Training activity information
Details
Perform a routine pacemaker follow-up and interpret device detected clinical diagnostic data
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 performing a routine pacemaker follow-up and interpreting the data.
- Consider how the relevant learning outcomes apply, specifically concerning performing follow-up and interpreting diagnostic data.
- Discuss with your training officer to gain clarity on expectations for interrogation, interpretation (e.g., normal parameter changes over time), and communication of findings.
What is your prior experience of this activity?
- Think about what you already know about pacemaker follow-up, device interrogation, and interpreting routine data.
- Consider possible challenges that might arise, such as unexpected lead measurements or unusual patient symptoms, 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 with specific device findings or programming.
- Acknowledge how you feel about performing the routine follow up? How confident are you in interpreting the data?
What do you anticipate you will learn from the experience?
- Consider the specific skills you want to develop related to efficient interrogation, interpretation, and patient interaction during follow-up.
- Identify specific insights you hope to gain regarding pacemaker function and patient management, including selection of appropriate pacing models and modes.
What additional considerations do you need to make?
- Consult actions identified from previous experiences with pacemaker follow-ups.
- Identify any important information about the patient or device history you need to consider beforehand, for example, the patient’s baseline ECG or previous device reports.
In action
Is anything unexpected occurring?
- Are you noticing anything surprising or different from what you anticipate whilst interrogating the device or interpreting the findings?
- Are you encountering situations such as:
- Unexpected device behaviour, complex arrhythmias (e.g., specific tachyarrhythmias) in the stored data, or difficulty interpreting clinical significance?
- Significant deviations in lead impedance trends or capture thresholds that challenge your interpretation of common findings?
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 which stored events are significant and require detailed review?
- Consider the steps you are taking in the moment, such as:
- Actively concentrating on complex arrhythmias, lead impedance trends, or correlating device data with patient symptoms?
- Seeking immediate guidance from a senior colleague or physician if you encounter unexpected device behaviour or complex findings?
- How are you feeling in that moment? For instance, are you finding it difficult to interpret complex arrhythmias? Is it affecting your confidence in your interpretation of common findings?
What is the conclusion or outcome?
- Identify how you are working within your scope of practice. For example, are the interrogation, interpretation, and communication tasks appropriate for your level of training and supervision?
- What are you learning as a result of the unexpected development? For example, are you learning to spot subtle trends or anomalies in the diagnostic data?
On action
What happened?
- Begin by summarising the key points of the experience of performing the follow-up.
- Consider specific events, actions, or interactions which felt important, such as the device interrogation process, the data you focused on e.g., battery status, lead impedance, sensing/capture thresholds, stored events, and any clinical data recorded.
- Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, immediately reviewing a specific stored event due to a reported patient symptom or unexpected lead data. 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 routine follow-up interpretation. What strengths did you demonstrate (e.g., thoroughness)? What skills and/or knowledge gaps were evident, for example, did you gain new insights into specific device parameters or diagnostic algorithms?
- Identify any challenges you experienced, such as challenging data sets to interpret or unexpected lead measurements, and how you reacted to these. How does this activity contribute to your understanding of device function and patient status?
- 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 from any feedback you have received with regards to your ability to perform a routine pacemaker follow up. What feedback have you had with regards to the accuracy of your interpretation of the data?
- Identify areas where you need to deepen your understanding of pacemaker function or interpretation of specific diagnostic data. How will you approach future routine follow-ups to ensure thoroughness and accuracy? 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 pacing modes or normal parameter changes over time?
Beyond action
Have you revisited the experiences?
- Have you reviewed your actions from your previous reflections for this activity? What aspects of interrogation, data interpretation (e.g., lead impedance trends), or report generation did you previously find challenging? Have you completed these previously identified actions? For example, if you planned to review the specific diagnostic data screens for mode switching, how did these improvements reflect in your current follow-ups and interpretations?
- Engage in professional storytelling with peers, near peers, or colleagues about challenging routine follow-up cases, such as subtle battery depletion warnings or intermittent sensing issues. Did their insights provide a new perspective on interpreting specific diagnostic data or reporting nuances, influencing your future analytical approach?
How have these experiences impacted upon current practice?
- Consider how the accumulated learning from performing or reflecting on routine pacemaker follow-up will support you in preparing for observed ‘in-person’ assessments for the module, such as a DOPS involving device interrogation or a Case-Based Discussion requiring analysis of device diagnostics.
- How have your diagnostic skills developed over time? For example, do you find it easier now to identify normal vs. abnormal findings, correlate data with patient symptoms, and form a clear interpretation that supports your ability to perform complex device follow-up?
- What transferable skills e.g., systematic interrogation or data correlation did you develop through this activity, and how does this progression support your ability to perform follow-up for more complex CIEDs (e.g., ICDs or CRTs)?
Relevant learning outcomes
| # | Outcome |
|---|---|
| # 2 |
Outcome
Perform and interpret complex CIED follow up and effectively communicate results to patients and clinical staff as appropriate. |