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

Details

Produce plans for upper limb nerve conduction studies on patients and prepare the room

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 planning and preparing to undertake upper limb nerve conduction studies. 

• Consider how the learning outcomes apply, specifically in relation to planning and preparing and applying legislation, guidelines, and managing risk when planning and preparing for the studies. 

• Discuss with your training officer to gain clarity of what is expected of you in relation to expectations for equipment setup, patient flow logistics, and integrating necessary safety protocols. 

What is your prior experience of this activity? 

• Think about what you already know about planning medical procedures or preparing clinical rooms. Have you previously planned neurophysiology tests? 

• Consider possible challenges you might face during the activity, such as logistical issues with moving NCS equipment, ensuring necessary resources (e.g., limb temperature monitors / thermometers) are available, or understanding procedural requirements. 

• 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 complexity of the planned study requires specialised equipment or protocols not covered in routine procedure. 

• Acknowledge how you feel about embarking on this planning and preparation task. 

What do you anticipate you will learn from the experience? 

• Consider the specific skills you want to develop, such as planning complex clinical procedures. 

• Identify the specific insights you hope to gain into the detailed requirements for upper limb NCS planning, including patient flow, equipment setup, and integrating safety protocols. 

What additional considerations do you need to make? 

• Consult actions identified following previous experiences of similar planning or preparation activities. 

• Identify important information you need to consider before embarking on the activity, such as reviewing academic content related to the anatomy of upper limb nerves (median, ulnar, radial) and the procedures for motor/sensory nerve conduction studies, as this knowledge is foundational for planning. 

In action

Is anything unexpected occurring? 

• Are you noticing anything surprising or different from what you anticipate whilst planning the study or preparing the room? 

• Are you encountering situations such as:  

• Logistical issues with moving large Nerve Conduction Studies (NCS) equipment into position that challenge the planned room layout? 

• The required resources e.g., specific electrodes or limb temperature monitors are immediately unavailable, challenging the preparation checklist? 

• Specific safety checks reveal a potential issue with the stimulator or recording equipment that was not anticipated in the plan? 

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 planning or room setup? 

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

• Immediately documenting the resource unavailability and implementing an alternative plan e.g., using backup equipment while ensuring compliance with safety protocols. 

• Halting the planning process to consult the departmental guideline or training officer to resolve a newly identified equipment safety concern. 

• How are you feeling in that moment? For instance, are you finding it difficult to adapt your pre-flection strategy? Is it affecting your confidence in ensuring the room meets safety standards? 

What is the conclusion or outcome? 

• Identify how you are working within your scope of practice. For example, are you successfully resolving the logistical issue by implementing an approved alternative equipment setup yourself? Or are you needing support because the identified safety issue requires senior technical review before the room can be deemed safe? 

• What are you learning as a result of the unexpected development? For example, are you mastering a more efficient technique for troubleshooting equipment setup issues? Or gaining insight into the criticality of external equipment checks when planning a study? 

 

On action

What happened? 

• Begin by summarising the key steps you took when producing the plan for upper limb nerve conduction studies and preparing the room. 

• Consider specific events, actions, or interactions which felt important, such as how you ensured compliance with safety protocols during the equipment setup, or how you integrated resource checks into your planning documentation. 

• Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, immediately halting the preparation to consult a technical guide when faced with an unexpected safety concern regarding the stimulator.  

• How did you feel during this experience, e.g., did you feel stressed by the logistical challenge or confident in your knowledge of safety guidelines? 

How has this experience contributed to your developing practice? 

• Identify what learning you can take from this experience regarding planning and preparation. What strengths did you demonstrate, e.g., meticulous adherence to the preparation checklist? What skills and/or knowledge gaps were evident, e.g., unfamiliarity with the correct positioning of complex monitoring equipment 

• Compare this experience against previous engagement with similar activities – were any previously identified actions for development achieved? Has your practice improved in integrating legislative requirements into your planning documentation? 

• Identify any challenges you experienced, such as needing to seek advice or clarification on scope of practice regarding whether an alternative equipment setup still met required departmental safety standards, 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 improving the efficiency and documentation of your room preparation process. 

• What will you do differently next time you approach planning and room preparation, for instance, by proactively conducting a technical check of all necessary monitoring equipment before starting the plan? 

• Do you need to practise any aspect of the activity further, such as reviewing departmental protocols for equipment layout or key learning outcomes related to managing risk during setup? 

Beyond action

Have you revisited the experiences? 

• How have your subsequent experiences of producing plans for nerve conduction studies (NCS) and preparing the room 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 urgent case required immediate room reconfiguration, testing your planning speed and efficiency, forced you to re-evaluate the meticulousness of your pre-planning checklist during your first attempt at this training activity. 

• Considering what you understand about risk management, equipment checks, and scheduling logistics 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 NCS planning and room preparation process based on further learning and experiences? For example, how you proactively reviewed and integrated the manufacturer’s specific guidelines on limb temperature measurement equipment calibration based on further learning. 

• Has discussing unexpected delays due to poor room preparation or the impact of inappropriate planning on workflow 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 time when incorrect electrode supplies caused a delay refined your understanding of the critical nature of pre-activity resource verification during planning. 

How have these experiences impacted upon current practice? 

• How has the learning from this initial training activity, in combination with subsequent NCS planning and preparation experiences, contributed to your overall confidence and competence in efficiently planning and preparing the clinical environment, particularly in preparing for assessments like Direct Observations of Practical Skills (DOPS) or Observed Communication Events (OCEs)? For example, how your accumulated ability in rapidly ensuring all required equipment and safety checks are complete now enables you to confidently present a prepared environment for a sensory and motor nerve conduction test during a DOPS assessment. 

• How has reflecting back on this specific training activity, combined with everything you’ve learned since, shaped your current approach to planning and preparing for upper limb 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 Technical Manager immediately when a required piece of specialist equipment for the study is out of calibration, recognising this falls outside routine preparation scope. 

• Looking holistically at your training journey, how has this initial NCS planning and preparation experience, revisited with your current perspective, contributed to your development in meeting the learning outcomes related to planning and preparing to undertake upper limb nerve conduction studies and managing risk? 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 the actual diagnostic test. 

Relevant learning outcomes

#	Outcome
# 1	Outcome Plan and prepare to undertake upper limb nerve conduction studies and multi-modality evoked potential studies.
# 7	Outcome Apply legislation and guidelines and manage risk in the performance of upper limb nerve conduction studies and multi-modality evoked potential studies.