Upper Gastrointestinal Physiology 2 —
Training activity: 8

Details

Produce accurate and concise technical/clinical reports for oesophageal manometry and pH-impedance investigations for a range of conditions

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 writing accurate and concise technical/clinical reports for manometry and pH-impedance investigations.
  • Consider how the learning outcomes apply, specifically in relation to analysing and interpreting data, producing reports that differentiate artefacts, and communicating findings clearly.
  • Discuss with your training officer to gain clarity of what is expected of you in relation to the expected format, structure, and key elements of a comprehensive report, including use of standardised terminology (e.g., Chicago Classification).
• What is your prior experience of this activity?
  • Think about what you already know about the essential components of a comprehensive manometry and pH-impedance report and the standardised terminology used in reporting.
  • Consider possible challenges you might face during the activity, such as summarising complex findings concisely, ensuring accuracy when dealing with subtle findings, or integrating pharmacological information into the report.
  • 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 when dealing with complex cases or subtle findings that require accurate technical description, or when reporting a finding that contradicts the patient’s history.
  • Acknowledge how you feel about the responsibility of interpreting data and communicating findings in a report that will inform patient care.
• What do you anticipate you will learn from the experience?
  • Consider the specific skills you want to develop, such as synthesising investigation data and interpreting complex findings into a coherent report.
  • Identify the specific insights you hope to gain into the level of detail and type of information that is most valuable to the referring clinician and improving your ability to make appropriate recommendations based on the report findings.
• What additional considerations do you need to make?
  • Consult actions identified following previous experiences of reviewing examples of well-written reports for manometry and pH-impedance studies.
  • Identify important information you need to consider before embarking on the activity, such as ensuring accuracy, particularly when dealing with complex cases or subtle findings.

In action

• Is anything unexpected occurring?
  • Are you noticing anything surprising or different from what you anticipate whilst producing the technical/clinical report?
  • Are you encountering situations such as:
    • The manometry findings conflict significantly with the pH-impedance findings (e.g., normal manometry but pathological reflux), complicating the synthesis of the report conclusion?
    • Difficulty arises in summarising complex adjunctive test results (e.g., MRS, RDC) concisely while maintaining accuracy and clinical relevance?
    • The required standardised terminology (e.g., Chicago Classification 4.0) for a rare motility disorder is less clear than expected, challenging accurate report phrasing?
• 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 data verification or terminology selection?
  • Consider the steps you are taking in the moment, such as:
    • Immediately re-reviewing the raw data for the conflicting findings to rule out technical error or artefact before proceeding with the contradictory conclusion.
    • Consulting departmental or published guidelines to confirm the specific standardised terminology for reporting the complex finding.
  • How are you feeling in that moment? For instance, are you finding it difficult to synthesise conflicting data from two different investigations? Is it affecting your confidence in accurately reflecting the diagnostic impression?
• What is the conclusion or outcome?
  • Identify how you are working within your scope of practice. For example, are you successfully articulating the objective findings from both investigations and clearly stating the area of conflict? Or are you needing support because the interpretation of the contradictory findings or the requirement to recommend complex treatment requires senior pathological verification before the report can be finalised?
  • What are you learning as a result of the unexpected development? For example, are you mastering a more effective strategy for integrating technical and physiological data into a concise report? Or gaining insight into the nuances of standardised reporting terminology?

On action

• What happened?
  • Begin by summarising the key steps you took when producing accurate and concise technical/clinical reports for manometry and pH-impedance investigations.
  • Consider specific events, actions, or interactions which felt important, such as how you ensured the report was technically accurate and clinically relevant, or how you articulated the findings for a complex case.
  • Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, immediately revisiting the raw data and re-measuring critical parameters to verify the initial figures before committing them to the report.
  • How did you feel during this experience, e.g., did you feel focused on maintaining the factual integrity of the data or stressed by the challenge of synthesising conflicting findings from manometry and pH-impedance?
• How has this experience contributed to your developing practice?
  • Identify what learning you can take from this experience regarding report production and clear communication.
  • What strengths did you demonstrate, e.g., accurate transcription and presentation of quantitative data?
  • What skills and/or knowledge gaps were evident, e.g., difficulty translating complex manometry findings into concise clinical terminology?
  • Compare this experience against previous engagement with similar activities – were any previously identified actions for development achieved?
  • Has your practice improved in synthesising investigation data and interpreting findings into a coherent report?
  • Identify any challenges you experienced, such as needing to seek advice or clarification on scope of practice regarding how to accurately report a highly complex or contradictory finding that requires specialist interpretation, 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 the structure, accuracy, and conciseness of your reports.
  • What will you do differently next time you approach report production, for instance, by proactively implementing a standardised report template to ensure consistent terminology and accurate presentation of key measurements?
  • Do you need to practise any aspect of the activity further, such as summarising complex findings from adjunctive tests or key learning outcomes related to producing accurate reports?

Beyond action

• Have you revisited the experiences?
  • How have your subsequent experiences of presenting complex cases to the MDT or analysing data from complex investigations since completing this specific training activity led you to revisit your initial approach or decisions during that activity? For example, needing to justify recommendations involving surgical intervention forced you to re-evaluate the clarity and conciseness of the terminology used to summarise complex manometry/pH-impedance findings during your first attempt at this training activity.
  • Considering what you understand about synthesising technical and clinical findings, standardised terminology, and clinical relevance 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 report writing structure and terminology based on further learning and experiences? For example, how you proactively reviewed and implemented standardised phrases for describing equivocal findings to ensure factual accuracy and avoid misleading interpretation, demonstrating you have adapted improvements based on further learning.
  • Has discussing complex or contradictory investigation reports or the impact of unclear recommendations 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 report where ambiguous terminology led to confusion in follow-up refined your understanding of the critical nature of producing accurate and concise technical/clinical reports.
• How have these experiences impacted upon current practice?
  • How has the learning from this initial training activity, in combination with all subsequent interpretation and presentation experiences, contributed to your overall confidence and competence in generating factual reports and synthesising data, particularly in preparing for assessments like Case-Based Discussions (CBDs)? For example, how your accumulated ability in structuring complex data from combined manometry and pH-impedance studies now enables you to confidently articulate the key findings of a complex report 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 reporting and professional communication?
  • 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 physician immediately when findings are highly complex or contradictory, requiring expert pathological verification before the report can be finalised.

Relevant learning outcomes

#	Outcome
# 3	Outcome Analyse and interpret the data producing complete reports for both high-resolution oesophageal manometry and oesophageal pH-impedance monitoring, making recommendations for subsequent management/treatment.
# 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.