Specialist Investigations in Gastrointestinal Physiology —
Training activity: 8

Details

Obtain a paediatric patient history under supervision, for two of the following gastrointestinal physiology investigations:

• Anorectal physiology
• Oesophageal manometry
• Ambulatory studies
• Breath testing, including SIBO, LI and FI

Type

Developmental training activity (DTA)

Evidence requirements

Evidence the activity has been undertaken by the trainee​.

Reflection on the activity at one or more time points after the event including learning from the activity and/or areas of the trainees practice for development.

An action plan to implement learning and/or to address skills or knowledge gaps identified.

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 are the key elements of a comprehensive paediatric gastrointestinal history relevant to these investigations?
• What specific questions are important to ask when taking a history from a paediatric patient (and their parents/guardians) being considered for Anorectal physiology, Oesophageal manometry, Ambulatory studies, or Breath testing?
• Are you familiar with age-appropriate communication techniques for interacting with children about their symptoms?
• Do you understand the importance of including information about diet, medications, developmental milestones, and family history in the assessment?
• What specific communication and history-taking skills for paediatric patients and their families do you hope to develop?
• Discuss this training activity with your training officer or supervisor to understand which investigations the patient is being considered for, the age of the child, and the specific aspects of the history you should focus on under supervision.
• Consider possible challenges, such as communicating with very young children or addressing parental anxieties. How will you prepare for these?
• Identify how confident you feel in your paediatric communication and history-taking skills. What resources or guidance might be helpful to review beforehand?
• Will you review any examples of paediatric gastrointestinal history questionnaires or guidelines?

In action

• Pay attention to your actions as you interact with the paediatric patient and their parent/guardian to obtain their history. How are you approaching the interview, asking questions in an age-appropriate and sensitive manner, and building rapport? Why are you structuring your questions in this way?
• What specific information are you aiming to gather relevant to the requested gastrointestinal physiology investigations? What decisions are you making about the types of questions to ask and how to phrase them?
• How are you observing and interpreting the verbal and non-verbal cues from the child and their parent/guardian?
• How effective is your current approach in gathering a comprehensive and relevant paediatric patient history?
• What challenges are you facing during the history-taking process? For example, are there communication difficulties with the child or parent, are they hesitant to provide certain information, or is it difficult to understand the chronology of symptoms?
• Are you improving your communication skills with paediatric patients and their families, your ability to elicit relevant information, or your understanding of how different symptoms relate to potential gastrointestinal disorders?
• Are there alternative ways you could be asking questions or engaging with the child and parent to obtain the necessary information? For example, could you use play-based techniques for younger children or involve the parent in different ways?
• Are you being mindful of the emotional aspects for the child and their family during the history-taking process?

On action

• Describe the process of obtaining the patient history from the paediatric patient (and their parent/guardian) for the two chosen investigations.
  • What specific questions did you ask to gather relevant information for each investigation?
  • What were the responses and concerns of the patient and their parent/guardian?
  • What adaptations did you make to your communication style based on the age and understanding of the child?
  • What were your observations of the interaction between yourself, the patient, and their parent/guardian during the history-taking process?
• What specific information is essential to obtain in a paediatric patient history for Anorectal physiology, Oesophageal manometry, Ambulatory studies, Breath testing?
  • How do you effectively communicate with and gather information from children of different ages and their parents/guardians?
  • What are the key considerations when taking a gastrointestinal history from a paediatric patient?
  • How does this activity contribute to your ability to employ compassionate communication and gather necessary patient information?
  • What challenges did you encounter, and how did you address them (under supervision)?
• What aspects of obtaining a paediatric patient history for gastrointestinal physiology investigations do you feel you need to develop further?
  • How will you approach history-taking with paediatric patients and their families in the future?
  • What resources or guidance will you seek to improve your history-taking skills in paediatric settings?

Beyond action

• Consider evaluating and re-evaluating your approach to obtaining the paediatric patient history under supervision. What specific questions did you ask, and how did you adapt your communication to the child’s age and understanding, as well as to the parents/guardians?
• What are the unique challenges and considerations when taking a history from a child and their caregivers?
• Have you revisited your understanding of the key clinical information relevant to the specified paediatric gastrointestinal physiology investigations? Has your ability to elicit this information effectively improved?
• Recognise that this training activity contributes to your ability to employ compassionate communication with patients to obtain informed consent ensuring patient comprehension, and to plan and perform gastrointestinal investigations in paediatrics, considering practical and emotional aspects. How has this experience enhanced your history-taking skills with paediatric patients and their families?
• How has this training activity influenced your appreciation of the role of parents/guardians and other healthcare professionals (HCPs) in the diagnostic process for paediatric gastrointestinal disorders?
• Identify the transferable skills you developed such as age-appropriate communication, active listening, empathy, and building trust with children and their families. How will these skills be essential in your future interactions with paediatric patients?
• Identify clear actions for continued development in your ability to obtain comprehensive and relevant paediatric patient histories for gastrointestinal physiology investigations. What further guidance or supervision could you seek in this area?

Relevant learning outcomes

#	Outcome
# 1	Outcome Apply the requirements for performing specialist gastrointestinal physiology investigations in a range of patients including paediatrics.
# 2	Outcome Perform a range of the specialist gastrointestinal physiology investigations, including safe intubation of the upper and lower gastrointestinal tract in a variety of adult and paediatric patient conditions.
# 3	Outcome Employ compassionate communication with patients to obtain informed consent ensuring patient comprehension.
# 5	Outcome Perform routine maintenance and calibration of equipment, identifying and managing faults, out of specification results and artefacts which may result in an inaccurate study being performed.
# 6	Outcome Identify the range of disorders diagnosed by advanced gastrointestinal investigations, the implications for the patient, impact their quality of life, potential treatments and the differential diagnosis.
# 7	Outcome Plan and perform gastrointestinal investigations in paediatrics, adapting practice to consider the practicalities and emotional aspects including age of the child, parental input, guardianship and external factors such as social services.