Prosthetic Reconstruction, Rehabilitation & Surgical Planning —
Training activity: 13

Details

Lead an assessment and discuss with the individual patient their requirements and expectation for a remake of an orbital prosthesis

Plan, design and manufacture the final prosthesis including the ocular component and provide aftercare support 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?

• Success involves effectively leading the assessment, thoroughly discussing patient requirements and expectations for a remake, and successfully planning, designing, manufacturing (including the ocular component), and fitting the orbital prosthesis, followed by providing comprehensive aftercare support. The outcome must align with the patient’s individual concerns, prognosis, and requirements.
• Pay attention to learning outcomes related to patient assessment, communication, design and manufacture of medical devices, and patient-centred care.
• Clarify the scope and specific details for this complex prosthetic remake.

What is your prior experience of this activity?

• What do you already know about orbital prosthetics, managing patient expectations for such delicate devices, or incorporating ocular components?
• What do you know about the ideal material properties required for an orbital prostheses?
• What specific challenges might you face with an orbital prosthesis remake, such as anatomical complexity, precise colour matching, or integration of the ocular component, and how will you prepare to address them?
• When and from whom would you seek advice regarding ophthalmic considerations or intricate manufacturing techniques?
• Consider how you feel about undertaking a task that directly impacts a patient’s facial appearance and vision-related aspects.

What do you anticipate you will learn from the experience?

• Focus on skills in advanced ocular component integration, nuanced patient communication for highly sensitive cases, or specific aftercare protocols for orbital prostheses.
• What new insights do you hope to gain about the psychological impact of such prostheses on patients, or the long-term management of orbital defects?

What additional considerations do you need to make?

• Revisit any previous reflections or feedback related to facial or ocular prostheses.
• What critical information is needed before the assessment, such as the condition of the anophthalmic socket, patient medical history, or details of the previous prosthesis?

In action

During the activity did anything unexpected occur?

• Are you noticing anything surprising or different from what you anticipate during the process of leading the assessment, ocular matching, or aftercare discussion? Are you encountering situations such as:
  • You encountering an unexpected difficulty in matching the ocular component?
  • The patient having an unanticipated emotional reaction during the fitting or aftercare discussion?
• How does this experience compare with previous experiences of similar activities?

How are you reacting to the unexpected development?

• How is this impacting your actions? For example, did you respond to the situation appropriately, perhaps by adjusting your communication style? Did you adapt or change your approach to the ocular component manufacturing or aftercare counselling? Is it affecting your ability to undertake the activity independently? Consider the steps you are taking in the moment, such as:
  • Are you immediately pausing the fitting to address patient distress or seeking advice on patient communication protocols?
  • Are you consulting technical manuals or senior colleagues regarding an anomaly in the ocular colour matching process?
• Consider how you are feeling in the moment. For instance, are you finding it difficult to adapt? Is it affecting your confidence? Do you feel 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 managing the technical aspects of the design by ensuring the ocular component matching follows established analogue or digital protocols?
  • Are you practicing within your scope by ensuring that aftercare advice is clearly limited to prosthesis maintenance and hygiene, rather than advising on medical issues related to the ocular socket?
  • Are you immediately seeking appropriate specialist support (e.g., nurse specialist or psychology service) if the patient exhibits unanticipated emotional distress?

What are you learning as a result of the unexpected development?

• Are you mastering a rapid troubleshooting method to resolve immediate difficulties in matching the ocular component’s iris colour or scleral vasculature?
• Are you learning how to adjust your communication pace and use empathetic language when you discuss prognosis and aftercare support with a patient who is displaying an unanticipated emotional reaction?

On action

What happened?

• Summarise the key points of the experience, from leading the assessment and discussing patient requirements to the planning, design, manufacturing of the orbital prosthesis (including the ocular component), and providing aftercare support.
• Consider specific events, actions, or interactions that felt important. Did any aspect of matching the ocular component or discussing ocular socket microbiology and reaction to materials prove particularly challenging?
• Include any ‘reflect-in-action’ moments where you adapted to the situation as it unfolded. For example, how did you respond if there was an unexpected difficulty in ocular component matching or if the patient had an unanticipated emotional reaction during the fitting or aftercare discussion?

How has this experience contributed to your developing practice?

• Identify what learning you can take from the experience. What strengths did you demonstrate in managing technical challenges of the ocular component or ensuring continuity in patient care? What skills and/or knowledge gaps were evident (e.g., understanding diseases associated with indwelling ocular prostheses or complex psychosocial support)?
• Compare this experience against previous engagement with similar activities. Has your practice improved in handling the specific nuances of orbital prostheses and aftercare support?
• Identify any challenges you experienced and how you reacted to these. Did these challenges affect your ability to deal with the situation independently?
• Identify anything significant about the activity. Did you need to seek advice or clarification regarding complex ocular manufacturing, patient prognosis, or recognising when onward referral for psychological support was needed?
• 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 safe impression material selection and techniques or develop a structured approach to aftercare support discussion.
• 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 an orbital 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 ocular component matching, aftercare support, or handling the psychological and emotional aspects of rehabilitation?
• 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 orbital prosthesis design with peers, near peers, or colleagues? Has discussing these experiences with others changed your view or understanding of the long-term patient prognosis or the intricacy of ocular manufacture?

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 proficiency in selecting appropriate biomedical materials and understanding ocular socket microbiology enhance your ability to pass an Observed Communication Event (OCE) where you discuss the design of the prosthesis?
• How has your practice related to applying the principals of a quality management system and independent working developed and evolved over time across multiple instances of undertaking this training activity?
• Can you identify specific examples of improvement or increased confidence in maintaining precise aftercare records to ensure the prosthesis adheres to a safe clinical standard?
• Based on your experiences, how has your ability to recognise when something related to orbital prosthetic rehabilitation is beyond your scope of practice improved?
• Do you have a clearer understanding of when and from whom (e.g., ophthalmologist, psychology specialist) you need to seek advice or clarification regarding diseases associated with indwelling ocular prostheses or complex patient grief/loss?

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.