Training activity information
Details
Perform high-resolution oesophageal manometry 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 a successful high-resolution oesophageal manometry investigation, from patient preparation to data acquisition.
- Consider how the learning outcomes apply, specifically in relation to ensuring all required manometry protocols are followed accurately and managing the patient during the procedure to ensure comfort and cooperation.
- Discuss with your training officer to gain clarity of what is expected of you in relation to the criteria for identifying and minimising artefacts during the recording and the specific requirements for performing manometry.
- What is your prior experience of this activity?
- Think about what you already know about the principles and technique of high-resolution oesophageal manometry.
- Consider possible challenges you might face during the activity, such as patient inability to cooperate or technical issues with the equipment.
- 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 unexpected complications related to patient management or technical troubleshooting arise during the procedure.
- Acknowledge how you feel about undertaking the investigations.
- What do you anticipate you will learn from the experience?
- Consider the specific skills you want to develop, such as performing the manometry procedure, including troubleshooting and patient coaching.
- Identify the specific insights you hope to gain into the complexities of acquiring optimal manometry data in different patients.
- What additional considerations do you need to make?
- Consult actions identified following previous experiences of manometry experiences or observations.
- Identify important information you need to consider before embarking on the activity, such as reviewing the patient’s history and referral indication to anticipate potential challenges.
In action
- Is anything unexpected occurring?
- Are you noticing anything surprising or different from what you anticipate whilst performing the high-resolution oesophageal manometry investigation?
- Are you encountering situations such as:
- The patient is unable to cooperate with required manoeuvres (e.g., multiple rapid swallows or single swallows on command), challenging the standard protocol?
- Significant technical artefacts (e.g., movement noise or electrical interference) appear on the data trace, compromising the quality of the measurements?
- The physiological tracing suggests a severe motility disorder (e.g., Achalasia) that was not fully anticipated by the referral, requiring adaptation of the procedure?
- 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, pacing of the test, or technical troubleshooting?
- Consider the steps you are taking in the moment, such as:
- Immediately pausing the test to adjust the patient’s positioning or providing tailored instructions/coaching to improve cooperation for a specific swallow.
- Making real-time adjustments to recording filters or checking catheter stability to mitigate noise while documenting the rationale for these changes.
- How are you feeling in that moment? For instance, are you finding it difficult to maintain technical quality while managing active patient movement? Is it affecting your confidence in applying the standard manometry protocol?
- What is the conclusion or outcome?
- Identify how you are working within your scope of practice. For example, are you successfully adapting the procedure and troubleshooting minor artefacts? Or are you needing support because a persistent, major equipment issue or acute patient distress requires senior clinical verification or termination of the study?
- What are you learning as a result of the unexpected development? For example, are you mastering a more effective technique for coaching swallows? Or gaining insight into the need for procedural adaptation based on unexpected motility patterns?
On action
- What happened?
- Begin by summarising the key steps you took when performing the high-resolution oesophageal manometry investigation.
- Consider specific events, actions, or interactions which felt important, such as how you provided reassurance and coaching to the patient during swallows to achieve valid data, or how you monitored the tracing for technical issues.
- Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, immediately adjusting recording filters when electrical interference was noted on the trace, maintaining diagnostic quality.
- How did you feel during this experience, e.g., did you feel focused on protocol adherence or challenged by the requirement to adapt the procedure to patient needs?
- How has this experience contributed to your developing practice?
- Identify what learning you can take from this experience regarding procedural execution and technical quality.
- What strengths did you demonstrate, e.g., effective patient management and coaching?
- What skills and/or knowledge gaps were evident, e.g., uncertainty in recognising specific artefacts during manometry?
- Compare this experience against previous engagement with similar activities – were any previously identified actions for development achieved?
- Has your practice improved in performing high-resolution oesophageal manometry in a range of patients?
- Identify any challenges you experienced, such as needing to seek advice or clarification on scope of practice regarding whether patient non-cooperation required adapting the procedure beyond the standard protocol, 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 refining your manometry performance technique, especially regarding troubleshooting artefacts.
- What will you do differently next time you approach performing high-resolution oesophageal manometry, for instance, by proactively reviewing academic content on common artefacts during manometry and strategies to minimise them?
- Do you need to practise any aspect of the activity further, such as managing patient comfort during the procedure or key learning outcomes related to performing manometry?
Beyond action
- Have you revisited the experiences?
- How have your subsequent experiences of analysing HR manometry studies since completing this specific training activity led you to revisit your initial approach or decisions during that activity? For example, struggling to analyse a trace due to excessive movement artefact forced you to re-evaluate the diligence of patient coaching and technical monitoring you applied during your first attempt at this training activity.
- Considering what you understand about procedural adherence, artefact identification, and the influence of patient cooperation 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 technical performance and patient coaching based on further learning and experiences? For example, how you proactively reviewed and integrated strategies for managing patient anxiety during the procedure after observing endoscopy.
- Has discussing complex HR manometry cases or the challenge of achieving patient compliance 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 insufficient data was acquired due to poor patient management refined your understanding of the critical nature of systematically performing the manometry investigation.
- 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 anatomical observation, contributed to your overall confidence and competence in performing high-resolution oesophageal manometry investigations, particularly in preparing for assessments like Direct Observations of Practical Skills (DOPS)? For example, how your accumulated ability in managing the manometry procedure and ensuring accurate data acquisition now enables you to confidently perform high-resolution oesophageal manometry 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 execution and technical troubleshooting?
- 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 technical support immediately when severe, unresolvable equipment issues compromise data integrity, recognising this falls outside routine procedural troubleshooting scope.
Relevant learning outcomes
| # | Outcome |
|---|---|
| # 1 |
Outcome
Perform safe intubation of the upper gastrointestinal tract in a range of patients. |
| # 4 |
Outcome
Perform high-resolution oesophageal manometry in a range of patients. |
| # 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. |