Training activity information
Details
Review and triage patient referrals under supervision, determining suitability for anorectal physiology investigations and endoanal ultrasound scanning
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 effectively reviewing and triaging patient referrals under supervision to determine suitability.
- Consider how the learning outcomes apply, specifically in relation to describing the requirements (indications and contraindications) of anorectal physiology investigations and demonstrating sensitivity to patient anxieties during this initial stage.
- Discuss with your training officer to gain clarity of what is expected of you in relation to the specific knowledge required regarding indications/contraindications and the expected level of supervision during the triage process.
- What is your prior experience of this activity?
- Think about what you already know about anorectal physiology investigations and endoanal ultrasound scanning indications and contraindications. Have you reviewed patient referrals before in any context?
- Consider possible challenges you might face during the activity, such as encountering incomplete patient information or complex patient history that complicates suitability.
- 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. You will need to seek advice from your Training Officer when required, for example if the complexity of the patient’s history or specific contraindications make determining suitability ambiguous.
- Acknowledge how you feel about reviewing and triaging patient referrals.
- What do you anticipate you will learn from the experience?
- Consider the specific skills you want to develop, such as applying triage criteria, accessing and applying local department protocols for referral triage, and exercising clinical judgment when applying indications and contraindications.
- Identify the specific insights you hope to gain into the patient pathway and the common reasons for referral in Lower Gastrointestinal Physiology, particularly understanding the link between symptoms and the need for investigation.
- What additional considerations do you need to make?
- Consult actions identified following previous experiences of reviewing clinical documentation or applying diagnostic criteria in any relevant context.
- Identify important information you need to consider before embarking on the activity, such as reviewing relevant academic content on conditions affecting the lower GI system and reviewing the specific learning outcomes.
In action
- Is anything unexpected occurring?
- Are you noticing anything surprising or different from what you anticipate whilst reviewing patient information or applying suitability criteria?
- Are you encountering situations such as:
- Patient history details are vague or complex, complicating the determination of suitability for investigation?
- You are uncertain about the specific indications or contraindications for a required investigation (e.g., endoanal ultrasound), requiring conscious referencing of guidelines?
- You identify a potential red flag or significant comorbidity that was not addressed in the referral, challenging the triage decision.
- 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 approach to analysing patient information or applying suitability criteria?
- Consider the steps you are taking in the moment, such as:
- Immediately pausing the triage to consult with your Training Officer regarding a complex or ambiguous patient history
- Probing deeper into the patient records or departmental guidelines to clarify suitability criteria
- How are you feeling in that moment? For instance, are you finding it difficult to apply the indications/contraindications accurately? Is it affecting your confidence in determining the suitability of the referral?
- What is the conclusion or outcome?
- Identify how you are working within your scope of practice. For example, are you successfully determining the suitability based on established criteria? Or are you needing support because the referral complexity requires senior clinical verification?
- What are you learning as a result of the unexpected development? For example, are you mastering a more efficient technique for applying key indications for anorectal physiology? Or gaining insight into patterns of appropriate referrals?
On action
- What happened?
- Begin by summarising the key steps you took when reviewing the patient referral history, confirming the requesting clinician’s details, and applying departmental criteria to determine the suitability for anorectal physiology investigations or endoanal ultrasound scanning.
- Consider specific events, actions, or interactions which felt important, such as how you identified that the patient’s history included a specific contraindication that meant the requested investigation was inappropriate, or how you ensured compliance with local data access protocols during the review.
- Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, immediately consulting the training officer when the referral documentation was ambiguous regarding a specific surgical history, which complicated the decision on suitability.
- How did you feel during this experience, e.g., did you feel focused on applying the indication/contraindication criteria or stressed by the responsibility of excluding an investigation based on the review?
- How has this experience contributed to your developing practice?
- Identify what learning you can take from this experience regarding the critical importance of linking clinical history to investigation suitability.
- What strengths did you demonstrate, e.g., meticulous adherence to the suitability checklist?
- What skills and/or knowledge gaps were evident, e.g., unfamiliarity with the specific indications for endoanal ultrasound scanning?
- Compare this experience against previous engagement with similar activities – were any previously identified actions for development achieved?
- Has your practice improved in efficiently reviewing complex referral documentation and extracting critical information?
- Identify any challenges you experienced, such as needing to seek advice or clarification on scope of practice regarding whether a specific patient co-morbidity constituted an absolute contraindication for anorectal manometry, and how you reacted to this.
- 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, with regards to improving your knowledge of specific indications and contraindications required for effective triage.
- What will you do differently next time you approach reviewing and triaging patient referrals, for instance, by proactively cross-referencing all referrals against a standard academic guide detailing the relevant physiology and required indications?
- Do you need to practise any aspect of the activity further, such as accurately applying clinical judgement to borderline suitability cases or key learning outcomes related to describing the requirements of anorectal physiology investigations?
Beyond action
- Have you revisited the experiences?
- How have your subsequent experiences of performing anorectal physiology investigations since completing this specific training activity led you to revisit your initial approach or decisions during that activity? For example, performing a study that was particularly challenging due to complex patient history, forced you to re-evaluate the meticulousness of your review of suitability criteria, indications, and contraindications during your first attempt at this training activity.
- Considering what you understand about investigation requirements, patient needs, and the overall clinical pathway now, were the actions or considerations you identified after your initial reflection on this training activity sufficient?
- How have you since implemented or adapted improvements in your triage decision-making process based on further learning and experiences? For example, how you proactively integrated knowledge from attending colorectal outpatient clinics to better assess the appropriateness of the onward referral.
- Has discussing challenging referral cases or the impact of ambiguous contraindications with colleagues, peers, or supervisors changed how you now view your initial experience in this training activity? For example, how professional storytelling with a senior colleague about a case where vague surgical history complicated the initial triage decision, refined your understanding of the critical nature of applying clear criteria when assessing patient suitability.
- How have these experiences impacted upon current practice?
- How has the learning from this initial training activity, in combination with subsequent experiences performing the investigations and discussing patient cases, contributed to your overall confidence and ability in applying knowledge of indications and contraindications and critically assessing clinical information, particularly in preparing for assessments like Case-Based Discussions (CBDs)? For example, how your accumulated ability in critically assessing information now enables you to confidently discuss patient case management and rationale for investigation selection during a CBD assessment.
- How has reflecting back on this specific training activity, combined with everything you’ve learned since, shaped your current approach to reviewing patient requests and contributing to clinical pathways?
- How does this evolved understanding help you identify when something is beyond your scope of practice or requires escalation? For example, how your evolved approach means you now routinely seek advice from the Training Officer or referring physician immediately when the suitability criteria for an investigation conflict with the patient’s acute clinical presentation, recognising this falls outside routine triage scope.
- Looking holistically at your training journey, how has this initial referral triage experience, revisited with your current perspective, contributed to your development in meeting the learning outcomes related to describing the requirements of anorectal physiology investigations, including indications and contraindications? For example, how this foundational experience has supported your development in practicing safely by providing the necessary knowledge base for the subsequent learning outcomes focused on performing the investigations effectively.
Relevant learning outcomes
| # | Outcome |
|---|---|
| # 1 |
Outcome
Describe the requirements of anorectal physiology investigations including indications and contraindications, and take a patient history. |
| # 7 |
Outcome
Apply and adapt their approach to the patient’s individual tolerance, personal experience and anxieties, demonstrating sensitivity to the emotional implications of intimate and invasive investigations on a patient’s wellbeing. |