Cardiac Core —
Training activity: 15

Details

Monitor and respond to patient changes during a procedure in the lab

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 monitoring and responding to patient changes during a procedure in the lab.
• Consider how the learning outcomes apply, specifically concerning ensuring patient safety, interpreting real-time haemodynamic data, and communicating effectively.
• What does proactive observation of patient status, accurate interpretation of real-time monitoring data (e.g., pressure changes), recognising deterioration, and immediate, appropriate response/escalation look like for this activity?
• Discuss with your training officer to gain clarity on expectations for vital signs/parameters to focus on, protocols for escalating concerns, and the scope of your immediate interventions.

What is your prior experience of this activity?

• Think about what you already know about assessing patient status during procedures, interpreting haemodynamic data, and recognising signs of adverse events or procedural complications.
• Consider possible challenges you might face during the activity, such as rapidly changing conditions, subtle or ambiguous haemodynamic or ECG signs, or needing to communicate effectively under pressure, 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 interpreting complex data or when immediate escalation of a patient change is required.
• Acknowledge how you feel about undertaking this activity involving direct patient safety and real-time intervention.

What do you anticipate you will learn from the experience?

• Consider the specific skills you want to develop related to real-time data interpretation, rapid recognition of subtle changes, and effective communication in a critical situation.
• Identify specific insights you hope to gain, perhaps about how specific procedural steps affect patient physiology or how the clinical team coordinates a response to patient changes, ensuring patient safety.

What additional considerations do you need to make?

• Consult actions identified following previous experience of patient monitoring, procedural support, or emergency response scenarios.
• Identify important information you need to consider before embarking on the activity, such as the patient’s known comorbidities, baseline status, specific risks associated with the procedure, and the location of emergency equipment.

In action

Is anything unexpected occurring?

• Are you noticing anything surprising or different from what you anticipate whilst observing the patient’s vital signs and physiological data?
• Are you encountering situations such as:
  • A rapid and unexpected deterioration of the patient e.g., sudden tachyarrhythmia or hypotension related to the ongoing procedure?
  • Subtle haemodynamic shifts or ECG changes that may indicate a procedural complication but are difficult to definitively classify as an emergency?
  • Difficulty communicating urgent findings clearly and concisely to the clinical team during a critical phase of the procedure?

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 prioritisation of monitoring parameters or communication strategy in the moment?
• Consider the steps you are taking in the moment, such as:
  • Immediately alerting the senior staff to a significant change in physiological parameters?
  • Initiating basic interventions within your scope, such as verifying monitoring connections or preparing emergency equipment?
  • Seeking immediate clarification on the clinical significance of a subtle change from the supervising physician?
• How are you feeling in that moment? For instance, are you finding it difficult to act quickly under pressure? Is it affecting your confidence in interpreting haemodynamic data or ensuring patient safety?

What is the conclusion or outcome?

• Identify how you are working within your scope of practice. For example, are you successfully providing accurate, real-time feedback to the team? Or are you needing support because the required intervention is beyond your scope?
• What are you learning as a result of the unexpected development? For example, are you mastering clear and urgent communication techniques during critical events? Or gaining insight into the immediate physiological manifestations of procedural complications?

On action

What happened?

• Begin by summarising the key points of the experience, detailing any changes in the patient’s status you observed during the procedure e.g., changes in vital signs, symptoms, ECG.
• Consider specific events, actions, or interactions which felt important, such as how you recognised these changes and your immediate response or actions taken.
• Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, immediately communicating observations or concerns to the procedural team. 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 monitor and react to patient changes in a dynamic procedural setting. What strengths did you demonstrate e.g., recognising signs of patient deterioration? What skills and/or knowledge gaps were evident e.g., understanding the appropriate initial responses or communicating observations under pressure?
• 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 communicating your observations or concerns to the procedural team, and how you reacted to these. How does this activity contribute to your patient safety and emergency response skills?
• Identify anything significant about the activity, such as needing to seek advice or clarification on appropriate escalation during a critical moment.
• 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 undertaking training or simulations.
• What will you do differently next time to prepare for and anticipate potential patient changes in future procedures? 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 enhancing your monitoring or response skills in specific procedural scenarios?

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 recognising subtle changes, responding quickly, and communicating clearly?
• Have you completed these previously identified actions? For example, if you planned to review emergency protocols or specific procedural risk factors, how did completing this action impact your subsequent performance when monitoring patient status?
• Engage in professional storytelling with peers, near peers, or colleagues about critical events or near-misses observed in the cath lab. How has discussing these events refined your ability to prioritise patient safety and interpret real-time data under pressure?

How have these experiences impacted upon current practice?

• Consider how the accumulated learning from performing or reflecting on patient monitoring and response will support you in preparing for observed ‘in-person’ assessments for the module, such as a DOPS or OCE requiring demonstration of effective communication or technical support during a critical event.
• How has your practice in real-time clinical support and interpretation developed and evolved over time? For example, how does the experience of monitoring a patient during a procedure inform your approach to triage diagnostic requests or recognise a deteriorating patient?
• What transferable skills e.g., situational awareness, quick decision-making, or crisis communication did you develop through this activity, and how will this understanding help you adapt to new technologies that require real-time patient assessment in the future?

Relevant learning outcomes

#	Outcome
# 3	Outcome Provide effective physiological and scientific support for pacemaker implant, providing technical expertise, ensuring patient safety and appropriate procedural documentation.
# 6	Outcome Interpret haemodynamic data for patients presenting to the cardiac cath lab with a range of conditions, recognising the role of these procedures within the patient pathway, limitations of diagnostics and troubleshooting where required.
# 8	Outcome Demonstrate the ability to communicate effectively with patients, carers and the wider multidisciplinary team.