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Staff Spotlight: Emily Kale

Thursday, March 2, 2017

Emily Kale, the supervisor for the Department’s Neurophysiologic Intraoperative Monitoring (NIOM) service, is the subject of this week’s staff spotlight. In this interview Kale talks to us about providing technical supervision during head, neck, and spinal surgeries at Duke, her editing duties for the Journal of Clinical Neurophysiology, and giving presentations on new NIOM techniques in Brazil, Indonesia, Germany, and other locations.

You’re currently the Neurology Department’s Neurophysiologic Intraoperative Monitoring Supervisor (NIOM). What does this work involve?

The NIOM team evaluates nervous system integrity during surgery. I provide provide leadership for the team by providing technical oversight as well as program and staff development.

A typical day begins with assisting junior technologists as they select monitoring paradigms for the surgeries they will monitor. Once surgery is in progress  I provide technical supervision during surgery. This involves optimization of evoked potential, EEG, and EMG  responses at the beginning of surgery, assessing intraoperative changes in those responses, providing technical assistance as needed, and helping communicate with the surgical team in the event of a true neurophysiologic change. In addition to this I provide quality reviews and write policies for NIOM at Duke University Hospital and Duke Regional Hospital. My favorite part of my job is assisting with NIOM research projects. Duke is known for cutting edge and high-quality NIOM, so collaborating with the surgical and anesthesia teams to evaluate different NIOM techniques is vital to keeping Duke in the forefront of our field. Most of the research I have done and travel associated with that would not have been possible without the guidance of the NIOM medical director and mentor, Aatif Husain, MD.

How did you first get interested in this line of work?
To be honest, I had no idea what the job truly involved when I found the listing on the Duke HR website; I just knew I wanted to work in the operating room. After a bit of research (some of which involved reading papers by Dr. Husain) I opted to apply for the job. The NIOM team offered me the opportunity to come in and watch a case and I was hooked. I remember thinking how elegant the evoked potential recordings were and how fluidly the NIOM team interacted with the surgeon. It was a team I could see myself becoming a part of.  

For two years now, you’ve also been the emerging content editor for the Journal of Clinical Neurophysiology. What are your responsibilities for this position? What do you enjoy the most about this work?
As emerging content editor I have developed a social media campaign for JCN, recently developed the Red Journal podcast series, and added various website enhancements. I enjoy finding new ways to deliver JCN content to the readership and increase reader engagement.

You recently won an award for a research presentation you gave at an international clinical neurophysiology meeting in Cartagena, Colombia. What was the topic of your presentation? What implications do your findings have for patient care?
The presentation title was “Motor-evoked potential double-train stimulation: Optimal number of pulses per train.” The new method introduced in this presentation improves the likelihood of successful motor-evoked potential monitoring in myelopathic patients. It also allows for reduction in necessary stimulation intensity which reduces patient movement during stimulation and potential for patient injury.

What did you enjoy most about Colombia?
La Popa, a convent on top of the city's highest hill,  was my favorite part of Cartagena. La Popa, which literally means “ship stern,” gets its name because of the hill's resemblance to the back of a ship. The convent offers a breathtaking 360-degree view of the city of Cartagena.

I also enjoyed meeting physicians from all over South America and learning about the practice of NIOM in those countries.

What passions or hobbies do you have outside of the Department?
I enjoy traveling, which I have been able to do through work. The past few years I have given presentations on NIOM techniques in Germany, Colombia, Indonesia, and most recently Brazil. It has been an honor to present at these international meetings with some of the most brilliant scientists in the world.  I have learned a great deal from the NIOM practitioners in these areas as well; we now use many new NIOM techniques at Duke as a result.

Of my work trips, my visit to Indonesia was one of the most rewarding. I was able to enter the operating room in Indonesia and assist with the monitoring provided during a brainstem tumor resection. The operating room was equipped with a number of cameras and microphones. As I help set up the monitoring for the surgery I described what was being done and why. The camera feeds were displayed live in a lecture hall in another part of the campus. Dr. Husain presented a lecture at intervals in between the critical parts of the surgery to explain the theory and methods used for that type of monitoring. It was wonderful to learn the different customs in the operating room and observe the NIOM practitioners there as they provided monitoring for other cases as well.

I also love walking on the tobacco trails with my little girl (9 months old, the best part of my day, every single day), and going to beer tastings with my husband.


Kale poses during a recent family trip to the Grand Canyon.