Training activity information
Details
Obtain images for a standard trans-thoracic echocardiogram in an adult patient under supervision
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 acquiring the standard views for a trans-thoracic echocardiogram (TTE) in an adult patient under supervision.
- Consider how the learning outcomes apply, specifically in relation to acquiring and interpreting the standard images for a patient with a structurally normal heart and effective communication with the patient and supervisor.
- What does achieving optimal image quality for the minimum dataset of a standard adult TTE look like for this activity?
- Discuss with your training officer to gain clarity on expectations for image acquisition quality, the range of standard views required, and your specific role while supervised.
What is your prior experience of this activity?
- Think about what you already know about echo anatomy, physics, instrumentation, and the techniques for acquiring standard views.
- Consider possible challenges you might face during the activity, such as patient positioning, locating acoustic windows, or achieving optimal image quality (e.g., managing artefacts), 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 acquiring images under supervision and encountering difficult patients or technical issues with the imaging modality.
- Acknowledge how you feel about embarking on this training activity involving direct patient imaging under supervision.
What do you anticipate you will learn from the experience?
- Consider the specific skills you want to develop related to probe manipulation, finding optimal acoustic windows, or refining image optimisation techniques.
- Identify specific insights you hope to gain regarding the factors that influence good image quality or navigating the challenges presented by different adult patient physical limitations.
What additional considerations do you need to make?
- Consult actions identified following previous experience of observation of echo procedures or related imaging experiences (e.g., reviewing previous TTE protocols).
- Identify important information you need to consider before embarking on the activity, such as the patient’s clinical presentation, physical limitations that might affect positioning, or the physics/instrumentation relevant to the acquisition.
In action
Is anything unexpected occurring?
- Are you noticing anything surprising or different from what you anticipate whilst positioning the patient or adjusting the ultrasound machine settings?
- Are you encountering situations such as:
- Significant difficulty finding a standard acoustic window (e.g., apical or parasternal) due to patient factors like body habitus or lung interference?
- Unexpected issues with image quality e.g., excessive reverberation or poor resolution despite attempting standard optimisation techniques (gain, depth)?
- The supervisor asking you to attempt views outside your expected training level, necessitating immediate adjustment of technique?
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 probe angulation or sequence of view acquisition in the moment?
- Consider the steps you are taking in the moment, such as:
- Rapidly moving to an alternative acoustic window (e.g., subcostal or suprasternal) if the standard window is unsuccessful?
- Immediately adjusting frequency or power settings to counteract image artefacts?
- Seeking immediate advice from your supervisor on optimal probe manipulation or machine settings (e.g., depth, gain) to obtain a difficult view?
- How are you feeling in that moment? For instance, are you finding it difficult to adapt your probe handling skills to the challenging patient anatomy? Is it affecting your confidence in achieving the minimum dataset?
What is the conclusion or outcome?
- Identify how you are working within your scope of practice. For example, are you successfully achieving the required views under supervision? Or are you needing support because technical image optimisation is beyond your current applied knowledge of physics/instrumentation?
- What are you learning as a result of the unexpected development? For example, are you mastering a more effective technique for finding the apical window in difficult patients? Or gaining insight into the nuances of artefact and optimisation?
On action
What happened?
- Begin by summarising the key points of the experience of obtaining images for a standard transthoracic echocardiogram.
- Consider specific events, actions, or interactions which felt important, such as the views you attempted to obtain, the equipment settings you used or adjusted, or any technical challenges e.g., patient positioning, image quality.
- Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, adapting your probe angulation or changing machine settings immediately to improve image quality. 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 acquiring standard echo images. What strengths did you demonstrate e.g., technique for obtaining specific views? What skills and/or knowledge gaps were evident e.g., dealing with difficult scans or image optimisation?
- 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 technical challenges related to patient anatomy, and how you reacted to these. How does this activity contribute to your practical echocardiography 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 seeking opportunities for supervised practice or feedback.
- What will you do differently next time you approach obtaining images in future echo studies? 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 improving your skills in acquiring specific views or technical 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 acquiring standard TTE views and optimising image quality?
- Have you completed these previously identified actions? For example, if you planned to review techniques for finding optimal acoustic windows in challenging patients, how did completing this action impact your subsequent performance when obtaining images under supervision?
- Engage in professional storytelling with peers, near peers, or colleagues about challenging image acquisition scenarios or troubleshooting echo artefacts. How has observing complex imaging modalities (e.g., TOE/DSE) influenced your perspective on image quality and optimisation?
How have these experiences impacted upon current practice?
- Consider how the accumulated learning from performing or reflecting on TTE image acquisition will support you in preparing for observed ‘in-person’ assessments for the module, such as the Direct Observation of Practical Skills (DOPS) titled ‘Obtain and optimise the standard views in a transthoracic echo’.
- How has your practice in applying technical skills and physics knowledge to image acquisition developed and evolved over time? For example, how do your skills in probe manipulation and artefact recognition developed here apply when performing measurements or interpreting abnormal studies?
- What transferable skills e.g., technical dexterity or systematic image assessment did you develop through this activity, and how has this foundational knowledge (e.g., in cardiac anatomy) informed decisions or problem-solving in other areas of cardiac diagnostics?
Relevant learning outcomes
| # | Outcome |
|---|---|
| # 2 |
Outcome
Perform a trans-thoracic echocardiogram by acquiring and interpreting the standard images to prepare a report for a patient with a structurally normal heart. |
| # 8 |
Outcome
Demonstrate the ability to communicate effectively with patients, carers and the wider multidisciplinary team. |