Electrophysiology —
Training activity: 8

Details

Perform diagnostic tests on patients for common conditions including:

• Maculopathy
• Optic neuropathy
• Retinopathy

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 specific knowledge must you possess regarding the pathophysiology of maculopathy, optic neuropathy, and retinopathy before you begin the testing process?
  • How well do you understand the clinical utility and application of the specific tests used for these conditions, such as PERG, VEP, ERG, and EOG?
  • What ISCEV standards or local protocols do you need to review to ensure accuracy in electrode placement and test execution for these specific pathologies?
• What do you need to know about the causes, site of the pathology in the visual pathway, and the mechanism of the disease?
  • Consider the specific insights you hope to gain from performing these diagnostic tests. Will you improve your technical skills in performing the tests, your ability to recognise patterns associated with these conditions, or your communication skills with patients?
  • Think about what you already know about these diagnostic tests and the common conditions listed.
  • What experience do you have with patient interaction and test administration in electrophysiology? Consider how the patients vision levels may affect ability to perform test i.e. fixate stimuli?
• Discuss this training activity with your training officer to clarify which specific tests you will be performing, the types of patients you might encounter, and any specific supervision arrangements.
  • Consider possible challenges you might face during the tests, such as patient cooperation, technical difficulties with equipment, or encountering unexpected findings. Think about how you might handle these situations, including when to seek assistance.
  • Identify how you feel about performing diagnostic tests on patients with these conditions. Consider any anxieties you might have and how you can address them through preparation.

In action

• Pay attention to your actions as you interact with the patient and operate the equipment.
  • How are you preparing the patient for the specific test? What steps are you taking for electrode placement?
  • How are you initiating and monitoring the recording? Why are you performing each step in this way?
  • What decisions are you making during the testing process? For example, how are you adjusting the settings on the equipment?
  • How are you responding to patient compliance or communication? How are you identifying and addressing potential artefacts?
  • What aspects of performing these diagnostic tests feel intuitive (e.g., electrode placement for a specific test you’ve done before), and what requires more conscious effort (e.g., troubleshooting a new type of artefact)?
• How effective are your actions in obtaining good quality recordings for each patient and condition?
  • Are you encountering any difficulties with signal quality? Are the patients comfortable and cooperative?
  • What challenges are you facing during these tests? For example, are you having trouble with electrode contact? Is the patient finding a particular test uncomfortable? Are you unsure how to minimise a specific type of artefact?
  • What can you learn from each test as it unfolds? Are you noticing patterns in the recordings related to specific conditions? Are you gaining a better understanding of how patient factors can affect the results?
  • How does this activity connect to your existing knowledge of electrophysiology and these common conditions? Are you able to apply your theoretical understanding to the practical situation? Are you identifying areas where your knowledge needs to be strengthened?
• Are there alternative approaches you could be considering for patient preparation or electrode placement if your initial attempts are unsuccessful? Could you try a different type of electrode? Could you modify your explanation to the patient?
  • What support or guidance might you need in this moment if you encounter a significant challenge (e.g., inability to obtain a recording)?
  • Are you confident in your ability to perform the tests safely and effectively, or do you feel that a specific aspect is beyond your current ability?

On action

• Summarise the key points of performing the diagnostic tests for each of the common conditions.
  • What types of tests did you perform?
  • What were the key steps involved for each? How did the patients respond?
  • What were your observations regarding the quality of the recordings obtained for each patient?
  •  Were there any significant artefacts or challenges in obtaining clear data?
  • Reflect on your interactions with the patients during the testing process. How did you prepare them for the tests? How did you manage any discomfort or anxiety?
• Did you become more proficient in specific tests?
  • Did you gain a better understanding of how these common conditions manifest in electrophysiological recordings?
  • Did you encounter any unusual patient presentations? Did you find a particular technique for managing artefacts to be very effective?
  • Did you make any adjustments to your approach based on your real-time observations and decisions?
  • How did the experience align with your understanding of standard operating procedures?
• What areas for continued development have been identified as a result of performing these tests?
  • Do you need more practice with specific testing protocols?
  • Do you want to improve your patient communication skills? W
  • ill you be more mindful of certain patient factors when preparing for tests?
  • Will you adopt any new techniques for optimising recording quality?
  • Will you review the ISCEV standards for these tests?
  • Will you seek feedback on your testing technique from a senior colleague? Would it be helpful to observe more experienced colleagues performing these tests?
  • Are there any training materials you should revisit?

Beyond action

• Have you reflected on specific patient cases or challenges you encountered during these tests since you first performed them?
  • Compare these experiences with those from other training activities or experiences where you performed different electrophysiological tests or interacted with patients.
  • What similarities or differences have you noticed in your approach and confidence levels over time?
  • What observable behaviours and practices related to patient interaction and test execution have you assimilated?
  • What key insights about performing these specific tests stand out to you now?
  • Has discussing your experiences or the outcomes with others offered new perspectives?
• Recognise that performing these diagnostic tests contributes to your overall training. How have these specific experiences built a foundation for your ability to perform a wider range of electrophysiological assessments?
  • Have they improved your practical skills in electrode placement or artefact management?
  • How have you applied the knowledge and skills gained from these experiences in subsequent patient testing or when assisting colleagues?
  • How has your confidence in performing these tests evolved?
• Identify the transferable skills you are developing, such as attention to detail, technical proficiency, and patient care.
  • How will your experiences with these common conditions inform your approach to more complex or rare cases in the future?
  • Identify clear actions for continued development of your diagnostic testing skills.
  • What specific areas related to these common conditions or the associated testing procedures will you focus on to further refine your 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.