Clinical Assessment in Respiratory and Sleep Science —
Training activity: 1

Details

Obtain informed consent from  patients to undertake a clinical history and assessment

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 obtaining informed consent.
• Consider how the learning outcomes apply, specifically concerning effectively communicating a complex procedure using lay terms to ensure the patient can provide consent, and demonstrating a patient-centred approach and effective communication.
• Discuss with your training officer to gain clarity on what is expected of you regarding the process and documentation of consent.

What is your prior experience of this activity?

• Think about what you already know about obtaining informed consent, including relevant legal and professional issues.
• Consider possible challenges you might face during the activity, such as communication barriers e.g., with patients with dementia, autism, or hearing impairment, or managing patient anxiety, and think about how you might handle them.
• Recognise the scope of your own practice for obtaining consent and know when you will need to seek advice or help, and from whom.
• Acknowledge how you feel about embarking on this training activity, particularly concerning communicating sensitive information or complex procedures.

What do you anticipate you will learn from the experience?

• Consider the specific skills you want to develop, such as optimising verbal and non-verbal communication, or adapting your language for clarity.
• Identify specific insights you hope to gain about patient engagement and ensuring truly informed consent.

What additional considerations do you need to make?

• Consult actions identified following previous experiences of obtaining consent or similar communication tasks.
• Identify important information you need to consider before embarking on the activity, such as patient-specific communication needs or the specific requirements for consent related to the clinical history and assessment.

In action

Is anything unexpected occurring?

• Are you noticing anything surprising or different from what you anticipate whilst explaining the clinical history and assessment procedure?
• Are you encountering situations such as:
  • The patient having high anxiety regarding the complexity of the assessment procedure, complicating the informed consent discussion.
  • A technical issue or communication barrier e.g., the patient having hearing impairment or struggling with lay terms that prevents successful comprehension of the procedure.

How are you reacting to the unexpected development?

• How is this impacting your actions? For example, are you responding to the situation appropriately? Are you adapting or changing your communication style or approach to explaining the procedure?
• Consider the steps you are taking in the moment, such as:
  • Immediately changing your explanation approach to simplify technical terms or using visual aids to address patient confusion.
  • Seeking immediate clarification from a supervisor on how to address complex concerns raised by the patient regarding the assessment risks or next steps.
• How are you feeling in that moment? For instance, are you finding it difficult to maintain clarity while managing patient anxiety? Is it affecting your confidence in reaching a successful conclusion of obtaining consent?

What is the conclusion or outcome?

• Identify how you are working within your scope of practice. For example, are you successfully resolving the communication issue yourself? Or are you needing support because the patient’s anxiety level requires senior clinical review?
• Identify what you are learning as a result of the unexpected development. For example, are you gaining insight into a more effective technique for explaining complex information concisely?

On action

What happened?

• Begin by summarising the key points of the experience of obtaining informed consent for a clinical history and assessment.
• Consider specific events, actions, or interactions that felt important during the consent process, including your own feelings at the time.
• Detail the specific steps taken to ensure the patient understood the assessment procedure, noting any points where you felt uncertainty or required high concentration.
• Include any ‘reflect-in-action’ moments where you adapted to the situation as it unfolded, for example, if the patient raised unexpected questions or concerns, and detail how you adjusted your explanation.
• Describe the necessity of immediately adjusting the explanation when the patient raised an unexpected query regarding the legal implications of providing consent, and how you ensured comprehension.

How has this experience contributed to your developing practice?

• Identify what learning you can take from this experience of obtaining consent.
• What strengths did you demonstrate e.g., explaining the assessment, and what skills or knowledge gaps were evident regarding the consent process or patient communication?
• Assess whether your strength in demonstrating a patient-centred approach was evident, or if a gap was identified in explaining the potential risks of the clinical history component.
• Compare this experience against previous engagements with similar activities. Were any previously identified actions for development in obtaining consent achieved? Has your practice in this area improved?
• Identify any challenges you experienced e.g., patient anxiety, complex questions and how you reacted to these. Did this affect your ability to obtain consent effectively? Were you able to overcome the challenges?
• Acknowledge any changes in your own feelings now that you are looking back on the experience.
• Identify anything significant about the activity, such as if you needed to seek advice or clarification, or if you needed to escalate to ensure you were working within your scope of practice.

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 learned, including from any feedback you have had with regards to you gaining informed consent from a patient. What has been said about your communication skills with patients in this context?
• What will you do differently next time you obtain informed consent? Has anything changed in terms of what you would do if faced with a similar situation again? Do you need to practise any aspect of obtaining consent further, such as explaining specific parts of the assessment?
• Plan to specifically review legal and professional issues related to consent documentation to improve future confidence, or practise explaining the specific features of the clinical assessment.

Beyond action

Have you revisited the experiences?

• Have you reviewed your actions from your previous reflections for this activity?
• What specific actions did you previously identify you would need to take to improve your practice related to the consent-taking process? Have you actively worked on completing those actions, and are you now ready to demonstrate improved proficiency in this area?
• Since identifying the need to clarify legal and professional issues regarding documentation, have you implemented this learning to improve your subsequent consent records?
• Consider if your view of the situation has changed because of analysing this with others. Have you engaged in discussions about the nuances of informed consent, perhaps focusing on challenging cases or ethical considerations?
• How has discussing a complex case (e.g., patient capacity) with a senior clinician altered or deepened your understanding of the intricacies of obtaining consent?

How have these experiences impacted upon current practice?

• Consider how the accumulated learning from performing or reflecting on this activity will support your future development and preparation for assessments.
• Consider how your learning from this training activity contributes to your ability to perform well in observed ‘in-person’ assessments for the module, particularly Observed Communication Events (OCEs) where explaining complex procedures and obtaining informed consent are assessed.
• Has your confidence in clearly explaining procedures, potential risks, and benefits to patients increased, directly supporting your performance in an OCE?
• Consider how your practice has developed and evolved over time, including recognising when something is beyond your scope of practice. How has your overall understanding of patient autonomy and shared decision-making evolved since your initial engagement, making you more attuned to recognising when additional support or clarification may be needed for a patient to provide truly informed consent?
• What transferable skills did you develop through this activity, and how will this understanding help you adapt to new challenges in the future? What transferable communication skills have you refined e.g., adapting language for clarity which can be applied to other areas of patient interaction?
• Identify clear actions for continued development in the area of obtaining informed consent, particularly regarding adapting your approach to diverse patient needs or complex information.

Relevant learning outcomes

#	Outcome
# 1	Outcome Identify the causes of common respiratory symptoms, including breathlessness (dyspnoea), wheezing, coughing and chest pain.
# 4	Outcome Demonstrate a patient centered approach to practice, considering communication with patients and relatives, the patient’s experience, quality of life and the wider social impact on the patient and their family.