Training activity information
Details
Take patient histories for a range of oesophageal conditions
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 obtaining a comprehensive and relevant patient history for common oesophageal conditions.
- Consider how the learning outcomes apply, specifically in relation to ensuring you gather all necessary information while making the patient feel comfortable and understood.
- Discuss with your training officer to gain clarity of what is expected of you in relation to what specific information is key for different oesophageal conditions encountered in the clinic and structuring the history taking process to be efficient yet thorough.
- What is your prior experience of this activity?
- Think about what you already know about common oesophageal conditions and their typical symptoms.
- Consider possible challenges you might face during the activity, such as communication barriers, complex patient symptoms, or limited time.
- 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 asking about sensitive information or symptoms might exceed your comfort level or expertise.
- Acknowledge how you feel about taking accurate patient histories.
- What do you anticipate you will learn from the experience?
- Consider the specific skills you want to develop, such as patient history taking, particularly for GI patients.
- Identify the specific insights you hope to gain into the diverse ways oesophageal conditions present and the impact they have on patients.
- What additional considerations do you need to make?
- Consult actions identified following previous experiences of history-taking experiences or communication training.
- Identify important information you need to consider before embarking on the activity, such as reviewing patient referral letters or understanding the purpose of the history taking for the planned investigation.
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 symptoms highly suggestive of an extra-oesophageal disorder (e.g., respiratory symptoms) that were not the focus of the referral, complicating the targeted history taking?
- Communication barriers arise unexpectedly (e.g., patient difficulty articulating complex dyspepsia symptoms), challenging your ability to demonstrate effective communication?
- You detect a clinical detail (e.g., severe weight loss or dysphagia progression) that requires an immediate adaptation of your questioning style to assess urgency?
- 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 structuring the history or prioritising sensitive questions to gather relevant information?
- Consider the steps you are taking in the moment, such as:
- Immediately adjusting your questioning to focus on the unexpected symptom detail, ensuring relevant pharmacological or lifestyle history is captured.
- Pausing the history taking to offer reassurance or discreetly seeking 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 differentiate between relevant and irrelevant symptoms? Is it affecting your confidence in gathering a comprehensive history 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 questioning to focus on clinical context? Or are you needing support because the patient’s complex history or distress is beyond your current experience for appropriate communication and documentation?
- What are you learning as a result of the unexpected development? For example, are you mastering a more effective technique for exploring extra-oesophageal symptoms? Or gaining insight into patterns of patient history that necessitate procedural modification?
On action
- What happened?
- Begin by summarising the key steps you took when obtaining the patient history for the specific oesophageal condition(s) you focused on.
- Consider specific events, actions, or interactions which felt important, such as how you managed the flow of the conversation when discussing highly complex or ambiguous symptoms, or how you linked the patient’s symptoms to the requirements of the intended investigation.
- 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 disclosed unexpected psychological distress related to their functional symptoms.
- How did you feel during this experience, e.g., did you feel focused on eliciting necessary information or challenged by the ambiguity of the reported symptoms?
- How has this experience contributed to your developing practice?
- Identify what learning you can take from this experience regarding history taking and effective communication.
- What strengths did you demonstrate, e.g., ability to structure the interview to cover all required areas?
- What skills and/or knowledge gaps were evident, e.g., unfamiliarity with the specific medication side effects relevant to oesophageal function?
- Compare this experience against previous engagement with similar activities – were any previously identified actions for development achieved?
- Has your practice improved in applying effective communication skills to ensure a positive patient experience?
- Identify any challenges you experienced, such as needing to seek advice or clarification on scope of practice regarding whether a specific symptom required immediate clinical escalation before proceeding with the planned history session, 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 history-taking structure and knowledge of oesophageal pathophysiology.
- What will you do differently next time you approach taking patient histories for a range of oesophageal conditions, for instance, by proactively reviewing academic content on functional symptoms and psychologic impact on oesophageal function?
- Do you need to practise any aspect of the activity further, such as asking open-ended questions to elicit subtle symptoms or key learning outcomes related to effective communication?
Beyond action
- Have you revisited the experiences?
- How have your subsequent experiences of analysing investigation results since completing this specific training activity led you to revisit your initial approach or decisions during that activity? For example, having difficulty interpreting a manometry result due to missing information about previous surgical interventions forced you to re-evaluate the meticulousness of your pharmaceutical and surgical history collection during your first attempt at this training activity.
- Considering what you understand about correlating history with specific investigation requirements and potential findings 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 questioning technique and clinical focus based on further learning and experiences? For example, how you proactively reviewed and integrated specific questions about swallowing difficulties (dysphagia) or non-cardiac chest pain to better guide the need for manometry.
- Has discussing complex patient histories or the impact of ambiguous symptoms on investigation selection 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 key history regarding extra-oesophageal symptoms was missed refined your understanding of the critical nature of effective communication and thorough history capture.
- How have these experiences impacted upon current practice?
- How has the learning from this initial training activity, in combination with subsequent interaction experiences and procedural knowledge, contributed to your overall confidence and competence in obtaining a clinical history and employing effective communication skills, particularly in preparing for assessments like Observed Communication Events (OCEs)? For example, how your accumulated ability in efficiently eliciting patient history now enables you to confidently obtain a clinical history for upper gastrointestinal 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 procedural planning and application of clinical knowledge?
- 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 clinician immediately when a patient history suggests urgent ‘red-flag’ symptoms (e.g., unexplained weight loss) that necessitate a deviation from routine investigation protocol, recognising this falls outside routine history documentation scope.
Relevant learning outcomes
| # | Outcome |
|---|---|
| # 7 |
Outcome
Explain the procedures for upper gastrointestinal physiology investigations to the patients, appropriately answering questions about the tests and obtain the patient’s informed consent. |
| # 8 |
Outcome
Employ effective communication skills to ensure a positive patient experience and valid test results when conducting invasive investigations. |