Paediatric Neurophysiology —
Training activity: 2

Details

Adapt and explain EEG procedures to a child and/or their parent/guardian to ensure co-operation with the diagnostic testing to include: Full term neonate (first 28 days of life) Infant (up to one year) Child under five Child over five A child with complex needs e.g. learning difficulties, language barrier or autistic spectrum disorder

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 adapting and explaining complex EEG procedures effectively to ensure cooperation from children and/or their parent/guardian, including those with complex needs like Autistic Spectrum Disorder or language barriers.
• Consider how the learning outcomes apply, specifically in relation to demonstrating effective and compassionate communication skills with all stakeholders and adapting communication for patient preparation.
• Discuss with your training officer to gain clarity of what is expected of you in relation to successful communication strategies for non-verbal children or those requiring interpreters, and how to document the efficacy of the explanation.

What is your prior experience of this activity?

• Think about what you already know about explaining complex medical procedures, approaching consent processes for different age groups, and communicating with individuals facing cognitive or language barriers.
• Consider possible challenges you might face during the activity, such as overcoming anxiety in a five-year-old facing electrode application, navigating language barriers without a professional interpreter, or engaging an unmotivated teenager in the preparation process, and think about how you might handle them.
• 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:
  • When there is uncertainty regarding the legal capacity of a parent/guardian to provide informed consent due to conflicting medical or social history
  • If a child with complex needs exhibits extreme resistance or distress that challenges standard calming or distraction techniques during the explanation phase
  • When selecting or using specific communication aids or visuals for a child with learning difficulties that are unfamiliar to departmental standard operating procedures
• Acknowledge how you feel about communicating potentially challenging technical information to vulnerable patient groups and ensuring their understanding and dignity.

What do you anticipate you will learn from the experience?

• Consider the specific skills you want to develop, such as refining the clarity, pace, and volume of your language to match the cognitive and developmental stage of children under five versus over five.
• Identify the specific insights you hope to gain into effective strategies for establishing rapport and managing expectations with children who have complex communication needs (e.g., Autistic Spectrum Disorder) to maximise their cooperation during the subsequent test.

What additional considerations do you need to make?

• Consult actions identified following previous experiences of Observed Communication Events (OCEs) where clarifying complex information was difficult or led to misunderstanding.
• Identify important information you need to consider before embarking on the activity, such as reviewing the child’s developmental assessment notes, confirming the availability of any required communication aids, and clarifying the specific legal requirements for obtaining consent for minors.

In action

Is anything unexpected occurring?

• Are you noticing anything surprising or different from what you anticipate whilst explaining the EEG procedure to the child or parent/guardian?
• Are you encountering situations such as:
  • The child or parent shows unexpectedly high levels of anxiety or distress following the explanation, jeopardising cooperation?
  • The child with complex needs (e.g., autistic spectrum disorder or language barrier) does not respond appropriately to initial communication strategies?
  • Critical questions arise about the subsequent test interpretation or results dissemination that require detailed explanation outside the standard script?

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 communication technique by simplifying language or introducing alternative visual aids immediately?
• Consider the steps you are taking in the moment, such as:
  • Immediately pausing the explanation and asking open-ended questions to gauge the specific source of the patient’s confusion or distress
  • Adjusting the pace or use of clinical terminology when addressing complex issues like sleep deprivation compliance to ensure clarity
• How are you feeling in that moment? For instance, are you finding it difficult to adapt your communication strategy to meet the specific age or developmental needs? Is it affecting your confidence in ensuring informed consent or co-operation?

What is the conclusion or outcome?

• Identify how you are working within your scope of practice. For example, are you successfully managing a simple language barrier using departmental guidelines or visual aids? Or are you needing support because the patient’s parent or guardian explicitly questions your technical explanation or raises a consent issue that falls outside routine protocol, requiring the intervention of the training officer or senior staff?
• What are you learning as a result of the unexpected development? For example, are you mastering a more effective empathetic communication strategy for managing paediatric anxiety?

On action

What happened?

• Begin by summarising the key steps you took when adapting and explaining the EEG procedure to the specific patient and/or guardian e.g., tailoring language for a five-year-old and addressing parent concerns.
• Consider specific events, actions, or interactions which felt important, such as how you simplified the concept of electrode paste and recording to alleviate a child’s anxiety, or how the parent reacted when you explained the duration of the procedure.
• Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, immediately changing your explanation strategy and resorting to visual aids when the child with complex needs showed no response to verbal instruction.
• How did you feel during this experience, e.g., did you feel challenged by the communication barrier or confident in your ability to adjust your explanation?

How has this experience contributed to your developing practice?

• Identify what learning you can take from this experience regarding effective communication. What strengths did you demonstrate, e.g., compassion and clarity when explaining possible minor discomforts? What skills and/or knowledge gaps were evident, e.g., unfamiliarity with specific communication tools required for patients with severe language barriers?
• Compare this experience against previous engagement with similar activities – has your practice improved in obtaining willing cooperation from paediatric patients?
• Identify any challenges you experienced, such as needing to seek advice or clarification on scope of practice regarding whether a parent’s understanding was sufficient to constitute informed consent, 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 communication techniques for varied paediatric patient groups.
• What will you do differently next time you approach explaining activation procedures, for instance, by proactively including a specific check-back question to ensure the parent/child truly understood the required level of cooperation?
• Do you need to practise any aspect of the activity further, such as role-playing consent discussions for different age groups or key learning outcomes related to effective and compassionate communication skills?

Beyond action

Have you revisited the experiences?

• How have your subsequent experiences adapting and explaining procedures to children or their guardians 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 presented with complex non-verbal communication needs requiring a specialised communication strategy forced you to re-evaluate the rigidity of the standard verbal explanation script you applied during your first attempt at this training activity.
• Considering what you understand about compassionate communication, capacity to consent, and age/developmental-appropriate explanations 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 procedural explanation technique based on further learning and experiences? For example, how you proactively integrated specific visual aids and shorter, simpler sentences when explaining activation procedures to children under five, demonstrating you have adapted improvements based on further learning.
• Has discussing ambiguous consent scenarios or managing parental anxiety or the impact of communication failure on patient cooperation 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 poor explanation of sleep deprivation requirements led to a failed study, refined your understanding of the critical nature of verifying comprehension during the explanation phase.

How have these experiences impacted upon current practice?

• How has the learning from this initial training activity, in combination with subsequent explanation and adaptation experiences, contributed to your overall confidence and skill in demonstrating effective and compassionate communication skills, particularly in preparing for assessments like Observed Communication Events (OCEs)? For example, how your accumulated ability in tailoring complex procedural information to diverse patient needs now enables you to confidently explain the EEG procedure in a manner appropriate to the age of the child 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 adapting and explaining EEG procedures? 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 Paediatric Neurophysiologist or Clinical Psychologist immediately when a patient with severe anxiety or complex needs refuses to proceed despite multiple communication attempts, recognising this falls outside routine explanation scope.
• Looking holistically at your training journey, how has this initial explanation and adaptation experience, revisited with your current perspective, contributed to your development in meeting the learning outcomes related to demonstrating effective and compassionate communication skills? For example, how this foundational experience in clear communication has supported your development in meeting subsequent learning outcomes focused on performing procedures which rely heavily on patient co-operation.

Relevant learning outcomes

#	Outcome
# 2	Outcome Prepare patients and environments for testing, maintaining safety and patient dignity.
# 3	Outcome Demonstrate effective and compassionate communication skills with all stakeholders, including patients and the multidisciplinary team.