Training activity information
Details
Prepare electrodes and other consumables for intraoperative neuromonitoring for spinal surgery. To include cases requiring:
- 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
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?
- Have you identified the expectations for selecting and preparing the correct electrodes and stimulation probes for a multi-modality case?
- How do the requirements for infection control and sterility apply to your preparation?
What is your prior experience of this activity?
- What do you know about different electrode types (e.g., subdermal needles vs. surface pads) and their specific applications?
- What challenges do you anticipate in ensuring you have the correct probes for triggered EMG mapping vs. continuous monitoring?
What do you anticipate you will learn from the experience?
- How will you develop a systematic approach to equipment preparation to ensure seamless procedural workflow?
- How will this experience deepen your understanding of the importance of meticulous preparation in reducing technical errors?
What additional considerations do you need to make?
- Have you consulted previous feedback on preparing electrode sets?
- Have you identified the specific needs of the procedure to ensure you have back-up consumables?
In action
During the activity is anything unexpected occurring?
- While selecting your equipment, are you noticing a shortage of specific stimulation probes or subdermal needles, or discovering an expired consumable?
- Are there changes to the surgical plan that require a different set of sterile consumables (e.g., moving to an anterior approach requiring surface electrodes)?
How are you reacting to the unexpected development?
- How are you ensuring you maintain infection control and sterility if you have to quickly source alternative equipment?
- Are you proactively preparing back-up consumables to account for potential technical failures during a long-duration or high-risk case?
What is the conclusion or outcome?
- Are you ensuring the procedural workflow remains seamless despite the equipment challenge?
- What are you learning about the importance of meticulous preparation in reducing technical sources of error?
On action
What happened?
- How would you summarise the experience of selecting and preparing the correct electrodes and stimulation probes for a multi-modality case?
- Which specific actions or interactions felt most important, such as ensuring strict adherence to sterility and infection control protocols while preparing subdermal needles?
- Did you have to adapt your preparation, perhaps by proactively sourcing back-up consumables after discovering an issue with the sterile packaging?
- How were you feeling during the preparation, especially when considering the specific needs of a high-risk or long-duration case?
How has this experience contributed to your developing practice?
- What learning can you take regarding your ability to systematically reduce technical sources of error in the operating room through meticulous preparation?
- What strengths did you demonstrate in maintaining the sterile field, and were there any gaps in your knowledge regarding different electrode applications?
- How has your technical efficiency in preparing for complex spinal approaches (anterior vs. posterior) evolved compared to your earlier attempts?
- Did you need to seek help from a senior colleague to ensure you had the correct stimulation probes for triggered EMG mapping?
What will you take from the experience moving forward?
- What specific actions will you now take, such as reviewing institutional standard operating procedures for device handling within the sterile environment?
- What will you do differently next time to ensure a seamless procedural workflow even in a high-pressure environment?
- Do you need further practice in preparing electrode sets for non-standard surgical procedures to ensure your technical skills remain versatile?
Beyond action
Have you revisited the experiences?
- Have you reviewed your actions from previous reflections on selecting and preparing consumables for cases requiring SSEP, MEP, and EMG?
- What actions did you identify to improve your technical preparation or sterile field management? Have you completed these actions?
- Engage in professional storytelling about ‘near misses’ or challenges in maintaining sterility during complex equipment transfers. How has this reinforced your appreciation for infection control and meticulous preparation?
How have these experiences impacted upon current practice?
- Consider how your practice in preparing electrode sets will support you in your formal in-person assessments.
- How has your attention to detail developed over time? For example, how does your proficiency in choosing between subdermal needles and surface pads inform your practice when preparing for non-standard surgical procedures?
- What transferable skills, such as contamination control or technical dexterity, did you develop, and how does this foundational knowledge inform your safety decisions in other interventional settings?
Relevant learning outcomes
| # | Outcome |
|---|---|
| # 1 |
Outcome
Plan and prepare for intraoperative neuromonitoring for spinal surgery |