Paediatric Neurophysiology —
Training activity: 7

Details

Assist in performing pre-term neonatal EEGs

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 assisting the lead operator during the performance of a pre-term neonatal EEG. Success means supporting the procedure while contributing to maintaining patient safety and providing the best possible patient experience.
• Consider how the learning outcomes apply, specifically in relation to performing the EEG procedure and actively observing and recognising normal/abnormal features in real-time.
• Discuss with the lead operator and your training officer your specific support role and responsibilities when assisting, such as managing equipment monitoring, impedance verification, or assisting with polygraphy monitoring.

What is your prior experience of this activity?

• Think about what you already know about assisting in technical procedures, supporting lead operators, and maintaining equipment readiness in a sensitive clinical environment.
• Consider possible challenges you might face while assisting, such as maintaining a quiet, dark environment, efficiently managing equipment in a small space without disrupting monitoring devices, or anticipating the lead operator’s needs during a critical moment. 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:
  • If you observe persistent artefact or technical noise that requires immediate, non-disruptive intervention, and the lead operator is focused on the patient
  • When the neonate exhibits physiological signs of distress (e.g., changes in respiration or oxygen saturation) that you must escalate to the clinical team, even if in a supporting role
  • If unforeseen environmental disturbances (e.g., nearby alarms or medical staff influx) threaten the integrity of the recording, requiring immediate guidance on procedural pausing or adaptation
• Acknowledge how you feel about being an active support role during a sensitive, high-stakes procedure on a pre-term neonate.

What do you anticipate you will learn from the experience?

• Consider the specific skills you want to develop, such as anticipatory teamwork, rapid technical support and problem-solving during recording, and practical application of safety and infection control protocols in the NICU setting.
• Identify the specific insights you hope to gain into the practicalities and technical limitations of performing an EEG on a pre-term neonate and the nuances of immature EEG patterns.

What additional considerations do you need to make?

• Consult actions identified following previous experiences of assisting in clinical procedures where maintaining a supporting role and escalating concerns appropriately were critical.
• Identify important information you need to consider before embarking on the activity, such as reviewing the specific tasks assigned to you, studying safety protocols for the neonatal environment, and being aware of the neonate’s clinical status and monitoring parameters.

In action

Is anything unexpected occurring?

• Are you noticing anything surprising or different from what you anticipate whilst assisting in the pre-term neonatal EEG?
• Are you encountering situations such as:
  • The infant shows unexpected physiological changes e.g., drop in oxygen saturation or cardiac changes during electrode application, requiring immediate cessation of activity?
  • Unresolved impedance issues persist that challenge the lead operator’s ability to obtain a clean tracing?
  • You observe abnormal EEG patterns that you were not prepared to see in real-time?

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 real-time monitoring and minimising disruption to the environment?
• Consider the steps you are taking in the moment, such as:
  • Immediately and quietly communicating observed physiological changes to the nursing staff or lead operator
  • Troubleshooting technical issues e.g., checking electrode connections under the direction of the lead operator
• How are you feeling in that moment? For instance, are you finding it difficult to support the integrity of the recording while prioritising patient safety? Is it affecting your confidence in recognising subtle immature EEG patterns?

What is the conclusion or outcome?

• Identify how you are working within your scope of practice. For example, are you successfully managing minor equipment adjustments as requested by the lead operator? Or are you needing support because you observe severe or unexpected immature EEG patterns that require immediate clinical review and decision-making by the supervising consultant?
• What are you learning as a result of the unexpected development? For example, are you gaining insight into the subtle physical signs of distress in pre-term neonates?

On action

What happened?

• Begin by summarising the key steps you took when assisting the lead operator in performing the pre-term neonatal EEG e.g., preparing the skin, applying electrodes, monitoring impedance, managing artifact.
• Consider specific events, actions, or interactions which felt important, such as how you supported the stability of the neonate’s head during electrode application, or how you observed and reported minor physiological changes to the nursing staff or lead operator.
• Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, immediately adjusting the impedance setting or filter when high-frequency artifact interfered with the trace quality.
• How did you feel during this experience, e.g., did you find the requirement for fine-motor control demanding or confident in your ability to technically support the procedure?

How has this experience contributed to your developing practice?

• Identify what learning you can take from this experience regarding performing neonatal EEGs and maintaining safety. What strengths did you demonstrate, e.g., vigilant monitoring of the technical quality of the recording? What skills and/or knowledge gaps were evident, e.g., difficulty immediately recognising subtle immature EEG patterns in real-time while performing technical support?
• Compare this experience against previous engagement with similar activities – has your practice improved in working collaboratively in a high-stakes clinical setting?
• Identify any challenges you experienced, such as needing to seek advice or clarification on scope of practice regarding when an observed physiological change warranted immediate escalation, 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 assisting with and performing sensitive neonatal procedures.
• What will you do differently next time you approach assisting a pre-term EEG, for instance, by proactively reviewing the expected normal EEG features for that specific conceptional age immediately before the recording begins?
• Do you need to practise any aspect of the activity further, such as refining artifact management techniques or key learning outcomes related to performing EEGs while ensuring patient experience?

Beyond action

Have you revisited the experiences?

• How have your subsequent experiences assisting with pre-term neonatal EEGs 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 pre-term neonate displayed highly subtle immature EEG patterns that were difficult to distinguish from artifact in real-time forced you to re-evaluate the intensity of focus you applied to real-time technical monitoring and pattern recognition during your first attempt at assisting.
• Considering what you understand about immature EEG features, non-disruptive support techniques, and safety vigilance 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 technical assistance and real-time monitoring skills based on further learning and experiences? For example, how you proactively reviewed and integrated specific checks for polygraphy leads to ensure the accompanying physiological data was optimally recorded during the pre-term study, demonstrating you have adapted improvements based on further learning.
• Has discussing technical failures or unexpected physiological responses or the impact of inappropriate assistance on the integrity of the recording 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 a loose electrode caused significant artifact during a critical sleep epoch, refined your understanding of the critical nature of meticulous electrode maintenance during the procedure.

How have these experiences impacted upon current practice?

• How has the learning from this initial training activity, in combination with subsequent assistance and performance experiences, contributed to your overall confidence and competence in performing or assisting with delicate neonatal EEGs, particularly in preparing for assessments like DOPS? For example, how your accumulated ability in non-disruptive monitoring and rapid artifact correction now enables you to confidently support the application of electrodes and recording for a high-risk patient during a practical assessment.
• How has reflecting back on this specific training activity, combined with everything you’ve learned since, shaped your current approach to assisting in pre-term neonatal 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 Lead Operator or Neonatal Team immediately when unexpected physiological distress is observed that may compromise the infant’s stability, recognising this requires immediate clinical consultation and not merely technical management.
• Looking holistically at your training journey, how has this initial assisting pre-term EEG experience, revisited with your current perspective, contributed to your development in meeting the learning outcomes related to identifying features, communication, and performing EEGs? For example, how this foundational experience in observation and support has directly informed your ability to identify immature EEG patterns required for subsequent activities.

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.
# 4	Outcome Perform neonatal and paediatric EEGs, including activation procedures in a range of conditions and ages, maintaining patient safety and ensuring patient experience.