Training activity information
Details
Safely intubate the oesophagus with oesophageal manometry catheters and pH-impedance catheters
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 safe and effective oesophageal intubation with manometry and pH-impedance catheters.
- Consider how the learning outcomes apply, specifically in relation to ensuring patient comfort and safety throughout the intubation process and confirming correct catheter placement.
- Discuss with your training officer to gain clarity of what is expected of you in relation to technique, patient types, communication standards when explaining the procedure, and managing patient anxiety during intubation.
- What is your prior experience of this activity?
- Think about what you already know about the anatomy and techniques involved in oesophageal intubation.
- Consider possible challenges you might face during the activity, such as gag reflex, patient anxiety, or anatomical variations.
- 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 anxiety or anatomical variations arise.
- Acknowledge how you feel about undertaking this intubation.
- What do you anticipate you will learn from the experience?
- Consider the specific skills you want to develop, such as intubation technique and patient management during the procedure.
- Identify the specific insights you hope to gain into different types of catheters (manometry and pH-impedance) and approaches for various patients or conditions.
- What additional considerations do you need to make?
- Consult actions identified following previous experiences of intubation or related procedures.
- Identify important information you need to consider before embarking on the activity, such as patient medical history, potential contraindications, or specific anatomical considerations.
In action
- Is anything unexpected occurring?
- Are you noticing anything surprising or different from what you anticipate whilst safely intubating the oesophagus?
- Are you encountering situations such as:
- The patient experiences a severe gag reflex or extreme anxiety during catheter insertion, challenging the smooth execution of the procedure?
- Difficulty arises in advancing the catheter due to unexpected anatomical resistance or patient movement?
- Initial manometry or pH-impedance tracing readings conflict with expected anatomical landmarks, making it challenging to confirm correct positioning?
- 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 insertion technique, lubrication, or patient communication?
- Consider the steps you are taking in the moment, such as:
- Immediately pausing the insertion and providing compassionate communication or reassurance to manage patient anxiety.
- Temporarily withdrawing the catheter slightly and adjusting the patient’s head/neck positioning to bypass anatomical resistance.
- How are you feeling in that moment? For instance, are you finding it difficult to maintain technical precision while focusing on managing the patient’s discomfort? Is it affecting your confidence in ensuring correct placement?
- What is the conclusion or outcome?
- Identify how you are working within your scope of practice. For example, are you successfully managing the gag reflex by instructing the patient on breathing techniques? Or are you needing support because the difficulty in advancing the catheter suggests an anatomical issue that requires senior clinical verification before attempting further intubation?
- What are you learning as a result of the unexpected development? For example, are you mastering a more effective technique for managing patient anxiety during intubation? Or gaining insight into correlating initial tracing cues with correct anatomical positioning?
On action
- What happened?
- Begin by summarising the key steps you took when performing the intubation procedure with the specific catheter type(s) you used.
- Consider specific events, actions, or interactions which felt important, such as how you managed the patient’s gag reflex or how you used compassionate communication to maintain comfort during catheter insertion.
- Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, immediately pausing and adjusting the catheter angle when unexpected resistance was encountered during advancement.
- How did you feel during this experience, e.g., did you feel focused on technical precision or stressed by the requirement to maintain patient comfort during an invasive procedure?
- How has this experience contributed to your developing practice?
- Identify what learning you can take from this experience regarding safe intubation techniques.
- What strengths did you demonstrate, e.g., effective patient management and support during the procedure?
- What skills and/or knowledge gaps were evident, e.g., unfamiliarity with the specific internal measurement cues used to confirm positioning of the pH-impedance catheter?
- Compare this experience against previous engagement with similar activities – were any previously identified actions for development achieved?
- Has your practice improved in safely performing intubation of the upper gastrointestinal tract?
- Identify any challenges you experienced, such as needing to seek advice or clarification on scope of practice regarding whether the persistent discomfort experienced by the patient required termination of the intubation attempt, 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 intubation technique and patient communication during invasive procedures.
- What will you do differently next time you approach oesophageal intubation, for instance, by proactively reviewing anatomical considerations related to the upper GI tract prior to the procedure?
- Do you need to practise any aspect of the activity further, such as refining your intubation technique for specific catheter types or key learning outcomes related to performing safe intubation?
Beyond action
- Have you revisited the experiences?
- How have your subsequent experiences of performing the manometry and pH monitoring investigations since completing this specific training activity led you to revisit your initial approach or decisions during that activity? For example, struggling to advance the catheter smoothly during a subsequent procedure forced you to re-evaluate the thoroughness of your technique and compassionate communication during the intubation process during your first attempt at this training activity.
- Considering what you understand about safe intubation and its direct contribution to the success of subsequent investigations 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 intubation technique and patient management based on further learning and experiences? For example, how you proactively integrated specific breathing instructions and reassurance techniques to manage the patient’s gag reflex during catheter insertion.
- Has discussing difficult intubations or the impact of unrecognised anatomical issues on procedural safety 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 a previous intubation attempt led to patient distress refined your understanding of the critical nature of recognising when to seek advice regarding procedural challenges.
- 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 investigation performance, contributed to your overall confidence and competence in performing safe intubation and demonstrating effective communication, particularly in preparing for assessments like Direct Observations of Practical Skills (DOPS)? For example, how your accumulated ability in safely performing intubation now enables you to confidently perform safe intubation and extubation of a manometry catheter 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 procedural safety and adapting technique to anatomical variation?
- 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 staff immediately when significant anatomical resistance or patient distress prevents safe intubation, recognising this falls outside routine procedural execution scope.
Relevant learning outcomes
| # | Outcome |
|---|---|
| # 1 |
Outcome
Perform safe intubation of the upper gastrointestinal tract in a range of patients. |
| # 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. |
| # 8 |
Outcome
Employ effective communication skills to ensure a positive patient experience and valid test results when conducting invasive investigations. |