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Measuring expertise in identifying interictal epileptiform discharges.

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    Area of Science:

    • Neurology
    • Medical Education
    • Biostatistics

    Background:

    • Interictal epileptiform discharges (IEDs) on EEG are crucial for epilepsy diagnosis.
    • EEG interpretation varies among readers with different training levels.
    • A standardized method to assess IED recognition skills is lacking.

    Purpose of the Study:

    • To develop and validate a test that quantifies the skill of readers in identifying IEDs.
    • To differentiate between expert, experienced non-expert, and novice EEG readers based on IED recognition.
    • To establish a reliable method for assessing EEG interpretation proficiency.

    Main Methods:

    • Developed an online test using 13,262 candidate IEDs, scored by eight fellowship-trained reviewers to create a gold standard.
    • Assessed reader performance based on sensitivity, false positive rate, and calibration.
    • Utilized a mathematical model to estimate reader skill and threshold, generating receiver operating characteristic (ROC) curves.

    Main Results:

    • Twenty-nine raters (9 experts, 7 experienced non-experts, 13 novices) completed the test.
    • Experts demonstrated superior performance with higher median area under the ROC curve (0.891) compared to experienced non-experts (0.852) and novices (0.735).
    • Novices exhibited higher uncertainty (noise level) in IED identification than experienced readers.

    Conclusions:

    • The developed test effectively distinguishes between expert and non-expert readers based on IED identification ability.
    • This assessment can identify and potentially correct variations in IED recognition thresholds among clinicians.
    • The findings support the use of standardized testing to improve EEG interpretation accuracy and training.