Training activity information
Details
Perform and interpret multifocal electroretinograms and review the results
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 mfERG tests and demonstrating initial interpretation of the results, aligning with learning outcomes related to performing techniques, troubleshooting, and understanding principles.
- What constitutes a successful mfERG recording and a reasonable initial interpretation of the complex waveforms? What are the key aspects of the mfERG response you need to look for?
- Discuss with your training officer to gain clarity of what is expected of you in performing and interpreting mfERGs.
- What is your prior experience of this activity?
- Think about what you already know about performing ERGs or dealing with complex waveform data.
- Consider possible challenges you might face, such as maintaining patient fixation, understanding the stimulus presentation, dealing with artefacts inherent in the mfERG technique, or the initial difficulty in interpreting the large volume of data. 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 troubleshooting specific mfERG issues or interpreting complex or abnormal responses.
- Acknowledge how you feel about accurately performing, interpreting and reviewing the results of multifocal electroretinograms.
- What do you anticipate you will learn from the experience?
- Consider the specific skills you want to develop in setting up and running mfERG tests, minimising artefacts, and identifying key features in the resulting waveforms, drawing upon previous experiences.
- Identify specific insights you hope to gain, perhaps regarding the spatial mapping of retinal function provided by mfERG, how it differs from full-field ERG, or how certain pathologies (like maculopathy) manifest in the mfERG.
- What additional considerations do you need to make?
- Consult actions identified following previous experience of performing ERGs or handling multi-channel data, if any.
- Identify important information you need to consider before embarking on the activity, such as the theoretical principles of mfERG, specific software and analysis tools, standard protocols for different clinical questions, and examples of normal and abnormal mfERG results.
In action
- Is anything unexpected occurring?
- Are you noticing anything surprising or different from what you anticipate while performing, interpreting, and reviewing mfERGs?
- Are you encountering situations such as:
- Persistent loss of patient fixation causing unacceptable regional artefact in the mfERG data despite repeated instructions?
- A specific sector or ring of the mfERG map showing unexpected suppression or loss that does not immediately correlate with the clinical history?
- The mfERG software or analysis tools malfunctioning during the complex data acquisition process?
- How is this experience comparing with previous experiences of similar activities, like performing or interpreting other electrophysiological tests?
- How are you reacting to the unexpected development?
- How is this impacting your actions? Did you adapt or change your approach to fixation management, data acquisition, or analysis in the moment?
- Consider the steps you are taking in the moment, such as:
- Immediately adjusting the patient’s viewing target or using specific feedback techniques to improve fixation during the test?
- Are you re-running a segment of the test or adjusting the averaging parameters on the fly to try and mitigate artefacts?
- Are you seeking clarification on interpreting an unusual sector-specific response from a mentor before concluding the initial review?
- How are you feeling in this moment? For instance, are you finding it difficult to undertake any part of the multifocal electroretinograms? Is it affecting your confidence in interpreting the complex mfERG waveform? Do you feel positive you can successfully review the results?
- What is the conclusion or outcome?
- Identify how you are working within your scope of practice when performing and interpreting mfERGs (e.g., accurately documenting data reliability limitations caused by fixation issues).
- What are you learning as a result of the unexpected development? For example, are you gaining key learning about mfERG fixation management techniques, or improving your proficiency in rapidly manipulating the complex analysis software to confirm regional findings?
On action
- What happened?
- Begin by summarising the key points of the experience of performing and interpreting multifocal electroretinograms (mfERGs) and reviewing the results.
- Consider specific events, actions, or interactions that felt important during the testing, interpretation, or review process, such as maintaining highly precise patient fixation or the initial difficulty in interpreting the complex topographical data. How did you feel during this experience?
- Include any ‘reflect-in-action’ moments where you adapted your approach in the moment during the activity, for instance, immediately adjusting the viewing target to correct fixation or rapidly manipulating the analysis software to isolate a questionable regional response.
- How has this experience contributed to your developing practice?
- Identify what learning you can take from this experience with mfERGs.
- What strengths did you demonstrate (e.g., technical setup for complex data acquisition, analytical skill in relating spatial functional maps to pathology)?
- What skills and/or knowledge gaps were evident (e.g., unfamiliarity with the full range of analysis tools, difficulty identifying mfERG-specific artefacts)?
- Compare this experience against previous engagements with similar complex data sets. Were any previously identified actions for development achieved? Has your practice in mfERG technique and interpretation improved?
- Identify any challenges you experienced during the testing, interpretation, or review process (e.g., persistent fixation loss, software/analysis difficulty) 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 mfERG activity, such as needing to seek advice or clarification on a complex or abnormal 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 or ‘next steps’ you will now take to support the assimilation of what you have learned, including from any feedback received regarding your ability to perform, interpret and review the results of the multifocal electroretinograms.
- What will you do differently next time you perform or interpret mfERGs? 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 advanced analysis of ring or sector data, or refining techniques for consistently achieving and maintaining optimal patient fixation during long duration tests.
Beyond action
- Have you revisited the experiences?
- Have you reviewed your actions from your previous reflections for performing and interpreting multifocal electroretinograms and reviewing the results?
- What actions did you identify you would need to take to improve your practice related to improving recording technique, waveform analysis, or your ability to interpret the results in relation to retinal pathology? Have you completed these actions? Are you ready to demonstrate this new learning into practice?
- Engage in professional storytelling about performing and interpreting multifocal 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 and interpreting multifocal ERGs will support you in preparing for relevant observed ‘in-person’ assessments for this module, such as Case-Based Discussions where you might be asked to interpret waveforms and discuss results.
- Consider how your practice related to performing and interpreting multifocal 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 |
|---|---|
| # 1 |
Outcome
Develop test plans from information given on referrals. |
| # 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. |