Attending surprised I want to do neurophys-EEG fellowship because I'm not a "natural" at reading EEGs

[IonClaws]

As the title states. I want to do additional training in CNP, mostly with an EEG focus, after residency, and my attending was surprised since I seemed more "left-brained" when looking at EEGs and haven't really gotten to the "right-brain" aspect of it. Like I work hard at reading the EEGs but it doesn't seem like I really "get it" as she has seen some other residents get them.

This is mostly based on how I look at the EEGs (i.e. always going through a stepwise process: how's the organization, how's the voltage, look if there's a PDR, if so what's the RRF, if not then where's the dominant rhythm, does one side have more low frequencies than the other and if so is it everywhere or just in 1-2 spots, etc...). I can notice if there's a blatant asymmetry between hemispheres but I'm not sure what to call them right away because some normal variants can look like abnormalities if I don't think of them in the correct context, so I'm very careful when calling things abnormal.

Overall this strikes me as something odd to say for multiple reasons...
1. I have no idea how anyone, let alone a beginner, can make a relatively objective assessment of any study without going through a logical process to sort out the noise and normal stuff from the abnormal stuff, ESPECIALLY with something that has as much noise as EEG;
2. My attending has over 100,000 reads, whereas I have maybe 100 or so (thus far);
3. I think that faster assessments could be made if someone has had lots more reads under their belt, and maybe that's what my attending isn't seeing.

Anyway, just wanted to share an experience. I don't think I'd let it push my desire for fellowship out the window necessarily, I just think it's not a fair assessment.

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[Telamir]

That's 100% BS. No one is a "natural" at reading EEGs. What does she mean by "left brained" anyway?

Having done exactly that fellowship my advice is to keep doing what you're doing. You want to take a step-wise approach when you are starting to read. From my own personal experience when I first started I was too "analytical". I'd get lost in the trees and not see the forest. What I'd recommend is when you first open an EEG pay close attention to the first few pages to "get to know the patient's brainwaves". Patients are typically awake during those times and you can most easily establish a PDR. Then scroll through the first few pages and look for signs of any obvious slowing.

Once you've established this start scrolling a little faster. At this point you're concerned mostly about the changes; you're "reading the Matrix". You should be able to say in your head "blink, eye movement artifact, myogenic artifact....drowsy...sleepy...N1/2" etc. Remember once you get to drowsiness/sleep is when all the interesting benign variants start coming out. When something jumps out at you slow down and try to think if it could be a benign variant. Wicket waves/spikes can be particularly challenging. Keep an eye out for asymmetric vertex waves. Also worth noting these are the stages in which epileptiform discharges start coming out so it's worth keeping in mind.

Three main montages you will use for basically everything is a longitudinal bipolar, vertex reference, and ear reference. Remember if you're going to use a reference to choose one farthest away from where the wave in question is, otherwise you'll blunt it.

One last tip and perhaps the greatest my mentors ever gave me: Call it normal until you can't. It's best to be an under-caller than an over-caller by far. Remember epilepsy/seizures are ultimately a clinical diagnosis. If you call an EEG normal on someone that has epilepsy/seizures they will eventually have another event and will be diagnosed. If you call a normal EEG abnormal you will put someone without seizures on medication and an "abnormal EEG" is VERY complicated to "reverse".

 

[Postictal Raiden]

That's 100% BS. No one is a "natural" at reading EEGs. What does she mean by "left brained" anyway?

Having done exactly that fellowship my advice is to keep doing what you're doing. You want to take a step-wise approach when you are starting to read. From my own personal experience when I first started I was too "analytical". I'd get lost in the trees and not see the forest. What I'd recommend is when you first open an EEG pay close attention to the first few pages to "get to know the patient's brainwaves". Patients are typically awake during those times and you can most easily establish a PDR. Then scroll through the first few pages and look for signs of any obvious slowing.

Once you've established this start scrolling a little faster. At this point you're concerned mostly about the changes; you're "reading the Matrix". You should be able to say in your head "blink, eye movement artifact, myogenic artifact....drowsy...sleepy...N1/2" etc. Remember once you get to drowsiness/sleep is when all the interesting benign variants start coming out. When something jumps out at you slow down and try to think if it could be a benign variant. Wicket waves/spikes can be particularly challenging. Keep an eye out for asymmetric vertex waves. Also worth noting these are the stages in which epileptiform discharges start coming out so it's worth keeping in mind.

Three main montages you will use for basically everything is a longitudinal bipolar, vertex reference, and ear reference. Remember if you're going to use a reference to choose one farthest away from where the wave in question is, otherwise you'll blunt it.

One last tip and perhaps the greatest my mentors ever gave me: Call it normal until you can't. It's best to be an under-caller than an over-caller by far. Remember epilepsy/seizures are ultimately a clinical diagnosis. If you call an EEG normal on someone that has epilepsy/seizures they will eventually have another event and will be diagnosed. If you call a normal EEG abnormal you will put someone without seizures on medication and an "abnormal EEG" is VERY complicated to "reverse".

Pure gold, thank you.

 

[Thama]

It sounds like that attending was doing a magic eye puzzle rather than reading EEGs.

 

[neglect]

That's 100% BS. No one is a "natural" at reading EEGs. What does she mean by "left brained" anyway?

Having done exactly that fellowship my advice is to keep doing what you're doing. You want to take a step-wise approach when you are starting to read. From my own personal experience when I first started I was too "analytical". I'd get lost in the trees and not see the forest. What I'd recommend is when you first open an EEG pay close attention to the first few pages to "get to know the patient's brainwaves". Patients are typically awake during those times and you can most easily establish a PDR. Then scroll through the first few pages and look for signs of any obvious slowing.

Once you've established this start scrolling a little faster. At this point you're concerned mostly about the changes; you're "reading the Matrix". You should be able to say in your head "blink, eye movement artifact, myogenic artifact....drowsy...sleepy...N1/2" etc. Remember once you get to drowsiness/sleep is when all the interesting benign variants start coming out. When something jumps out at you slow down and try to think if it could be a benign variant. Wicket waves/spikes can be particularly challenging. Keep an eye out for asymmetric vertex waves. Also worth noting these are the stages in which epileptiform discharges start coming out so it's worth keeping in mind.

Three main montages you will use for basically everything is a longitudinal bipolar, vertex reference, and ear reference. Remember if you're going to use a reference to choose one farthest away from where the wave in question is, otherwise you'll blunt it.

One last tip and perhaps the greatest my mentors ever gave me: Call it normal until you can't. It's best to be an under-caller than an over-caller by far. Remember epilepsy/seizures are ultimately a clinical diagnosis. If you call an EEG normal on someone that has epilepsy/seizures they will eventually have another event and will be diagnosed. If you call a normal EEG abnormal you will put someone without seizures on medication and an "abnormal EEG" is VERY complicated to "reverse".

Wouldn't be the first to overcall and overthink:

Frederic Andrews Gibbs and the Assassination of John Fitzgerald Kennedy

Frederic Gibbs, the peerless expert on electroencephalogrphy was summoned to provide opinion on the EEG tracing of Jack Ruby, who murdered Lee Harvey Oswald, the assassin of John Fitzgerald Kennedy, the American President, in 1963. Gibbs pleaded that ...

www.ncbi.nlm.nih.gov