To determine whether the knowledge and experience derived from the completion of a neurology clerkship improves the ability of medical students to distinguish between different paroxysmal spell types.

Research has suggested that the accuracy of a witness in depicting paroxysmal spells is dependent upon one’s medical knowledge. While neurologists will see these patients most frequently, physicians in other fields will as well and must rely only on the knowledge they gained during their neurology clerkship to best manage such patients.

48 medical students (25 pre-clerkship, 23 post-clerkship) from a single center were asked to review 12 clinical histories and videos of patients admitted in the Epilepsy Monitoring Unit (EMU). They were asked to diagnose events as seizure, non-epileptic behavioral spell (NEBS) or another physiologic event. Additionally, they were asked to give a confidence score (1-5, 5 being the highest) regarding their diagnosis. Diagnostic accuracy and confidence were compared between pre- and post-clerkship groups.

Diagnostic accuracy based on clinical history for all paroxysmal spells for pre-clerkship and post-clerkship groups was 46% and 56%, respectively. This difference was statistically significant (P=.013). Diagnostic accuracy based on observation for all paroxysmal spells for pre-clerkship and post-clerkship groups was 51% and 58%, respectively. However, this difference was not statistically significant (P=.079). Additionally, Post-clerkship students were more confident in their diagnosis based on clinical history (2.75 vs. 2.21, P=.008) but not based on observation (2.46 vs. 2.15, P=.119). 

The neurology clerkship prepares medical students to diagnose paroxysmal spells based on clinical history but not based on observation of the event in question.

With physicians increasingly being shown videos of events taken by patients/family hoping that it will help with clinical decision making, the incorporation of video-based lectures of paroxysmal spells within the clerkship may better prepare future doctors in the assessment of patients with such ailments.