Training activity information
Details
Perform a routine complex device follow-up and interpret device detected clinical diagnostic data:
- CRT
- ICD
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 routine follow-up and interpreting data for CRT and ICD devices.
- Consider how the relevant learning outcomes apply, specifically concerning interpreting complex device data, managing disease states (e.g., HF), and ICD management.
- Discuss with your training officer to gain clarity on expectations for complex device interpretation, including ICD therapy zones and CRT optimisation.
What is your prior experience of this activity?
- Think about what you already know about complex device follow-up, including SVT discriminators and heart failure diagnostics.
- Consider possible challenges that might arise e.g., complex arrhythmias, device alerts, 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 for complex device algorithms or patient symptoms.
- Acknowledge how you feel about performing routine complex device follow-ups. How confident do you feel in interpreting the data?
What do you anticipate you will learn from the experience?
- Consider the specific skills you want to develop related to interpreting CRT/ICD function, therapies (Shock and ATP), and complex diagnostics.
- Identify specific insights you hope to gain regarding the long-term management of CRT patients or the principles behind tachycardia detection.
What additional considerations do you need to make?
- Consult actions identified from previous experiences with complex device follow-ups.
- Identify any important information about the patient, their heart failure status, specific device model, or product-specific algorithms you need to consider beforehand.
In action
Is anything unexpected occurring?
- Are you noticing anything surprising or different from what you anticipate whilst reviewing stored therapies or interpreting heart failure diagnostics?
- Are you encountering situations such as:
- Inappropriate therapies (e.g., unnecessary shocks or ATP) recorded by the ICD device?
- Difficult to interpret ventricular arrhythmias (e.g., highly polymorphic VT) or ambiguous multi-parameter heart failure diagnostics (e.g., fluid trends) that require detailed knowledge of the device’s algorithms?
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 stored therapy was appropriate?
- Consider the steps you are taking in the moment, such as:
- Actively concentrating on interpreting complex stored electrograms from arrhythmias or assessing the efficacy of CRT pacing?
- Seeking immediate guidance from a senior colleague or physician if you encounter inappropriate therapies or difficult to interpret data?
- How are you feeling in that moment? For instance, are you needing to actively concentrate on complex heart failure data? Is it affecting your confidence in identifying significant events or trends for these complex devices?
What is the conclusion or outcome?
- Identify how you are working within your scope of practice. For example, are the interrogation, interpretation, and assessment tasks for these complex devices 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 deeper understanding of CRT/ICD specific diagnostics and therapies?
On action
What happened?
- Begin by summarising the key points of the experience of following up the complex device.
- Consider specific events, actions, or interactions which felt important, such as the device-specific data you analysed (e.g., shocking history, ATP delivery, biventricular pacing percentage, heart failure diagnostics), and how you interpreted its clinical significance.
- Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, reviewing stored electrograms (EGMs) to verify the appropriateness of an ICD therapy delivery. 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 complex device follow-ups. What strengths did you demonstrate (e.g., analytical skills)? What skills and/or knowledge gaps were evident, such as improving your understanding of CRT optimisation parameters or ICD therapy delivery and discriminators?
- Identify any challenges you experienced, such as interpreting complex diagnostic data or stored electrograms, and how you reacted to these. How does this activity contribute to your expertise in managing patients with advanced devices?
- 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 about your ability to perform the follow-up and the accuracy of your interpretation of the data.
- Identify specific aspects of CRT or ICD follow-up data analysis where you need further practice or knowledge. What resources will you use to enhance your interpretation skills for complex devices? 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 SVT discriminators or heart failure diagnostics?
Beyond action
Have you revisited the experiences?
- Have you reviewed your actions from your previous reflections for this activity? What specific device features e.g., CRT optimisation data, ICD diagnostics like VF detection details or data patterns did you previously find most difficult to interpret? Have you completed these previously identified actions? For example, if you planned to review algorithms for heart failure monitoring data e.g., thoracic impedance, how did this improve your analytical skills in managing these complex devices?
- Engage in professional storytelling with peers, near peers, or colleagues about challenging complex device follow-up cases or intricate diagnostic data patterns, such as distinguishing true ventricular tachycardia from noise. Did these conversations offer new insights into interpreting specific device behaviour or diagnostic algorithms, influencing your approach to similar cases in the future?
How have these experiences impacted upon current practice?
- Consider how the accumulated learning from performing or reflecting on complex device follow-up will support you in preparing for observed ‘in-person’ assessments for the module, such as a DOPS titled ‘Perform lead measurements and optimise settings on a CRT/ICD device.’
- How has your ability to interpret intricate diagnostic data and understand the clinical implications of the findings evolved? For example, how does this cumulative learning support your ability to make prescriptive recommendations and manage complex CIED patients requiring therapy changes?
- What transferable skills e.g., advanced data analysis or complex pattern recognition did you develop through this activity, and how does this competence enhance your role in applying specialist knowledge to programme and optimise CIEDs safely?
Relevant learning outcomes
| # | Outcome |
|---|---|
| # 2 |
Outcome
Perform and interpret complex CIED follow up and effectively communicate results to patients and clinical staff as appropriate. |