Nerve Conduction Studies & Evoked Potentials 1 —
Training activity: 5

Details

Produce a factual report for an upper limb nerve conduction study for: Carpal tunnel syndrome Ulnar nerve neuropathy

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 preparing a factual report that accurately reflects the NCS findings. 

• Consider how the learning outcomes apply, specifically in relation to preparing reports and ensuring the report constitutes clear communication of findings. 

• Discuss with your training officer to gain clarity of what is expected of you in relation to the expected format, structure, and key elements of a factual NCS report for conditions like carpal tunnel syndrome. 

What is your prior experience of this activity? 

• Think about what you already know about writing technical or clinical reports. Have you previously interpreted neurophysiological data or drafted reports based on such findings? 

• Consider possible challenges you might face during the activity, such as translating technical NCS measurements into precise clinical language or accurately correlating findings with the diagnostic criteria. 

• 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 NCS findings contradict the clinical presentation, requiring interpretive guidance from a senior colleague. 

• Acknowledge how you feel about the responsibility of interpreting data and communicating findings in a report that will inform patient care. 

What do you anticipate you will learn from the experience? 

• Consider the specific skills you want to develop, such as interpreting NCS data and translating findings into a clear, factual report. 

• Identify the specific insights you hope to gain into the correlation between NCS measurements (amplitude, latency, velocity) and the presence and severity of entrapment neuropathies. 

What additional considerations do you need to make? 

• Consult actions identified following previous experiences of data interpretation or report writing. 

• Identify important information you need to consider before embarking on the activity, such as reviewing academic content on the pathophysiology and nerve conduction findings in entrapment neuropathies and familiarising yourself with standard reporting templates. 

In action

Is anything unexpected occurring? 

• Are you noticing anything surprising or different from what you anticipate whilst producing the factual report? 

• Are you encountering situations such as:  

• • The NCS findings are ambiguous or conflict significantly with the expected clinical diagnosis e.g., severe symptoms but mild neurophysiological findings, complicating the interpretive conclusion 

• • Discrepancies exist between different measurements e.g., delayed latency but normal amplitude, making it difficult to accurately grade the severity of nerve entrapment. 

• • The report template or required language is less straightforward than expected when trying to communicate the findings clearly 

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 interpreting the data or structuring the report? 

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

• • Immediately revisiting the raw data and re-measuring critical parameters e.g., latency, amplitude to verify the initial figures before committing them to the report 

• • Pausing the drafting of the conclusion to consult reference material or departmental guidelines on grading severity for specific nerve entrapments 

• How are you feeling in that moment? For instance, are you finding it difficult to adapt the technical data into precise clinical language? Is it affecting your confidence in accurately grading the severity? 

What is the conclusion or outcome? 

• Identify how you are working within your scope of practice. For example, are you successfully synthesising conflicting measurement data into a coherent descriptive report using established nomenclature? Or are you needing support because the significant conflict between the clinical history and the neurophysiological findings requires specialist interpretive input? 

• What are you learning as a result of the unexpected development? For example, are you mastering a more rigorous strategy for verifying raw data before reporting? Or gaining insight into the nuances of correlating NCS findings with the pathophysiology of nerve entrapments? 

On action

What happened? 

• Begin by summarising the key steps you took when producing the factual report for the nerve conduction study. 

• Consider specific events, actions, or interactions which felt important, such as how you graded the severity of the entrapment neuropathy or how you ensured the language used in the report was clear and clinically relevant. 

• Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, immediately consulting departmental guidelines when faced with conflicting amplitude and velocity results, which complicated the overall interpretive conclusion.  

• How did you feel during this experience, e.g., did you feel focused on maintaining the factual integrity of the data or stressed by the ambiguity in correlating findings with the diagnosis? 

How has this experience contributed to your developing practice? 

• Identify what learning you can take from this experience regarding reporting. What strengths did you demonstrate, e.g., accurate presentation of quantitative data? What skills and/or knowledge gaps were evident, e.g., difficulty translating complex neurophysiological measurements into concise clinical terminology? 

• Compare this experience against previous engagement with similar activities – were any previously identified actions for development achieved? Has your practice improved in accurately grading the severity of nerve entrapments based on defined criteria? 

• Identify any challenges you experienced, such as needing to seek advice or clarification on scope of practice regarding the inclusion of interpretive statements that might go beyond factual data presentation, 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 producing factual and clinically relevant reports. 

• What will you do differently next time you approach writing a factual report, for instance, by proactively implementing a standardised template to ensure consistent grading and terminology for common entrapment neuropathies? 

• Do you need to practise any aspect of the activity further, such as reviewing academic content on the relationship between pathophysiology and NCS findings or key learning outcomes related to preparing factual reports? 

Beyond action

Have you revisited the experiences? 

• How have your subsequent experiences of producing factual reports for upper limb nerve conduction 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 complex case required integrating previous Electromyography (EMG) findings into the current report narrative forced you to re-evaluate the level of detail and contextualisation included in the ‘Interpretation’ section during your first attempt at this training activity. 

• Considering what you understand about standard reporting protocols, clear professional communication, and the clinical implications of velocity and amplitude data 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 report writing structure and terminology based on further learning and experiences? For example, how you proactively reviewed and integrated standardised templates for reporting median nerve pinch ratios to ensure consistency and clarity for referring clinicians, demonstrating you have adapted improvements based on further learning. 

• Has discussing reports where the conclusion was unclear or potentially misleading or the impact of minor typographical errors in report data 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 case where misreported amplitude data led to an incorrect clinical referral refined your understanding of the critical nature of meticulous data transcription and validation during report production. 

How have these experiences impacted upon current practice? 

• How has the learning from this initial training activity, in combination with subsequent NCS report writing experiences, contributed to your overall confidence and competence in producing accurate and professionally factual reports, particularly in preparing for assessments like Case-Based Discussions (CBDs) or OCEs? For example, how your accumulated ability in structuring complex data into a clear report summary now enables you to efficiently articulate the key diagnostic features of a CTS report during a CBD assessment. 

• How has reflecting back on this specific training activity, combined with everything you’ve learned since, shaped your current approach to producing factual reports 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 Senior Neurophysiologist immediately when drafting an interpretive summary for a case showing mixed axonal and demyelinating features, recognising this falls outside routine factual data scope. 

• Looking holistically at your training journey, how has this initial NCS report writing experience, revisited with your current perspective, contributed to your development in meeting the learning outcomes related to preparing reports 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 critically evaluating electroneuromyography procedures and their limitations. 

Relevant learning outcomes

#	Outcome
# 8	Outcome Prepare reports 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.