Training activity information
Details
Present a case study on a patient who underwent spinal surgery where motor evoked potential changes (alerts) were noted.
Type
Developmental training activity (DTA)
Evidence requirements
Evidence the activity has been undertaken by the trainee.
Reflection on the activity at one or more time points after the event including learning from the activity and/or areas of the trainees practice for development.
An action plan to implement learning and/or to address skills or knowledge gaps identified.
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 are the intended outcomes?
- How will this presentation help you demonstrate you can critically evaluate the evidence base for IONM?
What do you anticipate learning?
- What specific insights do you hope to gain regarding the interpretation of MEP signals in the context of anaesthetic and systemic changes like hypoxia or temperature drops?
What actions will you take in preparation?
- How will you discuss the selection of this case with your Training Officer to ensure it provides a clear example of MEP interpretation and theatre communication?
- What challenges do you anticipate when trying to explain technical MEP signal morphology to your peers?
In action
What are you doing?
- How are you approaching the presentation of MEP signal variability in the context of anaesthetic fade or systemic factors?
- What decisions are you making about how to structure the narrative of the theatre communication that followed the alert?
How are you progressing?
- How effective are your actions in demonstrating the medicolegal importance of the timely communication recorded in this case?
- What challenges are you facing in explaining the technical differentiation between a real MEP change and a non-pathological fluctuation?
How are you adapting?
- How are you adjusting your presentation if colleagues challenge the alarm criteria used during the procedure?
- What support or guidance do you need to further explore the iatrogenic complications highlighted by this specific case?
On action
What did you notice?
- What were the key points regarding the MEP signal variability and the theatre communication that followed the alert in this case?
What did you learn from the activity?
- What did you learn about the critical evaluation of the evidence base for using MEP alerts to prevent neurological damage?
- How did your analysis of this case improve your understanding of the interplay between anaesthesia (anaesthetic fade) and MEP stability?
What will you take from the experience moving forward?
- What ‘next steps’ have you identified to refine your interpretive skills for complex MEP changes?
- How will you apply the insights gained from this multidisciplinary discussion to your future practice?
Beyond action
Have you revisited the experiences?
- Looking back at the MEP case, how has your ability to critically evaluate IONM signals in the context of anaesthetic fade or systemic factors (like hypoxia) developed since that presentation?
How have these experiences impacted upon your current practice?
- How has your analysis of this MEP alert case informed the way you currently approach experiences regarding the risks and benefits of monitoring?
How might these experiences contribute towards your future practice?
- What clear actions have you identified for your continued professional development in interpreting the prognostic value of motor recovery based on your findings in this case?
Relevant learning outcomes
| # | Outcome |
|---|---|
| # 3 |
Outcome
Describe patient pathways for those undergoing intraoperative neuromonitoring during spinal surgery. |
| # 4 |
Outcome
Critically evaluate the evidence base for intraoperative neuromonitoring. |
| # 5 |
Outcome
Demonstrate effective and professional communication. |