Training activity information
Details
Perform clinical assessments of patients presenting with suspected sleep disordered breathing
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 conducting a comprehensive clinical assessment for suspected sleep disordered breathing.
- Consider how the learning outcomes apply, specifically concerning applying anatomical and physiological principles, using scoring tools (e.g., Mallampati), and performing assessments like body mass index and airway assessments. Success also involves demonstrating patient-centred care and recognising deteriorating patients.
- Discuss with your training officer to gain clarity on specific assessment techniques, expected findings, and the scope of assessment for sleep disordered breathing.
What is your prior experience of this activity?
- Think about what you already know about clinical assessment techniques, physiological landmarks, normal/abnormal findings related to the respiratory and cardiovascular systems, and specific features consistent with sleep disordered breathing.
- Consider possible challenges you might face during the activity, such as performing a thorough physical examination, interpreting findings, or using specific assessment tools, and think about how you might handle them.
- Recognise the scope of your own practice for performing clinical assessments in this context and know when you will need to seek advice or help, and from whom e.g., for escalation of deteriorating patients.
- Acknowledge how you feel about embarking on this training activity, particularly your confidence in applying various assessment techniques and recognising subtle signs.
What do you anticipate you will learn from the experience?
- Consider specific skills you want to develop, such as refining your physical examination techniques (e.g., inspection, palpation, percussion, auscultation), effectively using assessment tools, or integrating clinical findings to form differential diagnoses related to sleep disordered breathing.
- Identify specific insights you hope to gain regarding the patient’s journey with suspected sleep disordered breathing and the impact of your assessment on their care.
What additional considerations do you need to make?
- Consult actions identified following previous clinical assessment experiences, especially those involving respiratory or sleep conditions.
- Identify important information you need to consider before embarking on the activity, such as preparing the patient environment, understanding patient comfort during the assessment, and reviewing relevant anatomical structures and syndromes.
In action
Is anything unexpected occurring?
- Are you noticing anything surprising or different from what you anticipate whilst performing the clinical assessment of sleep disordered breathing?
- Are you encountering situations such as:
- Significant difficulty performing an airway assessment e.g., Mallampati score due to patient factors like body habitus, complicating the documentation of clinical findings.
- Encountering subtle clinical findings e.g., abnormal breath sounds or unusual anatomical variations like cleft palate that challenge your initial assessment that this is a routine sleep disordered breathing case.
How are you reacting to the unexpected development?
- How is this impacting your actions? For example, are you responding appropriately to an unusual symptom or finding? Are you adapting your assessment technique or line of questioning?
- Consider the steps you are taking in the moment, such as:
- Immediately adapting your physical examination technique (e.g., changing patient positioning) to secure an optimal assessment or seeking immediate advice on the interpretation of an unexpected physical finding.
- Actively recalling or reviewing scoring tool criteria (e.g., for Mallampati) to ensure accurate measurement despite difficulties.
- How are you feeling in that moment? For instance, are you finding it difficult to adapt your anatomical knowledge or physics principles to the challenging patient factors? Did it affect your confidence in performing the assessment?
What is the conclusion or outcome?
- Identify how you are working within your scope of practice. For example, are you successfully compensating for patient factors to complete the assessment? Or are you needing support because the interpretation of abnormal breath sounds requires senior clinical review?
- Identify what you are learning as a result of the unexpected development. For example, are you mastering a more effective technique for performing a challenging clinical assessment or gaining insight into the nuances of specific anatomical findings?
On action
What happened?
- Summarise the key points of the experience of performing a clinical assessment for suspected sleep disordered breathing.
- Detail the use of scoring tools (e.g., Mallampati) and the process of measuring parameters such as body mass index (BMI), noting how these physical assessments were integrated with the patient history.
- Include any ‘reflect-in-action’ moments where you adapted to the situation as it unfolded, for example, if you encountered an unusual symptom or finding e.g., unexpected anatomical variation like cleft palate, and how you adjusted your assessment technique or line of questioning.
- Describe how you immediately adjusted your physical examination technique e.g., focusing on inspection of the chest for hyperinflation when non-specific symptoms were reported, to ensure a comprehensive assessment.
How has this experience contributed to your developing practice?
- Identify what learning you can take from this experience of performing clinical assessments for sleep disordered breathing.
- What strengths did you demonstrate in your assessment skills or diagnostic reasoning, and what skills or knowledge gaps were evident in this specific area e.g., applying anatomical and physiological principles, or using specific assessment tools?
- Assess your strength in integrating history with physical findings (e.g., signs of hyperinflation), and identify if a gap exists in using specific scoring tools (e.g., Mallampati) accurately.
- Compare this experience against previous engagements with similar activities. Were any previously identified actions for development achieved? Has your practice in assessing patients with suspected sleep disordered breathing improved?
- Identify any challenges you experienced e.g., non-specific symptoms, patient comorbidities, technical issues and how you reacted to these. Did this affect your ability to perform a comprehensive assessment? 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 on assessment findings or differential diagnoses, 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 received about your ability to perform these clinical assessments.
- What will you do differently next time you perform a clinical assessment for suspected sleep disordered breathing? Has anything changed in terms of your assessment approach or diagnostic consideration? Do you need to practise any aspect of this assessment further?
- Plan to review the foundational knowledge of physiological landmarks and normal/abnormal breath sounds (e.g., crackles, wheezes) to enhance the accuracy of future physical examination techniques.
Beyond action
Have you revisited the experiences?
- Have you reviewed your actions from your previous reflections for this activity? Did you revisit your reflect-on-action notes, particularly concerning challenges or learning points, and apply these insights in subsequent assessments? Have you successfully addressed any previous skill or knowledge gaps identified?
- If a skill gap was previously identified in using scoring tools (e.g., Mallampati) or conducting specific airway assessments, how have you addressed this gap in subsequent patient assessments?
- Have you discussed complex cases of suspected sleep disordered breathing with senior clinicians or peers, engaging in professional storytelling? How did these discussions broaden your diagnostic perspective and refine your assessment approach, particularly regarding integrating the clinical examination of the cardiovascular system with the sleep history?
How have these experiences impacted upon current practice?
- Consider how your learning will support you in preparing for the observed ‘in-person’ assessments for the module. How does this ongoing learning contribute to your readiness for relevant Direct Observations of Practical Skills (DOPS) or Case-Based Discussions that require clinical assessment and interpretation in sleep medicine?
- How has your confidence and proficiency in performing comprehensive clinical assessments for sleep disordered breathing increased through repeated practice, strengthening your ability to apply anatomical and physiological principles?
- Consider how your practice has developed and evolved over time. Has your appreciation for the range of sleep disorders and their common signs and symptoms evolved, enabling more accurate identification of key signs during the physical examination?
- What transferable skills did you develop through this activity? What specific components of the clinical assessment e.g., airway assessment, physical examination, symptom evaluation do you now feel particularly strong in, and what areas still require further refinement, such as the ability to interpret abnormal breath sounds?
- What clear actions have you identified to deepen your expertise in this specialised area of clinical assessment, perhaps by seeking out diverse patient presentations or engaging with new research?
Relevant learning outcomes
| # | Outcome |
|---|---|
| # 1 |
Outcome
Identify the causes of common respiratory symptoms, including breathlessness (dyspnoea), wheezing, coughing and chest pain. |
| # 3 |
Outcome
Perform a clinical assessment of a patient with respiratory disease or a sleep condition ensuring recognition of the deteriorating patient and appropriate methods of escalation where appropriate. |
| # 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. |
| # 5 |
Outcome
Interpret the results of a clinical assessment and communicate effectively with respiratory scientists and non-respiratory health care colleagues. |