Training activity information
Details
Generate reports for intraoperative neuromonitoring for spinal surgeries and document communication with the theatre team for:
- Lower limb somatosensory evoked potentials
- Upper limb somatosensory evoked potentials
- Lower limb motor evoked potentials
- Upper limb motor 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?
- What is expected of you in relation to producing concise and accurate reports for both somatosensory and motor evoked potentials in spinal surgery?
- How are you applying local, national, and international guidelines to ensure the integrity of the data you record and report?
- What does a high-quality report look like that successfully documents the communication that occurred with the theatre team during critical surgical steps?
- How have you discussed the expectations for factual reporting and the potential medicolegal implications with your Training Officer?
What is your prior experience of this activity?
- What is your current level of knowledge regarding the interpretation and synthesis of IONM signal changes?
- What technical or interpretative challenges do you anticipate when differentiating artefacts from real signal changes in your reports?
- When might you need to seek advice from a senior colleague regarding complex signal changes or the phrasing of clinical recommendations?
- How do you feel about the responsibility of generating reports that may have significant medicolegal consequences?
What do you anticipate you will learn from the experience?
- What specific skills do you want to develop related to interpreting IONM signals in the context of anaesthetic and systemic changes?
- What insights do you hope to gain regarding the role of annotations and comments in creating a complete factual report?
What additional considerations do you need to make?
- What actions identified from previous reporting tasks should you consult before you begin?
- What critical information, such as the patient’s clinical context and the specific surgical milestones, do you need to review to ensure your report is accurate?
In action
Is anything unexpected occurring?
- Are you noticing anything surprising while synthesising the SSEP or MEP signal changes or reviewing the theatre annotations for the final report?
- Are you encountering a discrepancy between the live recorded events and the documented communication from the theatre briefing or huddle?
- Is a technical issue with the reporting software or reporting template making it difficult to accurately input key data points?
- How does the complexity of the signal changes in this case compare with your previous experiences of spinal surgery reporting?
How are you reacting to the unexpected development?
- How is an ambiguous annotation impacting your ability to produce a factual and accurate report? Are you adapting your reporting structure in the moment to better reflect the clinical reality?
- Are you finding it necessary to pause and consult a senior colleague to verify the clinical significance of a complex waveform before finalising the report?
- How are you feeling as you navigate the potential medicolegal implications of the report—is it affecting your confidence in phrasing clinical recommendations?
- Are you responding to the situation by seeking immediate clarification on local or national guidelines to ensure the integrity of the data?
What is the conclusion or outcome?
- Are you successfully resolving the reporting discrepancy while staying within your prescribed scope of practice?
- What are you learning about the role of annotations and comments as a result of troubleshooting this specific report?
- Are you mastering a more efficient technique for differentiating artefacts from real signal changes during the synthesis phase?
On action
What happened?
- How would you summarise the key points of your experience in generating these specific reports for SSEP and MEP in a spinal surgery case?
- Which specific events or interactions felt most important to document, particularly regarding the communication with the theatre team during critical surgical steps?
- How did you feel while interpreting and synthesising the IONM signal changes for the final report?
- Were there any ‘reflect-in-action’ moments during the reporting process where you had to adapt, such as reconsidering the significance of a baseline comparison or an annotation?
How has this experience contributed to your developing practice?
- What strengths did you demonstrate in producing concise and accurate reports that align with local, national, and international guidelines?
- What knowledge gaps were evident when you attempted to differentiate between real IONM signals and artefacts?
- How does this reporting experience compare against your previous attempts—has your ability to correlate signal changes with anaesthetic or systemic factors improved?
- Did you need to seek advice or clarification from a senior colleague to ensure the report correctly addressed the potential medicolegal implications?
- How did you react to challenges such as missing annotations or ambiguous theatre feedback, and did this affect the integrity of your data?
What will you take from the experience moving forward?
- What specific ‘next steps’ will you take to support the assimilation of what you have learned regarding the factual reporting of multiple modalities?
- What will you do differently next time you encounter complex signal fluctuations to ensure your report remains clear and logical for both specialist and non-specialist audiences?
- Do you need to further study the indicative content regarding anaesthetic fade or iatrogenic complications to improve your future interpretations?
Beyond action
Have you revisited the experiences?
- Have you reviewed your actions from previous reflections regarding the production of concise and accurate reports for spinal surgeries?
- What specific actions did you previously identify to improve your ability to document communication with the theatre team, and have you successfully completed these actions in your most recent reports?
- How has engaging in professional storytelling with peers or senior colleagues about complex ‘alert’ cases transformed your systematic approach to synthesising IONM signal changes?
- Are you now ready to demonstrate this new learning in practice during independent reporting, having analysed how your view of factual reporting has changed through clinical experience?
How have these experiences impacted upon your current practice?
- How will the accumulated learning from these reports support you in preparing for your Direct Observation of Practical Skills (DOPS) titled ‘Complete a final intraoperative neuromonitoring report’?
- How does your developed ability to report alerts and changes prepare you for the Observed Communication Event (OCE) where you must discuss a report containing IONM changes with a colleague?
- How has your practice in recognising the medicolegal implications of your written reports evolved, and can you identify instances where this has informed your phrasing of clinical recommendations?
- What transferable skills, such as advanced pattern recognition or the ability to translate technical findings for non-expert groups, have you developed through this activity?
Relevant learning outcomes
| # | Outcome |
|---|---|
| # 1 |
Outcome
Practice according to local protocols and national and international guidelines to ensure the integrity of data recorded for intraoperative neuromonitoring. |
| # 2 |
Outcome
Produce concise and accurate reports for intraoperative neuromonitoring during spinal surgery according to local, national, and international guidelines. |
| # 5 |
Outcome
Demonstrate effective and professional communication. |