Training activity information
Details
Perform and interpret autofluorescence images for patients
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, considering learning outcomes related to performing and interpreting a range of ophthalmic imaging modalities, combining information from electrophysiological and imaging findings to inform a diagnosis, employing effective communication, modifying and adapting protocols dependent on patients’ needs, and assessing and managing risks in the testing environment.
- What does successfully performing autofluorescence imaging look like, including patient setup, using the correct excitation/barrier filters, achieving proper focus and illumination, and capturing the relevant areas? What does interpreting the patterns of autofluorescence in the resulting images involve?
- Discuss with your training officer to gain clarity on what is expected of you when performing and interpreting autofluorescence imaging.
- What is your prior experience of this activity?
- Think about what you already know about the principles of autofluorescence imaging, the substances that cause autofluorescence in the retina (primarily lipofuscin), and the typical appearance of normal and pathological autofluorescence patterns.
- Consider possible challenges you might face during the procedure, such as ensuring adequate darkness for imaging, managing patient blinking, understanding the different patterns associated with various conditions, or differentiating between normal variability and pathology, and think about how you might handle them.
- 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 difficult image acquisition, interpreting complex patterns, or correlating findings with other imaging modalities.
- Acknowledge how you feel about independently performing and interpreting autofluorescence images for patients.
- What do you anticipate you will learn from the experience?
- Consider the specific skills you want to develop in performing autofluorescence imaging efficiently and correctly, systematically analysing the images, and recognising how different retinal pathologies manifest as changes in autofluorescence – drawing upon previous experiences.
- Identify specific insights you hope to gain regarding the underlying biological processes contributing to autofluorescence changes, how autofluorescence adds unique information compared to colour fundus imaging or OCT, or applying this technique in monitoring disease progression.
- What additional considerations do you need to make?
- Consult actions identified following previous experience with fundus imaging or fluorescence-based techniques, if any.
- Identify important information you need to consider before embarking on the activity, such as the reason for imaging (autofluorescence is often used for specific maculopathies), the required fields of view, potential need for dilation (though less critical than for colour fundus, can help with wider views), and preparing the patient for brief flashes of light.
In action
- Is anything unexpected occurring?
- Are you noticing anything surprising or different from what you anticipate while performing and interpreting autofluorescence images?
- Are you encountering situations such as patient movement or light sensitivity causing severe artefacts due to the exposure time, or an unusual pattern of hypo- or hyper-autofluorescence appearing that conflicts with the known clinical history?
- How is this experience comparing with previous experiences of similar activities, like performing other imaging modalities?
- How are you reacting to the unexpected development?
- Identify how this is impacting your actions during autofluorescence imaging and interpretation. Are you responding to the situation appropriately? Are you adapting or changing your approach? Is it affecting your ability to undertake the activity independently?
- In the moment, what steps are you taking, such as immediately adjusting patient instructions or the dark adaptation period to improve cooperation, or quickly re-running the sequence to ensure the AF signal is robust?
- How are you feeling in that moment? Is the need to quickly troubleshoot light-related artefacts affecting your confidence in achieving a valid AF image?
- What is the conclusion or outcome?
- Identify how are you working within your scope of practice when performing and interpreting autofluorescence images (e.g., are you accurately documenting the potential limitations of the image due to patient compliance)?
- Identify what are you learning as a result of the unexpected development e.g., gaining insight into managing patient comfort during AF acquisition?
On action
- What happened?
- Begin by summarising the key points of the experience of performing and interpreting autofluorescence (AF) images.
- Consider specific events, actions, or interactions that felt important during the procedure, such as ensuring optimal dark adaptation, managing light-related artefacts, or recognising patterns of hypo- and hyper-autofluorescence.
- Include any ‘reflect-in-action’ moments, where you had to adapt to the situation as it unfolded, for instance, instantly adjusting exposure time to mitigate artefact or seeking confirmation on an unusual AF pattern. How did you feel during this experience?
- How has this experience contributed to your developing practice?
- Identify what learning you can take from this experience regarding AF performance and interpretation.
- What strengths did you demonstrate (e.g., technical precision with AF filters, systematic analysis of patterns)?
- What skills and/or knowledge gaps were evident (e.g., unfamiliarity with AF manifestations of rarer pathologies or difficulty managing patient compliance during acquisition)?
- Compare this experience against previous imaging activities. Were any previously identified actions for development achieved? Has your practice in acquiring and interpreting AF images improved?
- Identify any challenges you experienced during the procedure (e.g., movement artefacts, difficulty achieving darkness, atypical patterns) 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 the activity, such as needing to seek advice or clarification on interpreting complex AF patterns or escalating due to inability to obtain diagnostic images.
- Acknowledge any changes in your own feelings now 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 learnt, including from any feedback you have received about your ability to perform and interpret autofluorescence images without direct supervision.
- What will you do differently next time you perform AF imaging? 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 the activity further? E.g., Practising patient management during AF acquisition or reviewing examples of AF patterns in specific conditions.
Beyond action
- Have you revisited the experiences?
- Have you reviewed the actions identified in your previous reflections for performing and interpreting autofluorescence images? What specific actions did you previously identify you would need to take to improve your practice, such as refining your autofluorescence acquisition technique, or improving your interpretation skills for specific autofluorescence patterns?
- Have you completed these previously identified actions? If so, how did completing them impact your subsequent performance of this activity?
- Are you ready to demonstrate this new learning confidently and consistently when performing and interpreting autofluorescence?
- Engage in professional storytelling about acquiring autofluorescence images in challenging conditions (e.g., patient blinking, low signal) or interpreting unusual autofluorescence patterns for specific conditions with peers, near peers, or colleagues. Has discussing these experiences changed your perspective or approach?
- How have these experiences impacted upon current practice?
- Consider how the accumulated learning from performing or reflecting on performing and interpreting autofluorescence will support you in preparing for relevant observed ‘in-person’ assessments for the module, such as Case-Based Discussions. This relates to demonstrating your ability to perform and interpret autofluorescence and critically evaluating images.
- How has your practice related to performing and interpreting autofluorescence developed and evolved over time? This includes recognising when something related to this activity is beyond your scope of practice, such as when autofluorescence findings are unusual or require specialist interpretation.
Relevant learning outcomes
| # | Outcome |
|---|---|
| # 2 |
Outcome
Perform and interpret a range of ophthalmic imaging modalities. |
| # 3 |
Outcome
Combine information from electrophysiological and imaging findings to inform a diagnosis. |
| # 4 |
Outcome
Employ effective communication with a range of individuals including the patient and the multidisciplinary team. |
| # 6 |
Outcome
Modify and adapt protocols dependent on patients’ needs. |
| # 7 |
Outcome
Assess and manage risks in the testing environment. |