Cardiac Core —
Training activity: 12

Details

Analyse and accurately report ILR results

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 analysing and accurately reporting Implantable Loop Recorder (ILR) results.
• Consider how the learning outcomes apply, specifically concerning managing ILR follow-up using remote monitoring, and demonstrating effective communication.
• What does thorough review of recorded data, accurate interpretation of events (e.g., arrhythmias), and producing an informative report that adheres to reporting standards look like for this activity?
• Discuss with your training officer to gain clarity on expectations for thorough analysis, accurate interpretation, report format, and communicating clinical significance of findings.

What is your prior experience of this activity?

• Think about what you already know about interpreting ILR recordings, recognising artefact versus true events, and using analysis software for device data.
• Consider possible challenges you might face during the activity, such as interpreting complex or rare arrhythmias, distinguishing technical artefact from physiological events, or summarizing large volumes of data concisely for reporting, 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 when encountering ambiguous data, complex arrhythmias, or difficulties in report phrasing.
• Acknowledge how you feel about embarking on this training activity involving the analysis and reporting of diagnostic physiological data.

What do you anticipate you will learn from the experience?

• Consider the specific skills you want to develop related to data pattern recognition, efficient software utilisation, or refining skills in structured reporting.
• Identify specific insights you hope to gain regarding correlating device findings with patient symptoms or translating complex device data into clear, clinically relevant reports.

What additional considerations do you need to make?

• Consult actions identified following previous experience of analysing physiological data (e.g., ECG or ambulatory monitoring) or report writing.
• Identify important information you need to consider before embarking on the activity, such as the patient’s clinical history, specific symptoms they reported, or relevant reporting guidelines for ILR follow-up.

In action

Is anything unexpected occurring?

• Are you noticing anything surprising or different from what you anticipate whilst reviewing the recorded data or structuring the report?
• Are you encountering situations such as:
  • Identifying complex arrhythmias or rhythm disturbances e.g., highly polymorphic VT that are difficult to classify definitively based on ILR traces alone?
  • A high volume of artefact that masks physiological events, making reliable analysis and interpretation challenging?
  • Discrepancy between the patient’s reported symptoms and the actual recorded events, complicating the clinical correlation and conclusion?

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 review workflow or the reporting format in the moment?
• Consider the steps you are taking in the moment, such as:
  • Immediately employing alternative analysis tools within the software to investigate or validate the classification of a complex rhythm?
  • Seeking immediate guidance from a senior colleague or cardiac electrophysiologist regarding the interpretation of complex data or ambiguous clinical correlation?
  • Adapting the phrasing of the report to clearly communicate the uncertainty or the need for further testing due to artefact or ambiguous data?
• How are you feeling in that moment? For instance, are you finding it difficult to focus on complex rhythm analysis? Is it affecting your confidence in producing an accurate and clear report?

What is the conclusion or outcome?

• Identify how you are working within your scope of practice. For example, are you successfully synthesising data into a concise report? Or are you needing support because the interpretation of rare arrhythmias requires senior expert input?
• What are you learning as a result of the unexpected development? For example, are you mastering a more effective strategy for correlating ILR findings with patient symptoms? Or gaining insight into best practice for reporting findings with clinical ambiguity?

On action

What happened?

• Begin by summarising the key points of the experience of analysing the ILR data and generating a report.
• Consider specific events, actions, or interactions which felt important, such as the types of events you focused on, how you correlated findings with patient symptoms, and the structure of your report.
• Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, immediately consulting external guidelines to classify a complex arrhythmia or troubleshooting noisy data. 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 your ability to interpret and report ILR findings. What strengths did you demonstrate e.g., identifying significant cardiac events? What skills and/or knowledge gaps were evident e.g., interpreting noisy data or writing a concise yet comprehensive report?
• 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 gaining a better understanding of the clinical significance of certain findings, and how you reacted to these. How does this activity contribute to your diagnostic reporting skills?
• Identify anything significant about the activity, such as needing to seek advice or clarification on interpreting complex or ambiguous findings.
• 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 seeking opportunities for expert review.
• What will you do differently next time to ensure the accuracy and clinical relevance of your future ILR reports? 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 focusing on specific types of events or reporting aspects?

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 analysing device data, classifying events, and writing clear reports?
• Have you completed these previously identified actions? For example, if you planned to review guidelines for correlating ILR findings with patient symptoms, how did completing this review impact your subsequent performance when finalising reports?
• Engage in professional storytelling with peers, near peers, or colleagues about challenging ILR interpretations, such as ambiguous device findings or high artefact load. How have discussions in multidisciplinary team meetings or with senior colleagues provided new insights into the clinical significance of specific ILR findings?

How have these experiences impacted upon current practice?

• Consider how the accumulated learning from performing or reflecting on ILR analysis and reporting will support you in preparing for observed ‘in-person’ assessments for the module, such as Case-Based Discussions requiring interpretation and reporting of genomic testing with recommendations.
• How has your practice related to analysis and interpretation of device data developed and evolved over time? For example, how does your experience with interpreting ILR findings inform your current analysis and reprogramming recommendations for pacemakers?
• What transferable skills e.g., critical data interpretation or concise clinical reporting did you develop through this activity, and how will this foundational understanding of device diagnostics help you adapt to new challenges in analysing or reporting findings from other cardiac monitoring systems in the future?

Relevant learning outcomes

#	Outcome
# 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.