Training activity information
Details
Obtain a history for lower gastrointestinal physiology investigations, including patients with complex social and/or mental health issues
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 applying advanced history taking skills to capture all relevant lower GI details, including complex social history and mental health issues, demonstrating compassion and empathy.
- Consider how the learning outcomes apply, specifically in relation to exploring sensitive topics (e.g., safeguarding issues like FGM or domestic violence), and critically appraising the key requirements for advanced clinical history taking.
- Discuss with your training officer to gain clarity of what is expected of you in relation to specific questioning techniques for sensitive topics and the necessary steps for handling potential safeguarding concerns.
- What is your prior experience of this activity?
- Think about what you already know about foundational history taking for lower GI conditions, principles of compassionate communication, and managing sensitive patient interviews.
- Consider possible challenges you might face during the activity, such as building rapport, managing patient distress or reluctance to disclose sensitive information, or differentiating symptoms related to mental health issues (e.g., anxiety, depression) from physical pathology.
- 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 a patient discloses information raising immediate safeguarding concerns (e.g., domestic violence or FGM), or if managing severe psychological distress exceeds your current expertise.
- Acknowledge how you feel about conducting advanced history taking and addressing sensitive social issues.
- What do you anticipate you will learn from the experience?
- Consider the specific skills you want to develop, such as refining advanced history taking skills, empathetic questioning techniques, and the ability to elicit subtle details related to complex social histories.
- Identify the specific insights you hope to gain into the profound influence of complex social or psychological factors on lower GI symptoms and the investigation process.
- What additional considerations do you need to make?
- Consult actions identified following previous experiences of managing complex or sensitive patient interactions.
- Identify important information you need to consider before embarking on the activity, such as local policies and procedures for reporting safeguarding issues, and reviewing academic content on psychological influences on bowel function.
In action
- Is anything unexpected occurring?
- Are you noticing anything surprising or different from what you anticipate whilst taking the advanced clinical history?
- Are you encountering situations such as:
- The patient discloses a sensitive or safeguarding issue (e.g., FGM, domestic abuse) that requires immediate professional action?
- The patient exhibits unexpected emotional distress or confusion when discussing their symptoms, challenging your compassionate communication skills?
- The patient’s symptoms appear highly functional or intertwined with mental health issues, complicating the focus of the physiological investigation?
- 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 questioning, documentation, or emotional support?
- Consider the steps you are taking in the moment, such as:
- Immediately pausing the interview to reassure the patient, while mentally reviewing local safeguarding protocols.
- Adjusting the flow of the conversation to move away from the sensitive topic temporarily, allowing the patient to regain composure.
- How are you feeling in that moment? For instance, are you finding it difficult to manage your own emotional response to sensitive disclosures? Is it affecting your confidence in conducting the advanced history taking required for complex patients?
- What is the conclusion or outcome?
- Identify how you are working within your scope of practice. For example, are you successfully documenting the complex history while maintaining compassionate boundaries? Or are you needing support because the patient disclosure necessitates immediate application of safeguarding procedures, requiring urgent consultation with the Training Officer?
- What are you learning as a result of the unexpected development? For example, are you mastering advanced questioning techniques for complex social histories? Or gaining insight into the immediate protocols required when handling safeguarding concerns?
On action
- What happened?
- Begin by summarising the key steps you took when obtaining the patient history, particularly focusing on exploring complex social history, mental health issues, and addressing anxieties about intimate examinations.
- Consider specific events, actions, or interactions which felt important, such as how you built rapport and created a safe environment or how you handled a disclosure related to sensitive topics (e.g., safeguarding issues like FGM).
- How did you feel during this experience, e.g., did you feel focused on demonstrating compassion and empathy or stressed by the responsibility of addressing safeguarding issues?
- Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, immediately adjusting your questioning approach or providing emotional support when the patient exhibited unexpected distress or disclosed sensitive information.
- How has this experience contributed to your developing practice?
- Identify what learning you can take from this experience regarding advanced history taking.
- What strengths did you demonstrate, e.g., effective empathetic communication or ability to explore complex issues sensitive questions?
- What skills and/or knowledge gaps were evident, e.g., unfamiliarity with specific questioning techniques for mental health issues or knowledge of local safeguarding protocols?
- Compare this experience against previous engagement with similar activities – were any previously identified actions for development achieved?
- Has your practice improved in confidently obtaining histories from patients with complex social and/or mental health issues?
- Identify any challenges you experienced, such as needing to seek advice or clarification on scope of practice regarding how to proceed when a patient disclosed potential safeguarding issues, requiring immediate escalation, 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 approach to sensitive topics and managing emotional distress.
- What will you do differently next time you approach advanced history taking, for instance, by proactively reviewing local policies and procedures for reporting safeguarding issues and studying guidance on communication skills for sensitive topics?
- Do you need to practise any aspect of the activity further, such as role-playing sensitive interviews or key learning outcomes related to applying advanced history taking skills?
Beyond action
- Have you revisited the experiences?
- How have your subsequent experiences of performing investigations or presenting cases at MDTs since completing this specific training activity led you to revisit your initial approach or decisions during that activity? For example, encountering patient cases where the complexity of symptoms was highly linked to anxiety/depression forced you to re-evaluate the depth of exploration of complex social history and mental health factors during your first attempt at this training activity.
- Considering what you understand about safeguarding protocols, psychological factors, and critically appraising advanced history taking 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 questioning technique and compassionate communication based on further learning and experiences? For example, how you proactively reviewed and integrated protocols for handling sensitive disclosures (e.g., FGM or domestic violence), demonstrating you have adapted improvements based on further learning.
- Has discussing challenging sensitive history taking or the impact of social factors on patient management 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 crucial safeguarding concerns were almost missed refined your understanding of the critical nature of applying advanced history taking skills with compassion and empathy.
- How have these experiences impacted upon current practice?
- How has the learning from this initial training activity, in combination with subsequent patient interactions and MDT participation, contributed to your overall confidence and competence in applying advanced history taking skills, particularly in preparing for assessments like Observed Communication Events (OCEs)? For example, how your accumulated ability in exploring complex social history with empathy now enables you to confidently obtain a detailed patient history for anorectal physiology investigations 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 managing sensitive patient interviews?
- 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 Psychologist immediately when faced with severe emotional distress or an immediate safeguarding concern that requires specialist input or escalation protocols.
Relevant learning outcomes
| # | Outcome |
|---|---|
| # 4 |
Outcome
Apply advanced history taking skills to explore a patient’s more complex social history with compassion and empathy. |