Paediatric Neurophysiology —
Training activity: 8

Details

Draft full factual reports for 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

• Identify what is expected of you in relation to drafting a full factual report for a pre-term neonatal EEG. Success requires accurately describing the age-specific normal and any abnormal features and generating factual reports assessing clinical priority and identifying cases requiring escalation.
• Consider how the learning outcomes apply, specifically in relation to accurately interpreting immature and discontinuous patterns and formulating a clinically relevant report for the neonatal team.
• Discuss with your training officer what constitutes an accurate description of the specific developmental features of pre-term neonatal EEG maturation e.g., specific waveform morphology, state changes, or voltage that must be included in the factual report.

What is your prior experience of this activity?

• Think about what you already know about EEG interpretation, understanding developmental change, and formal report drafting. Have you previously studied or interpreted the unique developmental patterns of pre-term EEGs?
• Consider possible challenges you might face during the activity, such as distinguishing physiological discontinuity from subtle electrographic seizures, using correct conceptional age terminology in the report, or assessing clinical priority for very subtle abnormalities e.g., mild voltage asymmetry. 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:
• If a highly discontinuous or severely depressed pattern is observed that suggests severe brain injury, requiring senior consultation to determine the appropriate urgency grading for the report
• When you are uncertain of the precise conceptional age classification for reporting purposes, as this dictates the ‘normal’ expected pattern
• If the EEG shows findings suggestive of a condition requiring immediate change to medical management, necessitating clarification on the correct escalation process to the neonatologist
• Acknowledge how you feel about interpreting highly specialised, developmental EEGs and drafting reports that inform potentially critical clinical decisions for neonates.

What do you anticipate you will learn from the experience?

• Consider the specific skills you want to develop, such as applying integrative understanding of EEG development and features according to conceptional age to accurately interpret and annotate the study.
• Identify the specific insights you hope to gain into the structure and key terminology required for drafting comprehensive factual reports for pre-term neonates.

What additional considerations do you need to make?

• Consult actions identified following previous experiences of drafting reports where complex or immature findings required meticulous, evidence-based language.
• Identify important information you need to consider before embarking on the activity, such as reviewing academic content on pre-term neonatal EEG development and specific pathologies seen at this age and ensuring you access examples of previously signed-off pre-term reports.

In action

Is anything unexpected occurring?

• Are you noticing anything surprising or different from what you anticipate whilst drafting a report on a pre-term neonatal EEG?
• Are you encountering situations such as:
  • Difficulty correlating the discontinuous EEG pattern with the documented conceptional age, challenging the normative assessment criteria?
  • A subtle but concerning abnormality e.g., highly focal discharge or extremely depressed background is present that complicates the descriptive terminology?
  • The clinical priority of the reported abnormality is unclear and requires careful phrasing in the factual report?

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 descriptive terminology to ensure accuracy regarding developmental features?
• Consider the steps you are taking in the moment, such as:
  • Immediately consulting academic resources e.g., conceptional age guidelines to verify the normality of the observed EEG features
  • Reviewing previous examples of reports to ensure consistency in language used for describing specific patterns like trace discontinue
• How are you feeling in that moment? For instance, are you finding it difficult to ensure the report is factual and clinically relevant? Is it affecting your confidence in applying developmental knowledge?

What is the conclusion or outcome?

• Identify how you are working within your scope of practice. For example, are you successfully describing a normal pattern appropriate for the conceptional age and articulating the findings clearly? Or are you needing support because the abnormality detected is so severe or complex that it requires immediate senior consultation to determine the appropriate clinical priority and language for the report?
• What are you learning as a result of the unexpected development? For example, are you mastering the specific descriptive language required for pre-term EEG interpretation?

On action

What happened?

• Begin by summarising the key steps you took when interpreting the recording, identifying specific developmental features, and drafting the full factual report for the pre-term neonate e.g., describing discontinuous background activity and specific graphoelements.
• Consider specific events, actions, or interactions which felt important, such as how you correlated the EEG features with the conceptional age, or how you phrased the descriptive findings to assess clinical priority for the neonatal team.
• Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, immediately seeking consultation when the observed pattern suggested potential subclinical seizures that required urgent reporting.
• How did you feel during this experience, e.g., did you feel the weight of the diagnostic responsibility or confident in your ability to apply specialised normative criteria?

How has this experience contributed to your developing practice?

• Identify what learning you can take from this experience regarding pre-term EEG reporting. What strengths did you demonstrate, e.g., accurate application of conceptional age criteria to classify background activity? What skills and/or knowledge gaps were evident, e.g., difficulty translating complex, immature patterns into standardised descriptive terminology for the factual report?
• Compare this experience against previous engagement with similar activities – has your practice improved in identifying and describing the highly specialised features of pre-term development?
• Identify any challenges you experienced, such as needing to seek advice or clarification on scope of practice regarding the level of certainty required to report an equivocal finding, 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 drafting factual reports for pre-term EEGs.
• What will you do differently next time you approach drafting a pre-term report, for instance, by systematically reviewing all relevant academic literature on specific developmental wavefrom morpholgies before finalising the description?
• Do you need to practise any aspect of the activity further, such as reviewing examples of reports covering various pathological pre-term states or key learning outcomes related to identifying features of normal and abnormal neonatal EEGs?

Beyond action

Have you revisited the experiences?

• How have your subsequent experiences drafting factual reports for 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 case required detailed reporting on the relationship between conceptional age and specific graphoelements forced you to re-evaluate the accuracy of developmental terminology you applied during your first attempt at drafting a pre-term report.
• Considering what you understand about pre-term EEG features according to conceptional age, identifying clinical priority, and standard report structuring 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 pre-term report terminology and developmental assessment based on further learning and experiences? For example, how you proactively reviewed and integrated academic content on pre-term EEG development to ensure accurate classification of specific patterns (e.g., trace discontinuity) into your reports, demonstrating you have adapted improvements based on further learning.
• Has discussing reports where specific developmental features were misclassified or the impact of imprecise language on neonatal diagnosis 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 case where poor reporting led to an initial misdiagnosis of encephalopathy, refined your understanding of the critical nature of meticulous adherence to developmental guidelines in pre-term reporting.

How have these experiences impacted upon current practice?

• How has the learning from this initial training activity, in combination with subsequent pre-term report drafting and review experiences, contributed to your overall confidence and competence in generating factual reports that assess clinical priority for neonates? For example, how your accumulated ability in accurately describing developmental EEG features now enables you to efficiently and confidently draft a clear conclusion regarding prognostic significance during a relevant assessment.
• How has reflecting back on this specific training activity, combined with everything you’ve learned since, shaped your current approach to drafting full factual reports for pre-term neonates? 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 pre-term trace shows findings that require interpretation beyond simple maturational assessment e.g., highly suspicious findings for intraventricular haemorrhage, recognising this requires specialist clinical interpretation.
• Looking holistically at your training journey, how has this initial pre-term report drafting experience, revisited with your current perspective, contributed to your development in meeting the learning outcomes related to identifying neonatal features and generating factual reports? For example, how this foundational experience has supported your development in applying integrative understanding of EEG development and practicing safely by ensuring high-quality diagnostic output.

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.