Training activity information
Details
Review a patient’s symptoms and history and make recommendations for bowel management techniques
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 systematically reviewing the patient’s clinical presentation and developing appropriate, tailored recommendations for bowel management techniques.
- Consider how the learning outcomes apply, specifically in relation to applying knowledge of conservative treatments (e.g., diet, laxatives, TAI, biofeedback) and advanced history taking to ensure recommendations are patient centred.
- Discuss with your training officer to gain clarity of what is expected of you in relation to the specific criteria for recommending different management strategies (e.g., trans-anal irrigation vs. bulk-forming laxatives) and ensuring documentation is clear.
- What is your prior experience of this activity?
- Think about what you already know about common bowel management techniques, dietary advice, and pharmacological agents used in lower GI conditions.
- Consider possible challenges you might face during the activity, such as translating complex physiological findings (e.g., slow transit time) into practical lifestyle advice, or managing patient expectations regarding symptom improvement.
- 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 the patient requires specialist input (e.g., dietitian for specific dietary fibre advice) or if initiating complex therapies (e.g., trans-anal irrigation) is required.
- Acknowledge how you feel about providing patient advice that requires significant behavioural change.
- What do you anticipate you will learn from the experience?
- Consider the specific skills you want to develop, such as integrating historical and physiological data to formulate management plans, and demonstrating clear and effective patient education.
- Identify the specific insights you hope to gain into the practical application and efficacy of various conservative treatments in a real-world setting.
- What additional considerations do you need to make?
- Consult actions identified following previous experiences of providing management advice to patients or obtaining histories from complex patients.
- Identify important information you need to consider before embarking on the activity, such as reviewing the patient’s motivation and capability for lifestyle changes, and reviewing academic content on indications and contraindications for specific conservative treatments.
In action
- Is anything unexpected occurring?
- Are you noticing anything surprising or different from what you anticipate whilst reviewing the patient’s history or making recommendations for bowel management?
- Are you encountering situations such as:
- The patient’s complex symptoms (e.g., severe pain, nausea) suggest a pathology outside routine lower GI management, challenging the scope of your recommendations?
- Difficulty arises in matching a specific physiological finding (e.g., slow transit) with an effective and patient-acceptable management technique?
- The patient expresses firm resistance or cultural opposition to a standard, evidence-based management technique (e.g., trans-anal irrigation)?
- 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 conservative treatment recommendations or patient education?
- Consider the steps you are taking in the moment, such as:
- Immediately exploring the patient’s rationale for resistance to a technique and adapting your approach to offer acceptable alternatives.
- Pausing the recommendation phase to consult guidelines on alternative management strategies for complex, multi-symptom presentations.
- How are you feeling in that moment? For instance, are you finding it difficult to translate physiological data into practical, patient-centred advice? Is it affecting your confidence in formulating safe and effective recommendations?
- What is the conclusion or outcome?
- Identify how you are working within your scope of practice. For example, are you successfully integrating history and physiological data to recommend a suitable conservative management plan? Or are you needing support because the complexity of the non-GI symptoms requires specialist medical or psychological input before management can be finalised?
- What are you learning as a result of the unexpected development? For example, are you mastering a more systematic approach to selecting appropriate conservative treatments? Or gaining insight into managing patient expectations regarding bowel management techniques?
On action
- What happened?
- Begin by summarising the key steps you took when reviewing the patient’s symptoms and history and making recommendations for bowel management techniques.
- Consider specific events, actions, or interactions which felt important, such as how you identified that the symptoms were primarily related to motility or structural issues, or how you formulated practical, patient-centred lifestyle advice.
- How did you feel during this experience, e.g., did you feel focused on practical application or challenged by the complexity of integrating medical history with lifestyle recommendations?
- Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, immediately re-evaluating a recommendation for increased fibre intake when the patient revealed a history of irritable bowel syndrome (IBS) symptoms.
- How has this experience contributed to your developing practice?
- Identify what learning you can take from this experience regarding clinical reasoning and management planning.
- What strengths did you demonstrate, e.g., logical connection between history and proposed management or effective communication of dietary advice?
- What skills and/or knowledge gaps were evident, e.g., uncertainty regarding the precise indications for advanced conservative treatments like trans-anal irrigation (TAI) or specific dietary therapies (e.g., low FODMAP diet)?
- Compare this experience against previous engagement with similar activities – were any previously identified actions for development achieved?
- Has your practice improved in translating physiological and historical data into practical management plans?
- Identify any challenges you experienced, such as needing to seek advice or clarification on scope of practice regarding recommending treatments (e.g., specialist physiotherapy or TAI) that require specialist initiation or long-term follow-up, 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 knowledge base of conservative treatments and their specific indications.
- What will you do differently next time you approach reviewing a patient’s case for bowel management recommendations, for instance, by proactively researching the indications and contraindications for trans-anal irrigation and the low FODMAP diet?
- Do you need to practise any aspect of the activity further, such as formulating detailed patient-specific management plans 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 discussing patient compliance during history taking since completing this specific training activity led you to revisit your initial approach or decisions during that activity? For example, reviewing a patient case where recommended management failed due to non-compliance forced you to re-evaluate the diligence of your assessment of the patient’s capability and motivation during your first attempt at this training activity.
- Considering what you understand about various conservative treatments, applying advanced history taking, and effective patient education 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 management recommendation strategy and justification based on further learning and experiences? For example, how you proactively reviewed and integrated guidelines on trans-anal irrigation (TAI) indications and contraindications to ensure appropriate advice is given.
- Has discussing challenging cases requiring complex, non-pharmacological management or the impact of patient compliance on treatment efficacy 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 patient who struggled with dietary changes refined your understanding of the critical nature of integrating patient-specific factors into management plans.
- 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 conservative treatments, contributed to your overall confidence and ability in making management recommendations and applying clinical knowledge, particularly in preparing for assessments like Case-Based Discussions (CBDs)? For example, how your accumulated ability in justifying the selection of conservative treatments (e.g., biofeedback vs. TAI) now enables you to confidently discuss bowel management strategies during a CBD assessment.
- How has reflecting back on this specific training activity, combined with everything you’ve learned since, shaped your current approach to providing patient management advice?
- 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 dietician/physiotherapist immediately when a patient requires highly specialised, intensive behavioural modification or dietary intervention, recognising this falls outside routine symptom review scope.
Relevant learning outcomes
| # | Outcome |
|---|---|
| # 4 |
Outcome
Apply advanced history taking skills to explore a patient’s more complex social history with compassion and empathy. |
| # 5 |
Outcome
Summarise and present patients at a pelvic floor multidisciplinary team meeting and contribute to the decision-making process for patient care. |