Nerve Conduction Studies & Evoked Potentials 1 —
Training activity: 3

Details

Obtain informed consent for upper limb nerve conduction studies and inform patients of results dissemination

Type

Entrustable training activity (ETA)

Evidence requirements

Evidence the activity has been undertaken by the trainee repeatedly, consistently, and effectively over time, in a range of situations. This may include occasions where the trainee has not successfully achieved the outcome of the activity themselves. For example, because it was not appropriate to undertake the task in the circumstances or the trainees recognised their own limitations and sought help or advice to ensure the activity reached an appropriate conclusion. ​

Reflection at multiple timepoints on the trainee learning journey for this activity.

Reflective practice guidance

The guidance below is provided to support reflection at different time points, providing you with questions to aid you to reflect for this training activity. They are provided for guidance and should not be considered as a mandatory checklist. Trainees should not be expected to provide answers to each of the guidance questions listed.

Before action

What does success look like? 

• Identify what is expected of you in relation to effectively explaining the procedure to obtain informed consent. 

• Consider how the learning outcomes apply, specifically in relation to explaining procedures to patients in order to obtain informed consent and demonstrating effective and compassionate communication skills. 

• Discuss with your training officer to gain clarity of what is expected of you in relation to the specific information that must be included in the consent discussion and the procedure for documenting consent. 

What is your prior experience of this activity? 

• Think about what you already know about explaining medical procedures or obtaining consent, especially for neurophysiological tests. 

• Consider possible challenges you might face during the activity, such as explaining complex information clearly, ensuring patient understanding, or addressing patient concerns about electrical stimulation. 

• Recognise the scope of your own practice for this activity i.e. know when you will need to seek advice or help, and from whom. You will need to seek advice from your Training Officer when required, for example if the patient requires an alternative procedure due to allergies or inability to consent, necessitating discussion of alternatives outside standard protocol. 

• Acknowledge how you feel about the responsibility of obtaining informed consent and discussing sensitive information like test results. 

What do you anticipate you will learn from the experience? 

• Consider the specific skills you want to develop, such as explaining the nature of NCS and the consent process effectively to diverse patients. 

• Identify the specific insights you hope to gain into patient concerns or questions that commonly arise during the consent process for NCS. 

What additional considerations do you need to make? 

• Consult actions identified following previous experiences of obtaining consent or explaining procedures. 

• Identify important information you need to consider before embarking on the activity, such as knowing the specific NCS procedure to be performed, potential side effects, and the standard pathway for results dissemination. 

In action

Is anything unexpected occurring? 

• Are you noticing anything surprising or different from what you anticipate whilst explaining the procedure to obtain consent or discussing results dissemination? 

• Are you encountering situations such as:  

• • The patient expresses unexpected high anxiety or fear regarding the electrical stimulation used in the NCS, challenging the standard explanation 

• • The patient raises complex questions regarding the potential risks or subsequent results dissemination pathway that require detailed explanation beyond the standard script 

• • A language barrier or comprehension difficulty makes it challenging to confirm that informed consent has truly been obtained 

How are you reacting to the unexpected development? 

• How is this impacting your actions? For example, are you responding to the situation appropriately? Are you adapting or changing your approach to explaining the information or addressing patient concerns? 

• Consider the steps you are taking in the moment, such as:  

• • Immediately adjusting your communication style to employ simplified language or visual aids to alleviate patient anxiety about the procedure 

• • Pausing the consent process to seek immediate guidance on using interpreting services or alternative communication aids to ensure valid consent is obtained 

• How are you feeling in that moment? For instance, are you finding it difficult to adapt the complexity of the explanation while maintaining clear communication? Is it affecting your confidence in ensuring the patient is truly informed? 

What is the conclusion or outcome? 

• Identify how you are working within your scope of practice. For example, are you successfully resolving patient anxiety by providing appropriate reassurance and simplifying the explanation of risks and results dissemination? Or are you needing support because a serious communication barrier or complex legal question requires input from your Training Officer? 

• What are you learning as a result of the unexpected development? For example, are you mastering a more effective strategy for addressing common patient fears about NCS? Or gaining insight into the legal requirements for documenting informed consent in challenging circumstances? 

On action

What happened? 

• Begin by summarising the key steps you took when explaining the upper limb nerve conduction study and obtaining informed consent. 

• Consider specific events, actions, or interactions which felt important, such as how you addressed the patient’s concerns regarding electrical stimulation or how clearly you outlined the results dissemination pathway. 

• Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, immediately adjusting your explanation when the patient expressed unexpected high anxiety about the procedure, to ensure compassionate communication.  

• How did you feel during this experience, e.g., did you feel confident in adapting your communication style or challenged by the need to manage patient emotion? 

How has this experience contributed to your developing practice? 

• Identify what learning you can take from this experience regarding consent. What strengths did you demonstrate, e.g., ability to clearly explain technical procedures? What skills and/or knowledge gaps were evident, e.g., difficulty in precisely communicating the timeline for results dissemination? 

• Compare this experience against previous engagement with similar activities – were any previously identified actions for development achieved? Has your practice improved in confirming patient comprehension of the risks and benefits of NCS? 

• Identify any challenges you experienced, such as needing to seek advice or clarification on scope of practice regarding the required documentation if a patient provided verbal, but not written, consent (if applicable), and how you reacted to this. 

What will you take from the experience moving forward? 

• Identify the actions or ‘next steps’ you will now take to support the assimilation of what you have learnt, including from any feedback you have received, with regards to obtaining informed consent and managing patient expectations regarding results dissemination. 

• What will you do differently next time you approach obtaining consent, for instance, by proactively using visual aids to explain the mild sensation of electrical stimulation? 

• Do you need to practise any aspect of the activity further, such as reviewing communication scripts for managing anxious patients or key learning outcomes related to explaining procedures and communicating compassionately? 

Beyond action

Have you revisited the experiences? 

• How have your subsequent experiences of obtaining informed consent and discussing results dissemination pathways since completing this specific training activity led you to revisit your initial approach or decisions during that activity? For example, how an instance where a subsequent patient required detailed explanation of risk due to specific cultural beliefs or language barriers forced you to re-evaluate the clarity and comprehensibility of your consent discussion during your first attempt at this training activity. 

• Considering what you understand about medical ethics, capacity to consent, and compassionate communication now, were the actions or considerations you identified after your initial reflection on this training activity sufficient? How have you since implemented or adapted improvements in your consent process and patient information delivery based on further learning and experiences? For example, how you proactively implemented a standardised ‘teach-back’ method to ensure the patient understood how their results would be communicated to their consultant, demonstrating you have adapted improvements based on further learning. 

• Has discussing challenging consent scenarios (e.g., patient declining part of the test) or the impact of communication failure on patient confidence with colleagues, peers, or supervisors changed how you now view your initial experience in this training activity? For example, how professional storytelling with a senior colleague about a formal complaint regarding poor explanation of results turnaround time refined your understanding of the critical nature of transparent communication regarding administrative processes during the consent stage. 

How have these experiences impacted upon current practice? 

• How has the learning from this initial training activity, in combination with subsequent consent and patient information delivery experiences, contributed to your overall confidence and competence in explaining procedures and obtaining informed consent, particularly in preparing for assessments like DOPS or OCEs? For example, how your accumulated ability in simplifying complex neurological concepts now enables you to perform a thorough explanation of procedure and obtain informed consent during an OCE assessment. 

• How has reflecting back on this specific training activity, combined with everything you’ve learned since, shaped your current approach to obtaining informed consent for nerve conduction studies? How does this evolved understanding help you identify when something is beyond your scope of practice or requires escalation? For example, how your evolved approach means you now routinely seek advice from the Training Officer or Clinical Governance Lead immediately when a patient expresses significant confusion about their capacity to consent or requires a complex legal interpretation, recognising this falls outside routine consent scope. 

• Looking holistically at your training journey, how has this initial consent and results dissemination experience, revisited with your current perspective, contributed to your development in meeting the learning outcomes related to explaining procedures to patients, obtaining informed consent, and demonstrating effective communication skills? For example, how this foundational experience has supported your development in practicing safely by providing the necessary knowledge base for the subsequent learning outcomes focused on ethical data handling and professional reporting.

Relevant learning outcomes

#	Outcome
# 4	Outcome Explain procedures to patients in order to obtain informed consent for upper limb nerve conduction studies and multi-modality evoked potential studies.
# 9	Outcome Demonstrate effective and compassionate communication skills with all stakeholder including patients and the multidisciplinary team.