Introduction to Intraoperative Neurophysiologic Monitoring

History

When a patient undergoes surgery, they cannot speak for themselves. No one knew this truth better than pioneering IONM physician, Dr. Thirumoorthi Seshan. Intraoperative Neurophysiologic Monitoring (IONM) was not only his expertise but also his passion. The Center for Electroneurodiagnostics (CEN) began from his vision of a healthier world — a place where people are empowered to speak up for those who cannot speak for themselves.

In the early 1980s, Dr. Seshan began utilizing methods to assist several prominent surgeons with pediatric scoliosis corrections. Recognizing the importance of IONM and its vital role in patient safety, Dr. Seshan saw tremendous value in sharing his knowledge with others. Because of this, he founded an IONM training program that would eventually become known as the Center for Electroneurodiagnostics. The program he birthed empowers individuals to keep patients safe from surgical injury and able to maintain their livelihood.

Dr. Seshan’s ultimate goal was to create a comprehensive educational program that encompassed all of the ideals necessary to create highly skilled surgical neurophysiologists. Today, CEN produces hundreds of qualified and employable clinicians each year. At the time of his passing, Dr. Seshan alone had monitored thousands of cases. Now, because of his vision, CEN graduates will go on to monitor and protect thousands more.

Courses

The program is divided into three courses:

Total hours: 15 clock hours (theory)
Delivery: Online

Description: In the Introduction to Intraoperative Neurophysiologic Monitoring online course, you will:

  • Obtain a comprehensive foundation of surgical neurophysiology as a medical specialty
  • Absorb the knowledge required to be successfully employed in this growing field
  • Discover myriad critical areas in the modules — including anatomy and physiology, monitoring basics, and types of surgeries (which will be explored in depth later in future courses)
  • Gain context, along with the engaging material
  • Learn through online content, in-person resources, homework and exams
  • Grow a thorough understanding of human anatomy and the interconnected systems necessary for human function
  • Explore the role of Surgical Neurophysiologist and how it applies in a clinical setting

Objectives: Upon completion of this course, students will be able to:

  • Demonstrate knowledge of human anatomy and physiology
  • Define the role of the surgical neurophysiologist
  • Summarize the role that neurological monitoring plays in surgeries
  • Describe the setup of monitoring equipment
  • Differentiate modality (data) types and understand their applications
  • Identify the types of surgeries most likely to include a monitoring component
  • List the types of data obtained through surgical monitoring
  • Analyze how anatomical systems intersect with surgical monitoring to provide data that enhances patient care

Total hours: 60 clock hours (42 clock hours theory, 18 clock hours lab)
Delivery: Classroom

Description: Students continue to build on the foundational knowledge learned in the Introduction course and apply this knowledge. To understand the duties of a surgical neurophysiologist, students must become familiar with the various components of the equipment.

  • Enjoy hands-on practice
  • Utilize monitoring equipment
  • Prepare for the practicum portion of the program
  • Explore the hardware and software and its use on patients
  • Study the appropriate surgical supplies
  • Gain a thorough understanding of preoperative patient interaction and its importance
  • Master the procedures for obtaining baseline data, data interpretation and documentation of results
  • Discover how to communicate with the surgical staff and remote reading physician

Objectives: Upon completion of this course, students will be able to:

  • Summarize quality patient care
  • Interview the patient independently
  • Outline case needs with the surgeon(s)
  • Identify and follow all safety protocols
  • Set up monitoring equipment
  • Place electrodes on the patient correctly based on surgery type
  • Perform appropriate modalities based on surgery type or type requested by the surgeon
  • Troubleshoot technical issues
  • Interpret data in consultation with the remote reading physician
  • Lead overall communication with the surgical team
  • Recognize, document and record all relevant events correctly
  • Maintain and safeguard records
  • Identify intraoperative changes and their significance
  • Manage communication of significant changes to the surgical team after consulting with the reading physician
  • Observe all relevant patient and personal safety precautions

Total hours: 225 hours (10 weeks) (est. 4.5 hours per day)
Delivery: Internship

Description: The goal of the Practicum is for students to develop their hands-on skills in the operating room. During this time, students will work under the supervision of a senior surgical neurophysiologist and learn to monitor both basic and advanced spine cases. Depending on the operating room schedule and the timing of the Practicum, students may even have the opportunity to participate in highly specialized cases.

Additionally, training opportunities will extend outside of the operating room to further each student’s industry knowledge and enable them to gain critical IONM workplace skills. When students are not in the operating room, they engage in training exercises. You will:

  • Create reports on a variety of surgeries, pathologies and patient conditions
  • Simulate cases in the office by setting up and modifying the cascade protocols
  • Run modalities on fellow students to increase familiarity with the equipment
  • Explore how to troubleshoot situations that may arise in the operating room
  • Learn to correctly document a case in the EMR from fictional cases online
  • Remotely shadow a case in the office

The Practicum is completed over 10 weeks. Students will be assigned to an approved Practicum (externship) provider. Each student’s schedule will vary during this time based on the OR schedule at the hospital facility. Additionally, to participate in the Practicum, each student must complete all hospital requirements before entering the operating room. These requirements include:

  • Completing a background check
  • Receiving up-to-date vaccinations
  • Completing a screening for bloodborne pathogens AND a drug screening
  • Purchasing liability insurance

Objectives: Upon completion of this course, students will be able to successfully demonstrate all skills on the practicum checklist at a rating of 5, including:

  • Patient setup – stimulator electrodes
  • Patient setup – recording electrodes
  • Equipment setup
  • Data acquisitions
  • Waveforms and cursors
  • Technical troubleshooting
  • Vitals and anesthetics troubleshooting, under the oversight of the remote reading physician

Students will be evaluated on skills after every case by the practicum supervisor. Skills are rated on a scale of 1 to 5, with 5 being the highest. To sit for the final exam, students must achieve a rating of 5 for each skill on the checklist.

The final exam is worth 100 percent of the grade. Students must achieve a minimum grade of 70 percent to pass the course.

Upon successful completion of all three program components, students will receive a certificate of completion.

Preparation for the Certification in Neurophysiologic Monitoring (CNIM) Exam

Coming soon