Cardiac Core —
Training activity: 2

Details

Perform and interpret the following diagnostic tests:

• 12 lead ECG
• Ambulatory 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 performing and interpreting 12 lead ECG and Ambulatory monitoring.
• Consider how the learning outcomes apply, specifically in relation to performing these tests to construct a detailed report and making recommendations regarding further investigations and/or clinical management.
• What does accurate performance, interpretation, reporting, and clinical recommendation formulation look like for this activity?
• Discuss with your training officer to gain clarity on expectations for interpretation, reporting, and clinical recommendations based on ECG/ambulatory monitoring findings.

What is your prior experience of this activity?

• Think about what you already know about the techniques for obtaining good quality recordings and the principles of interpretation for these tests.
• Consider possible challenges you might face during the activity, such as technical issues, patient factors, or complex findings (e.g., specific tachyarrhythmias), and think about how you might 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 and making recommendations based on complex or ambiguous ECG/ambulatory monitoring findings.
• Acknowledge how you feel about embarking on performing and interpreting these diagnostic tests.

What do you anticipate you will learn from the experience?

• Consider the specific skills you want to develop related to performance, interpretation (e.g., identifying different types of ECG abnormalities), or structured reporting.
• Identify specific insights you hope to gain regarding the process of formulating recommendations or the correlation between findings (like ischaemic changes or AV blocks) and specific clinical questions.

What additional considerations do you need to make?

• Consult actions identified following previous experience of interpreting physiological data or writing reports.
• Identify important information you need to consider before embarking on the activity, such as patient history, the specific clinical question from the referral, or relevant interpretation guidelines.

In action

Is anything unexpected occurring?

• Are you noticing anything surprising or different from what you anticipate whilst performing the ECG acquisition or interpreting the tracing?
• Are you encountering situations such as:
  • A technical issue that leads to significant artefact or noise on the ECG trace, compromising image quality, or failure of the ambulatory monitor to initiate recording?
  • Identifying a complex or novel arrhythmia that falls outside the standard training examples e.g., a specific wide-complex tachycardia, challenging your interpretation approach?
  • The ECG findings contradicting the expected clinical presentation e.g., finding ischaemic changes in an asymptomatic patient or complicating the diagnostic process?

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 lead placement or interpretation strategy?
• Consider the steps you are taking in the moment, such as:
  • Troubleshooting the monitoring connections immediately to eliminate noise or artefact to secure a good quality recording?
  • Seeking immediate advice from a senior colleague or training officer to verify the classification or clinical significance of a complex or ambiguous ECG finding?
  • Immediately consulting a specific reference guide to apply criteria for interpreting findings like SA node disease or AV blocks?
• How are you feeling in that moment? For instance, are you finding it difficult to adapt your interpretation strategy? Is it affecting your confidence in obtaining a good quality recording?

What is the conclusion or outcome?

• Identify how you are working within your scope of practice. For example, are you successfully resolving the technical issue yourself? Or are you needing support because the complexity of the finding requires senior clinical review?
• What are you learning as a result of the unexpected development? For example, are you learning a more efficient technique for troubleshooting technical issues? Or gaining insight into the hierarchy of criteria used for classifying tachyarrhythmias?

On action

What happened?

• Begin by summarising the key points of the experience of performing and interpreting the 12 lead ECG and/or Ambulatory monitoring.
• Consider specific events, actions, or interactions which felt important, such as how you approached interpretation, the key findings you observed, or any challenges with equipment or signal quality.
• Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, adjusting lead placement immediately due to artefact or adapting your interpretation strategy due to an unexpected finding. 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 performing and interpreting these tests. What strengths did you demonstrate e.g., technical skills in acquiring data? What skills and/or knowledge gaps were evident e.g., specific arrhythmias or artefact recognition?
• 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 handling unexpected or unclear findings, and how you reacted to these. How does this activity contribute to your diagnostic skills as a Cardiac Scientist?
• 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 from any feedback you have received regarding your ability to perform or interpret these tests.
• What will you do differently next time you encounter challenges with equipment or signal quality? 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 exploring specific areas of interpreting 12 lead ECGs or Ambulatory monitoring or consulting specific resources?

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 performing and interpreting 12 lead ECG or ambulatory monitoring?
• Have you completed these previously identified actions? For example, if you planned to consult guidelines for classifying specific tachyarrhythmias or SA node disease, how did completing this review impact your subsequent performance of interpretation?
• Engage in professional storytelling with peers, near peers, or colleagues about challenges and successes in interpreting complex or ambiguous ECG/ambulatory monitoring findings. How has discussing these cases influenced your systematic approach to interpretation and reporting?

How have these experiences impacted upon current practice?

• Consider how the accumulated learning from performing or reflecting on ECG and ambulatory monitoring interpretation will support you in preparing for observed ‘in-person’ assessments for the module, such as Case-Based Discussions that require making recommendations based on physiological data.
• How has your practice in interpreting physiological data developed and evolved over time? For example, can you identify instances in your current practice where the foundational knowledge gained from interpreting ischaemic changes or AV blocks has informed decisions for interpreting complex data from other diagnostic modalities?
• What transferable skills e.g., diagnostic reasoning or pattern recognition did you develop through this activity, and how will this understanding help you evaluate and adopt new monitoring or diagnostic technologies in the future?

Relevant learning outcomes

#	Outcome
# 1	Outcome Perform and interpret 12-lead and ambulatory ECG monitoring to construct a detailed report and make recommendations regarding further investigations and/or clinical management.