Overall Goals and Objectives

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:

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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).

Suggested Readings:

1.         The treatment of Epilepsy: Principles and Practice, Wyllie
2.         Epilepsy: Mechanisms, Models and Translational perspectives: Rho, Sankar et al
3.         Jasper’s basic mechanisms of the Epilepsies, Avoli, Delgado-Escueta et al
4.         Text book of epilepsy surgery, Hans Luders
5.         Current Practice of Clinical Electroencephalography 4th ed Ebersole
6.         Epilepsy, Miller and Goodkin 1st ed 2014

Latest revision: 05/31/2018

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