Epigraph Vol. 21 Issue 2, Spring 2019
ILAE creates curriculum and standards for epileptology education worldwide
The ILAE’s Task Force for Epilepsy Education has developed a roadmap for a competency-based curriculum in epileptology, meant to address educational gaps and strengthen the knowledge of all health professionals who care for people with epilepsy.
“We aim to improve epilepsy education around the globe, and create international standards for educational goals,” said Ingmar Blümcke (University Hospitals Erlangen), chair of the Epilepsy Education Task Force, which authored a recent article in Epileptic Disorders that outlines the roadmap (en Español). “We envision that our new teaching program will become the pre-eminent resource for any of our constituency seeking comprehensive teaching in epileptology.”
Why a curriculum?
Seizures are one of the most common presentations in clinical settings and may be addressed or managed by a variety of medical professionals. In some countries, there is little to no access to epilepsy specialists, and people with epilepsy receive care from general practitioners.
To ensure appropriate and accurate diagnosis and treatment, a common body of knowledge should exist among all health care professionals providing care in these settings. In reality, education and knowledge vary widely. This contributes to a treatment gap that can exceed 90% in some countries; that is, fewer than 10% of people with epilepsy receive the treatment they need.
At the same time, epilepsy is a multifaceted, nuanced condition that usually requires lifelong care. Many epilepsy types are difficult to control and clinically complex, or are the expression of rare brain disorders, requiring interdisciplinary approaches and highly skilled clinicians. In these situations, highly trained specialists are expected to guide specialized care in a cost-effective manner.
Each year, the ILAE invests time and resources in educational activities; without standards or metrics, however, there is little information available on outcomes or learner satisfaction. “The development of a competency-based curriculum is a rational solution that also will help ILAE’s constituency access state-of-the-art knowledge and teaching,” Blümcke said.
“While the ILAE has a long history of accomplishments in education, in order to achieve global professional competence, it is necessary to have a broader vision that takes into account new possibilities and educational methods, and which encompasses the diverse needs of professionals in a range of cultural contexts, economic conditions, and health care settings,” said Elza Marcia Yacubian (University of São Paulo), Task Force member. “This curriculum can be considered a step toward decreasing the educational gap, and thus, decreasing the treatment gap.”
Keys to the curriculum
The curriculum encompasses 7 domains, 42 competencies and 124 learning objectives. Each learning objective is mapped to a competency, domain, and level of proficiency.
The Task Force developed the competencies to represent the spectrum of skills and knowledge for best medical practice in epileptology. Input was requested from constituents. The resulting catalogue of competencies was the blueprint for developing the common body of knowledge that should be held by health care professionals caring for people with epilepsy.
The curriculum allows for three levels of learning:
Entry (Level 1)
This level is intended for clinicians trained in adult and child neurology, internists, pediatricians and psychiatrists, as well as other professionals who provide care to people with epilepsy.
Proficiency (Level 2)
This level covers a broader and deeper spectrum of knowledge and skills in epileptology. Participants qualified for this level must have demonstrated mastery of Level 1 learning objectives.
Advanced proficiency (Level 3)
This level is provided to epileptologists interested in more advanced or specialized training, such as epilepsy in neonates, planning of intracranial electrode implantation, interpretation of invasive EEG recordings, post-processing in EEG, MEG and MRI, analysis of genetic investigations, design and management of clinical drug trials, or organization and management of epilepsy surgery centers or research programs. Candidates must demonstrate mastery of Level 2 material. Level 3 includes practical clinical training in specialized epilepsy centers.
The seven domains include:
- Diagnosis (9 competencies, 40 learning objectives)
- Counseling (10 competencies, 22 learning objectives)
- Pharmacological treatment (7 competencies, 18 learning objectives)
- Epilepsy surgery (7 competencies, 7 learning objectives)
- Emergencies (3 competencies, 9 learning objectives
- Comorbidities (2 competencies, 8 learning objectives)
- Biology of epilepsy (4 competencies)
As a sample, the first two learning objectives are listed below:
Domain 1: Diagnosis
Competency 1.1: Demonstrate working knowledge of etiologies for focal and generalized epilepsies in children and adults
- Learning objective 1.1.1: Describe the major etiologies for epilepsy (Level 1)
- Learning objective 1.1.2: Describe the common structural etiologies (hippocampal sclerosis, tumors, malformations, etc.) (Level 2)
“The curriculum builds a base for all of ILAE’s future teaching activities,” said Blümcke. “It presents a matrix for a comprehensive ILAE teaching portfolio: Case-based e-learning courses, face-to-face workshops and topic-oriented summer schools—as well as teaching seminars at congresses—can now be aligned with the curriculum and will address specific, measurable learning objectives.”
Support for the curriculum appears strong; 83% of survey respondents said they would take self-paced e-learning courses to enhance their knowledge of epilepsy, and only 1.4% of survey respondents did not think the curriculum would help them structure educational activities in their region.
Manuela Ochoa Urrea, a neurology resident at the Central Military Hospital, Bogota, Colombia, looks forward to a global curriculum in multiple languages that provides unified, evidence-based knowledge.
She is particularly pleased that counseling is included as a learning domain. “Sometimes, we as caregivers struggle to give appropriate counseling,” she said. “We’re not always taught how to give an epilepsy diagnosis or to pay attention to basic, life-changing needs that patients and families have.”
The comprehensive nature of the curriculum continues a shift toward proactive, patient-centered care. “Comprehensive epilepsy management must go beyond seizure management to address psychosocial issues, psychiatric comorbidities, patient education and quality of life,” said Rosa Michaelis, (Community Hospital Herdecke, Germany), chair of ILAE’s Psychology Task Force. “From the perspective of the Task Force, the early integration of basic learning objectives in these areas is one of the most exciting opportunities offered by the curriculum.”
ILAE is currently developing a case-based e-learning course covering diagnosis, treatment and patient counseling for the most common epilepsies, said Blümcke. The course will be aimed at Level 1 learners and translated into several languages. Many members of ILAE’s Young Epileptology Section (YES) are providing input. During the second half of 2019, ILAE plans to engage learners to help test and refine the course.
Another near-term goal is assembling a comprehensive portfolio of learning activities aimed at Level 2 learners.
Seeds of future learning
This competency-based approach will allow for a more systematic and strategic approach to developing educational offerings for the ILAE. Furthermore, it will make it possible for ILAE to create formal programs for a variety of learner levels, which can be undertaken in a step-wise, self-paced fashion.
“This curriculum is the germinated seed of the future,” said Yacubian. “From now on, all ILAE congresses, as well as ILAE-endorsed and supported courses, workshops and summer schools worldwide will be organized on the basis of this list of competencies.”
“The importance of this roadmap cannot be overemphasized,” said ILAE President Samuel Wiebe (University of Calgary). “Lack of education is one of the main barriers to epilepsy care around the world. With the curriculum, any educational activity, in any format, can now be assessed in terms of its ability to achieve clearly delineated learning objectives in epileptology at various levels of proficiency.”
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