Clinical neurophysiology training and certification in the United States: 2000: American Board of Psychiatry and Neurology, neurology residency review committee

Clinical Neurophysiology Fellowship Program Directors Survey on a Standardized Fellowship Match Process: A Call for Action

PURPOSE

To survey US Clinical Neurophysiology (CNP) fellowship program directors on the nature of CNP and related training programs, current recruitment cycle, and views for a standardized process.

METHODS

A 23-question electronic survey was sent to all 93 US Accreditation Council for Graduate Medical Education-accredited CNP fellowship program directors from December 2020 to January 2021.

RESULTS

The response rate was 60%. There was great variability in the number of CNP positions and CNP tracks offered. The following tracks were identified: 48% EEG dominant, 26% EMG dominant, 22% split equally between EEG and EMG, and 2% and 1% were neurophysiologic intraoperative monitoring and autonomic dominant, respectively. Of the responding institutions, 43% offered a second year of training options to CNP fellows, mainly in conjunction with Epilepsy fellowship, which was pursued by 25% of CNP fellows. Many programs indicated flexibility in their design between different CNP tracks or between CNP and other related training programs based on the available candidates. The median percentage of CNP fellowship positions filled over the last 5 years was 80%, and there was great variation in the recruitment timeline across institutions. Overall, 86% of program directors favored a universal timeline and 71% favored a formal match for CNP. The respondents were split between an independent CNP match (39%) and joining the initiatives of affiliate societies on a standardized process (61%).

CONCLUSIONS

There is significant heterogeneity in the makeup of the CNP fellowship programs and the recruitment process. The majority of CNP program directors are in favor of standardization of the recruitment process.

Subspecialization in clinical neurophysiology: Development and current status

OBJECTIVE

To describe the development and current status of training and certification in clinical neurophysiology (CNP); to explore the impact of the newer subspecialties in sleep medicine, neuromuscular medicine, and epilepsy; and to obtain information about aspects of practice in the subspecialty.

METHODS

Information about training programs and certification was obtained from the records of the Accreditation Council for Graduate Medical Education and the American Board of Psychiatry and Neurology, and diplomates were surveyed about their CNP practice activities and attitudes toward certification/recertification.

RESULTS

In the years since the first examination was administered, a robust number of CNP training programs developed, but recently, there has been a decrease in the number of programs and fellows, although the number of programs and fellows in the subspecialties of epilepsy, neuromuscular medicine, and sleep medicine has increased. A diplomate survey indicated that most respondents devoted significant practice time to CNP procedures, especially to EEGs and EMGs. Although more diplomates performed EEGs than EMGs, a substantial portion performed both. Most diplomates were planning to or had maintained certification in CNP.

CONCLUSION

Over 3,000 neurologists, child neurologists, and psychiatrists have obtained certification in CNP, and the majority are participating in recertification. Although the newer and overlapping subspecialties of epilepsy, neuromuscular medicine, and sleep medicine may be having a negative impact on CNP, it continues to have a relatively large number of programs and attracts a relatively large number of fellows.

Factors affecting the yield of pediatric EEGs in clinical practice

Clinical factors affecting the yield of 2,500 pediatric electroencephalograms were analyzed. Electroencephalograms were interpreted as epileptiform in 40% of children with epilepsy. Most electroencephalograms were ordered for seizure in children not taking anti-epileptic drugs; just 15% showed epileptiform features. Six percent of electroencephalograms were epileptiform in non-seizure patients. The neurologist significantly influenced the odds of epileptiform interpretation (P = 0.022) and the recommendation to repeat the electroencephalogram (P < 0.001). In practice most electroencephalograms ordered for seizure are actually for non-seizure. In routine pediatric practice, electroencephalography has a low yield and appears to be over-used.