Dust Yourself Off and Try Again: Navigating Challenges in the Neurodiagnostic Field

The neurodiagnostic field—particularly EEG (electroencephalography)—can make even the most seasoned professionals question their knowledge. It's a specialty that demands flexibility, perseverance, and a relentless focus on solutions. Throughout my career, I’ve learned that challenges in this field aren’t roadblocks—they’re opportunities to grow.

Starting Out: Measurement Is Key

I completed an online neurodiagnostic program. We had multiple web session focused on learning to measure prior to starting our clinicals at the hospital. We practiced on a foam head and this was my reaction after my first session in January 2016.

For anyone new to EEG, the first step is mastering measurements, particularly the International 10-20 system. This globally recognized method ensures electrode placement is standardized, allowing EEG results to be compared accurately across regions and countries. The “10” and “20” represent the percentage distances between electrodes based on the skull’s dimensions—either 10% or 20%.

When learning to measure, expect hurdles like accidentally moving the measuring tape, unclear marks, or miscalculating percentages. Patient movement can further complicate things. However, with practice, these challenges diminish.

Pro Tip: Always double-check your measurements, especially as a beginner. Collaborate with colleagues to verify accuracy and track your progress. With time, you’ll gain confidence and speed, ensuring that your measurements meet the required standards, such as the 30-minute time limit for EEG exam eligibility.

Every head is unique, and measurements won’t always align perfectly. That’s okay! Keep practicing, refining your skills, and, most importantly, trying again.

The mannequin head we practice on is often referred to as a Sam Head. It is very important to practice measuring and parting hair.

Applying Electrodes: Learning by Doing

As students/ trainees we regularly measured each others heads and practiced apply the electrodes. This experience was incredibly valuable. I often volunteered my head.

Just like measuring, electrode application can feel daunting at first. Every patient brings unique challenges, and no single technique works for everyone. High or imbalanced impedances, patient restlessness, and the need for different materials (e.g., paste or collodion) require flexibility.

When I was a student, a mentor gave me advice that has stuck with me: “You can fix anything you don’t apply to your standards.” This reminder has helped me through countless challenging setups. When in doubt, do your best to care for your patient, and don’t hesitate to ask a more experienced colleague for guidance.

You won’t always have smooth setups, and sometimes external factors prevent a successful test. But those moments shouldn’t deter you from continuing to strive for excellence. Remember, you can’t control every circumstance—focus instead on finding solutions with the knowledge you have.

Reading the Squiggles: A Lifelong Learning Process

If measuring and applying electrodes are physically demanding, reading an EEG is intellectually rigorous. Interpreting EEGs is like learning a new language, only to discover that the vocabulary and grammar keep evolving. Terminology changes, research advances, and patient variables—such as medical history, medications, and structural abnormalities—add complexity.

Chart found on learningeeg.com showing a summary of the expected patterns seen in neonatal EEG based on PMA (postmenstrual age also called conceptual or conception age).

For example, understanding a patient’s background or posterior dominant rhythm is just the start. You’ll also need to recognize benign patterns and learn to differentiate between normal and concerning findings. Charts like neonatal EEG patterns can be helpful, but they won’t eliminate self-doubt entirely.

Even experienced epileptologists admit to second-guessing themselves occasionally. What sets them apart is their commitment to continuous learning and collaboration. If you miss identifying something significant, like a seizure, use it as a learning opportunity.

Pro Tip: Stay flexible and curious. When unsure, gather additional information or seek advice from colleagues or reading physicians.

Practice Makes Better

I prefer the phrase “practice makes better” over “practice makes perfect.” Perfection implies flawlessness, while “better” celebrates progress.

Measuring: With consistent practice, your speed and accuracy will improve. Confidence will replace hesitation as you learn to adapt to various patient head shapes and sizes.
Electrode Application: Over time, you’ll perfect the amount of paste or collodion needed and develop techniques for even the most challenging setups.
Reading EEGs: Experience will sharpen your pattern recognition. Monitoring long-term EEGs over hours or days will improve your ability to notice subtle changes. And when in doubt, never hesitate to seek a second opinion.

Keep Going: Growth Through Challenges

The neurodiagnostic field isn’t easy—it’s filled with moments that test your skills, knowledge, and patience. But it’s also immensely rewarding. The key is to embrace each challenge as a chance to grow.

When something doesn’t go as planned, dust yourself off and try again. With time, practice, and support, you’ll become a more confident and skilled professional, capable of making a real difference in patients’ lives.

Resources:

Learning EEG website - Neonatal Overview https://www.learningeeg.com/neonatal

ABRET Neurodiagnostic Credentialing and Accreditation

https://abret.org/