Training activity information
Details
Perform extended protocol ERGs including two of the following:
- S cones
- On/off ERGs
- PHNR
- Dark adapted red flash
- Luminance response series
- STR
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 includes successfully performing at least two specific extended ERG protocols while adhering to learning outcomes related to preparation, performance, troubleshooting, and effective communication.
- What constitutes a successful recording for these specific extended ERG protocols (e.g., S cones, On/off ERGs), including appropriate patient preparation, equipment setup, data acquisition, and troubleshooting?
- Discuss with your training officer to gain clarity of what is expected of you in performing these extended ERG protocols.
- What is your prior experience of this activity?
- Think about what you already know about performing standard ERG tests or any of these specific extended protocols.
- Consider possible challenges you might face, such as patient fatigue during longer protocols, technical difficulties specific to the extended techniques (e.g., specific stimulus requirements), or interpreting real-time data quality for these variations. 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 unusual responses or equipment issues during extended testing.
- Acknowledge how you feel about performing extended protocol ERGs.
- What do you anticipate you will learn from the experience?
- Consider the specific skills you want to develop in executing these extended ERG protocols precisely and troubleshooting issues unique to them, drawing upon previous experiences with standard ERGs.
- Identify specific insights you hope to gain, perhaps regarding the clinical utility of these specific extended responses (e.g., PHNR for ganglion cell function) or optimising recording parameters for challenging waveforms.
- What additional considerations do you need to make?
- Consult actions identified following previous experience of performing ERGs or similar advanced tests, if any.
- Identify important information you need to consider before embarking on the activity, such as specific ISCEV guidelines for these extended protocols, required equipment and stimuli, patient suitability for longer testing, and potential artefact sources specific to these techniques.
In action
- Is anything unexpected occurring?
- Are you noticing anything surprising or different from what you anticipate while performing the extended protocol ERGs?
- Are you encountering situations such as:
- The patient exhibiting unexpected fatigue or cooperation issues during a typically lengthy extended protocol (e.g., Luminance response series)?
- A technical parameter specific to the extended protocol (e.g., S cone filter or stimulus timing) failing to adhere to the required standards?
- An abnormal or unexpectedly suppressed waveform appearing for one of the specific extended protocols (e.g., low PHNR) that contradicts the results from the standard ERG?
- How is this experience comparing with previous experiences of similar activities, like performing standard or other extended ERG protocols?
- How are you reacting to the unexpected development?
- How is this impacting your actions? Did you adapt or change your approach to the procedure, or patient management in the moment?
- Consider the steps you are taking in the moment, such as:
- Immediately implementing a rapid patient communication technique or using distraction methods to manage cooperation issues during the extended protocol?
- Are you pausing the test sequence to troubleshoot a specific stimulus delivery failure or filter setting required for the extended protocol?
- Are you seeking senior advice on the spot regarding the clinical significance of a highly unusual waveform from one of the specific extended protocols?
- How are you feeling in this moment? For instance, are you finding it difficult to adapt? Is it affecting your confidence in mastering the extended protocols? Do you feel positive you can reach a successful conclusion?
- What is the conclusion or outcome?
- Identify how you are working within your scope of practice when performing extended protocol ERGs (e.g., ensuring all modifications adhere to safety standards while striving for compliance).
- What are you learning as a result of the unexpected development? For example, are you gaining crucial technical learning about specific extended ERG stimulus control and calibration, or mastering patient pacing strategies essential for long protocols?
On action
- What happened?
- Begin by summarising the key points of the experience of performing the extended protocol ERGs (including the two selected types).
- Consider specific events, actions, or interactions that felt important during the test performance, such as managing patient fatigue during longer, specialized protocols or ensuring the technical setup met ISCEV standards for specific stimuli (e.g., S cones). How did you feel during this experience?
- Include any ‘reflect-in-action’ moments where you adapted your approach in the moment during the procedure, for instance, pausing the sequence to troubleshoot a specific stimulus delivery failure or adapting patient pacing to maintain compliance.
- How has this experience contributed to your developing practice?
- Identify what learning you can take from this experience with extended protocol ERGs.
- What strengths did you demonstrate (e.g., technical adherence to specialised protocols, systematic troubleshooting of specific artefact sources)?
- What skills and/or knowledge gaps were evident (e.g., unfamiliarity with the specific clinical utility of PHNR, or optimal recording parameters for the STR)?
- Compare this experience against previous times you have performed ERGs. Were any previously identified actions for development achieved? Has your practice in executing and troubleshooting complex protocols improved?
- Identify any challenges you experienced during the test performance (e.g., patient cooperation issues due to duration, specific equipment issues) 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 extended ERG activity, such as needing to seek advice or clarification on an unusual waveform response or needing to escalate to ensure you were working within your scope of practice.
- 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 perform extended protocol ERGs.
- What will you do differently next time you perform these extended ERG protocols? Has anything changed in terms of what you would do if you were faced with a similar testing situation again?
- Do you need to practise any aspect of performing extended ERGs further? E.g., Practising patient pacing strategies for long dark adaptation phases, or refining the technical handling of specific filters and stimuli required for these specialised protocols.
Beyond action
- Have you revisited the experiences?
- Have you reviewed your actions from your previous reflections for performing extended protocol ERGs?
- What actions did you identify you would need to take to improve your practice related to mastering specific extended protocols (e.g., S cones, PHNR) or troubleshooting challenges during these tests? Have you completed these actions? Are you ready to demonstrate this new learning into practice?
- Engage in professional storytelling about performing extended protocol ERGs with peers, near peers, or colleagues. Consider if your view of the situation has changed because of analysing this with others.
- How have these experiences impacted upon current practice?
- Consider how the accumulated learning from performing or reflecting on performing extended protocol ERGs will support you in preparing for relevant observed ‘in-person’ assessments for this module, such as the Direct Observation of Practical Skills (DOPS) specifically for performing an extended ERG protocol, or Case-Based Discussions where interpretation might be discussed.
- Consider how your practice related to performing extended protocol ERGs 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 |
|---|---|
| # 2 |
Outcome
Prepare patients and the clinical environment for both standard and advanced electrophysiological techniques. |
| # 3 |
Outcome
Perform standard and advanced electrophysiological techniques using correct procedures. |
| # 4 |
Outcome
Identify, assess and remedy issues encountered while performing testing. |
| # 7 |
Outcome
Employ effective communication with a range of individuals, including the patient and the multidisciplinary team. |