Training activity information
Details
Perform the following adjunctive testing during oesophageal manometry as appropriate:
- Solid swallows
- Multiple rapid swallows
- Rapid drinking challenge
- Positional changes
- Prolonged investigation with a test meal
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 performing and monitoring adjunctive manometry tests (e.g., solid swallows, multiple rapid swallows, rapid drinking challenge).
- Consider how the learning outcomes apply, specifically in relation to performing high-resolution oesophageal manometry in complex patients and interpreting specific manometric patterns.
- Discuss with your training officer to gain clarity of what is expected of you in relation to the specific protocols for each adjunctive test, appropriate patient coaching, and technical execution requirements.
- What is your prior experience of this activity?
- Think about what you already know about the physiological basis and clinical utility of each adjunctive test listed, and the standard manometry procedure.
- Consider possible challenges you might face during the activity, such as executing the specific protocols correctly (e.g., rapid drinking challenge), managing patient cooperation during positional changes, or difficulty determining which test is appropriate for a given patient.
- 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 patient non-cooperation prevents the execution of a key test (e.g., multiple rapid swallows), or if initial findings suggest complex issues requiring non-standard adjunctive tests.
- Acknowledge how you feel about the technical execution and real-time decision-making required for adjunctive testing.
- What do you anticipate you will learn from the experience?
- Consider the specific skills you want to develop, such as technical skills in administering and monitoring adjunctive tests, and improving your ability to execute procedures like solid swallows, MRS, or RDC.
- Identify the specific insights you hope to gain into how the results of adjunctive tests modify or confirm findings from baseline manometry, and how to integrate these findings into the overall interpretation.
- What additional considerations do you need to make?
- Consult actions identified following previous experiences of reviewing the specific protocols for each adjunctive test.
- Identify important information you need to consider before embarking on the activity, such as understanding the clinical utility of each adjunctive test and preparing to explain the procedures clearly to the patient.
In action
- Is anything unexpected occurring?
- Are you noticing anything surprising or different from what you anticipate whilst performing adjunctive manometry tests (e.g., MRS, RDC, Solid Swallow)?
- Are you encountering situations such as:
- The patient is unable or unwilling to cooperate with complex manoeuvres (e.g., Multiple Rapid Swallows), compromising the diagnostic value of the test?
- The Rapid Drinking Challenge (RDC) elicits severe, unexpected chest pain or symptoms, requiring immediate cessation of the procedure?
- Technical issues arise with the manometry catheter during positional changes or the prolonged test meal 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 patient coaching, procedural termination, or technical troubleshooting?
- Consider the steps you are taking in the moment, such as:
- Immediately stopping the adjunctive test and providing reassurance to assess patient safety and symptoms.
- Adjusting the test plan in real-time to substitute an unsuccessful adjunctive test with an appropriate alternative.
- How are you feeling in that moment? For instance, are you finding it difficult to maintain procedural adherence while managing patient discomfort? Is it affecting your confidence in obtaining valid data for complex tests like the RDC?
- What is the conclusion or outcome?
- Identify how you are working within your scope of practice. For example, are you successfully modifying the coaching technique to obtain valid MRS data and documenting the procedural adaptation? Or are you needing support because the unexpected symptom during the RDC requires senior medical review before continuing the remainder of the study?
- What are you learning as a result of the unexpected development? For example, are you mastering advanced patient coaching techniques for complex manometry manoeuvres? Or gaining insight into the real-time physiological response to adjunctive testing?
On action
- What happened?
- Begin by summarising the key steps you took when performing adjunctive manometry tests (e.g., Multiple rapid swallows (MRS), Rapid drinking challenge (RDC), Solid swallows).
- Consider specific events, actions, or interactions which felt important, such as how you coached the patient to perform specific manoeuvres or how you monitored the physiological response during the test meal.
- Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, immediately pausing the RDC when the patient reported unexpected symptoms or modifying the coaching technique when the patient struggled to cooperate with MRS.
- How did you feel during this experience, e.g., did you feel focused on technical execution or challenged by maintaining patient cooperation during complex manoeuvres?
- How has this experience contributed to your developing practice?
- Identify what learning you can take from this experience regarding performing complex manometry and communication.
- What strengths did you demonstrate, e.g., effective patient coaching to obtain valid swallows?
- What skills and/or knowledge gaps were evident, e.g., unfamiliarity with interpreting subtle patterns elicited by positional changes or difficulty adapting protocols due to patient non-cooperation?
- Compare this experience against previous engagement with similar activities – were any previously identified actions for development achieved?
- Has your practice improved in performing high-resolution oesophageal manometry in the complex patient?
- Identify any challenges you experienced, such as needing to seek advice or clarification on scope of practice regarding procedural termination due to patient discomfort or the diagnostic adequacy of a test that could not be completed, 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 execution and interpretation of adjunctive tests.
- What will you do differently next time you approach adjunctive testing, for instance, by proactively reviewing the physiological responses expected for MRS and RDC in normal and abnormal motility?
- Do you need to practise any aspect of the activity further, such as interpreting manometric patterns in the proximal oesophagus / cricopharynx or key learning outcomes related to performing the full range of adjunctive tests?
Beyond action
- Have you revisited the experiences?
- How have your subsequent experiences of performing manometry for complex cases or analysing the full diagnostic reports since completing this specific training activity led you to revisit your initial approach or decisions during that activity? For example, struggling to obtain valid data during a subsequent Multiple Rapid Swallow (MRS) test forced you to re-evaluate the precision of your patient coaching and technical execution during your first attempt at this training activity.
- Considering what you understand about the physiological basis of adjunctive tests, technical proficiency, and data interpretation 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 procedural technique and patient management based on further learning and experiences? For example, how you proactively reviewed and integrated specific guidelines for monitoring manometric patterns in the proximal oesophagus during adjunctive testing, demonstrating you have adapted improvements based on further learning.
- Has discussing difficulties in patient cooperation during RDC or the diagnostic utility of adjunctive tests 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 solid swallows provided crucial diagnostic information refined your understanding of the critical nature of selecting and executing the correct adjunctive test.
- How have these experiences impacted upon current practice?
- How has the learning from this initial training activity, in combination with subsequent performance and reporting experiences, contributed to your overall confidence and competence in performing high-resolution oesophageal manometry with a full range of adjunctive tests, particularly in preparing for assessments like Direct Observations of Practical Skills (DOPS)? For example, how your accumulated ability in safely and accurately executing the RDC and MRS protocols now enables you to confidently perform adjunctive tests with oesophageal manometry 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 performing complex manometry?
- 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 medical staff immediately when a patient reports unexpected severe symptoms during a rapid drinking challenge, recognising this requires immediate clinical safety assessment.
Relevant learning outcomes
| # | Outcome |
|---|---|
| # 1 |
Outcome
Perform high-resolution oesophageal manometry in the complex patient, including a full range of adjunctive tests as appropriate. |
| # 4 |
Outcome
Analyse and interpret the data producing preliminary reports from high-resolution manometry (HRM), differentiating between artefact and physiological occurrences. |
| # 6 |
Outcome
Employ effective communication skills to present information to a variety of audiences including patients, carers and healthcare professional colleagues. |
| # 7 |
Outcome
Interpret manometric patterns in the proximal oesophagus/crycopharynx and identify abnormalities, using knowledge from the wider multidisciplinary team. |