Training activity information
Details
Obtain and document a history from patients attending for the following evoked potentials studies:
- Visual
- Auditory
- Somato-sensory
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 obtaining and documenting a relevant clinical history for multi-modality evoked potential studies.
- Consider how the learning outcomes apply, specifically in relation to obtaining a clinical history 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 historical details that are most relevant for each type of evoked potential study (VEP, AEP, SSEP).
What is your prior experience of this activity?
- Think about what you already know about taking patient histories, particularly for neurological or sensory complaints.
- Consider possible challenges you might face during the activity, such as eliciting specific historical details relevant to central neurological or sensory pathways e.g., retrochiasmal lesions, brainstem pathology.
- 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’s history suggests a rare or complex central nervous system disorder that requires specialist knowledge to interpret.
- Acknowledge how you feel about taking histories for patients with potentially complex sensory or neurological issues.
What do you anticipate you will learn from the experience?
- Consider the specific skills you want to develop, such as conducting targeted clinical interviews for specific neurophysiological tests, focusing on symptoms related to the neural pathways being tested.
- Identify the specific insights you hope to gain into how patient history informs the interpretation and performance of VEP, AEP, and SSEP tests.
What additional considerations do you need to make?
- Consult actions identified following previous experiences of patient history taking.
- Identify important information you need to consider before embarking on the activity, such as reviewing the referral information and understanding the common clinical uses and associated conditions for VEP, AEP, and SSEP.
In action
Is anything unexpected occurring?
- Are you noticing anything surprising or different from what you anticipate whilst obtaining the patient history for evoked potential studies?
- Are you encountering situations such as:
-
- The patient reports unexpected or confusing sensory symptoms e.g., transient visual disturbances for VEP or unilateral hearing loss for AEP that require focused investigation to understand the clinical context
-
- The history suggests complex central nervous system pathology e.g., possible demyelination or specific brainstem lesion that was not fully anticipated by the referral, complicating the history documentation
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- You realise the required pre-test measures e.g., visual acuity or hearing threshold are significantly outside normal limits, requiring immediate adjustment to the history questions
How are you reacting to the unexpected development?
- How is this impacting your actions? For example, are you responding to the situation appropriately? Did you adapt or change your approach to asking questions or documenting the information?
- Consider the steps you are taking in the moment, such as:
-
- Immediately adjusting the focus of the interview to concentrate on specific symptoms relevant to the suspected central pathway pathology e.g., visual field cuts for VEP
-
- Pausing documentation to ensure precise, detailed recording of the complex symptoms, recognising their importance for eventual report interpretation
- How are you feeling in that moment? For instance, are you finding it difficult to adapt your history-taking to focus on central nervous system symptoms? Is it affecting your confidence in obtaining a comprehensive history for multi-modality EP tests?
What is the conclusion or outcome?
- Identify how you are working within your scope of practice. For example, are you successfully documenting the complex history using structured questioning and identifying relevant pre-test measures? Or are you needing support because the patient’s presentation is indicative of a rare or highly complex central neurological condition requiring immediate specialist input on the appropriate history focus?
- What are you learning as a result of the unexpected development? For example, are you mastering a more effective strategy for eliciting specific symptoms relevant to central nervous system disorders? Or gaining insight into the wide array of pathologies evaluated by evoked potentials?
On action
What happened?
- Begin by summarising the key steps you took when obtaining and documenting the clinical history for VEP, AEP, and SSEP patients.
- Consider specific events, actions, or interactions which felt important, such as how you inquired about visual acuity for VEP or how you tailored history questions to identify central nervous system pathology relevant to AEP or SSEP.
- Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, immediately redirecting the conversation to focus on subtle symptoms related to retrochiasmal lesions when the initial history was vague, ensuring a relevant history was obtained.
- How did you feel during this experience, e.g., did you feel focused on eliciting necessary neurological details or challenged by the patient’s confusion regarding symptoms?
How has this experience contributed to your developing practice?
- Identify what learning you can take from this experience regarding history taking for EP studies. What strengths did you demonstrate, e.g., ability to obtain a history relevant to multiple sensory pathways? What skills and/or knowledge gaps were evident, e.g., difficulty in confidently assessing the relevance of specific pre-test measures e.g., auditory threshold?
- Compare this experience against previous engagement with similar activities – were any previously identified actions for development achieved? Has your practice improved in documenting complex symptoms related to central nervous system pathology?
- Identify any challenges you experienced, such as needing to seek advice or clarification on scope of practice regarding how to document a history that potentially suggests non-organic visual loss, 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 and documenting a relevant clinical history for evoked potential studies.
- What will you do differently next time you approach history taking for EP studies, for instance, by proactively reviewing the pathophysiology of key EP-related conditions e.g., multiple sclerosis to guide question selection?
- Do you need to practise any aspect of the activity further, such as eliciting historical details relevant to central demyelination or key learning outcomes related to obtaining a clinical history?
Beyond action
Have you revisited the experiences?
- How have your subsequent experiences of obtaining and documenting a history for evoked potentials studies 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 attending for a visual evoked potentials presented with complex, non-organic visual loss forced you to re-evaluate the necessary depth of history taking regarding visual acuity and symptom timeline you applied during your first attempt at this training activity.
- Considering what you understand about pathophysiology of demyelinating disease, key factors affecting evoked potentials results (e.g., age, medication), and the necessity of accurate pre-test measures 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 evoked potentials history taking and documentation process based on further learning and experiences? For example, how you proactively incorporated specific questions about patient compliance or attention span (factors affecting evoked potentials recording quality) into your standard history template, demonstrating you have adapted improvements based on further learning.
- Has discussing cases where critical history details (e.g., medication list) were missing or the impact of poor history on evoked potentials interpretation 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 an auditory evoked potentials result affected by ototoxic medication refined your understanding of the critical nature of comprehensive pharmaceutical history capture before testing.
How have these experiences impacted upon current practice?
- How has the learning from this initial training activity, in combination with subsequent evoked potentials history taking experiences, contributed to your overall confidence and competence in obtaining and documenting patient history for visual, auditory, and somato-sensory evoked potentials studies, particularly in preparing for assessments like DOPS or OCEs? For example, how your accumulated ability in eliciting critical, relevant details regarding symptoms and non-pathological effects now enables you to confidently structure a clinical history during an OCE assessment focusing on obtaining patient history.
- How has reflecting back on this specific training activity, combined with everything you’ve learned since, shaped your current approach to history taking for evoked potentials? 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 Referring Clinician or Senior Pathologist immediately when a patient’s history suggests a rapidly progressing neurological deficit that requires urgent investigation prioritisation, recognising this falls outside routine history documentation scope.
- Looking holistically at your training journey, how has these initial evoked potentials history taking experience, revisited with your current perspective, contributed to your development in meeting the learning outcomes related to obtaining a clinical history 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 performing pre-test measures (e.g., auditory threshold).
Relevant learning outcomes
| # | Outcome |
|---|---|
| # 3 |
Outcome
Obtain a clinical history from patients attending an upper limb nerve conduction study and a multi-modality evoked potential studies. |
| # 9 |
Outcome
Demonstrate effective and compassionate communication skills with all stakeholder including patients and the multidisciplinary team. |