Training activity information
Details
Regularly monitor and interpret recorded responses throughout surgical procedures for spinal, to include:
- communicating with the theatre team
- identifying and responding to factors impacting responses
- documenting any relevant pathogenic, non-pathogenic, and neurophysiological changes when required.
For both:
- Lower limb somatosensory evoked potentials
- Upper limb somatosensory evoked potentials
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 regularly monitoring and interpreting Somatosensory Evoked Potential (SSEP) responses?
- How do the learning outcomes apply to identifying pathogenic versus non-pathogenic changes and communicating alerts?
- What clarity have you gained from your Training Officer regarding the specific alarm criteria for SSEPs to be used for this case?
What is your prior experience of this activity?
- What do you know about common surgical steps and mechanisms that cause SSEP signal changes?
- What challenges, such as differentiating between systemic effects and iatrogenic injury, do you anticipate?
- How do you feel about the responsibility of interpreting high-stakes physiological SSEP data in real-time?
What do you anticipate you will learn from the experience?
- What skills in real-time interpretation and rapid clinical reasoning for SSEPs do you want to develop?
- What insights do you hope to gain regarding the patterns and timing of changes related to spinal instrumentation?
What additional considerations do you need to make?
- Have you reviewed national guidelines or evidence on identifying and preventing neurological damage specifically for SSEPs?
- What critical surgical milestones should you be aware of before SSEP monitoring begins?
In action
During the activity is anything unexpected occurring?
- Is a significant signal drop or a change in reproducibility occurring for the SSEPs that meets established alarm criteria?
How are you reacting to the unexpected development?
- Are you communicating with the theatre team immediately and investigating non-pathological sources of changes like temperature or blood pressure?
- Is the need for rapid clinical reasoning and interpretation for the SSEPs affecting your performance in this high-pressure moment?
What is the conclusion or outcome?
- Are you successfully documenting relevant pathogenic changes and ensuring your feedback remains within your scope of practice?
On action
What happened?
- How would you summarise the experience of regularly monitoring and interpreting the SSEP responses during the case?
- Which specific surgical mechanisms or common steps led to noticeable SSEP signal changes?
- How did you approach communicating with the theatre team when SSEP changes were identified?
- What were your feelings when interpreting whether an SSEP change was pathogenic or non-pathogenic?
How has this experience contributed to your developing practice?
- What strengths did you demonstrate in applying the alarm criteria to the live SSEP data?
- How effectively were you able to document and annotate relevant changes in real-time?
- What knowledge gaps regarding iatrogenic complications became evident to you during the SSEP interpretation?
- Compare this to previous cases—has your rapid clinical reasoning regarding SSEPs improved?
What will you take from the experience moving forward?
- What ‘next steps’ will you take to support your assimilation of identifying neurological damage?
- What will you do differently next time to ensure your communication is timely and accurate during critical surgical steps?
Beyond action
Have you revisited the experiences?
- Have you reviewed your previous reflections on monitoring and interpreting recorded SSEP responses?
- What actions did you identify to improve your identification of pathogenic versus non-pathogenic SSEP changes?
- How has professional storytelling about significant SSEP signal alerts and ‘near misses’ influenced your rapid clinical reasoning during critical surgical steps?
How have these experiences impacted upon current practice?
- How has the accumulated learning from interpreting real-time SSEP data supported your preparation for in-person assessments on intraoperative interpretations?
- How has your practice in applying SSEP alarm criteria developed, and can you recognise when a finding requires urgent escalation?
- What transferable skills in crisis communication and diagnostic triage have you developed through this high-stakes 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. |
| # 4 |
Outcome
Identify and respond to factors that impact intraoperative neuromonitoring for spinal surgery including technical problems and physiological effects. |
| # 5 |
Outcome
Identify, communicate and document relevant changes noted in intraoperative neuromonitoring for spinal surgery. |
| # 7 |
Outcome
Demonstrate effective and professional communication skills with the multidisciplinary theatre team. |