Training activity information
Details
Interpret and report a range of abnormal 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 identifying, describing, and reporting a range of specific abnormalities (e.g., sphincter defects, anal fistula, obstetric injury grades).
- Consider how the learning outcomes apply, specifically in relation to grading the severity of pathological findings (e.g., obstetric injuries) and differentiating true abnormalities from imaging artefacts.
- Discuss with your training officer to gain clarity of what is expected of you in relation to the required terminology, the classification systems for specific pathologies (e.g., obstetric anal sphincter injuries), and the necessary detail for a high-quality report.
- What is your prior experience of this activity?
- Think about what you already know about the ultrasound appearance of lower GI pathologies from academic study or observations.
- Consider possible challenges you might face during the activity, such as interpreting complex pathology (e.g., identifying subtle extensions of a fistula tract), accurately grading obstetric sphincter injuries, or distinguishing abnormalities from technical artefacts.
- 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 unsure about the significance of a finding, the accurate grading of a pathology, or the appropriate method for describing a rare abnormality.
- Acknowledge how you feel about interpreting complex, potentially severe pathological findings.
- What do you anticipate you will learn from the experience?
- Consider the specific skills you want to develop, such as advanced pattern recognition, accurate grading of pathological severity, and confident differentiation of abnormality from artefact.
- Identify the specific insights you hope to gain into the clinical impact and surgical implications of various abnormal endoanal ultrasound findings.
- What additional considerations do you need to make?
- Consult actions identified following previous experiences of interpreting or reporting abnormal imaging studies.
- Identify important information you need to consider before embarking on the activity, such as reviewing classification systems for abnormalities (e.g., obstetric sphincter injuries) and familiarising yourself with example reports for complex cases.
In action
- Is anything unexpected occurring?
- Are you noticing anything surprising or different from what you anticipate whilst interpreting the abnormal endoanal ultrasound scans?
- Are you encountering situations such as:
- Difficulty arises in accurately grading a specific abnormality (e.g., obstetric anal sphincter injury (OASIS) severity) according to established criteria?
- The pathology (e.g., a fistula tract) is highly complex or extensive, challenging your ability to accurately trace its full extent for surgical reporting?
- The imaging findings conflict significantly with the patient’s documented clinical history, complicating the report description?
- 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, pathology grading, or report description?
- Consider the steps you are taking in the moment, such as:
- Immediately consulting the specific classification guidelines (e.g., OASIS grading system) to ensure accurate grading of the abnormality.
- Pausing the report drafting to consult surgical references to understand the critical information needed by the operating team.
- How are you feeling in that moment? For instance, are you finding it difficult to confidently differentiate specific types of complex pathology? Is it affecting your confidence in producing a clinically relevant report that accurately reflects the extent of the abnormality?
- What is the conclusion or outcome?
- Identify how you are working within your scope of practice. For example, are you successfully applying classification systems and describing the pathology using standardised surgical terminology? Or are you needing support because the complexity of the pathology (e.g., multi-branching fistula) requires senior imaging review before final reporting to ensure surgical accuracy?
- What are you learning as a result of the unexpected development? For example, are you mastering a systematic approach to accurately grading obstetric injuries? Or gaining insight into the critical details required in reporting complex fistulae?
On action
- What happened?
- Begin by summarising the key steps you took when interpreting the abnormal endoanal ultrasound scan, including the specific pathologies identified (e.g., sphincter defects, anal fistula, abscesses), and drafting the report.
- Consider specific events, actions, or interactions which felt important, such as how you accurately graded the severity of a specific abnormality (e.g., obstetric anal sphincter injury) or how you differentiated between a true abnormality and imaging artefacts.
- How did you feel during this experience, e.g., did you feel focused on accurate grading or stressed by the complexity of the pathology (e.g., tracing a fistula tract)?
- Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, immediately consulting specific classification guidelines (e.g., OASIS grading system) to ensure accurate reporting of the abnormality.
- How has this experience contributed to your developing practice?
- Identify what learning you can take from this experience regarding abnormal pathology identification and reporting.
- What strengths did you demonstrate, e.g., systematic analysis of images to identify all abnormalities and clear documentation of findings?
- What skills and/or knowledge gaps were evident, e.g., uncertainty in distinguishing complex pathology from technical artefacts or accurately grading specific injuries?
- Compare this experience against previous engagement with similar activities – were any previously identified actions for development achieved?
- Has your practice improved in accurately grading the severity of pathological findings?
- Identify any challenges you experienced, such as needing to seek advice or clarification on scope of practice regarding the required interpretive language when findings were highly contradictory to the clinical history or suggested a rare pathology, 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 refining your interpretation methodology for complex abnormalities and ensuring accurate reporting terminology.
- What will you do differently next time you approach interpreting and reporting an abnormal endoanal ultrasound scan, for instance, by proactively reviewing classification systems for abnormalities (e.g., obstetric sphincter injuries) and studying example reports for complex cases?
- Do you need to practise any aspect of the activity further, such as identifying artefacts or key learning outcomes related to accurately identifying and reporting abnormalities?
Beyond action
- Have you revisited the experiences?
- How have your subsequent experiences of performing anorectal physiology investigations or presenting complex cases at MDTs since completing this specific training activity led you to revisit your initial approach or decisions during that activity? For example, preparing an MDT presentation where specific surgical planning required meticulous grading of an obstetric anal sphincter injury (OASIS) forced you to re-evaluate the diligence of your grading and descriptive reporting during your first attempt at this training activity.
- Considering what you understand about applying specific classification systems, surgical implications, and generating 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 grading methodology and pathological description based on further learning and experiences? For example, how you proactively reviewed and integrated specific guidelines for identifying and reporting abnormalities like anal fistula or sphincter defects, demonstrating you have adapted improvements based on further learning.
- Has discussing complex or unusual abnormalities or the clinical impact of inaccurate reporting on surgical outcomes 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 inaccurate OASIS grading led to a change in the surgical plan refined your understanding of the critical nature of accurate interpretation and reporting of abnormal endoanal ultrasound scans.
- How have these experiences impacted upon current practice?
- How has the learning from this initial training activity, in combination with subsequent investigation performance and patient presentations, contributed to your overall confidence and ability in interpreting and reporting abnormal endoanal ultrasound scans, particularly in preparing for assessments like Direct Observations of Practical Skills (DOPS)? For example, how your accumulated ability in accurately grading pathological findings now enables you to confidently interpret and report a complex 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 diagnostic reasoning and reporting complex findings?
- 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 Consultant Radiologist immediately when encountering complex or rare pathology (e.g., highly complex fistula) that requires expert pathological interpretation before reporting, recognising this falls outside routine pathology classification 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. |