Consensus document on electroencephalography education in anaesthesiology: defining learning outcomes: A modified four-round Delphi study

Abstract

BACKGROUND – The brain is the primary target of general anaesthesia, yet routine brain monitoring remains underutilised. Although electroencephalography (EEG) is increasingly recognised as an important tool for assessing brain states during anaesthesia, inconsistent training and over-reliance on processed indices have hindered its adoption in clinical practice. OBJECTIVE(S) – To define a set of core learning outcomes for EEG education in anaesthesiology through expert consensus, aiming to support the development of a structured, tiered curriculum for both basic and advanced EEG training. DESIGN – Modified four-round Delphi study. SETTING – Multinational, online Delphi panel involving 33 anaesthesiology experts across various academic and clinical institutions. The study was conducted between 29 May 2023 and 28 November 2024. PARTICIPANTS – Thirty-three international anaesthesiology experts with recognised experience in EEG use, teaching and/or research. Experts were purposively sampled to ensure diversity in geography, clinical background, subspecialty focus and broad spectrum of perspectives. INTERVENTION(S) – Not applicable. MAIN OUTCOME MEASURES – Consensus on learning outcomes, defined as at least 80% agreement (score of 9 or 10) on a 10-point Likert scale for Rounds 1 to 3, or at least 80% agreement for binary yes/no responses in Round 4. RESULTS – Consensus was achieved for 58 out of 191 learning outcomes across both basic and advanced EEG training levels. Accepted items were grouped into dimensions, including EEG Fundamentals, Raw EEG, Anaesthetic Effects, Processed EEG, Artefacts, Nociception, Patient Variability, Integration with Anaesthetic Management, Clinical Immersion and Continuous Professional Learning. Foundational dimensions had higher agreement than advanced or emerging areas, such as neurofeedback or pharmacogenomics. CONCLUSIONS – This Delphi consensus defines a comprehensive framework of EEG learning outcomes for anaesthesiology education. The framework supports the development of structured curricula and reflects a growing need for EEG competence in anaesthesia practice to improve patient monitoring and safety. Further research is needed to validate the outcomes in educational and clinical settings. TRIAL REGISTRATION – Not applicable.