Training activity information
Details
Analyse high-resolution oesophageal manometry studies, identifying normal motility
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 accurate and complete analysis of a high-resolution oesophageal manometry study.
- Consider how the learning outcomes apply, specifically in relation to applying established algorithms and criteria to identify normal motility patterns.
- Discuss with your training officer to gain clarity of what is expected of you in relation to the expected steps in the analysis process, from data loading to preliminary interpretation, and specific requirements for manometry analysis.
- What is your prior experience of this activity?
- Think about what you already know about high-resolution oesophageal manometry analysis principles, including normal values and patterns.
- Consider possible challenges you might face during the activity, such as poor-quality tracing, complex motility patterns, or software issues.
- 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 preliminary interpretation reveals complex motility patterns that require expert review.
- Acknowledge how you feel about undertaking the analysis as specified in this training activity.
- What do you anticipate you will learn from the experience?
- Consider the specific skills you want to develop, such as manometry analysis, including identifying artefacts and applying diagnostic algorithms.
- Identify the specific insights you hope to gain into the variability of normal oesophageal motility.
- What additional considerations do you need to make?
- Consult actions identified following previous experiences of data analysis or interpretation.
- Identify important information you need to consider before embarking on the activity, such as understanding the patient’s clinical history and the indications for the study.
In action
- Is anything unexpected occurring?
- Are you noticing anything surprising or different from what you anticipate whilst analysing the HRM study or applying the motility criteria?
- Are you encountering situations such as:
- A significant portion of the manometry trace is obscured by movement or swallowing artefact, complicating the calculation of key metrics?
- The automated software analysis provides metrics (e.g., Integrated Relaxation Pressure, IRP) that appear highly inconsistent with the visual assessment of the tracing, challenging your interpretation?
- The recorded patient effort (swallows) is insufficient to complete the standard diagnostic algorithm, requiring careful assessment of data quality?
- 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 measuring key segments or applying diagnostic algorithms?
- Consider the steps you are taking in the moment, such as:
- Immediately flagging the artefact sections and manually re-measuring the relevant pressure components (e.g., distal contractile integral, DCI) to ensure accuracy.
- Consulting the Chicago Classification criteria guidelines to confirm the application of the appropriate step-down logic due to insufficient valid data.
- How are you feeling in that moment? For instance, are you finding it difficult to apply the established algorithms correctly when data quality is low? Is it affecting your confidence in accurately classifying the motility pattern?
- What is the conclusion or outcome?
- Identify how you are working within your scope of practice. For example, are you successfully identifying and excluding artefacts from the analysis? Or are you needing support because the trace quality is so poor that the study is non-diagnostic, requiring senior consultation on how to report non-diagnostic findings?
- What are you learning as a result of the unexpected development? For example, are you mastering a more efficient technique for identifying and excluding specific artefacts? Or gaining insight into the systematic steps required to apply established motility algorithms?
On action
- What happened?
- Begin by summarising the key steps you took when analysing the HR Manometry study, focusing on identifying normal motility patterns.
- Consider specific events, actions, or interactions which felt important, such as how you applied the established algorithms (e.g., Chicago Classification criteria) to interpret the data, or how you differentiated between physiological occurrences and artefacts.
- Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, immediately seeking consultation when the analysis software generated a metric (e.g., IRP) that visually contradicted the observed tracing.
- How did you feel during this experience, e.g., did you feel focused on applying criteria accurately or stressed by the need to resolve ambiguity in the tracing?
- How has this experience contributed to your developing practice?
- Identify what learning you can take from this experience regarding manometry analysis and interpretation.
- What strengths did you demonstrate, e.g., accurate application of diagnostic algorithms to classify normal motility?
- What skills and/or knowledge gaps were evident, e.g., difficulty confidently excluding subtle artefacts from the data analysis?
- Compare this experience against previous engagement with similar activities – were any previously identified actions for development achieved?
- Has your practice improved in analysing and interpreting data to produce preliminary reports?
- Identify any challenges you experienced, such as needing to seek advice or clarification on scope of practice regarding whether the poor quality of a specific section of the trace rendered the entire study non-diagnostic, 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 manometry analysis methodology and artefact recognition.
- What will you do differently next time you approach analysing HR Manometry studies, for instance, by proactively reviewing academic content on normal manometric values and the application of algorithms to define normal?
- Do you need to practise any aspect of the activity further, such as applying criteria consistently to borderline studies or key learning outcomes related to differentiating between artefact and physiological occurrences?
Beyond action
- Have you revisited the experiences?
- How have your subsequent experiences of analysing abnormal manometry studies or engaging with academic content since completing this specific training activity led you to revisit your initial approach or decisions during that activity? For example, struggling to differentiate a subtle motility disorder from a severe normal variant in a subsequent case forced you to re-evaluate the diligence with which you applied established algorithms and criteria during your first attempt at this training activity.
- Considering what you understand about applying diagnostic algorithms, differentiating artefact, and relating findings to report drafting 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 analysis methodology and interpretation speed based on further learning and experiences? For example, how you proactively reviewed and integrated criteria from the Chicago Classification to consistently classify motility patterns.
- Has discussing complex analysis cases or the impact of misclassification on patient management 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 normal finding was nearly misreported as a disorder refined your understanding of the critical nature of systematic analysis and critically appraising investigations.
- How have these experiences impacted upon current practice?
- How has the learning from this initial training activity, in combination with subsequent procedural experiences and report drafting, contributed to your overall confidence and ability in analysing and interpreting manometry data, particularly in preparing for assessments like Case-Based Discussions (CBDs)? For example, how your accumulated ability in applying manometry algorithms to identify motility patterns now enables you to confidently discuss the interpretation and clinical implications of an HR manometry study 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 manometry data verification?
- 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 senior pathologist immediately when ambiguity arises between a technical artefact and a genuine physiological occurrence, recognising this falls outside routine analysis scope.
Relevant learning outcomes
| # | Outcome |
|---|---|
| # 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. |
| # 6 |
Outcome
Analyse and interpret data to produce preliminary reports for high-resolution oesophageal manometry and 24-hour ambulatory oesophageal pH monitoring, differentiating between artefact and physiological occurrences. |
| # 8 |
Outcome
Employ effective communication skills to ensure a positive patient experience and valid test results when conducting invasive investigations. |