Training activity information
Details
Modify diagnostic test paradigms for patient compliance with testing
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 successfully adapting existing test protocols to improve patient compliance, ensuring that the modified test still yields clinically useful information.
- What constitutes a successful modification for a non-compliant patient? How can you balance the need for standard data acquisition with the patient’s ability to participate?
- Discuss with your training officer to gain clarity of what is expected of you in modifying paradigms for patient compliance.
- What is your prior experience of this activity?
- Think about what you already know about working with patients who have difficulty cooperating with testing (e.g., children or those with complex needs).
- Consider possible challenges you might face, such as identifying why a patient is non-compliant (e.g., anxiety, understanding, physical discomfort), knowing which parameters can be changed without invalidating results, or maintaining communication. 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 significantly modifying protocols or dealing with severely non-compliant patients.
- Acknowledge how you feel about modifying diagnostic test paradigms in the context of this training activity.
- What do you anticipate you will learn from the experience?
- Consider the specific skills you want to develop in assessing patient capabilities, creatively adapting test procedures within acceptable limits, and using communication techniques to enhance cooperation, drawing upon previous experiences.
- Identify specific insights you hope to gain, perhaps regarding the impact of different patient factors (age, cognitive state, anxiety) on test performance, or the limitations of test modifications.
- What additional considerations do you need to make?
- Consult actions identified following previous experience of working with challenging patients or adapting procedures, if any.
- Identify important information you need to consider before embarking on the activity, such as understanding the core requirements of each test, potential acceptable ranges for stimulus duration or number of trials, and strategies for patient engagement and rapport-building.
In action
- Is anything unexpected occurring?
- Are you noticing anything surprising or different from what you anticipate while modifying test paradigms for patient compliance?
- Are you encountering situations such as:
- The chosen modification (e.g., shortening test time or changing stimulus intensity) failing to improve patient cooperation as expected?
- The patient, or their carer, raising unforeseen concerns about the deviation from the standard protocol?
- The modified test, despite being completed, yielding an unstable or unreliable waveform due to the adaptation?
- How is this experience comparing with previous experiences of similar activities, like modifying other test paradigms or addressing compliance issues?
- How are you reacting to the unexpected development?
- How is this impacting your actions? Did you adapt or change your approach to the modification or patient interaction in the moment?
- Consider the steps you are taking in the moment, such as:
- Immediately stopping the modified test and communicating the need to revert to a different, perhaps simpler, protocol?
- Are you seeking immediate sign-off from a supervising colleague for the extreme modification required to proceed with a complex patient?
- Are you clearly documenting the rationale and limitations of the modification in real-time to maintain professional accountability?
- How are you feeling in that moment? For instance, are you finding it difficult to modify the test paradigms? Is it affecting your confidence in judging the acceptability of protocol deviations? Do you feel positive you are alleviating any patient concerns?
- What is the conclusion or outcome?
- Identify how you are working within your scope of practice when modifying test paradigms for patient compliance (e.g., ensuring patient safety is prioritized over obtaining perfect data).
- What are you learning as a result of the unexpected development? For example, are you gaining crucial insight into the acceptable limits and impact of specific protocol modifications (e.g., duration vs. intensity changes) on waveform reliability?
On action
- What happened?
- Begin by summarising the key points of the experience of modifying test paradigms to improve patient compliance.
- Consider specific events, actions, or interactions that felt important during this process, such as communication with the patient or carer regarding the protocol deviation, or assessing the impact of the modification on the potential results. How did you feel during this experience?
- Include any ‘reflect-in-action’ moments where you adapted your approach in the moment during the modification, for instance, instantly reversing a modification that proved ineffective or seeking immediate senior sign-off for a significant protocol change.
- How has this experience contributed to your developing practice?
- Identify what learning you can take from this experience of adapting for patient compliance.
- What strengths did you demonstrate (e.g., empathetic communication, problem-solving within defined test validity limits)?
- What skills and/or knowledge gaps were evident (e.g., unfamiliarity with the acceptable range of modification for a specific test, or strategies for managing complex patient anxiety)?
- Compare this experience against previous times you have had to modify tests for patient needs. Were any previously identified actions for development achieved? Has your practice in achieving clinically valid data despite patient limitations improved?
- Identify any challenges you experienced with patient compliance or modifying the test (e.g., patient resistance, ethical considerations) 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 test modification validity or needing to escalate, perhaps regarding patient safety or test compromise.
- 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 modify diagnostic test paradigms for patients.
- What will you do differently next time you need to modify test paradigms for patient compliance? 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 adaptation further? E.g., Developing a structured, tiered approach to protocol modification based on patient need, or refining documentation of modification rationale and resulting data limitations.
Beyond action
- Have you revisited the experiences?
- Have you reviewed your actions from your previous reflections for modifying diagnostic test paradigms for patient compliance with testing?
- What actions did you identify you would need to take to improve your practice related to enhancing your communication skills, improving patient preparation, or developing strategies for managing challenging patient behaviours? Have you completed these actions? Are you ready to demonstrate this new learning into practice?
- Engage in professional storytelling about modifying test paradigms for patient compliance 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 modifying test paradigms for patient compliance will support you in preparing for relevant observed ‘in-person’ assessments for this module, such as Observed Communication Events e.g., taking a patient history where communication barriers/adjustments are needed or Direct Observations of Practical Skills when performing a test on a patient with complex needs.
- Consider how your practice related to modifying test paradigms for patient compliance 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. |