Training activity information
Details
Optimise recorded responses throughout intraoperative neuromonitoring for 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 maintaining optimal signal quality across all modalities throughout the surgery?
- How do the learning outcomes apply to signal optimisation and troubleshooting recording artifacts?
- Have you discussed with your Training Officer which technical parameters (e.g., gain, filters, stimulation intensity) you are entrusted to adjust?
What is your prior experience of this activity?
- What knowledge of IONM signals optimisation do you already possess?
- What technical challenges, such as electromagnetic interference from other surgical tools, do you anticipate?
- How do you feel about managing technical signal fluctuations during critical surgical steps?
What do you anticipate you will learn from the experience?
- What specific technical troubleshooting skills do you want to develop?
- What insights do you hope to gain regarding the interplay between anaesthetic levels and signal stability?
What additional considerations do you need to make?
- Have you consulted previous reflections on artifact recognition?
- What information regarding the surgical timeline do you need to ensure timely signal optimisation?
In action
During the activity is anything unexpected occurring?
- Is there a sudden increase in electromagnetic interference or a drift in signal quality due to changing anaesthetic levels?
How are you reacting to the unexpected development?
- Are you optimising the responses by adjusting filters, gain, or stimulation intensity in real-time?
- Is it difficult for you to adapt your optimisation technique while the surgery is in a critical phase?
What is the conclusion or outcome?
- Are you mastering a more effective technique for signal optimisation as the situation unfolds?
On action
What happened?
- How would you summarise the actions you took to optimise the SSEP, MEP, and EMG signals throughout the procedure?
- What specific machine settings (e.g., gain, filters, stimulation intensity) did you adjust, and why?
- Include any ‘reflect-in-action’ moments where you had to troubleshoot recording artefacts as they occurred.
How has this experience contributed to your developing practice?
- What learning did you take regarding the requirements for recording high-quality signals in a dynamic theatre environment?
- How has your technical practice in signal optimisation improved since your last engagement with this activity?
- Were you able to successfully overcome challenges related to non-pathological sources of signal changes?
What will you take from the experience moving forward?
- What actions will you take to improve your artefact recognition and optimisation speed?
- What specific technical parameters do you need to study further to refine your optimisation strategy?
Beyond action
Have you revisited the experiences?
- Have you reviewed your actions regarding the real-time optimisation of recorded responses?
- What technical adjustments (e.g., gain, filters, stimulation intensity) did you identify as requiring further practice, and have you completed these actions?
- How has discussing artefact recognition with senior colleagues transformed your ability to maintain high-quality signals in a noisy environment?
How have these experiences impacted upon current practice?
- How has your proficiency in signal optimisation evolved to support you during the more complex interpretative phases of monitoring?
- Can you identify moments in your current practice where your understanding of anaesthetic and systemic effects has informed your optimisation decisions?
- What transferable skills in technical problem-solving have you developed that apply to other neurophysiological modalities?
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. |
| # 4 |
Outcome
Identify and respond to factors that impact intraoperative neuromonitoring for spinal surgery including technical problems and physiological effects. |