Upper Gastrointestinal Physiology 1 —
Training activity: 10

Details

Draft written reports for upper gastrointestinal physiology investigations, recommending follow-up\additional investigation, including:

• High resolution oesophageal manometry
• 24-hour ambulatory pH studies.

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 a clear, concise, and clinically relevant written report for a manometry or pH study.
  • Consider how the learning outcomes apply, specifically in relation to effectively summarising the key findings and formulating appropriate recommendations for follow-up or additional investigations.
  • Discuss with your training officer to gain clarity of what is expected of you in relation to examples of good reports, reporting standards, and the criteria defining appropriate recommendations.
• What is your prior experience of this activity?
  • Think about what you already know about structuring and writing clinical reports.
  • Consider possible challenges you might face during the activity, such as translating complex findings into clear language, formulating appropriate recommendations, or integrating patient history.
  • 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 interpretation requires complex pathological input or if you are unsure about the formulation of specific recommendations.
  • Acknowledge how you feel about drafting the written reports as specified.
• What do you anticipate you will learn from the experience?
  • Consider the specific skills you want to develop, such as clinical report writing, particularly for GI physiology studies.
  • Identify the specific insights you hope to gain into how report findings influence patient management and the decision-making process for further steps.
• What additional considerations do you need to make?
  • Consult actions identified following previous experiences of drafting reports or receiving feedback on your writing.
  • Identify important information you need to consider before embarking on the activity, such as ensuring the analysis is complete and accurate and reviewing the patient’s full clinical picture.

In action

• Is anything unexpected occurring?
  • Are you noticing anything surprising or different from what you anticipate whilst drafting the written report for an HRM or pH study?
  • Are you encountering situations such as:
    • Difficulty arises in translating complex manometric or pH findings into clear, concise clinical language for the referring physician?
    • The objective findings (e.g., normal manometry) conflict with a strong clinical history (e.g., severe dysphagia), making the formulation of follow-up recommendations difficult?
    • Uncertainty arises regarding the specific terminology or format required for reporting highly complex pH/impedance findings?
• 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 report structure or terminology to ensure clear communication?
  • Consider the steps you are taking in the moment, such as:
    • Immediately consulting departmental guidelines or previous reports to ensure standardised terminology is used for complex findings.
    • Pausing the drafting of the recommendation section to consult academic material or the Training Officer about appropriate follow-up tests when findings and history conflict.
  • How are you feeling in that moment? For instance, are you finding it difficult to integrate objective data with clinical context concisely? Is it affecting your confidence in formulating appropriate recommendations for additional investigations?
• What is the conclusion or outcome?
  • Identify how you are working within your scope of practice. For example, are you successfully documenting all factual measurements and observations objectively? Or are you needing support because the interpretation of borderline or conflicting findings requires expert pathological input to formulate recommendations outside routine scope?
  • What are you learning as a result of the unexpected development? For example, are you mastering a more rigorous strategy for integrating clinical context into the factual report? Or gaining insight into the range of non-physiological follow-up investigations?

On action

• What happened?
  • Begin by summarising the key steps you took when drafting the written report(s) for the specified upper gastrointestinal physiology investigation(s).
  • Consider specific events, actions, or interactions which felt important, such as how you ensured the report contained concise factual data or how you formulated a recommendation for additional investigation (e.g., barium swallow or endoscopy) based on the findings.
  • Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, immediately seeking clarification on the clinical context when analysis revealed a motility finding that highly contradicted the patient’s reported symptoms.
  • How did you feel during this experience, e.g., did you feel challenged by the difficulty of integrating conflicting information or confident in your ability to present complex data clearly?
• How has this experience contributed to your developing practice?
  • Identify what learning you can take from this experience regarding reporting and clinical reasoning.
  • What strengths did you demonstrate, e.g., logical structuring of the report and clear presentation of key measurements?
  • What skills and/or knowledge gaps were evident, e.g., unfamiliarity with the full range of surgical/endoscopic interventions that might be recommended for follow-up?
  • Compare this experience against previous engagement with similar activities – were any previously identified actions for development achieved?
  • Has your practice improved in producing preliminary reports and making appropriate recommendations?
  • Identify any challenges you experienced, such as needing to seek advice or clarification on scope of practice regarding the precise terminology required for grading the severity of a motility disorder in the report, and how you reacted to this.
• What will you take from the experience moving forward?
  • Identify the actions 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 report drafting, including synthesising complex analysis findings and formulating recommendations.
  • What will you do differently next time you approach drafting written reports, for instance, by proactively reviewing academic content on surgical/endoscopic interventions (e.g., fundoplication, POEM) to ensure relevant recommendations are considered?
  • Do you need to practise any aspect of the activity further, such as summarising complex information concisely or key learning outcomes related to producing preliminary reports?

Beyond action

• Have you revisited the experiences?
  • How have your subsequent experiences of discussing patient management at clinics or reading finalised reports from senior staff since completing this specific training activity led you to revisit your initial approach or decisions during that activity? For example, finding that a recommendation you made for additional investigation was deemed clinically inappropriate forced you to re-evaluate the clarity and clinical relevance of your report structure and recommendation phrasing during your first attempt at this training activity.
  • Considering what you understand about communicating complex findings concisely and formulating appropriate next steps 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 report writing style and recommendation formulation based on further learning and experiences? For example, how you proactively reviewed and integrated the standardised terminology for reporting manometry and pH studies to ensure clear and unambiguous communication.
  • Has discussing ambiguous report conclusions or the impact of unclear recommendations on the patient pathway 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 report that required extensive clarification for the referring doctor refined your understanding of the critical nature of concise, accurate reporting and recommendation setting.
• How have these experiences impacted upon current practice?
  • How has the learning from this initial training activity, in combination with subsequent related experiences and clinical observation, contributed to your overall confidence and ability in producing preliminary reports and making recommendations, particularly in preparing for assessments like Case-Based Discussions (CBDs)? For example, how your accumulated ability in synthesising complex manometry and pH data into a clear report now enables you to confidently present the clinical findings and recommend follow-up investigations 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 professional communication through written documents?
  • 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 medical consultant immediately when findings suggest complex surgical or oncological intervention, recognising this falls outside routine recommendation scope.

Relevant learning outcomes

#	Outcome
# 2	Outcome Identify the requirements for upper gastrointestinal investigations in a range of patients with different conditions, adapting the procedure to answer the specific question while taking the patients’ needs into account.
# 6	Outcome Analyse and interpret data to produce preliminary reports for high-resolution oesophageal manometry and 24-hour ambulatory oesophageal pH monitoring, differentiating between artefact and physiological occurrences.