Nerve Conduction Studies & Evoked Potentials 1 —
Training activity: 6

Details

Produce plans and prepare the room to conduct the following evoked potential studies for: 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 effectively planning and preparing for Visual (VEP), Auditory (AEP), and Somato-sensory (SSEP) evoked potential studies. 

• Consider how the learning outcomes apply, specifically in relation to planning and preparing to undertake multi-modality evoked potential studies and applying legislation, guidelines, and managing risk during the preparation. 

• Discuss with your training officer to gain clarity of what is expected of you in relation to specific equipment needs, patient requirements, and room setup protocols for each evoked potential modality. 

What is your prior experience of this activity? 

• Think about what you already know about planning or preparing for complex medical tests, especially neurophysiological studies. 

• Consider possible challenges you might face during the activity, such as ensuring correct sensory stimuli are available, managing lighting/sound conditions, or selecting appropriate electrodes. 

• 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 required setup involves highly complex technical requirements or if specialised sensory calibration is needed beyond routine procedure. 

• Acknowledge how you feel about planning for multiple types of evoked potential studies. 

What do you anticipate you will learn from the experience? 

• Consider the specific skills you want to develop, such as planning the logistics and technical setup required for different evoked potential modalities. 

• Identify the specific insights you hope to gain into the unique requirements and non-pathological effects e.g., contrast/luminance, stimulus rate that must be controlled for in VEP, AEP, and SSEP planning. 

What additional considerations do you need to make? 

• Consult actions identified following previous experiences of planning for medical procedures. 

• Identify important information you need to consider before embarking on the activity, such as reviewing academic content on the principles of derivation, electrode placement, instrumentation, stimulation parameters, and non-pathological effects specific to VEP, AEP, and SSEP. 

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 for evoked potential studies? 

• Are you encountering situations such as:  

• • The required specific sensory stimuli e.g., precise visual checkerboard, calibrated auditory clicks, or specialised SSEP stimulators are unavailable or malfunctioning, compromising the planning phase  

• • Environmental factors e.g., ambient light leakage for VEP, or unexpected noise for AEP are encountered during setup, challenging the plan to control non-pathological effects  

• • The planning reveals a conflict in equipment compatibility for a combined multi-modality approach, requiring immediate technical review 

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 for the three modalities? 

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

• • Immediately implementing measures to control the environmental factor e.g., adjusting room lighting or sound baffling to ensure the study can proceed safely and reliably 

• • Consulting the technical team to resolve the equipment malfunction or planning around the incompatibility by rescheduling one modality 

• How are you feeling in that moment? For instance, are you finding it difficult to adapt the plan for one modality without compromising the others? Is it affecting your confidence in preparing the environment to minimise non-pathological effects? 

What is the conclusion or outcome? 

• Identify how you are working within your scope of practice. For example, are you successfully mitigating environmental issues by applying standard noise/light control measures? Or are you needing support because the required sensory stimulus generator for one modality is fundamentally faulty, requiring senior technical approval to cancel the study? 

• What are you learning as a result of the unexpected development? For example, are you mastering a more effective technique for performing comprehensive equipment checks for multi-modality studies? Or gaining insight into the specific technical prerequisites for VEP, AEP, and SSEP? 

On action

What happened? 

• Begin by summarising the key steps you took when producing plans and preparing the room for the different evoked potential studies visual, auditory, somato-sensory. 

• Consider specific events, actions, or interactions which felt important, such as how you planned to control environmental factors (e.g., lighting, sound) for each modality or how you ensured the correct sensory stimulation equipment was available. 

• Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, immediately adjusting the setup plan when unexpected ambient noise was identified in the room, threatening the reliability of auditory evoked potentials.  

• How did you feel during this experience, e.g., did you feel focused on applying risk management techniques or overwhelmed by the simultaneous requirements of three modalities? 

How has this experience contributed to your developing practice? 

• Identify what learning you can take from this experience regarding multi-modality planning. What strengths did you demonstrate, e.g., systematic approach to inventory checking for specific EP equipment? What skills and/or knowledge gaps were evident, e.g., unfamiliarity with the specific acoustic requirements for AEP testing? 

• Compare this experience against previous engagement with similar activities – were any previously identified actions for development achieved? Has your practice improved in planning and preparing for complex multi-modality studies? 

• Identify any challenges you experienced, such as needing to seek advice or clarification on scope of practice regarding the need to adapt a complex, combined plan into sequential steps due to resource limitations, 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 planning and preparation for VEP, AEP, and SSEP studies. 

• What will you do differently next time you approach planning and preparing for EP studies, for instance, by proactively implementing a modality-specific checklist to ensure all sensory requirements e.g., contrast/luminance are controlled for? 

• Do you need to practise any aspect of the activity further, such as reviewing non-pathological effects on evoked potentials or key aspects of planning the room setup? 

Beyond action

Have you revisited the experiences? 

• How have your subsequent experiences of producing plans for Evoked Potential (EP) studies 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 Somato-sensory EP required specific handling of non-pathological effects (e.g., limb length measurement for correct normative data application) forced you to re-evaluate the thoroughness of pre-study biometrics collection you applied during your first attempt at this training activity. 

• Considering what you understand about electrode impedance, stimulus parameters, non-pathological effects (e.g., age, medication), and the specific setup required for visual/auditory/somato-sensory EP modalities 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 planning and room preparation process based on further learning and experiences? For example, how you proactively implemented a mandatory check of background light and ambient sound levels prior to commencing a visual or auditory EP, demonstrating you have adapted improvements based on further learning. 

• Has discussing poor quality EP recordings due to high electrode impedance or the impact of incorrect planning on study duration 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 Visual EP that failed due to inappropriate check size selection refined your understanding of the critical nature of modality-specific parameter review during the planning phase.

Have you revisited the experiences? 

• How have your subsequent experiences of producing plans for Evoked Potential (EP) studies 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 Somato-sensory EP required specific handling of non-pathological effects (e.g., limb length measurement for correct normative data application) forced you to re-evaluate the thoroughness of pre-study biometrics collection you applied during your first attempt at this training activity. 

• Considering what you understand about electrode impedance, stimulus parameters, non-pathological effects (e.g., age, medication), and the specific setup required for visual/auditory/somato-sensory EP modalities 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 planning and room preparation process based on further learning and experiences? For example, how you proactively implemented a mandatory check of background light and ambient sound levels prior to commencing a visual or auditory EP, demonstrating you have adapted improvements based on further learning. 

• Has discussing poor quality EP recordings due to high electrode impedance or the impact of incorrect planning on study duration 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 Visual EP that failed due to inappropriate check size selection refined your understanding of the critical nature of modality-specific parameter review during the planning phase. 

How have these experiences impacted upon current practice? 

• How has the learning from this initial training activity, in combination with subsequent EP planning and preparation experiences, contributed to your overall confidence and competence in planning and preparing the environment for multi-modality evoked potentials, particularly in preparing for assessments like DOPS or OCEs? For example, how your accumulated ability in setting up complex electrode derivation and identifying appropriate stimulation sites now enables you to confidently prepare and apply electrodes for an evoked potential recording 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 evoked potential 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 EP Specialist immediately when non-standard electrode placement is required for a highly complex or distorted case, recognising this falls outside routine preparation scope. 

• Looking holistically at your training journey, how has this initial EP planning and preparation experience, revisited with your current perspective, contributed to your development in meeting the learning outcomes related to planning and preparing multi-modality evoked potential 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 pre-test measures (e.g., visual acuity, sensory threshold). 

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.