Neuroanesthesiologists as interoperative neurophysiologists: a collaborative cognitive apprenticeship model of training in a community of clinical practice

Directing intraoperative neurophysiologic monitoring(IONM) is a patient care activity for which no formal training programs exist, even though the need for well-trained practitioners is readily evident while caring for patients with diseases of the brain, spinal cord, spinal column, or nervous system. Here, we present the theoretical basis and institutional experience for a successful model of learning a new and complex set of skills: the medical direction of IONM. In a major academic institution, a clinical communityof practiceabsorbed new members with professional backgrounds ranging from a recent neuroanesthesia fellowship to several decades of neuroanesthesia practice and trained them in a collaborative cognitive apprenticeshipmodel to medically direct IONM. Our communityof practicecomprises experienced technicians, a diplomate of the American Board of NeurophysiologicMonitoring (DABNM), and six neuroanesthesiologists. This group forms the base of the scaffolding or structure where the apprenticeshipand learning take place. The clinical communityof practicehas trained eight new members in the medical direction of IONM. The group has also trained four outside anesthesiologists—one of whom went on to become certified as a DABNM—who went on to develop the IONM program at a major children’s hospital. This collaborative cognitive apprenticeshipin anesthesiologyto learn the medical direction of IONM is quite innovative as it integrates new members and expands the range of existing ones. In our model, the entire community is elevated by the reciprocal interactions of master clinicians, novice apprentices, and the communityof practice.