national standards for clinical neurophysiology

National Standards for Clinical Neurophysiology - Basic Level Sept 2009 Prepared by the ANS Education Sub Group 2008

National Standards

For

Clinical Neurophysiology

Basic Level

Individuals Record of Clinical Practice (IRCP)

2009


Professional Body Examination dates

Part I Practical Examinations will take place over the period from 1st June to the first 2 weeks of July each year. Portfolios will be assessed at that time. Part II Practical Examinations will take place on in May of year IV. Part II portfolios will need to be submitted 3 week prior to this date Employers and Students board of Study days are your opportunity to give feedback to the college/university, and attendance is encourages by ANS. These dates are issued by the HEI at the beginning of term.


NATIONAL STANDARDS – IRCP

Contents 1. Introduction and General Guidelines

a) General guidelines including the RCCP training guidelines. b) Role of Assessors c) Assessment Process

2. Portfolio Layout 3. National Standards Units

a) Professional Practice Unit b) EEG Unit c) Evoked Potential Unit d) Peripheral Neurophysiology Unit

4. Professional Practice Unit

a) Guidelines b) National Standards c) Range Specification d) Reference Guidance TP Workbook e) TP Workbook Tasks Tasks: 1 – 19

5. EEG Unit

a) Guidelines b) National Standards c) Range Specification d) Knowledge Specification e) Additional Evidence Requirement f) EEG Assessment Unit


6. Evoked Potentials Unit a) Guidelines

b) National Standards c) Range Specification d) Knowledge Specification e) Additional Evidence Requirement f) Evoked Potential Assessment unit

7. Peripheral Neurophysiology a) Guidelines b) National Standards c) Range Specification d) Knowledge Specification e) Additional Evidence Requirement f) Peripheral Neurophysiology Assessment unit

8. Recommended Reading List


National Standards

For


Introduction

And

General Guidelines

© ANS 2008. The National Standards for Clinical Neurophysiology were prepared by the EPTA (now ANS) Working Group 2004 and revised by ANS Education Sub Group 2008. Single or multiple copying of any part, by any means, or electronic storage or transmission for any purpose without the prior permission of the Chair of the Education Subgroup on behalf of ANS is in breach of Copyright Law.


General Guidelines Introduction The NHS requires a workforce that is fit for the purpose, and Clinical Governance demands professionals to be self-regulating. It is therefore necessary to ensure that the workforce is competent to practice against National Standards on which the individual Record of Clinical Practice (IRCP) is based and for the professions within clinical physiology to develop and maintain such standards. Educational Aims • To attain an understanding of techniques employed in Neurophysiology, in order to

explain the rationale for investigation and treatment of disease, modification of the investigations and interpretation of the test results.

• To become practically competent in specific areas of Neurophysiology, and to master the principles, both technically and clinically, underlying the work.

Educational Objectives • To obtain BSc in Clinical Physiology (Neurophysiology). • To obtain professional qualification covering the competencies as defined by Grade

‘A’ TP. Achieved by: • Completion of academic modules and associated assessment • Structured in-service training/ clinical placement using the IRCP Organisation of the Training Students will either be full-time or be appointed directly into post within a department offering an approved programme. Students with appropriate A levels or equivalent will take four years to complete the programme. It should be noted however that there are entry points at year 2 and 3 for those with appropriate qualifications. Students wishing to enter the programme at these entry points will be considered on their individual merits. In departments where the full range of investigations is not available, secondments to another department will be necessary. This should be arranged by the employing department in conjunction with the educational institution, or for full-time students by the educational institution. The student will have a work-based assessor (WBA), who will be responsible for assessment and in-service training. Competence to Practice will be assessed by completion of the IRCP, which will include:

• Performance evidence • Question and answer


• College/University-based assignments, projects, case studies and formal written tests

In addition, students are required to produce an evidence portfolio containing tracings/recordings for which he/she has provided interpretations and where appropriate factual reports. Students should follow the instructions for presentation that are included in the IRCP. Training Guidelines In order to ensure that students receive high quality training and have a positive outcome to their course of study, it is necessary to provide a safe and effective learning environment in the workplace. To facilitate this, the Registration Council for Clinical Physiology (RCCP) has developed the following set of guidelines for training centres. RCCP strongly advise that these are adhered to: These guidelines are designed for training and assessment of students in the workplace following the BSc in Clinical Physiology and are in line with the HPC standards of education and training. Institutions that follow the full-time route are directed to the section of those standards related to clinical placements. It is the duty of the department responsible for student training to provide an environment which supports the student through the degree programme, encourages self-directed learning and provides safe working practice. The Training Centre must:

• Provide a safe environment and promote safe and effective practice

• Ensure that at least one experienced clinical physiologist is available to provide adequate supervision for students at ALL times

• Provide an adequate number of appropriately qualified and experienced training

staff members who are fully conversant with the requirements of both the specialist option syllabus and the IRCP. (It is recommended that one assessor should be nominated for a maximum of two students)

• Ensure that the syllabus and the IRCP have been thoroughly understood and that

the department ensures that it can provide the training and assessment opportunities stated within it.

• Provide access to ALL the procedures within the IRCP. If there are particular

investigations that are not available on site, the employer is responsible for organising a secondment to another department, in consultation with the education provider. (Education providers will take responsibility for work placements for full-time students).


• Ensure that assessors to be competent in the investigations they are assessing.

Consequently departments will require specialist assessors within sub-specialities.

• Ensure that study time is made available during the working day. For each hour taught, it is expected that students will undertake at least 2 hours of self-directed study. It is recommended that 3½-7½ hours a week should be made available to students in the workplace during the academic year.

• Nominate a work-based assessor for each student. This person may also be the

trainer. Assessors must possess a relevant and current assessor qualification (For example, D32/D33 or equivalent, CGLI 7407, A units, PGCE, Practical examiners for the relevant professional body, or specialist training deemed appropriate by education providers).

• Ensure that time is made available during the working day for the Work Based

Assessor to undertake and prepare for their role.

• Provide learning resources within the department, including periodicals, books and IT facilities (including Internet access) must be appropriate to the curriculum and must be readily available to students and staff

• Make a range of learning and teaching materials available.

• Operate an equal opportunities and anti-discriminatory policy in relation to

students, together with an indication of how this will be implemented and monitored should be in place

Study Time Guidelines All students will be given time to study during their working time. They will be allocated approximately 1 day every two weeks during term time for their own study. Study time is allocated pro rata. Guidelines for this time are as follows: 1. Students are not expected to stay within the department to study although a computer

should be available for study. Staff may also use the medical school library. Students can also use the time to take advantage of the college facilities.

2. All students must inform the Head of Department as to where they will be

contactable. If the Head of Department is unavailable please inform the Department Lead Physiologist or Training Co-ordinator. Home study is permitted if prior permission is granted.

3. Study time may also be used to make appointments with the Training Co-ordinator

regarding training issues or fit in assessments if required. However, this should not compromise study time if the student has outstanding work to be completed.


4. Study time will be organised in advance. Students will be given a timetable detailing

their study time. 5. If study time is not required for any reason please inform the Head of Department or

the Training Coordinator. 6. If sick leave is taken on the day of allocated study leave, that study leave is forfeited. 7. Requests to rearrange study days can be made to the Training Coordinator. Each

request will be reviewed individually. 8. Staff and management should both keep an accurate record of study time. Staff

should record study days on their monthly time sheet. Trainers and work-based assessors: Learning, teaching and supervision must be designed to encourage safe and effective practice, independent learning and appropriate professional conduct Consequently, all training staff: placements standards

• Must have relevant professional qualifications and experience • Must be appropriately registered • Must undertake appropriate assessor training.

Training staff should develop a working relationship with the education provider to ensure that they are fully prepared and are able to provide information about and an understanding of the following:

• The learning outcomes to be achieved • The assessment procedures including the implications of, and any action to be

taken in case of failure; communication and lines of responsibility Managing Work-Based Training Training is the process by which an ‘expert’ shares information with a student. It is assumed that the trainer knows the right answers. This may be true, but it is important to note that it is possible that a student is trained by more than one person and that each trainer might adopt a slightly different way of doing things. This is not necessarily doing the wrong things, just doing them differently. It is important then to ensure consistent training standards throughout the department. Effective training is about unlocking the potential of the students to maximise their effectiveness at work. Training is about helping them to learn and develop. Undertaking a programme of formalised training and assessment in the workplace is challenging, both for students and the trainer/assessor. Although it takes up valuable time, making this


investment in the student will result in a more productive, effective and efficient clinical physiologist.

The degree programme intends to produce a ‘competent’ clinical physiologist. However the range of investigations being undertaken is broad and often complex. Therefore a degree of supervision is maintained for different investigations. For some, competence is gained under direct supervision, for others indirect supervision. Students will perform routine investigations that are straightforward independently, but with someone immediately available for advice and support. For investigations that are more complex, students should perform the investigation in the presence of a qualified supervisor. Feedback from students has shown that some find the adjustment to dealing with patients very challenging. Dealing with the sick, working on wards for the first time and coping with emergencies is extremely stressful for them. Trainers and assessors are advised to be sensitive to these feelings and provide adequate support. Learning There are many factors that affect learning. The intellectual capability of students must be suitable for their work role. The trainer may need to break down tasks into simpler or smaller steps to allow students to learn at their own pace. The trainer needs to constantly evaluate student performance and understanding so they do not feel overwhelmed by too much information. The trainer should be sensitive to previous learning experiences that may have had a negative impact on students. The relationship between a trainer and students in the workplace is a special one as the trainer is also a colleague or superior. Good communication skills are required of the trainer and s/he should be sensitive to any learning difficulties that students may experience, such as dyslexia or language difficulties.


Creating a learning environment In order to create a learning environment 6 factors contribute to a positive learning environment:

• Autonomy and recognition: the extent to which the student is valued, acknowledged and encouraged to be responsible for his/her own learning

• Job satisfaction: the extent to which the student enjoys work and intend to pursue the career

• Role clarity: whether staff understand and appreciate the roles and responsibilities • Quality of supervision: how this facilities or impedes improved practice • Peer support: the degree of support shown by colleagues • Opportunities for learning: the extent to which learning opportunities are available

and/or restricted Learning which takes place in the working environment requires everyone to help in the learning process. For example, by ensuring that there is teamwork and support for everyone within the team. Learning will take place when students feel valued and supported. Being unsupported, made to feel foolish or not being given appropriate guidance can be de-motivating. Stress like this takes its toll on everyone, and this can make the environment uncomfortable and one where individuals feel undervalued. A suitable learning environment would be one where:

• The head of department and trainers interact purposefully with students • Students are treated kindly and staff are willing to teach • Students are encouraged to ask questions and not made to feel foolish • Students are made to feel important and valued • The manager is a role model in providing this atmosphere

The role of the trainer When entering the trainer role, it is important to understand a little about psychological conditioning and motivational theory. Personal characteristics and self-esteem may affect students’ ability to learn. Failure to achieve can be frustrating and de-motivating for students. Effective feedback will encourage students to participate. Through taking on the role of trainer/assessor the practitioner will see benefits, not only for students, but for the trainer’s own personal development. The trainer’s main role is providing encouragement and support for the student. It is about involving and inspiring rather than directing and controlling. There are certain characteristics of effective trainers:

• Sound knowledge base and intellectual competence, and enthusiasm for their subject

• Recognition of their own limitations • Feeling for students emotional, cultural and social needs


• Appreciation of the students’ intellectual development • Ability to assess the degree of student understanding, answer questions and offer

explanations • Respect the student and treat as an equal • Patience, consideration, emotional stability, maturity and sound judgment • Ability to offer minimal criticism, be constructive in giving feedback but

maximise student responsiveness • Self awareness and confidence • Sense of humour • Dynamic, approachable and pragmatic • Good communication skills • Good role model

The humanistic view suggests that learning is part of self-development. In this model the trainer becomes a facilitator providing resources to assist students, encouraging self-directed learning and taking responsibility for their own learning. The trainer’s role in this instance is to:

1. Set up the training opportunity 2. Build rapport with the student 3. Assess performance 4. Provide feedback 5. Implement changes to performance where necessary

A single training session will have little or no effect on improving the student’s skills or changing his/her behaviour. Competent performance is only achieved through repeated attempts to master clinical skills and ongoing support from the trainer. Training sessions should be carried out on a regular basis. It is worth noting that although a lot of the knowledge that underpins successful performance in the workplace is delivered within the degree programme, it is vital that there is some re-enforcement within the workplace. Covering a complex subject once only is unlikely to be sufficient for students to take in. Organising training: Before any training session, both the student and the trainer should review past and current progress. Once training sessions are booked, they should not be cancelled unless there is absolutely no option. Students who are part of the department establishment tend to be treated as a ‘useful pair of hands’ quite quickly. However training should not be compromised by service need. Before training begins it is useful to set some ground rules. Both the trainer and students need to be clear about what is required from each. It is also important that students feel that discussions are treated with confidentiality. This creates an atmosphere of trust, encouraging them to stretch the boundaries of their experience.


When giving feedback after assessment, the assessor is making judgements on whether students met performance criteria or not, not expressing feelings about student performance. In the context of training however, it is sometimes appropriate to discuss how students FEEL about their job, skills and personal aspirations. Therefore, an empathetic approach to students is important. They should be made aware that the trainer has been a student too, and understands the difficulties and frustrations that they may be feeling. It can also be very constructive to start a feedback session by asking the student directly to reflect on the assessment, focussing on aspects that he/she felt went well and those that could be improved upon. This aids the development of reflective techniques and usually makes the session much easier to manage if the student identifies his/her own areas of development. The BSc programme has been designed to produce a knowledgeable and competent clinical physiologist. The knowledge underpinning competent performance is delivered during the taught modules, both generic and specialist. Students develop their practical skills in the workplace, and their competence is evaluated by assessment in the workplace. In order to achieve successful outcomes to assessments, it is necessary to ensure that departments have a structured training programme for students. In addition to supporting the student through the work-based part of the programme, it is necessary to provide support for course work. This involves:

• Helping students select an appropriate topic for the final year project • Assisting students in obtaining ethics approval if this is necessary • Supporting students undertaking the project and statistical analysis of data • Providing time and resources for course work and projects • Helping students prepare for professional body examinations

It is advisable to have a formalised plan for training that is closely linked to the deadlines contained within the clinical practice logbook. The training plan should be agreed with students at the start of training and reviewed regularly. The training plan should include an induction period when students can familiarise themselves with all aspects of the dept. Set periods of training in specified areas with agreed outcomes for each area and target dates for completion should be included. (It is important to include some time for reflection/study in each placement). The organisation of training in a specific area would need to be tailored to the level of sophistication of the investigation. Goal-setting Although the IRCP sets out what needs to be covered during the degree programme, this alone is insufficient to be able to undertake a programme of training. It is important to set short, medium and long-term goals and review these regularly. For BSc students starting the programme in Year 1, it is suggested that a set of goals should be set which are to be achieved by the time students undertake PI of their professional body examination, with short term goals for each semester. A new set of goals should be set for Years 3&4 in line


with PII examination. These goals should be put in writing and reviewed regularly. For specialities that contain a variety of different investigations it is advisable to nominate trainers for each investigation. A training file1 for each student containing the training plan, the competencies for that investigation and any training materials related to it should be kept by the trainer to ensure that a consistent standard is maintained. Within each section of the IRCP is a list of the knowledge required for each investigation. Each trainer and assessor should ensure that any training given, and questions asked during work-based assessments are in line with these syllabi. It is sound clinical practice to have set policies, procedures and protocols for each investigation undertaken within the clinical setting. This is of particular importance for students. When they are being trained by different practitioners in a particular investigation, confusion arises if the procedure followed differs. It is advisable to have all policies, procedures etc., in a central file, or give a copy of each to the student for him/her to place in their file. Reflective Practice The move to underpin all aspects of care within a rationale based on evidence requires skill in assessing evidence, analysis, decision-making and reflection. The relationship between a work-based assessor and a student should provide opportunities for reflecting on performance. We can therefore assume that supervision and work-based assessment both contribute to reflective practice. We all think about what we are doing during our clinical practice, but few of us actually use reflective thinking that is purposeful, intentional and skilled. This activity requires analytical and critical thinking skills and making judgements on effectiveness. It is about uncovering and exposing thoughts, feelings and behaviours. The difference between routine thinking and reflective thinking is that the former is static whereas the latter involves a willingness to learn and change by purposefully going through events some time after they have occurred. Reflection is the process of looking back on what has been done and pondering on it and learning lessons from what did or did not work. The act of deliberation when a practitioner consciously stops and thinks what shall I do now? Reflection can be considered as IN practice or ON practice. Reflection IN practice is thinking about action as it is happening and reflection ON practice is that which happens after an event has occurred. One could also consider reflecting on what MIGHT happen, this could form part of a discussion between a work-based assessor and a student. Reflection is a useful tool in the training process for both the assessor and the student. Keeping a reflective diary provides an opportunity to review events and analyse them. What happened? Could events have been managed differently / better? In his book


Practising Clinical Supervision, John Driscoll quotes Johns 1996: Reflection is a window through which the practitioner can view and focus self within the context of his/her own lived experience in ways that enable him/her to confront, understand and work towards resolving the contradictions within his/her practice between what is desirable and actual practice. Through the conflict of contradiction, the commitment to realise desirable work and understanding why things are as they are, the practitioner is empowered to take more appropriate action in future situations. A model that is useful for professional practice is reflecting on the event by asking:

• What happened? • What did I / others do? • How did I react?

There then needs to be an analysis of this:

• How did I feel about the event? • What was the effect of what I did / did not do? • Do I need to review / improve my skills?

This is the process of discovering what learning needs result from the event and this is noted in the reflective practice diary. Next an action plan should be drawn up which addresses the issues from the event. The diagram on the next page demonstrates this process. RCCP system for continuing professional development is based on reflection. The form used to document this reflective activity can be found on the RCCP website. (Practising Clinical Supervision – A Reflective Approach by John Driscoll 2000)

Having an experience in clinical practice WHAT?

Description of the event

Purposefully reflecting on selected aspects of that experience occurring in clinical practice

Now what? Proposed actions following the event

Action – the new learning from that experience in clinical practice

Discovering what learning arises from the process of reflection

So What? An analysis of the event


Guidelines for the assessment process (i) Principles of assessing evidence There are a number of accepted principles, which apply to the assessment of evidence. Evidence needs to be: -

• Valid • Sufficient • Authentic • Current • Transferable

Validity: Assessors need to ensure that the performance evidence being presented is appropriate to the Standard being assessed. Evidence which comes from real working environments, and which reflects performance, knowledge and understanding, is highly valid. Evidence from simulation, case studies etc., has a lower level of validity, and can only be used as additional evidence where there is insufficient evidence from performance. CPR competencies would have to be derived from simulations. Sufficiency: The overall evidence should: • Include performance evidence for each investigation • Demonstrate that the student has the knowledge and understanding specified for each

investigation, and is able to apply it • Cover all aspects as specified in the evidence requirements [including range] • Conform to the specified evidence requirements Authentic: Assessors need to be sure that the student has produced the work. Transferable: The Assessor needs to be satisfied that the student’s performance is not limited to one context or occasion. (ii) Process of assessment: Assessment planning involves agreeing with the student: • What is to be assessed • Where and when the assessment will take place • Who will be involved • How the assessment will happen, including time scale This is a formal process, and should be documented, with both assessor and student agreeing on these points.


Types of evidence that are used for the assessment process are: Primary evidence: • Direct observation • Products of work • Questioning Supplementary evidence: • Simulation • Role play • Witness testimony All forms of evidence do not hold the same value, and the highest value should be given to work-based activity, projects etc. Assessors are encouraged to use this type of evidence. Assessment process: An Assessor will: • Judge the evidence against the occupational standards • Give constructive feedback to the student • Maintain records of student progress • Ensure that there is open access to the assessment process, and ensure there is equality

of opportunity for all students • Attend updates for assessors (iii) Guidelines for practical assessments: Range: The ‘range’ specifies the various conditions under which assessments are carried out. It may involve using different types of equipment, working in a variety of environments, or dealing with different categories of patient. Reference will need to be made to the range required to complete the assessments. It may be possible, when planning an assessment, to ensure as many of the criteria in the range are covered. In the unlikely event that these criteria are not covered during the planned assessments, other evidence collected during the training period may be presented. Sources of evidence:

IRCP This is documented evidence of assessment events in which the student has participated during their training. It is also a place for the student to store relevant evidence has been produced during the course of study. Any evidence that relates to patients MUST by made anonymous. Patient confidentiality is paramount and failure of professional body practical examinations will result if this is not strictly adhered to.


As part of the IRCP, there is a collection of recordings and factual reports, plus the completed log sheets that demonstrates the student’s ability to measure, interpret and report a range of procedures.

Direct observation Most assessments will be by direct observation of student dealing with patients. Assessors should ensure the student is clear about the assessment process before beginning. During the assessment process, assessors should remain unobtrusive and must not intervene unless there is a risk to patient safety, or if the procedure may be compromised. Feedback should be given to the candidate, and all assessment documents should be completed, signed and dated.

Oral questions A number of questions must be asked on each assessment opportunity. RCCP recommend at least 2 and a maximum of 5. These must be documented, and appear with the assessment documentation. Oral questions must not be asked when the patient is present. Questioning must not interrupt the assessment procedure. Guidance for the assessment process Work place assessment should take place only when the student and the assessor agree that the student is ready. The assessor should complete an assessment plan, which is agreed with the student before the assessment and both the assessor and student sign it. The assessor should indicate the standards the student is to meet. ALL performance criteria must be met for a successful outcome. If it is not possible to meet a performance criterion by observation, questions must be asked which relate to that performance criterion. When a date for assessment is agreed, the assessor and the student should meet to review the assessment plan and should both sign the record of assessment to document the assessment event. Assessments should be by direct observation; simulations should only be used when direct observation is not possible, or would compromise patient safety. During each assessment, the assessor should observe the student without questioning or intervention, unless an emergency arises, or the patient is put at risk by the actions of the student. At the end of the assessment the assessor and student should retire to a private and quiet place where the assessor will question the student on the knowledge underpinning the performance criteria. The product from the investigation must be used during questioning. A minimum of two questions and a maximum of five should be asked per assessment.


Questions are asked to test the student’s understanding and any performance criteria that cannot be observed on that occasion. When a performance criterion is met a tick is placed in the appropriate column. If during an assessment a PC is not met, a Q is placed in the column and a question asked during the Q&A session after the assessment. No more than three questions must be used as a substitute for observation. If a question is answered incorrectly this must be clearly identified and assessors should ensure that a similar question is asked at the next assessment. Throughout the programme, an Internal Verifier from the education provider will visit to check the assessment process and ensure the quality of the assessment process, for the assessor and student. The verification process must be documented and evidence in IRCP, it is suggested that the form found in appendix 2 should be used. The IRCP (Part I) should be completed by early summer in Year 2, and presented at the Part I practical examination. The Record of Clinical Practice (Part II) should be completed by spring in Year 4, and presented prior to the Part II practical examination (date will be advised by the HEI) Criteria for professional body scrutiny of IRCP When students undertake their professional body practical examinations their IRCP is evaluated. The criteria below are those used to determine success or failure. There are three possible outcomes: Pass, resubmit and fail.


Resubmission Criteria

If the IRCP is referred, students are given TWO weeks in which to rectify the problems. They will be notified by letter, which identifies the missing evidence. They will be instructed to fax or send the amendments to a nominated individual. If students fail to send the material by the required date, the status is changed to FAIL and students have to re-submit the IRCP at the re-sit date.

Fail Criteria If the IRCP is failed, students are instructed to resubmit the IRCP at the re-sit date.

• Patient identification present on up to 5% of data

• Missing signatures • Evidence of at least 1 assessment

plan per section • Inadequate range of

patients/pathology • Guidelines for presentation have

not been met

• Patient identification present on more than 5% of data

• Incomplete evidence portfolio (Students must produce all of the required evidence)

• Incorrectly analysed or poor quality data • Missing sections and/or assessments • Photocopied signatures/assessment plans • No evidence provided for the assessments1 • Significant portion of range omitted2 • No assessment plans • At least 80% of assessments done on the

same day Candidates who fail will be required to attend the

next resit date following the exam date 1 If the product of the assessment is not included, students will be required to do

another assessment

2 The evidence should reflect the type of patient/ pathology etc specified in the

programme handbook

All IRCPs must be moderated at an Examination Board prior to confirmation of a final grade. Dates for the examinations will be made available by HEI.


The Role of ANS : The ANS Education Subgroup will have the overall responsibility for: - • Validation of theoretical teaching and practical training for purposes of professional

qualification, and for the assessment of both • Nominating Professional Body Moderator • Nominating National Assessors (Clinical) • Nominating National Assessors (Technical) • Responsible for training of the National Assessors The ANS National Exam Board has the overall responsibility for: - • Administration of final assessments of the Part I and II (including re-sits). • Quality Assurance procedures. • Awarding Honorary Examination Certificates. Competence to Practice will be assessed by: - • Practical assessments • Question and answer • Performance evidence • College-based assignments, projects, case studies and formal written tests • Completion of required assessment • Completion of Evidence Portfolio Quality Assurance Monitoring • Training, updating and monitoring of assessors • Appeals procedure • ANS strongly recommends attendance to professionally led WBA training days.


Roles and Responsibilities of National Examiners/Assessors involved in the process: Professional Body Moderator Should be of suitable professional background and have experience/status suitable to sit as a Professional Body Moderator. A PBM will not be associated with the Higher Education Institution in any other way. • Monitors the delivered content of Neurophysiology Specialist Option Module • Reviews course content against ANS Exam Board Criteria • Monitors assessment of module • Ensures National Standards both professional and academic are maintained • Attends College/University Exam Board Meetings • Provides reports to ANS Exam Board National Assessors (Clinical) • Qualified Assessor • Performs practical assessment of TP at TPS work place • Provides report and feed-back to ANS Examination Co-ordinator • Attends ANS Exam Board meetings as appropriate • Attends training and up-dating e.g. training days • Reviews evidence portfolio National Assessors (Technical) • Qualified Assessor • Vocationally competent • Performs practical assessment of TP at TPS work place • Reviews evidence portfolio • Provides report and feed-back to ANS Examination Co-ordinator • Provides feed-back to WBA • Attends training and up-dating e.g. training days


Work Based Assessors (WBAs) The relationship of the TP and the WBA is an important one and it is vital that the WBA works closely with the TP. WBA are there to assist, support and assess during the training period. This must be someone from the department who has the relevant qualifications/experience in training. Roles of WBA; • Qualified Assessor • Vocationally competent • Plans the training and assessment of Trainee Practitioner • Meets the TP on a regular basis and monitors progress • Advises the TP on acceptable types and range of evidence required • Performs assessments against the National Standards • Liaises with National Assessor (Technical) about final assessment • Prepares TP work place for the final assessment • Advises the TP on collating their evidence portfolio • Guides the development of the evidence portfolio for relevance, authenticity and

sufficiency against the minimum guidelines • Undertakes observations of the TP to ensure competence • Ensures that 3 competent assessments are taken for each modality – EEG, EP and

NCS- against the minimum guidelines • Ensures constant feedback is given to the TP • Provides extra provision for learning where necessary. • Acts as support/ mentor for the TP, ensuring that they understand the pathway of

support. • Attends training meetings such as WBA courses • Encourages membership of ANS


Assessment Process

ANS Council

ANS Strategic Education Group

ANS Education Sub Group

ANS National Examination Board

Professional Body Moderator External Assessors Assessment of Underpinning Knowledge Assessment of Practical Skills

National Assessors (Technical) National Assessors (Clinical) Qualified Registered TP Medical TP Assessment Qualification Assessment Qualifications

Work based Assessors (WBA)

Assessment Qualifications

University Clinical Co-ordinator

Trainee Practitioner (TP)


National Standards

For


Basic Level

Part I

Competent TP


PORTFOLIO LAYOUT (Part I only ) Part II Portfolio layout is covered in a later section. 3 loose-leaf folders

• The folders should contain clearly marked sections (see below). • Trainee’s name and hospital at the front of each folder.

Section One: Folder 1 Should contain:

1. All of the required formal assessments. 2. Calibration using an external signal source:

o Frequency response curves, noise and common mode rejection ratio Evidence must be provided in the portfolio that extended machine checks have been performed by the candidate using an external calibration device.

This must include:

- Graphs documenting frequency response data across a range of filter settings, including calculation of the frequencies at the -3dB points. - Calculation of internal noise. - Calculation of CMRR.

A witness statement should be included by the work-based assessor, confirming that the work was performed by the TP. This should also include a range of questions/answers which demonstrate that the TP understands the underlying concepts.

3. Polygraphy assessment evidence. Section Two: Folder 2 Should contain:

1. List of Criteria Table (this will contain in table form any assessment criteria not covered during all of the 3 formal assessments; including the date it was covered, investigation number and comments from the assessor).

2. Copy of the Range Statement (witness statement or other evidence numbered by each piece of the Range).


Section Three: Folder 2 Should contain: -Additional Evidence.

1. Summary List of the EEGs performed independently in each of the categories listed.

2. Abnormal EEG reports, copies of request forms and samples of the EEG for at least 10 of the conditions/syndromes listed. Ten of the EEGs themselves must be available for the Part I assessment. The Part I Assessors will select 2 of these to discuss with the TP on the day of the final assessment.


Section Four: Folder 3 Should contain:

1. Professional Practice Evidence. To assist with the forms and paperwork we have put a pack together that we suggest you use to document the supporting evidence required in your portfolio.

The following pack contains:

1) Trainee Practitioner /Patient Log sheet -Witness Statement Sheet. 2) Range Statement form numbered and in columns. * 3) Assessment Criteria Table for 3 assessments. * 4) Assessment Summary sheets. * 5) Number of investigations summary sheet and 10 abnormal

reports. *

*You will need to find the appropriate forms from the Assessment Logbook depending on which assessment you are preparing for - Part I or Part II.


1) Trainee Practitioner/ Patient Log Sheet – Witness Statement Sheet

Trainee Practitioner (TP)………………………………………………… EEG No. ……………... Assessor (WBA) ………………………………………………….. ….Date …………….……. TP Involvement: Observes Assists Performs Investigation Performed: Patient Type: Age: Clinical Problem:

Expected/possible EEG abnormality:

Problems Encountered:

Recording Information:

Abnormalities Found:

Range covered:


Assignment set by WBA:

WBA/TP Reflective Comments: Signature WBA: Trainee Practitioner:


2) Range Statement form, numbered and in columns An example of how to complete this illustrated below: The range of conditions and circumstances under which the TP must be able to competently plan, prepare, perform and report on-site and off-site EEG recordings are: Ranges:- Evidence

Reference 1.0 1.1 1.2 1.3 1.4

Patient State Awake Asleep Altered state of consciousness Poor compliance

TP/ Patient Log sheet EEG No 12450

TP/Patient Log Sheet EEG No 13479 Witness statement EEG No 345789

2.0 2.1 2.2 2.3 2.4 2.5 2.6 2.7 2.8 2.9 2.10 2.11

Patients Condition Patient presenting with any problem requiring EEG investigation Patient with communication difficulties Patient who requires mobility aids Patient requiring additional explanation and support to achieve an understanding of the investigation. Patient on prescribed medication Patient who requires medication as part of the investigation Patient whose drug regimen may influence the conduct of the examination Patient whose condition requires modification of the plan Patient who is connected to other equipment Patient in whom activation procedure is contraindicated Patient with photosensitive epilepsy

etc

3.0 3.1 3.2 3.3 3.4 3.5

Equipment Standard EEG machine Non invasive EEG electrodes Photic stimulator Additional transducers for specific test Signal generator

etc

All sections of the range need to be complete with relevant evidence references as illustrated above.


3) Assessment Criteria Table An Example of this is illustrated below: Completion of all performance criteria during the training period In the eventuality of one of the performance criteria not being met over the 3 assessments carried out by the work-based assessor, keep a record of when the TP demonstrated competence in that particular aspect of the procedure over the training period. Evidence of this will need to be accessible to the National Assessors at the final assessment, should they require it.

Assessment Criteria not applicable during all 3 assessments

EEG No./Date when AC covered

Assessor Comments

Section 3: 3.3 Section 5: 5.10 etc

12400 / 2.4.04 12200 / 19.12.03

See witness statement Process abandoned


4) Assessment Summary Sheet Example below

ASSESSMENT SUMMARY SHEET - EEG

Assessment No.

Date Type EEG:- Adult/Child/Sleep/Portable

Range covered Achieved Not Achieved Abandoned


5) Number of investigations summary sheet and abnormal reports Example below: Additional Evidence Requirements for EEG Section Additional evidence, covering a range of conditions and number of EEGs performed under supervision required for completion of this section. Please note that the numbers listed below are EXAMPLES and that there is no mandatory number of tests required. [Information must be available for final assessment for the National Assessors to view if necessary] Number of EEGs performed independently: Test Numbers Adults 200 Children 15 Children under 5 20 Sleep EEGs 9 Portable EEGs in non-dedicated environment 4 Provide EEG factual reports, together with the consultant’s conclusion and examples of the recording to support the diagnosis from a range of at least 10 of the following disorders (one of these may be a non epileptic seizure). These need to be signed, dated and witnessed by WBA to confirm that these are the TP’s own work. Disorder EEG No. Generalised epilepsies Partial epilepsies 14324

12340 etc

Epilepsy syndromes e.g. West syndrome, typical absence, Juvenile myoclonic epilepsy , benign epilepsy of centro-temporal origin etc.

Cerebral inflammatory process e.g. encephalitis meningitis etc Degenerative disorders e.g. Alzheimer’s CJD etc Cerebrovascular disorders Metabolic disorders Others e.g. non epileptic seizures etc Ten of the above need to be available for review by the National Assessors, who will pick 2 of them to discuss with the TP.


National Standards

For


Professional Practice Unit


Guidelines for each Unit Professional Practice Unit Good Professional Practice Aims To enable the TP to contribute, promote and monitor good professional practice Objectives To ensure the TP is able to: - • Promote, monitor and maintain Health and Safety in the workplace • Contribute to the welfare of patients and visitors • Contribute to effective team working, Clinical Governance and audit • Ensures confidentiality and compliance with the Data Protection Act Achieved by: • Practical experience, with appropriate training within the work environment • Use of the Knowledge Specification List • Underpinning knowledge - from hospital and college-based tutorials and formal

lectures • Completion of assessed Evidence Portfolio and Witness Statements. Tasks within this

unit are to be kept in folder 3 of the Evidence Portfolio. On completion of each task evidence must be signed by the TP and countersigned by the work-based assessor.

Assessment Procedure For each section of the Unit evidence of competent performance will be by practical assessment performed by the designated work-based assessor.


PROFESSIONAL PRACTICE UNIT:

Unit 1: Good Professional Practice

Section 1: Promote, monitor and maintain Health and Safety in the workplace Section 2: Contribute to the welfare of patients and visitors Section 3: Contribute to effective team working, Clinical Governance and Audit Section 4: Ensure confidentiality and compliance with the requirements of

legislation and local organisational policies

Summary This unit describes standards for good professional practice. These include ensuring Health and Safety in the workplace by the anticipation and avoidance of hazards and the appropriate management of medical and other emergencies, untoward incidents and complaints. The unit also addresses issues of patient confidentiality and data protection, team working, attitudes to patients of varied ethnic and social backgrounds / gender / religious persuasion and sexual orientation, and patients and/or visitors who are aggressive, disruptive or disturbed. The TP must contribute to Clinical Governance and audit.


Section 1: Promote, monitor and maintain Health and Safety in the work place The Trainee Practitioner must be able to: 1.1 Identify, minimise and where possible eliminate any potential risks to patients, visitors and staff in

accordance with current legislative and local policies/procedures.

1.2 Manage medical emergencies appropriately and promptly.

1.3 Follow fire and non-medical emergency procedures promptly.

1.4 Manage accidents and untoward incidents within their own capabilities and report in accordance with local procedures.

Performance evidence required TP must gather evidence in Evidence Portfolio


Section 2: Contribute to the welfare of patients and visitors The Trainee Practitioner must be able to: 2.1 Establish effective communication with all conscious patients and adopt special methods for patients

with sensory impairment or linguistic difficulties.

2.2 Explain (where the patient’s mental capacity permits) the nature of the proposed investigation, it’s purpose, possible discomforts or hazards, and obtain informed consent from the patient or their guardian.

2.3 Monitor the behaviour of patients/visitors and, where there is cause for concern, take preventative action.

2.4 Communicate with patients/visitors to promote acceptable behaviour.

2.5 Identify possible intruders and take appropriate action.



Section 3: Contribute to effective team working Clinical Governance and Audit The Trainee Practitioner must be able to: 3.1 Ensure that behaviour to others in the team supports the effective functioning of the team.

3.2 Keep other members of the team informed of activities as appropriate.

3.3 Deal with differences in opinion in a way which tries to avoid offence, and resolve conflicts in ways that

maintain respect.

3.4 Seek advice from the appropriate person if experiencing problems in working effectively with other team members.

3.5 Participate in departmental Clinical Governance and audit meetings.

3.6 Take responsibility for their development, learning and performance.

3.7 Use feedback from others constructively to improve future work performance.



Section 4: Ensure confidentiality and compliance with the requirements of Legislation and Local Organisational Policy The Trainee Practitioner must be able to: 4.1 Store and retrieve information from recording systems in compliance with the requirements of legislation

and organisational policy.

4.2 Make records that are accurate and legible and contain only the information necessary for the record’s purpose.

4.3 Disclose information only to those who have the right and need to know, and only after proof of identity has been obtained.

4.4 Handle confidential records securely and store them in the correct place.



PROFESSIONAL PRACTICE UNIT: The range of risks and circumstances under which the TP must be able to competently promote, monitor and maintain Health and Safety in the work place are: Ranges Applicable

to sections 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 1.9

Potential risks Electrical Toxicological Microbiological Fire hazards Other environmental Obstructions to safe passage Manual handling Spillage Waste disposal

1

2.0 2.1 2.2 2.3 2.4 2.5 2.6 2.7

Medical Emergencies & Risks Seizures Collapse including syncope Other states of altered consciousness Acute psychiatric disturbance Acute cardiopulmonary insufficiency Anaphylaxis Intoxication - alcohol substance abuse

1

3.0 3.1 3.2 3.3

Media Electronic Written Printed

4

4.0 4.1 4.2 4.3

Precautions in relation to: Overhearing information Overseeing information Deliberate unauthorised access

4

5.0 5.1 5.2 5.3

Communication Electronic Written Oral

4


TRAINEE PRACTITIONER WORKBOOK

This workbook has been developed to help you prove competence and demonstrate underpinning knowledge required for this unit. Please complete the following tasks, add and index the evidence required to demonstrate competence against each sub-section. Keep your evidence in Folder 3 of your Evidence Portfolio. On completion of each task the evidence should be signed by both the TP and WBA. For actual events the following evidence can be used: -

Reflective statement Testimony Witness statement Copies of official documents generated by events [e.g. accident forms] Reports

Other evidence can be used: - Audit Risk Assessment Projects [college work etc.] Direct questioning [evidence must appear in portfolio] Simulation [can be used in the absence of other evidence being available]

If you have any problems completing this workbook seek help from your work-based Assessor. Reference Guide: The following information can be used as reference information for completing the workbook: - • Patients Charter • Policies relating to information • Hospital and other Health and Safety/Access to Information documentation • Hospital Equal Opportunities Policy • Information given to patients relating to appointments and tests • Policies for use with interpreters/chaperones etc. • Hospital and Departmental policies of confidentiality of patient information • Hospital and Departmental policies on storage of stock • Policy of Equipment Maintenance and Service • Policy for Infection Control and hand hygiene.


Trainee Practitioner Workbook Tasks Task 1 Responsibilities - Health and Safety Both employers and employees have duties under the Health and Safety Act and Regulations.

a) List examples of what these are:

Employers Employees

b) List the laws and regulations relating to Health, Safety and Security. Task 2 How do you deal with emergencies? a.) Draw or attach a floor plan of your area which identifies emergency call systems, fire exits and assembly points, fire fighting equipment and resuscitation equipment. b) Dealing with emergencies: Write a short statement describing what actions you must take in all the emergencies listed in the range: Electric shock Fire Seizures Serious fall Syncope Cardiac Arrest Acute Respiratory Distress Severe bleeding Violent aggressive behaviour


Task 3 Recording Accidents procedure: Write a short statement of the procedure you would follow in recording and reporting an accident/untoward incident in the following situations: - a) Accident/untoward incident to staff. b) Accident/untoward incident to patient/visitor. Task 4 Risk Assessment: There are a number of health, safety and security risks common to your working environment. Identify and list the risks with any actions required to minimise them. For example; Risk Identified Action Required e.g. fire door wedged open Remove wedge inform line manager etc Task 5 Risks: There are a number of health, safety and security risks common to working in a hospital environment. What would you do in the following situations? Risk Identified Action Required The brakes on a trolley are not working. An oxygen cylinder is leaking. A patient asks you to stand her up from the wheel chair, as she is unable to help herself. There is no one around to help.

There is a spillage of urine on the floor in a patient walkway.

A cable on the machine you are using to investigate a patient is loose.


Task 6 1) Give examples of the different types of hazardous and non-hazardous waste in your area. 2) How do you dispose of the different types of waste in your area? 3) How do you dispose of needles? 4) For clinical safe practice, give examples of the precautions taken, protective equipment

[including clothing] and safe disposal requirements in your work area. 5) Write a short statement on how you would deal with the following: -

a) Spillage of blood b) Patient with a provisional diagnosis of Creutzfeldt-Jacob disease c) Patient with HIV/Hepatitis d) Patient with MRSA

6) Identify the handling aids available in your department. 7) Discuss the precautions you would need to take when dealing with bed-bound Patients: -

a) In the department b) In a high-dependency area


8) What is the staff’s responsibility with respect to infection control and hand hygiene?

a) In your department. b) On ward areas.

9) How would you deal with soiled linen in your department? 10) With regard to your local infection control policy, how would you clean/disinfect the following? : -

a) Electrical equipment. b) Metal dressing trolley. c) Couch. d) EEG electrodes. e) Surface NCV electrodes.

11) What is meant by hospital-acquired infection (giving examples)? 12) Describe how effective hand washing may help reduce the above. Task 7 Your employer provides you with mandatory training with regard to Health and Safety. List below the training and any assessment undertaken during your training period: - Date Training Assessment [tick if

appropriate]

NB: Evidence of attendance is required for your portfolio.


Task 8 Handling potentially dangerous materials:

a) What is the name of the Act which deals with the handling of potentially dangerous materials? b)You need to be aware of all the potentially dangerous materials you work with and you must know how to deal with them.

Note down the following information for each hazardous piece of equipment or substance you use at work. See the example used as a guide.

Equipmen t/Substance

Associated Risk

Actual risk to patient/staff

Instructions for use/storage information

Actions required following an incident

Methylated spirit

Flammable Moderately toxic

Fire Eye - Corneal damage possible Ingestion - moderate toxicity Skin – irritant

Keep in secure container. Store in a fireproof fume cupboard. Goggles or face shield. Rubber or plastic gloves

First Aid:- Eyes -wash with water for 10 minutes obtain medical attention Skin - wash with water Ingestion - wash mouth with water ;obtain medical attention. Lungs - remove from exposure obtain medical advice


Task 9 1) Discuss why in your explanation of any procedure you undertake it is essential to obtain consent. 2) Describe the local procedure for obtaining consent to activation procedures. 3) When preparing a patient for an EEG, discuss how you would communicate with them in the following situations: -

a) Hearing impaired b) Profoundly deaf c) Non-English speaking d) In a wheel-chair e) Child f) Learning difficulties g) Visual Impairment h) In a Confused/agitated state

Task 10 Discuss briefly what you would do in the following situations: -

a) You find someone that you do not recognise in a non-patient area in your department. b) During an EEG recording a psychotic patient becomes verbally abusive and starts pulling off the electrodes. c) You are performing an EEG in a room adjacent to, but isolated from the rest of the department and your patient starts to complain about having chest pain.


Task 11

a) List the policies or legislation which relate to Access to Information in your workplace. b) Briefly describe what each of these documents requires of all staff in your work area.

Task 12 List all types of records kept in your work area and the access rights/precautions taken to ensure all of the Trust/Department policies are met. Types of records Format Access/precautions


Task 13 Records need to be understandable to the people who read them. Many records use medical terms or jargon. Look at the records used in your area and list some medical terms and other abbreviations which are commonly used. Write a brief explanation of each abbreviation or term that could be understood by a new member of staff.

Abbreviation What it means

Task 14 Write down what you should do in the following scenarios: -

a) You discover the name of a patient attending for an investigation is spelt incorrectly on their medical records. b) On investigating a commotion in reception you find a confused, elderly patient attacking another patient. You separate them, using the minimum force necessary. You do not want to cause a fuss so you do not report it. Next day you are summoned to the manager’s office and accused of assaulting one of the patients. The patient’s lower arm shows bruising that was allegedly caused by you. What records should you have made, and to whom should it have been reported? What could be the consequence of this procedure not being followed? c) You receive a phone call from a doctor in a GP’s surgery wanting the results of an investigation. What do you do? d) You receive a telephone call from someone wanting to speak to a co-worker in your department who is currently performing an investigation. Describe how you would deal with this situation. e) You are the first person to arrive in the department and a relative of a colleague rings with the information that they will not be in today as they are not well. What do you do?


Task 15

a) What would you do if a patient demands to read their notes? b) How are records coded and filed correctly in medical records and in your work area? c) In what situations might you have to refuse to give information? How would you do so politely without offending the individual? d) What special considerations would you make when booking an appointment for a young child? Include in your description any special requirements with regard to the type of information required.

Task 16 a) List various ways/situations in which information is given to, and disseminated between staff within your work area. b) Which do you perceive as the most effective and efficient way, and why?

Task 17

a) Briefly describe what clinical governance requires of you. b) List the quality and audit activities you have been involved in.

Task 18 Professional development:

a) What is a professional portfolio? b) List the professionals in the NHS that are required to compile a portfolio. c) What is the purpose of compiling a professional portfolio? d) List the information that may be contained in a professional portfolio. e) How would you make use of reflective practice in professional development? f) What is Critical Incident Analysis?


Task 19 You will be involved in all sorts of training and development activities throughout your training period. Keep a record of these activities on the sheet. Include meetings [departmental, regional & national],training sessions, performance reviews, personal development planning etc. NAME: TRUST: START DATE: DATES Start/finish ACTIVITY OTHER EVIDENCE

Certificates/assessments etc. VENUE

Trainee Practitioner Name Date Work based Assessors Name Date Verified by [print name] Date


National Standards

For


EEG Unit


Guidelines for each Unit EEG Unit Record and Report Conventional EEGs in Adults & Children Aims To enable the Trainee Practitioner (TP) to become competent in recording and reporting conventional EEGs in a range of environments, in both adults and children. Objectives To ensure the trainee is able to: - • Calibrate and prepare equipment including the EEG machine, electrodes and

transducers. • Plan and prepare the investigation on the basis of information about the patient’s

condition, including obtaining additional information from a patient history, where appropriate.

• Modify the investigation according to the clinical problem, the patient history and the EEG findings.

• Perform EEG investigations with appropriate polygraphy. • Carry out activation procedures. • Complete the investigation and prepare a report, including identification of normal and

abnormal findings. Achieved by: • Practical experience with appropriate training within the work environment. • Use of the Knowledge Specification List. • Underpinning knowledge from college-based tutorials and formal lectures. • Completion of all required assessments. Assessment Procedure For each section of the Unit evidence of competent performance will be by practical assessment, performed by the designated work-based assessor. The ANS National Examination Assessors will perform a final assessment at the end of this Unit, which will include examination of the candidates completed logbook/portfolio


EEG UNIT: Record and report conventional electroencephalograms (EEGs) in adults and children

Sections 1) Plan and prepare for on-site and off-site EEG recordings

2) Prepare equipment for EEG recordings

3) Prepare patients for EEG recordings

4) Monitor and record EEGs with appropriate polygraphy

5) Implement and monitor activation procedures during EEGs

6) Complete and report EEG investigations

Summary This unit describes recording and reporting of conventional electroencephalograms (EEGs). The unit applies to patients of all ages (neonates optional) and clinical and behavioural states, for any condition leading to a request for an EEG. An essential part of this investigation is the preparation of equipment such as the EEG machines, electrodes and transducers. The preparation of equipment includes the calibration of the recording system. It is important that the TP plans the investigation on the basis of information about the patient's condition. The TP is required to obtain a relevant history from the patient, to record the patient’s state at the time of investigation and to document current medication, results of other relevant investigations etc. The unit also covers preparing the patient for the investigation and carrying out the investigation. Special planning and preparation are required for transporting equipment and recording an EEG in a non-dedicated environment. The TP must be able to modify the investigation, taking account of the clinical problem and the EEG findings, in order to obtain accurate and useful results.This may require the adjustment of controls, the application of additional electrodes or modification of the state of the patient. It will also require the TP to minimise or eliminate any artefacts which occur. The TP must also be able to carry out activation procedures including hyperventilation (HV), intermittent photic stimulation (IPS) and sleep induction. On completion of the investigation, the TP is required to provide a factual report of the results. The TP must be able to provide factual reports on both normal and abnormal EEGs.


The candidate will be expected to have a practical understanding of machine checks, and additionally will be expected to perform extended testing; providing evidence that they have produced frequency response curves and calculation of common mode rejection ratio and internal noise (using an external calibration source where required). Principles of good practice The beliefs and rights of the patients must be acknowledged, and the TP must take into account the patient's communication needs when discussing, explaining and conducting the investigation.

The TP must also seek to maintain the patient's sense of dignity and self esteem during the investigation. These principles are presumed to apply throughout every part of these National Standards for Clinical Neurophysiology.


Section 1: Plan and prepare for on-site and off-site EEG recordings

The TP must be able to:

1.1 Ensure that all available data pertinent to the investigation upon the patient is available, in accordance

with recommended procedures, and checked for validity.

1.2 Evaluate the above data and plan the investigation.

1.3 Where the above data is insufficient to produce a valid plan, request further data, or refer the matter to senior staff.

1.4 Discuss, where appropriate, the location for the investigation, and any special needs of the patient.

1.5 Seek advice if the skills or knowledge required for the investigation is beyond that of the TP.

1.6 Ensure that any medication prescribed for the investigation is available.

1.7 Make arrangements where necessary for the transport of equipment and accessories outside the dedicated laboratory.

Performance evidence required

4 Assessments to include: -

Adult

Child under 5 years of age

Portable recording in a non-dedicated environment

Planned sleep or other non-routine investigation

Polygraphy *

*Should a suitable opportunity not arise during one of the formal assessments a simulation could be used and assessed (evidence should be presented with the formal assessment).


Section 2: Prepare equipment for EEG recordings


2.1 Check that the equipment selected is in a safe condition and operates correctly, including all relevant

peripheral devices.

2.2 Assess printer function (if used) and check that adequate paper is available.

2.3 Ensure that there is adequate available storage media for the proposed investigation.

2.4 Ensure that default settings, sampling rate, number of channels enabled etc. are appropriate.

2.5 Ensure that recording parameters e.g. sensitivity, low & high pass filters, notch filter etc. are checked and are appropriate.

2.6 Perform an auto calibration/amplifier integrity check.

2.7 Assess sensitivity using a square wave signal - all channels are tested over a range of settings.

2.8 Check the photic stimulator is functioning, and assess the accuracy of the photic marker.

2.9 Assess the display speed and check the accuracy of the time marker.

2.10 Identify equipment faults and either report or rectify as appropriate, in accordance with departmental policy.

2.11 Produce a formal record of machine performance (relating to 2.6-2.10)

2.12 Ensure that the necessary type (and quantity) of consumables are available for the planned investigation.

2.13 Ensure equipment and accessories are checked in the base department before transportation for off-site recordings.



Dedicated environment

Non-dedicated environment

Equipment log (machine function and faults) must include extended calibration checks *


Section 3: Prepare patients for EEG recordings The TP must be able to:

3.1 Confirm the patient’s identity matches that on the referral documents

3.2 Accurately enter/identify the patient’s information on the recording machine.

3.3 Establish effective communication with the patient/carers. Explain the test in a manner liable to ensure

that their co-operation is enlisted. 3.4 Obtain a full, but concise history, relevant to the investigation and record this information accurately

3.5 Discuss and confirm the patient's current medication with the patient &/or carers, and record any recent variations.

3.6 Accurately assess the patient’s present condition based on all of the available information - including case notes, direct observation and questioning of patient and carers.

3.7 Following 3.4, consider any modifications to the planned procedures and refer to senior staff as required

3.8 Accurately mark electrode sites in accordance with the recommended placement system, ensuring appropriate accuracy with electrode distances (e.g. within +/- 0.5cm).

3.9 Attach electrodes and transducers correctly and securely ensuring appropriate accuracy (e.g. within +/- 0.5cm).

3.10 Ensure leads are appropriately and securely positioned and connections to the headbox are checked as correct.

3.11 Assist the patient into a position that is comfortable (as per local procedures) thereby optimising the quality of the recording.

3.12 Confirm that contact impedances are appropriate to electrode type and to the patient.

3.13 Perform preparation efficiently (e.g. co-operative adult 30 minutes approximately).*

3.14 Administer/organise for the administration of medication required for the investigation in accordance with local protocols and procedures.

*30 minutes recommended time for performance criteria 3.8-3.12


Where the patient is a child;

3.15 Encourage parents/siblings/carers to participate.

3.16 Make the recording area suitable for children.

3.17 Fully inform parents/relatives/carer of the nature and purpose of the investigation.

3.18 Adopt a suitable approach to the child to optimise co-operation.

3.19 Ensure arrangements are made for feeds and for comforters, where appropriate.



Adult


Non-dedicated environment

Planned sleep or other non-routine investigation

Polygraphy


Section 4: Monitor and Record EEGs with appropriate Polygraphy* The TP must be able to:

4.1 Employ a range of montages appropriate to the clinical problem and take recordings correctly. For

digital recordings this includes referential data checks at the beginning and end of recording (as a minimum).

4.2 Continuously monitor the results of the investigation, reviewing for validity, accuracy and clinical significance. Interactively modifies the procedure (including encouragement of spontaneous sleep) to optimise the collection of clinically useful data.

4.3 Use appropriate control settings during the investigation to optimise the identification of clinically useful data.

4.4 Modify electrode positions, apply additional electrodes and transducers as appropriate and use non-standard montages according to the patient characteristics, clinical problem, and findings during the recording.

4.5 Identify and eliminate artefacts or minimise and annotate them.

4.6 Ensure that patients having seizures and other medical emergencies are correctly managed

4.7 Give the necessary support to patients in disturbed mental states and treat them in accordance with agreed guidelines.

4.8 Accurately and legibly annotate the EEG recording.

4.9 Record a single channel ECG.

4.10* Record Polygraphic variables, as indicated by the clinical condition of the patient, and ensuring machine settings are adjusted appropriately (filter settings etc.).

4.11 Accurately identify the need to modify or extend the current investigation and refer to a senior member of staff for advice, if necessary.



Using a range of montages bipolar common and average reference and non routine montages

Adult


Portable recording in a non-dedicated environment

Planned sleep

Polygraphy *

*Should a suitable opportunity not arise during one of the formal assessments a simulation could be used and assessed (evidence should be presented with the formal assessment).


Section 5: Implement and monitor activation procedures during EEG The TP must be able to:

5.1 Review the data obtained from the initial recording to assess the relevance of the proposed activation

procedure. 5.2 Establish that the proposed activation procedure is not contraindicated and is performed to department

guidelines. 5.3 Accurately identify any indications that activation should not proceed and refer to a senior member of

staff for discussion, if appropriate. 5.4 Provide the patient with a clear and accurate explanation of the procedure and encouraged them to clarify

any areas of concern. 5.5 Treat the patients in a manner which is likely to encourage co-operation and confidence and maintain

their dignity. 5.6 Obtains consent to perform the procedure.

5.7 Make the immediate environment suitable for the intended activation procedure.

5.8 Position the patient suitably to perform the activation procedure.

5.9 Implement the activation procedure correctly and safely in accordance with conventional protocol and encourage the patient to co-operate.

5.10 Annotate details relevant to the procedure (time, effort, eyes open etc)

5.11 Continuously monitor the activation procedure and accurately record changes in the condition of the patient.

5.12 Accurately identify and respond promptly to any indications that the activation procedure should be discontinued.

Additionally for Intermittent Photic Stimulation:

5.13 In the event of a photo-paroxysmal response being obtained, follow the correct local procedures.



Hyperventilation

Intermittent Photic Stimulation

Sleep

Polygraphy

Adult



Section 6: Complete and factually report EEG investigations


6.1 Completely remove electrodes and transducers and carefully clean the sites with minimum discomfort to

the patient. * 6.2 Reassure the patient and give them sufficient time to recover from the investigation prior to leaving the

department. * 6.3 Clearly and accurately inform the patient of the procedure for notification of the results from the

investigation. * 6.4 Treat the patients in a manner which is likely to preserve their dignity, confidence and self esteem

throughout the investigation. * 6.5 Ensure that any required transportation/portering services and escort are made available to coincide with

the completion of the investigation and the readiness of the patient to leave. * 6.6 Clean equipment (and where appropriate sterilise it), in accordance with local policy, and leave it in a

condition suitable for re-use. * 6.7 Dispose of consumable in a safe manner and place. * 6.8 Adhere to local infection control and hand hygiene policies and procedures throughout the investigation.

6.9 Ensure that annotations made to recordings and other patient documentation are accurate, legible and

complete. 6.10 Manipulate the data - to include: measuring frequency and amplitude, re-montaging to enhance specific

features etc. Demonstrate other skills, for example; editing a montage, searching for events, demonstrating the effect of changing machine parameters and setting up a new montage.

6.11 Promptly prepare a concise, accurate factual report- covering the procedures employed, together with the neurophysiological findings and clinical events, drawing the clinician’s attention to features considered to be of clinical importance.

6.12 Establish the degree of urgency for the clinical report and forward the factual report to the clinician within the required time.

6.13 Follow appropriate archiving procedures.



Adult


6 Assessments of reports on records, to include adult adolescent, child under 5 years of age, clinical events, abnormal recordings in epilepsy and abnormal recordings in other disorders.

NOTE: The candidate will need to include at least 3 additional reports in addition to those produced during the formal assessments in order to satisfy the above.

* 6.2-6.8 only needs 2 formal assessments e.g. sleep and child under 5years


EEG UNIT The range of conditions and circumstances under which the TP must be able to competently plan, prepare, perform and report on-site and off-site EEG recordings are: Ranges: - Applicable to

sections: - 1.0 1.1 1.2 1.3 1.4

Patient State Awake Asleep Altered state of consciousness or behaviour Poor compliance

1 & 3

2.0 2.1 2.2 2.3 2.4 2.5 2.6 2.7 2.8 2.9 2.10 2.11

Patients Condition Patient presenting with any problem requiring EEG investigation Patient with communication difficulties Patient who requires mobility aids Patient requiring additional explanation and support to achieve an understanding of the investigation. Patient on prescribed medication Patient who requires medication as part of the investigation Patient whose drug regimen may influence the conduct of the examination Patient whose condition requires modification of the plan Patient who is connected to other equipment Patient in whom activation procedure is contraindicated Patient with photosensitive epilepsy

1 3 4 & 5

3.0 3.1 3.2 3.3 3.4

Equipment Standard EEG machine including digital Non invasive EEG electrodes Photic stimulator Additional transducers for specific test

1 2 3 4 & 6

4.0 4.1 4.2

Carers Medical and nursing staff Parents and relatives

1 & 3

5.0 5.1 5.2

Location Dedicated Neurophysiology environment Other locations within or outside the base hospital premises

1 2 3 & 4

6.0 6.1 6.2

Records Calibration Faults and remedial action

2


7.0 7.1

Age Patients of all ages excluding neonates

1 3 4 5 & 6

8.0 8.1 8.2 8.3

Appropriate control settings Adjusting machine controls to optimise the display Applying additional electrodes and transducers Using non-standard montages

4

9.0 9.1 9.2

Artefacts Biological Non-biological

4

10.0 10.1 10.2 10.3

Annotation Control settings Clinical states and events Any necessary adjustments

4 5 & 6

11.0 11.1 11.2

EEG Phenomena Normal Abnormal

4 5 & 6

12.0 12.1 12.2 12.3 12.4

Polygraphic procedures Surface EMG Eye movement Respiration Tremor

4

13.0 13.1 13.2 13.3 13.4 13.5

Environment Lighting Heating Ventilation Interference Sources Hazards

5

14.0 14.1 14.2 14.3

Activation procedures Hyperventilation (HV) Intermittent Photic Stimulation (IPS) Sleep induction

5

15.0 15.1 15.2 15.3

Descriptive data EEG recording Procedures employed Patient information

6

16.0 16.1 16.2 16.3 16.4

Report Normal recordings Abnormal recordings Clinical events Non standard procedures

6


1. Record and report conventional Electroencephalograms (EEGs) in adults and children.

Knowledge Specification for the Whole of this Unit The trainee practitioner is required to know and understand the following: Patient Care 1) The importance of ensuring identity of the patient and that the identification of the patient is correct

on all documentation. 2) The basic assessment of the condition of patients. 3) The ways in which the patient's condition may have an impact on the planned investigation. 4) The principles and methods of effective communication with patients and escorts. 5) The reasons why it is important to put the patient at ease. 6) The sorts of questions the patient may have and the appropriate answers to such questions. 7) The required position of the patient and how to help the patient become more comfortable. 8) How to maintain the patient's sense of dignity and self-esteem during the investigation. 9) Guidelines for responding to ictal events or disturbed states. 10) Infection control / hand hygiene issues related to patient-care. Neurophysiological Principles Required for Planning the EEG 10) The need to liaise with parents /guardian to ensure maximum co-operation of the child. 11) The need to liaise with nursing staff, where appropriate, to ensure that the patient is not compromised. 12) The level and type of support which the technician can give to a patient who is suffering a seizure

or disturbed state. 13) Environment is appropriately prepared and all necessary consumables and equipment available in a

dedicated or non-dedicated environment. 14) Procedures and responsibilities for notification of follow up arrangements. 15) Policies and arrangements for escorting and/or transporting patients.


Anatomy and Physiology Relevant to EEGs 16) Development and maturation of the central nervous system (CNS). 17) Major anatomical divisions of the nervous system: brain, cerebellum, brainstem and spinal cord 18) Basic functional divisions of the nervous system. 19) Anatomy and physiology of: cerebral circulation, cerebro-spinal fluid (CSF), cortical and sub-

cortical structures, other body systems. 20) Diagrammatic representation of cortical and sub-cortical structures, brainstem, ventricles, meninges,

hemispheres and lobes, reticular formation, cranial nerves, thalamus, internal capsule. 21) Motor and sensory pathways - central and peripheral. 22) Pathology of the brain. 23) The aetiology and symptomology of common pathological processes and the role of EEG in their

investigation. 24) Clinical features of disease of the nervous system. 25) Effect of cardio-respiratory and metabolic disorders on the EEG. 26) Effect and use of prescribed and non-prescribed drugs in relation to conventional EEG recordings. EEG Equipment Characteristics and Classification 27) The characteristics and specifications for digital recording systems. 28) The characteristics of electrodes and transducers. 29) The electrical safety classification of equipment. 30) Principles and practice for patient isolation with reference to equipment class. EEG Equipment Operation 31) Principles underlying the operational requirements of a recording system. 32) The structure and function of the component parts of a conventional multi channel

electroencephalogram, including; - Amplifiers - Filters and their effect on the recorded electrical activity - Display systems: different types, detailed characteristics and criteria for selection - Principles of digitalisation.


Equipment operation 33) Principles of the operation of EEG equipment. 34) Amplifier input connections for bipolar and referential (common reference and average reference) recording techniques. 35) Methods of derivation and design of montages. 36) Lateralisation and localisation of normal variants and abnormal phenomena and their effect on the

EEG display. 37) Characteristics and origins of physical and biological artefacts, methods of identification and means of elimination. 38) The use of machine controls, including their effect on the original signal and their use to highlight salient features. 39) Principles and procedures for the selection and use of additional electrodes and transducers. 40) Principles underlying the range of polygraph recording methods and for determining the selection of

particular methods. 41) Relationship of the annotation to data on recording. 42) The principles relating anomalies to current clinical problem/previous findings. Calibration of EEG equipment 43) The principles of standard calibration procedures. 44) The purpose of calibrating records. Fault finding identification and rectification 45) Principles and testing of a complete recording system and the detection and identification of

equipment faults. 46) Principles underlying the use of basic test equipment, including multimeters and signal generators

for calibration, and fault identification. 47) Procedures for the rectification of simple equipment faults. 48) Limit of responsibility in terms of rectifying faults. 49) The correct procedures for reporting faults. Medication 50) Modes of drug delivery, action and side effects. 51) Organisational procedures for drug administration.


Selection preparation and placing of electrodes for EEG 52) Central nervous system: maturation, detailed anatomy and Physiology. 53) Pathophysiological conditions of the central nervous system, aetiology and symptomology. 54) Electrode characteristics:

- Electrode potential - Polarisation - Electrode impedance and its effect on data - Silver/silver chloride electrodes.

55) Maintenance of electrodes. 56) Reasons for selection of electrodes. 57) Standard measurement/placement systems of electrodes and application to include International 10-

20 system and Maudsley (or Modified Maudsley) system. 58) Electrode/transducer characteristics and method of application. 59) Impedance measurement. Normal patterns of EEG and the recognition of clinical abnormalities 60) Origin of the EEG signal. 61) Details of the variety of patterns of normal and abnormal EEG activity and normal

variants/phenomena. 62) Normal and abnormal findings in ECG, EOG and other basic polygraphic recordings. 63) Effect of natural and induced sleep on the recording. 64) Methods of relating the findings of EEG investigations to common pathophysiological conditions

and non-organic disorders. 65) Effects of medication on the EEG. 66) Purposes and methods of activation. 67) Recording procedure for activation. 68) Normal findings of activation procedures. 69) Interaction with common pathophysiological conditions. 70) Indications that the procedures should be discontinued.


Hyperventilation (HV) 71) The physiology of hyperventilation. 72) Hyperventilation – the effects of age. 73) Variation with blood sugar levels. 74) EEG abnormalities and activation procedures. Intermittent Photic Stimulation (IPS) 75) Rationale of procedure for photic stimulation. 76) Risks to patients and others. 77) Normal variation of responses to photic stimulation. 78) Atypical and abnormal responses to photic stimulation. 79) Alternative methods of photic stimulation. 80) Characteristics of photic stimulators. Sleep activation 81) Value in relation to clinical problem. 82) Stages of sleep. 83) Medication/deprivation. Equipment maintenance and disposal 84) Principles of electrode sterilisation and cleaning methods. 85) Health and safety requirements for disposing of consumables. Report writing for EEG investigations 86) Organisational requirements for report writing. 87) Normal values for frequency, amplitude and amount in relation to age. 88) Definitions of standard terms used to describe data. 89) Principles underlying the procedures for quantitative assessment of an EEG recording. 90) Effects of medication (prescribed or not) on normal values. 91) Electrographic features associated with disease.


92) Pathological conditions and changes: in relation to age, space occupying lesions, epilepsy, infection,

cerebrovascular disease, metabolic disorders, degenerative disorders, head injury, psychiatric disorders.

93) The correlation of normal rhythms/variants/phenomena with changing physical state as a basis for preparing factual reports and determining acceptable ranges of variables.

94) Effect of stimulation on normal and abnormal values. 95) Effect of patient state on normal values; including anxiety, relative hypoglycaemia, drowsiness. 96) Appropriate storage of acquired data. 97) Organisational rules for urgency of clinical reports.


Additional Evidence Requirements for EEG Section Additional evidence covering a range of conditions and the number of EEGs performed under supervision are required for completion of this section. [Information must be available for final assessment for the external examiner to view if necessary] Number of EEGs performed independently: Number Adults Children under 5 Sleep EEGs Portable EEGs in a non-dedicated environment Provide EEG factual reports, together with the Consultant’s conclusion and some examples of the recording to support the diagnosis from a range of at least 10 of the following disorders (one of these may be a non epileptic seizure)**. These need to be signed, dated and witnessed by WBA. Disorder EEG No. Generalised epilepsies Partial epilepsies Epilepsy syndromes e.g. West syndrome, typical absence. Juvenile myoclonic epilepsy, benign epilepsy of centro-temporal origin etc.

Cerebral inflammatory process e.g. encephalitis meningitis etc Degenerative disorders e.g. Alzheimer’s CJD etc Cerebrovascular disorders Metabolic disorders Others e.g. non epileptic seizures etc **During the final assessment, the records corresponding to these 10 reports need to be available. The examiners will pick 2 of these for further examination.


Frequency response curves, noise and common mode rejection ratio Evidence must be provided in the portfolio that extended machine checks have been performed by the candidate using an external calibration device. This must include:

• Graphs documenting frequency response data, including calculation of the frequencies at the -3dB points, across a range of filter settings.

• Calculation of internal noise. • Calculation of CMRR.



Part II


PART II Portfolios

• 2 folders • Name of Candidate and hospital on the front page of each

Folder 1: Section One

Should contain:

o All of the required formal assessments which have been carried out by the WBA for both EP’s and NCV / CTS (see later for assessment information)

o Final Assessment Summary Sheet o Frequency response curves, noise and common mode rejection ratio

Evidence must be provided in the portfolio that extended machine checks have been performed by the candidate using an external calibration device.

This must include:

- Graphs documenting frequency response data across a range of filter settings, including calculation of the frequencies at the -3dB points. - Calculation of internal noise. - Calculation of CMRR.


Folder 2: Section One

Should contain:

o List of Criteria Table. o Copy of Range Statement. o Witness statements or numbered evidence related to each of the required

range elements.

Folder 2 : Section Two

Should contain:


o Additional Evidence Requirements.

o Summary List of the numbers of NCV’s and EP’s performed

independently by the candidate.

o Abnormal VEP’s, evidence of observation of SEP’s and BAEP’s and case reports of EMGs/extended nerve studies performed by a clinician. These should include 5 examples from the list contained in the handbook and should have written evidence of questions and answers relating to this work. This evidence must be countersigned by the WBA/supervisor.

Please Note: •It will be necessary for the candidate’s portfolio to be assessed in advance of the Part II examination day. Feedback on the Portfolios will be given on the final assessment day. Portfolios will also be returned to Candidates on the final assessment day. The formal work-based assessments should be included in the portfolios. The assessment documentation should include:

o Written evidence of the pre-assessment plan – signed and agreed by both the candidate and the WBA.

o Completed assessment sheets (signed and dated). IMPORTANT: this must include the feedback sheet with a clear indication as to the success of the candidate.

o Written evidence of any questioning which took place during the assessment, and the candidate’s answers

o Products of work (report and appropriate printouts – anonymised)

Evoked Potential Assessments

There should be 2 in-house assessments for EPs (one of which should include a flash). The results are to include normal and abnormal data (for pattern VEP/flash VEP). If it has not been possible to record an abnormal flash VEP it is recommended that this is covered by questioning and/or a written exercise. The WBA must ensure that the questions and answers are fully documented. It is also recommended that an example of an abnormal waveform is included. This may be one that was recorded in the department on another occasion, or an example from a text book. The candidate would be expected to comment on this, to demonstrate understanding.


If the facility to record particular modalities is not available in the candidate’s home department arrangements should be made for a secondment to an appropriate department. Please note that the assessment that will take place during the final assessment is the 3rd EP assessment.

Peripheral Neurophysiology Assessments CTS There should be 3 in-house assessments for CTS investigation. At least one of these assessments should include abnormal results. As a minimum, the candidate needs to demonstrate competency in performing:

- a median nerve sensory study - a sensory study on another nerve - a ‘sensitive test’ - a median motor study.

The candidate must include a written factual report – including both numerical data evaluation and an interpretive comment. These do not have to be included in the report sent to the referring clinician. Please note that the final assessment at the Part II exam is the 4th assessment.


National Standards

For


Evoked Potentials Unit


Guidelines for each Unit Evoked Potentials Unit Record and Report Visual Evoked Potentials Aims To enable the TP to become competent in recording and reporting visual evoked potentials. Objectives To ensure the TP is able to: - • Calibrate and prepare equipment including the EP system, stimulators and non-

invasive electrodes. • Plan and prepare the investigation for EPs on the basis of information about the

patient’s condition including giving appropriate assistance and support to maximise the patient’s comfort

• Modify and, if appropriate, extend the investigation. • Complete the investigation and prepare a report of the results including identification

of normal and abnormal findings. Achieved by: • Practical experience, with appropriate training within the work environment. • Use of the Knowledge Specification List. • Underpinning knowledge from college-based tutorials and formal lectures. • Completion of required assessments. Assessment Procedure For each section of the Unit evidence of competent performance will be by practical assessment performed by the designated WBA. The ANS National Examination Assessors will perform a final assessment at the end of this Unit, which will include examination of the candidates completed logbook/portfolio


EVOKED POTENTIAL UNIT: Record and report Visual Evoked Potentials Sections 1 Prepare the environment and equipment for obtaining visual evoked potentials 2 Plan recordings of visual evoked potentials 3 Prepare patients for recording visual evoked potentials 4 Monitor and record visual evoked potentials 5 Complete and report the results of visual evoked potentials Summary This unit covers recording and reporting visual evoked potentials. The unit applies to patients with any condition leading to a request for visual evoked potentials. An essential part of this investigation is the preparation of the equipment and the environment. Equipment may include conventional evoked potential recording systems, stimulators and non-invasive electrodes. The TP must also give the appropriate level of support and reassurance. The TP is required to plan the investigation based on information about the patient's state and condition and prepare the patient for the investigation. The TP must be able to modify or extend the procedure in order to obtain accurate and useful results. This will require the TP to minimise any artefacts that occur during the investigation. On completion of the investigation the TP is required to provide a factual report of the results to include a written interpretation of the results. The TP must be able to provide factual reports on normal and abnormal recordings. The candidate will be expected to have a practical understanding of machine checks, and additionally will be expected to perform extended testing; providing evidence that they have produced frequency response curves and calculation of common mode rejection ratio and internal noise (using an external calibration source where required).


Section 1: Prepare the environment and equipment for obtaining Visual Evoked Potentials The TP must be able to: 1.1 Check the equipment to be used for safe condition and correct operation, including all relevant peripheral

devices. 1.2 Identify any faults and report and/or rectify them (if possible) in accordance with departmental

procedure. 1.3 Check that there is adequate storage volume for the investigation

1.4 Perform a basic machine check in all modalities to be used.

1.5 Make a formal record of machine performance (as described in 1.4).

1.6 Accurately identify and report and/or rectify equipment faults.

1.7 Ensure that environmental conditions are suitable for the investigation.


2 Assessments

Equipment fault log.


Section 2: Plan recordings of Visual Evoked Potentials The TP must be able to: 2.1 Ensure that all available data pertinent to the investigation upon the patient is available and checked for

validity 2.2 Evaluate the above data and thus plan the investigation.

2.3 Seek advice if there is any requirement for skills or knowledge beyond that of the candidate (the

candidate recognises their own limits) 2.4 Take appropriate action where the data is insufficient to produce a valid plan.

2.5 Discuss any special needs of the patient are discussed with the patient and/or their carers.

2.6 Select appropriate apparatus for the test.

2.7 Ensure that the required consumables are present for the test, in sufficient quantity.

2.8 Ensure that the recording environment is made suitable for the needs of the patient.


2 Assessments: pattern and flash, at least one of which must be flash VEP.


Section 3: Prepare patients for recordings of Visual Evoked Potentials The TP must be able to: 3.1 Confirm the patient’s identity from the referral documents

3.2 Correctly identify /enter the patient’s information on the recording system

3.3 Establish effective communication with the patient/carers. Explain the test in a manner liable to ensure

that their co-operation is enlisted. 3.4 Obtain a full but concise history, relevant to the investigation and record the information accurately

3.5 The patient’s condition is accurately assessed, based on all the available information, including case

notes, direct observation and questioning of patient and carers. 3.6 Following 3.4 and 3.5, consider any modifications to the planned procedures.

3.7 Seek advice if there is any requirement for skills or knowledge beyond that of the candidate (the

candidate recognises their own limits) 3.8 Accurately assess visual acuity ensuring the required correction is used.

3.9 Accurately mark electrode sites in accordance with a recommended placement system and the planned

investigation. 3.10 Ensure that electrodes are correctly and securely sited and leads are correctly positioned.

3.11 Confirm that contact impedances are appropriate to the electrode type.

3.12 Assist the patient to reach a position that is comfortable and optimises the quality of the recording.

3.13 Ensure that stimulators are correctly and accurately positioned in accordance with recommended

procedures and adjusted in accordance with the type of investigation. 3.14 Ensure that vision is corrected, as appropriate for the patient and the test.


2 Assessments: pattern and flash, at least one of which must be flash VEP


Section 4: Monitor and record Visual Evoked Potentials The TP must be able to: 4.1 Provide the necessary level of support and reassurance to the patient throughout the investigation.

4.2 Select appropriate recording programs according to standard protocol.

4.3 Confirm that machine settings (filters, stimulus parameters etc) are correct for the investigation

4.4 Modify machine controls, as necessary, to optimise the display and highlight salient features.

4.5 Mask/patch the eye not being tested adequately to ensure it receives no stimulus

4.6 Monitor the technical quality of raw data.

4.7 Identify, eliminate or minimise any artefacts.

4.8 Give the patient clear instructions for the procedure and monitor compliance/attention.

4.9 Perform the procedures in accordance with standard protocols.

4.10 Monitor the quality of the raw data during the signal averaging process

4.11 Ensure that sufficient samples are averaged to yield a waveform which is stable and contains minimal

noise. 4.12 Check evoked potentials for reproducibility.

4.13 Ensure that the recording is legibly annotated to show control settings stimulus settings clinical states

and events. Performance evidence required

2 Assessments: pattern and flash, at least one of which must be flash VEP


Section 5: Complete and report the results of Visual Evoked Potentials The TP must be able to: 5.1 Completely remove electrodes and transducers, cleaning the site carefully and with minimum discomfort

to the patient.

5.2 Reassure the patient and give them sufficient time to recover from the investigation prior to leaving the department.

5.3 Accurately and clearly inform the patient of the results notification procedure.

5.4 Ensure that any required transportation and escort are made available to coincide with the completion of the investigation and the readiness of the patient to leave.

5.5 Clean equipment (sterilise as appropriate) leaving it in a condition suitable for re-use.

5.6 Dispose of consumables in a safe manner and place.

5.7 Adhere to local infection control and hand hygiene policies and procedures throughout the investigation.

5.8 Annotate recordings and other patient documentation, ensuring it is accurate, legible and complete.

5.9 Compare salient features of the evoked potential waveforms with local normative data

5.10 Prepare a concise, accurate factual report; covering the procedures employed, together with any relevant neurophysiological findings and clinical events. Comment upon how the numerical data obtained correlates with normative data and also give a brief interpretive comment (even though this may not appear in the final report issued by the department).

5.11 Establish the degree of urgency for the clinical report is and forward the factual report to the clinician within the locally required time scale.



Normal and Abnormal results in each of the following Pattern and flash VEP EXPLANATORY NOTE: At least one assessment must include flash and at least one must include pattern reversal stimulation. Additional waveforms / reports should be included (preferably, but not essentially, the candidate’s own work) to show both a normal and abnormal result for each test type.


EVOKED POTENTIALS UNIT: The range of conditions and circumstances under which the TP must be able to competently plan, prepare, perform and report on visual evoked potentials are: Ranges Applicable to

sections: 1.0 1.1 1.2 1.3

Equipment Conventional Evoked Potential system Visual Evoked Potential stimulators

Stroboscopic lamp Pattern Reversal Full Field and Half Field

Non invasive electrodes

1 3 4 & 5

2.0 2.1

Types of Investigation Visual Evoked Potentials

Flash Pattern

All Sections

3.0 3.1

Environment Ambient lighting

1

4.0 4.1 4.2 4.3 4.4 4.5 4.6

Patients Condition Patient with any condition requiring evoked potential investigation Patient who requires mobility aids Patient with communication difficulties Patient with assisted vision or hearing Patient exhibiting symptoms of illness Patient whose condition requires modification of the plan

2 3 4 & 5

5.0 5.1 5.2

Visual Evoked Potentials Normal Abnormal

4 &5

6.0 6.1 6.2

Carers Medical and Nursing Staff Patients and relatives

3

7.0 7.1 7.2

Records Calibration Faults and remedial action

1


2.Record and report Visual Evoked Potentials. Knowledge Specification for the Whole of this Unit The trainee practitioner is required to know and understand the following: Patient Care 1) Principles and methods of effective communication.

2) The reasons why it is important to put the patient at ease and provide reassurance and support. 3) The sorts of questions the patient may have and the appropriate answers to such questions. 4) Basic assessment of the patient’s condition. 5) The ways in which the patient’s condition may have an impact on the planned investigation. 6) The suitable position of the patient for the investigation. 7) Procedures and responsibilities for notification of follow up arrangements. 8) Policies and arrangements for escorting and/or transporting patients.

Anatomy and physiology 9) The basic anatomy and physiology development and maturation of the central nervous system

(CNS).

10) Major anatomical divisions of the nervous system: brain cerebellum brainstem lobes spinal cord. 11) Anatomy and physiology of the eye and visual pathways. 12) Anatomy and physiology of the ear and auditory pathways. 13) Anatomy and physiology of the peripheral nervous system. 14) Pathophysiology of the eye and visual pathways. 15) Pathophysiology of the ear and auditory pathways. 16) Pathophysiology of the peripheral nervous system.


17) Pathology of the brain. 18) Clinical features of disease of the nervous system. 19) Anatomy and physiology of other body systems. Equipment characteristics and classification 20) Characteristics and specifications of stroboscopic and pattern reversal stimulators. 21) Characteristics and specifications of auditory stimulators and earphones. 22) Characteristics and specifications of nerve stimulators (constant current and constant voltage) 23) Specifications and component parts of multi–modality evoked potentials 24) Electrode characteristics including:

- Electrode potential - Silver/silver chloride electrodes - Maintenance of electrodes - Selection of electrodes

25) Principles of digitisation. 26) Signal averaging. 27) Signal/noise ratio. 28) Standard recording characteristics. Setting up and using equipment for Evoked Potentials 29) Principles of the use of evoked potential equipment. 30) Procedures for checking the functional operation of stimulators. 31) Procedures for testing the recording system: detection identification and rectification of equipment

faults. 32) Principles of patient electrical isolation with reference to equipment class. 33) The range of operational requirements of the equipment selected. 34) Standard recording characteristics. 35) Operational use and detailed characteristics of amplifiers filter settings appropriate for modality of

study. 36) Use of flash and pattern stimulators.


37) Selection of electrodes appropriate to modality of study. 38) Principles of electrode sterilisation. 39) Health and safety requirements for disposing of consumables. Calibration 40) Appropriate calibration procedures. 41) Use of signal generators in calibration and testing. Planning the Evoked Potential Investigation 42) Neurophysiological principles relevant to planning the evoked potential study. 43) The request for the investigation and specific requirements. 44) Determining electrode placement with reference to the modality of the evoked potential being

studied. Acquisition of the Evoked Potential 45) The purpose of the modality of the evoked potential being studied. 46) The aetiology and symptomology of common pathological process and the role of the evoked

potential in their investigation. 47) Other related investigations. 48) Selection of electrodes, methods of application and position appropriate to the modality of the

evoked potential investigation. 49) Measurement of visual acuity, and the effect on the visual evoked potential. 50) Principles and methods of calculation of the angular size of the pattern stimulus. 51) Measurement of auditory threshold and its effect on the auditory evoked potential. 52) Principles involved in acoustic masking. 53) Details of the types and effects of regularly occurring physical artefacts and interference. 54) Physiological artefacts and their effects on the evoked potential. 55) Principles of derivation and design of montages suitable for recording from each modality of evoked potential. 56) Relation of abnormalities and anomalies to the current clinical problem.


57) Morphology and nomenclature of each modality of evoked potential. 58) Components of evoked potentials in relation to physiological origin. 59) Causes of non-response including non/poor compliance and pathological processes element. 60) Normal and abnormal evoked potential findings. 61) Agreed departmental normative values of evoked potential amplitudes and latencies in relation to

age. 62) Effect of stimulus parameters and non-pathological factors on the evoked potential. Report writing 63) Evoked potential findings in normal subjects and in relation to age and gender. 64) Principles relating abnormal findings to pathophysiology. 65) Organisational requirements for report writing. 66) Definitions of the specific waveforms measured in the evoked potential. 67) Effects of prescribed and non-prescribed medication on normal values. 68) Procedures for urgency of clinical reports.


Additional Evidence Requirements for Evoked Potential Section Additional evidence covering the range of conditions and the number of independently performed Visual Evoked Potentials are required for completion of this unit.

VEPs performed independently Number Pattern Flash Independently performed VEPs should include both normal and abnormal results. Brainstem Auditory and Somatosensory Evoked Potentials There is no practical assessment for these modalities. The candidate is expected to provide portfolio evidence of observation which must include: 1) A witness statement from the person performing the tests, verifying that the student observed and understood the purpose, procedure undertaken and results of the investigation. 2) Waveforms obtained from the investigation, including numerical data. 3)The candidate should include their own interpretive comments – relating the numerical data obtained to normal values, and also including comments relating the waveforms obtained to pathophysiology. Frequency response curves, noise and common mode rejection ratio Evidence must be provided in the portfolio that extended machine checks have been performed by the candidate using an external calibration device. This must include:

• Graphs documenting frequency response data, including calculation of the frequencies at the -3dB points, across a range of filter settings




National Standards

For


Peripheral Neurophysiology Unit


Guidelines for each Unit Peripheral Neurophysiology Unit Record and Report Nerve Conduction Studies in Carpal Tunnel Syndrome and understand further investigation of the Peripheral Nervous System Aims To enable the Trainee Practitioner to become competent in recording and reporting Nerve Conduction Studies in Carpal Tunnel Syndrome (CTS) and to develop an understanding of additional investigations of the Peripheral Nervous System (PNS) Objectives To ensure the TP is able to plan and perform: - • Calibration and preparation of equipment, including the EMG machine, stimulators

and invasive and non-invasive electrodes • Plan and prepare the investigation for CTS on the basis of information about the

patient’s condition including giving appropriate assistance and support to maximise the patient’s comfort

• Complete the investigation for CTS and prepare a report • Attend clinician-led clinics (assisting where appropriate) in order to gain a further

understanding of a wider range of investigations of the PNS Achieved by: • Practical experience with appropriate training within the work environment • Use of the Knowledge Specification List • Underpinning knowledge from college-based tutorials and formal lectures • Completion of required assessments and exercises. Assessment Procedure For each section of the Unit evidence of competent performance will be by practical assessment or by examination of the products of the candidates own work. These assessments will be performed by the dedicated WBA. The ANS National Examination Assessors will perform a final assessment at the end of this Unit, which will include examination of the candidates completed logbook/portfolio


PERIPHERAL NEUROPHYSIOLOGY UNIT: Record and report nerve conduction studies in Carpal Tunnel Syndrome (CTS) and understand further investigation of the Peripheral Nervous System (PNS)

Sections

1) Prepare equipment and the environment for investigating the peripheral nervous system (PNS). 2) Plan and prepare for recording nerve conduction studies (in CTS). 3) Prepare patients for investigations of the peripheral nervous system. 4) Perform nerve conduction studies in patients with Carpal Tunnel Syndrome. 5) Prepare a factual report on the carpal tunnel studies – to include an accurate presentation of numerical data AND a brief interpretational comment upon the results (NOTE: the interpretational comment does not have to be included in the document which is sent to the referring clinician, but is for the purposes of the logbook only).

6) Complete investigations of the peripheral nervous system. Importantly, the TP must adhere to local infection control and hand hygiene policies and procedures.

Additionally, the TP will attend and assist (where appropriate) clinician-led investigations, including EMG.

Summary This unit describes the work of TPs who perform peripheral nerve conduction studies in patients with CTS. The TP must prepare the equipment and the patient for the investigation. Types of equipment that the TP is required to prepare and use include the conventional EMG system, non-invasive electrodes and skin thermometers. Preparation of the patient will include measuring, recording and modifying skin temperature and helping the patient to reach a position that is comfortable and suitable for the investigation. In performing nerve conduction studies in CTS the TP will assess the clinical problem plan and carry out the investigation and provide a factual report of the results. The TP will also recognise the need for further investigations and advise medical personnel accordingly. Additionally, the TP will attend clinician-led investigations, where they may be required to provide support to the clinician in the form of operating equipment, positioning electrodes, supporting and reassuring the patient and completing calculations when necessary. Following these clinics, the TP will be expected to produce a series of case studies, providing waveforms obtained in the investigation and discussing how these relate to the clinical state/neuropathology of that case.


The candidate will be expected to have a practical understanding of machine checks, and additionally will be expected to perform extended testing; providing evidence that they have produced frequency response curves and calculation of common mode rejection ratio and internal noise (using an external calibration source where required).


Section 1: Prepare equipment and environment for investigating the peripheral nervous system (PNS) The TP must be able to: 1.1 Check the equipment is in a safe condition to use

1.2 Identify faults and rectify and/or report them properly

1.3 Identify the amount of storage space required by the test and check there is sufficient storage space on

the equipment

1.4 Perform a basic machine check on the machine (in all modalities to be used)

1.5 Produce a formal record of the machine performance

1.6 Identify faults relating to machine performance and rectify (if possible) or report them properly

Performance evidence required 4 Assessments in CTS Equipment log (machine function and faults).

Additionally extended calibration checks should be presented in the logbook, with a statement from the WBA confirming that these are the results of the candidates own work, and including written evidence of questions/answers relating to this topic (in order to provide evidence of understanding).


Section 2: Plan and prepare for recording nerve conduction studies (in CTS)

The TP must be able to: 2.1 Assemble and check all pertinent data concerning the patient, establishing that the nature of the

requested investigation is valid.

2.2 Plan the investigation following evaluation of the information concerning the patient and the clinical problem.

2.3 Seek advice if the planned investigation is beyond the scope or current skills of the trainee.

2.4 Select and correctly prepare appropriate electrodes and stimulators.

2.5 Ensure that all consumables likely to be required are available

2.6 Ensure that all equipment required is prepared in line with local infection control guidelines Performance evidence required 4 Assessments


Section 3: Prepare patients for investigations of the peripheral nervous system.

The TP must be able to: 3.1 Ensure that the patient's identity is confirmed as correct.

3.2 Ensure that the patient’s data is accurately transferred to the recording system. 3.3 Ensure that effective communication with the patient is established and patients and carers are told what

the investigation entails and their co-operation enlisted.

3.4 Obtain a full and concise history relevant to the investigation

3.5 Consider any modifications to the planned procedure which may be required in light of the history obtained.

3.6 Ensure the environment is suitable for the investigation, taking into account any special needs of the patient.

3.7 Measure and record the patient's skin temperature. Modify this if required and ensure that it is maintained at a suitable level.

Performance evidence required 4 Assessments in CTS


Section 4: Perform nerve conduction studies in patients with suspected Carpal Tunnel Syndrome The TP must be able to: 4.1 Ensure that correct programs are selected for performing sensory NCS and that the default settings

(filters, time base etc) are correct.

4.2 Correctly and securely position recording electrodes for a median sensory study

4.3 Correctly and securely position recording electrodes for a second (comparative) sensory nerve.

4.4 Correctly and securely position electrodes for a ‘sensitive’ sensory test

4.5 Correctly position stimulators for sensory nerve tests, paying particular attention to polarity.

4.6 Deliver supramaximal stimuli so as to obtain optimum sensory responses..

4.7 Identify artefacts and eliminate or minimise during sensory NCS

4.8 Accurately measure and document distances between stimulation and recording electrodes

4.9 Accurately and correctly mark SNAPs for latency and amplitude

4.10 Calculate sensory conduction velocities.

4.11 Continuously review the data obtained and, if required, modifies the procedure accordingly.

4.12 Select correct programs for motor studies and ensure that default settings are confirmed to be correct.

4.13 Correctly and securely position recording electrodes for motor NCS –median nerve.

4.14 Correctly position stimulator for motor NCS- distal (including polarity)

4.15 Correctly position stimulator for motor NCS- proximal (including polarity)

4.16

Deliver supramaximal stimuli in order to achieve optimal motor responses

4.17 Identify artefacts and eliminate or minimise during motor NCS

4.18 Accurately measure and document distances between stimulation and recording electrodes

4.19 Calculate motor conduction velocity

4.20 Continuously review the data and, if required, modify the procedure accordingly.

4.21 Review data from the complete investigation is and seek advice if additional investigations appear to be required

Performance evidence required 4 Assessments (must include at least 1 abnormal}


Section 5: Report nerve conduction studies in patients with suspected Carpal Tunnel Syndrome The TP must be able to: 5.1 Accurately and legibly prepare the waveforms obtained in the investigation, with clearly presented

numerical data.

5.2 Prepare a brief written factual report, to include an assessment of the numerical data (comparing to normative data) and also basic interpretational comments (NOTE: This data/comments need not be included in the report issued to the referring clinician

5.3 Submit the report to the reporting Neurophysiologist (or reporting clinician), taking account of the urgency of the referral.

Performance evidence required 4Assessments (must include at least 1 abnormal)


Section 6: Complete investigations of the peripheral nervous system The TP must be able to: 6.1 Remove electrodes and clean sites in accordance with local infection control policies

6.2 Dispose of consumables promptly and appropriately

6.3 Tell the patient the procedure by which they get the results of the test

6.4 Allow the patient adequate time to recover from the procedure and give any assistance required for their

transport.

6.5 Clean and disinfect the equipment in accordance with local policy, leaving it in a fit condition for re-use.

6.6 Adhere to local infection control and hand hygiene policy throughout the procedure.

Performance evidence required 4Assessments


PERIPHERAL NEUROPHYSIOLOGY UNIT: The range of conditions and circumstances under which the TP must be able to competently prepare equipment and the environment for Peripheral Nervous system investigation perform and report on nerve conduction studies in Carpal Tunnel Syndrome (CTS) and assist with Peripheral Nervous System investigations (PNS) are:

Ranges Applicable to sections:

1.0 1.1 1.2 1.3 1.4

Equipment Conventional EMG/NCS system Invasive and non invasive electrodes Skin thermometers Stimulators

All Sections

2.0 2.1 2.2

Investigations Electromyography Nerve Conduction Studies

All Sections

3.0 3.1 3.2 3.3

Patients Condition Patient who requires mobility aids Patient with communication difficulty Patient with any condition requiring nerve conduction screening

All sections

4.0 4.1 4.2

Results Normal Abnormal

4 &5


Knowledge Specification for the Whole of this Unit The trainee practitioner is required to know and understand the following: Patient care 1) Principles and methods of effective communication. 2) The reasons why it is important to put the patient at ease and provided with reassurance. 3) The appropriate position of the patient for different types of recording and how to help the patient become more comfortable. 4) Terminology used during investigation of the peripheral nervous system. Anatomy of the peripheral nervous system 5) Anatomy and maturation of the peripheral nervous system. 6) Pathophysiology of the peripheral nervous system and implications for patient position. 7) The nerves and muscles to be examined. 8) Influence of patient height on data. Equipment characteristics and classification 9) The characteristics and specification of recording systems. 10) Component parts of a conventional EMG machine. 11) Invasive and non-invasive electrode characteristics:

- Electrode potential - Silver/silver chloride electrodes - Care of electrodes - Selection of electrodes - Impedance.


Preparation and use of equipment for investigating the peripheral nervous system 12) Appropriate calibration procedures.

13) Selection and operation of amplifiers. 14) Filters and their effects on recorded data. 15) The operation and use of stimulators. 16) Signal/noise ratio and averaging. 17) Principles of digitalisation. 18) Measurement and placement of electrodes and methods of application. 19) Procedures for electrode maintenance. 20) Standard procedures for sterilising equipment. 21) Recording characteristics of apparatus and effects of controls. 22) Artefacts and interference which may occur.


Fault identification and rectification 23) Methods of identifying equipment faults. 24) Procedures for rectification of simple equipment faults. Skin Temperature 25) Methods of measuring skin temperature. 26) Methods of warming and cooling skin temperature. 27) Effect of warming and cooling on nerve conduction velocity (NCV). Report Writing 28) Normal and abnormal findings in EMG and NCS. 29) Calculation of NCV. 30) Influence of limb length and skin temperature on calculation. 31) Results obtained in relation to pathophysiology.


Additional Evidence Requirements for investigations of Peripheral Nervous System Additional evidence covering a range of conditions and the number of independently performed Nerve Conduction Studies for CTS are required for completion of this unit. [Information must be available for final assessment for the National Assessors to view if necessary] Number of studies [CTS] performed independently : Number……… Attending clinican-led investigations When attending clinician-led clinics the TP should provide case-study evidence of experience, background knowledge and understanding of at least 5 of the following conditions: Disorder Test No. Motor Neurone Disease Cervical/Lumbar radiculopathy Brachial plexus lesions [e.g. trauma brachial neuritis] Peripheral Neuropathy for example; Demylinating e.g. Guillain Barre Syndrome Axonal e.g. Diabetes, Mononeuritis Multiplex

Entrapment neuropathies e.g. ulnar nerve lesions, peroneal nerve (not to include CTS)

Myaesthenia Gravis Myopathies e.g. polymyositis, muscular dystrophy Myotonic conditions e.g. dystrophia myotonica Each case study should: Contain results and waveforms obtained during an investigation attended by the TP. Contain background information relating to the condition and its pathophysiology. Include comments by the TP relating the waveforms and results obtained to the condition being investigated. Be supported by a WBA statement that the work is that of the TP, and should include written evidence of questions/answers (to demonstrate the TP understands the work).


Frequency response curves, noise and common mode rejection ratio Evidence must be provided in the portfolio that extended machine checks have been performed by the candidate using an external calibration device. This must include:

• Graphs documenting frequency response data, including calculation of the frequencies at the -3dB points, across a range of filter settings.




ANS National Examination Board

Quality Assurance Document

Final Practical Assessments

BSc Clinical Physiology

(Neurophysiology Option)


Standards:

• Professionalism • Accountability • Openness

National Assessor Profile: The ANS National Examination Board will hold information about assessors, including their vocational experience and qualifications related to assessment/verification, training delivery and attendance at ANS national examiner training days. The ANS national examination board will define the area of assessment (allocation and location of candidates for final practical assessments). The assessor role will be defined via role descriptors and assessors will be required to demonstrate active involvement in training (portfolio evidence). The ANS National Examination Board: The Board will maintain national examiners assessment packs in the following units:

• Electroencephalography • Evoked Potentials • Peripheral Neurophysiology

The completed packs and assessment outcome for each candidate will be held and presented for external inspection as and when required. The Board will also maintain a quality assurance guidelines document for distribution to all National Assessors. Requirements for the Role of National Assessor: In order to gain the necessary experience of the national assessment process both clinical and technical national assessors will, in addition to attendance at specific training days, be required to participate in 2 observations and, on one occasion, be observed by a senior national assessor whilst carrying out the final practical assessment. National assessors are required to attend a training day at least once every 3-year period. The ANS national examination board will maintain documentation for the observations.


Complaints and Appeals Procedure:

APPEALS PROCEDURE EPTA/ANS Professional Examinations

Appeals procedure for candidates who wish to appeal against the decision of a section or sections of the ANS professional examinations. If you feel that you have been unfairly graded or assessed during any part of your assessment process you have the right to appeal against the decision. This decision however should not be taken lightly and you should be clear on your reasons before you proceed. You are advised to discuss your appeal with your work based supervisor before you submit your appeal, but this is not a mandatory requirement. You may also wish to notify your HEI. The following guidelines will ensure that the Appeals Board is able to review your appeal on its individual merits. Candidate Instructions:

1. If you wish to appeal against a decision made on a section or sections of your assessment, you should apply in writing or by e-mail to ‘Exam Appeals’, c/o the ANS Education Chairperson and/or Examination Board Chairperson ANS Education Committee (address and e-mail via the ANS website), as quickly as possible following confirmation of your results. This appeal must be received within two weeks following receipt of your results.

2. You should state clearly:

a. What specific grievance you have b. Details confirming your appeal c. Any specific personnel concerned & any dates or times concerned d. Any other relevant information which would support your appeal

3. A standard letter or e-mail confirming receipt of your appeal will be sent within 5 working days of receipt of your appeal documents from the ANS Education Chairperson and/or Examination Board Chairperson.

4. Your appeal will be considered by a panel of Appeals Committee Members which

will include: two Education Committee members, who are not directly involved with the individual appeal case and one other person who is a non-education ANS council member, who has knowledge of Assessment processes.

5. The examination paper work will be reviewed by the committee and re-evaluated

following the standard assessment format. If this is an observed assessment of performance, the appeal committee may contact the candidate and the assessor to discuss the case.


6. A formal reply with the decision on your appeal will be sent within 4 weeks of

receipt of your appeal letter.

7. A Report will be forwarded to the candidate, and will be copied to the HEI and Head of Department (and also the Work Based Supervisor if requested by the candidate). The report will give full details of the Appeal Board’s decision and how it was reached.


National Standards

For


Recommended Reading List


Recommended Reading List

Textbooks EEG Current Practice of Clinical Electroencephalography ISBN: 0781716942 2002 Paperback Edited by Ebersole J.Sand Pedley TA 3rd Edition Published by Lippincott Williams & Wilkins Electroencephalography – ISBN: 0683302841 1998 Hardback Basic principles clinical applications & related fields 4th Edition Edited by Neidermeyer E and Lopes da Silva F Published by Lippencott Williams and Wilkins EEG in Clinical Practice ISBN: 0750695110 1994 Hardback Hughes JR 2nd Edition Published by Butterworth Heinemann Digital EEG in Clinical Practice ISBN:0397516355 1995 Hardback Wong P Published by Lippincott Williams & Wilkins Electrodiagnosis in Clinical Neurology ISBN:0443075492 1999 Hardback Edited by Aminoff MJ Published by Churchill Livingstone Electroencephalography Primer ISBN: 0444821481 1999 Paperback Fisch BJ Spehlmann R ISBN: 0444821473 1999 Hardback 3rd Edition Published by Elsevier The Essentials of Clinical Neurophysiology ISBN: 0750674415 2003 Paperback Karl E. Misulis & Thomas C. Head 3rd Edition Published by Butterworth Heinemann Clinical Neurophysiology: EEG Paediatric ISBN:0444512578 2003 Hardback Neurophysiolology Special Techniques & Applications: Vol 2. C.D. Binnie Published by Elsevier


EMG/NCS Electrodiagnosis in Diseases of Nerve and Muscle ISBN: 0195129776 2001 Hardback Kimura J Oxford University Press Manual of Nerve Conduction Velocity and Clinical ISBN:0781701384 1994 Hardback Neurophysiology DeLisa JA Published by Lippincott Williams & Wilkins Clinical Neurophysiology: EMG NCS and EP’s ISBN:0444512527 2004 Hardback Vol 1. Binnie Cooper Mauguier Osselton Prior Tedman Published by Elsevier Science LTD. Evoked Potentials Evoked Potentials in Clinical Testing ISBN: 0443040508 1993 Hardback Edited by Halliday AM Published by Churchill Livingstone Evoked Potentials in Clinical Medicine ISBN:0397516592 1997 Hardback Edited by Chiappa KH Published by Lippincott Williams & Wilkins Clinical Neurophysiology: EMG NCS and EP’s ISBN:0444512527 2004 Hardback Vol 1. Binnie Cooper Mauguier Osselton Prior Tedman Published by Elsevier Science LTD. Other Relevant Textbooks Paediatric Neurology ISBN: 044305200X 1993 Hardback Edited by Brett EM Published by Churchill Livingstone

Clinical Epilepsy ISBN: 044304936X 1995 Hardback Duncan JS Shorvon SD Fish DR Published by Churchill Livingstone


Relevant Journals Clinical Neurophysiology (formerly ‘The EEG Journal’/Electroencephalography and Clinical Neurophysiology) Journal of Clinical Neurophysiology (Journal of the American EEG Society) The Journal of Electrophysiological Technology (JET) Epilepsia Journal of Neurology Neurosurgery and Psychiatry (JNNP) Neurology

national standards for clinical neurophysiology

Documents

national standards units

ans education sub group

clinical governance

general guidelines ans

potential assessment

behalf of ans

education subgroup

evoked potentials unit