Training activity information
Details
Use multichannel VEPs to assess:
- Pre-chiasmal
- Chiasmal
- Post chiasmal pathway function
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 this specific activity. This involves successfully performing multichannel VEP tests and using the results to infer function along different parts of the visual pathway (pre-chiasmal, chiasmal, post-chiasmal).
- What constitutes a successful multichannel VEP recording and a valid assessment of pathway function? What specific aspects of the multichannel VEP waveform provide information about these different pathway locations?
- Discuss with your training officer to gain clarity of what is expected of you in using multichannel VEPs for pathway assessment.
- What is your prior experience of this activity?
- Think about what you already know about performing standard VEPs, working with multichannel recording systems, or concepts related to neuroanatomy of the visual pathway.
- Consider possible challenges you might face, such as accurate electrode placement for multichannel recording, understanding phase relationships between channels, dealing with artefacts affecting specific channels, or relating waveform abnormalities to specific pathway lesions. Think about how you might handle these challenges.
- 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 complex multichannel VEP analysis or interpreting results in the context of specific neurological conditions.
- Acknowledge how you feel about assessing the specified pathway functions using multichannel VEPs.
- What do you anticipate you will learn from the experience?
- Consider the specific skills you want to develop in setting up and acquiring multichannel VEP data, analysing spatial distribution and timing across channels, and correlating electrophysiological findings with anatomical pathway function, drawing upon previous experiences.
- Identify specific insights you hope to gain, perhaps regarding how multichannel VEPs can help localise lesions, the importance of specific filter settings or analysis techniques, or the clinical applications of this advanced VEP technique.
- What additional considerations do you need to make?
- Consult actions identified following previous experience of performing VEPs or working with multichannel systems, if any.
- Identify important information you need to consider before embarking on the activity, such as the neuroanatomy of the visual pathway, principles of multichannel recording and analysis, standard protocols for multichannel VEPs, and expected normal responses for different pathway locations.
In action
- Is anything unexpected occurring?
- Are you noticing anything surprising or different from what you anticipate while using multichannel VEPs to assess pathway function?
- Are you encountering situations such as:
- A significant, localised artefact (e.g., electrode artefact) on only one or two channels of the multichannel array, corrupting topographical analysis?
- Contradictory phase or amplitude relationships appearing across channels, making localisation of the signal source difficult?
- The clinical findings (e.g., MRI lesion location) not aligning with the electrophysiological localization provided by the multichannel VEP?
- How is this experience comparing with previous experiences of similar activities, like using standard VEPs or other techniques to assess pathway function?
- How are you reacting to the unexpected development?
- How is this impacting your actions? Did you adapt or change your recording setup, electrode placement, or interpretation focus in the moment?
- Consider the steps you are taking in the moment, such as:
- Immediately re-checking the impedance and physical connection for the anomalous channel(s) while the patient remains connected?
- Are you adjusting the VEP stimulus parameters (e.g., contrast or field size) to try and isolate the function of a specific pathway segment?
- Are you consulting an anatomical diagram or textbook to verify the expected topographical distribution of a signal for a specific lesion location?
- How are you feeling in that moment? For instance, are you finding it difficult to use multichannel VEPs? Is it affecting your confidence in performing advanced topographical analysis? Do you feel positive that you can assess all the pathway functions successfully?
- What is the conclusion or outcome?
- Identify how you are working within your scope of practice when using multichannel VEPs (e.g., documenting the need for complex, high-density analysis beyond standard protocols).
- What are you learning as a result of the unexpected development? For example, are you gaining critical learning about multichannel system verification and calibration, or improving your ability to apply neuroanatomy concepts instantly to interpret VEP phase and amplitude distribution?
On action
- What happened?
- Begin by summarising the key points of the experience of using multichannel VEPs to assess pathway function (pre-chiasmal, chiasmal, or post-chiasmal).
- Consider specific events, actions, or interactions that felt important during the testing, interpretation, or analysis process, such as ensuring accurate placement for topographical mapping or analysing the phase relationships across channels. How did you feel during this experience?
- Include any ‘reflect-in-action’ moments where you adapted your approach in the moment during the activity, for instance, rapidly troubleshooting a localized electrode artefact on a single channel or adjusting the analysis window based on an initial waveform observation.
- How has this experience contributed to your developing practice?
- Identify what learning you can take from this experience with multichannel VEPs and pathway assessment.
- What strengths did you demonstrate (e.g., technical precision in electrode placement, analytical skill in correlating topographical data with neuroanatomy)?
- What skills and/or knowledge gaps were evident (e.g., difficulty interpreting complex phase inversions, unfamiliarity with advanced filtering in multichannel systems)?
- Compare this experience against previous times you have performed VEPs. Were any previously identified actions for development achieved? Has your practice in advanced visual pathway assessment improved?
- Identify any challenges you experienced (e.g., difficulty obtaining consistent data across all channels, interpretation of contradictory findings) and how you reacted to these. Did this affect your ability to deal with the situation? Were you able to overcome the challenges?
- Identify anything significant about this multichannel VEP activity, such as needing to seek advice or clarification on complex neurophysiological findings or needing to escalate to ensure you were working within your scope of practice.
- 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 received regarding your ability to use multichannel VEPs to assess different pathway functions.
- What will you do differently next time you use multichannel VEPs for pathway assessment? Has anything changed in terms of what you would do if you were faced with a similar situation again?
- Do you need to practise any aspect of this activity further? E.g., Practising reviewing anatomical distribution of VEP components for specific lesion localizations, or refining electrode placement protocols for optimal signal-to-noise ratio across all channels.
Beyond action
- Have you revisited the experiences?
- Have you reviewed your actions from your previous reflections for using multichannel VEPs to assess pathway function?
- What actions did you identify you would need to take to improve your practice related to improving multichannel VEP recording techniques, enhancing your understanding of neuroanatomy related to the visual pathway, or improving your interpretation of multichannel data to localise dysfunction? Have you completed these actions? Are you ready to demonstrate this new learning into practice?
- Engage in professional storytelling about using multichannel VEPs with peers, near peers, or colleagues. Consider if your view of the situation has changed because of analysing this with others.
- How have these experiences impacted upon current practice?
- Consider how the accumulated learning from performing or reflecting on using multichannel VEPs will support you in preparing for relevant observed ‘in-person’ assessments for this module, such as the Direct Observation of Practical Skills (DOPS) specifically for performing an advanced VEP test or Case-Based Discussions where you interpret waveforms and discuss findings related to pathway function.
- Consider how your practice related to using multichannel VEPs has developed and evolved over time. This includes recognising when something related to this activity is beyond your scope of practice.
Relevant learning outcomes
| # | Outcome |
|---|---|
| # 1 |
Outcome
Develop test plans from information given on referrals. |
| # 2 |
Outcome
Prepare patients and the clinical environment for both standard and advanced electrophysiological techniques. |
| # 3 |
Outcome
Perform standard and advanced electrophysiological techniques using correct procedures. |
| # 4 |
Outcome
Identify, assess and remedy issues encountered while performing testing. |
| # 6 |
Outcome
Prepare and participate in quality assurance activity in the department. |