Training activity information
Details
Take patient histories for anorectal physiology investigations
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 gathering all necessary information when taking a patient history for anorectal physiology investigations.
- Consider how the learning outcomes apply, specifically in relation to taking a patient history pertinent to indications/contraindications and demonstrating sensitivity and adapting your approach when discussing intimate symptoms.
- Discuss with your training officer to gain clarity of what is expected of you in relation to the specific communication skills essential for successful history taking, and the necessary depth of information regarding lower gastrointestinal function and disorders.
- What is your prior experience of this activity?
- Think about what you already know about taking patient histories, especially regarding sensitive topics such as bowel function, incontinence, or previous surgeries.
- Consider possible challenges you might face during the activity, such as patient difficulty or embarrassment discussing symptoms, or language barriers.
- 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 patient presents with a highly complex history (e.g., related to previous cancer operations or severe neurological deficit) that requires expert interpretation to guide investigation planning.
- Acknowledge how you feel about taking patient histories in the context of this training activity.
- What do you anticipate you will learn from the experience?
- Consider the specific skills you want to develop, such as eliciting specific history points relevant to lower GI conditions and improving your ability to adapt your communication style to different patients.
- Identify the specific insights you hope to gain into the types of symptoms and histories presented by patients requiring these investigations, and how taking histories helps you better understand the indications for the investigations.
- What additional considerations do you need to make?
- Consult actions identified following previous experiences of performing patient interviews or gathering sensitive clinical information.
- Identify important information you need to consider before embarking on the activity, such as reviewing relevant academic content about lower GI conditions and their symptoms and reviewing the patient’s referral prior to the consultation.
In action
- Is anything unexpected occurring?
- Are you noticing anything surprising or different from what you anticipate whilst obtaining the patient history or reviewing symptom details?
- Are you encountering situations such as:
- The patient presents with complex or conflicting symptoms that significantly deviate from the expected referral pathology, complicating the focused history taking?
- Communication barriers arise unexpectedly (e.g., patient difficulty articulating sensitive symptoms), challenging your ability to maintain compassionate communication?
- You detect a clinical detail (e.g., severe pain, major psychological distress) that requires an immediate adaptation of your questioning style?
- 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 asking sensitive questions or structuring the conversation to manage complexity?
- Consider the steps you are taking in the moment, such as:
- Immediately adjusting your questioning to focus on the unexpected clinical history detail, while simultaneously documenting the information clearly.
- Pausing the history taking to offer reassurance or discreetly seek advice from a senior colleague about managing a highly distressed patient?
- How are you feeling in that moment? For instance, are you finding it difficult to adapt your history-taking strategy to manage the complex symptoms? Is it affecting your confidence in gathering all relevant information pertinent to the investigation?
- What is the conclusion or outcome?
- Identify how you are working within your scope of practice. For example, are you successfully eliciting a comprehensive history by adapting your communication style? Or are you needing support because the patient’s complex history or distress is beyond your current experience for appropriate management?
- What are you learning as a result of the unexpected development? For example, are you mastering a more effective technique for gathering sensitive patient information? Or gaining insight into the wide range of symptoms that may necessitate anorectal physiology investigations?
On action
- What happened?
- Begin by summarising the key steps you took when establishing rapport, eliciting detailed information about lower gastrointestinal function and symptoms, and documenting the patient’s medical and surgical history pertinent to the investigation.
- Consider specific events, actions, or interactions which felt important, such as how you sensitively navigated questions about faecal incontinence or previous anal surgeries, or how you sought to correlate symptoms with the indications for the specific tests.
- Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, immediately changing your questioning approach when the patient displayed acute embarrassment or distress when discussing intimate symptoms.
- How did you feel during this experience, e.g., did you feel focused on obtaining the necessary facts or challenged by the need to maintain compassionate communication?
- How has this experience contributed to your developing practice?
- Identify what learning you can take from this experience regarding effective, focused history taking for lower GI conditions and demonstrating sensitivity.
- What strengths did you demonstrate, e.g., ability to structure the history taking efficiently?
- What skills and/or knowledge gaps were evident, e.g., unfamiliarity with the detailed pharmaceutical history relevant to bowel function?
- Compare this experience against previous engagement with similar activities – were any previously identified actions for development achieved?
- Has your practice improved in eliciting sensitive patient information with greater confidence?
- Identify any challenges you experienced, such as needing to seek advice or clarification on scope of practice regarding how to manage unexpected patient emotional distress during the history taking, 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 refining your history-taking technique and consistently applying sensitive communication.
- What will you do differently next time you approach taking a patient history, for instance, by proactively ensuring you have a specific, structured set of questions prepared for assessing the severity of faecal incontinence?
- Do you need to practise any aspect of the activity further, such as asking open-ended questions to encourage disclosure of sensitive information or key learning outcomes related to taking a pertinent patient history?
Beyond action
- Have you revisited the experiences?
- How have your subsequent experiences of performing the investigation or analysing results since completing this specific training activity led you to revisit your initial approach or decisions during that activity? For example, analysing a result where specific symptoms required detailed clarification for interpretation, forced you to re-evaluate the depth of pharmaceutical or surgical history collection you applied during your first attempt at history taking during your first attempt at this training activity.
- Considering what you understand about connecting symptoms to indications and maintaining sensitive communication 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 history-taking approach, prioritising specific questions, based on further learning and experiences? For example, how you proactively integrated specific questions related to neurological conditions or childbirth history after learning about their impact on pelvic floor function.
- Has discussing particularly insightful patient histories or the impact of managing anxiety when discussing intimate symptoms 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 patient who was initially hesitant to disclose sensitive faecal incontinence symptoms, refined your understanding of the critical nature of establishing rapport and sensitive questioning.
- How have these experiences impacted upon current practice?
- How has the learning from this initial training activity, in combination with subsequent interaction experiences like obtaining consent and providing reassurance, contributed to your overall confidence and ability in gathering relevant clinical information and sensitive communication, particularly in preparing for assessments like Observed Communication Events (OCEs)? For example, how your accumulated ability in gathering relevant clinical information now enables you to confidently obtain a patient history for anorectal physiology investigations during an OCE assessment.
- How has reflecting back on this specific training activity, combined with everything you’ve learned since, shaped your current approach to tailoring the investigation to the patient’s needs? 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 specialist nurse immediately when a patient presents with symptoms highly suggestive of inflammatory bowel disease, requiring urgent referral pathway verification, recognising this falls outside routine history documentation scope.
- Looking holistically at your training journey, how has this initial history-taking experience, revisited with your current perspective, contributed to your development in meeting the learning outcomes related to taking a patient history and demonstrating sensitivity? 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 procedure safely and 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. |