Training activity information
Details
Perform appropriate manoeuvres to assess lead integrity
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 are the expectations for performing manoeuvres to assess lead integrity.
- Consider how the relevant learning outcomes apply to lead assessment and CIED system integrity.
- Discuss with your training officer to gain clarity on expectations for specific testing manoeuvres and interpretation of results.
What is your prior experience of this activity?
- Think about what you already know about assessing lead integrity and performing the necessary manoeuvres.
- Consider possible challenges that might arise e.g., interpreting subtle or ambiguous findings from lead testing, such as marginal impedance values and think about how you might handle them.
- Recognise the scope of your own practice for this activity, i.e., know when/from whom you will need to seek advice or help when interpreting potential lead failures or device hardware problems, and from whom.
- Acknowledge how you feel about performing such manoeuvres.
What do you anticipate you will learn from the experience?
- Consider the specific skills you want to develop related to lead testing, data interpretation (e.g., resistance/impedance), and patient interaction during testing.
- Identify specific insights you hope to gain regarding common lead issues and how they present.
What additional considerations do you need to make?
- Consult actions identified from previous experiences with device follow-up or troubleshooting.
- Identify any important information about the specific lead type or known symptoms that might suggest a lead issue you need to consider beforehand.
In action
Is anything unexpected occurring?
- Are you noticing anything surprising or different from what you anticipate whilst executing lead integrity tests?
- Are you encountering situations such as:
- Abnormal or unstable measurements e.g., high impedance or widely fluctuating capture thresholds being obtained from the lead tests?
- Difficulty obtaining reliable measurements due to technical issues or patient movement during specific tests?
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 deciding if the results are within expected ranges e.g., based on lead type or time since implant?
- Consider the steps you are taking in the moment, such as:
- Actively concentrating on performing accurate capture threshold tests or interpreting complex sensing measurements?
- Seeking immediate guidance from a senior colleague or physician if you obtain abnormal or unstable measurements, or if you are unsure how to interpret the findings?
- How are you feeling in that moment? For instance, are you finding it difficult to interpret complex sensing measurements? Is it affecting your confidence in interpreting the results?
What is the conclusion or outcome?
- Identify how you are working within your scope of practice. For example, are the lead assessment manoeuvres you are performing appropriate for your level of training and supervision?
- What are you learning as a result of the unexpected development? For example, are you gaining a better feel for performing these specific manoeuvres or learning how different factors affect expected values?
On action
What happened?
- Begin by summarising the key points of the experience of assessing lead integrity.
- Consider specific events, actions, or interactions which felt important, such as the manoeuvres you performed e.g., impedance checks, threshold testing, lead extra-stimulus testing if applicable, and note any abnormal findings or challenges in performing the manoeuvres.
- Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, performing an additional test immediately due to an equivocal impedance reading or patient discomfort. 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 lead integrity assessment techniques. What strengths did you demonstrate (e.g., technical skill)? What skills and/or knowledge gaps were evident, such as difficulties in interpreting equivocal findings or subtle changes in lead parameters?
- Identify any challenges you experienced, such as managing patient discomfort during testing, and how you reacted to these. How does this activity contribute to your ability to identify potential lead issues?
- 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, including incorporating any feedback received with regards to your performance of manoeuvres for lead integrity.
- Identify any specific manoeuvres or interpretation nuances e.g., distinguishing noise from true lead fracture where you need further practice or knowledge. How will you ensure comprehensive and accurate lead integrity assessment in future device checks? 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 normal parameter changes and potential lead hardware problems?
Beyond action
Have you revisited the experiences?
- Have you reviewed your actions from your previous reflections for this activity? What specific manoeuvres e.g., impedance checks, capture thresholds, sensing tests or interpretation criteria e.g., recognising lead fracture patterns did you previously find challenging? Have you completed these previously identified actions? For example, if you planned to review expected lead measurements for specific lead models, how did this improve your ability to perform and interpret the assessment accurately?
- Engage in professional storytelling with peers, near peers, or colleagues about lead assessment findings, particularly ambiguous or concerning results like intermittent oversensing. Did their insights provide a new perspective on interpreting data or troubleshooting potential lead problems, influencing your approach in future assessments?
How have these experiences impacted upon current practice?
- Consider how the accumulated learning from performing or reflecting on lead integrity assessment will support you in preparing for observed ‘in-person’ assessments for the module, such as an OCE where you must communicate lead status to a physician.
- How has your confidence in systematically assessing lead function developed over time? For example, how does this development support your ability to identify significant clinical findings during a device check, such as a high impedance alert indicating a lead break?
- What transferable skills e.g., systematic technical assessment or recognising failure patterns did you develop through this activity, and how does this skill assist you in evaluating the integrity of non-pacing leads, such as those used for haemodynamic monitoring?
Relevant learning outcomes
| # | Outcome |
|---|---|
| # 2 |
Outcome
Perform and interpret complex CIED follow up and effectively communicate results to patients and clinical staff as appropriate. |