The fellow will determine with the attending at the start of the day which case they will follow. The fellow will be in the OR for baselines and/or for critical portions of the case, monitors remotely during less critical portions, and writes the preliminary summary of the IOM report. Writing the report triggers a record of the procedure to be placed in the procedure log administered by the program coordinator monthly. The coding department notifies the program coordinator of such procedures.

The fellows will have better access to live cases via reading stations in the IOM reading room or through Citrix. This independent access will facilitate participation by the fellow in live communication with IOM Tech’s and attending’s through the case. The aim would be for 1 case per day of IOM provided it does not conflict with other scheduled fellowship activities or prescheduled clinics. Fellow-directed readings and/or other didactics will be reviewed with an attending once per week.

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ACGME Competency Goals

Patient Care

Goals: The fellow will learn how to use Intra-operative neuromonitoring techniques to improve surgical outcomes.

Medical knowledge

Goals: The fellow will understand the neuroanatomy, IOM techniques (EEG, MEPs, VEP, SSEPs, direct cortical stimulation) and when these tools should be used.

Interpersonal and Communication Skills

Goals: Communicate with patients, allied staff, and referring providers with empathy, professionalism, and by effective transfer of knowledge, especially between IOM technologist and surgeons.

Practice-Based Learning and Improvement

Goals: The fellow will be involved in improving the quality of the care of IOM through QI projects, scholarly activities, and/or participation in multi-disciplinary planning of surgery and neuromonitoring.


Goals: The fellow will be professional in verbal communications and in timely reporting of neurophysiology studies.

Systems-Based Practice

Goals: The fellow recognizes that he/she is part of a treatment team and participates within the treatment group effectively. The treatment groups including surgeons, IOM technologists, anesthesiology, and OR staff.

Objectives and Evaluation Matrix

As with all of the individual rotations described in this section, the specific objectives of the continuity clinic are reflected in the entrustable professional activities and individual milestones. These form the basis for the fellow’s evaluation, which is completed by his or her clinic attending twice each year. (Please see the section End-of-Rotation Evaluations for the list of milestone abbreviations).

IOM Rotation Objectives

Upon completion of the curriculum, fellows will . . .

EPA #EPA DescriptionMilestones
1Know type of monitoring modalities and indications for each in IOM and evoked potentialsPC3, PC4, PC5, PC6, PC7, MK1, MK5, SP3
2Describe trouble shooting and ways to differentiate physiology from artifactual changes in IOM (BAER, EEG, SSEPs, MEP)PC3, PC4, PC5, PC6, PC7, MK1, MK5, SP3
3Perform direct cortical stimulation at bedside and/or in the OR for language and/or motor mappingPC1, PC2, PC3, MK1, MK3
4Demonstrate professional and effective communication with OR team (surgeon and anesthesiologist) and IOM technologistsPC1, PC2, PC3, MK1, MK3
5Learn the effects of anesthesia and systemic effects on IOM modalities and EPPC3, PC4, PC5, PC6, PC7, MK5, PL1
6Demonstrate high level of professionalism when performing electrodiagnostic studiesPR1, PR2, IC1
7Know placement of electrodes for commonly used IOM modalitiesIC1, IC2, IC3

Latest revision: 10-28-2022, Aaron Struck, MD

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