Nerve Conduction Studies & Evoked Potentials 1 —
Training activity: 8

Details

Explain and obtain consent for evoked potential tests, including:

• 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 explaining the procedures and obtaining informed consent for VEP, AEP, and SSEP. 

• Consider how the learning outcomes apply, specifically in relation to explaining procedures to patients in order to obtain informed consent for multi-modality evoked potential studies. 

• Discuss with your training officer to gain clarity of what is expected of you in relation to the necessary details for explaining VEP, AEP, and SSEP procedures, including stimuli used and patient requirements (e.g., visual acuity checks for VEP, auditory threshold for AEP). 

What is your prior experience of this activity? 

• Think about what you already know about explaining medical tests or obtaining consent. 

• Consider possible challenges you might face during the activity, such as explaining complex sensory stimuli or ensuring patient cooperation during the test. 

• 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 expresses significant anxiety about the test or presents with a language barrier that requires specific communication support. 

• Acknowledge how you feel about obtaining consent for tests that might require patient cooperation with specific sensory tasks. 

What do you anticipate you will learn from the experience? 

• Consider the specific skills you want to develop, such as explaining the distinct aspects of VEP, AEP, and SSEP procedures clearly. 

• Identify the specific insights you hope to gain regarding common patient questions or concerns about sensory-based evoked potential tests. 

What additional considerations do you need to make? 

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

• Identify important information you need to consider before embarking on the activity, such as understanding the specific stimuli and patient tasks required for each modality and potential non-pathological effects that might influence the test. 

In action

Is anything unexpected occurring? 

• Are you noticing anything surprising or different from what you anticipate whilst explaining the procedure to obtain consent for evoked potential tests? 

• Are you encountering situations such as:  

• The patient expresses confusion or reluctance regarding the specific sensory requirement of one test e.g., maintaining fixation for VEP or responding to auditory threshold tests for AEP, challenging your explanation 

• Misconceptions about the nature of the EP tests e.g., confusing them with an EEG or MRI require immediate correction and tailored explanation 

• A critical piece of information is missing from the referral e.g., reason for test or potential associated risk, requiring immediate clarification before consent can be fully 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 focusing the explanation on the specific sensory stimulus and patient cooperation required for the challenging modality e.g., explaining the flickering checkerboard stimulus for VEP 

• Pausing the consent discussion to contact the referring clinic to clarify the missing information before proceeding with the consent documentation 

• How are you feeling in that moment? For instance, are you finding it difficult to adapt your explanation to address specific misconceptions? Is it affecting your confidence in ensuring comprehensive informed consent is secured? 

What is the conclusion or outcome? 

• Identify how you are working within your scope of practice. For example, are you successfully clarifying the misconceptions and securing consent for all three modalities by using clear, precise language? Or are you needing support because the patient refuses one specific modality, requiring immediate consultation on whether the partial consent is diagnostically adequate? 

• What are you learning as a result of the unexpected development? For example, are you mastering a more effective strategy for explaining complex sensory tests simply? Or gaining insight into the importance of pre-emptive clarification of referral details prior to the consent conversation? 

On action

What happened? 

• Begin by summarising the key steps you took when explaining the VEP, AEP, and SSEP procedures and obtaining informed consent. 

• Consider specific events, actions, or interactions which felt important, such as how you explained the stimuli used for each modality or how you managed patient expectation regarding the length of the procedure. 

• Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, immediately simplifying the explanation of the sensory threshold test when the patient expressed confusion, ensuring the patient was fully informed.  

• How did you feel during this experience, e.g., did you feel confident in tailoring the complex explanation or challenged by the need to secure multi-modality consent simultaneously? 

How has this experience contributed to your developing practice? 

• Identify what learning you can take from this experience regarding consent for EP studies. What strengths did you demonstrate, e.g., ability to clearly explain modality-specific procedures? What skills and/or knowledge gaps were evident, e.g., difficulty articulating the distinction between the sensory threshold and the actual SSEP recording process? 

• Compare this experience against previous engagement with similar activities – were any previously identified actions for development achieved? Has your practice improved in confirming the patient’s comprehension of the sensory requirements of EP studies? 

• Identify any challenges you experienced, such as needing to seek advice or clarification on scope of practice regarding whether a patient’s difficulty maintaining fixation (required for VEP) invalidated their overall consent for the test battery, 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 explaining procedures and obtaining consent for multi-modality EP tests. 

• What will you do differently next time you approach obtaining consent for EP studies, for instance, by proactively reviewing the non-pathological effects (e.g., fixation, attention) with the patient as part of the consent discussion? 

• Do you need to practise any aspect of the activity further, such as explaining the technical differences between VEP, AEP, and SSEP to a layperson or key learning outcomes related to explaining procedures to obtain informed consent? 

Beyond action

Have you revisited the experiences? 

• How have your subsequent experiences of explaining and obtaining consent for evoked potential (EP) tests 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 with severe anxiety about the somato-sensory electrical stimulation forced you to re-evaluate the empathetic phrasing used to describe the sensory threshold test during your first attempt at this training activity. 

• Considering what you understand about the sensory nature of EP tests, patient comfort management, and the legal requirements for consent 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 EP consent explanation and procedure briefing based on further learning and experiences? For example, how you proactively developed a visual aid illustrating the Visual EP checkerboard pattern and the corresponding recording locations to enhance patient understanding, demonstrating you have adapted improvements based on further learning. 

• Has discussing patient discomfort during stimulation or the impact of confusion on patient cooperation during EP testing 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 failed auditory EP due to poor patient cooperation reinforced the need for clear, proactive explanation of patient expectations and environmental conditions 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 EP consent and explanation experiences, contributed to your overall confidence and competence in explaining procedures and obtaining informed consent for multi-modality EP tests, particularly in preparing for assessments like DOPS or OCEs? For example, how your accumulated ability in managing patient expectations regarding sensory stimuli (light/sound/shock) now enables you to perform a comprehensive 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 explaining and obtaining consent 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 Senior Clinician or Consultant immediately when a patient refuses a necessary component of the EP study due to pain or severe discomfort, recognising this requires clinical consultation outside routine consent procedure scope. 

• Looking holistically at your training journey, how has this initial EP explanation and consent 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 performing accurate pre-test measures and applying ethical guidelines. 

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.