Clinical Neurophysiology CESR Portfolio Guide

Generic Capabilities in Practice 1

• Aware of, and adheres to, the GMC professional requirements
• Aware of public health issues including population health, social determinants of health and global health perspectives
• Demonstrates effective clinical leadership
• Demonstrates promotion of an open and transparent culture
• Keeps up to date through learning and teaching
• Demonstrates engagement in career planning
• Demonstrates capabilities in dealing with complexity and uncertainty
• Aware of the role and processes for commissioning
• Aware of the need to use resources wisely

Generic Capabilities in Practice 2

• Aware of national legislation and legal responsibilities, including safeguarding vulnerable groups
• Behaves in accordance with ethical and legal requirements
• Demonstrates ability to offer apology or explanation when appropriate
• Demonstrate ability to lead the clinical team in ensuring that ethical and legal factors are considered openly and consistently

Generic Capabilities in Practice 3

• Communicates clearly with patients and carers in a variety of settings
• Communicates effectively with clinical and other professional colleagues
• Identifies and manages barriers to communication (e.g. cognitive impairment, speech and hearing problems, capacity issues)
• Demonstrates effective consultation skills including effective verbal and non-verbal interpersonal skills
• Shares decision making by informing the patient, prioritising the patient’s goals and wishes, and respecting the patient’s beliefs, concerns and expectations
• Shares decision making with children and young people
• Applies management and team working skills appropriately, including influencing, negotiating, re-assessing priorities and effectively managing complex, dynamic situations

Generic Capabilities in Practice 4

• Makes patient safety a priority in clinical practice
• Raises and escalates concerns where there is an issue with patient safety or quality of care
• Demonstrates commitment to learning from patient safety investigations and complaints
• Shares good practice appropriately
• Contributes to and delivers quality improvement
• Understands basic Human Factors principles and practice at individual, team, organisational and system levels
• Understands the importance of non-technical skills and crisis resource management
• Recognises and works within limit of personal competence
• Avoids organising unnecessary investigations or prescribing poorly evidenced treatments

Generic Capabilities in Practice 5

• Manages clinical information / data appropriately
• Understands principles of research and academic writing
• Demonstrates ability to carry out critical appraisal of the literature
• Understands the role of evidence in clinical practice and demonstrates shared decision making with patients
• Understands public health epidemiology and global health patterns
• Demonstrates appropriate knowledge of research methods, including qualitative and quantitative approaches in scientific enquiry
• Demonstrates appropriate knowledge of research principles and concepts and the translation of research into practice
• Follows guidelines on ethical conduct in research and consent for research
• Recognises potential of applied informatics, genomics, stratified risk and personalised medicine and seeks advice for patient benefit when appropriate

Generic Capabilities in Practice 6

• Delivers effective teaching and training to medical students, junior doctors and other healthcare professionals
• Delivers effective feedback with action plan
• Able to supervise less experienced trainees in their clinical assessment and management of patients
• Able to supervise less experienced trainees in carrying out appropriate practical procedures
• Able to act as a clinical supervisor to doctors in earlier stages of training

Specialty Specific Capabilities in Practice 1

• Leads the multidisciplinary team in the investigation of peripheral nerve and muscle disorders.
• Utilises nerve conduction and electromyography equipment and understands how and why they work.
• Makes decisions about purchasing and ordering equipment to perform investigations.
• Complies with laws and regulations regarding health and safety, confidentiality, information governance and safeguarding of vulnerable patients.
• Ensures quality assurance through audit and quality improvement projects.
• Understands the anatomy and physiology of the central and peripheral nervous systems and muscles.
• Understands the effects of different pathologies on central and peripheral nervous systems and muscle and how they are investigated.
• Performs sensory and motor nerve conduction studies, F Waves, H reflexes, blink reflexes, repetitive nerve stimulation and electromyography.
• Recognises electrical artefacts and knows how to overcome them.
• Assesses referrals for likely diagnosis and recommends investigation protocols.
• Assesses, examines and performs investigations to look for neuromuscular disease and disorders of the anterior horns.
• Assesses clinical and physiological findings, and formulates and produces a report detailing likely diagnosis, anatomical location of a lesion, pathology and prognosis, further investigations and treatment as appropriate.
• Assesses clinical and physiological findings and communicates the findings with patients and colleagues effectively

Specialty Specific Capabilities in Practice 2

• Leads the multidisciplinary team in the investigation of seizures, disorders of consciousness and organic brain disease.
• Utilises electroencephalography equipment and understands how and why they work.
• Makes decisions about purchasing and ordering equipment to perform investigations.
• Complies with laws and regulations regarding health and safety, confidentiality, information governance and safeguarding of vulnerable patients.
• Ensures quality assurance through audit and quality improvement projects.
• Understands the anatomy and physiology of the central nervous system.
• Understands the effects of different pathologies on the brain and how they are investigated.
• Assesses referrals for likely diagnosis and recommends investigation protocols including the use of hyperventilation and photic stimulation, length of recording, sleep, sleep deprivation and autosuggestion.
• Recognises benign variants in EEG traces
• Understands and recognises the effect of age on EEG traces.
• Understands and takes account of medication and its effects.
• Assesses, examines and interprets investigations and video recordings to look for patients with suspected seizure disorders, non-epileptic attacks and organic brain disease.
• Assesses clinical and physiological findings, and formulates and produces a report detailing likely diagnosis, anatomical location of a lesion, pathology and prognosis, further investigations and treatment as appropriate.
• Performs EEG recordings in adults and children.
• Recognises electrical artefacts and knows how to overcome them.
• Assesses clinical and physiological findings and communicates the findings with patients and colleagues effectively

Specialty Specific Capabilities in Practice 3

• Leads the multidisciplinary team in the investigation of peripheral and central nervous system disorders using visual evoked potentials (VEPs) and somatosensory sensory evoked potentials (SSEPs).
• Utilises recording and stimulating equipment and understands how and why they work.
• Makes decisions about purchasing and ordering equipment to perform investigations.
• Recognises electrical artefacts and knows how to overcome them.
• Assesses referrals for likely diagnosis or region of injury and recommends investigation protocols.
• Understands and recognises the effect of age on evoked potential traces.
• Understands and takes account of medication and cooling.
• Complies with laws and regulations regarding health and safety, confidentiality, information governance and safeguarding of vulnerable patients.
• Ensures quality assurance through audit and quality improvement projects.
• Understands the anatomy and physiology of the peripheral and central nervous system.
• Understands the effects of different pathologies on the nervous system and how they are investigated.
• Performs VEP, SSEP and motor evoked potential (MEP) recordings in adults and children.
• Performs and interprets SSEP recordings during spinal or cranial surgery to monitor neurological function or identify neurological structures and anatomy.
• Assesses, examines and interprets VEPs in patients with neuroinflammatory disease, disorders of optic nerve routing and optic nerve compression.
• Assesses, examines and interprets SSEPs in patients with demyelinating disease scoliosis, and hypoxic brain injury.
• Assesses, examines and interprets motor evoked potential and/or SSEPs in patients during cranial or spinal surgery
• Assesses nerve root functioning during spinal surgery
• Assesses clinical and physiological findings, formulates and produces a report detailing likely diagnosis, anatomical location of a lesion, pathology and prognosis, further investigations and treatment as appropriate.
• Assesses clinical and physiological findings and communicates the findings with patients and colleagues effectively.

Specialty Specific Capabilities in Practice 4

• Performs electromyography and records and analyses motor units to measure amplitude, duration and turns / amplitude analysis
• Interprets findings to differentiate between neurogenic and myopathic disorders
• Assesses clinical and physiological findings, and formulates and produces a report detailing likely diagnosis, anatomical location of a lesion, pathology and prognosis, further investigations and treatment as appropriate.
• Assesses clinical and physiological findings and communicates the findings with patients and colleagues effectively
• Performs stimulated and voluntary single fibre electromyography and records jitter and block to assess the function of the neuromuscular junction
• Interprets findings to identify disorders of neuromuscular junction transmission
• Assesses clinical and physiological findings, and formulates and produces a report detailing likely diagnosis, anatomical location of a lesion, pathology and prognosis, further investigations and treatment as appropriate.
• Assesses clinical and physiological findings and communicates the findings with patients and colleagues effectively

Specialty Specific Capabilities in Practice 5

• Leads the multidisciplinary team in the investigation of seizures, disorders of consciousness, disorders of sleep and organic brain disorders.
• Utilises electroencephalography and polysomnography equipment and understands how and why they work.
• Ensures quality assurance through audit and quality improvement projects.
• Assesses referrals for likely diagnosis and recommends appropriate investigation protocols including EEG recordings, drug reduction, duration of recording, polysomnography
• Understands and takes account of medication and its effects.
• Recognises and interprets EEG correlates of different seizure types
• Understands the role of EEG in presurgical assessment of epilepsy
• Understands the role of EEG is the management of status epilepticus
• Recognises and interprets common ECG changes in cardiac arrhythmias associated with loss of consciousness
• Assesses history, clinical and physiological findings of ambulatory EEGs and video EEG telemetry, and formulates and produces a report detailing likely diagnosis, anatomical location of a lesion, pathology and prognosis, further investigations and treatment as appropriate.
• Leads the multidisciplinary team in the investigation of seizures in patients being considered for surgical treatment
• Assesses referrals for likely diagnosis and recommends appropriate investigation protocols including intracranial and extracranial recordings, depth electrodes, drug reduction, duration of recording, polysomnography
• Recognises and interprets seizure semiology
• Recognises and interprets scalp EEG correlates of different seizure types
• Elicits and assesses seizure histories and proposes a differential diagnosis
• Assists the surgeon and supervises the physiologist in setting up and performing intra-operative electrocorticographic recordings and in identification and correction of common artefacts and faults
• Assesses clinical and physiological findings of scalp and intracranial EEGs and formulates a report detailing likely diagnosis, anatomical location of a lesion, pathology and prognosis, further investigations and treatment as appropriate.
• Assesses clinical and physiological findings of ambulatory EEGs and video EEG telemetry, and communicates the findings with patients and colleagues effectively.
• Assesses clinical and physiological findings of scalp EEG and intracranial EEG is patients in epilepsy surgery programmes, and communicates the findings with patients and colleagues effectively.
• Leads the multidisciplinary team in the investigation of disorders of sleep
• Elicits and assesses sleep disorder histories and proposes a differential diagnosis
• Identifies American Academy of Sleep Medicine EEG sleep stages and recognises abnormal patterns
• Interprets MSLT recordings
• Assesses clinical and physiological findings of EEG and polysomnography and formulates a report detailing likely diagnosis, anatomical location of a lesion, pathology and prognosis, further investigations and treatment as appropriate.
• Assesses clinical and physiological findings of EEG and polysomnography and communicates the findings with patients and colleagues effectively.

Specialty Specific Capabilities in Practice 6

• Leads the multidisciplinary team in the investigation of patients with suspected retinopathy and optic nerve disease
• Utilises recording electrodes, VEP equipment, Ganzfeld stimulator and multifocal ERG stimulators and understands how and why they work.
• Ensures quality assurance through audit and quality improvement projects.
• Assesses referrals for likely diagnosis and recommends appropriate investigation protocols including VEP, Electroretinograms, Electro-oculograms and Multifocal ERG
• Understands and recognises the effect of age on ERG traces.
• Understands and takes account of medication and its effects.
• Assesses clinical and physiological findings, and formulates and produces a report detailing likely diagnosis, anatomical location of a lesion, pathology and prognosis, further investigations and treatment as appropriate.
• Assesses clinical and physiological findings and communicates the findings with patients or colleagues effectively.
• Leads the multidisciplinary team in the investigation of patients with hearing or balance impairment or suspected brainstem disease
• Utilises recording electrodes and acoustic stimulators and knows how and why they work.
• Recognises electrical artefacts and knows how to overcome them.
• Assesses referrals for likely diagnosis and recommends appropriate investigation protocols.
• Understands and recognises the effect of age on BAEP traces.
• Leads the multidisciplinary team in the investigation of patients with event and movement-related cortical potentials
• Utilises recording electrodes and stimulators and knows how and why they work.
• Leads the multidisciplinary team in the investigation of motor pathway function and central motor conduction time
• Utilises recording electrodes and TMS stimulators, and understands how and why they work.

Currency Window

Evidence of your recent practice will be given more weight to reflect current capabilities and we suggest that approximately 50% of your evidence for a curriculum outcome is drawn from within the last five years of clinical practice (WTE).

Evidence Volume

around 100 electronically uploaded documents