Training activity information
Details
Programme the intraoperative monitoring system (machine) used for spinal surgeries for:
- Lower limb somatosensory evoked potentials
- Upper limb somatosensory evoked potentials
- Lower limb motor evoked potentials
- Upper limb motor evoked potentials
- Upper limb free-run electromyography
- Lower limb free-run electromyography
- Triggered electromyography
Type
Developmental training activity (DTA)
Evidence requirements
Evidence the activity has been undertaken by the trainee.
Reflection on the activity at one or more time points after the event including learning from the activity and/or areas of the trainees practice for development.
An action plan to implement learning and/or to address skills or knowledge gaps identified.
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 is the intended outcome of being able to programme the IONM system for SSEPs, MEPs, and triggered/free-running EMG? Why is technical precision in setting parameters essential for reliable monitoring?
- What are the specific technical considerations—such as electrode placement, montages, instrumentation, and stimulation/recording parameters—required for each modality according to local and national standards?
- What do you anticipate learning about the practical application of machine configuration and the importance of system calibration? How will you improve your skills in identifying potential technical errors during the programming phase?
- How will you prepare by reviewing the equipment manuals and practicing the programming steps under supervision? What potential sources of error (e.g., artefact or incorrect montage selection) do you plan to troubleshoot?
In action
- What specific recording and stimulation parameters (e.g., pulse width, intensity, filters) are you focusing on to optimise the signal-to-noise ratio?
- How are you ensuring the electrode montages selected correctly target the specific muscle groups or sensory pathways relevant to the surgical site?
- What tools or software techniques are you using to ensure the system is correctly calibrated and functioning for triggered vs. free-running EMG?
- What challenges are you facing in identifying non-pathological sources of error (e.g., electrode impedance) during the setup?
- Are you referencing the national recording standards as you configure the software and document the machine checks?
- What aspects of the machine programming feel routine, and what requires more focused attention due to the complexity of this specific multi-modality case?
On action
- Describe the process of setting up and programming the machine for modalities such as SSEP, MEP, and free-running or triggered EMG.
- What did you notice about selecting specific recording and stimulation parameters for this case?
- What did you learn about the instrumentation and technical considerations (e.g., electrode placement and montages) required for spinal surgery monitoring?
- Were there any unexpected challenges in identifying non-pathological sources of error during the programming phase?
- How did your focus during the setup impact your confidence in the recording’s accuracy?
- What technical skills related to machine programming need further development? What resources, such as system manuals or internal calibration protocols, will you consult to improve your precision?
Beyond action
Have you revisited the experiences?
- Have you compared your initial machine programming technique for triggered and free-running EMG with your current precision and efficiency?
- Have you revisited any reflections regarding technical errors or artefacts encountered during setup; how has your management of these challenges changed?
How have these experiences impacted upon your current practice?
- How has the technical proficiency gained in programming the system supported your preparation for the in-person assessments for the module?
- How has your understanding of instrumentation and stimulator/recording parameters influenced your wider practice in neurophysiology?
How might these experiences contribute towards your future practice?
- Identify the transferable skills of technical accuracy and system troubleshooting you are developing.
- How will you ensure your technical skills remain current as new device technologies and mapping/monitoring software are introduced to the specialty?
Relevant learning outcomes
| # | Outcome |
|---|---|
| # 1 |
Outcome
Plan and prepare for intraoperative neuromonitoring for spinal surgery |