Education Research: How Child Neurologists Counsel About Reproductive Health and Epilepsy: Gaps in Accuracy and...

The American Academy of Neurology (AAN) 2017 Women With Epilepsy Quality Measure advises all neurologists, including child neurologists, to counsel all 12- to 44-year-old female patients with epilepsy annually about at least 2 of 3 following topics: folic acid supplementation, interactions between antiseizure medications (ASMs) and contraception, and the effect of ASMs on pregnancy and/or fetal or child development. We hypothesized that child neurologists do not consistently conduct clear, factually accurate, and guideline-concordant counseling in this area. Therefore, as a targeted educational needs assessment, we performed a simulation-based evaluation of child neurologist knowledge and skill in this area to inform future educational intervention development.

We recruited child neurology trainees (residents and fellows), attending physicians, and advanced practice providers (APPs) through a national listserv to engage in 3 virtual scenarios, simulating telemedicine appointments. We instructed them to perform reproductive health counseling for a female youth with epilepsy and their parent. We provided participants with detailed medical information about the patient before each scenario. We recorded and transcribed simulations. Coders performed content analysis to identify discussion of guideline-concordant counseling topics, assess factual accuracy, and analyze style of counseling for consistency with plain language.

Twenty-one individuals each performed the scenarios (11 attending physicians, 9 child neurology trainees, and 1 APP). Twelve (57%) addressed at least 2 of the 3 topics in the AAN quality measure across all scenarios. None (0%) performed guideline-concordant counseling without inaccuracies or omissions of key information across all scenarios. We identified no significant differences between attending physicians vs other provider types in stratified analyses. Qualitative analysis revealed that provider communication was rarely consistent with plain language standards. Common stylistic features included (1) long conversational turns, (2) multiple topics per turn, (3) complex sentence structures, and (4) use of jargon.

In case-based stimulation scenarios, most child neurologists discussed at least 2 of 3 AAN-recommended topics. However, participants commonly included factual inaccuracies and omitted key information, and did not use plain language, highlighting the need for training. Informed by our study findings, we will design and test a training intervention for child neurologists in this area as a future direction.