Advanced Diagnostics in Respiratory and Sleep Science —
Training activity: 1

Details

Undertake diagnostic investigations in the following range of patients/conditions and interpret the findings

• Suspected muscle weakness
• Suspected asthma or COPD
• 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 undertaking and interpreting diagnostic investigations for conditions such as suspected muscle weakness, asthma/COPD, or sleep-disordered breathing.
• Consider how the learning outcomes apply, specifically concerning preparing equipment and the environment, preparing patients, selecting appropriate diagnostic assessments based on referral criteria, generating reports, and demonstrating a patient-centred approach.
• Discuss with your training officer to gain clarity on expectations for interpreting findings, ensuring you draw upon your knowledge of the physiology of the lungs and different pathophysiologies.
• Ensure your interpretation draws upon knowledge of the physiology of the lungs and different pathophysiologies to effectively answer clinical questions.

What is your prior experience of this activity?

• Think about what you already know about undertaking and interpreting these specific diagnostic investigations.
• Consider possible challenges you might face, such as equipment preparation, patient preparation, or interpreting complex findings, and think about how you might handle them.
• Recognise the scope of your own practice; know when you will need to seek advice or help, for example, if you encounter an unexpected patient response or a complex diagnostic finding that is beyond your current scope of practice.
• Acknowledge how you feel about embarking on this training activity, especially regarding managing different patient conditions and interpreting diverse results.
• Anticipate a challenge in interpreting results for suspected muscle weakness and plan to review different methods and reference ranges used in muscle study investigations.

What do you anticipate you will learn from the experience?

• Consider the specific skills you want to develop related to conducting and interpreting investigations, including patient preparation, using different methods, and interpreting reference ranges.
• Identify specific insights you hope to gain regarding report generation and answering clinical questions effectively.
• Aim to develop specific skills in selecting appropriate diagnostic assessments based on referral criteria, especially when differentiating between COPD and asthma.

What additional considerations do you need to make?

• Consult any actions identified from previous experiences related to diagnostic investigations or patient communication that you need to consider before starting.
• Identify important information you need to review, such as specific protocols for lung function testing, muscle function tests, or multichannel sleep studies.
• Review the protocol for multichannel sleep studies before assessment to ensure familiarity with the required setup.

In action

Is anything unexpected occurring?

• Are you noticing anything surprising or different from what you anticipate whilst performing the diagnostic investigation or interpreting the findings?
• Are you encountering situations such as:
  • A technical issue that leads to significant artefact or noise on the trace, compromising recording quality, or a failure of the physiological monitoring equipment to initiate recording?
  • Identifying an unusual or novel finding e.g., complex pattern in a muscle weakness study, or an atypical sleep-related rhythm disturbance that falls outside standard training examples, challenging your interpretation approach?
  • The investigation findings contradicting the expected clinical presentation e.g., finding severe airflow obstruction in an asymptomatic patient, complicating the diagnostic process?

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 approach to investigation technique or interpretation strategy?
• Consider the steps you are taking in the moment, such as:
  • Troubleshooting the monitoring connections immediately to eliminate noise or artefact to secure a good quality recording.
  • Seeking immediate advice from a senior colleague or training officer to verify the classification or clinical significance of a complex or ambiguous physiological finding.
  • Immediately consulting a specific reference guide to apply criteria for interpreting findings.
• How are you feeling in that moment? For instance, are you finding it difficult to adapt your interpretation strategy? Is it affecting your confidence in conducting the investigation or interpreting the results?

What is the conclusion or outcome?

• Identify how you are working within your scope of practice. For example, are you successfully resolving the technical issue yourself? Or are you needing support because the complexity of the finding requires senior clinical review?
• Identify what you are learning as a result of the unexpected development. For example, are you mastering a more efficient technique for troubleshooting technical issues? Or gaining insight into the hierarchy of criteria used for classifying complex physiological findings?

On action

What happened?

• Begin by summarising the key points of the experience of undertaking the diagnostic investigation e.g., for suspected muscle weakness, suspected asthma or COPD, suspected sleep disordered breathing and interpreting the findings.
• Consider specific events, actions, or interactions that felt important during the investigation or interpretation, including your own feelings.
• Detail how you approached interpretation, the key findings you observed e.g., complex pattern in a muscle weakness study, and any challenges with equipment or signal quality.
• Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, troubleshooting a technical issue immediately or adapting your interpretation strategy due to an unexpected finding.
• Describe the necessity of troubleshooting the monitoring connections to eliminate artefact or noise to secure a good quality recording during the investigation.

How has this experience contributed to your developing practice?

• Identify what learning you can take from this experience regarding performing and interpreting these diagnostic tests.
• What strengths did you demonstrate e.g., technical skills in acquiring data? What skills and/or knowledge gaps were evident e.g., specific conditions or artefact recognition?
• Assess your strength in preparing patients for the investigation versus a knowledge gap in understanding how different pathophysiologies (like asthma or COPD) manifest in diagnostic results.
• Compare this experience against previous engagement with similar activities. Were any previously identified actions for development achieved? Has your practice in conducting or interpreting these investigations improved?
• Identify any challenges you experienced e.g., unexpected patient cooperation issues, complex data, ambiguous findings and how you reacted to these. Did this affect your ability to deal with the situation effectively? Were you able to overcome the challenges?
• Identify anything significant about the activity. Did you need to seek advice or clarification regarding the protocol or interpretation? Did you need to escalate findings to ensure you were working within your scope of practice?
• Acknowledge any changes in your own feelings now that you are looking back on the experience.

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 undertake diagnostic investigations across the range of conditions.
• What will you do differently next time you undertake a diagnostic investigation or interpret its findings? Has anything changed in terms of what you would do if you were faced with a similar situation again?
• Plan to specifically review different methods and reference ranges used in muscle study investigations to improve the accuracy of future reports.
• Do you need to practise any aspect of this activity further to improve your proficiency?

Beyond action

Have you revisited the experiences?

• Have you reviewed your actions from your previous reflections for this activity? What specific steps did you plan to take to improve your practice in areas like patient preparation, equipment handling for specific investigations e.g., suspected muscle weakness, suspected asthma or COPD, or suspected sleep disordered breathing, or interpretation of findings? Have you successfully completed these actions, and are you now ready to consistently demonstrate this new learning in your current and future diagnostic practice?
• Engage in professional storytelling with peers, near peers, or colleagues. Did discussing your approach to patients with suspected asthma/COPD or sleep-disordered breathing change your perspective or understanding? Such as considering how discussing the approach to interpreting findings in patients with suspected asthma/COPD with peers influenced your systematic approach to diagnosis.

How have these experiences impacted upon current practice?

• Consider how the accumulated learning from performing or reflecting on these diagnostic investigations will support your future development and preparation for assessments.
• How will the collective learning from these investigations support your preparation for observed ‘in-person’ assessments, particularly related to patient assessment or report generation?
• How has your practice in undertaking these diverse diagnostic investigations evolved over time? Are you more adept at recognising when a patient’s condition or an investigation procedure is beyond your current scope of practice, requiring you to seek advice or escalate?
• What transferable skills did you develop through this activity, and how will this understanding help you adapt to new challenges in the future? Such as systematic data acquisition and interpretation of physiological findings which can be applied to other advanced diagnostic tests.
• Identify clear actions for continued development in the area of undertaking and interpreting diverse diagnostic investigations. Such as planning future actions to address remaining skill gaps in interpreting complex muscle weakness patterns or refining techniques for patient preparation.

Relevant learning outcomes

#	Outcome
# 1	Outcome Prepare equipment and the environment in order to undertake advanced respiratory diagnostic investigations.
# 2	Outcome Prepare patients to undergo advanced respiratory diagnostic investigations.
# 3	Outcome Select the appropriate diagnostic assessment based on referral criteria.
# 5	Outcome Generate reports and answer clinical questions using the results of investigations, other physiological parameters and patient history.
# 6	Outcome Employ effective communication skills and compassion with a range of patients enabling patients to understand their treatment pathway.
# 7	Outcome Demonstrate a patient centered approach to practice, considering communication with patients and relatives and the patient experience.