Fertility, Assisted Reproduction and HFEA Regulation —
Training activity: 1

Details

Review case notes as part of preparation for treatment to ensure the treatment pathway is appropriate

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.

Considerations

• Reasons and justification for treatment
• Stimulation regimens
• Factors that influence treatment plan
• Indications for use of donor gametes
• Communication with the multidisciplinary team including the timing of egg collection
• Informed consent given for treatment
• Viral screening
• Record keeping
• HFEA regulations

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 reviewing case notes for treatment preparation, for example, extracting, verifying, or cross-referencing specific information from the patient notes.
• Consider how the learning outcomes apply, specifically in relation to determining a patient’s pathway based on their clinical presentation.
• Discuss with your Training Officer to gain clarity of what is expected of you in relation to the clarity and accuracy of the case note review.

What is your prior experience of this activity?

• Think about what you already know about reviewing clinical case notes or patient histories. Have you reviewed notes in a fertility context before?
• Consider possible challenges you might face during the activity, such as incomplete notes, complex medical histories, or difficulty locating specific information, 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. You will need to seek advice from your Training Officer when required, for example, if the notes suggest a conflict between the historical diagnosis and the current treatment plan.
• Acknowledge how you feel about embarking on this training activity, particularly concerning the responsibility of reviewing patient information that impacts their treatment pathway.

What do you anticipate you will learn from the experience?

• Consider the specific skills you want to develop, such as efficiently navigating case notes, identifying critical information related to diagnosis, or cross-referencing clinical findings with treatment plans.
• Identify the specific insights you hope to gain from engaging with the activity, such as a deeper understanding of how clinical presentation directly dictates treatment decisions.

What additional considerations do you need to make?

• Consult actions identified following previous experience of reviewing patient information or similar tasks.
• Identify important information you need to consider before embarking on the activity, such as the specific patient’s diagnosis or treatment stage, or any particular aspects the Training Officer highlighted for review.

In action

Is anything unexpected occurring?

• Are you noticing anything surprising or different from what you anticipate whilst reviewing the case notes?
• Are you encountering situations such as:
  • Conflicting information or details that surprised you?
  • The patient’s history or previous results deviating from what you anticipated for this treatment pathway?

How are you reacting to the unexpected development?

• How is this impacting your actions? For example, are you immediately recognising the significance of the unexpected information? Are you pausing your review or taking a specific action as a result?
• Consider the steps you are taking in the moment, such as physically flagging the unexpected information.
• How are you feeling in that moment? For instance, are you finding it difficult to maintain focus? Is it affecting your confidence in determining the appropriateness of the treatment pathway?

What is the conclusion or outcome?

• Identify how you are working within your scope of practice. For example, are you making a mental note or physically flagging the unexpected information? Or are you needing support because the finding requires senior input to question the appropriateness of the treatment pathway?
• What are you learning as a result of the unexpected development? For example, are you gaining insight into which specific details require verification during the review process?

On action

What happened?

• Begin by summarising the key steps you took when reviewing the case notes, including the key information you gathered and the process you followed to review them.
• Consider specific events, actions, or interactions which felt important, such as reviewing specific details related to the patient’s clinical presentation or history that verified the current treatment pathway.
• Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, pausing the review and consulting the patient’s historical diagnosis when an initial detail appeared contradictory to the current treatment plan.
• How did you feel during this experience, e.g., did you feel confident in validating the clinical decisions or stressed by the ambiguity in a section of the notes?

How has this experience contributed to your developing practice?

• Identify what learning you can take from this experience regarding determining an appropriate patient pathway based on clinical presentation. What strengths did you demonstrate, e.g., meticulous focus on verifying eligibility criteria?
• What skills and/or knowledge gaps were evident, e.g., unfamiliarity with the weight given to specific historic co-morbidities?
• Compare this experience against previous engagement with similar activities – were any previously identified actions for development achieved? Has your practice improved in systematically checking all required criteria to ensure the pathway is appropriate?
• Identify any challenges you experienced, such as ambiguity in the notes or difficulty linking a historical finding to the present plan. Identify how you reacted to this, e.g., needing to seek advice or clarification on scope of practice regarding which clinical findings should immediately raise a red flag.

What will you take from the experience moving forward?

• Identify the actions or ‘next steps’ you will now take to support the assimilation of what you have learnt, including from any feedback you have received, with regards to improving the efficiency of your note review process.
• What will you do differently next time you approach reviewing case notes for pathway appropriateness, for instance, by proactively establishing a checklist of essential data points to check before validating the treatment pathway.
• Do you need to practise any aspect of the activity further, such as reviewing academic content on specific treatment exclusion criteria or key learning outcomes related to determining a patient’s pathway?

Beyond action

Have you revisited the experiences?

• How have your subsequent experiences of reviewing case notes and contributing to patient pathways since completing this specific training activity led you to revisit your initial approach or decisions during that activity? For example, how an instance where a subsequent urgent case required rapid verification of eligibility criteria forced you to re-evaluate the meticulousness of your initial history review during your first attempt at this training activity.
• Considering what you understand about patient clinical presentation, treatment pathway determination and necessary eligibility checks now, were the actions or considerations you identified after your initial reflection on this training activity sufficient? How have you since implemented or adapted improvements in your case note review process based on further learning and experiences? For example, how you proactively integrated a systematic check of historical treatment outcomes against current diagnosis based on further learning.
• Has discussing complex patient pathways or the criticality of accurate history review with colleagues, peers, or supervisors changed how you now view your initial experience in this training activity? For example, how professional storytelling with a senior colleague about a time when missing a key contraindication in the notes refined your understanding of the critical nature of verifying all patient eligibility criteria during the review process.

How have these experiences impacted upon current practice?

• How has the learning from this initial training activity, in combination with subsequent case note review experiences, contributed to your overall confidence and ability in determining appropriate patient pathways, particularly in preparing for assessments like DOPS or OCEs? For example, how your accumulated ability in critically reviewing information and cross-referencing eligibility criteria now enables you to confidently justify treatment decisions and accurately verify documentation during a Direct Observation of Practical Skills (DOPS) assessment.
• How has reflecting back on this specific training activity, combined with everything you’ve learned since, shaped your current approach to case note review? How does this evolved understanding help you identify when something is beyond your scope of practice or requires escalation? For example, how your evolved approach means you now routinely seek advice from the Training Officer or Clinical Consultant immediately when conflicting information suggests a complex medical history or non-standard diagnosis, recognising this requires senior clinical input regarding the patient pathway.
• Looking holistically at your training journey, how has this initial case note review experience, revisited with your current perspective, contributed to your development in meeting the learning outcomes related to determining a patient’s pathway? For example, how this foundational experience has supported your development in critically reviewing clinical data to ensure accurate pathway planning, which is essential for subsequent specialist modules.

Relevant learning outcomes

#	Outcome
# 1	Outcome Determine a patient’s pathway, including assisted reproduction options and stimulation regimens based on clinical presentation.