Training activity information
Details
Support a pacemaker implant, minimising personal radiation exposure
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 when supporting a pacemaker implant and minimising personal radiation exposure.
- Consider how the relevant learning outcomes apply, particularly regarding radiation safety principles.
- Discuss with your training officer to gain clarity on expectations, especially concerning positioning and use of shielding.
What is your prior experience of this activity?
- Think about what you already know about supporting pacemaker implants and radiation safety.
- Consider possible challenges that might arise (e.g., complex patient positioning, extended fluoroscopy time) and think about how you might handle them while minimising exposure.
- Recognise the scope of your own practice for this activity, i.e., know when/from whom you will need to seek advice or help regarding radiation safety or procedural support.
- Acknowledge how you feel about taking a supporting role in pacemaker implantation. How confident do you feel in minimising your personal radiation exposure?
What do you anticipate you will learn from the experience?
- Consider the specific skills you want to develop related to supporting implants and applying radiation protection principles e.g., distance, shielding.
- Identify specific insights you hope to gain regarding procedural support and managing fluoroscopy dose in the cath lab.
What additional considerations do you need to make?
- Consult actions identified from previous experiences with implants or radiation safety monitoring.
- Identify any important information you need to consider before supporting the implant, such as reviewing guidelines on radiation associated with X-rays and fluoroscopy.
In action
Is anything unexpected occurring?
- Are you noticing anything surprising or different from what you anticipate whilst positioning yourself or assisting the implanting physician?
- Are you encountering situations such as:
- The fluoroscopy time exceeding the anticipated duration requiring prolonged exposure?
- The imaging view requiring unexpected positioning that challenges your ability to safely utilise shielding?
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 when to adjust your position relative to the X-ray source?
- Consider the steps you are taking in the moment, such as:
- Actively concentrating on anticipating fluoroscopy use and positioning yourself safely during critical moments?
- Seeking immediate guidance from the physician or radiographer if you are unsure about safe positioning or the correct use of shielding?
- How are you feeling in that moment? For instance, are you needing to actively concentrate on anticipating fluoroscopy use? Is it affecting your confidence in maintaining safety while supporting the procedure?
What is the conclusion or outcome?
- Identify how you are working within your scope of practice. For example, are your actions related to supporting the procedure and radiation safety appropriate for your role?
- What are you learning as a result of the unexpected development? For example, are you gaining a better understanding of radiation scatter and how procedure steps affect exposure?
On action
What happened?
- Begin by summarising the key points of the experience of supporting the implant.
- Consider specific events, actions, or interactions which felt important, such as how you minimised your radiation exposure e.g., positioning, shielding. Note the use of fluoroscopy and the duration of radiation exposure.
- Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, adjusting your body position immediately due to a change in the physician’s fluoroscopic angle or extended X-ray time. 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 radiation safety principles. What strengths did you demonstrate e.g., adherence to protocols? What skills and/or knowledge gaps were evident, such as areas where you could improve your technique or awareness regarding radiation exposure?
- How does this activity contribute to your long-term occupational safety?
- Identify any challenges you experienced, and how you reacted to these.
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, incorporating any feedback you have received with regards to the support you gave to the pacemaker implantation procedure.
- Identify concrete steps you will take in future implants to further minimise your personal radiation dose, such as optimising your position or ensuring proper shielding is used. 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 dose limits or scatter physics?
Beyond action
Have you revisited the experiences?
- Have you reviewed your actions from your previous reflections for this activity? What specific positioning, shielding, or workflow techniques did you previously identify as needing improvement? Have you completed these previously identified actions? For example, if you planned to consult the guidelines on optimal distance from the X-ray source, how did actively practising this method impact your effectiveness in reducing your personal radiation dose?
- Engage in professional storytelling with peers, near peers, or colleagues about radiation safety practices or dose reduction strategies, such as managing your position during different phases of the implant. Did these discussions offer new perspectives on shielding, workflow, or equipment use (e.g., using the last image hold feature) that will influence your approach in future procedures?
How have these experiences impacted upon current practice?
- Consider how the accumulated learning from performing or reflecting on radiation safety will support you in preparing for observed ‘in-person’ assessments for the module, such as an Observed Clinical Event (OCE) or DOPS that requires safe practice in the cardiac catheterisation lab.
- How has your understanding of scatter radiation and your ability to optimise your position evolved over time? For example, how does this cumulative learning contribute to your long-term professional safety and inform your practice when supporting complex device implants (e.g., CRT/ICD)?
- What transferable skills e.g., risk awareness or adherence to safety protocols did you develop through this activity, and how will this understanding help you apply safety principles when working with other imaging modalities?
Relevant learning outcomes
| # | Outcome |
|---|---|
| # 1 |
Outcome
Demonstrate effective physiological and scientific support for complex CIED implant, providing technical expertise, ensuring patient safety and appropriate procedural documentation. |