Training activity information
Details
Perform and interpret optical coherence tomography (OCT) imaging 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 OCT imaging look like, including patient positioning, achieving good signal strength, acquiring appropriate scans, and recognising common artefacts?
- What does interpreting the resulting images involve, identifying key anatomical structures and pathological changes?
- Discuss with your training officer to gain clarity on what is expected of you when performing and interpreting OCT.
- What is your prior experience of this activity?
- Think about what you already know about the principles of OCT, operating the equipment, patient alignment, and recognising normal retinal/anterior segment anatomy on OCT scans.
- Consider possible challenges you might face during the procedure, such as poor patient fixation, media opacities (e.g., cataract), difficulty achieving good signal, or identifying subtle pathology on the scan, 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 scans, difficult patients, or interpreting unusual findings.
- Acknowledge how you feel about performing and interpreting OCT imaging independently.
- What do you anticipate you will learn from the experience?
- Consider the specific skills you want to develop in operating different types of OCT (e.g., Time domain, Fourier domain, Swept source), optimising image acquisition, identifying artefacts, and confidently interpreting a range of retinal and potentially anterior segment pathology on OCT – drawing upon previous experiences.
- Identify specific insights you hope to gain regarding the relationship between OCT findings and clinical presentation, how OCT complements other imaging modalities, or applying knowledge of OCT physics to troubleshoot issues.
- What additional considerations do you need to make?
- Consult actions identified following previous experience with OCT or similar cross-sectional imaging techniques, if any.
- Identify important information you need to consider before embarking on the activity, such as the reason for the scan, specific areas of interest based on referral information, potential need for dilation, and expected pathological findings for common conditions.
In action
- Is anything unexpected occurring?
- Are you noticing anything surprising or different from what you anticipate while performing and interpreting OCT imaging?
- Are you encountering situations such as persistent low signal strength or prominent movement artefact despite troubleshooting, or an unexpected anatomical variation or pathology that requires an immediate, non-standard scan pattern modification?
- 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 OCT performance 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 troubleshooting alignment/focus, increasing averaging/repetition, or adapting the scan pattern to better characterise an unexpected finding?
- How are you feeling in that moment? Is the unexpected technical issue affecting your confidence in your ability to obtain diagnostic quality images? Are you finding it challenging to interpret the potentially poor-quality data?
- What is the conclusion or outcome?
- Identify how are you working within your scope of practice when performing and interpreting OCT imaging e.g., are you accurately documenting data reliability limitations caused by patient factors?
- Identify what are you learning as a result of the unexpected development e.g., gaining key learning about OCT fixation management techniques?
On action
- What happened?
- Begin by summarising the key points of the experience of performing and interpreting the OCT imaging.
- Consider specific events, actions, or interactions that felt important during the procedure, such as achieving optimal signal strength, managing fixation issues, or identifying early pathological signs.
- Include any ‘reflect-in-action’ moments, where you had to adapt to the situation as it unfolded, for instance, instantly troubleshooting alignment issues or modifying the scan pattern to capture an unexpected lesion. 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 OCT performance and interpretation.
- What strengths did you demonstrate (e.g., technical proficiency in scanning, ability to recognise artefacts)?
- What skills and/or knowledge gaps were evident (e.g., unfamiliarity with advanced OCT features, difficulty interpreting subtle or complex pathology)?
- Compare this experience against previous OCT activities. Were any previously identified actions for development achieved? Has your practice in obtaining and interpreting diagnostic OCT images improved?
- Identify any challenges you experienced during the procedure (e.g., poor patient compliance, persistent low signal, complex artefacts) 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 an unusual finding or escalating due to data reliability concerns.
- 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 identifying your ability to perform and interpret OCT imaging independently.
- What will you do differently next time you perform OCT? 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 specific troubleshooting steps for movement artefact or focusing on recognising specific pathological layers.
Beyond action
- Have you revisited the experiences?
- Have you reviewed the actions identified in your previous reflections performing and interpreting optical coherence tomography (OCT) imaging?
- What specific actions did you previously identify you would need to take to improve your practice, such as refining your OCT acquisition technique, improving your interpretation skills, or becoming better at identifying artefacts? 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 OCT?
- Engage in professional storytelling about troubleshooting persistent OCT acquisition artefacts (e.g., motion, segmentation errors) or interpreting ambiguous OCT findings 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 OCT will support you in preparing for relevant observed ‘in-person’ assessments for the S-OV-S4 module. This includes DOPS like ‘Set up a patient and perform an OCT’ or ‘Assess an image for artefacts,’ or Case-Based Discussions. This relates to demonstrating your ability to perform and interpret OCT and critically evaluating images.
- How has your practice related to performing and interpreting OCT developed and evolved over time? This includes recognising when something related to this activity is beyond your scope of practice, such as when OCT findings are ambiguous 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. |