Ophthalmic Imaging —
Training activity: 3

Details

Select the appropriate ophthalmic imaging for patients presenting with:

• Retinal disease
• Post-retinal disease

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 creating imaging plans, employing effective communication, modifying and adapting protocols dependent on patients’ needs, assessing and managing risks in the testing environment, and selecting and operating ophthalmic imaging equipment.
  • What does selecting the appropriate imaging modality look like for specific retinal or post-retinal conditions? How do you ensure the selection aligns with the diagnostic question and patient needs?
  • Discuss with your training officer to gain clarity on what is expected of you when selecting imaging for retinal conditions.
• What is your prior experience of this activity?
  • Think about what you already know about common retinal diseases and the suitability of different imaging techniques (e.g., OCT for macula, angiography for vascular issues, fundus photography for documentation).
  • Consider possible challenges you might face, such as atypical presentations, complex co-morbidities, needing to select between seemingly similar options, or patient factors limiting certain techniques, 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 complex cases or less common retinal conditions.
  • Acknowledge how you feel about your ability to select appropriate ophthalmic imaging techniques for the retinal conditions stated.
• What do you anticipate you will learn from the experience?
  • Consider the specific skills you want to develop in differential diagnosis thinking based on patient history and clinical signs and translating that into the optimal imaging selection – drawing upon previous experiences.
  • Identify specific insights you hope to gain regarding the subtle indications for specific imaging techniques, how to prioritise based on the suspected pathology, or the strengths and weaknesses of different modalities for various retinal conditions.
• What additional considerations do you need to make?
  • Consult actions identified following previous experience of selecting diagnostic tests or working with patients with retinal pathology, if any.
  • Identify important information you need to consider before embarking on the activity, such as the specific clinical question from the referral, patient age and cooperation, potential for discomfort with certain techniques (like angiography), and the need to adapt protocols.

In action

• Is anything unexpected occurring?
  • Are you noticing anything surprising or different from what you anticipate while selecting appropriate ophthalmic imaging for patients with retinal or post-retinal disease?
  • Are you encountering situations such as a key imaging technique being unsuitable due to severe media opacity, or the patient presenting with an atypical combination of signs/symptoms that requires selection of a modality not initially considered?
  • How is this experience comparing with previous experiences of similar activities, like selecting imaging for other conditions?
• How are you reacting to the unexpected development?
  • Identify how this is impacting your actions during imaging selection. 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 consulting senior advice regarding the optimal selection when the primary choice is technically limited, or quickly justifying your alternative selection based on the specific clinical question?
  • How are you feeling in this moment? Is the need for immediate adaptation affecting your confidence in justifying the selected modality for the specific retinal condition?
• What is the conclusion or outcome?
  • Identify how are you working within your scope of practice when selecting ophthalmic imaging for patients with retinal or post-retinal disease e.g., are you confirming the suitability of the modality with a senior clinician before proceeding with a major change?
  • Identify what are you learning as a result of the unexpected development e.g., gaining insight into the limitations of specific modalities in the presence of media opacity?

On action

• What happened?
  • Begin by summarising the key points of the experience of selecting the appropriate imaging modality for the retinal/post-retinal condition.
  • Consider specific events, actions, or interactions that felt important during the selection, such as justifying the choice based on pathology, considering media opacities, or adapting to patient constraints.
  • Include any ‘reflect-in-action’ moments, where you had to adapt to the situation as it unfolded, for instance, switching from OCT to fundus photography due to a severe cataract. 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 selecting imaging for retinal pathology.
  • What strengths did you demonstrate e.g., clinical reasoning in test selection, knowledge of modality limitations?
  • What skills and/or knowledge gaps were evident e.g., unfamiliarity with the optimal modality for a rare retinal presentation or insufficient understanding of modality limitations?
  • Compare this experience against previous test selection activities. Were any previously identified actions for development achieved? Has your practice in selecting appropriate imaging improved?
  • Identify any challenges you experienced during selection e.g., atypical presentation, technical limitations 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 the most suitable test or escalating to ensure you were working within your scope of practice.
  • 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 you will now take to support the assimilation of what you have learnt, including from any feedback you have received with regards to your ability to select appropriate imaging for the stated diseases.
  • What will you do differently next time you select imaging for retinal disease? 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 differential diagnosis to refine test selection.

Beyond action

• Have you revisited the experiences?
  • Have you reviewed the actions identified in your previous reflections for selecting the appropriate ophthalmic imaging for patients presenting with retinal or post-retinal disease?
  • What specific actions did you previously identify you would need to take to improve your practice, such as improving your understanding of how different imaging modalities apply to specific retinal conditions, or refining your selection process based on the stage or type of disease? 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 selecting imaging for retinal disease?
  • Engage in professional storytelling about the process of selecting and justifying imaging modalities for subtle or ambiguous retinal/post-retinal disease presentations, or cases where the imaging choice significantly impacted clinical management 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 selecting imaging for retinal disease 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 a range of modalities and combine information from imaging findings to inform a diagnosis.
  • How has your practice related to selecting imaging for retinal disease developed and evolved over time? This includes recognising when something related to this activity is beyond your scope of practice, such as when dealing with rare or complex disease presentations that require specialist input.

Relevant learning outcomes

#	Outcome
# 1	Outcome Create imaging plans based on referral information.
# 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.
# 8	Outcome Select and operate ophthalmic imaging equipment.