Prosthetic Reconstruction, Rehabilitation & Surgical Planning —
Training activity: 12

Details

Lead an assessment and discuss with a patient their requirements and expectations for a remake of a nasal prosthesis

Plan, design, manufacture and fit a nasal prosthesis based on their individual concerns, prognosis and their individual requirements

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?

• Clearly define the process of leading an assessment, discussing requirements and expectations, and the subsequent planning, design, manufacture, and fitting of a nasal prosthesis. Ensure the final prosthesis addresses the patient’s individual concerns, prognosis, and requirements.
• Consider learning outcomes related to patient-centred care, communication, planning, designing, and manufacturing medical devices.
• Consider the biomechanical properties required for a nasal prosthesis.
• Seek clarity on specific expectations for this particular patient case.

What is your prior experience of this activity?

• What do you already know about leading patient assessments for prosthetic remakes, designing nasal prostheses, or similar custom medical device manufacturing?
• What difficulties might arise during the assessment, discussion, or manufacturing process (e.g., managing patient expectations, complex anatomical considerations, material challenges), and how might you handle them?
• When would you need to seek advice or help, and from whom e.g., a Consultant in Restorative Dentistry, a surgeon, or a specialist nurse?
• How do you feel about embarking on this activity, especially given its focus on individual patient needs and expectations?

What do you anticipate you will learn from the experience?

• What skills do you want to refine, such as advanced communication for managing expectations, detailed prosthetic design based on individual needs, or specific manufacturing techniques?
• What insights do you hope to gain regarding patient communication, the nuances of prosthetic remakes, or the application of different materials for nasal prostheses?

What additional considerations do you need to make?

• Review any actions identified from prior experiences with facial prostheses or similar patient interactions.
• What crucial information do you need before starting, such as patient history, previous prosthesis details, or specific aesthetic requirements?

In action

During the activity is anything unexpected occurring?

• Are you noticing anything surprising or different from what you anticipate during the process of leading the assessment, design, or fitting of the nasal prosthesis? Are you encountering situations such as:
  • The patient revealing new, unstated preferences during the design phase?
  • An unforeseen challenge during the manufacturing or fitting process?
• 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? For example, are you responding to the unexpected challenge appropriately? Are you adapting or changing your approach to patient communication or the manufacturing process? Is it affecting your ability to undertake the activity independently?
• Consider the steps you are taking in the moment, such as:
  • Are you immediately troubleshooting the material failure or revising the physical dimensions of the prosthesis design?
  • Are you seeking advice from a more experienced colleague or your training officer to understand the anomaly with the design or fit?
• Consider how you are feeling in the moment. For instance, are you finding it difficult to adapt? Is it affecting your confidence? Are you feeling positive you can reach a successful conclusion?

What is the conclusion or outcome?

• How are you working within your scope of practice?
  • Are you successfully concluding the fitting by ensuring the chosen materials adhere to national regulatory biocompatibility standards and are correctly documenting for the custom medical device?
  • Are you practicing within your scope by documenting the precise rationale for the design modification (e.g., adjusting retention based on skin condition or anatomical changes) in the patient’s record?
  • Are you successfully managing patient expectations by focusing the discussion on holistic concerns (e.g., social or psychological comfort), while recognising when complex psychological needs required referral?
• What are you learning as a result of the unexpected development?
  • Are you learning a new, rapid technique for manipulating silicone colouration or extrinsic pigmentation based on the unexpected complexity of the patient’s natural skin tone?
  • Are you gaining increased proficiency in anticipating and mitigating common fitting complications (like acoustic seal issues or movement) based on specific anatomical measurements taken during the initial assessment?

On action

What happened?

• Summarise the key points of the experience, from leading the assessment and discussing patient requirements to the planning, design, manufacturing, and fitting of the nasal prosthesis.
• Consider specific events, actions, or interactions that felt important, including your own feelings during the process. Did any particular moment during the assessment, such as clarifying the patient’s prognosis or direct colour matching, stand out?
• Include any ‘reflect-in-action’ moments where you adapted to the situation as it unfolded. For example, how did you adjust if the patient’s preferences required modifying the retention method (e.g., switching from adhesive to an implant-retained design) or if you had to troubleshoot a colour mismatch during extrinsic pigmentation?

How has this experience contributed to your developing practice?

• Identify what learning you can take from the experience. What strengths did you demonstrate, particularly in patient communication or design adaptation for a nasal prosthesis remake? Were any skills or knowledge gaps evident (e.g., unfamiliarity with specific biomedical materials or complex aesthetic expectations)?
• Compare this experience against previous engagement with similar activities. Has your practice improved in handling patient expectations or specific technical aspects of facial prosthetic materials, properties, biocompatibility and colouration?
• Identify any challenges you experienced and how you reacted to these. Were you able to overcome challenges such as managing patient fears/anxiety during the fitting process?
• Identify anything significant about the activity. For instance, did you need to seek advice or clarification regarding long-term patient prognosis or legal documentation requirements?
• Acknowledge any changes in your own feelings now that you are looking back on the experience.

What will you take from the experience moving forward?

• Identify the actions / ‘next steps’ you will now take to support the assimilation of what you have learnt.
• What will you do differently next time? For example, practise direct colour match using traditional analogue processes or review protocols for analysing prognosis based on patient concerns.
• Do you need to practise any aspect of this activity further?

Beyond action

Have you revisited the experiences?

• Have you revisited your previous reflections (reflect-before-action, reflect-in-action, and reflect-on-action) for this specific activity (remaking a nasal prosthesis)?
• When reviewing these past reflections, what actions for improvement did you previously identify you would need to take to improve your practice related to patient assessment and discussion regarding nasal prostheses, ensuring biocompatibility of materials, or adapting the design based on patient prognosis?
• Have you completed these previously identified actions? If not, what are the barriers? 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 this task?
• Have you engaged in professional storytelling or discussed your experiences of planning, designing, manufacturing, and fitting nasal prostheses with peers, near peers, or colleagues? Has discussing these experiences with others changed your view or understanding of handling complex patient expectations or technical challenges in remakes?

How have these experiences impacted upon current practice?

• Considering your cumulative experiences and reflections on this activity, how will the learning you have gained support you in preparing for relevant observed ‘in-person’ assessments for the module? For example, how does your improved understanding of prognosis and individual requirements contribute to your ability to succeed in a Case-based Discussion (CBD) involving a facial prosthesis patient?
• How has your practice related to delivering quality patient-centred care and communicating effectively developed and evolved over time across multiple instances of undertaking this training activity?
• Can you identify specific examples of improvement or increased confidence in efficiently managing communication regarding complex design choices?
• Based on your experiences, how has your ability to recognise when something related to nasal prosthesis design, manufacture, or fit is beyond your scope of practice improved?
• Do you have a clearer understanding of when and from whom (e.g., restorative dentistry consultant, surgical colleague) you need to seek advice or clarification regarding unusual retention methods or complex psychological responses to the prosthesis?

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 Identify patients who need further specialist support and refer to the appropriate healthcare specialist.
# 5	Outcome Analyse and interpret patient investigations, multimodal imaging and information.
# 6	Outcome Perform clinical investigations, formulate treatment plans and manufacture medical devices to a safe clinical standard.
# 8	Outcome Select appropriate biomedical materials and components/instrumentation used in the treatment of patients and the manufacture of custom-made medical devices.
# 9	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.
# 10	Outcome Apply the principals of a quality management system to their professional practice.
# 12	Outcome Assess and interpret patients’ needs to provide customised treatment dependent on medical, physical, social and psychological requirements.