Electrophysiology —
Training activity: 2

Details

Perform electrode placement for:

• VEP
• Retinal testing (PERG, ERG)
• EOG

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?
  • Identify what is expected of you in relation to performing electrode placement for the identified tests. Consider how the learning outcomes apply, such as, preparing and setting up the test environment and patient, evaluating and incorporating local and ISCEV standards, and employing effective communication.
  • What does accurate and secure electrode placement look like for VEP, PERG, ERG, and EOG tests, adhering to relevant standards (e.g., ISCEV standards, 10-20 placement systems)?
  • Discuss with your training officer to gain clarity on what is expected of you in performing electrode placement.
• What is your prior experience of this activity?
  • Think about what you already know about electrode placement techniques, including different types of electrodes and skin preparation.
  • Consider possible challenges you might face, such as patient discomfort, movement artefacts, anatomical variations, or difficulty with specific electrode types, and think about how you might handle them.
  • Recognise the scope of your own practice for this activity i.e. know when you will need to seek advice or help, and from whom, regarding difficult placements or unexpected issues.
  • Acknowledge how you feel about performing electrode placement for VEP, retinal testing and EOG.
• What do you anticipate you will learn from the experience?
  • Consider specific skills you want to develop in precise electrode placement for different tests and patient types – drawing upon previous experiences.
  • Identify specific insights you hope to gain regarding optimising signal quality through placement, patient comfort during placement, or applying standards like ISCEV.
• What additional considerations do you need to make?
  • Consult actions identified following previous experience of electrode placement, if any.
  • Identify important information you need to consider before embarking on the activity, such as required equipment, skin preparation protocols, electrode types for specific tests, and anatomical landmarks (e.g., 10-20 system).

In action

• Is anything unexpected occurring?
  • Are you noticing anything surprising or different from what you anticipate during the electrode placements for each of the identified tests?
  • Are you encountering practical or anatomical challenges, such as:
    • Difficulty identifying the correct location for an electrode based on the 10-20 system due to unusual patient anatomy or hair?
    • Persistent issues with electrode impedance remaining high despite appropriate skin preparation, similar to equipment failing a pre-use check?
• How are you reacting to the unexpected development?
  • How is this impacting your actions? For example, are you responding to the situation appropriately? Are you adapting or changing your approach to the electrode placement? Is it affecting your ability to undertake the activity independently?
  • Consider the steps you are taking in the moment, such as:
    • Are you re-checking electrode placement or the quality of the preparation immediately?
    • Are you consulting relevant SOPs for setup more thoroughly than planned?
    • If the issue is complex (e.g., persistent high impedance), are you seeking advice from a more experienced colleague or your training officer to understand the anomaly?
    • Are you changing your initial approach to securing the electrodes based on a new insight about the specific test requirement (PERG vs. EOG) or the patient’s tolerance?
  • How are you feeling in this moment? If you encounter persistent issues with electrode impedance remaining high despite appropriate preparation, or difficulty locating an electrode based on the 10-20 system due to patient anatomy, consider:
    • Is the persistent high impedance issue affecting your confidence in the quality of your skin preparation or technique?
    • Are you finding it difficult to adapt your placement technique to secure electrodes effectively based on unusual patient anatomy?
    • Do you feel positive you could reach a successful conclusion and achieve acceptable impedance levels in a timely manner for the test (e.g., PERG vs. EOG)?
• What is the conclusion or outcome?
  • Identify how you are working within your scope of practice. For example, are you:
    • Successfully managing the situation yourself?
    • Needing support because the issue (e.g., persistent technical error with the placement system or patient contraindication) is beyond your current scope?
  • What are you learning in the moment? For instance, are you learning a more efficient method for securing electrodes or a specific technique for addressing high impedance quickly?

On action

• What happened?
  • Begin by summarising the key points of the experience of performing electrode placement for the specified tests (VEP, PERG, ERG, EOG).
  • Consider specific events, actions, or interactions that felt important during the electrode placement, such as managing skin preparation protocols, ensuring optimal impedance, or dealing with patient restlessness. How did you feel during this experience?
  • Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, adjusting the electrode placement system (e.g., 10-20 system guidelines) due to anatomical constraints or quickly troubleshooting high impedance.
  • How has this experience contributed to your developing practice?
• Identify what learning you can take from this experience of electrode placement.
  • What strengths did you demonstrate (e.g., technical precision in placement, proficiency in achieving low impedance, adherence to safety standards)?
  • What skills and/or knowledge gaps were evident (e.g., unfamiliarity with a specific electrode type (e.g., gold cup vs. dermal patch) or optimal placement technique for a complex patient group)?
  • Compare this experience against previous times you have engaged with similar electrode placement activities. Has your practice in this area improved?
  • Identify any challenges you experienced during electrode placement (e.g., achieving necessary precision, material curing issues, time constraints) and how you reacted to these.
  • Acknowledge any changes in how you feel about this type of electrode placement now that you are looking back on the experience.
• What will you take from the experience moving forward?
  • Identify the actions you will now take to support the assimilation of what you have learned, including from any feedback you have received regarding your ability to perform accurate electrode placement.
  • What will you do differently next time you perform electrode placement?
  • Do you need to practise any aspect of electrode placement further? E.g., Practising specific skin preparation techniques to consistently achieve low impedance, or reviewing the anatomical landmarks for accurate electrode placement according to ISCEV standards.

Beyond action

• Have you revisited the experiences?
  • Have you reviewed your actions from your previous reflections for electrode placement? What specific actions did you previously identify to improve your practice related to technical precision in placement, proficiency in achieving low impedance, or adherence to ISCEV standards?
  • Have you completed these previously identified actions? If so, how did completing them impact your subsequent performance of this activity? Are you ready to demonstrate this new learning confidently and consistently when performing electrode placement?
  • Discuss with mentors or peers the complexities of different electrode placements (e.g., dermal patch vs. gold cup) for various tests. Did their insights provide a new understanding of past challenges?
• How have these experiences impacted upon current practice?
  • Consider how the accumulated learning from performing or reflecting on electrode placement will support you in preparing for relevant observed ‘in-person’ assessments for this module, such as DOPS like ‘Set up equipment and perform a VEP test on a patient’ or ‘Set up equipment and perform an ERG test on a patient’.
  • How has your practice related to electrode placement developed and evolved over time, including recognising when anatomical constraints or persistent impedance issues are beyond your scope of practice?

Relevant learning outcomes

#	Outcome
# 2	Outcome Prepare and set up the test environment and patient for different electrophysiological tests.
# 6	Outcome Evaluate and incorporate local and ISCEV standards in practice.
# 7	Outcome Employ effective communication with a range of individuals including the patient and the multidisciplinary team.