Cross training EEG and polysomnography skills in a combined laboratory setting has benefits for technologists.

The sleep monitoring-related fields—electroencephalography (EEG), electromyography/nerve conduction studies (EMG/NCS), interoperative monitoring (IOM), evoked potentials, and polysomnography (PSG)—are evolving at a rapid pace, and, for technologists, this means flexibility becomes ever more important. As I found out first hand, one good way to create this flexibility is through cross training. The results of a methodological approach for cross training toward multiple certifications are beneficial to technologists, patients, and employers.

My basic skills before learning EEG, EMG/NCS, and nocturnal polysomnography (NPSG) were in nursing and information technology (IT). I had the advantage of working in a large teaching hospital where departments and professionals shared experiences. I worked as a psychiatric technician for various departments, and, in the evenings, I combined nursing courses and IT certification programs.

As I learned about drug side effects, I also learned that IT certification was inherently necessary. I became a member of the Computing Technology Industry Association (COMPTIA) and adept at computer repair, networking, and troubleshooting, as well as A+ and Network+ certified. My third goal was to complete my Security+ certification.

Since I pursued my computer certifications at the same time I was studying for my registered EEG (R/EEG) technician credential, I had to balance two learning curves while working, too—a sometimes frustrating situation. At the hospital, I answered an employment advertisement from another department and began working for neurophysiology. That is where I comprehensively learned EEG for neonates, emergency department care, some IOM, and long-term monitoring (LTM). I spent free time looking at neonatal EEG patterns, reading Network+ texts, and attending in-services as often as possible, which hospital management encouraged.

I separated working on my IT skills from my other studies by setting up a small computer lab in my basement. To ensure the needs of the patients came first, I read up on EEG skills at work and applied them with repetition.

Laboratory managers should be aware that in-house training in a university setting should be not just for medical students. I attended the same in-services and vendor-sponsored lunches the medical students did. The key was the consis-tency of these opportunities, which increases the probability of passing board examinations. 

Balancing Goals
In cross training it is easy to feel overworked. It helps to prioritize as you reach junctions in your career. Juxtapose management needs with patient needs. This can lead to cross training being used in novel situations. One example was how my background in mental health and my EEG job training ended up making me more effective when working with LTM pediatric patients. With pediatric patients, time becomes a commodity. Parents are usually upset and need the technologist’s attention. Both physicians and parents appreciated my communication skills and computer skills while hooking up a child for monitoring.

The cross-training technician should know that some observers will be confused by “cross certification.” It helps to explain how such skills can play off one another, especially in the operating room and when talking to IT or bioengineering department representatives. I explain it as leading to quicker problem solving to the benefit of the patient.

Joining multiple professional societies when cross training is also helpful. I found it was well worth the money to become a member of the American Society of Electroneurodiagnostic Technologists (ASET), COMPTIA, and the Western Society of Electrodiagnostic Technologists (WSET). Doing so allowed me to touch base with other technicians, prepare for examinations, and partake in forums. Asking the societies questions about new areas of interest also can lead to certification later on.

Often continuing education and certification efforts are seen as something that might take the technologist away from time spent gaining valuable on-the-job work training, but the two tracks are actually congruous. When I worked in LTM, I combined my A+ certification skills with my EEG skills because of aging equipment that needed my troubleshooting skills. I had a busy schedule and the bioengineering staff was busy too. For problem solving, I would visit Web sites, get diagrams, compare parts, and explain things to newer technicians. I took advantage of any lulls in my shift to study, review EEG patterns, or ask to sit in the reading room with the physicians. I kept a small notebook on the portable EEG machine and, if in a sleep laboratory, reviewed notes as the patient slept. I had a rule of visiting the medical library before going to my car at the end of the day, and I would use “show me” and “thanks” for gathering advice from sales technologists or physicians.

Putting Cross Training to Work
I applied my cross-training skills to alleviate the anxiety of subgroups of patients, especially the elderly. Some technologists would read a chart to gather information on the patient. I opted to walk to the floor and say “hi” to the patients to assess their moods. I found that humor and a recitation of a “verbal resume” was helpful in dealing with the elderly. In some cases where dementia was an issue, repetition was also very important. The general rule while doing a procedure is: Talk is good while silence produces tension.

Another patient group where cross training ended up being useful was pediatric autistic patients, who can be difficult for both sleep and EEG laboratories to deal with. These children often cannot tolerate being touched, so technologists must be patient during hookup. My previous mental health experience helped me here. I found that animation DVDs, music, and children’s books used during preparation of EEG or NPSG made for a more artifact-free EEG. Giving the child and parents a tour of the laboratory a week beforehand also helped.

Combining EEG and Sleep Skills
As I later worked for a private practice, I was asked to help out in a new EMG laboratory one floor above our sleep laboratory. It was a challenge to take on another set of textbooks, but it led to a new set of skills. I found that it was possible to put EEG and sleep laboratories together. The sleep laboratory was new, and I was willing to incorporate portable EEG technology into it.

I found that, in certain cases, it is possible to save money by using cross-trained technicians, especially when there is a shortage of technicians. In addition, the expansion of the epilepsy/sleep apnea syndrome behooves the technologist to cross certify over time.

However, cross training does require independent study. When I accepted the private practice position, I learned to work alone and on a team. I also learned to ask three questions for an embedded laboratory to be efficient:

1. Does the sleep laboratory have a neurologist or neurology specialist on staff?

2. Does the neurologist interpret overnight sleep recordings?

3. Does the center have the necessary equipment and staff expertise for the performance of a full EEG throughout the sleep recording (NPSG)?

The sleep apnea patient with possible nocturnal seizures will ask many questions at night when a physician is not around. As I continue my cross certification, I have had the chance to observe such patients. They rest easier if a cross-trained technologist can answer questions as the patient prepares to settle in for a NPSG. I felt that my IT, EEG, and sleep laboratory skills made for an easier night (or day) for many patients.

Lawrence J. Pelow is EEG Neurotechnologist at Tucson Medical Center (TMC), Tucson, Ariz. He can be reached at