Training activity information
Details
Complete a risk assessment for a specified patient who requires intraoperative neuromonitoring for spinal surgery considering the patient’s clinical history and all relevant pre-operative findings. To include patients that require:
- Intraoperative somatosensory evoked potentials
- Intraoperative motor evoked potentials
- Free-running and 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 performing a patient-specific risk assessment? How do the patient’s clinical history and pre-operative findings (e.g., radiology or baseline neurophysiology) influence the risk profile for SSEPs, MEPs, and EMG?
- What specific knowledge of disorders of the CNS and PNS (e.g., myelopathies, diabetes, or scoliosis) do you need to identify potential challenges in recording or interpreting signals for this patient?
- What insights do you hope to gain regarding the correlation between pre-operative imaging (like MRI or bending films) and the technical risks of the planned monitoring?
- How will you prepare by reviewing the patient’s medical records and specific surgical approach? What potential challenges do you foresee in obtaining high-quality data from a patient with pre-existing neurological deficits?
In action
- What specific features of the patient’s clinical history (e.g., diabetes, myelopathy, or scoliosis) are you focusing on, and how are they influencing your risk profile for MEPs or SSEPs?
- How are you relating the pre-operative radiology (e.g., MRI or bending films) to the potential technical challenges of recording signals?
- What decisions are you making about which modalities carry the highest risk for this particular patient based on their pre-existing neurological status?
- How confident are you in interpreting the baseline neurophysiology in light of the suspected pathology?
- What support or guidance might you need in this moment to differentiate between pathological and non-pathological risks for this specific case?
On action
- Summarise the patient’s clinical history and the pre-operative findings (e.g., radiology or baseline neurophysiology) you considered during this assessment. What specific modalities (SSEP, MEP, or EMG) were required for this patient?
- What did you learn about how specific disorders of the nervous system (e.g., myelopathies or diabetes) affect IONM recordings and patient risk?
- Were there any unexpected findings in the patient’s radiology that influenced your risk profile?
- How does this experience relate to your ability to correlate clinical history with neurophysiological risk?
- What areas of your patient assessment skills could be refined?
- What resources or guidance from a supervisor might help you better interpret complex pre-operative findings in the future?
Beyond action
Have you revisited the experiences?
- Have you revisited the specific cases where you correlated a patient’s clinical history and pre-operative findings (like MRI or bending films) with the technical risks of SSEPs, MEPs, and EMG?
- How does your current ability to identify challenges for patients with disorders like myelopathy or diabetes compare to your initial assessments?
How have these experiences impacted upon your current practice?
- How has the process of performing patient-specific risk assessments contributed to your critical reasoning skills during observed clinical events?
- Reflect on any instances where pre-operative baseline neurophysiology findings altered your monitoring plan—how has this influenced your wider clinical perspective?
How might these experiences contribute towards your future practice?
- Identify the transferable skills in clinical data synthesis and technical planning you are refining.
- How will you seek out opportunities to further develop your expertise in managing increasingly complex patient presentations for intraoperative monitoring?
Relevant learning outcomes
| # | Outcome |
|---|---|
| # 1 |
Outcome
Plan and prepare for intraoperative neuromonitoring for spinal surgery |
| # 2 |
Outcome
Obtain clinical histories for patients undergoing intraoperative neuromonitoring. |
| # 3 |
Outcome
Identify other investigations and procedures required before spinal surgery is undertaken. |
| # 4 |
Outcome
Apply legislation and guidelines and manage risk in the performance of intraoperative neuro monitoring. |
| # | Outcome |