Electrophysiology Procedures & Cardiac Rhythm Management —
Training activity: 27

Details

Perform a cardioversion

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 when performing a cardioversion.
• Consider how the relevant learning outcomes, specifically regarding performing the cardiac physiological role for delivery of therapies to help terminate arrhythmias.
• Discuss with your training officer to gain clarity on expectations for equipment setup, safety checks, and procedural steps.

What is your prior experience of this activity?

• Think about what you already know about performing cardioversion (including safety checks, equipment, patient monitoring).
• Consider possible challenges that might arise (e.g., failed cardioversion, equipment malfunction, complications, patient anxiety) 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 regarding patient stability or procedure endpoints, and from whom.
• Acknowledge how you feel about undertaking a cardioversion without direct supervision.

What do you anticipate you will learn from the experience?

• Consider the specific skills you want to develop related to patient preparation, application of electrical techniques, and real-time assessment of rhythm response.
• Identify specific insights you hope to gain regarding the practical aspects and patient safety measures required for electrical rhythm management.

What additional considerations do you need to make?

• Consult actions identified from previous experiences with emergency procedures or rhythm management.
• Identify any important information about the patient’s clinical condition, anticoagulation status, or previous cardioversion attempts you need to consider beforehand.

In action

Is anything unexpected occurring?

• Are you noticing anything surprising or different from what you anticipate whilst preparing the equipment or delivering the shock?
• Are you encountering situations such as:
  • Equipment malfunction e.g., failure of the synchronised mode to activate or patient instability during the procedure?
  • Unsuccessful cardioversion requiring rapid reassessment of energy levels or pad placement?

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 whether the synchronised mode is active?
• Consider the steps you are taking in the moment, such as:
  • Actively concentrating on ensuring patient safety e.g., removing patches, ensuring clear contact and confirming synchronisation?
  • Immediately seeking guidance from the supervising physician or nursing staff if the equipment malfunctions or the patient becomes unstable?
• How are you feeling in that moment? For instance, are you finding it difficult to rapidly assess the post-cardioversion rhythm? Is it affecting your confidence in ensuring patient safety?

What is the conclusion or outcome?

• Identify how you are working within your scope of practice. For example, are the tasks you are performing during cardioversion appropriate for your level of training and under direct supervision?
• What are you learning as a result of the unexpected development? For example, are you gaining a better understanding of the practical aspects of performing cardioversion?

On action

What happened?

• Begin by summarising the key points of the experience of performing or assisting with the cardioversion.
• Consider specific events, actions, or interactions which felt important, such as patient preparation, equipment setup, safety checks e.g., ensuring synchronised mode is active, energy selection, and monitoring of the patient’s response.
• Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, rapidly reassessing pad placement after an initial unsuccessful shock or troubleshooting equipment malfunction. 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 the cardioversion procedure. What strengths did you demonstrate (e.g., adherence to safety protocols)? What skills and/or knowledge gaps were evident, such as challenges in coordinating with the team or ensuring patient safety (e.g., managing post-shock rhythm)?
• Identify any challenges you experienced, such as technical skills in using the defibrillator/cardioverter, and how you reacted to these. How does this activity contribute to your skills in managing specific arrhythmias?
• 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 regards your ability to perform a cardioversion.
• Identify specific steps or safety considerations in cardioversion e.g., patient’s anticoagulation status, energy selection that you need to focus on in future procedures. What resources or practice opportunities would be beneficial? 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 guidelines for electrical techniques for terminating arrhythmias?

Beyond action

Have you revisited the experiences?

• Have you reviewed your actions from your previous reflections for this activity? What specific aspects of patient preparation e.g., sedation checks), equipment setup e.g., synchronised mode verification, safety checks, or post-procedure monitoring did you previously find challenging? Have you completed these previously identified actions? For example, if you planned to review national guidelines for typical energy settings used in cardioversion, how did this improve your technique and understanding of the procedure?
• Engage in professional storytelling with peers, near peers, or colleagues about cardioversion cases or protocols, such as unexpected rhythm changes post-shock. Did these conversations offer new insights into patient selection, energy settings, or managing potential complications, influencing your approach to future cardioversions?

How have these experiences impacted upon current practice?

• Consider how the accumulated learning from performing or reflecting on cardioversion will support you in preparing for observed ‘in-person’ assessments for the module, such as a DOPS or OCE requiring demonstration of safe procedural support.
• How has your ability to safely and effectively prepare for and perform the procedure as part of a team evolved? For example, how does this developing skill relate to delivering other therapies to help terminate arrhythmias, such as pacing?
• What transferable skills e.g., synchronised electrical therapy application or emergency equipment readiness did you develop through this activity, and how does this skill inform your readiness for other acute patient interventions?

Relevant learning outcomes

#	Outcome
# 6	Outcome Perform cardiac physiological role for simple electrophysiology procedures for diagnostic investigations and delivery of therapies to help terminate arrhythmias.