Nerve Conduction Studies & Evoked Potentials 2 —
Training activity: 1

Details

Plan and prepare for lower limb nerve conduction studies to screen a patient for peripheral neuropathy

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 planning and preparing lower limb nerve conduction studies.
• Consider how the learning outcomes apply, specifically in relation to planning and preparing lower limb nerve conduction studies and applying legislation and guidelines and managing risk.
• Discuss with your training officer to gain clarity of what is expected of you in relation to successful planning and preparation for this specific activity, including relevant clinical context like screening for peripheral neuropathy.

What is your prior experience of this activity?

• Think about what you already know about planning and preparing for nerve conduction studies, particularly lower limb studies.
• Consider possible challenges you might face during the activity, such as planning for specific patient conditions (e.g., different types of peripheral neuropathy) or ensuring compliance with relevant legislation and guidelines 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:
  • When planning for a complex case such as large fibre vs small fibre neuropathy requires specialised parameter setting
  • If required resources or specialist equipment for a study are limited
  • When clarifying the application of new legislation regarding patient data or risk management
• Acknowledge how you feel about embarking on planning and preparing this training activity.

What do you anticipate you will learn from the experience?

• Consider the specific skills you want to develop, such as reviewing patient history for relevant details, identifying appropriate study parameters (e.g., recording/stimulus parameters for lower limbs), or applying risk management principles, drawing upon previous experiences.
• Identify the specific insights you hope to gain into the nuances of planning for peripheral neuropathy screening or appreciating the impact of clinical context on the planning process.

What additional considerations do you need to make?

• Consult actions identified following previous experiences of planning or preparing similar activities.
• Identify important information you need to consider before embarking on the activity, such as specific clinic protocols, required equipment, patient history details related to peripheral neuropathy, or relevant legislation/guidelines.

In action

Is anything unexpected occurring?

• Are you noticing anything surprising or different from what you anticipate whilst planning and preparing the equipment setup or room layout for the lower limb nerve conduction studies (NCS)?
• Are you encountering situations such as:
  • Patient history details e.g., complex co-morbidities or medication use differ from what was expected, complicating your initial selection of standard recording/stimulus parameters?
  • A required piece of equipment for studying a specific nerve (e.g., the tibial nerve) is malfunctioning or unavailable, challenging the planned execution?
  • The clinical context provided for peripheral neuropathy screening is ambiguous, complicating the assessment of critical information required for planning the study?

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 resource allocation or safety checks due to unexpected logistical hurdles?
• Consider the steps you are taking in the moment, such as:
  • Immediately halting the preparation to consult the relevant legislation or guidelines if a planning decision involves a potential safety risk
  • Proactively adjusting the planned order of the studies e.g., delaying the sural nerve study to accommodate unexpected resource limitations
• How are you feeling in that moment? For instance, are you finding it difficult to adapt your planning strategy while ensuring compliance with safety guidelines? Is it affecting your confidence in preparing for the patient encounter?

What is the conclusion or outcome?

• Identify how you are working within your scope of practice. For example, are you successfully resolving a simple equipment conflict yourself by substituting standard materials? Or are you needing support because the complexity of the risk management required for a specific patient condition necessitates senior technical advice?
• What are you learning as a result of the unexpected development? For example, are you mastering a more effective verification checklist for lower limb NCS equipment? Or gaining insight into which specific guidelines govern urgent equipment replacement?

On action

What happened?

• Begin by summarising the key steps you took when planning and preparing for the lower limb nerve conduction studies (NCS).
• Consider specific events, actions, or interactions which felt important, such as how you reviewed the patient’s history to select the appropriate nerves or how you ensured the testing environment met safety and temperature requirements.
• Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, immediately seeking clarification on equipment compatibility when a piece of monitoring gear appeared unfamiliar, requiring adjustment to your preparation plan.
• How did you feel during this experience, e.g., were you confident in your rapid decision to consult safety guidelines or stressed by the unexpected need to adjust your preparation timeline?

How has this experience contributed to your developing practice?

• Identify what learning you can take from this experience regarding planning and preparation for lower limb studies. What strengths did you demonstrate, e.g., meticulous adherence to procedural checklists for limb preparation? What skills and/or knowledge gaps were evident, e.g., unfamiliarity with the nuanced electrode placement requirements for a specific nerve or specific risk management requirements?
• Compare this experience against previous engagement with similar activities – has your practice improved in applying legislation and guidelines during the planning phase?
• Identify any challenges you experienced, such as needing to seek advice or clarification on scope of practice regarding whether specific co-morbidities (e.g., severe edema) necessitated a modification to standard planning protocols, 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 optimising planning and preparation for lower limb NCS.
• What will you do differently next time you approach planning a lower limb peripheral neuropathy screen, for instance, by proactively confirming the availability and calibration status of all temperature monitoring equipment?
• Do you need to practise any aspect of the activity further, such as reviewing detailed anatomical landmarks for lower limb electrode placement or key learning outcomes related to risk management in test preparation?

Beyond action

Have you revisited the experiences?

• How have your subsequent experiences planning and preparing lower limb nerve conduction studies (NCS), especially those for specific neuropathy types or high-risk cases, 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 urgent case required highly detailed preparation under strict biosafety protocols forced you to re-evaluate the depth of risk assessment regarding environmental preparation you applied during your first attempt at this training activity.
• Considering what you understand about planning NCS and applying legislation and guidelines 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 NCS planning and preparation checklist based on further learning and experiences? For example, how you proactively reviewed and integrated new sections of the local procedural protocol concerning limb temperature monitoring to ensure maximum diagnostic yield, demonstrating you have adapted improvements based on further learning.
• Has discussing unexpected logistical hurdles or the impact of resource limitations 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 delay caused by inadequate equipment setup, refined your understanding of the critical nature of pre-procedure resource verification during planning.

How have these experiences impacted upon current practice?

• How has the learning from this initial training activity, in combination with subsequent planning and preparing experiences, contributed to your overall confidence and competence in planning and preparing the clinical environment for lower limb NCS, particularly in preparing for assessments like Direct Observations of Practical Skills (DOPS) related to lower limb studies? For example, how your accumulated ability in rapidly ensuring all required equipment and safety checks are complete now enables you to confidently present a prepared environment for NCS recording 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 planning and preparing for lower limb NCS? 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 Clinical Governance Lead immediately when a risk management decision regarding patient safety or data privacy falls outside routine departmental guidelines.
• Looking holistically at your training journey, how has this initial planning and preparation experience, revisited with your current perspective, contributed to your development in meeting the learning outcomes related to planning NCS and applying guidelines/managing risk? For example, how this foundational experience in resource management has supported your development in practicing safely by providing the necessary knowledge base for the subsequent learning outcomes focused on performing the actual study

Relevant learning outcomes

#	Outcome
# 1	Outcome Plan and prepare lower limb nerve conduction studies.
# 7	Outcome Apply legislation and guidelines and manage risk in the performance of upper limb nerve conduction studies and a multi-modality evoked potential studies.