Video-Based Training for Seizure Diagnosis
Background and aim: The difficulties in differentiating epileptic seizures (ES) from psychogenic non-epileptic seizures (PNES) are well known. However, interventions to enhance diagnostic accuracy have not been well studied. We sought to evaluate the accuracy of discrimination between ES and PNES before and after targeted training among medical students.
Methods: A teaching module incorporating videos of typical ES and PNES was used for training. Typical ES and PNES, 10 each, were shown in a random mix. The participants were asked to make a diagnosis as the baseline test, followed by a detailed discussion on videos. One month later, a 1 h lecture was delivered on the diagnosis and classification of seizures, followed by two more tests 3 and 6 months later, using a similar format, but different videos. A group of emergency medicine trainees also went through the preteaching test for comparison. We used summary receiver operating characteristic curves and area under the curve (AUC) to quantify the discriminating ability and z scores to assess the differences between AUC between different stages of training.
Results: In medical students, the AUC improved significantly from 0.52 (95% CI 0.49 to 0.55) at the baseline to 0.64 (95% CI 0.59 to 0.69, p<0.001) at 3 months and 0.63 (95% CI 0.57 to 0.69, p<0.001) at 6 months. At 3 and 6 months testing, they achieved results similar to that of emergency medicine trainees (p=0.5).
Conclusions: Targeted video-based training increases the accuracy of visual discrimination of seizures short-term and medium-term.
Seizures and seizure mimickers present a common diagnostic problem at emergency departments, hospital wards and outpatient clinics. A detailed history including eye-witness account and physical examination are considered to be the cornerstones in the diagnosis of seizures. Differentiating epileptic seizures (ES) from psychogenic non-epileptic seizures (PNES) is a major diagnostic challenge. The reported rate of misdiagnosis of PNES as epilepsy ranges from 20% to 26%, and the average delay in diagnosing PNES has been reported to be as long as 7–9 years. The misdiagnosis of PNES as epilepsy is associated with potentially deleterious consequences, such as unnecessary interventions (intubation, ventilation, central venous lines, intensive care), inappropriate prescribing of antiepileptic medications, expensive investigations, frequent hospital visits, financial loss to the individual, healthcare system and society at large, and even rare cases of death due to unnecessary treatment. In view of this, there is a pressing need to enhance the diagnostic accuracy of healthcare professionals in this area.
One potential approach to improve seizure recognition among health professionals is to incorporate it into training at the undergraduate level. In a previous study, we demonstrated that junior doctors had very low accuracy of 0.54 for the diagnosis of ES and PNES. We speculate this low value could be due to the lack of exposure to seizures and formal training on the subject during their undergraduate period. It is possible that neurology education may be hampered by 'neurophobia'-the fear of neurology. Investigators have sought to reduce this fear through improved techniques of medical education. There is a dearth of studies looking at interventions to improve diagnostic skills, particularly with regards to seizure recognition among medical students. This issue has a particular practical relevance in the transition from a medical student to an intern doctor. Against this backdrop, we sought to investigate whether targeted training using videos of typical ES and PNES would result in persistently improved diagnostic accuracy. This was conducted as a 'proof of concept' study of targeted training involving medical students.
Abstract and Introduction
Abstract
Background and aim: The difficulties in differentiating epileptic seizures (ES) from psychogenic non-epileptic seizures (PNES) are well known. However, interventions to enhance diagnostic accuracy have not been well studied. We sought to evaluate the accuracy of discrimination between ES and PNES before and after targeted training among medical students.
Methods: A teaching module incorporating videos of typical ES and PNES was used for training. Typical ES and PNES, 10 each, were shown in a random mix. The participants were asked to make a diagnosis as the baseline test, followed by a detailed discussion on videos. One month later, a 1 h lecture was delivered on the diagnosis and classification of seizures, followed by two more tests 3 and 6 months later, using a similar format, but different videos. A group of emergency medicine trainees also went through the preteaching test for comparison. We used summary receiver operating characteristic curves and area under the curve (AUC) to quantify the discriminating ability and z scores to assess the differences between AUC between different stages of training.
Results: In medical students, the AUC improved significantly from 0.52 (95% CI 0.49 to 0.55) at the baseline to 0.64 (95% CI 0.59 to 0.69, p<0.001) at 3 months and 0.63 (95% CI 0.57 to 0.69, p<0.001) at 6 months. At 3 and 6 months testing, they achieved results similar to that of emergency medicine trainees (p=0.5).
Conclusions: Targeted video-based training increases the accuracy of visual discrimination of seizures short-term and medium-term.
Introduction
Seizures and seizure mimickers present a common diagnostic problem at emergency departments, hospital wards and outpatient clinics. A detailed history including eye-witness account and physical examination are considered to be the cornerstones in the diagnosis of seizures. Differentiating epileptic seizures (ES) from psychogenic non-epileptic seizures (PNES) is a major diagnostic challenge. The reported rate of misdiagnosis of PNES as epilepsy ranges from 20% to 26%, and the average delay in diagnosing PNES has been reported to be as long as 7–9 years. The misdiagnosis of PNES as epilepsy is associated with potentially deleterious consequences, such as unnecessary interventions (intubation, ventilation, central venous lines, intensive care), inappropriate prescribing of antiepileptic medications, expensive investigations, frequent hospital visits, financial loss to the individual, healthcare system and society at large, and even rare cases of death due to unnecessary treatment. In view of this, there is a pressing need to enhance the diagnostic accuracy of healthcare professionals in this area.
One potential approach to improve seizure recognition among health professionals is to incorporate it into training at the undergraduate level. In a previous study, we demonstrated that junior doctors had very low accuracy of 0.54 for the diagnosis of ES and PNES. We speculate this low value could be due to the lack of exposure to seizures and formal training on the subject during their undergraduate period. It is possible that neurology education may be hampered by 'neurophobia'-the fear of neurology. Investigators have sought to reduce this fear through improved techniques of medical education. There is a dearth of studies looking at interventions to improve diagnostic skills, particularly with regards to seizure recognition among medical students. This issue has a particular practical relevance in the transition from a medical student to an intern doctor. Against this backdrop, we sought to investigate whether targeted training using videos of typical ES and PNES would result in persistently improved diagnostic accuracy. This was conducted as a 'proof of concept' study of targeted training involving medical students.
Source...