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Special Interests Section – Fall 2019

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Dear Colleagues, 

We have our Board of Trustees to thank for our current topic. Thanks BOT!!  This quarter we will be visiting clinical sites. The Board asked us to share how a student could learn from us in our modality of NDT.  They also asked us to share how a student might help our clinical site stay fresh and innovative.  

Our field of NDT is a broad career path. We have so many opportunities to explore. Wouldn’t it be great to share those opportunities with an excited, curious student?   

My areas of expertise are IT troubleshooting, clinical processes and remote LTM monitoring. These areas are fascinating, always changing, and engaging.  While having a student means I would need to wear something other than my blue jeans and t-shirts to work, it would be more educational for me to teach them about what I do every day than they might hope to learn from me. I LOVE to teach!  I love to LEARN! Students give us all those opportunities and we can improve our lab and our patient care and processes by showing students what we do.  

Our Special Interest Section Leaders jumped right in and provided powerful articles. Please read and enjoy and as always please write us with your own experiences.  

Much gratitude to my own teachers and mentors! 

Petra Davidson, BS, R. EEG/EP T., FASET 

Ambulatory EEG
Autonomic Testing
Clinical EEG
Department Managers
Epilepsy Monitoring (1)
Epilepsy Monitoring (2)
Intraoperative Neurophysiological Monitoring
Nerve Conduction Studies
Neurodiagnostic Education (1)
Neurodiagnostic Education (2)
Pediatrics & Neonatology
Technologist Entrepreneurs

Interest Section: Ambulatory EEG 

Interest Section Leader: Jennifer Carlile, R. EEG T.  

Our topic for this article is, “How can a student learn from your clinical site, your colleagues about your modality of NDT and how might a student help your site stay fresh and innovative?”  

We have had the great pleasure to work with a few students over the last few years and even hired a couple of them. One of the benefits of having students work in our office was for them to experience the full scope of ambulatory EEG recording. They could see start to finish how this was accomplished at different levels. As with any diagnostic test, there are behind-the-scenes operations that need to be taken care of prior to the patient being tested. Obtaining and receiving the order, insurance verification, scheduling, organizing supplies and equipment needed for the monitoring session and finally, setting up and testing the patient. Once the testing is complete, a download and a review of the data, and commenting on or clipping data for the physician are all key components for the ambulatory EEG process. The students get to observe all these steps and, hopefully, the most fun part for them is interacting with the patients or reviewing the EEG.  

During each of these steps we are working together as a team. This may be the first time a student gets to experience this modality. Every person on the team brings something to the table, their own knowledge level, their own experiences and advice. So again, working together as a team helps the process flow smoothly. The students bring new ways of looking at the modality, and what they have learned in the classroom can be altogether different as how one might use it out in the field. A long as we respect the different levels of knowledge and work together as a team, our common goals will be met.  

Interest Section: Autonomic Testing 

Interest Section Leader: Marcia N. Hawthorne, R. EEG T., CAP 

I love to teach, and I really didn’t know this until I started this profession.  I love to verbalize what it is that I’m doing and why it’s being done.  When autonomic testing is performed without actually thinking about what is being done and why, bad habits can begin.  If a new technologist or student is being trained, consistency is a key component of the training.  When training a student or new technologist, shortcuts cannot be taken. Policies and procedures are always being discussed and reviewed. When these things are being consistently reviewed and practiced, fewer mistakes are being made.  As technologists, our role is crucial to ensure accurate testing.  Training students and new technologists not only helps us perform our testing accurately, but it also helps us to be a part of an amazing profession by training new technologists to do the same.  Neurodiagnostics is a profession to take pride in and it is growing by leaps and bounds every year.  What an extraordinary thing to be a part of.   

In addition, there have been several times during training I have learned something new from the trainee or student, which was then utilized to improve our lab!  These students and new technologists are reading textbooks and are in online classes daily and they are learning the things that we were all taught but sometimes we forget.  They help us to refresh our memories and because of that, become better technologists.  I’ve enjoyed each student/trainee that I’ve had the pleasure of training; each one has taught me something and for that I am thankful. 

Interest Section: Clinical EEG 

Interest Section Leader: Emily Scanlan, R. EEG T. 

In my current role, I am the classroom and clinical instructor for Mayo Clinic School of Health Sciences in Rochester, MN. We have students in our labs year-round. Students have the unique opportunity to rotate through several different areas at one site. Students get to spend time in our outpatient area, our inpatient hospital lab and our Epilepsy Monitoring Unit. Completing clinicals in our Rochester campus allows students to see some very unique and rare waveforms that many other institutions may not come across.  

I love teaching and have been doing it since 2012. Students have a unique position in our labs. They are able to see what we are doing and at times may come up with an idea to help improve things or our schedule. So often we are used to doing things a certain way that it may be difficult to see another way to do things. This is why I love student feedback. I don’t like to admit it often, but the students are getting younger and are VERY technologically savvy. This is great for the institutions and often leads to advancement in technology in the lab areas.  

Special Interest Section: 
Department Managers 

Interest Section Leader:  Kathy Johnson, R. EEG/EP T., RPSGT, FASET 

Welcome to Fall!  This time of year brings memories of back to school…no matter how long it has been since you stepped onto that yellow school bus in your brand new back-to-school outfit with your pristine spiral notebook and excitement in your heart.  For many of us, the tables have turned and we have gone from being a student to spending at least part of our time being a teacher, either formally or informally.   That is not to say we shouldn’t continue to learn new things but we often find that we spend a lot of time passing along the knowledge we have acquired over our years in the field, even if the job description is not that of instructor.    

In keeping this section related to management, I thought a bit about what I am teaching my staff, both my on-the-job trainees and my more seasoned and knowledgeable staff about management. While we typically think of management as directing or overseeing the activities of others, another very important aspect is self-management. Merriam-Webster’s Dictionary defines self-management as “…finding the self-control and mastery needed to take control of one’s work…”.  Self-management is a critical factor for success in most occupations and has been said to be the single biggest factor in performance. There are many factors involved in self-management, but some of the most important are:  time management, problem solving, communication and controlling stress.   

Developing good time management skills means learning to produce quality results in a timely manner.    It does not mean being the fastest hook-up tech or getting the most tests done in a single day. Rather, it means being able to effectively plan your work to accomplish the best outcome for your patient and using any down time effectively to complete the numerous other tasks for which you are responsible.  Time management requires an understanding of the priorities for your workflow, what needs to be done right away and what can wait.      

Problem solving is an essential skill for any employee but is a big part of what we do as ND technologists.  Even the most difficult patient or most challenging testing problem can usually be effectively handled if one is continually processing the options for a successful result.  Consideration of all the facts, analysis of the situation and using the technical skills you have been taught will help you solve most problems.   Even knowing when you are in over your head and asking for assistance is an element of problem solving. Like most old sayings, “Two heads are better than one,” is frequently applicable to the problems we encounter. 

Communication is vitally important in all that we do as ND technologists. Being able to clearly educate your patient on the testing process, communicating with your co-workers and providing physicians with optimal information in a timely manner are all important aspects of the job that require ND technologists to develop excellent communication skills.  Telling the neurologist that the patient’s EEG is “kinda slow” is not as helpful as communicating that your post-stroke patient has a consistent 50 µV, delta focus in the left hemisphere, most prominent in the frontal area.   

One of the most important self-management tools for anyone in health care today is the ability to understand and manage stress. Many ND technologists work in areas that are extremely stressful, including the operating room, critical care units, LTM units, etc. but stress is not limited to these environments. Avoidance of stress is rarely possible but understanding your primary stressors and developing methods to cope with them will go a long way toward avoiding the mistakes that are often made when one is stressed. The inability to cope with stress can result in difficulty performing even the simplest tasks which will likely result in frustration and loss of productivity.   

So, putting some additional emphasis on self-management is going to go on my action plan for my staff (and for myself)……….who says old dogs can’t learn new tricks? 

Interest Section: Epilepsy Monitoring 

Interest Section Leader: Magdalena Warzecha, R. EEG/EP T., CLTM 

Being a clinical site for neurodiagnostic programs has been part of our company’s operations for almost 10 years. We have not only trained students, but also recruited between 20-25 techs into the field of neurodiagnostics in several states in the Midwest. Our company specializes in EEG; we perform routine EEGs, monitored, in-home EEGs, as well as bedside EEG hookups and ICU/EMU cEEG monitoring.  

As the company grew and expanded over the years, we needed to add technologists in many states, but with a national shortage of techs and lack of seated programs it wasn’t always an easy task in many locations. Recruiting and training our own work force was one way of increasing staff. Nearly all techs we recruited completed accredited programs and became our full-time employees, and many earned ABRET credentials in EEG and some also continued on to get certified in LTM.   

Most of the online neurodiagnostic schools require students to enroll with clinical sites simultaneously when enrolling in a neurodiagnostic technology program. Seated programs may have different rotation requirements and they vary for different schools. In our company, registered technologists or lead techs oversee students in each location. The clinical educator oversees all sites and provides extra help, teaching sessions with physicians, record reviews, board prep classes and webinars. After students’ initial clinical site orientation and compliance and infection control orientation, we start clinical training with the 10-20 system of measuring and marking the head. I can’t tell you how many manikin heads we have in our offices, some with very creative hair styles!  During the first weeks of clinical practice students shadow techs performing EEGs, but gradually they begin to take a more active role in the process, learn bedside manners, help type in patient history, prepare equipment, start the study, measure and mark a real patient’s head and apply electrodes. As students advance further in their education, we introduce more record reviews and bring on more advanced topics in clinical practice: cEEG, ICU EEG, periodic patterns and their clinical significance. Advancement in clinical training correlates with students’ advancement in the neurodiagnostic program; all accredited programs have very specific expectations for clinical sites and provide tools to monitor and report students’ progress.  

Giving students plenty of hands-on experience is key to acquiring competencies, but I think showing them how their work is important in helping physicians to diagnose and treat patients is equally important. During clinical practice students should also learn about the possibilities of where they can go in the field of neurodiagnostics. This is their first contact with the field, and it is up to clinical site instructors to make it a positive and inspiring experience. I always enjoyed teaching techs pattern recognition, clinical correlates, seizures classification, recognizing electrographic seizures and interictal discharges, showing the differences between artifact and real activity. Not every student will advance and become registered but igniting curiosity and drive towards learning as well as showing students a path to advancing their career is one of the most important and rewarding aspects of clinical education.  

Interest Section: Epilepsy Monitoring 

Interest Section Leader: Susan Hollar, BA, R. EEG T. 

One of the most rewarding opportunities is being a clinical site for NDT programs. While it is a big commitment of time and effort, it is worth it. The opportunity to bring someone into the field who is excited, has new ideas, and is engaged, rejuvenates the entire team.  

The environment of an academic hospital provides a lot of opportunity to see a wide variety of patients and illnesses. We have neonate to hospice care and all that falls in between. The opportunity to introduce a student to all ages is a big plus. The exposure to all ages broadens the experience and knowledge of the student. It is very different hooking up a premature infant than a scared two-year-old. Having a student increases the awareness of bald or thinning haired patients. Everyone is on the lookout for that perfect human head for the student to measure.  

Our hospital is a quaternary care center for the region. We get the sickest of the sick for our region. This provides opportunity to see many of those illnesses, disorders and syndromes usually only seen in the textbooks. It really helps with board exams when you can associate the disorder with an experience. 

The opportunity to experience the Operating Room (OR) from CEA and Epilepsy Surgery also is provided to the students. This often is their first exposure to the OR world. While we don’t offer the IONM path, it helps students get that experience to see if they are interested in the surgical side of the field.  

Students are also exposed to the Epilepsy Monitoring Unit (EMU) for both children and adults. This allows the student to encounter patients who are living with epilepsy. There is opportunity to see how relationships are developed when you see the same patient as they go through the journey. 

Interacting with students refreshes the synergy of the entire staff. It demands use of the professional vocabulary, refreshing formulas and reviewing all anatomy! The other big plus is the opportunity to see the skill, compassion, and work ethic of a technologist before hiring them.  

Some of my best technologist hires were first my students! Right, Anna Bonner!  

Interest Section: Intraoperative Neurophysiological Monitoring 

Interest Section Leader: Justin W. Silverstein, DHSc, CNIM 

Long ago, when I began in neuromonitoring, you learned on the job. There were no courses or degrees in surgical neurophysiology, so you were at the mercy of the people training you and your own drive to learn from textbooks and journal articles. Some groups back then did have a didactic portion to their training paradigm, but these programs were truncated versions of courses which tended to focus on basic science and a brief overview of modalities for a few weeks only. Unfortunately, there was no real substance or enough time to become masterful in the science. Even those who had the opportunity to learn in a didactic setting still obtained most of their understanding in the Operating Room (OR) with a senior clinician. Due to this lack of formal training in the field, some groups tailored their hiring practices to only hiring individuals with advanced degrees where the clinician would come in with a solid foundation to begin with (e.g. chiropractors, audiologists, neuroscientists, biomedical engineers, etc.). Other groups just hired people with any background – which has led to a broad bandwidth of education and understanding in our field.  

As someone who has personally taken a circuitous route to gain the education and knowledge I now possess in this field (I am not going to rehash my journey here – feel free to go back to the ASET News Archive where I chronicled part of my journey in my first ever interest section article back in the spring of 2010; reference below),  I wanted to give the same opportunity to others when I started my own neuromonitoring group back in 2011 without causing them the out-of-pocket expense it may take to gain a higher education. With the lack of formal educational programs, I wanted to provide people with the tools needed to succeed in a career of surgical neurophysiology. I made a conscious decision to not hire people for today or tomorrow, but for a year or two down the line. I created a fellowship program where individuals with what I deemed was the appropriate background (engineering, neuroscience, kinesiology, etc.) could learn our trade in a more organized and disciplined fashion.  

The fellowship program I created is one year long, where fellows get an entire year of both didactic and clinical education. The fellows are hired by us with the plan to be a full-fledged provider for us once they have completed the fellowship. There is no cost to them other than a termed contract with us. I currently have two educators who work with each fellow class. It is a rigorous course that starts with basics and progresses to complex understandings of the dynamics of surgical neurophysiology. The course is currently broken down into 18 sections. Aside from classroom teaching, each section has textbook and journal assignments, along with webinars and worksheets. At the end of each section there is an exam the fellows must take in order to proceed to the next section. We hold our fellows to an extremely high standard and require a 90% passing grade for them to move on. Unfortunately, if they cannot pass the exams within two attempts, their fellow status with us is re-evaluated. At around the eight-month mark, we also start prepping the fellows to sit for the CNIM exam. A typical week for our fellows is two to three days in the classroom and two to three days in the OR with a senior CNIM.  

Our program is comprehensive and the fellows really gain an understanding of our science. By the time they are able to cover a case independently they will have amassed many hours of classroom and OR time that even though it’s their “first” case, they have seen so many that they are comfortable with how to run a case and what to do should something go wrong.  

Times are changing and more programs are now available to individuals who want to gain entry in the field of surgical neurophysiology. Unfortunately, these programs are still sparse. I live by the adage that if you want to be an expert in something you must put in your 10,000 hours. The program I have created puts my staff on that path to hopefully facilitate creating more competent clinicians in our field from the ground up.  

Reference: Silverstein. J (2010). Intra-Operative Monitoring. ASET News 34:(1)27-8. 

Interest Section: Nerve Conduction Studies 

Interest Section Leader: Dorothy J Gaiter, MHA, R. EEGT, CNCT, R. NCST, FASET 

“Teachers affect eternity; no one can tell where their influence stops.” 

~Henry Brooks Adams~ 

Teaching for me is a different path in that I travel to the trainees’ clinical site. I specialize in cross-training techs who are already in the Neurodiagnostic field as well as a few who are new to electrodiagnostics (i.e., NCS), although these trainees were already working in the healthcare arena, but unfamiliar with nerve conductions and/or EEG. I enjoy and love teaching others in the field of Neurodiagnostics. Some characteristics of a good teacher:  

  • Great listener and communicator 
  • Knowledgeable 
  • Inspirational 
  • Patience and kindness  
  • Cheerleader 

The purpose of teaching is to inspire techs to succeed in the field and to develop self-motivation to improve the lives of patients, as well as themselves, and to maintain a positive attitude in accepting change as the field continues to transform and grow. My tagline is: “Motivation comes from within… Focus, Continue and Finish Well.” 

The method I take is not to intimidate, but to ease trainees’ apprehension and anxiousness. Therefore, I must have an open mind with a humble approach, because it is not about trying to impress, but to be patient and caring in training and teaching them no matter their level of knowledge or skill set. The one thing I learned and continue to learn from every site…someone can always impart something to the teacher, no matter how minor and the teacher ought to be receptive.  

At the end of the day, I want the trainees to have nothing less than excellent and quality skills and confidence within themselves to service their patients in the field of Neurodiagnostics. A few of the actual (i.e., verbatim) comments from trainees at the end of training: 

“You really know how to relate whatever you’re teaching at the time to your trainees’ level. I know that not having the formal education could be a hindrance, but you didn’t allow it to be. You were able to relate all subject matter to our level and really take the time to explain. I also think that a strong point of the training was the fact that you held a good pace of teaching that was both conducive to effective learning as well as being timely so that we could get enough teaching material in for the training to be effective.” 

“My team told several times how passionate you are about your profession and how confident they felt about EEG testing thanks to your training.” 

“She is very knowledgeable and patient. She is exceptional at meeting individual trainee needs through communication and her interpersonal skills. Dorothy went the extra mile in providing us with the necessary tools, i.e. covering the basics as well as having materials that we didn’t realize we would need. Needless to say, we were a challenge, ‘opportunity.’” 

Lastly, another important factor is encouraging techs to join one of the professional organizations to increase his or her knowledge base in learning and getting registered in whatever area of the field for which their passion lies because knowledge is power and education is a fundamental pathway to the road of success for every tech, trainee or student.  

“It is the supreme art of the teacher to awaken joy in creative expression and knowledge.” 

~ Albert Einstein~ 

 “The task of the modern educator is not to cut down jungles, but to irrigate deserts.” 

~C. S. Lewis~ 

Interest Section: Neurodiagnostic Education 

Interest Section Leader: Anna-Marie Beck, MOL, R. EEG T., FASET 

Students can affect a clinical site in so many ways! They are full of an energy that can be contagious if we let it. They also have a desire to learn from everyone! They want to see it all and experience all that NDT has to offer. If you are lucky enough to work with a student, you should embrace these qualities. Now, this doesn’t answer the question, “How can a student learn from me?” but I will attempt to answer that now. 

Students typically come to the clinic sites with new information. This is the result of their instructors being current on guideline changes and new terminology, for example; however, we as technologists do them a disservice if we are presented with any new information and continue to use old information (e.g., LPDs [new] vs. PLEDS [old]). Keep in mind that when students take their board exams, the new terminology is what they will see, and you may impact their knowledge if you continue to use the old information. They have worked hard to learn the foreign NDT language, and we (as a profession) should embrace and encourage this quality in them. They may not say it to you (the clinical site), but they bring that back to their instructors, that feeling of defeat is powerful to them as they are learning a completely new career. They worry that they were taught incorrectly, or worse, that the clinical site did not think it is necessary to keep up on new information.  

Students are fun, energetic and can be rejuvenating to a lab if you welcome them in. Be open to any new information presented. Don’t worry if you can’t answer their questions, their instructors cannot always answer them either! As an instructor, I have sent them to clinical sites to ask some questions. Students can truly impact a lab in so many ways, they can present new information, they can help us (technologists) to learn or re-learn things we ‘just know’ and they can energize us with the passion we have for our field. As a clinical preceptor, you are tasked with being open to new information, energy and new colleagues; I encourage you to embrace them all as students are our future. 

Interest Section: Neurodiagnostic Education 

Interest Section Leader: Mark Ryland, AuD, R. EP T., R.NCS.T., CNCT, FASET 

Since I have been at Cuyahoga Community College now for about 15 years, I have realized teachers come in many forms.  As a fledgling Program Manager, I learned a great deal from the other Health Career Program Managers (some of which had programs running for over 20 years), and a great deal of the success of our NDT Program can be attributed to them for all their guidance and assistance. 

For the most part, the students who graduate from our program always praise the faculty, preceptors and the clinical staff at our sites for their success; thanking them for guiding them through the minefield of their two years in the program. I am always flattered when a student says I inspired them, but I remind them they were the ones who put in the time, did the studying and got the grades to get through. 

I have found that when students begin clinicals, they bring new skills back to our class-labs, and I learn from them through their clinical instructors. Because many of the students are younger (they could be my grandchildren!), they are wicked computer savvy, and have shown me several capabilities and little shortcuts our diagnostic equipment can do. It is always refreshing to learn from someone younger than you! 

And I think the program and the influx of new, fresh minds has helped the clinical sites stay up on things. It is just such a win-win situation on both sides for a clinical facility to hook-up with an educational program. I feel blessed to have so many outstanding clinical sites, with truly dedicated Technologists, and Technical Supervisors, literally surrounding our college program! 

Faculty, staff, Preceptors and Supervising Technologists are both teachers and students pretty much every day, as we can all learn from each other. 

Interest Section: Pediatrics & Neonatology 

Interest Section Leader: Melanie Sewkarran, R. EEG T., CLTM 

Students are all we know. We don’t have a pool of trained EEG techs in our geographical area, so several years ago we realized we needed to start training our own. We’ve had students around in varying numbers for nearly 20 years. In addition to being the most effective avenue for us to gain and retain EEG staff, it also benefits our department by keeping us on our toes. Since we’re constantly in teaching mode it helps us continually re-evaluate why and how we do things. Students tend to bring with them a fresh perspective.  I can’t tell you how many times we’ve had a student come in and ask why we did (or did not) do something a certain way and the rest of us just stared at each other trying to think of a good reason. While it’s a bit humbling for someone so new to notice an opportunity for improvement that we’ve overlooked, we’re definitely grateful for the fresh eyes.  

Another benefit is that it helps keep our fully-trained EEG techs fresh because they are constantly getting questions from the students. Some of the school work the students have to do can spark a friendly debate among the group and then all of us wait with baited breath to see the correct answer. I also believe that any time you’re asked to teach what you know to someone else, your own knowledge and understanding deepens. So, while having students can be seen as an additional burden on your team, I think that the benefits far outweigh the costs. Our students definitely make us better!  

Interest Section: Technologist Entrepreneurs 

Interest Section Leader: Janna Cheek, R. EEG T., CNIM 

My particular area of expertise is EEG artifact recognition and troubleshooting.  I also love teaching basic EEG 101 and head measurement and have put together a two-day hands-on class with a Power Point presentation that walks each student through the step-by-step guide on how to achieve correct lead placement and, just as critical, achieving equal and low impedances. As the field of neurodiagnostics is constantly evolving, the root concept does not change. I recall and cherish my training days with analog recordings and the afternoons and hours spent in record review with the neurologist, fellow or resident reader.  I have developed a record review class that I feel is so needed in every aspect from being able to communicate with the physician as to a positive or negative routine recording to editing LTMs and AEEGs prior to final review. When a student walks out of my class with a smile and a true understanding of a particular waveform, sleep recognition or even when they finally have all leads on the head correctly with the impedances below 5KΩ, it means I have turned the light on to a new level of knowledge for this person. I LOVE giving students new opportunities and have designed several basic short courses for the beginner and offer individual and weekend classes per individual or department request.   

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