Introduction
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.
Professionalism
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 above for the list of milestone abbreviations).
Rotation ObjectivesUpon completion of the curriculum, the fellow will… | ||
| EPA # | New EPA Description | Milestones |
| 1 | Understand the types of monitoring modalities and indications in IOM and evoked potentials (EP) | PC7, MK1, SP3 |
| 2 | Trouble shoot and differentiate physiology from artifactual changes in IOM (BAER, EEG, SSEPs, MEP) | PC4, PC7, MK1, SP3 |
| 3 | Perform direct cortical stimulation at bedside and/or in the OR for language and/or motor mapping | PC4, PC7, MK1, MK3, PC5 |
| 4 | Demonstrate professional and effective communication with OR team (surgeon and anesthesiologist) and IOM technologists | PR1, PR2, IC4, IC5 |
| 5 | Understand the effects of anesthesia and systemic effects on IOM modalities and EP | PC4, PL1 |
| 6 | Understand alarm criteria of IOM modalities | PC3, PC4, PC5, PL1 |
| 7 | Understand placement of electrodes for commonly used IOM modalities | PC4, MK1, MK2, PL1 |
Schedule
At the start of rotation, please coordinate with the attending and IOM staff for the day on which cases to follow and when to go to the OR for direct observation. If OR cases are not available, intracarotid sodium amytal (Wada), diagnostic EP studies, or clinic time may be considered.
A short, relevant reading in the textbooks each day of the rotation can be coordinated with the attending of the day. Check with Bryan Wheeler in IOM re: ability to access IOM studies.
Work Hours
The estimated number of work hours is 40 per week.
Suggested References
A Practical Approach to Neurophysiologic Intraoperative Monitoring, Second Edition, edited by Aatif Husain (2015) and Intraoperative Neurophysiology: A Comprehensive Guide to Monitoring and Mapping, edited by Mirela Simon (2018).
Please check Ebling Library or EEG reading room for copies to borrow.
Latest revision: 10/28/2022, Aaron Struck, MD
