Training activity information
Details
Safely perform endoanal ultrasound scans for patients with a variety of indications
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 performing the endoanal ultrasound scan safely, maintaining patient comfort and dignity, and acquiring images that meet technical standards.
- Consider how the learning outcomes apply, specifically in relation to obtaining specific anatomical landmarks and standard scan views required for a range of conditions.
- Discuss with your training officer to gain clarity of what is expected of you in relation to the necessary patient positioning, infection control protocols, and quality standards for image acquisition.
- What is your prior experience of this activity?
- Think about what you already know about the endoanal ultrasound procedure, technique, and basic image acquisition from observations or prior experience.
- Consider possible challenges you might face during the activity, such as encountering poor image quality due to technical issues, patient discomfort affecting positioning, or difficulty visualising specific structures (e.g., external anal sphincter defect from obstetric injury).
- 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 image quality is suboptimal, if a finding is unclear, or if you encounter unexpected patient distress or technical malfunction.
- Acknowledge how you feel about performing the scan and ensuring image quality while prioritising safety.
- What do you anticipate you will learn from the experience?
- Consider the specific skills you want to develop, such as mastering probe manipulation, image optimisation, and accurately identifying the specific anatomical structures and pathologies for different indications.
- Identify the specific insights you hope to gain into how various conditions (e.g., fistula, sphincter defect) translate into ultrasound images.
- What additional considerations do you need to make?
- Consult actions identified following previous experiences of performing or observing ultrasound scans regarding patient interaction or technical setup.
- Identify important information you need to consider before embarking on the activity, such as confirming equipment preparation and calibration, and reviewing the patient-specific history and indications.
In action
- Is anything unexpected occurring?
- Are you noticing anything surprising or different from what you anticipate whilst safely performing the endoanal ultrasound scan?
- Are you encountering situations such as:
- The patient experiences unexpected severe pain or discomfort, challenging your technique and communication?
- You find it difficult to acquire high-quality images due to patient movement or technical issues, complicating the assessment for specific indications?
- An unexpected anatomical distortion or finding emerges, making standard probe manipulation difficult?
- 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 probe manipulation, patient positioning, or image optimisation?
- Consider the steps you are taking in the moment, such as:
- Immediately pausing the scan and verbally checking in with the patient to reassess their comfort level.
- Adjusting the gain or focus settings in real-time to try and resolve unexpected image quality issues.
- How are you feeling in that moment? For instance, are you finding it difficult to maintain technical precision while managing patient cooperation? Is it affecting your confidence in obtaining all required standard scan views?
- What is the conclusion or outcome?
- Identify how you are working within your scope of practice. For example, are you successfully adjusting the patient’s position and continuing the scan safely to obtain diagnostic images? Or are you needing support because a persistent, major equipment malfunction or unmanageable patient distress requires senior intervention?
- What are you learning as a result of the unexpected development? For example, are you mastering a more efficient technique for image optimisation? Or gaining insight into how patient position directly influences anatomical visibility?
On action
- What happened?
- Begin by summarising the key steps you took when performing the endoanal ultrasound scan procedure, detailing patient positioning, infection control checks, and acquiring the necessary images.
- Consider specific events, actions, or interactions which felt important, such as how you maintained the patient’s dignity and comfort during probe insertion or how you navigated the anatomical challenge to obtain standard scan views.
- How did you feel during this experience, e.g., did you feel focused on obtaining diagnostic images or stressed by unexpected technical issues (e.g., equipment malfunction)?
- Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, immediately adjusting the probe manipulation or image settings to mitigate unexpected image quality issues.
- How has this experience contributed to your developing practice?
- Identify what learning you can take from this experience regarding scanning technique and patient safety.
- What strengths did you demonstrate, e.g., ability to perform the scan safely and effectively, or adjusting your technique for anatomical variation?
- What skills and/or knowledge gaps were evident, e.g., unfamiliarity with specific patient positioning requirements or troubleshooting technical issues with the ultrasound equipment?
- Compare this experience against previous engagement with similar activities – were any previously identified actions for development achieved?
- Has your practice improved in adapting your technique to ensure safe, patient-centred practice?
- Identify any challenges you experienced, such as needing to seek advice or clarification on scope of practice regarding whether suboptimal image quality required senior clinical input before proceeding to the next stage of the scan, 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 refining your probe manipulation and image optimisation skills.
- What will you do differently next time you approach performing an endoanal ultrasound scan, for instance, by proactively reviewing guidance on optimising image quality for challenging anatomical presentations?
- Do you need to practise any aspect of the activity further, such as patient positioning, probe control, or key learning outcomes related to performing the scan safely?
Beyond action
- Have you revisited the experiences?
- How have your subsequent experiences of interpreting endoanal ultrasound scans or reviewing advanced pelvic floor anatomy since completing this specific training activity led you to revisit your initial approach or decisions during that activity? For example, difficulty interpreting a specific anatomical feature (e.g., sphincter defect) in a subsequent scan forced you to re-evaluate the diligence of your image acquisition technique and adherence to standard scan views during your first attempt at this training activity.
- Considering what you understand about image quality, anatomical requirements, and safety protocols 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 probe manipulation and image optimisation technique based on further learning and experiences? For example, how you proactively reviewed and integrated specific techniques for maintaining patient comfort during the scan to minimise movement artefact, demonstrating you have adapted improvements based on further learning.
- Has discussing challenging scan acquisition or the impact of poor technique on diagnostic quality 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 suboptimal images led to diagnostic uncertainty refined your understanding of the critical nature of performing the endoanal ultrasound scan safely and effectively.
- How have these experiences impacted upon current practice?
- How has the learning from this initial training activity, in combination with subsequent interpretation experiences and performing other investigations, contributed to your overall confidence and ability in performing the endoanal ultrasound scan, particularly in preparing for assessments like Direct Observations of Practical Skills (DOPS)? For example, how your accumulated ability in applying the probe and acquiring the required scan views for a variety of indications now enables you to confidently perform an endoanal ultrasound scan according to local protocol 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 image acquisition and safety management?
- 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 specialist clinician immediately when a severe, unexpected technical issue or patient distress prevents safe continuation of the scan, recognising this falls outside routine procedural execution scope.
Relevant learning outcomes
| # | Outcome |
|---|---|
| # 2 |
Outcome
Perform and interpret endoanal ultrasound scans safely for a range of conditions, identifying normal and abnormal findings, and produce high-quality reports. |