Diagnostic investigations in clinical neurophysiology produce abstract waveforms that are vulnerable to many environmental and human factors. In very few other branches of diagnostic medicine is the training and skill of the operator so fundamental to the clinical validity of the test, which must be interpreted within the clinical context. Accordingly, competent, well-trained staff are essential and the specialty places great emphasis on the quality of both medical and scientific practitioners. It has developed rigorous training programmes in conjunction with the Joint Royal Colleges of Physicians Training Board (JRCPTB) and Modernising Scientific Careers (MSC) at the Practitioner Training Programme (PTP), Scientist Training Programme (STP) and Higher Specialist Scientific Training (HSST) levels, as well as professional exams for healthcare scientists that supplement the MSC syllabus.
Regular medical audits are fundamental to maintaining quality and the specialty has a multidisciplinary Joint National Audit Project, founded by the British Society for Clinical Neurophysiology (BSCN) and the Association of Neurophysiological Scientists (ANS). It undertakes national audits of practice and adherence to guidelines, the results of which are published in peer reviewed medical journals and online.
The BSCN and ANS have jointly contributed to developing an IQIPS (Improving Quality in Physiological Services) module – a CQC-approved scheme allowing for accreditation of individual departments by the UK Accreditation Service (UKAS). Accreditation covers the four domains of: patient experience; safety; facilities, resources and workforce; and clinical. IQIPS is at an early stage in its roll out – at the time of writing only one department has achieved accreditation – but this is expected to become universal, and the specialty strongly encourages its adoption. The cost and work involved in gaining accreditation are significant and perceived as a barrier by some provider trusts. It is in the interests of both commissioners and patients that IQIPS is widely adopted.
Both the British Society for Clinical Neurophysiology and Association of Neurophysiological Scientists provide educational meetings and training courses for their members, to facilitate continuing professional development and encourage lifelong learning.
Many departments participate in regional specialty groups, which may include peer review and audit components as well as education. Peer review for consultants carrying out electromyography has been particularly difficult to achieve but should be encouraged, perhaps between neighbouring departments. The BSCN is developing a quality assurance programme for peer review of electroencephalography (EEGs).