Advanced Diagnostics in Respiratory and Sleep Science —
Training activity: 2

Details

Interpret full lung function tests in the following range of conditions and make recommendations for further testing to aid patient management

• Airflow obstruction
• Intra-thoracic restrictive ventilatory defect
• Extra-thoracic restrictive ventilatory defect

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 when interpreting full lung function tests for airflow obstruction, intra-thoracic restrictive ventilatory defect, and extra-thoracic restrictive ventilatory defect.
• Consider how the learning outcomes apply, specifically concerning generating comprehensive reports and making recommendations for further testing to aid patient management. Success also involves ensuring interpretations demonstrate a patient-centred approach and effective communication.
• Discuss with your training officer to gain clarity on expectations for interpretation and recommendations. Discuss the clarity expected for making recommendations for further testing based on complex lung volume results.

What is your prior experience of this activity?

• Think about what you already know about interpreting spirometry, lung volumes, transfer factor, and reversibility tests.
• Consider possible challenges you might face in distinguishing between different types of restrictive defects or in formulating appropriate recommendations, 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 instance, when interpreting complex or ambiguous test results.
• Acknowledge how you feel about embarking on this training activity, especially regarding the responsibility of making management recommendations.
• If previous experience involved simple obstruction, acknowledge the challenge of distinguishing between intra-thoracic and extra-thoracic restrictive ventilatory defect based on lung volume patterns.

What do you anticipate you will learn from the experience?

• Consider the specific skills you want to develop in interpreting diverse lung function patterns and formulating precise recommendations.
• Identify specific insights you hope to gain into how these interpretations influence patient management and how to communicate them effectively, potentially in a multidisciplinary team meeting setting.
• Focus on gaining insight into how lung function interpretation is communicated in a multidisciplinary team meeting setting to influence patient management.

What additional considerations do you need to make?

• Review actions identified from previous experiences related to interpreting lung function tests or making clinical recommendations.
• Identify important information you need to consider, such as specific guidelines for interpretation or patient history, before interpreting these test results.
• Review specific guidelines for interpretation to ensure accurate classification of the degree of airflow obstruction.

In action

Is anything unexpected occurring?

• Are you noticing anything surprising or different from what you anticipate whilst interpreting the lung function tests or formulating recommendations?
• Are you encountering situations such as:
  • Ambiguous lung volume results that make precise distinction between intra-thoracic and extra-thoracic restrictive ventilatory defects difficult, challenging your interpretation?
  • A discrepancy between the spirometry results and the transfer factor results that is difficult to correlate with common pathophysiologies?

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 interpretation methodology or your recommendations for further testing?
• Consider the steps you are taking in the moment, such as:
  • Immediately consulting specific interpretation guidelines to apply criteria for classifying unusual patterns of airflow obstruction or restrictive defect.
  • Seeking immediate advice from a senior colleague to verify the clinical significance of a complex or ambiguous lung function finding.
  • Adapting the phrasing of the report to clearly communicate the uncertainty or ambiguity of the defect classification.
• 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 interpreting the results or making recommendations?

What is the conclusion or outcome?

• Identify how you are working within your scope of practice. For example, are you successfully synthesising complex data into a concise report? Or are you needing support because the interpretation of the defect requires senior expert input?
• Identify what you are learning as a result of the unexpected development. For example, are you gaining insight into best practice for reporting findings with clinical ambiguity? Or mastering a more efficient strategy for correlating multiple lung function parameters?

On action

What happened?

• Begin by summarising the key points of the experience of interpreting full lung function tests e.g., for airflow obstruction, intra-thoracic restrictive ventilatory defect, extra-thoracic restrictive ventilatory defect and making recommendations.
• Consider specific events, actions, or interactions that felt important during the interpretation or recommendation process, including your own feelings.
• Detail how you interpreted spirometry, lung volumes, and transfer factor, focusing on the distinction between the restrictive ventilatory defects.
• Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, consulting specific interpretation guidelines immediately due to an unusual test pattern or adapting your interpretation strategy due to a complex patient history impacting your recommendations.
• Describe how you immediately consulted external resources when faced with ambiguous lung volume results that made precise distinction between restrictive defects difficult.

How has this experience contributed to your developing practice?

• Identify what learning you can take from this experience regarding interpreting lung function tests and making recommendations.
• What strengths did you demonstrate e.g., applying knowledge of lung physiology? What skills and/or knowledge gaps were evident e.g., interpreting complex patterns or tailoring recommendations?
• Evaluate your strength in applying physiological knowledge to classify airflow obstruction, versus a gap in formulating precise recommendations for further testing to aid patient management.
• Compare this experience against previous engagement with similar interpretation activities. Were any previously identified actions for development achieved? Has your practice in interpreting these tests or making recommendations improved?
• Identify any challenges you experienced e.g., conflicting test results, difficult clinical context, uncertainty in recommendations 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 interpretation guidelines or management pathways? 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 interpret full lung function tests. What feedback have you had about the recommendations for further testing you have made for the different conditions?
• What will you do differently next time you interpret lung function tests or make recommendations? Has anything changed in terms of what you would do if you were faced with a similar situation again?
• Resolve to review national and international guidelines to ensure accurate classification of defects and appropriate recommendations for further testing.
• 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 actions did you identify for improving your interpretation skills, especially for challenging cases like complex restrictive defects, or your ability to formulate recommendations for further testing to aid patient management, especially for defects like intra-thoracic or extra-thoracic restrictive ventilatory defect? Have these actions been implemented, and do you feel confident in demonstrating an improved ability to interpret and recommend based on lung function tests?
• Engage in professional storytelling with peers, near peers, or colleagues. Did discussing your approaches to interpreting lung function tests for various conditions with peers or senior colleagues alter your understanding or approach to specific patterns, such as severe airflow obstruction or mixed defects?

How have these experiences impacted upon current practice?

• Consider how this accumulated experience will contribute to your success in relevant ‘in-person’ assessments, such as communicating results in a multidisciplinary team meeting or lung function findings.
• Reflect on how your ability to interpret and make recommendations has matured. Can you now more confidently identify nuanced patterns, or are you more aware of the limitations of your current scope when dealing with highly complex or rare conditions? For example, identify when complex restrictive defects exceed the current scope of practice, requiring senior input.
• What transferable skills did you develop through this activity? For example, clinical reasoning and applying national and international guidelines for interpretation that can be used across other diagnostic reporting tasks.
• Identify clear actions for continued development in the area of interpreting full lung function tests and making recommendations. For example, planning to dedicate time to review guidelines for interpreting ambiguous patterns of ventilation to improve report generation.

Relevant learning outcomes

#	Outcome
# 5	Outcome Generate reports and answer clinical questions using the results of investigations, other physiological parameters and patient history.
# 7	Outcome Demonstrate a patient centered approach to practice, considering communication with patients and relatives and the patient experience.