How quickly should a neuromonitoring trainee advance toward independence?

I recently published a few questions on Survey Monkey and then contacted folks on LinkedIn and Facebook, asking them to complete the survey.

My survey began with the following instructions:

We’d like to know your opinion about how quickly inexperienced IONM trainees should acquire certain skills in the OR. In answering the questions to follow, please indicate how many weeks of training in the OR you think are required to adopt the skill set.

Survey Results

Note: for all graphs, the Y-axis is “Percent of Survey Responses”, and X-axis is “Number of Weeks”.

Question 1: 

How many weeks before an inexperienced trainee is competent to begin placing electrodes under your direct supervision?

s5q1

Comments:

I usually get trainees acquainted with placing electrodes on their first or second day in the OR. They may only place a couple of electrodes, but you have to start somewhere.

Question 2: 

How many weeks before an inexperienced trainee is competent to interview, examine and consent a patient independently?

s5q2

Comments:

None.

Question 3: 

How many weeks before an inexperienced trainee is competent to review an IONM plan with a surgeon?

s5q3

Comments:

The trend here suggests that the overwhelming majority of people think that a trainee isn’t competent to hold a basic conversation with a surgeon until at least 8 weeks into training.

Question 4: 

How many weeks before an inexperienced trainee is competent to talk to an anesthesiologist about the optimal anesthesia regimen for IONM?

s5q4

Comments:

None.

Question 5: 

How many weeks before an inexperienced trainee is competent to set up all electrodes and collect baselines on a basic lumbar fusion case?

s5q5

Other:

  • Still with registered tech at their side.
  • 52 weeks
  • If solo, then 1 year.
  • Depends on education and clinical background.
  • Approx 8 weeks give or take depending on how they are picking up the training
  • It is dependent, setting up not difficult, understanding the issues that arise or make arise takes a while.

Comments:

Most surprising here is that 2 respondants thought a trainee needs an entire year of training in the OR before he/she can set up a basic lumbar case.

Question 6: 

How many weeks before an inexperienced trainee is competent to stimulate pedicle screws under your direct supervision?

s5q6

Comments:

This is probably the most surprising to me of all questions. I don’t think this simple task takes so a trainee so many weeks or months to perform, particularly if I am standing directly over their shoulder telling them exactly what to say and do.

Question 7: 

How many weeks before an inexperienced trainee is competent to stimulate pedicle screws under minimal supervision?

s5q7

Comments:

None.

Question 8: 

How many weeks before an inexperienced trainee is competent to set up all electrodes and collect baselines on an ACDF?

s5q8

Other:

  • Still with registered tech at their side.
  • 2 years
  • If solo, then 1 year.
  • 24 weeks
  • 16 weeks
  • It is dependant, setting up is not difficult, understanding the issues that arise or may arise takes a while
  • Depends on their education and clinical background

Comments:

If you said 1-2 years, I’d love to hear your reasons.

Question 9: 

How many weeks before an inexperienced trainee is competent to set up all electrodes and collect baselines on a PCDF?

s5q9

Other:

  • Still with registered tech at their side.
  • Independently, at least 20 months
  • 2 years
  • If solo, then 1 year.
  • Depends on their education and clinical background
  • set up and aquire pre-position and post-position baselines quickly can be diffcult for trainee.
  • 30 weeks
  • 24 weeks – trainee competency would allow for more/less
  • depending on the frequency of monitoring and abnormalities that arise. Learning to set up is not difficult. Understanding how to localize the error or abnormalities that arise.

Comments:

If you said 1-2 years, I’d love to hear your reasons.

Question 10: 

Do you believe that it is important for trainees to learn how to measure and mark a patient’s head?

s5q10

Responses:

  • Our trainees are always trained for a year before unsupervised.
  • Conceptual knowledge is fundamental to any clinical application.
  • It builds a good base to learn needle positions and work up speed, but may not be able to be done in a clinical setting at facilities we go to. Can also backfire if NP becomes reliant on marks and not natural skull based landmarks. There will be times that you are not able to measure and mark the head.
  • So many of our trainees place too far anterior for motor lead placement. Measuring and marking for the first 12 weeks, when time allows, would be beneficial.
  • Yes but not immediately. More important to learn how to measure quickly in the OR. Once they are competent and comfortable with basic lead placement then they should learn how to get precise measurements for full EEG setup, which will further hone their basic lead setup

Comments:

I believe this is absolutely essential, and I’m so happy to hear that 93% of people agree with me.

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