Gametes and Fertilisation —
Training activity: 6

Details

Load a catheter for IUI using donor or partner sperm

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 relation to performing witness checks, for example, ensuring mandatory verification of patient identity and material at critical laboratory stages.
• Consider how the learning outcomes apply, specifically how performing accurate witness checks ensures you are practicing in accordance with the statutory and regulatory framework and HFEA requirements.
• Discuss with your Training Officer to gain clarity of what is expected of you in relation to the critical points at which witnessing is mandatory and the level of detail required for documentation.

What is your prior experience of this activity?

• Think about what you already know about the equipment and techniques used for IUI.
• Consider possible challenges you might face during the activity, such as difficult catheter insertion (SOP dependant).
• 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.
• Acknowledge how you feel about performing this clinical procedure that may involve direct patient interaction.

What do you anticipate you will learn from the experience?

• Consider the specific skills you want to develop, such as practical skills in loading a catheter for IUI.
• Identify the specific insights you hope to gain into the clinical aspects of IUI, including patient interaction and procedure flow.

What additional considerations do you need to make?

• If you do not perform IUI at your clinic, ask your peers about their experiences at other clinics.
• Consult actions identified following previous experiences of clinical procedures or patient safety checks, such as at embryo transfer.
• Identify important information you need to consider before embarking on the activity, such as the specific protocol for IUI in your clinic, the relevant HFEA regulations concerning donor or partner sperm, and confirming the timing of the procedure relative to the patient’s ovulation.

In action

Is anything unexpected occurring?

• Are you noticing anything surprising or different from what you anticipate whilst loading the IUI catheter?
• Are you encountering situations such as:
  • The prepared sperm sample quality being different than anticipated?
  • Unforeseen challenges during the IUI procedure itself (e.g., difficulty with the catheter)? (SOP dependant)

How are you reacting to the unexpected development?

• How is this impacting your actions? For example, are you responding to the situation appropriately? Did you need to adjust your handling of the catheter?
• Consider the steps you are taking in the moment, such as modifying the procedure based on technical difficulties (e.g., switching to a different catheter).
• How are you feeling in that moment? For instance, are you finding it difficult if the procedure was technically challenging? Is it affecting your confidence in completing the IUI successfully?

What is the conclusion or outcome?

• Identify how you are working within your scope of practice. For example, were you able to successfully load the catheter? Or are you needing support because you encountered a problem?
• What are you learning as a result of the unexpected development? For example, are you gaining insight into the practical aspects of performing IUI and managing potential difficulties?

On action

What happened?

• Begin by summarising the key steps you took when loading the IUI catheter. How did you ensure the correct sample was used (donor or partner) in accordance with HFEA regulations?
• Consider specific events, actions, or interactions which felt important, such as the communication with the patient regarding the procedure (SOP dependant).
• Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, having to reload the sample in an alternative catheter.
• How did you feel during this experience, e.g., did you feel calm and systematic or stressed by the responsibility of the procedure?

How has this experience contributed to your developing practice?

• Identify what learning you can take from this experience regarding loading a catheter for IUI. What strengths did you demonstrate, e.g., meticulous adherence to aseptic technique?
• What skills and/or knowledge gaps were evident, e.g., ensuring documentation was complete for donor sperm use?
• Compare this experience against previous engagement with similar activities – were any previously identified actions for development related to insemination procedures achieved? Has your practice improved in performing the IUI procedure smoothly and confidently?
• Identify any challenges you experienced, such as patient anxiety or technical issues during catheter use, and how you reacted to this. This might include needing to seek advice or clarification on scope of practice regarding when to abort or modify the procedure due to logistical or technical difficulties.

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 your patient communication prior to and during the procedure.
• What will you do differently next time you approach performing an IUI, for instance, by proactively checking the patient’s history for previous difficult transfers to anticipate potential catheter issues?
• Do you need to practise any aspect of the activity further, such as refining catheter handling skills or key learning outcomes related to applying HFEA regulations?

Beyond action

Have you revisited the experiences?

• How have your subsequent experiences of performing insemination by IUI using donor or partner sperm 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 IUI involved technical difficulty during catheter insertion forced you to re-evaluate the importance of pre-procedural checks and patient comfort management during your first attempt at this training activity (if applicable).
• Considering what you understand about procedural competence, patient care, and handling gametes and instruments during IUI 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 aseptic technique and communication during IUI based on further learning and experiences?
• Has discussing technical challenges during IUI or patient management during the procedure with colleagues, peers, or supervisors changed how you now view your initial experience in this training activity? For example, how professional storytelling with a clinical colleague about the IUI procedure refined your understanding of the critical nature of patient communication and procedural ability.

How have these experiences impacted upon current practice?

• How has the learning from this initial training activity, in combination with subsequent IUI experiences, contributed to your overall confidence and ability in performing clinical procedures and patient management, particularly in preparing for assessments like DOPS or OCEs? For example, how your accumulated skills developed in aseptic technique, delicate handling of instruments, and communication with conscious patients now enable you to confidently perform the IUI procedure and manage patient comfort during a DOPS assessment (if applicable at your clinic).
• How has reflecting back on this specific training activity, combined with everything you’ve learned since, shaped your current approach to performing insemination by IUI? 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 your Training Officer if the prepared donor sperm quality is sub-optimal, recognising this requires immediate procedural modification or support.
• Looking holistically at your training journey, how has this initial IUI experience, revisited with your current perspective, contributed to your development in meeting the learning outcomes related to practicing in accordance with HFEA regulations? For example, how this foundational experience has supported your development in procedural competence and meticulous adherence to clinical protocols, ensuring HFEA compliance during procedures involving gametes.

Relevant learning outcomes

#	Outcome
# 5	Outcome Perform IVF insemination.
# 7	Outcome Practice in accordance with HFEA regulations.