Impact of Simulation on Critical Care Fellows' Electroencephalography Learning

Introduction Continuous electroencephalography (EEG) is an important monitoring modality in the intensive care unit and a key skill for critical care fellows (CCFs) to learn. Our objective was to evaluate with CCFs an EEG educational curriculum on a web-based simulator. Methods This prospective cohort study was conducted at a major academic medical center in Florida. After Institutional Review Board approval, 13 CCFs from anesthesiology, surgery, and pulmonary medicine consented to take an EEG curriculum. A 25-item EEG assessment was completed at baseline, after 10 EEG interpretations with a neurophysiologist, and after 10 clinically relevant EEG-based simulations providing clinical EEG interpretation hints. A 50-minute tutorial podcast was viewed after the baseline assessment. Main assessment outcomes included multiple outcomes related to web-based simulator performance: percent of hints used, percent of first words on EEG interpretation correct, and percent hint-based EEG interpretation score correct, with higher scores indicating more correct answers. Participants completed a 25-item EEG assessment before (baseline) and after the web-based simulator. Results All 13 CCFs completed the curriculum. Between scenarios, there were differences in percent of hints used (F-9,F-108 =11.7, p < 0.001), percent of first words correct (F-9,F-108 = 13.6, p < 0.001), and overall percent hint- based score (F-9,F-108= 14.0, p < 0.001). Nonconvulsive status epilepticus had the lowest percent of hints used (15%) and the highest hint-based score (87%). Overall percent hint-based score (mean across all scenarios) was positively correlated with change in performance as the number of correct answers on the 25-item EEG assessment from before to after the web-based simulator activity (Spearman's rho=0.67, p= 0.023). Conclusions A self-paced EEG interpretation curriculum involving a flipped classroom and screen-based simulation each requiring less than an hour to complete significantly improved CCF scores on the EEG assessment compared to baseline.