Craniofacial and Trauma Rehabilitation —
Training activity: 13

Details

Perform a clinical examination of a patient with a craniofacial deformity requiring prosthetic rehabilitation

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 performing a clinical examination of a patient with a craniofacial deformity for prosthetic rehabilitation. Consider how the learning outcomes apply, such as assessing and interpreting patient needs and performing clinical investigations.
• Discuss with your training officer to gain clarity on specific criteria for thoroughness, identification of key features, and patient comfort during the examination.

What is your prior experience of this activity?

• Think about what you already know about performing clinical examinations, especially for patients with craniofacial deformities or those requiring prosthetics.
• Consider possible challenges you might face, such as patient anxiety or complex anatomical variations, and think about how you might handle them.
• Recognise the scope of your own practice for clinical examinations of this nature, and know when you will need to seek advice or help and from whom.
• Acknowledge how you feel about undertaking this hands-on clinical examination.

What do you anticipate you will learn from the experience?

• Consider the specific skills you want to develop in palpation, visual assessment, or functional evaluation of craniofacial structures, drawing upon previous observational experiences.
• Identify the specific insights you hope to gain about the impact of craniofacial deformities on patients and the critical factors for successful prosthetic rehabilitation.

What additional considerations do you need to make?

• Consult actions identified following previous experience with patient examinations or observations of senior colleagues that could improve your technique.
• Identify important information you need to consider before performing the examination, such as the specific type of craniofacial deformity, potential prosthetic solutions, or patient.
• What are the challenges you are likely to face in designing a prosthesis?

In action

Is anything unexpected occurring?

• Are you noticing anything surprising or different from what you anticipate during the clinical examination?
• Are you encountering situations such as:
  • An unexpected finding regarding the size, contour, or texture of the craniofacial deformity?
  • The patient reporting unexpected discomfort or pain during gentle palpation of the soft or hard tissues?
  • A physical constraint (e.g., neck mobility issues or limited mouth opening) that hinders standard assessment procedures?
  • Signs of potential active infection or inflammation near the site that was not indicated in the notes?
• Is any aspect of the examination differing from what you are anticipating?

How are you reacting to the unexpected development?

• How is this impacting your actions? Did you adjust your examination technique or approach when something unexpected occurred?
• Consider the steps you are taking in the moment, such as:
  • Immediately adapting the examination sequence or minimising palpation due to reported pain or discomfort?
  • Seeking immediate consultation for a medical red flag (e.g., signs of infection or swelling)?
  • Adjusting lighting or magnification to thoroughly investigate a subtle finding regarding tissue integrity?
• How are you feeling in this moment? Do you feel confident in your ability to adapt and continue the examination effectively while prioritising patient safety?

What is the conclusion or outcome?

• Identify how you are working within your scope of practice (e.g., prioritising patient safety and adapting the exam, and recognising when a medical red flag requires immediate senior or ENT input).
• What are you learning as a result of the unexpected development? For example, are you gaining key learning about performing a thorough examination of a craniofacial deformity and responding to patient needs?

On action

What happened?

• Begin by summarising the key points of the clinical examination, including the specific aspects of the craniofacial deformity and how it relates to prosthetic rehabilitation.
• Consider specific events, actions, or interactions which felt important, including your own feelings during the experience. E.g., Using specific lighting techniques to accurately assess soft tissue colour and texture; encountering limited mouth opening affecting palpation access; or determining the best angle for photographic documentation of the deformity.
• Include any ‘reflect-in-action’ moments where you adapted to the situation (e.g., modifying your examination technique or sequence) as it unfolded.

 

How has this experience contributed to your developing practice?

• Identify what learning you can take from this experience regarding performing focused examinations for craniofacial deformities.
• What strengths did you demonstrate in your examination technique, palpation, or visual assessment?
• What skills and/or knowledge gaps were evident in understanding the anatomical implications of the deformity or its impact on prosthetic design?
• Compare this experience against previous clinical examinations. Were any previous identified actions for development achieved? Has your practice improved in performing focused examinations for craniofacial deformities?
• Identify any challenges you experienced (e.g., patient cooperation, complex anatomical variations, time constraints) 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. Did you need to seek advice or clarification regarding examination findings or their interpretation? Did you need 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 this 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 you received.
• What will you do differently next time you perform such an examination? Has anything changed in terms of your understanding of craniofacial deformities or examination protocols?
• Do you need to practise any specific examination techniques or anatomical knowledge further? E.g., Practising focused palpation and visual assessment of specific craniofacial landmarks relevant to prosthetic retention, or reviewing anatomical knowledge related to common congenital deformities.

Beyond action

Have you revisited the experiences?

• Look back at your reflections on previous clinical examinations for craniofacial deformities. What actions did you pinpoint to enhance your examination technique or your ability to interpret findings? Have you completed these actions, and how will you show this new learning in your next examination?
• Discuss with senior colleagues or peers particular cases involving complex craniofacial deformities. Has their input altered your approach or understanding of the assessment process?

How have these experiences impacted upon current practice?

• How does the learning from these examinations prepare you for in person assessments related to performing clinical examinations?
• How has your practice in analysing and interpreting patient investigations and information, and your ability to assess patients’ needs to provide customised treatment, evolved through these experiences?

Relevant learning outcomes

#	Outcome
# 1	Outcome Deliver quality patient centred care with the best interests of patients in all elements of practice.
# 2	Outcome Practice in accordance with local and national health and safety policies, regulatory requirements and overall service governance.
# 3	Outcome Communicate effectively with patients, relatives, healthcare professionals and other stakeholders.
# 5	Outcome Practice in partnership with other clinical specialisms as part of a multidisciplinary team and understand their roles and their impact on patient care and pathway.
# 6	Outcome Perform clinical investigations, formulate treatment plans and manufacture medical devices to a safe clinical standard.
# 7	Outcome Analyse and interpret patient investigations, multimodal imaging and information.
# 9	Outcome Assess and interpret patients’ needs to provide customised treatment dependent on medical, physical, social and psychological requirements.