Paediatric Neurophysiology —
Training activity: 4

Details

Interpret and annotate EEGs, and produce a full factual report for a normal recording to include the following: Full term neonate (first 28 days of life) Infant (up to one year) Child under five Child over five

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 accurately interpreting and annotating a normal EEG recording across the paediatric age spectrum (neonate through child over five) and producing a full factual report that meets clinical reporting standards.
• Consider how the learning outcomes apply, specifically in relation to identifying features of normal neonatal and paediatric EEGs and generating factual reports.
• Discuss with your training officer what constitutes a comprehensive and clinically accurate factual report for a normal EEG that correctly identifies the subtle nuances of normal maturational patterns without misinterpreting benign variants as pathological.

What is your prior experience of this activity?

• Think about what you already know about EEG interpretation principles, normal variants in neurophysiology, and structuring formal clinical reports.
• Consider possible challenges you might face during the activity, such as distinguishing normal age-specific variants (e.g., mu rhythm) from subtle pathology, accurately annotating key sleep features (e.g., sleep state changes) in an infant, or clearly articulating the developmental findings in the factual report. How might you handle these challenges?
• 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 a focal change is noted that might represent a benign normal variant but requires senior confirmation to definitively rule out subtle pathology
  • If you encounter a normal EEG pattern for a specific age (e.g., a specific graphoelement in a sleeping infant) that you have not previously seen or studied, requiring verification of its benign nature
  • When the clinical history suggests strong pathology (e.g., frequent clinical events) but the recording is definitively normal, requiring clarity on how to phrase the report’s conclusion and clinical correlation
• Acknowledge how you feel about interpreting normal paediatric EEGs, recognising the complexity of developmental maturation patterns across the age range.

What do you anticipate you will learn from the experience?

• Consider the specific skills you want to develop, such as microscopic pattern recognition for normal EEG development and accurate annotation of sleep state changes.
• Identify the specific insights you hope to gain into the most efficient and standardized layout and terminology required for a high-quality factual report of a normal study.

What additional considerations do you need to make?

• Consult actions identified following previous experiences of interpreting complex neurophysiological data or writing reports where ambiguity in findings could mislead the clinician.
• Identify important information you need to consider before embarking on the activity, such as reviewing key academic content on EEG features according to conceptional age (pre-term and full-term neonatal EEG) and normal variants and reviewing departmental templates for normal reports.

In action

Is anything unexpected occurring?

• Are you noticing anything surprising or different from what you anticipate whilst interpreting a seemingly normal EEG across different paediatric ages?
• Are you encountering situations such as:
  • A prominent normal variant (e.g., a specific rhythm or pattern) that initially causes you to question the overall normality of the tracing?
  • Difficulty accurately annotating the specific features of sleep state changes in an infant due to subtle transition points or movement artefact?
  • The maturational pattern observed does not perfectly align with the expected developmental age, requiring careful correlation with clinical history?

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 systematic review by immediately cross-referencing uncertain waveforms with multiple montages or time scales?
• Consider the steps you are taking in the moment, such as:
  • Immediately consulting academic resources or departmental atlases to confirm the expected morphology of the age-appropriate rhythm
  • Pausing the report drafting to meticulously re-examine the sleep epoch annotations before committing to a final description
• How are you feeling in that moment? For instance, are you finding it difficult to differentiate between a benign finding and subtle pathology? Is it affecting your confidence in categorising the EEG as definitively normal?

What is the conclusion or outcome?

• Identify how you are working within your scope of practice. For example, are you successfully differentiating between benign variants and subtle abnormalities using established scoring rules? Or are you needing support because the report structure requires specialised formatting for documenting maturational features for which you lack familiarity?
• What are you learning as a result of the unexpected development? For example, are you mastering a more efficient technique for identifying key maturational features in paediatric EEGs?

On action

What happened?

• Begin by summarising the key steps you took when interpreting the EEG, annotating specific normal patterns, and drafting the factual report for the specific age group e.g., reviewing sleep architecture in an infant.
• Consider specific events, actions, or interactions which felt important, such as how you differentiated a normal age-specific variant from subtle pathology, or how you phrased the technical description in the final factual report.
• Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, immediately seeking confirmation from a senior colleague when a finding appeared borderline between a benign variant and an interictal discharge.
• How did you feel during this experience, e.g., did you feel determined to achieve accurate classification or stressed by the ambiguity of the trace?

How has this experience contributed to your developing practice?

• Identify what learning you can take from this experience regarding EEG interpretation and reporting. What strengths did you demonstrate, e.g., accurate identification of sleep state changes? What skills and/or knowledge gaps were evident, e.g., unfamiliarity with the nomenclature for describing specific age-appropriate maturational patterns?
• Compare this experience against previous engagement with similar activities – has your practice improved in identifying and describing the nuances of normal EEG development?
• Identify any challenges you experienced, such as needing to seek advice or clarification on scope of practice regarding how to classify a potentially ambiguous finding which affected the final report, 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 interpreting and reporting normal paediatric EEGs.
• What will you do differently next time you approach drafting a factual report for a normal case, for instance, by proactively integrating specific conceptional age data into the report to justify the expected normal features?
• Do you need to practise any aspect of the activity further, such as reviewing atlases of normal paediatric EEG variants or key learning outcomes related to identifying features of normal neonatal and paediatric EEGs?

Beyond action

Have you revisited the experiences?

• How have your subsequent experiences interpreting and reporting normal EEGs across different paediatric 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 case required meticulous distinction between a normal age-appropriate variant (e.g., mu rhythm) and subtle epileptic features forced you to re-evaluate the detail of annotation regarding benign graphoelements you applied during your first attempt at this training activity.
• Considering what you understand about EEG maturation patterns according to conceptional age and standard reporting protocols 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 normal EEG reporting structure and maturational feature identification based on further learning and experiences? For example, how you proactively reviewed and integrated standardised criteria for annotating sleep state changes based on further learning about infant sleep architecture.
• Has discussing reports where normal variants were potentially misclassified or the impact of unclear annotation on senior review with colleagues, peers, or supervisors changed how you now view your initial experience in this training activity? For example, how professional storytelling with a medical consultant about a time when excessive annotation of benign rhythms caused unnecessary report length, refined your understanding of the critical nature of focusing annotation on clinically relevant features.

How have these experiences impacted upon current practice?

• How has the learning from this initial training activity, in combination with subsequent normal EEG interpretation and reporting experiences, contributed to your overall confidence and competence in identifying features of normal paediatric EEGs and generating factual reports? For example, how your accumulated ability in accurately identifying maturational patterns and normal variants now enables you to efficiently summarise the key developmental features of a normal infant EEG during an assessment.
• How has reflecting back on this specific training activity, combined with everything you’ve learned since, shaped your current approach to interpreting and reporting normal paediatric EEGs? 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 Consultant Clinical Scientist immediately when a normal-appearing tracing contradicts a strong clinical history suggesting subtle epileptic activity, recognising this falls outside routine normal reporting scope.
• Looking holistically at your training journey, how has this initial normal EEG interpretation and reporting experience, revisited with your current perspective, contributed to your development in meeting the learning outcomes related to identifying normal features and generating factual reports? For example, how this foundational experience in identifying normal maturational patterns has supported your development in meeting subsequent learning outcomes focused on critically appraising and discussing the clinical significance and interpretation of the paediatric EEG.

Relevant learning outcomes

#	Outcome
# 1	Outcome Identify features of normal and abnormal neonatal and paediatric EEGs, including activation procedures.
# 3	Outcome Demonstrate effective and compassionate communication skills with all stakeholders, including patients and the multidisciplinary team.
# 5	Outcome Generate factual reports on a range of conditions and ages assessing, clinical priority and identifying cases requiring escalation.