Training activity information
Details
Interpret and report a range of normal endoanal ultrasound scans for both male and female patients
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 accurately interpreting and identifying the normal appearance of anatomical landmarks in both male and female endoanal ultrasound scans.
- Consider how the learning outcomes apply, specifically in relation to producing a high-quality, systematic report that clearly describes normal findings and excludes potential abnormalities.
- Discuss with your training officer to gain clarity of what is expected of you in relation to the specific descriptive terminology and structure required for a report describing normal anal canal and pelvic floor anatomy.
- What is your prior experience of this activity?
- Think about what you already know about anatomical structures in the lower GI tract and image interpretation principles from previous modules or observations.
- Consider possible challenges you might face during the activity, such as confidently differentiating subtle normal variations from potential abnormalities, or struggling to maintain a systematic review process.
- 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 you are uncertain about the classification of a specific anatomical landmark or variant, or require clarification on reporting standards.
- Acknowledge how you feel about the responsibility of confirming an image as definitively normal.
- What do you anticipate you will learn from the experience?
- Consider the specific skills you want to develop, such as systematic image interpretation, applying descriptive terminology, and efficiently structuring a high-quality report.
- Identify the specific insights you hope to gain into the subtle differences in normal endoanal anatomy between male and female patients.
- What additional considerations do you need to make?
- Consult actions identified following previous experiences of interpreting or reporting imaging studies.
- Identify important information you need to consider before embarking on the activity, such as reviewing departmental report templates and anatomical atlases illustrating normal male and female endoanal ultrasound appearances.
In action
- Is anything unexpected occurring?
- Are you noticing anything surprising or different from what you anticipate whilst interpreting the normal endoanal ultrasound scans?
- Are you encountering situations such as:
- Difficulty arises in confidently differentiating a subtle normal anatomical variant (e.g., muscle asymmetry) from a minor pathological finding?
- Image artefact complicates the clear visualisation of a specific anatomical landmark, challenging the process of reporting the image as normal?
- You are uncertain about the specific standardised descriptive terminology required for a normal report for the opposite sex (e.g., male vs. female anatomy)?
- 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 image review or report phrasing?
- Consider the steps you are taking in the moment, such as:
- Immediately cross-referencing the uncertain image against anatomical atlases or departmental archives of normal scans to confirm findings.
- Pausing the drafting of the report conclusion to clarify the specific required nomenclature for describing the normal anatomy.
- How are you feeling in that moment? For instance, are you finding it difficult to confidently exclude subtle pathology? Is it affecting your confidence in maintaining objective and concise reporting?
- What is the conclusion or outcome?
- Identify how you are working within your scope of practice. For example, are you successfully applying systematic interpretation methods to confidently classify the anatomy as normal? Or are you needing support because the ambiguity of a borderline finding requires senior review for final pathological clearance?
- What are you learning as a result of the unexpected development? For example, are you mastering a more rigorous system for systematically reviewing endoanal anatomy? Or gaining insight into the subtle variations in normal male and female endoanal ultrasound appearance?
On action
- What happened?
- Begin by summarising the key steps you took when interpreting the normal endoanal ultrasound scan and drafting the high-quality report.
- Consider specific events, actions, or interactions which felt important, such as how you identified the key anatomical landmarks or ensured the terminology used in the report accurately described the normal internal and external anal sphincters.
- How did you feel during this experience, e.g., did you feel confident in identifying all structures as normal or challenged by confidently differentiating a subtle normal variant from potential pathology?
- Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, immediately pausing to cross-reference the uncertain image against anatomical atlases to confirm the finding as normal.
- How has this experience contributed to your developing practice?
- Identify what learning you can take from this experience regarding interpretation and reporting.
- What strengths did you demonstrate, e.g., systematic review of the anatomy and accurate identification of normal findings?
- What skills and/or knowledge gaps were evident, e.g., unfamiliarity with subtle normal anatomical variations between male and female patients?
- Compare this experience against previous engagement with similar activities – were any previously identified actions for development achieved?
- Has your practice improved in confidently interpreting and reporting normal endoanal ultrasound scans?
- Identify any challenges you experienced, such as needing to seek advice or clarification on scope of practice regarding the precise anatomical terminology required for reporting normal findings, 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 systematic image review and reporting structure.
- What will you do differently next time you approach interpreting and reporting a normal endoanal ultrasound scan, for instance, by proactively reviewing anatomical atlases illustrating normal male and female endoanal ultrasound appearances?
- Do you need to practise any aspect of the activity further, such as reviewing anatomical terminology or key learning outcomes related to accurately interpreting normal endoanal ultrasound scans?
Beyond action
- Have you revisited the experiences?
- How have your subsequent experiences of interpreting abnormal scans or reviewing complex anatomical diagrams since completing this specific training activity led you to revisit your initial approach or decisions during that activity? For example, almost misclassifying a normal anatomical variant as a pathology in a subsequent case forced you to re-evaluate the diligence with which you confirmed normal anatomical landmarks during your first attempt at this training activity.
- Considering what you understand about the systematic review of anatomy, differential diagnosis, and producing high-quality reports 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 image interpretation methodology and descriptive terminology based on further learning and experiences? For example, how you proactively created and integrated a detailed checklist of anatomical landmarks (e.g., internal/external anal sphincter) to confirm normal status for both male and female patients.
- Has discussing ambiguous normal variants or the impact of unclear reporting on clinical decisions 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 misinterpreted as a pathological defect refined your understanding of the critical nature of systematic image review and precise reporting of normal anatomy.
- 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 of lower GI pathophysiology, contributed to your overall confidence and ability in interpreting endoanal ultrasound scans, particularly in preparing for assessments like Direct Observations of Practical Skills (DOPS)? For example, how your accumulated ability in systematically identifying normal anatomy now enables you to confidently interpret and report a normal endoanal ultrasound scan 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 systematic image interpretation? 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 imaging technician immediately when a persistent technical artefact obscures key anatomical structures, making definitive normal classification impossible, recognising this falls outside routine interpretation 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. |