Training activity information
Details
Perform a range of electrophysiology tests and make recommendations for further testing to include:
- PERG
- VEP
- 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 the range of electrophysiology tests and making recommendations for further testing. Consider how the learning outcomes apply, related to preparing for, performing and troubleshooting tests as well as preparing data, identifying waveforms, and communicating effectively.
- What does success in performing PERG, VEP, ERG, and EOG tests look like, including setup, recording, troubleshooting, and obtaining reliable data? What constitutes appropriate recommendations for further testing based on initial findings?
- Discuss with your training officer to gain clarity on what is expected of you in performing these tests and making recommendations.
- What is your prior experience of this activity?
- Think about what you already know about performing these specific electrophysiology tests and interpreting initial findings.
- Consider possible challenges you might face in performing the full range of tests, obtaining good quality data, or determining appropriate further testing, 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 unusual results, complex cases, or recommendations.
- Acknowledge how you feel about performing these range of tests and making recommendations for further testing.
- What do you anticipate you will learn from the experience?
- Consider specific skills you want to develop in mastering the execution of each test type (PERG, VEP, ERG, EOG) and the decision-making process for recommending further tests – drawing upon previous experiences.
- Identify specific insights you hope to gain regarding test variations, nuances in waveforms related to different conditions (e.g., Maculopathy, Optic neuropathy, Retinopathy), and how different tests complement each other.
- What additional considerations do you need to make?
- Consult actions identified following previous experience of performing these tests or similar diagnostic procedures, if any.
- Identify important information you need to consider before embarking on the activity, such as test protocols (e.g., ISCEV), typical waveforms and ranges, common artefacts and how they affect results, and criteria for recommending specific additional tests.
In action
- Is anything unexpected occurring?
- Are you noticing anything surprising or different from what you anticipate whilst you perform a range of electrophysiology tests?
- Are you encountering situations, such as:
- Unexpected findings during a test (e.g., a flat PERG trace) that is contradicting the patient’s reported history or other initial findings?
- Difficulty obtaining reliable and consistent waveforms during VEP or ERG despite multiple re-checks of the setup?
- The patient is experiencing severe fatigue or discomfort unexpectedly, necessitating a significant modification of the scheduled test battery or sequence?
- 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 performing the electrophysiology tests? How is it impacting upon your ability to make recommendations for further testing? Is it affecting your ability to undertake the activity independently?
- Consider the steps you are taking in the moment, such as:
- Are you immediately re-testing specific parameters or stimulus settings to verify the unexpected finding?
- Are you consulting test protocols or clinical guidelines for unexpected results or complex waveform patterns?
- Are you changing your sequence of tests or the specific parameters based on initial unexpected results (e.g., prioritising a more robust objective test over a behavioural one, or adjusting time allowed for breaks) based on the patient’s immediate presentation or fatigue levels?
- If the interpretation of conflicting results is challenging, are you seeking advice from a more experienced colleague before moving on?
- Did the issue affect your ability to undertake the activity independently?
- How are you feeling in this moment? If you encounter unexpected findings (e.g., a flat PERG trace) that is contradicting the patient’s history, or if you are struggling to obtain reliable and consistent waveforms during VEP or ERG, consider:
- Is the conflicting or unreliable data (e.g., EOG results conflicting with ERG results) affecting your confidence in the accuracy of your clinical interpretation?
- Are you finding it difficult to adapt your remaining test sequence or the timing of breaks in response to unexpected patient fatigue?
- Do you feel positive you could reach a successful conclusion regarding the overall clinical recommendations despite the technical or interpretive inconsistencies encountered?
- 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, or are you needing support because a significant finding (e.g., suspected Central pathology requires immediate medical attention) requires escalation or intervention beyond your scope?
- What are you learning as a result of the unexpected development? For example, are you learning new strategies for patient instruction to improve response reliability, or a more systematic approach to test interpretation when EOG results conflict with ERG findings?
On action
- What happened?
- Begin by summarising the key points of the experience of performing the range of tests and formulating recommendations for further testing.
- Consider specific events, actions, or interactions that felt important during the testing and recommendation process, such as ensuring all test parameters adhered to ISCEV standards, adapting the testing sequence based on initial results, or justifying the clinical necessity of further testing (e.g., shifting from standard ERG protocols to specialised testing). 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, modifying the test intensity or duration due to patient cooperation, or immediately noting a discrepancy in results that altered your preliminary recommendation.
- How has this experience contributed to your developing practice?
- Identify what learning you can take from this experience of performing tests and making recommendations.
- What strengths did you demonstrate (e.g., technical competence in running diverse protocols, analytical skill in relating test outcome to initial findings, effective communication of provisional recommendations)?
- What skills and/or knowledge gaps were evident (e.g., unfamiliarity with the full test types and ranges or the necessary differential diagnosis required to justify a specific further test)?
- Compare this experience against previous testing or recommendation activities. Has your practice in this area improved?
- Identify any challenges you experienced (e.g., achieving reliable readings across all tests, formulating a clear rationale for advanced testing) and how you reacted to these.
- Acknowledge any changes in your own feelings 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 a range of electrophysiology tests and accurately identify relevant further tests required.
- What will you do differently next time you perform these tests and make recommendations?
- Do you need to practise any aspect of performing these tests or making recommendations further? E.g., Practising formulating comprehensive narratives that systematically link test findings and rationale for onward testing, or reviewing the clinical applications of advanced testing ranges.
Beyond action
- Have you revisited the experiences?
- Have you reviewed your actions from your previous reflections for performing a range of tests and making recommendations? What specific actions did you previously identify to improve your practice related to adhering to ISCEV standards, analytical skill in relating test outcomes to findings, or justifying the clinical necessity of further testing?
- 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 tests and formulating recommendations
- Engage in professional storytelling with peers or colleagues about cases where initial findings led to complex recommendation paths. Has discussing these situations from different angles provided new insights into differential diagnosis?
- How have these experiences impacted upon current practice?
- Consider how the accumulated learning from performing or reflecting on tests and making recommendations will support you in preparing for relevant observed ‘in-person’ assessments for this module, such as Case-based Discussions (CBDs). This relates to demonstrating a critical understanding of tests and interpreting waveforms.
- How has your practice related to performing tests and making recommendations developed and evolved over time, including recognising when the required diagnosis or justification for advanced testing is beyond your scope of practice?
Relevant learning outcomes
| # | Outcome |
|---|---|
| # 1 |
Outcome
Demonstrate a critical understanding of electrophysiological tests used in the diagnosis of visual disorders. |
| # 2 |
Outcome
Prepare and set up the test environment and patient for different electrophysiological tests. |
| # 3 |
Outcome
Perform recordings of the electrophysiological tests and perform basic troubleshooting. |
| # 4 |
Outcome
Prepare data obtained for reporting, including correct annotation of waveforms and indications of factors that may alter the ability to reliably report data. |
| # 5 |
Outcome
Identify and differentiate normal and abnormal waveforms produced during testing. |
| # 7 |
Outcome
Employ effective communication with a range of individuals including the patient and the multidisciplinary team. |