Paediatric Neurophysiology —
Training activity: 3

Details

Prepare patients and perform an EEG 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 successfully performing the EEG procedure itself, including accurate head measurement and electrode application (within 5mm accuracy), across the specified age groups and patient complexity.
• Consider how the learning outcomes apply, specifically in relation to performing neonatal and paediatric EEGs in a range of conditions and ages, maintaining patient safety and ensuring patient experience, and preparing patients and environments for testing.
• Discuss with your training officer what constitutes a successful Direct Observations of Practical Skills (DOPS) level performance of electrode application and clean recording for infants and children.

What is your prior experience of this activity?

• Think about what you already know about technical procedures like EEGs, including head measurement (e.g., 10-20 system) and electrode application.
• Consider possible challenges you might face during the activity, such as maintaining electrode application accuracy on a highly mobile toddler, obtaining a clean recording despite patient anxiety or physical agitation, or adapting technical protocols for complex neurological needs, 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:
  • If significant, unresolvable technical issues e.g., persistent electrical noise or severe, high impedance compromise data quality and routine troubleshooting steps have failed
  • When the patient exhibits an unexpected clinical response during electrode application e.g., a complex partial seizure that requires immediate clinical management and escalation
  • If anatomical distortion or complex needs prevent the use of standard 10-20 electrode placement e.g., difficulty applying leads accurately due to a recent surgical site
• Acknowledge how you feel about performing technical EEGs on paediatric patients, particularly managing potential patient movement and ensuring high data quality.

What do you anticipate you will learn from the experience?

• Consider the specific skills you want to develop, such as accurate head measurement techniques appropriate for varying head sizes, mastering electrode application on different hair textures/types, and integrating patient management techniques to minimise movement artefact.
• Identify the specific insights you hope to gain into the practical challenges and required technical adaptations when performing EEGs on diverse paediatric patients, especially those with complex needs.

What additional considerations do you need to make?

• Consult actions identified following previous experiences of performing patient procedures where technical precision or patient management influenced the outcome.
• Identify important information you need to consider before embarking on the activity, such as reviewing the detailed procedural protocol for each age group, anticipating possible movement disorders based on history, and checking the relevant academic content on electrode placement accuracy.

In action

Is anything unexpected occurring?

• Are you noticing anything surprising or different from what you anticipate whilst preparing the patient or performing the EEG?
• Are you encountering situations such as:
  • Sudden patient movement or agitation (e.g., toddler or infant) during electrode application that compromises the accuracy of the 10-20 system measurement?
  • Persistent, unresolvable technical artifact or high impedance despite standard skin preparation and troubleshooting efforts?
  • The child develops unexpected signs of distress or illness during the recording, challenging patient safety management?

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 patient positioning or managing the recording environment to maintain safety?
• Consider the steps you are taking in the moment, such as:
  • Immediately halting electrode application and repositioning the child or adjusting distraction methods to ensure measurement accuracy is maintained
  • Making real-time adjustments to recording parameters or filters to mitigate noise while documenting the rationale for these changes
• How are you feeling in that moment? For instance, are you finding it difficult to maintain precision while managing active patient movement? Is it affecting your confidence in achieving a diagnostically acceptable recording?

What is the conclusion or outcome?

• Identify how you are working within your scope of practice. For example, are you successfully troubleshooting a minor electrical noise issue by checking ground leads and documentation? Or are you needing support because the child develops unexpected clinical instability or a suspected seizure during the procedure, requiring immediate clinical escalation and intervention by senior medical staff?
• What are you learning as a result of the unexpected development? For example, are you gaining insight into the critical importance of distraction techniques and rapid electrode application for uncooperative age groups?

On action

What happened?

• Begin by summarising the key steps you took when preparing the patient (e.g., head measurement, skin preparation) and performing the EEG for the specific case.
• Consider specific events, actions, or interactions which felt important, such as how you maintained safety while applying electrodes accurately (e.g., within 5mm) to a child who was restless, or how you managed the electrical and environmental safety checks before starting the recording.
• Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, immediately pausing the recording and adjusting the electrode placement when excessive movement artefact severely compromised signal quality.
• How did you feel during this experience, e.g., did you feel anxious about correcting the technical issue or focused on achieving optimal electrode application?

How has this experience contributed to your developing practice?

• Identify what learning you can take from this experience regarding EEG performance and patient safety. What strengths did you demonstrate, e.g., technical accuracy in head measurement and electrode application? What skills and/or knowledge gaps were evident, e.g., difficulty maintaining composure and concentration when facing continuous patient movement?
• Compare this experience against previous engagement with similar activities – has your practice improved in efficiently performing technical steps while maintaining communication and safety?
• Identify any challenges you experienced, such as needing to seek advice or clarification on scope of practice regarding the safe termination of the recording when a child exhibited escalating distress, 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 technical EEG performance across diverse paediatric needs.
• What will you do differently next time you approach performing an EEG on a restless child, for instance, by proactively implementing more effective distraction techniques or non-pharmacological soothing methods?
• Do you need to practise any aspect of the activity further, such as refining electrode application accuracy or key learning outcomes related to performing neonatal and paediatric EEGs while maintaining patient safety?

Beyond action

Have you revisited the experiences?

• How have your subsequent experiences performing EEGs on different age groups 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 infant required electrode application and recording management while being held by a parent to minimize distress forced you to re-evaluate the inflexibility of the standard electrode application protocol you applied during your first attempt at this training activity.
• Considering what you understand about maintaining patient safety and experience, technical accuracy e.g., electrode application to within 5mm accuracy, and artifact management 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 patient preparation and technical performance based on further learning and experiences? For example, how you proactively integrated the use of non-pharmacological distraction techniques e.g., age-appropriate toys or media to minimise movement artefact during recording, demonstrating you have adapted improvements based on further learning.
• Has discussing challenging procedures requiring modification of electrode placement or the impact of severe movement artefact on data quality 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 excessive technical artifact led to an inconclusive report, refined your understanding of the critical nature of vigilant artifact management during the recording.

How have these experiences impacted upon current practice?

• How has the learning from this initial training activity, in combination with subsequent EEG performance experiences, contributed to your overall confidence and competence in performing neonatal and paediatric EEGs, particularly in preparing for assessments like DOPS? For example, how your accumulated ability in performing accurate head measurement and efficient, accurate electrode application now enables you to confidently record a paediatric resting EEG 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 performing EEGs on paediatric patients? 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 Consultant Clinical Scientist immediately when unresolvable technical noise or interference is compromising signal integrity, potentially masking crucial epileptic features, recognising this falls outside routine technical troubleshooting scope.
• Looking holistically at your training journey, how has this initial EEG performance experience, revisited with your current perspective, contributed to your development in meeting the learning outcomes related to performing EEGs and maintaining patient safety and preparing patients and environments? 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 identifying abnormal features based on high-quality recordings.

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.