Training activity information
Details
Undertake relevant clinical history of patients referred with respiratory symptoms and develop a plan for further management
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 taking a comprehensive clinical history, including presenting complaint, past medical history, drug history, family history, and social history relevant to respiratory symptoms.
- Consider how the learning outcomes apply, specifically concerning developing a preliminary plan for further management and demonstrating a patient-centred approach.
- Discuss with your training officer to gain clarity of what is expected, perhaps reviewing specific learning outcomes related to evaluating clinical history and identifying causes of common respiratory symptoms.
What is your prior experience of this activity?
- Think about what you already know about taking patient histories, including knowledge of common respiratory symptoms e.g., breathlessness, wheezing, coughing, chest pain and relevant associated factors like smoking or allergies.
- Consider possible challenges you might face during the activity, such as eliciting detailed information, managing sensitive topics (e.g., social history), or developing an initial management plan, and think about how you might handle them.
- Recognise the scope of your own practice for history taking and management planning, and know when you will need to seek advice or help, and from whom.
- Acknowledge how you feel about embarking on this training activity, perhaps considering your confidence in identifying key information or formulating plans.
What do you anticipate you will learn from the experience?
- Consider specific skills you want to develop, such as refining your questioning technique, improving your ability to connect symptoms to underlying causes, or enhancing your diagnostic reasoning for respiratory conditions.
- Identify specific insights you hope to gain regarding the patient’s experience of respiratory disease and its wider social impact.
What additional considerations do you need to make?
- Consult actions identified following previous history-taking experiences or similar assessment activities.
- Identify important information you need to consider before embarking on the activity, such as reviewing typical patient pathways or specific protocols for initial management of respiratory symptoms.
In action
Is anything unexpected occurring?
- Are you noticing anything surprising or different from what you anticipate whilst gathering history or planning management for respiratory symptoms?
- Are you encountering situations such as:
- The elicited symptoms (e.g., breathlessness) contradicting the expected clinical presentation or initial differential diagnosis, challenging your management plan formulation.
- The patient providing a high volume of ambiguous information that masks the key presenting complaint, making efficient history taking difficult.
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 your line of questioning or your initial management ideas?
- Consider the steps you are taking in the moment, such as:
- Rapidly adapting your questioning technique to focus on specific respiratory parameters (e.g., onset, severity, relieving factors) to clarify ambiguous information.
- Seeking immediate advice from a senior colleague or training officer to verify the clinical significance of unusual symptoms or refine your preliminary management plan.
- How are you feeling in that moment? For instance, are you finding it difficult to adapt your diagnostic strategy to the conflicting data? Did it affect your confidence in developing a plan?
What is the conclusion or outcome?
- Identify how you are working within your scope of practice. For example, are you successfully refining the management plan based on the unexpected history? Or are you needing support because the complexity of the symptoms requires senior clinical input for differential diagnosis?
- Identify what you are learning as a result of the unexpected development. For example, are you gaining insight into the hierarchy of criteria used for classifying complex respiratory symptom patterns?
On action
What happened?
- Summarise the key points of the experience of taking a clinical history for respiratory symptoms and developing a management plan.
- Consider specific events, actions, or interactions that felt important during history-taking or planning, including your own feelings during the experience.
- Detail the process of eliciting social history e.g., smoking or occupational exposure and how that impacted the subsequent formulation of the management plan.
- Include any ‘reflect-in-action’ moments where you adapted to the situation as it unfolded, for example, if the patient presented with unusual symptoms or if your initial management ideas needed adjustment.
- Note the specific instance where symptoms of wheezing contradicted the patient’s age and history, requiring an immediate adjustment in the approach to questioning to differentiate potential causes.
How has this experience contributed to your developing practice?
- Identify what learning you can take from this experience of history-taking and plan development for respiratory symptoms.
- What strengths did you demonstrate in gathering information or formulating a plan, and what skills or knowledge gaps were evident e.g., knowledge of common respiratory symptoms or plan development?
- Assess your ability to evaluate the clinical history and identify if your strengths lay in identifying the impact of social history or if a gap existed in understanding aetiology of certain respiratory signs.
- Compare this experience against previous engagements with similar activities. Were any previously identified actions for development achieved? Has your practice in taking clinical histories or developing plans improved?
- Identify any challenges you experienced e.g., vague symptoms, complex medical history and how you reacted to these. Did this affect your ability to develop an appropriate management plan? 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 regarding the history or plan, 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 on your history-taking accuracy. What feedback have you received about your plan for further management?
- What will you do differently next time you undertake a clinical history for respiratory symptoms and develop a management plan? Has anything changed in terms of your approach to questioning or planning? Do you need to practise any aspect of this activity further?
- Practise techniques for achieving conciseness during history taking, or review patient pathways for common respiratory complaints to improve planning efficiency.
Beyond action
Have you revisited the experiences?
- Have you reviewed your actions from your previous reflections for this activity? Did you implement any identified strategies to improve your history-taking technique, such as better structuring your questions or more effectively eliciting social history and its impact?
- How has implementing strategies to improve structuring your questions or more effectively eliciting social history and its impact influenced your subsequent interactions with patients presenting with respiratory symptoms?
- Have you discussed particular respiratory cases or challenging patient histories with peers or supervisors? How did these discussions refine your ability to interpret historical data, such as wheezing or breathlessness, and formulate a preliminary management plan?
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 support your preparation for Case-Based Discussions that require the evaluation of patient histories and the formulation of management strategies?
- How has your improved ability to identify the causes of common respiratory symptoms and evaluate a patient’s clinical history strengthened your preparation for an upcoming Case-Based Discussion?
- How has your ability to identify the causes of common respiratory symptoms and evaluate a patient’s clinical history for respiratory disease improved through repeated exposure and reflection, making you more confident in recognising significant findings that might indicate a deteriorating patient?
- What transferable skills did you develop through this activity? What specific questioning techniques or assessment frameworks for respiratory histories have you found most effective and now consistently apply?
- Identify clear actions for continued development that have been identified in your ability to take comprehensive respiratory histories or develop initial management plans, drawing upon your accumulated experiences.
Relevant learning outcomes
| # | Outcome |
|---|---|
| # 1 |
Outcome
Identify the causes of common respiratory symptoms, including breathlessness (dyspnoea), wheezing, coughing and chest pain. |
| # 2 |
Outcome
Evaluate the clinical history of a patient with respiratory disease or a sleep condition taking into account the history of the presenting complaint, past medical history, drug history, family history and social history. |
| # 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. |