Endocrinology and Diabetes —
Training activity: 9

Details

Identify cases that require urgent intervention and offer clinical advice on the follow-up and/or further management of the patient

Type

Entrustable training activity (ETA)

Evidence requirements

Evidence the activity has been undertaken by the trainee repeatedly, consistently, and effectively over time, in a range of situations. This may include occasions where the trainee has not successfully achieved the outcome of the activity themselves. For example, because it was not appropriate to undertake the task in the circumstances or the trainees recognised their own limitations and sought help or advice to ensure the activity reached an appropriate conclusion. ​

Reflection at multiple timepoints on the trainee learning journey for this activity.

Reflective practice guidance

The guidance below is provided to support reflection at different time points, providing you with questions to aid you to reflect for this training activity. They are provided for guidance and should not be considered as a mandatory checklist. Trainees should not be expected to provide answers to each of the guidance questions listed.

Before action

What does success look like?

• Identify what is expected of you in relation to effectively identifying urgent endocrine/diabetes cases based on laboratory results and providing appropriate clinical advice for follow-up/management.
• Consider how the learning outcomes apply, specifically in relation to performing analysis/management of endocrine disorders and diabetes mellitus, practicing in partnership with other specialisms, and interpreting and reporting on investigations in the correct clinical context.
• Discuss with your training officer to gain clarity of what is expected of you in relation to recognising critical results (e.g., extreme hyper/hypoglycemia, severe electrolyte imbalance), confirming the urgency, and formulating concise and helpful advice for clinical teams.

What is your prior experience of this activity?

• Think about what you already know about identifying urgent endocrine/diabetes results (e.g., Addisonian crisis, DKA) and providing clinical advice or escalating critical findings.
• Consider possible challenges you might face during the activity, such as interpreting results without full clinical details (e.g., medication history), communicating effectively with high-stress clinical teams, or ensuring the advice provided is within your professional scope.
• Recognise the scope of your own practice for this activity i.e. know when you will need to seek advice or help, and from whom. You will need to seek advice from your Training Officer when required, for example when a critically low sodium result suggests acute adrenal crisis, requiring immediate communication and specialist clinical team input, or if there is ambiguity in the urgency classification of a result.
• Acknowledge how you feel about embarking on this activity of identifying urgent cases and offering advice, recognising the critical patient safety implications.

What do you anticipate you will learn from the experience?

• Consider the specific skills you want to develop, such as rapidly interpreting results in a critical context, prioritising information for effective communication, and drafting appropriate short-term clinical advice for management.
• Identify the specific insights you hope to gain into the clinical impact of urgent laboratory results, effective communication protocols with clinical teams, or understanding urgent management pathways (e.g., protocols for managing hypercalcaemic crisis).

What additional considerations do you need to make?

• Consult actions identified following previous experiences with interpreting urgent results or providing advice where communication or scope of practice issues were identified.
• Identify important information you need to consider before embarking on the activity, such as understanding critical reference intervals for urgent conditions (e.g., potassium, glucose, calcium), clinical guidelines for urgent endocrine/diabetes conditions, and the communication pathways for critical results within the organisation.

In action

Is anything unexpected occurring?

• Are you noticing anything surprising or different from what you anticipate whilst reviewing results to identify urgent cases?
• Are you encountering situations such as:
  • Equivocal results (e.g., borderline severe hypoglycaemia or extreme electrolyte imbalance) where urgency is unclear?
  • Issues accessing relevant clinical history (e.g., medication list) required to confirm an adrenal crisis?
  • Identifying a life-threatening pattern that requires immediate communication and specific management advice (e.g., extreme hyperkalaemia or DKA)?

How are you reacting to the unexpected development?

• How is this impacting your actions? For example, are you responding to the situation appropriately? Are you adapting or changing your approach to prioritisation or communication due to the urgency?
• Consider the steps you are taking in the moment, such as:
  • Immediately prioritising the case and formulating initial advice (e.g., stat glucose recheck or emergency fluid administration advice)
  • Consulting internal urgent endocrine/diabetes protocols (e.g., for DKA or Addisonian crisis)
  • Seeking immediate clinical context from the ward to confirm the patient’s acute presentation
• How are you feeling in that moment? For instance, are you finding it difficult to maintain composure while managing the case escalation? Is it affecting your confidence in formulating the appropriate immediate management advice?

What is the conclusion or outcome?

• Identify how you are working within your scope of practice. For example, are you successfully identifying a clear critical result and escalating it according to protocol? Or are you needing support because the appropriate clinical advice for a rare acute presentation (e.g., severe thyroid storm) requires consultant input?
• What are you learning as a result of the unexpected development? For example, are you mastering the critical communication pathways for urgent results? Or gaining insight into the acute management strategies for endocrine emergencies?

 

On action

What happened?

• Begin by summarising the key steps you took when identifying a case requiring urgent intervention (e.g., severe hypoglycaemia or hypercalcaemic crisis) and offering clinical advice.
• Consider specific events, actions, or interactions which felt important, such as confirming the critical biochemical result with a repeat test or communicating the clinical advice clearly and concisely to the referring healthcare professional.
• Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, immediately consulting departmental guidelines to determine the appropriate escalation pathway for a suspected Addisonian crisis.
• How did you feel during this experience, e.g., did you feel focused on ensuring patient safety and following critical result procedures or stressed by the need for timely and accurate communication?

How has this experience contributed to your developing practice?

• Identify what learning you can take from this experience regarding recognising and managing urgent endocrine/diabetes cases. What strengths did you demonstrate, e.g., clear and effective communication with clinical teams?
• What skills and/or knowledge gaps were evident, e.g., unfamiliarity with the immediate management pathways for a specific endocrine emergency?
• Compare this experience against previous engagement with similar activities – were any previously identified actions for development achieved? Has your practice improved in formulating and communicating appropriate clinical advice based on laboratory results?
• Identify any challenges you experienced, such as needing to seek advice or clarification on scope of practice regarding the exact level of clinical advice permitted before senior consultation was mandatory, and how you reacted to this.

What will you take from the experience moving forward?

• Identify the actions or ‘next steps’ you will now take to support the assimilation of what you have learnt, including from any feedback you have received, with regards to improving your ability to identify cases requiring urgent intervention.
• What will you do differently next time you approach providing clinical advice for an urgent case, for instance, by proactively preparing concise talking points that cover both the critical result and initial recommended actions?
• Do you need to practise any aspect of the activity further, such as reviewing specific endocrine emergency protocols (e.g., DKA, hypercalcaemic crisis) or key learning outcomes related to understanding management pathways when offering advice?

 

Beyond action

Have you revisited the experiences?

• How have your subsequent experiences of interpreting a wider range of endocrine and diabetes results since completing this specific training activity led you to revisit your initial approach or decisions during that activity? For example, how an instance where a subsequent case involving a rapidly deteriorating patient with acute diabetic complications required immediate clinical communication forced you to re-evaluate the speed and clarity of your critical result escalation protocol?
• Considering what you understand about critical reference intervals, acute endocrine emergencies, and effective communication with clinical teams now, were the actions or considerations you identified after your initial reflection on this training activity sufficient? How have you since implemented or adapted improvements in your urgent case identification and communication strategy based on further learning and experiences? For example, how you proactively reviewed and integrated institutional guidelines for the urgent management of conditions like diabetic ketoacidosis (DKA) or adrenal crisis, demonstrating you have adapted improvements based on further learning?
• Has discussing urgent cases or the impact of delayed or unclear advice with colleagues, peers, or supervisors changed how you now view your initial experience in this training activity? For example, how professional storytelling with a senior colleague about a near miss involving a critical sodium result suggesting adrenal crisis refined your understanding of the critical nature of effective communication with clinical teams?

How have these experiences impacted upon current practice?

• How has the learning from this initial training activity, in combination with subsequent experiences of interpreting a wider range of endocrine and diabetes results, contributed to your overall confidence and competence in assessing clinical priority and providing advice, particularly in preparing for assessments like Observed Clinical Events (OCEs) or Case-based Discussions (CBDs)? For example, how your accumulated ability in assessing clinical priority and formulating clinical advice now enables you to confidently discuss acute patient management during a CBD assessment or discuss an abnormal thyroid function test with a healthcare professional during an OCE.
• How has reflecting back on this specific training activity, combined with everything you’ve learned since, shaped your current approach to critical result management? How does this evolved understanding help you identify when something is beyond your scope of practice or requires escalation? For example, how your evolved approach means you now routinely apply a clear escalation protocol for critical results and seek advice immediately when a result is ambiguous but potentially life-threatening (e.g., severe electrolyte imbalance or suspected Addisonian crisis), recognising this requires immediate senior consultation outside routine critical value management.
• Looking holistically at your training journey, how has this initial urgent case identification experience, revisited with your current perspective, contributed to your development in meeting the learning outcomes related to practicing in partnership with other clinical specialisms and interpreting and reporting on clinical and laboratory investigations in the correct clinical context? For example, how this foundational experience has supported your future responsibilities, potentially including authorising results or leading a duty biochemistry service.

Relevant learning outcomes

#	Outcome
# 1	Outcome Perform clinical and laboratory investigation, analysis and management of endocrine disorders.
# 2	Outcome Perform clinical and laboratory investigation, analysis and management of diabetes mellitus.
# 4	Outcome Interpret and report on clinical and laboratory investigations for endocrinology and diabetes mellitus in the correct clinical context.