title: How do doctors in training react to seizures?
abstract: OBJECTIVE
  There are scant data on how doctors approach seizures in the acute setting. We sought to study (a) exposure to seizure disorders as well as relevant training and (b) reactions to seizures in the acute setting, among medical residents undergoing physician training.
  
  
  METHODS
  The exposure to and training on seizure disorders were assessed using a structured questionnaire first. Then, they were tested with 20 videos consisting of 10 epileptic seizures (ESs) and 10 psychogenic nonepileptic seizures (PNESs). After each video, we asked three questions to test (a) the diagnosis and the practice of administration of benzodiazepines to terminate the seizure, (b) the estimation of seizure duration, and (c) the practice of intubation. The accuracy of diagnosis was measured by the area under the summary receiver operating characteristics curve (AUC). The difference between true seizure duration and estimated duration was evaluated using paired-sample t-test.
  
  
  RESULTS
  A total of 48 trainees participated in the study. The majority witnessed seizures in movies (37, 77.1%) and television (35, 72.9%). Only 12 (25%) received bedside teaching on seizure disorders. Their diagnostic accuracy of seizures was very poor (AUC=0.54). Participants significantly underestimated the duration of seizures. Thirty-five doctors made an illogical decision to intubate but not to terminate the seizure with intravenous benzodiazepine.
  
  
  CONCLUSIONS
  The diagnostic accuracy of seizures is poor among trainees, and their estimates of seizure duration are unreliable. Our study highlights potential pitfalls in the acute management of seizures and the need for more training on seizure disorders.
authors.affiliation: Department of Neurosciences, Monash Health, Monash Medical Centre, Melbourne, Australia; Department of Medicine, Monash University, Melbourne, Australia. Electronic address: udaya.seneviratne@monash.edu.
authors.forename: Udaya
authors.initials: U
authors.lastname: Seneviratne
authors.affiliation: Department of Neurosciences, Monash Health, Monash Medical Centre, Melbourne, Australia; Department of Medicine, Monash University, Melbourne, Australia. Electronic address: henry.ma@monashhealth.org.
authors.forename: Henry
authors.initials: H
authors.lastname: Ma
authors.affiliation: Department of Neurosciences, Monash Health, Monash Medical Centre, Melbourne, Australia; Department of Medicine, Monash University, Melbourne, Australia. Electronic address: thanh.phan@monash.edu.
authors.forename: Thanh G
authors.initials: TG
authors.lastname: Phan
mesh_terms: D000328:Adult; D001569:Benzodiazepines / Q000627:therapeutic use; D003430:Cross-Sectional Studies; D003951:Diagnostic Errors / Q000517:prevention & control*; D019468:Disease Management; D004569:Electroencephalography / Q000379:methods; D005260:Female; D006801:Humans; D007396:Internship and Residency / Q000379:methods* / Q000592:standards; D008297:Male; D010820:Physicians / Q000592:standards*; D012640:Seizures / Q000175:diagnosis* / Q000523:psychology / Q000628:therapy*; D011795:Surveys and Questionnaires
chemical_list: D001569:Benzodiazepines
keywords: Acute treatment of seizures; Epilepsy semiology; Medical education; Movies; Neurophobia; Television; Video-EEG use in epilepsy