Upper Gastrointestinal Physiology 2 —
Training activity: 10

Details

Review and present the results of investigations for a complex patient case, making recommendations for treatment to other multidisciplinary team colleagues

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 reviewing and presenting complex case results and formulating appropriate recommendations for treatment.
  • Consider how the learning outcomes apply, specifically in relation to practicing professionally within the MDT, employing effective communication skills, and identifying pharmacological interactions.
  • Discuss with your training officer to gain clarity of what is expected of you in relation to the content and structure of the presentation, anticipating multidisciplinary questions, and ensuring recommendations integrate pharmacological considerations.
• What is your prior experience of this activity?
  • Think about what you already know about the specific complex patient case, the format for MDT presentations, and the range of potential treatment options (e.g., anti-reflux surgery, POEM, Botox).
  • Consider possible challenges you might face during the activity, such as synthesising complex history/investigations and anticipating questions from multidisciplinary colleagues.
  • 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 discussing recommendations that involve complex or non-standard surgical interventions, or if significant pharmacological interactions complicate the treatment plan.
  • Acknowledge how you feel about presenting a complex patient case and contributing to definitive patient care decisions in a multidisciplinary setting.
• What do you anticipate you will learn from the experience?
  • Consider the specific skills you want to develop, such as synthesising and presenting complex patient information concisely and effectively and formulating evidence-based treatment recommendations.
  • Identify the specific insights you hope to gain into the multidisciplinary decision-making process for complex cases, and how pharmacological interactions influence patient management.
• What additional considerations do you need to make?
  • Consult actions identified following previous experiences of observing MDTs or preparing presentations.
  • Identify important information you need to consider before embarking on the activity, such as thoroughly reviewing all relevant patient information and investigation results and preparing a clear structure or outline for your presentation.

In action

• Is anything unexpected occurring?
  • Are you noticing anything surprising or different from what you anticipate whilst reviewing the complex patient case or presenting the results to the MDT?
  • Are you encountering situations such as:
    • MDT colleagues question the technical accuracy or interpretation of the manometry or pH-impedance findings you presented?
    • A significant piece of clinical history or pharmacological interaction is introduced by an MDT colleague that complicates your pre-prepared recommendation?
    • Significant conflict arises among specialists regarding the optimal treatment (e.g., surgery vs. endoscopic intervention), requiring diplomatic navigation?
• 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 justifying your findings or formulating your recommendation in real-time?
  • Consider the steps you are taking in the moment, such as:
    • Immediately defending the physiological findings by referencing specific data points or diagnostic criteria.
    • Acknowledging the new information (e.g., pharmacological history) and stating that the recommendation requires immediate modification pending consultation.
  • How are you feeling in that moment? For instance, are you finding it difficult to navigate conflicting specialist opinions? Is it affecting your confidence in the robust nature of the investigation findings you presented?
• What is the conclusion or outcome?
  • Identify how you are working within your scope of practice. For example, are you successfully articulating the limitations of the physiological findings and contributing to the MDT decision-making process? Or are you needing support because the MDT discussion requires complex, non-physiological input (e.g., specialised surgical risks or pharmacological management) that falls outside your technical expertise?
  • What are you learning as a result of the unexpected development? For example, are you mastering strategies for professionally practicing within the multidisciplinary team? Or gaining insight into the critical role of pharmacological awareness in patient care decisions?

On action

• What happened?
  • Begin by summarising the key steps you took when reviewing the complex patient case and presenting the investigation results (e.g., manometry, pH-impedance reports) to the multidisciplinary team (MDT).
  • Consider specific events, actions, or interactions which felt important, such as how you structured the presentation of investigation findings or how you formulated treatment recommendations based on complex data.
  • Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, immediately defending the physiological findings or modifying a recommendation when a colleague introduced new information about the patient’s pharmacological history.
  • How did you feel during this experience, e.g., did you feel confident practicing professionally within the multidisciplinary team or challenged when faced with complex questions about treatment options?
• How has this experience contributed to your developing practice?
  • Identify what learning you can take from this experience regarding professional practice and communication.
  • What strengths did you demonstrate, e.g., synthesising and presenting complex physiological findings concisely?
  • What skills and/or knowledge gaps were evident, e.g., difficulty responding to questions about complex surgical interventions or unfamiliarity with the influence of certain drugs on patient management?
  • 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 the MDT decision-making process?
  • Identify any challenges you experienced, such as needing to seek advice or clarification on scope of practice regarding treatment recommendations that involve non-physiological interventions or managing complex pharmacological interactions, 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 MDT presentation structure and ensuring all recommendations are justified.
  • What will you do differently next time you approach presenting a complex patient case, for instance, by proactively researching the range of surgical and conservative treatment options (e.g., anti-reflux surgery or POEM) to better inform your recommendations?
  • Do you need to practise any aspect of the activity further, such as summarising complex investigation results or key learning outcomes related to recognising factors affected by pharmacological interactions?

Beyond action

• Have you revisited the experiences?
  • How have your subsequent experiences of producing complex reports or attending surgical/endoscopic therapy clinics since completing this specific training activity led you to revisit your initial approach or decisions during that activity? For example, discussion in a subsequent MDT about treatment options forced you to re-evaluate the breadth of your knowledge regarding surgical interventions (e.g., anti-reflux surgery or POEM) when formulating initial recommendations during your first attempt at this training activity.
  • Considering what you understand about professional practice within the MDT, effective communication, and pharmacological impact 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 review and presentation structure based on further learning and experiences? For example, how you proactively reviewed and integrated protocols for clearly documenting pharmacological factors that influence investigation results when presenting the case, demonstrating you have adapted improvements based on further learning.
  • Has discussing conflicting opinions within the MDT or the management of pharmacological issues 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 poor synthesis of multiple investigations led to an inappropriate recommendation refined your understanding of the critical nature of presenting a clear, synthesised argument to the MDT.
• How have these experiences impacted upon current practice?
  • How has the learning from this initial training activity, in combination with subsequent reporting and clinical observations contributed to your overall confidence and ability in practicing professionally within the MDT and making recommendations, particularly in preparing for assessments like Case-Based Discussions (CBDs)? For example, how your accumulated ability in synthesising complex manometry and pH-impedance findings now enables you to confidently justify treatment recommendations 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 collaborative patient care?
  • 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 a treatment recommendation involves complex surgical procedures or non-standard pharmacological regimes, recognising this requires input beyond routine physiological interpretation.

Relevant learning outcomes

#	Outcome
# 5	Outcome Practice professionally within the multidisciplinary team.
# 6	Outcome Employ effective communication skills to present information to a variety of audiences including patients, carers and healthcare professional colleagues.
# 8	Outcome Identify situations where physiological measurements are affected by pharmacological interactions and the impact this may have on test results.