Paediatric Neurophysiology —
Training activity: 5

Details

Interpret and annotate EEGs and produce a full factual report for abnormal recordings to include each of the following conditions: Epilepsy syndromes Acquired brain injuries Infections Non epileptic

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 abnormal EEG recordings linked to conditions such as epilepsy syndromes, acquired brain injuries, Infections, and non-epileptic conditions. Success requires assessing clinical priority and identifying cases requiring escalation.
• Consider how the learning outcomes apply, specifically in relation to identifying features of abnormal paediatric EEGs and generating factual reports assessing clinical priority and identifying cases requiring escalation.
• Discuss with your training officer what constitutes a comprehensive and clinically actionable factual report for abnormal paediatric EEGs, including how to clearly articulate findings, assess priority, and suggest escalation for urgent conditions e.g., those suggestive of Herpes simplex encephalitis or Lennox-Gastaut syndrome.

What is your prior experience of this activity?

• Think about what you already know about identifying abnormal EEG features (e.g., generalised spike-wave, focal slowing) and correlating those findings with clinical context and pathology.
• Consider possible challenges you might face during the activity, such as recognising rare or complex patterns e.g., Continuous Spike-and-Slow Wave during Sleep (CSWS), linking vague clinical symptoms to non-epileptic findings, or correctly assessing the severity and urgency of acute findings (clinical priority). How might you handle these complex 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 encountering highly pathological or urgent patterns e.g., focal slowing suggesting acute cerebral infection that require immediate clinical communication and escalation protocols
  • If a recording is ambiguous e.g., features suggest an acquired brain injury but the extent is unclear and specialist input is required to determine the appropriate prognostic language for the report
  • When identifying specific patterns associated with rare epileptic syndromes (e.g., Juvenile Myoclonic Epilepsy) that necessitate confirming the findings against specialised academic content
• Acknowledge how you feel about interpreting abnormal and potentially urgent paediatric EEG findings, recognising the heavy responsibility linked to the report’s diagnostic significance.

What do you anticipate you will learn from the experience?

• Consider the specific skills you want to develop, such as rapidly identifying hallmark EEG patterns for key paediatric neurological disorders and assessing the necessity for escalation based on pattern severity.
• Identify the specific insights you hope to gain into correlating EEG findings with clinical presentation and prognosis and effectively communicating abnormal results in a clear, factual report format.

What additional considerations do you need to make?

• Consult actions identified following previous experiences of interpreting complex medical data or reporting findings that required immediate clinical action or specialist attention.
• Identify important information you need to consider before embarking on the activity, such as reviewing academic content on the pathophysiology, clinical presentation, and EEG findings of relevant paediatric neurological disorders and epileptic syndromes.

In action

Is anything unexpected occurring?

• Are you noticing anything surprising or different from what you anticipate whilst interpreting an abnormal EEG related to conditions like epilepsy syndromes, acquired brain injuries, or infections?
• Are you encountering situations such as:
  • The observed EEG pattern does not clearly fit the expected morphology for the suspected clinical condition (e.g., an unusual manifestation of a specific epileptic syndrome)?
  • A highly subtle or intermittent abnormality is found e.g., equivocal focal slowing that challenges robust classification?
  • The abnormality detected suggests an acutely urgent condition e.g., Herpes simplex encephalitis requiring immediate action?

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 correlating the EEG pattern with the clinical history to assess diagnostic fit?
• Consider the steps you are taking in the moment, such as:
  • Immediately checking the EEG against the academic diagnostic criteria for complex epileptic syndromes e.g., Lennox-Gastaut syndrome or Landau-Kleffner syndrome to confirm the classification
  • Prioritising the documentation of findings that impact clinical priority and potential escalation pathways
• How are you feeling in that moment? For instance, are you finding it difficult to assess the severity of the findings? Is it affecting your confidence in reporting the correct pathology?

What is the conclusion or outcome?

• Identify how you are working within your scope of practice. For example, are you successfully categorising a clear abnormality and documenting its features? Or are you needing support because the findings suggest an acute and urgent condition requiring immediate senior clinical review and escalation?
• What are you learning as a result of the unexpected development? For example, are you gaining insight into the importance of rapid identification of life-threatening patterns in paediatric neurophysiology?

On action

What happened?

• Begin by summarising the key steps you took when interpreting, annotating, and drafting the factual report for the abnormal EEG case (e.g., identifying epileptic discharges or focal slowing due to acquired brain injury).
• Consider specific events, actions, or interactions which felt important, such as how you linked the observed abnormal pattern to the patient’s clinical history (e.g., suspected epilepsy syndrome), or how you articulated the clinical priority in the report conclusion.
• Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, immediately focusing the report on features suggestive of a highly urgent condition (e.g., Herpes simplex encephalitis) and escalating the case.
• How did you feel during this experience, e.g., did you feel acutely aware of the patient management implications or challenged by the complexity of the abnormal trace?

How has this experience contributed to your developing practice?

• Identify what learning you can take from this experience regarding abnormal EEG interpretation and factual reporting. What strengths did you demonstrate, e.g., recognition of specific epileptic discharge morphology? What skills and/or knowledge gaps were evident, e.g., uncertainty about the specific patterns associated with rare non-epileptic conditions?
• Compare this experience against previous engagement with similar activities – has your practice improved in assessing clinical priority and determining the necessity for escalation?
• Identify any challenges you experienced, such as needing to seek advice or clarification on scope of practice regarding the need to escalate a case due to unexpected acute pathological findings, 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 analysing and reporting pathological paediatric EEGs.
• What will you do differently next time you approach reporting an abnormal recording, for instance, by proactively referencing specific academic descriptions of the suspected pathology (e.g., Lennox-Gastaut syndrome) to ensure the report is robust?
• Do you need to practise any aspect of the activity further, such as reviewing cases illustrating various paediatric epileptic syndromes or key learning outcomes related to generating factual reports assessing clinical priority?

Beyond action

Have you revisited the experiences?

• How have your subsequent experiences interpreting and reporting abnormal EEGs for conditions like epilepsy syndromes and acquired brain injuries 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 therapeutic interventions (e.g., drug treatment) with the current EEG findings forced you to re-evaluate the thoroughness of clinical history integration you applied during your first attempt at interpreting an abnormal EEG.
• Considering what you understand about pathophysiology of specific epileptic syndromes, assessing clinical priority, and the need for escalation 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 abnormal EEG interpretation and factual report structure based on further learning and experiences? For example, how you proactively reviewed and implemented a standardised escalation protocol for patterns suggestive of acute infection (e.g., Herpes simplex encephalitis) or status epilepticus, demonstrating you have adapted improvements based on further learning.
• Has discussing reports where the classification of an epileptic syndrome was ambiguous or the impact of poor assessment of clinical priority with medical consultants, 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 delay in reporting an acute case due to underestimation of urgency, refined your understanding of the critical nature of rapid prioritisation and clear report conclusions during abnormal reporting.

How have these experiences impacted upon current practice?

• How has the learning from this initial training activity, in combination with subsequent abnormal EEG interpretation and reporting experiences, contributed to your overall confidence and competence in identifying abnormal features and generating factual reports that assess clinical priority? For example, how your accumulated ability in recognising specific hallmark patterns (e.g., hypsarrhythmia in West syndrome) now enables you to efficiently articulate the key diagnostic findings and urgency assessment during a Case-Based Discussion (CBD) 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 abnormal 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 Neurophysiologist immediately when a highly unusual or complex pattern is observed (e.g., CSWS or Reye syndrome) that does not fit known academic classification, recognising this requires specialist pathological input.
• Looking holistically at your training journey, how has this initial abnormal EEG interpretation and reporting experience, revisited with your current perspective, contributed to your development in meeting the learning outcomes related to identifying abnormal features and generating factual reports? For example, how this foundational experience has supported your development in understanding the pathophysiology of paediatric neurological disorders and providing the necessary knowledge base for meeting subsequent learning outcomes focused on describing paediatric neurophysiology patient pathways.

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.