Clinical practice applicability and relevance to non-specialists of a paediatric EEG online learning tool.

BACKGROUND: Paediatric electroencephalography (EEG) training is inadequate amongst healthcare practitioners and technicians managing children with epilepsy in sub-Saharan Africa. An entry level handbook was developed for healthcare practitioners in sub-Saharan Africa and subsequently made globally accessible via the International Child Neurology Teaching Network. AIM: To investigate the usefulness of a paediatric online EEG handbook. METHOD: A survey of the ICNApedia online EEG handbook was circulated (December 2021-June 2022), to all 108 handbook registered participants (39 countries) via the research electronic data capture (REDCap) from the University of Cape Town (UCT). RESULTS: Fifty participants from 25 countries responded: 8 from high income, 16 upper-middle income, 21 lower-middle income and 5 from low-income. 32 (64%) fully and 18 (36%) partially completed the survey. 35/50 (70%) had completed the handbook and seven respondents had partially completed the handbook. Responses supported the handbook as a good entry point to learn EEGs, especially for paediatrics. Likert scale ratings supported the handbook as relevant for gaining/enhancing knowledge and improving diagnosis and management of patients with confidence. The handbook was considered user friendly, comprehensible, and provided a practical experience. For improving EEG reading skills the handbook helped skills development via reinforcement and good illustrations. 29/32 (90%) of respondents confirmed that they are using learnt skills from the handbook in their current work. CONCLUSION: In resource limited settings non-specialist clinicians often provide extended services including EEG interpretation. The survey supports that the handbook is supporting this niche skills area, especially for the accessibility of knowledge gained. The handbook will continue to be adapted in-line with survey feedback.

Evaluation of EEG training curricula for non-specialist clinicians: a systematic qualitative review.

OBJECTIVE: Neurologists and epileptologists are scarce in sub-Saharan Africa (SSA). Whilst electroencephalograms (EEGs) are becoming more available in the region, interpretation is typically undertaken by non-specialist clinicians with limited or no training. This is a systematic review of the peer-reviewed literature on EEG training of non-specialist clinicians worldwide, assessing the efficacy of the training methodology and the curricula content. METHODS: The published literature was searched for papers relating to EEG training of non-specialist clinicians worldwide (1/01/1989-30/06/2020). All regions of the world were included and assessed for content on efficacy of curricula and potential adaptability or applicability to resource-poor settings. The grey literature was searched using ProQuest and Primo databases and references from review articles. The websites of the International League Against Epilepsy, International Federation of Clinical Neurophysiologist, American Academy of Neurology and World Federation of Neurology were reviewed for reports (non-peer reviewed) which described roll-out and impact of novel EEG training curricula. RESULTS: There was limited data. From 2,613 articles, 15 complied with the study question. Ten studies were performed on cross-speciality clinicians, four on neurology registrars and one on a combination of healthcare workers. There was diversity of curricula models used. The studies themselves lacked consistency and directness. A few training programs were trialled in low-middle-income countries (LMICs) and paediatric training was included in only two. An ideal training curriculum was not evident nor evaluated for resource-poor settings. However, diverse teaching models were reported and set the foundations for further development of EEG training curricula for non-specialist clinicians. SIGNIFICANCE: There is a lack of access to education in EEG training and interpretation for non-specialist clinicians in LMICs. Existing models need to be expanded or adapted and evaluated for this population group.

Understanding the landscape of electrophysiology services for children in sub-Saharan Africa.

Incidence of epilepsy is greatest in infancy and childhood; this is especially evident in sub-Saharan Africa (SSA). The aim of this study was to understand access to electrophysiology services in SSA including which health practitioner performs and interprets paediatric electroencephalogram (EEG) studies as well as their training in paediatric EEG. A web-based survey was sent to a cohort of health care practitioners who manage children with epilepsy in SSA. The questions addressed whether EEG was available to these health care practitioners, how the practitioners accessed EEG and who assisted interpretation of the study results. The survey was circulated (June-December 2019) to 305 participants from 32 African countries. A total of 73 (16 partial and 57 complete) surveys were returned from 18 countries. The respondents fell into two main categories: those with access to an EEG machine (44/73; 60%) and those without access to an EEG machine (29/73; 40%). For 32% (23/73), there was no dedicated technician and for 34% (25/73) no neurologist. Access to a neurologist resulted in the highest proportion of EEGs performed per annum. Of the respondents, 77% (56/73) agreed that there was a need for a paediatric apprenticeship in EEG skills. Qualitative data to justify need for paediatric EEG training was grouped into three themes: (1) "professional development"; (2) "better care"; and (3) "help paediatric patients and neurologists". There is a lack of paediatric EEG training amongst doctors and technicians working with epilepsy in SSA. Expanding training beyond current capacity in SSA, for technicians and practitioners involved in EEG, is necessary.

Towards a pedagogical model of teaching with ICTs for mathematics attainment in primary school: A review of studies 2008-2018.

This article reviews literature in the field of ICTs in teaching/learning mathematics at an elementary school level. The findings to date in the field of teaching with technology in mathematics classrooms are very conflictual, with some studies indicating that ICTs impact positively on achievement through altering pedagogy, while other studies indicate that the effect on achievement and pedagogy is in fact negative. The current paper seeks to address the conflictual data by analysing a variety of meta-analyses and studies in order to answer the following questions: Does pedagogy alter with the use of ICTs in grade 6 mathematics classrooms and if so, in what ways does it vary? Secondly, does student achievement in mathematics change with the use of ICTs as teaching tools and if so, in what ways does it do so? Findings from the review indicate that student achievement in mathematics can be positively impacted using technology, depending on the pedagogical practices used by teachers. Technology on its own appears to have no significant impact on student's attainment. There is a dearth of findings regarding pedagogical variation with ICTs outside of a single meta-analysis that indicates that a 'constructivist' approach to teaching/learning with technology is the most effective approach to developing students' conceptually. Due to this gap in the literature, the paper outlines a theoretical framework for providing a nuanced study of pedagogical variation with ICTs drawing on Cultural Historical Activity Theory and TPACK that can track pedagogical change along various dimensions.