Craniofacial and Trauma Rehabilitation —
Training activity: 15

Details

Resolve a patient issue with a prosthesis. Plan design and manufacture a new improved definitive prosthesis. Collect patient feedback on the innovations at a follow up clinic and critically evaluate your definitive prosthesis

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 resolving the patient’s issue, designing/manufacturing an improved prosthesis, and evaluating it. Consider how the learning outcomes apply, such as patient satisfaction, functional improvement, and critical evaluation.
• Discuss with your training officer to gain clarity on your problem-solving approach, the quality of the new prosthesis, and your evaluation methodology.

What is your prior experience of this activity?

• Think about what you already know about troubleshooting prosthetic issues, designing new devices, or collecting patient feedback.
• Consider possible challenges you might face in diagnosing issues or eliciting feedback and think about how you might handle them.
• Recognise the scope of your own practice for problem-solving, design, and evaluation in prosthetics, and know when you will need to seek advice or help and from whom.
• Acknowledge how you feel about undertaking this multi-faceted training activity.

What do you anticipate you will learn from the experience?

• Consider the specific skills you want to develop in diagnostic assessment of prosthetics, iterative design, patient communication for feedback, and critical self-evaluation.
• Identify the specific insights you hope to gain about the long-term challenges of prosthetic use, the importance of patient feedback, and the continuous improvement cycle in prosthetics.

What additional considerations do you need to make?

• Consult actions identified following previous experience with patient complaints or device modifications that could improve your approach.
• Identify important information you need to consider before embarking on the activity, such as the original prosthesis’s history, the patient’s current symptoms, and available innovative materials or design techniques.

In action

Is anything unexpected occurring?

• Are you noticing anything surprising or different from what you anticipate during the resolution of the patient issue or while planning, designing, and manufacturing the new definitive prosthesis?
• Are you encountering situations such as:
  • The underlying anatomical change (e.g., significant tissue recession or swelling) being the unexpected cause of the issue, requiring a major change to the definitive plan?
  • The new ‘improved’ device failing a quality check during manufacturing or testing?
  • Unexpected patient feedback during the initial assessment (e.g., the patient stating the issue is cosmetic rather than functional, despite your objective findings)?
  • Technical difficulties with the manufacturing software or machinery used for the improved design?
• How is this experience comparing with previous experiences of similar activities?

How are you reacting to the unexpected development?

• How is this impacting your actions? Did you adapt your approach or actions in the moment to resolve the patient issue and ensure the new definitive prosthesis was successfully developed?
• Consider the steps you are taking in the moment, such as:
  • Immediately performing an in-situ adjustment to the old prosthesis to sustain function until the new one is complete?
  • Revising the material selection or structural design instantly based on a new anatomical or tissue finding?
  • Are you consulting troubleshooting manuals or technical support for difficulties encountered in manufacturing the new device?
• How are you feeling in this moment? Is the challenge affecting your confidence in your problem-solving abilities or the feasibility of the innovative design?

What is the conclusion or outcome?

• Identify how you are working within your scope of practice (e.g., recognising when the resolution required consultation with an external maxillofacial prosthetist or surgeon due to anatomical change beyond prosthetic adjustment).
• What are you learning as a result of the unexpected development? For example, are you gaining key learning during the process about efficient troubleshooting algorithms for prosthetic issues, or realising the necessity of linking subjective patient feedback to objective design modifications?

On action

What happened?

• Begin by summarising the key points of the entire process, from resolving the initial patient issue to planning, designing, manufacturing the new prosthesis, collecting feedback, and critically evaluating the outcome.
• Consider specific events, actions, or interactions which felt important, including your own feelings during the experience. E.g., Systematically dismantling the old prosthesis to identify the exact failure point; running a pilot test of the new retention mechanism before final manufacture; or conducting a structured interview to capture functional feedback from the patient.
• Include any ‘reflect-in-action’ moments where you adapted to the situation, e.g., modifying design based on manufacturing limitations or patient input, as it unfolded

How has this experience contributed to your developing practice?

• Identify what learning you can take from this experience regarding problem-solving, design improvement, and patient-centred care.
• What strengths did you demonstrate in problem-solving, innovative design, technical execution, and patient-centred care (feedback collection)?
• What skills and/or knowledge gaps were evident in understanding the root cause of the initial issue, material science for improvement, or effectively gathering feedback?
• Compare this experience against previous prosthesis-related activities. Were any previous identified actions for development achieved?
• Has your practice improved in addressing patient issues, designing for long-term solutions, or critical evaluation?
• Identify any challenges you experienced (e.g., diagnosing the original issue, manufacturing complexities for the “improved” design, obtaining comprehensive patient feedback) 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 on the patient’s concern, design principles, or feedback methods? Did you need to escalate to ensure the patient’s needs were met within your scope of practice?
• Acknowledge any changes in your own feelings now that you are looking back on the experience, particularly regarding patient interaction and critical self-assessment.

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 encounter a prosthesis issue or undertake a redesign project? Has anything changed in terms of your systematic approach to problem-solving and quality improvement?
• Do you need to practise any aspect of this activity further, such as advanced design software or patient communication strategies for feedback? E.g., Practising systematic root cause analysis for prosthesis failure/issues, or refining methods for collecting and analysing patient-reported outcome measures (PROMs), or using advanced design software for iterative prosthesis design.

Beyond action

Have you revisited the experiences?

• Go back to your reflections on resolving patient issues and manufacturing improved prostheses. What actions did you identify for better problem-solving, design innovation, or patient feedback collection? Have these actions been completed, and can you now demonstrate this enhanced learning in practice?
• Share your experiences of resolving patient issues and gathering feedback with peers or senior colleagues. Has this dialogue provided new strategies for innovation or patient management?

How have these experiences impacted upon current practice?

• How will the learning from identifying and resolving patient issues, and critically evaluating prostheses, support your preparation for observed assessments?
• How has your practice in critically evaluating medical devices, incorporating patient feedback, and applying quality management principles developed over time?

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.
# 4	Outcome Apply the principals of a quality management system to their professional practice.
# 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.
# 8	Outcome Select appropriate biomedical materials and components used in the treatment of patients and the manufacture of custom-made medical devices.
# 9	Outcome Assess and interpret patients’ needs to provide customised treatment dependent on medical, physical, social and psychological requirements.