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Consensus document on electroencephalography education in anaesthesiology: defining learning outcomes: A modified
Joana Berger-Estilita1, Dana Baron Shahaf, Odmara L Barreto Chang
1From the Institute for Medical Education, University of Bern (JBE), Department of Anaesthesiology and Intensive Care, Salem-Spital, Hirslanden Hospital Group, Bern, Switzerland (JBE), RISE-Health, Centre for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal (JBE), Department of Anaesthesiology and Intensive Care, Rambam Healthcare Campus, Haifa, Israel (AR, DBS), Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, California, USA (OLBC), Department of Anaesthesia and Intensive Care Medicine, Liège University Hospital, Liège, Belgium (VB), Anaesthesia and Perioperative Neuroscience Laboratory, GIGA-Consciousness, GIGA-Research, Liège University, Liège, Belgium (VB), Department of Intensive Care Medicine, University Hospital of Zürich, Zürich, Switzerland (IC), Department of Anaesthesiology and Surgical Intensive Care, Hospital del Mar; Hospital del Mar Research Institute, Barcelona, Spain (JLF-C), Department of Anesthesiology, Columbia University Medical Center, New York, New York, USA (PSG), Division of Anaesthesiology, Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals and Faculty of Medicine (MG), Unit of Development and Research in Medical Education (UDREM), Faculty of Medicine, University of Geneva, Geneva, Switzerland (MG), Department of Anesthesiology, Montréal Neurological Institute and Hospital, McGill University, Montréal, Québec, Canada (BAG), Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland (FL, HAK, DH), Department for Anesthesiology and Intensive Care, School of Medicine, Technical University of Munich, Munich, Germany; and Hessing Clinic for Anesthesiology, Intensive Care and Pain Medicine, Augsburg, Germany (SK), Department of Anaesthesiology and Intensive Care, Zealand University Hospital, Nyk⊘bing F., Denmark (SK, KJ), Department of Anesthesiology, University of Minnesota Medical School, Minneapolis, MN, USA (FMR), Department of Anaesthesiology, Oslo University Hospital, Oslo, Norway (IJR), Centre for Anaesthesiology and Intensive Care, Hirslanden Klinik Aarau, Hirslanden Medical Group, Aarau, Switzerland (HAK), Charité - University Medicine Humboldt University Berlin, Department for Anesthesiology and Intensive Care Medicine, Berlin, Germany (SK), Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Department of Anesthesiology and Intensive Care, Istanbul, Turkey (OKD), Department of Anaesthesiology and Intensive Care, School of Medicine and Health, Technical University of Munich, Munich, Germany (GS, SP, MK), Department of Anesthesiology, Yale School of Medicine, New Haven, Connecticut, USA (JH), Anesthesiology and Pain Medicine Institute, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates (FAL), Balgrist University Hospital, Zurich (APM), Institute of Anaesthesiology and Intensive Care, Spital Limmattal, Schlieren, Switzerland (IM), Anaesthesiology and Intensive Care Unit Department, Ankara University Faculty of Medicine (BCM), Ankara University Brain Research Center (AÜBAUM); Department of Interdisciplinary Neuroscience, Health Sciences Institute, Ankara University, Ankara, Turkey (BCM), Department of Anesthesiology, Washington University School of Medicine, Saint Louis, Missouri, USA (BP), Department of Neuroanesthesia, Neurocritical and Postoperative Care, Spedali Civili University Hospital of Brescia, Brescia (FR), Department of Anesthesia and Critical Care, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy (SR), Department of Health Science, University of Florence, Florence, Italy (SR), Department of Anaesthesia, Intensive Care and Pain Medicine, General University Hospital. Universidad Europea de Valencia, Valencia, Spain (CSR), Hospital Base San José Osorno, Universidad Austral de Chile (POS), Private practice, Johannesburg, South Africa (DS), Department of Anaesthesia and Intensive Care Medicine, Medical University Innsbruck, Innsbruck, Austria (BS), Department of Anaesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany (MS), Metropolitan University of Santos (UNIMES), Santos, Brazil (FT), Irmandade da Santa Casa da Misericórdia de Santos Hospital, Santos, Brazil (FT), Department of Anesthesiology, Mass General Brigham, Harvard Medical School, Boston, Massachusetts, USA (SV), Anaesthesiology Department, Unidade Local de Saúde de São João (SV), UNIC@RISE, Centre for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal (SV), University Medicine Greifswald, Department of Anaesthesia, Intensive Care, Emergency Medicine and Pain Medicine, Greifswald, Germany (FvD), Department of Anaesthesiology, Helora (SS), Department of Surgery, UMons, Research Institute for Health Sciences and Technology, University of Mons, Mons, Belgium (SS), and Department of Anaesthesiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands (ARA).
Background:
The brain is the primary target of general anaesthesia, yet routine brain monitoring remains underutilised. Although electroencephalography (EEG) is increasingly recognised as an important tool for assessing brain states during anaesthesia, inconsistent training and over-reliance on processed indices have hindered its adoption in clinical practice.
Objectives:
To define a set of core learning outcomes for EEG education in anaesthesiology through expert consensus, aiming to support the development of a structured, tiered curriculum for both basic and advanced EEG training.
Design:
Modified four-round Delphi study.
Setting:
Multinational, online Delphi panel involving 33 anaesthesiology experts across various academic and clinical institutions. The study was conducted between 29 May 2023 and 28 November 2024.
Participants:
Thirty-three international anaesthesiology experts with recognised experience in EEG use, teaching and/or research. Experts were purposively sampled to ensure diversity in geography, clinical background, subspecialty focus and broad spectrum of perspectives.
Interventions:
Not applicable.
Main Outcome Measures:
Consensus on learning outcomes, defined as at least 80% agreement (score of 9 or 10) on a 10-point Likert scale for Rounds 1 to 3, or at least 80% agreement for binary yes/no responses in Round 4.
Results:
Consensus was achieved for 58 out of 191 learning outcomes across both basic and advanced EEG training levels. Accepted items were grouped into dimensions, including EEG Fundamentals, Raw EEG, Anaesthetic Effects, Processed EEG, Artefacts, Nociception, Patient Variability, Integration with Anaesthetic Management, Clinical Immersion and Continuous Professional Learning. Foundational dimensions had higher agreement than advanced or emerging areas, such as neurofeedback or pharmacogenomics.
Conclusions:
This Delphi consensus defines a comprehensive framework of EEG learning outcomes for anaesthesiology education. The framework supports the development of structured curricula and reflects a growing need for EEG competence in anaesthesia practice to improve patient monitoring and safety. Further research is needed to validate the outcomes in educational and clinical settings.
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