Training activity information
Details
Explain the procedure and obtain written informed consent from patients 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 successfully explaining the anorectal physiology investigation procedures and obtaining valid written informed consent.
- Consider how the learning outcomes apply, specifically in relation to explaining the procedure and appropriately answering questions and demonstrating sensitivity while adapting communication due to the intimate nature of the investigation.
- Discuss with your training officer to gain clarity of what is expected of you in relation to the specific information that must be included in the consent discussion (e.g., risks, benefits, potential discomforts), and the procedure for documenting the written informed consent.
- What is your prior experience of this activity?
- Think about what you already know about explaining medical procedures or obtaining consent, especially for sensitive or invasive tests. Are you confident in your knowledge of the investigations (manometry, sensation testing, balloon expulsion)?
- Consider possible challenges you might face during the activity, such as managing patient anxiety about intimate procedures, ensuring patient comprehension of medical information, or addressing unexpected ethical concerns.
- 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 expresses significant anxiety or refusal regarding the procedure, or if there is ambiguity regarding the patient’s capacity to consent.
- Acknowledge how you feel about the responsibility of obtaining informed consent and discussing intimate procedures.
- What do you anticipate you will learn from the experience?
- Consider the specific skills you want to develop, such as tailoring explanations for complex and sensitive information, and applying compassionate communication strategies to manage patient anxiety.
- Identify the specific insights you hope to gain into common patient concerns and questions about these investigations and understanding the critical importance of tailored explanations.
- What additional considerations do you need to make?
- Consult actions identified following previous experiences of explaining procedures, obtaining consent, or managing anxious patients.
- Identify important information you need to consider before embarking on the activity, such as reviewing the key steps and purpose of each anorectal physiology investigation and checking for cultural sensitivities or the need for an interpreter.
In action
- Is anything unexpected occurring?
- Are you noticing anything surprising or different from what you anticipate whilst explaining the procedure or obtaining consent?
- Are you encountering situations such as:
- The patient expresses unexpected high anxiety or distress regarding the intimate nature of the investigation, challenging the standard explanation?
- The patient raises complex questions regarding the potential discomfort or refusal of specific parts of the test, requiring detailed explanation beyond the standard script?
- A comprehension difficulty or language barrier makes it challenging to confirm that valid informed consent has truly been obtained.
- 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 communication technique or risk explanation?
- Consider the steps you are taking in the moment, such as:
- Immediately adjusting your communication style to employ simpler language or visual aids to alleviate patient anxiety about the procedure
- Pausing the consent process to consult a guide or discreetly seek advice from your Training Officer about addressing complex questions regarding risk or alternatives
- How are you feeling in that moment? For instance, are you finding it difficult to adapt your explanation to manage high patient distress? Is it affecting your confidence in ensuring the patient is truly informed?
- What is the conclusion or outcome?
- Identify how you are working within your scope of practice. For example, are you successfully resolving patient anxiety by providing appropriate reassurance and securing consent? Or are you needing support because the patient’s capacity to consent is ambiguous, requiring senior clinical input?
- What are you learning as a result of the unexpected development? For example, are you mastering a more effective strategy for addressing patient fears about intimate investigations? Or gaining insight into the ethical requirements for documenting informed consent?
On action
- What happened?
- Begin by summarising the key steps you took when introducing the anorectal physiology procedure, explaining the purpose, detailing what the patient would experience, answering all questions, and documenting the patient’s written informed consent.
- Consider specific events, actions, or interactions which felt important, such as how you provided reassurance regarding the potentially intimate nature of the investigation, or how clearly you articulated the patient’s right to withdraw consent at any point.
- Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, immediately rephrasing the explanation of the balloon expulsion test when the patient appeared confused or anxious about the procedure’s mechanics.
- How did you feel during this experience, e.g., did you feel responsible for ensuring full comprehension or challenged by the need to address high levels of patient anxiety?
- How has this experience contributed to your developing practice?
- Identify what learning you can take from this experience regarding the ethical requirements of consent and applying sensitive communication for intimate procedures.
- What strengths did you demonstrate, e.g., comprehensive knowledge of the procedure steps?
- What skills and/or knowledge gaps were evident, e.g., difficulty confidently answering complex questions about potential complications?
- Compare this experience against previous engagement with similar activities – were any previously identified actions for development achieved?
- Has your practice improved in ensuring the patient fully understands the steps of the procedure and their implications?
- Identify any challenges you experienced, such as needing to seek advice or clarification on scope of practice regarding documenting consent when the patient was hesitant or requested procedural modification, 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 clear and compassionate explanation of the procedure.
- What will you do differently next time you approach explaining the procedure and obtaining consent, for instance, by proactively using specific visual aids to demystify the manometry catheter and balloon components?
- Do you need to practise any aspect of the activity further, such as addressing patient anxieties about the sensation of the procedure or key learning outcomes related to explaining the procedure for consent?
Beyond action
- Have you revisited the experiences?
- How have your subsequent experiences of providing reassurance during procedures or addressing patient misunderstanding since completing this specific training activity led you to revisit your initial approach or decisions during that activity? For example, having a patient express confusion during the balloon expulsion test forced you to re-evaluate the clarity of the pre-procedure explanation of the steps and required patient effort during your first attempt at this training activity.
- Considering what you understand about clear communication, patient autonomy, and managing anxiety 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 explanation technique, ensuring full understanding of risks and benefits, based on further learning and experiences? For example, how you proactively started using simple visual aids to illustrate the manometry catheter to demystify the intimate procedure.
- Has discussing challenging conversations around consent or the impact of communication failure on patient confidence 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 misunderstood the procedure’s duration and scope, refined your understanding of the critical nature of ensuring patient comprehension of all procedural details.
- How have these experiences impacted upon current practice?
- How has the learning from this initial training activity, in combination with subsequent patient interaction experiences and observing patient care, contributed to your overall confidence and competence in explaining procedures and demonstrating sensitivity, particularly in preparing for assessments like Observed Communication Events (OCEs)? For example, how your accumulated ability in explaining complex medical information simply now enables you to confidently explain an anorectal physiology procedure and obtain informed consent 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 navigating ethical considerations and securing consent? 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 legal proxy immediately when a concern arises regarding the patient’s capacity to provide valid written informed consent, recognising this falls outside routine procedure explanation scope.
- Looking holistically at your training journey, how has this initial consent experience, revisited with your current perspective, contributed to your development in meeting the learning outcomes related to explaining the procedure 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 safely performing the procedure itself.
Relevant learning outcomes
| # | Outcome |
|---|---|
| # 1 |
Outcome
Describe the requirements of anorectal physiology investigations including indications and contraindications, and take a patient history. |
| # 3 |
Outcome
Explain the procedure for anorectal physiology investigations to patients, appropriately answer questions about the procedure and obtain the patient’s informed consent. |
| # 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. |