Training activity information
Details
Prepare patients undergoing spinal surgery in readiness to record the following intraoperative neuromonitoring 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 requirements for recording high-quality signals across multiple modalities, including SSEPs, MEPs, and free-run EMG?
- How do the learning outcomes apply to patient preparation?
- Have you confirmed the specific electrode placement protocols required for the planned spinal levels with your Training Officer?
What is your prior experience of this activity?
- What is your current knowledge regarding the recording of SSEP, MEP, and EMG?
- What challenges, such as patient skin integrity or the presence of pre-existing metalwork, do you anticipate?
- How do you feel about performing these preparations under theatre time constraints?
What do you anticipate you will learn from the experience?
- What specific skills in electrode application and signal integrity verification do you want to develop?
- What insights into signal morphology and amplitude do you hope to gain during the setup phase?
What additional considerations do you need to make?
- Have you reviewed actions from previous experiences of this training activity on electrode application?
- Does the patient have specific physical limitations that might affect electrode placement?
In action
During the activity is anything unexpected occurring?
- Are you encountering skin integrity issues, unexpected metalwork, or patient positioning that makes standard SSEP/MEP sites inaccessible?
How are you reacting to the unexpected development?
- Are you adapting your electrode placement strategy immediately to ensure high-quality signal recording?
- Is it difficult for you to maintain focus on the accuracy of electrode sites while preparing under time pressure?
What is the conclusion or outcome?
- Are you successfully optimising the setup for multiple modalities while staying within your level of training?
On action
What happened?
- How would you summarise the experience of preparing the patient to record upper and lower limb SSEPs, MEPs, and free-run EMG?
- Which electrode application steps felt most important to you to ensure high-quality signal recording?
- Did you encounter any ‘reflect-in-action’ moments where patient positioning required an immediate adjustment of your planned electrode sites?
How has this experience contributed to your developing practice?
- What strengths did you demonstrate in technical electrode application?
- Comparing this to previous cases, has your accuracy in identifying anatomical landmarks for nerve root mapping improved?
- Were any knowledge gaps evident to you regarding the recording requirements for multiple modalities simultaneously?
What will you take from the experience moving forward?
- What will you do differently next time to ensure patient safety and signal integrity are maintained during the prep phase?
- Do you need to practice the application of electrodes for specific modalities (e.g., motor evoked potentials) to improve your speed or accuracy?
Beyond action
Have you revisited the experiences?
- Have you reviewed your actions from previous reflections regarding the application of electrodes for multiple modalities (SSEPs, MEPs, EMG)?
- Have you completed the actions identified to improve your accuracy in identifying anatomical landmarks?
- How has sharing stories with peers about challenging patient positioning (e.g., prone or lateral) influenced your current optimisation strategy for signal integrity?
How have these experiences impacted upon current practice?
- How has this accumulated experience supported your readiness for the module in-person assessments?
- In what ways has your technical practice evolved to handle patient-specific limitations more effectively?
- What technical dexterity have you developed that is transferable to other neurophysiological recording settings?
Relevant learning outcomes
| # | Outcome |
|---|---|
| # 1 |
Outcome
Follow the pre-operative plan for intraoperative neuromonitoring for spinal surgery, making any necessary adjustments based on information available on the day of monitoring. |
| # 2 |
Outcome
Set pre-operative baseline recordings for intraoperative neuromonitoring for spinal surgery. |
| # 3 |
Outcome
Record free running and/or triggered electromyography during intraoperative neuromonitoring for spinal surgery. |