Training activity information
Details
Review and select appropriate diagnostic test from patient referrals
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 this specific activity. This involves understanding developing test plans from referral information.
- What constitutes an appropriate diagnostic test selection based on the information in the referral? What key pieces of information should guide your test selection?
- Discuss with your training officer to gain clarity of what is expected of you in selecting tests from referrals.
- What is your prior experience of this activity?
- Think about what you already know about interpreting patient referrals or selecting diagnostic tests in ophthalmology or a related field.
- Consider possible challenges you might face, such as ambiguous or incomplete referral information, understanding complex medical history, or choosing between multiple potential tests. Think about how you might handle these challenges.
- 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, regarding challenging referrals or unfamiliar conditions.
- Acknowledge how you feel about using patient referrals to accurately review and selecting appropriate diagnostic tests
- What do you anticipate you will learn from the experience?
- Consider the specific skills you want to develop in interpreting different types of referrals and justifying your choice of diagnostic tests, drawing upon previous experiences of similar tasks.
- Identify specific insights you hope to gain, perhaps related to recognising patterns in referral information that point to specific conditions (e.g., maculopathy, optic neuropathy, retinopathy) or understanding the implications of different referral sources.
- What additional considerations do you need to make?
- Consult any actions identified following previous experience of reviewing and selecting appropriate diagnostic testing from patient referrals.
- Identify important information you need to consider before embarking on the activity, such as relevant clinical guidelines, departmental protocols for specific conditions, or access to patient history systems.
In action
- Is anything unexpected occurring?
- Are you noticing anything surprising or different from what you anticipate while reviewing and selecting the diagnostic test?
- Are you encountering situations such as:
- The referral information being ambiguous or highly incomplete, forcing you to guess the underlying condition or requiring clarification beyond routine expectation?
- The referral suggesting a differential diagnosis that requires a test you are unfamiliar with or rarely perform?
- The patient’s complex medical history, detailed in the notes, contradicting the straightforward test request on the referral form?
- How is this experience comparing with previous experiences of similar activities, like reviewing other referrals or selecting tests?
- How are you reacting to the unexpected development?
- How is this impacting your actions? Did you adapt or change your approach to analysis or information gathering in the moment?
- Consider the steps you are taking in the moment, such as:
- Immediately pausing the selection processto consult a senior colleague or written protocol to resolve the ambiguity of the referral?
- Are you ensuring your test selection aligns with the expected diagnostic plan?
- Are you seeking immediate advicefrom a more experienced colleague on how to approach a complex differential diagnosis based on limited information?
- How are you feeling in this moment? For instance, are you finding it difficult to select appropriate diagnostic tests from the referrals presented? Is it affecting your confidence to proceed? Do you feel positive that you can be successful?
- What is the conclusion or outcome?
- Identify how you are working within your scope of practice when reviewing referrals and selecting tests (e.g., successfully prioritizing clinical urgency while escalating uncertainty regarding diagnosis).
- What are you learning as a result of the unexpected development? For example, are you learning a more effective technique for quickly cross-referencing clinical guidelines with referral symptoms, or gaining a crucial insight into how to document the rationale for your test selection clearly?
On action
- What happened?
- Begin by summarising the key points of the experience of reviewing patient referrals and selecting appropriate diagnostic tests.
- Consider specific events, actions, or interactions that felt important during the review and selection process, such as managing ambiguous referral information or determining the clinical necessity for a complex test battery. How did you feel during this experience?
- Include any ‘reflect-in-action’ moments where you adapted your approach in the moment during the review, for instance, immediately consulting clinical guidelines to justify a test selection or deciding to seek clarification on patient history.
- How has this experience contributed to your developing practice?
- Identify what learning you can take from this experience regarding reviewing referrals and selecting tests.
- What strengths did you demonstrate (e.g., efficient interpretation, analytical skill in diagnosis planning)?
- What skills and/or knowledge gaps were evident (e.g., unfamiliarity with specific disease presentations or challenges in managing complex differential diagnoses)?
- Compare this experience against previous similar activities. Were any previously identified actions for development achieved? Has your practice in planning diagnostic strategies improved?
- Identify any challenges you experienced during the referral review (e.g., incomplete data, time constraints) and how you reacted to these. Did this affect your ability to deal with the situation? Were you able to overcome the challenges?
- Identify anything significant about this activity, such as needing to seek advice or clarification on the required test or needing to escalate to ensure you were working within your scope of practice when selecting tests.
- Acknowledge any changes in your own feelings now that you are looking back on the experience.
- What will you take from the experience moving forward?
- Identify the actions you will now take to support the assimilation of what you have learned, including from any feedback received regarding your ability to select appropriate diagnostic tests.
- What will you do differently next time you review referrals and select tests? Has anything changed in terms of what you would do if you were faced with a similar situation again?
- Do you need to practise any aspect of this activity further? E.g., Practising rapidly cross-referencing clinical guidelines for specific conditions or refining a standardised process for documenting the rationale for test selection.
Beyond action
- Have you revisited the experiences?
- Have you reviewed your actions from your previous reflections for reviewing and selecting appropriate diagnostic tests from patient referrals?
- What actions did you identify you would need to take to improve your practice related to improving your understanding of referral information or your rationale for test selection?
- Have you completed these actions? Are you ready to demonstrate this new learning into practice confidently and consistently?
- How has discussing your experiences with others changed your view of selecting appropriate testing for patient referrals.
- How have these experiences impacted upon current practice?
- Consider how the accumulated learning from performing or reflecting on reviewing and selecting diagnostic tests will support you in preparing for relevant observed ‘in-person’ assessments for the S-OV-S3 module, such as Case-Based Discussions where you might discuss patient cases and test selection or Observed Communication Events where you discuss patient results or give verbal reports.
- Consider how your practice related to reviewing and selecting diagnostic tests has developed and evolved over time. This includes recognising when something related to this activity is beyond your scope of practice.
Relevant learning outcomes
| # | Outcome |
|---|---|
| # 1 |
Outcome
Develop test plans from information given on referrals. |
| # 4 |
Outcome
Identify, assess and remedy issues encountered while performing testing. |
| # 5 |
Outcome
Interpret and report results of electrophysiological tests. |
| # 7 |
Outcome
Employ effective communication with a range of individuals, including the patient and the multidisciplinary team. |