Education Research: Defining Competencies and Consensus in Canadian Epilepsy Fellowship Training: A Thematic Discourse Analysis of Expert Perspectives.

Background and objectives: Epilepsy fellowship training in Canada is heterogeneous in program length, extent of electroencephalography (EEG) training, and exposure to transitional and surgical care. This study aimed to develop a national framework for epilepsy fellowship curricula by analyzing expert consensus within the Canadian League Against Epilepsy (CLAE) through thematic discourse analysis.

Methods: We conducted a qualitative thematic discourse analysis of recorded CLAE expert panel meetings with 22 participants, including fellowship program directors and faculty educators. Discussions addressed core competencies, assessment practices, program duration, transition training, and advanced care. Transcripts were analyzed to identify recurrent discursive patterns and areas of alignment and tension.

Results: Six interrelated themes were identified, emphasizing early mastery of foundational competencies, a staged introduction of advanced skills, hybrid time-and-competency structures, the formative use of EEG examinations, flexible transition and surgical exposure pathways, and guidance rather than governance. Participants negotiated national coherence while preserving institutional flexibility.

Discussion: The findings support early acquisition of core competencies, context-sensitive advanced training, and formative assessment guided by competency-based medical education and sociocultural learning principles. This framework balances standardization with institutional flexibility to improve patient safety, trainee preparedness, and equitable access across Canadian programs.