (Interpersonal and Communication Skills, Professionalism);
Competence in communicating succinctly and clearly with other healthcare professionals, with a proper respect for the principles of HIPAA regulations (Interpersonal and Communication Skills, Professionalism);
Skill in self-assessment and self-improvement (Practice-Based Learning and Improvement);
Skill in practice assessment, as well as both practice- and systems improvement, to enhance quality of care and improve patient safety (Practice-Based Learning and Improvement, Systems-Based Practice).

Specific Academic / Research

At the end of the training program, the fellow will have developed…

A scholarly approach to the practice of epilepsy, including the incorporation of evidence-based medicine into clinical decision-making (Practice Based Learning and Improvement);
Basic knowledge of clinical trial design and statistical testing, as well as the ability to utilize this knowledge for critical interpretation of medical literature (Medical Knowledge, Practice-Based Learning and Improvement);
First-hand experience at the process of clinical research, ideally via participation in a clinical or translational research project (or even by assisting with patient enrollment into an ongoing project), or quality improvement. (Interpersonal and Communication Skills, Professionalism, Practice-Based Learning and Improvement); and
First-hand experience at the process of data presentation and peer-review, ideally via submission of one abstract or manuscript during the course of training (Interpersonal and Communication Skills, Medical Knowledge, Professionalism).