TNA Clinical IOM Program Weekly Form TNA Clinical IOM Program Weekly Eval Fom This form is to assess the student’s performance over the course of the work week. Student's Name First Last Date MM slash DD slash YYYY Understanding anatomy (5 highest, 1 lowest)(Required) 1 2 3 4 5 N/A (Not applicable this week) 1. Knowledge of anatomy and physiology 2. Knowledge of muscle groups, nerve roots associated with muscle groupsUnderstanding types of modalities (5 highest, 1 lowest)(Required) 1 2 3 4 5 N/A (Not applicable this week) SSEPs, MEPs, EMG, T-EMG, S-EMG, TOF, EEGSpinal Procedures (5 highest, 1 lowest) 1 2 3 4 5 N/A (Not applicable this week) 1. Understanding types of cervical, thoracic, and lumbar cases as well as the modality guidelines associated with each case 2. Understanding anesthesia protocols for each type of case/and modalities selectedENT, Cardiovascular, Neurosurgical Procedures (5 highest, 1 lowest) 1 2 3 4 5 N/A (Not applicable this week) 1. Understanding the types of cases and modality guidelines associated with each type of case. 2. Understanding anesthesia protocols for each type of cases and modalities selected.Prepping (5 highest, 1 lowest)(Required) 1 2 3 4 5 1. Pre patient set up 2. Patient interview and patient consent 3. Patient in room documentedPatient set up, needle placement, & bed hook up (5 highest, 1 lowest) 1 2 3 4 5 N/A (Not applicable this week) 1. Ability to apply different types of electrodes to a patient’s anatomy with precision & speed in preparation of monitoring a surgical procedure 2. Prepares patients for testing by attaching monitoring devices & explaining test procedures Clinical correlations (5 highest, 1 lowest) 1 2 3 4 5 N/A (Not applicable this week) 1. Ability to understand various electronic and neurophysiological waveforms. 2. Understands the clinical correlations between abnormal responses and various disease states.Communication (5 highest, 1 lowest) 1 2 3 4 5 N/A (Not applicable this week) 1. Case logging/note taking 2. Communication with surgeon, anesthesia, readerPost case (5 highest, 1 lowest) 1 2 3 4 5 N/A (Not applicable this week) 1. Proper disposal of needles, clean up 2. Communication with the surgical team 3. Interpersonal and communication skills necessary to interact with MDs, medical staff, patients, visitors, other hospital employees, and company personnel. 3. Reporting baselines, surgical events, and closing data to the surgeon.Additional commentsPreceptor's Name First Last Preceptor's Email CAPTCHA