Training activity information
Details
Obtain, report, document and feedback baselines for the modalities being monitored in spinal surgery. To include:
- 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 establishing robust baselines for SSEP, MEP, and EMG?
- How do the learning outcomes apply to documenting and feeding back these findings to the surgeon?
- What has your Training Officer defined as the threshold for signal reproducibility and morphology for a ‘successful’ baseline?
What is your prior experience of this activity?
- What do you know about the importance of baseline recording and how pre-existing pathologies might affect them?
- What challenges, such as signal suppression due to induction anaesthesia, do you anticipate?
- How do you feel about your ability to interpret baseline data accurately for the theatre team?
What do you anticipate you will learn from the experience?
- What skills in baseline establishing and documentation do you hope to refine?
- What insights into the relationship between pre-operative functional status and baseline recordings do you hope to gain?
What additional considerations do you need to make?
- Have you reviewed feedback from previous baseline reports?
- What critical patient-specific data, such as pre-existing motor disturbances, must you consider when interpreting the initial signals?
In action
During the activity is anything unexpected occurring?
- Are you noticing unexpectedly low amplitudes or signal suppression in the waveform morphology that seems out of proportion to anaesthetic or systemic effects?
How are you reacting to the unexpected development?
- Are you immediately reporting and feeding back these findings to the surgeon and adapting recording parameters to improve signal reproducibility?
- Do you feel confident in using these baselines as the reference for the rest of the surgery?
What is the conclusion or outcome?
- What are you learning about the relationship between the patient’s pre-operative status and the initial intraoperative signals?
On action
What happened?
- How would you summarise the experience of establishing and reporting baselines for all monitored modalities?
- What did you notice about the signal morphology and amplitude of the initial recordings?
- How did you feel when feeding back the baseline status to the theatre team?
How has this experience contributed to your developing practice?
- What strengths did you demonstrate in setting pre-operative baseline recordings?
- How has your understanding of fluctuations and reproducibility in signals evolved after this experience?
- Were there any knowledge gaps evident regarding the anaesthetic or systemic effects on baseline signals?
What will you take from the experience moving forward?
- What will you do differently next time to ensure the baselines are robustly documented and communicated?
- Do you need to further study the prognostic value of baseline morphology to improve your future feedback?
Beyond action
Have you revisited the experiences?
- Have you reviewed your reflections on establishing pre-operative baseline recordings?
- What specific actions did you identify to improve your documentation and feedback of baseline findings to the surgeon?
- Have you engaged in storytelling regarding ‘unstable’ baselines, and how did those discussions change your interpretation of signal morphology and amplitude?
How have these experiences impacted upon current practice?
- How will the learning from these activities support you in the in-person assessments for the module?
- How has your ability to correlate pre-existing pathology with baseline signals developed over time?
- What transferable skills in prognostic evaluation have you developed through this activity?
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. |
| # 7 |
Outcome
Demonstrate effective and professional communication skills with the multidisciplinary theatre team. |