Training activity information
Details
Perform standard 24-hour ambulatory oesophageal pH monitoring
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 performing standard 24-hour ambulatory oesophageal pH monitoring, including the expected steps and standards.
- Consider how the learning outcomes apply, specifically in relation to ensuring safe intubation and correct placement of the pH catheter.
- Discuss with your training officer to gain clarity of what is expected of you in relation to criteria defining a successful setup that will yield accurate and analysable data.
- What is your prior experience of this activity?
- Think about what you already know about 24-hour ambulatory oesophageal pH monitoring procedures.
- Consider possible challenges you might face during the activity, such as patient comfort, catheter placement, or equipment function.
- 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 complications related to patient interaction or clinical decision-making arise during the setup.
- Acknowledge how you feel about undertaking the monitoring.
- What do you anticipate you will learn from the experience?
- Consider the specific skills you want to develop, such as performing 24-hour pH monitoring, including patient interaction and equipment setup.
- Identify the specific insights you hope to gain into the practical aspects of the procedure and factors influencing data quality.
- What additional considerations do you need to make?
- Consult actions identified following previous experiences of performing or observing similar procedures.
- Identify important information you need to consider before embarking on the activity, such as patient preparation requirements, specific equipment details, or safety protocols.
In action
- Is anything unexpected occurring?
- Are you noticing anything surprising or different from what you anticipate whilst performing the setup for 24-hour ambulatory oesophageal pH monitoring?
- Are you encountering situations such as:
- The patient expresses confusion or reluctance regarding the required 24-hour compliance procedures (e.g., recording symptoms/events in the diary or managing medication cessation)?
- Unexpected difficulties arise with the monitor attachment or connection, challenging the setup workflow?
- You detect a technical issue with the pH recording unit that was not identified during initial checks?
- 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 patient instruction or equipment preparation?
- Consider the steps you are taking in the moment, such as:
- Immediately pausing the setup to re-explain the diary requirements using simplified language or visual aids to ensure patient comprehension.
- Halting the monitoring connection to consult the departmental guideline or Training Officer about an unexpected technical reading from the pH unit.
- How are you feeling in that moment? For instance, are you finding it difficult to ensure the patient understands the required compliance over 24 hours? Is it affecting your confidence in the functionality of the monitoring unit?
- What is the conclusion or outcome?
- Identify how you are working within your scope of practice. For example, are you successfully resolving minor technical issues (e.g., connectivity) by implementing approved troubleshooting steps yourself? Or are you needing support because patient non-compliance or distress requires senior clinical input before proceeding with the ambulatory setup?
- What are you learning as a result of the unexpected development? For example, are you mastering a more efficient technique for verifying the integrity of the pH probe connection? Or gaining insight into the most common patient concerns regarding 24-hour monitoring compliance?
On action
- What happened?
- Begin by summarising the key steps you took when performing the standard 24-hour ambulatory oesophageal pH monitoring procedure.
- Consider specific events, actions, or interactions which felt important, such as how you explained the requirements regarding diet and medication cessation, or how you ensured the patient understood the diary recording instructions.
- Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, immediately adjusting your communication style to address unexpected patient anxiety about the length of the monitoring period.
- How did you feel during this experience, e.g., did you feel focused on patient compliance or challenged by the need to explain the threshold of pH4?
- How has this experience contributed to your developing practice?
- Identify what learning you can take from this experience regarding performance and patient interaction.
- What strengths did you demonstrate, e.g., effective patient support during the setup?
- What skills and/or knowledge gaps were evident, e.g., unfamiliarity with the detailed procedure for addressing non-compliance regarding event marking in the patient diary?
- Compare this experience against previous engagement with similar activities – were any previously identified actions for development achieved?
- Has your practice improved in explaining procedures, risks, benefits, and obtaining consent?
- Identify any challenges you experienced, such as needing to seek advice or clarification on scope of practice regarding whether minor equipment malfunctions during setup compromised the integrity of the subsequent 24-hour recording, 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 patient communication regarding requirements of pH monitoring.
- What will you do differently next time you approach performing standard 24-hour ambulatory oesophageal pH monitoring, for instance, by proactively using visual aids to explain the concepts of acid exposure time and the threshold of pH4?
- Do you need to practise any aspect of the activity further, such as explaining the requirement for medication cessation or key learning outcomes related to performing 24-hour pH monitoring?
Beyond action
- Have you revisited the experiences?
- How have your subsequent experiences of analysing 24-hour pH studies since completing this specific training activity led you to revisit your initial approach or decisions during that activity? For example, analysing a study with poor patient compliance or missing diary entries forced you to re-evaluate the depth of the explanation regarding patient instructions and compliance during your first attempt at this training activity.
- Considering what you understand about patient compliance, communication, and the influence of correct performance on data quality 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 patient instruction and interaction technique based on further learning and experiences? For example, how you proactively integrated a specific check-back question to confirm the patient understood the requirements for recording symptoms in the diary.
- Has discussing difficulties in patient compliance or the impact of patient experience on successful recording 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 failed study due to patient misunderstanding of medication cessation refined your understanding of the critical nature of linking procedural performance to clear patient explanation.
- 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 analysis, contributed to your overall confidence and competence in performing the monitoring and managing patient interactions, particularly in preparing for assessments like Direct Observations of Practical Skills (DOPS)? For example, how your accumulated ability in setting up the monitor and ensuring correct catheter placement now enables you to confidently perform a 24-hour ambulatory oesophageal pH study setup during a DOPS assessment.
- How has reflecting back on this specific training activity, combined with everything you’ve learned since, shaped your current approach to patient communication regarding prolonged monitoring? 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 Clinical Nurse Specialist immediately when a patient reports acute distress or severe inability to manage the monitoring equipment during setup, recognising this falls outside routine procedural performance scope.
Relevant learning outcomes
| # | Outcome |
|---|---|
| # 1 |
Outcome
Perform safe intubation of the upper gastrointestinal tract in a range of patients. |
| # 3 |
Outcome
Perform routine maintenance and calibration procedures specific to the equipment required for each investigation of the upper gastrointestinal tract. |
| # 5 |
Outcome
Perform 24-hour ambulatory oesophageal pH or pH-impedance monitoring, including following techniques of safe intubation in adult patients presenting with a range of conditions. |