Training activity information
Details
Perform sensory, motor and F-Wave lower limb nerve conduction studies for peripheral neuropathy including the following measurements: Limb temperature Amplitude and latency Velocity
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 performing sensory, motor, and F-Wave studies on lower limbs, including accurate measurement of parameters like limb temperature, amplitude, latency, and velocity.
- Consider how the learning outcomes apply, specifically in relation to performing lower limb nerve conduction studies, applying legislation/guidelines/risk management, and demonstrating effective communication.
- Discuss with your training officer to gain clarity of what is expected of you in relation to successful performance of these specific studies, ensuring quality data collection for peripheral neuropathy screening.
What is your prior experience of this activity?
- Think about what you already know about performing nerve conduction studies, particularly lower limb motor, sensory, and F-Wave techniques.
- Consider possible challenges you might face during the activity, such as achieving optimal electrode placement (lower limb nerves), dealing with patient movement or discomfort, obtaining accurate measurements (e.g., limb temperature), or troubleshooting technical issues, 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:
- If unresolvable technical artifact compromises the signal quality, requiring specialist technical intervention
- When the patient experiences severe, unexpected discomfort during F-Wave stimulation
- If unusual findings (e.g., extremely low amplitude) require immediate confirmation of the recording parameters before continuation
- Acknowledge how you feel about performing such studies and taking the measurements specified.
What do you anticipate you will learn from the experience?
- Consider the specific skills you want to develop, such as precise electrode placement (tibial, sural, common peroneal), mastering stimulation and recording techniques for lower limb nerves, performing specific measurements accurately, and applying safety protocols, drawing upon previous experiences.
- Identify the specific insights you hope to gain into understanding how technical factors impact measurement accuracy or appreciating the practical challenges of performing studies on different patients.
What additional considerations do you need to make?
- Consult actions identified following previous experiences of performing nerve conduction studies.
- Identify important information you need to consider before embarking on the activity, such as patient-specific factors (e.g., anatomy, condition), required equipment setup, specific measurement protocols, and relevant safety guidelines.
In action
Is anything unexpected occurring?
- Are you noticing anything surprising or different from what you anticipate whilst performing the NCS, setting up electrodes, or taking measurements?
- Are you encountering situations such as:
- Persistent high impedance or technical noise compromises the signal quality, making accurate measurement of amplitude or velocity impossible, despite initial troubleshooting?
- The limb temperature measurement is unexpectedly low, requiring immediate corrective action to maintain the accuracy of the study parameters
- The patient reacts unexpectedly strongly to the stimulation, leading to excessive movement artefact during F-Wave acquisition
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 technical troubleshooting or patient management in the moment?
- Consider the steps you are taking in the moment, such as:
- Immediately stopping the recording to re-clean the skin and re-apply electrodes for the Tibial or Sural nerve study to reduce impedance
- Adjusting the amplitude or rate of stimulation while communicating effectively with the patient to minimise discomfort and movement artefact
- How are you feeling in that moment? For instance, are you finding it difficult to maintain technical precision while focusing on patient comfort? Is it affecting your confidence in acquiring high-quality data?
What is the conclusion or outcome?
- Identify how you are working within your scope of practice. For example, are you successfully resolving minor technical noise by adjusting filter settings and ground leads? Or are you needing support because severe, persistent noise or equipment failure compromises the ability to obtain data and requires the intervention of a senior technical specialist?
- What are you learning as a result of the unexpected development? For example, are you mastering a more effective technical workflow for managing impedance issues on the lower limbs? Or gaining insight into the critical consequences of sub-optimal limb temperature on velocity measurement?
On action
What happened?
- Begin by summarising the key steps you took when performing the lower limb NCS, including measuring limb temperature and acquiring sensory, motor, and F-Wave data.
- Consider specific events, actions, or interactions which felt important, such as how you managed electrode placement to maximise the sural sensory nerve action potential (SNAP) amplitude, or the technical difficulty encountered during supramaximal stimulation for the F-Wave.
- Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, immediately checking the limb temperature and adjusting heating when the recorded nerve velocity was unexpectedly low, indicating a technical error that required prompt troubleshooting.
- How did you feel during this experience, e.g., were you confident in your technical troubleshooting ability, or frustrated by persistent patient movement affecting the recording quality?
How has this experience contributed to your developing practice?
- Identify what learning you can take from this experience regarding lower limb NCS performance. What strengths did you demonstrate, e.g., technical accuracy in measuring distance for velocity calculations? What skills and/or knowledge gaps were evident, e.g., difficulty obtaining a clean signal due to poor surface anatomy palpation?
- Compare this experience against previous engagement with similar activities – has your practice improved in applying safety protocols and managing technical challenges during the procedure?
- Identify any challenges you experienced, such as needing to seek advice or clarification on scope of practice regarding unresolvable electrical noise that compromised all collected data, requiring senior technical intervention, 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 performing lower limb nerve conduction studies.
- What will you do differently next time you approach lower limb F-Wave acquisition, for instance, by proactively increasing communication with the patient immediately prior to supramaximal stimulation to minimise surprise and movement?
- Do you need to practise any aspect of the activity further, such as refining electrode placement for optimal Sural SNAP recording or key learning outcomes related to performing diagnostic tests accurately?
Beyond action
Have you revisited the experiences?
- How have your subsequent experiences performing lower limb NCS, especially challenging cases with technical difficulties or excessive patient movement, 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 patient with severe edema required multiple attempts at electrode placement for the sural SNAP forced you to re-evaluate the speed and precision of electrode application you applied during your first attempt at this training activity.
- Considering what you understand about technical performance, risk management, and maintaining accurate measurements 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 technique and troubleshooting protocols based on further learning and experiences? For example, how you proactively implemented the use of specialized skin preparation techniques to minimise impedance issues, demonstrating you have adapted improvements based on further learning.
- Has discussing unresolvable technical artifact or the impact of sub-optimal recording quality on diagnostic data 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 inaccurate limb temperature compromised velocity measurement, refined your understanding of the critical nature of meticulous environmental control during NCS performance.
How have these experiences impacted upon current practice?
- How has the learning from this initial training activity, in combination with subsequent NCS performance experiences, contributed to your overall confidence and competence in performing lower limb nerve conduction studies, particularly in preparing for assessments like DOPS? For example, how your accumulated ability in performing motor, sensory, and F-Wave studies now enables you to confidently execute the required technical procedures 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 performing 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 Technical Specialist immediately when unresolvable electrical artifact or equipment failure severely compromises data quality, recognising this falls outside routine technical troubleshooting scope.
- Looking holistically at your training journey, how has this initial NCS performance experience, revisited with your current perspective, contributed to your development in meeting the learning outcomes related to performance, risk management, and communication? For example, how this foundational experience in technical accuracy has supported your development in meeting subsequent learning outcomes focused on interpreting results.
Relevant learning outcomes
| # | Outcome |
|---|---|
| # 5 |
Outcome
Perform lower limb nerve conduction studies on a range of patients. |
| # 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. |
| # 12 |
Outcome
Demonstrate effective and compassionate communication skills with all stakeholders, including patients and the multidisciplinary team. |