Training activity information
Details
Perform, analyse and report non-invasive hydrogen or hydrogen-methane breath tests
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 a non-invasive hydrogen or hydrogen-methane breath test, including timing and sample collection.
- Consider how the learning outcomes apply, specifically in relation to ensuring accurate performance of the test and producing a well-structured report.
- Discuss with your training officer to gain clarity of what is expected of you in relation to the criteria for a well-structured and clinically relevant report for a breath test and the module’s expectations for test performance, analysis, and reporting.
- What is your prior experience of this activity?
- Think about what you already know about the principles and protocols for hydrogen or hydrogen-methane breath tests.
- Consider possible challenges you might face during the activity, such as patient understanding of instructions, compliance with dietary restrictions, or issues with sample collection.
- 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 initial interpretation of the test results suggests a highly complex or contradictory finding.
- Acknowledge how you feel about performing, analysing and reporting on the tests specified.
- What do you anticipate you will learn from the experience?
- Consider the specific skills you want to develop, such as performing, analysing, and reporting breath tests.
- Identify the specific insights you hope to gain into the interpretation of different breath gas patterns and their clinical significance.
- What additional considerations do you need to make?
- Consult actions identified following previous experiences of non-invasive GI tests or reporting.
- Identify important information you need to consider before embarking on the activity, such as patient preparation (diet/medication restrictions) and specific laboratory protocols.
In action
- Is anything unexpected occurring?
- Are you noticing anything surprising or different from what you anticipate whilst performing the test, collecting samples, or beginning analysis/reporting?
- Are you encountering situations such as:
- The patient experiences unexpected adverse symptoms (e.g., severe bloating or nausea) during the breath collection period, challenging compliance?
- Initial breath samples show unexpectedly high baseline levels of hydrogen or methane, complicating the interpretation of the subsequent rise?
- Technical issues arise with the breath analyser unit during sample injection, threatening data integrity?
- 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 sample collection timing or initial analysis checks?
- Consider the steps you are taking in the moment, such as:
- Immediately documenting the patient’s adverse symptoms and verifying the consumption time of the substrate to ensure accurate timing of subsequent samples.
- Pausing the analysis/reporting to consult reference guidelines on handling excessively high baseline gas readings.
- How are you feeling in that moment? For instance, are you finding it difficult to manage patient comfort during the test? Is it affecting your confidence in the reliability of the baseline gas reading?
- What is the conclusion or outcome?
- Identify how you are working within your scope of practice. For example, are you successfully implementing minor technical troubleshooting steps for the analyser? Or are you needing support because the complex interpretation of conflicting gas patterns requires senior pathological review before drafting the report?
- What are you learning as a result of the unexpected development? For example, are you mastering a technique for efficient sample injection? Or gaining insight into the critical non-compliance factors that affect breath test accuracy?
On action
- What happened?
- Begin by summarising the key steps you took when performing, analysing, and drafting a report for the breath test you undertook.
- Consider specific events, actions, or interactions which felt important, such as how clearly you explained the post-investigation process to the patient or how you applied specific analysis criteria during the interpretation.
- Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, immediately documenting and seeking advice when initial analysis showed unusually high baseline hydrogen levels, complicating interpretation.
- How did you feel during this experience, e.g., did you feel focused on analytical accuracy or challenged by ensuring patient compliance?
- How has this experience contributed to your developing practice?
- Identify what learning you can take from this experience regarding non-invasive test performance and reporting.
- What strengths did you demonstrate, e.g., accurate analysis of breath gas patterns?
- What skills and/or knowledge gaps were evident, e.g., unfamiliarity with the nomenclature or required structure for a breath test report?
- Compare this experience against previous engagement with similar activities – were any previously identified actions for development achieved?
- Has your practice improved in performing the test accurately and reporting concisely?
- Identify any challenges you experienced, such as needing to seek advice or clarification on scope of practice regarding whether the analysis of borderline results required senior pathological verification before being reported, 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 reporting structure and clinical context for breath tests.
- What will you do differently next time you approach performing, analysing, and reporting non-invasive hydrogen or hydrogen-methane breath tests, for instance, by proactively reviewing relevant literature on factors affecting breath test results, such as patient dietary restrictions?
- Do you need to practise any aspect of the activity further, such as applying analysis algorithms to complex gas patterns or key learning outcomes related to producing a concise written report?
Beyond action
- Have you revisited the experiences?
- How have your subsequent experiences of performing more invasive investigations or analysis since completing this specific training activity led you to revisit your initial approach or decisions during that activity? For example, dealing with a patient who failed to adhere to pre-test dietary restrictions forced you to re-evaluate the diligence of the patient education phase during your first attempt at this training activity.
- Considering what you understand about accurate test performance and the analysis and reporting of results 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 test execution and analysis strategy based on further learning and experiences? For example, how you proactively reviewed and integrated specific guidelines for interpreting excessively high baseline breath gas levels.
- Has discussing complex breath test interpretations or challenges related to non-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 false-positive breath test result due to poor sample collection refined your understanding of the critical nature of meticulous test performance and detailed reporting.
- How have these experiences impacted upon current practice?
- How has the learning from this initial training activity, in combination with subsequent interpretation experiences and academic study, contributed to your overall confidence and competence in performing, analysing, and reporting non-invasive tests, particularly in preparing for assessments like Case-Based Discussions (CBDs)? For example, how your accumulated ability in interpreting complex breath gas patterns now enables you to confidently discuss breath test diagnostic criteria 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 advising patients on non-invasive tests?
- 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 appropriate specialist immediately when interpreting highly complex or ambiguous results that conflict with clinical presentation, recognising this falls outside routine non-invasive test analysis scope.
Relevant learning outcomes
| # | Outcome |
|---|---|
| # 9 |
Outcome
Perform non-invasive hydrogen or hydrogen-methane breath tests and explain the post-investigation process to the patient. |
| # 10 |
Outcome
Interpret the results of non-invasive hydrogen and hydrogen-methane breath tests and produce a concise written report. |