Training activity information
Details
Download and analyse a range of 24-hour ambulatory oesophageal pH studies
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 downloading and complete analysis of a 24-hour ambulatory oesophageal pH study.
- Consider how the learning outcomes apply, specifically in relation to applying established criteria (e.g., DeMeester score, symptom association indices) to interpret the study findings.
- Discuss with your training officer to gain clarity of what is expected of you in relation to integrating relevant patient diary information into the analysis and the specific requirements for pH study analysis.
- What is your prior experience of this activity?
- Think about what you already know about 24-hour pH study analysis principles, including normal values and parameters defining reflux.
- Consider possible challenges you might face during the activity, such as artefacts, patient non-compliance with diary, or complex symptom correlation.
- 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 symptom-reflux association issues that require expert review.
- Acknowledge how you feel about undertaking the analysis as specified in the training activity.
- What do you anticipate you will learn from the experience?
- Consider the specific skills you want to develop, such as pH study analysis, including artifact identification and symptom-reflux association.
- Identify the specific insights you hope to gain into the variability of reflux patterns and their relationship with patient symptoms.
- 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 medication history and diary entries.
In action
- Is anything unexpected occurring?
- Are you noticing anything surprising or different from what you anticipate whilst downloading or analysing the 24-hour pH study data?
- Are you encountering situations such as:
- The data download process fails or is corrupted, requiring immediate technical troubleshooting?
- The patient diary is incomplete or conflicts significantly with the objective pH data (e.g., patient reports severe symptoms during a period where pH remained stable), complicating the symptom association analysis?
- Artefacts (e.g., baseline shifts, electrode saturation) are observed across large portions of the recording, making the calculation of metrics like the DeMeester score unreliable?
- 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 data download or analysis methodology?
- Consider the steps you are taking in the moment, such as:
- Immediately attempting an alternative download method or consulting technical support to recover potentially lost data.
- Flagging the artefactual sections and manually correcting the baseline drift or excluding those segments from key measurements.
- How are you feeling in that moment? For instance, are you finding it difficult to correlate complex symptom indices accurately? Is it affecting your confidence in the validity of the study’s overall diagnostic conclusion?
- What is the conclusion or outcome?
- Identify how you are working within your scope of practice. For example, are you successfully correcting minor artefacts or reconciling small inconsistencies in the patient diary? Or are you needing support because the extent of artefacts or data corruption necessitates reporting the study as non-diagnostic, requiring senior verification?
- What are you learning as a result of the unexpected development? For example, are you mastering a more rigorous verification process for symptom association indices? Or gaining insight into the software troubleshooting steps required during download?
On action
- What happened?
- Begin by summarising the key steps you took when downloading and analysing the range of 24-hour ambulatory oesophageal pH studies.
- Consider specific events, actions, or interactions which felt important, such as how you calculated the DeMeester score or symptom association indices, or how you handled conflicting data between the objective pH trace and the patient’s diary entries.
- Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, immediately checking the integrity of the data file when artefacts were observed across a large portion of the recording.
- How did you feel during this experience, e.g., did you feel focused on accurate calculation or challenged by correlating complex patient symptoms with reflux events?
- How has this experience contributed to your developing practice?
- Identify what learning you can take from this experience regarding data analysis and interpretation in prolonged monitoring.
- What strengths did you demonstrate, e.g., meticulous data handling and calculation of required indices?
- What skills and/or knowledge gaps were evident, e.g., unfamiliarity with the standard procedure for handling large gaps or discrepancies in the patient diary?
- 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 for ambulatory pH monitoring?
- Identify any challenges you experienced, such as needing to seek advice or clarification on scope of practice regarding the final interpretation of a study where significant technical artefact compromised the reliability of the DeMeester score, and how you reacted to this.
- What will you take from the experience moving forward?
- Identify the actions or ‘next steps’ 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 analysis of symptom correlation and artefact mitigation.
- What will you do differently next time you approach downloading and analysing 24-hour ambulatory oesophageal pH studies, for instance, by proactively reviewing academic content on normal values for pH analysis, including acid exposure time and symptom association indices?
- Do you need to practise any aspect of the activity further, such as calculation of symptom association indices 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 drafting reports or analysing pH studies involving complex symptom correlation since completing this specific training activity led you to revisit your initial approach or decisions during that activity? For example, finding that a patient’s quality of life was severely impacted despite borderline DeMeester scores forced you to re-evaluate the weight given to symptom association indices during your first attempt at this training activity.
- Considering what you understand about pH thresholds, symptom correlation indices, and the overall impact of GI conditions on patients 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 data analysis methodology and interpretation based on further learning and experiences? For example, how you proactively reviewed and integrated criteria for classifying reflux episodes (acid vs. non-acid) after studying the physiological impact of different reflux types.
- Has discussing complex pH study interpretations or the impact of discrepancies between patient diary entries and objective data 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 borderline study that required careful correlation of symptom association refined your understanding of the critical nature of meticulous data analysis.
- 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 analysing and interpreting pH study data, particularly in preparing for assessments like Case-Based Discussions (CBDs)? For example, how your accumulated ability in calculating and interpreting symptom association indices now enables you to confidently discuss the diagnostic findings and limitations of a 24-hour pH 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 integrating patient perception with objective data?
- 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 consultant immediately when objective findings suggest minimal reflux, but the patient reports severe, unmanageable symptoms, recognising this conflict requires specialist clinical correlation.
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. |