Module information
Details
- Title
- Reporting and Reviewing Intraoperative Neuromonitoring
- Type
- Specialist
- Module code
- S-NI-S5-R
- Credits
- 10
- Requirement
- Compulsory
Aim of this module
This module aims to provide trainees with experience reviewing data and reporting intraoperative neuromonitoring for spinal surgery.
Work-based content
Competencies
| # | Learning outcome | Competency | Action |
|---|---|---|---|
| # 1 | Learning outcome 1, 5 |
Competency
Document and arrange to have faulty equipment checked and repaired. To include:
|
Action View |
| # 2 | Learning outcome 1, 2, 5 |
Competency
Generate reports for intraoperative neuromonitoring for spinal surgeries and document communication with the theatre team for:
|
Action View |
| # 3 | Learning outcome 1, 2, 5 |
Competency
Generate reports for intraoperative neuromonitoring for spinal surgeries and document communication with the theatre team for:
and/or
|
Action View |
| # 4 | Learning outcome 3 |
Competency
Back up and archive data and reports from intraoperative neuromonitoring for spinal surgeries |
Action View |
| # 5 | Learning outcome 1, 3 |
Competency
Contribute to a database of intraoperative neuromonitoring cases performed |
Action View |
| # 6 | Learning outcome 3, 5 |
Competency
Produce a process map of the patient pathway for spinal surgeries through the service from referral to dissemination and archival of report. Present this to an appropriate non-expert group for example a patient interest group, PPI group or other healthcare professionals who do not work in IONM. |
Action View |
| # 7 | Learning outcome 3, 5 |
Competency
Present a case study on a patient who underwent spinal surgery where somatosensory evoked potential changes (alerts) were noted. |
Action View |
| # 8 | Learning outcome 3, 4, 5 |
Competency
Present a case study on a patient who underwent spinal surgery where motor evoked potential changes (alerts) were noted. |
Action View |
| # 9 | Learning outcome 1, 2, 5 |
Competency
Audit an intraoperative neuromonitoring corrective spinal surgery case report against guidelines and report findings to a relevant department meeting.
|
Action View |
| # 10 | Learning outcome 1, 4, 5 |
Competency
Critically evaluate a SOP used for spinal surgery intraoperative neuromonitoring against guidelines and make recommendations for improvements. |
Action View |
Assessments
Complete 2 Case-Based Discussions
Complete 2 DOPS or OCEs
Direct Observation of Practical Skills Titles
- Check and test intraoperative neuromonitoring equipment following repair or routine servicing.
- Complete a final intraoperative neuromonitoring report where somatosensory evoked potentials, motor evoked potentials, free running or triggered EMG have been employed in spinal surgery.
Observed Communication Event Titles
- Discuss the report from a case where there have been intraoperative neuromonitoring changes with a colleague.
- Obtain a detailed follow up on a patient that has had intraoperative neuromonitoring.
Learning outcomes
| # | Learning outcome |
|---|---|
| 1 | Practice according to local protocols and national and international guidelines to ensure the integrity of data recorded for intraoperative neuromonitoring. |
| 2 | Produce concise and accurate reports for intraoperative neuromonitoring during spinal surgery according to local, national, and international guidelines. |
| 3 | Describe patient pathways for those undergoing intraoperative neuromonitoring during spinal surgery. |
| 4 | Critically evaluate the evidence base for intraoperative neuromonitoring. |
| 5 | Demonstrate effective and professional communication. |
Academic content (MSc in Clinical Science)
Important information
The academic parts of this module will be detailed and communicated to you by your university. Please contact them if you have questions regarding this module and its assessments. The module titles in your MSc may not be exactly identical to the work-based modules shown in the e-portfolio. Your modules will be aligned, however, to ensure that your academic and work-based learning are complimentary.
Learning outcomes
- Interpret and synthesise IONM signal changes in the context of spinal surgeries.
- Critically evaluate IONM signals considering the anaesthetic and systemic changes.
- Demonstrate understanding of the importance of IONM baselines.
- Critically apply appropriate alarm criteria to interpret IONM signals compared to their baselines.
- Critically evaluate IONM reports understanding their significance and medicolegal implications.
Indicative content
- Effects of anaesthetics drugs and muscle relaxants on the different IONM modalities. Anaesthetic fade.
- Effects of systemic factors (hypoxia, blood loss, blood pressure, temperature) on electrophysiological signals (EPs and EMG).
- Appropriate comparison of IONM signals with their baselines.
- Interpretation of IONM signal changes and their relevance to the surgical step.
- Identification of artefacts, and differentiation from real IONM signals.
- Relevant information to document during the signals acquisition: role of annotations and comments.
- Importance of accurate and timely communication with the surgical team.
- Generating a complete factual IONM report.
- Importance of the accuracy of the written report, and the potential medicolegal implications.
Clinical experiences
Important information
Clinical experiential learning is the range of activities trainees may undertake in order to gain the experience and evidence to demonstrate their achievement of module competencies and assessments. The list is not definitive or mandatory, but training officers should ensure, as best training practice, that trainees gain as many of these clinical experiences as possible. They should be included in training plans, and once undertaken they should support the completion of module assessments and competencies within the e-portfolio.
Activities
- Visit an IQIPs accredited department of any discipline to appreciate the potential role of IQIPs within intraoperative neuromonitoring services
- Attend a surgical team meeting/discussion where spinal surgery cases of note are reviewed and discussed
- Observe patient care along the patient pathway from post-op recovery to post-op clinics to appreciate the patients’ experience of their care
- Review a report for complex intraoperative neuromonitoring/mapping to appreciate the extra modalities that may be needed and reporting requirements