Cardiac Core —
Training activity: 10

Details

Enroll a patient for home monitoring

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 enrolling a patient for home monitoring.
• Consider how the learning outcomes apply, specifically in relation to managing follow-up, including remote monitoring for devices like Implantable Loop Recorders (ILRs), and demonstrating effective communication with the patient.
• What does a successful enrolment, including patient comprehension and technical setup for remote monitoring look like for this activity?
• Discuss with your training officer to gain clarity on expectations for patient education regarding device function and the successful technical enrolment procedure.

What is your prior experience of this activity?

• Think about what you already know about the home monitoring system being used, its purpose, and the steps required for patient enrolment.
• Consider possible challenges you might face during the activity, such as patient technical literacy, connectivity issues, or explaining the system’s role in pacemaker/ILR follow-up and think about how you might plan to handle them.
• 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 for complex technical issues with the home monitoring system or detailed clinical queries related to the device.
• Acknowledge how you feel about embarking on this training activity involving technical setup and patient communication.

What do you anticipate you will learn from the experience?

• Consider the specific skills you want to develop related to technical guidance, patient education, or effective communication.
• Identify specific insights you hope to gain regarding common patient difficulties with home monitoring technology or effective ways to explain its benefits in the context of device follow-up.

What additional considerations do you need to make?

• Consult actions identified following previous experience of patient education or technical support tasks.
• Identify important information you need to consider before embarking on the activity, such as the specific requirements of the monitoring system, the patient’s individual needs, or the purpose of the device (pacemaker or ILR).

In action

Is anything unexpected occurring?

• Are you noticing anything surprising or different from what you anticipate whilst explaining the system or setting up the equipment?
• Are you encountering situations such as:
  • The patient having unexpected technical difficulties or high anxiety regarding the connectivity or complexity of the monitoring equipment?
  • An equipment malfunction during the setup process that prevents successful enrolment or data transmission verification?
  • The patient asking a complex clinical question about the data transmission or alerts that requires detailed knowledge of device function beyond the basic enrolment script?

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 communication style or technical setup process?
• Consider the steps you are taking in the moment, such as:
  • Immediately changing your explanation approach to simplify technical terms or using visual aids to address patient confusion?
  • Troubleshooting the network connection or device synchronisation steps in the moment to overcome a technical setup failure?
  • Seeking immediate clarification from a senior colleague on a complex question regarding device follow-up data transmission or potential alerts?
• How are you feeling in that moment? For instance, are you finding it difficult to maintain clarity while managing technical issues? Is it affecting your confidence in demonstrating effective communication?

What is the conclusion or outcome?

• Identify how you are working within your scope of practice. For example, are you successfully completing the enrolment and ensuring patient comprehension? Or are you needing support because the technical issue requires specialist device support?
• What are you learning as a result of the unexpected development? For example, are you mastering better techniques for explaining complex technical information? Or gaining insight into common patient challenges related to Implantable Loop Recorder (ILR) follow-up?

On action

What happened?

• Begin by summarising the key points of the experience of enroling the patient for home monitoring.
• Consider specific events, actions, or interactions which felt important, such as the information you conveyed to the patient, the steps for setting up the equipment, or any questions or concerns the patient raised.
• Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, immediately changing your approach to explaining the system clearly due to patient confusion or troubleshooting a setup issue. How did you feel during this experience?

How has this experience contributed to your developing practice?

• Identify what learning you can take from this experience regarding the home monitoring system and patient enrolment. What strengths did you demonstrate e.g., effective communication? What skills and/or knowledge gaps were evident e.g., understanding the technical setup or common issues patients encounter?
• Compare this experience against previous engagement with similar activities – were any previously identified actions for development achieved? Has your practice improved?
• Identify any challenges you experienced, such as explaining the system clearly and ensuring the patient felt comfortable, and how you reacted to these. How does this activity contribute to your patient education and device management skills?
• Acknowledge any changes in your own feelings now you are looking back on the experience.

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 incorporating any feedback received about your ability to enrol a patient for home monitoring.
• What will you do differently next time you approach explaining home monitoring or troubleshooting initial setup issues? Has anything changed in terms of what you would do if you were faced with a similar situation again?
• Do you need to practise any aspect of the activity further, such as reviewing resources or training materials for patient enrolment?

Beyond action

Have you revisited the experiences?

• Have you reviewed your actions from your previous reflections for this activity? What specific actions did you previously identify you would need to take to improve your practice related to technical setup and communication during home monitoring enrolment?
• Have you completed these previously identified actions? For example, if you planned to review patient education resources to enhance clarity, how did completing this review impact your subsequent performance when explaining device function and remote monitoring?
• Engage in professional storytelling with peers, near peers, or colleagues about challenges and successes in patient communication regarding device technology. How has discussing difficulties with patient technical literacy changed your approach to patient education for other procedures?

How have these experiences impacted upon current practice?

• Consider how the accumulated learning from performing or reflecting on patient enrolment for home monitoring will support you in preparing for observed ‘in-person’ assessments for the module.
• How has your practice in effective communication and understanding device follow-up developed and evolved over time? For example, how does your foundational knowledge from enrolment help you manage follow-up post implant or troubleshoot device issues remotely?
• What transferable skills e.g., technical instruction or patient-centred communication did you develop through this activity, and how will this understanding help you evaluate and adopt new remote monitoring technologies or communication strategies in the future?

Relevant learning outcomes

#	Outcome
# 4	Outcome Perform and interpret routine follow-up of pacemakers and make appropriate programming changes to ensure safe functioning of the device.
# 5	Outcome Prepare and setup for implantable loop recorder (ILR) insertion and manage follow-up post implant, including use of remote monitoring.
# 8	Outcome Demonstrate the ability to communicate effectively with patients, carers and the wider multidisciplinary team.