Epilepsy Milestones 2.0 - An Updated Framework for Assessing Epilepsy Fellowships and Fellows

OBJECTIVE

Accreditation Council for Graduate Medical Education (ACGME) accredited Epilepsy Fellowships like other ACGME accredited training programs use Milestones to establish learning objectives and to evaluate how well trainees are achieving these goals. The ACGME began developing the second iteration of the Milestones six years ago, which are now being adapted to all specialties. Here we describe the process by which Epilepsy Milestones 2.0 were developed and summarize them.

METHODS

A work group of nine board certified, adult and pediatric epileptologists reviewed Epilepsy Milestones 1.0 and revised them using a modified Delphi approach.

RESULTS

The new Milestones share structural changes with all other specialties including a clearer stepwise progression in professional development and the harmonized Milestones that address competencies common to all medical fields. Much of the Epilepsy specific content remains the same, though a major addition is a set of Milestones focused on reading and interpreting electroencephalograms (EEGs), which the old Milestones lacked. Epilepsy Milestones 2.0 includes a Supplemental Guide to help Program Directors implement the new Milestones. Together, Epilepsy Milestones 2.0 and the Supplemental Guide recognize advances in epilepsy including stereo EEG, neurostimulation, genetics, and safety in Epilepsy Monitoring Units.

SIGNIFICANCE

Epilepsy Milestones 2.0 address the shortcomings of the old Milestones and should facilitate the assessment of Epilepsy Fellowships and fellows by Program Directors, faculty, and fellows themselves.

Measurement of the penetration of 56 cosmetic relevant chemicals into and through human skin using a standardized protocol

OECD test guideline 428 compliant protocol using human skin was used to test the penetration of 56 cosmetic‐relevant chemicals. The penetration of finite doses (10 μL/cm²) of chemicals was measured over 24 hours. The dermal delivery (DD) (amount in the epidermis, dermis and receptor fluid [RF]) ranged between 0.03 ± 0.02 and 72.61 ± 8.89 μg/cm². The DD of seven chemicals was comparable with in vivo values. The DD was mainly accounted for by the amount in the RF, although there were some exceptions, particularly of low DD chemicals. While there was some variability due to cell outliers and donor variation, the overall reproducibility was very good. As six chemicals had to be applied in 100% ethanol due to low aqueous solubility, we compared the penetration of four chemicals with similar physicochemical properties applied in ethanol and phosphate‐buffered saline. Of these, the DD of hydrocortisone was the same in both solvents, while the DD of propylparaben, geraniol and benzophenone was lower in ethanol. Some chemicals displayed an infinite dose kinetic profile; whereas, the cumulative absorption of others into the RF reflected the finite dosing profile, possibly due to chemical volatility, total absorption, chemical precipitation through vehicle evaporation or protein binding (or a combination of these). These investigations provide a substantial and consistent set of skin penetration data that can help improve the understanding of skin penetration, as well as improve the prediction capacity of in silico skin penetration models.

The penetration of 56 chemicals was tested in human skin using a standard protocol. Dermal delivery correlated with the amount in the receptor fluid (RF). The impact of solvent on penetration was evaluated. Despite finite doses being applied, different profiles of cumulative absorption kinetics into the RF were observed. These data may help understand skin penetration and improve the prediction capacity of in silico skin penetration models.