A randomized controlled educational pilot trial of interictal epileptiform discharge identification for neurology residents

This study evaluated a technology-enhanced, retrieval-based program for teaching neurology residents to identify interictal epileptiform discharges (IEDs). Junior residents were randomized to rate 500 candidate IEDs with instant feedback on either a web browser (intervention 1) or an iOS app (intervention 2), or to an inactive control group. All participants completed pre- and post-training assessments. Twenty-one residents completed the study (control n=8; intervention 1 n=6; intervention 2 n=7), most without prior EEG experience. Intervention 1 produced significant improvements in AUC (.74->.85), sensitivity (.53->.75), and confidence (1.33->2.33; all p<.05). Intervention 2 improved AUC (.81->.86) and confidence in identifying IEDs and spike-wave discharges (2.00->3.14; p<.05). Controls showed no meaningful change. This program significantly improved IED identification, with web-based training producing the greatest objective gains. It may serve as an effective supplement to resident EEG education.