Training activity information
Details
Explain the procedure and obtain written informed consent from patients for endoanal ultrasound scanning
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 effectively explaining the endoanal ultrasound procedure, answering all patient questions, and obtaining valid written informed consent.
- Consider how the learning outcomes apply, specifically in relation to explaining the purpose, steps involved, potential discomfort, and risks associated with endoanal ultrasound scanning.
- Discuss with your training officer to gain clarity of what is expected of you in relation to the specific information that must be included in the consent discussion, particularly concerning the intimate nature of the procedure and managing cultural sensitivities.
- What is your prior experience of this activity?
- Think about what you already know about the endoanal ultrasound procedure, its indications, and processes for obtaining consent for intimate clinical procedures.
- Consider possible challenges you might face during the activity, such as patient anxiety, cultural sensitivities around intimate procedures, or difficulty ensuring full patient comprehension of the procedure.
- 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 there is ambiguity regarding the patient’s capacity to provide consent, or if patient anxiety is severe and unmanageable.
- Acknowledge how you feel about the responsibility of obtaining informed consent for an intimate procedure.
- What do you anticipate you will learn from the experience?
- Consider the specific skills you want to develop, such as refining communication techniques for explaining sensitive procedures simply, ensuring informed consent is truly obtained.
- Identify the specific insights you hope to gain into common patient concerns or questions related to endoanal ultrasound.
- What additional considerations do you need to make?
- Consult actions identified following previous experiences of explaining procedures or obtaining consent, especially for sensitive tests.
- Identify important information you need to consider before embarking on the activity, such as reviewing the patient’s medical history or any prior notes on their disposition or anxieties.
In action
- Is anything unexpected occurring?
- Are you noticing anything surprising or different from what you anticipate whilst explaining the procedure or obtaining informed consent?
- Are you encountering situations such as:
- The patient expresses unexpected high anxiety or confusion regarding the intimate nature of the investigation, challenging your communication approach?
- The patient raises complex questions regarding potential risks or alternatives that require detailed explanation beyond the standard script?
- A comprehension difficulty or language barrier makes it challenging to confirm that valid informed consent has truly been obtained?
- 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 communication technique or risk explanation to alleviate distress?
- Consider the steps you are taking in the moment, such as:
- Immediately adjusting your communication style to employ simpler language or visual aids to clarify the steps of the endoanal ultrasound
- Pausing the consent process to offer reassurance or discreetly seek advice from your Training Officer about managing a highly anxious patient
- How are you feeling in that moment? For instance, are you finding it difficult to ensure the patient understands the details of the procedure and their right to withdraw consent? Is it affecting your confidence in ensuring that compassionate care is demonstrated?
- What is the conclusion or outcome?
- Identify how you are working within your scope of practice. For example, are you successfully securing valid informed consent by adapting your explanation style? Or are you needing support because a complex ethical or capacity question requires senior clinical governance review?
- What are you learning as a result of the unexpected development? For example, are you mastering a more effective empathetic approach to communicating the intimate nature of the endoanal ultrasound? Or gaining insight into the critical steps for documenting informed consent?
On action
- What happened?
- Begin by summarising the key steps you took when explaining the endoanal ultrasound procedure, answering patient questions, and detailing the process of obtaining written informed consent.
- Consider specific events, actions, or interactions which felt important, such as how you provided suitable guidance and reassurance to the patient, especially if they seemed nervous, or how you explained the purpose and steps involved in the endoanal ultrasound scan.
- How did you feel during this experience, e.g., did you feel confident in adapting your communication style or challenged by the patient’s unexpected high anxiety regarding the intimate procedure?
- Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, immediately simplifying the language or rephrasing information when the patient expressed confusion or reluctance.
- How has this experience contributed to your developing practice?
- Identify what learning you can take from this experience regarding communication and consent.
- What strengths did you demonstrate, e.g., ability to clearly explain the technical procedure or compassionate communication?
- What skills and/or knowledge gaps were evident, e.g., difficulty in precisely communicating potential risks or alternatives related to the endoanal ultrasound?
- Compare this experience against previous engagement with similar activities – were any previously identified actions for development achieved?
- Has your practice improved in confirming patient comprehension of the procedure and managing anxiety during the explanation phase?
- Identify any challenges you experienced, such as needing to seek advice or clarification on scope of practice regarding ambiguity concerning the patient’s capacity to consent or refusal of procedures, 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 explanation strategy to ensure comprehension and managing patient expectations.
- What will you do differently next time you approach explaining the endoanal ultrasound procedure and obtaining consent, for instance, by proactively reviewing patient information materials or role-playing explanations for sensitive procedures?
- Do you need to practise any aspect of the activity further, such as refining communication scripts for managing anxious patients or key learning outcomes related to explaining the procedure for consent?
Beyond action
- Have you revisited the experiences?
- How have your subsequent experiences of performing the endoanal ultrasound scans or taking advanced histories since completing this specific training activity led you to revisit your initial approach or decisions during that activity? For example, encountering a highly anxious patient during a subsequent scan forced you to re-evaluate the clarity and compassionate phrasing used during your initial explanation of the procedure and associated risks during your first attempt at this training activity.
- Considering what you understand about advanced history taking, patient-centred care, and the ethical/legal requirements of consent 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 explanation technique and patient reassurance approach based on further learning and experiences? For example, how you proactively integrated a check-back question or visual aids to confirm the patient understood the steps of the endoanal ultrasound, demonstrating you have adapted improvements based on further learning.
- Has discussing complex consent scenarios or the impact of communication failure on patient confidence 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 misunderstanding regarding the patient’s right to withdraw consent mid-procedure refined your understanding of the critical nature of ensuring transparent, compassionate communication.
- How have these experiences impacted upon current practice?
- How has the learning from this initial training activity, in combination with subsequent experiences obtaining histories and performing other lower GI procedures, contributed to your overall confidence and competence in explaining procedures and obtaining informed consent, particularly in preparing for assessments like Observed Communication Events (OCEs)? For example, how your accumulated ability in addressing patient anxieties about intimate procedures now enables you to confidently explain the procedure and obtain informed consent 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 patient communication regarding sensitive procedures?
- 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 Clinical Governance Lead immediately when a patient raises complex ethical or legal concerns about their capacity to consent.
Relevant learning outcomes
| # | Outcome |
|---|---|
| # 1 |
Outcome
Explain the procedure for endoanal ultrasound scanning to patients, answer questions about the procedure and obtain the patient’s informed consent. |
| # 4 |
Outcome
Apply advanced history taking skills to explore a patient’s more complex social history with compassion and empathy. |