Training activity information
Details
Perform and interpret a normal echo
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 in relation to performing and interpreting a normal echo.
- Consider how the relevant learning outcomes apply, specifically concerning acquiring and interpreting cardiac images, applying health and safety principles, demonstrating safe practice according to guidelines, assessing patient presentation and summarising information for reports.
- What does accurate analysis and interpretation of the results of the normal trans-thoracic echo look like, specifically including accurate measurements according to national guidelines for a normal echo?
- What would a clear and accurate interpretation of a normal echo involve?
- Discuss with your training officer to gain clarity of what is expected of you in relation to being able to perform and interpret a normal echo without direct supervision.
What is your prior experience of this activity?
- Think about what you already know about performing and interpreting normal echocardiograms.
- Consider possible challenges you might face during the activity, such as patient cooperation, image quality issues, ensuring correct measurements, or identifying subtle normal variations, 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, and from whom (e.g., supervisor, senior colleague).
- Acknowledge how you feel about performing and interpreting a normal echo unsupervised.
What do you anticipate you will learn from the experience?
- Consider the specific skills you want to develop – drawing upon previous experiences if applicable – related to image acquisition, optimisation, measurement, and interpretation of a normal echo.
- Identify specific insights you hope to gain from engaging with the activity, perhaps related to workflow, efficiency, or specific anatomical views.
What additional considerations do you need to make?
- Consult actions identified following previous experience of the activity or related activities. Have you noted anything from prior attempts that you need to focus on this time?
- Identify important information you need to consider before embarking on the activity, such as checking equipment is functioning correctly, understanding the patient’s basic clinical context to ensure the scan is appropriate, or reviewing relevant protocols.
In action
Is anything unexpected occurring?
- Are you noticing anything surprising or different from what you anticipate whilst performing the scan or approaching the interpretation and measurement of acquired images?
- Are you encountering situations such as:
- Technical issues where unexpected issues with image quality compromise your ability to make accurate measurements according to national guidelines?
- Patient factors affecting image acquisition, leading to significant difficulty finding standard acoustic windows despite attempts at probe manipulation or machine adjustments?
- Encountering a subtle finding or variation that challenges your initial interpretation of the results as ‘normal’?
- How is this experience comparing with previous experiences of similar activities?
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 adapting or changing your probe angulation or scan depth in the moment based on the live image quality?
- Consider the steps you are taking in the moment:
- Immediately adjusting frequency or power settings (gain, sector width) to optimise specific views or counteract image artefacts?
- Actively recalling measurement criteria or specific anatomical landmarks to ensure accurate measurements?
- Seeking immediate input from your supervisor if you are struggling to obtain a crucial view or encounter a finding you are not certain is normal?
- How are you feeling in that moment? For instance, are you finding it difficult to adapt your knowledge of echo anatomy or physics to the challenge? Is it affecting your confidence in your initial interpretation of findings as ‘normal’?
What is the conclusion or outcome?
- Identify how you are working within your scope of practice. For example, are you successfully troubleshooting image quality issues yourself? Or are you needing support because the complexity of the finding requires senior input?
- What are you learning as a result of the unexpected development? For example, are you learning a more effective technique for image optimisation in real-time, or gaining insight into identifying subtle normal findings or anatomical variations as you scan?
On action
What happened?
- Begin by summarising the key points of the experience of performing and interpreting the normal trans-thoracic echo.
- Consider specific events, actions, or interactions which felt important during the activity, such as patient preparation, successful acquisition of standard views, or the key measurements made.
- Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, immediately adjusting machine settings to resolve image quality issues or dealing with an unexpected finding that challenged your initial interpretation of ‘normal’. 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 image acquisition, interpretation of normal anatomy, or measurement accuracy according to national guidelines.
- What strengths did you demonstrate e.g., ability to obtain specific standard views? What skills and/or knowledge gaps were evident e.g., unfamiliarity with certain anatomical variations or challenges with specific measurement techniques?
- Compare this experience against previous engagement with similar activities – were any previously identified actions for development achieved? Has your practice in performing or interpreting a normal echo improved?
- Identify any challenges you experienced, such as dealing with a difficult patient window or ensuring accuracy of key measurements, and how you reacted to these. Did this affect your ability to deal with the situation? Were you able to overcome the challenges?
- Identify anything significant about the activity, such as needing to seek advice or clarification on interpreting an ambiguous finding or escalating a machine issue, to ensure that you were working within your scope of practice.
- 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 to support the assimilation of what you have learnt, including from any feedback you have received regarding your scanning or interpretation skills.
- What will you do differently next time you perform a normal echo, for instance, focusing on improving your technique for a challenging view or refining a specific measurement strategy? 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 specific measurements or performing dedicated image optimisation practice sessions?
Beyond action
Have you revisited the experiences?
- Look back at your previous reflections and notes from performing and interpreting normal echoes. What specific areas did you previously identify for improvement e.g., obtaining a particular view, refining a measurement technique, or an interpretation step?
- How effectively have you implemented the actions you planned based on earlier reflections? Can you now consistently demonstrate improvement in those areas, confirming you are ready to demonstrate this new learning in practice?
- Have you discussed specific challenging normal echo cases e.g., technically difficult scans or aspects of interpretation with your supervisor or colleagues? How did their insights or alternative approaches influence your understanding and future practice?
How have these experiences impacted upon current practice?
- Evolution of practice: How has your ability to perform and interpret a normal echo evolved from your first attempts to your most recent ones? Consider changes in your efficiency, image quality, confidence, and accuracy of interpretation.
- Consider how your proficiency in performing and interpreting normal echoes contributes to your preparation for relevant formal assessments for the module, such as DOPS, OCEs, or Case-based Discussions. For example, does it improve your ability to discuss basic cardiac anatomy and function or apply health and safety principles?
- How has the accumulated experience of performing normal echoes helped you to more easily identify abnormal findings or variations when they occur? Does it help you recognise when a finding is outside your scope of practice, and you might need to seek advice?
Relevant learning outcomes
| # | Outcome |
|---|---|
| # 1 |
Outcome
Acquire and interpret cardiac images for a range of normal and pathological conditions. |
| # 4 |
Outcome
Apply knowledge of health and safety principles to maintain own and patient safety. |
| # 6 |
Outcome
Demonstrate safe practice in line with local, national and international guidelines and standards. |