Training activity information
Details
Prepare the recording and stimulating system (machine) for performing intraoperative neuromonitoring for spinal surgery. To include checking modalities:
- 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 performing internal calibration and pre-recording machine checks?
- How will you verify that all recording and stimulation parameters are correctly configured for SSEP, MEP, and EMG?
What is your prior experience of this activity?
- What is your current knowledge of IONM instrumentation, including filters, gain settings, and stimulator outputs?
- What technical challenges, such as identifying and eliminating common artefacts, do you anticipate encountering?
What do you anticipate you will learn from the experience?
- How will you master the technical nuances of machine configuration for complex spinal surgeries?
- What insights do you hope to gain regarding how non-pathological factors can be identified during the setup phase?
What additional considerations do you need to make?
- Have you consulted previous experiences of machine checks or software modifications?
- Have you reviewed the equipment manuals and national guidelines regarding best practice for system maintenance?
In action
During the activity is anything unexpected occurring?
- During the machine check or internal calibration, are you noticing an unexpectedly high noise floor or a failure in one of the stimulator channels?
- Are you finding that the software configuration for UL/LL SSEP and MEP isn’t correctly loading for the specific surgical levels required?
How are you reacting to the unexpected development?
- How are you troubleshooting technical issues, such as identifying artefacts or checking cable integrity, in the moment?
- Are you deciding to modify the filters or gain settings immediately to optimise the signal-to-noise ratio for the upcoming recording?
What is the conclusion or outcome?
- Are you successfully resolving the technical issue to ensure the system is safe and ready for the patient?
- What are you learning about identifying and mitigating non-pathological factors during the setup phase?
On action
What happened?
- How would you summarise the key points of performing internal calibration and pre-recording machine checks on the IONM equipment?
- Which specific actions felt most important, such as verifying that all recording and stimulation parameters (filters, gain, pulse width) were correctly configured?
- What ‘reflect-in-action’ moments occurred where you had to troubleshoot a technical issue, such as identifying a high noise floor or a hardware malfunction, before the procedure began?
- How were you feeling after completing the system checks, and did you feel confident that all non-pathological factors had been identified and mitigated?
How has this experience contributed to your developing practice?
- What learning can you take regarding your understanding of IONM instrumentation and the importance of system calibration?
- What strengths did you demonstrate in identifying common artefacts, and what knowledge gaps were evident regarding complex software modifications?
- How has your technical proficiency in machine configuration for diverse surgical levels improved compared to your previous performance?
- Did you need to seek technical support to ensure you were working within your scope of practice during a complex system failure?
What will you take from the experience moving forward?
- What specific ‘next steps’ will you now take to further develop your practice in this area?
- What will you do differently next time to ensure the equipment calibration and safety checks are even more seamless?
- Do you need to further review the equipment manuals or national guidelines to refine your systematic approach to system maintenance?
Beyond action
Have you revisited the experiences?
- Have you reviewed your previous reflections on performing internal calibration and pre-recording machine checks?
- What specific actions did you previously identify to improve your ability to identify non-pathological sources of error or operating theatre artefact?
- Have you completed these actions? For example, if you reviewed the national guidelines or machine manuals to refine your troubleshooting steps for UL/LL SSEP and MEP configurations, how has this improved your technical setup speed and accuracy?
- Engage in professional storytelling with peers about instances where machine checks identified a potential technical failure before the procedure began. How has this influenced your commitment to technical verification and patient safety?
How have these experiences impacted upon current practice?
- Consider how your proficiency in machine preparation will support you in with the in-person assessments for this module.
- How has your understanding of instrumentation and software configuration evolved? For example, how do the skills developed here help you recognise when a technical error is masking a physiological event?
- What transferable skills, such as systematic troubleshooting or technical problem-solving, did you develop, and how will this help you adopt and integrate new monitoring technologies in the operating room environment?
Relevant learning outcomes
| # | Outcome |
|---|---|
| # 1 |
Outcome
Plan and prepare for intraoperative neuromonitoring for spinal surgery |