Training activity information
Details
Present a complex patient at a pelvic floor multidisciplinary team and make recommendations for further treatments
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 summarising and presenting a complex patient case concisely and logically at a pelvic floor MDT meeting.
- Consider how the learning outcomes apply, specifically in relation to contributing effectively to the decision-making process, which includes critically appraising relevant investigations and interventions.
- Discuss with your training officer to gain clarity of what is expected of you in relation to the content and structure of the presentation, the expected depth of knowledge regarding treatment options (e.g., neuromodulation, biofeedback, surgical intervention), and the criteria for appropriate recommendations.
- What is your prior experience of this activity?
- Think about what you already know about the pelvic floor MDT format, interdisciplinary communication, and the range of conservative/surgical/pharmacological interventions for lower GI conditions.
- Consider possible challenges you might face during the activity, such as presenting a complex history/data concisely under time pressure, defending recommendations against expert opinion, or responding to questions about ancillary investigations (e.g., MRI proctography).
- 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 specific recommendation falls outside routine departmental guidelines or requires detailed knowledge of complex surgical procedures.
- Acknowledge how you feel about presenting a complex patient and contributing to definitive patient care decisions.
- What do you anticipate you will learn from the experience?
- Consider the specific skills you want to develop, such as structuring and delivering a concise clinical presentation, communicating complex physiological data to a multidisciplinary audience, and formulating evidence-based recommendations.
- Identify the specific insights you hope to gain into the collaborative decision-making process and the perspective of other pelvic floor specialists (e.g., surgeons, physiotherapists).
- What additional considerations do you need to make?
- Consult actions identified following previous experiences of observing MDTs or presenting cases in other clinical settings.
- Identify important information you need to consider before embarking on the activity, such as thoroughly reviewing all patient history and investigation results, and preparing notes on treatment options (e.g., sacral nerve neuromodulation (SNM), biofeedback).
In action
- Is anything unexpected occurring?
- Are you noticing anything surprising or different from what you anticipate whilst presenting the patient or participating in the decision-making process?
- Are you encountering situations such as:
- The multidisciplinary team (MDT) raises specific questions about complex surgical interventions or alternative management options (e.g., sacral nerve neuromodulation) that fall outside your immediate expertise?
- New clinical information is raised by an MDT member (e.g., recent imaging) that contradicts the data you are presenting, challenging your recommendation?
- Significant disagreement arises among specialists regarding the optimal treatment pathway, requiring you to navigate conflicting professional opinions?
- 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 recommendation phrasing or presentation structure?
- Consider the steps you are taking in the moment, such as:
- Immediately pausing to acknowledge the new information and adjusting your summary to incorporate the change.
- Articulating your recommendation clearly, justifying it with the physiological data you collected, even if it contradicts a surgical preference.
- How are you feeling in that moment? For instance, are you finding it difficult to defend your physiological findings against alternative clinical interpretations? Is it affecting your confidence in contributing effectively to the MDT decision-making process?
- What is the conclusion or outcome?
- Identify how you are working within your scope of practice. For example, are you successfully summarising the physiological findings and making appropriate, well-justified recommendations? Or are you needing support because a complex ethical or legal issue regarding the treatment pathway requires input from senior clinical governance?
- What are you learning as a result of the unexpected development? For example, are you mastering a more concise and evidence-based approach to presenting complex patient data? Or gaining insight into the critical factors driving multidisciplinary decision-making?
On action
- What happened?
- Begin by summarising the key steps you took when summarising the patient case and presenting it at the pelvic floor MDT meeting. What clinical history and investigation findings did you present?
- Consider specific events, actions, or interactions which felt important, such as how you articulated the physiological findings (e.g., manometry results) and how you formulated recommendations for further treatments.
- How did you feel during this experience, e.g., did you feel confident in contributing to the decision-making process or stressed when responding to complex questions from surgical or medical specialists?
- Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, immediately adapting your presentation structure or responding to a specialist’s question about alternative treatments (e.g., sacral nerve neuromodulation or biofeedback).
- How has this experience contributed to your developing practice?
- Identify what learning you can take from this experience regarding MDT presentation and collaborative decision-making.
- What strengths did you demonstrate, e.g., concise summarisation of complex physiological data or clear articulation of treatment rationale?
- What skills and/or knowledge gaps were evident, e.g., unfamiliarity with the full range of surgical interventions or the precise indications for certain treatments?
- Compare this experience against previous engagement with similar activities – were any previously identified actions for development achieved?
- Has your practice improved in contributing effectively to MDT discussions and formulating appropriate recommendations?
- Identify any challenges you experienced, such as needing to seek advice or clarification on scope of practice regarding a recommendation that required detailed knowledge of surgical procedures or interventions outside your routine scope, 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 case presentation skills and enhancing your knowledge of treatment options.
- What will you do differently next time you approach presenting a complex patient at an MDT, for instance, by proactively reviewing academic content on conservative treatments (e.g., biofeedback, TAI) and advanced interventions (e.g., SNM) to formulate comprehensive recommendations?
- Do you need to practise any aspect of the activity further, such as structuring concise clinical presentations or key learning outcomes related to contributing to decision-making?
Beyond action
- Have you revisited the experiences?
- How have your subsequent experiences of reviewing patient outcomes or engaging with academic content on surgical/conservative interventions since completing this specific training activity led you to revisit your initial approach or decisions during that activity? For example, reading specialised academic content on the long-term efficacy of a recommended treatment (e.g., sacral nerve neuromodulation) forced you to re-evaluate the justification and phrasing of your treatment recommendations during your first attempt at this training activity.
- Considering what you understand about collaborative decision-making, critically appraising interventions, and concise communication 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 case presentation structure and recommendation clarity based on further learning and experiences? For example, how you proactively reviewed and integrated presentation techniques to efficiently summarise complex history and investigation findings, demonstrating you have adapted improvements based on further learning.
- Has discussing challenging MDT questions or the impact of conflicting specialist opinions 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 presentation where key physiological data was overlooked refined your understanding of the critical nature of synthesising multidisciplinary information and contributing to decision-making.
- How have these experiences impacted upon current practice?
- How has the learning from this initial training activity, in combination with subsequent patient interpretation and patient care activities, contributed to your overall confidence and ability in presenting complex cases and contributing to patient care decisions, particularly in preparing for assessments like Observed Communication Events (OCEs)? For example, how your accumulated ability in summarising and justifying management recommendations now enables you to confidently present a patient at a pelvic floor multidisciplinary team 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 collaborative clinical practice?
- 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 Surgeon immediately when formulating recommendations that require detailed knowledge of rare surgical procedures, recognising this falls outside routine physiological interpretation scope.
Relevant learning outcomes
| # | Outcome |
|---|---|
| # 5 |
Outcome
Summarise and present patients at a pelvic floor multidisciplinary team meeting and contribute to the decision-making process for patient care. |