Training activity information
Details
Review referrals for patients with suspected asthma and identify the most appropriate challenge testing methodology to answer the clinical question
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 reviewing referrals for suspected asthma and identifying the most appropriate challenge testing methodology.
- Consider how the learning outcomes apply, including selecting diagnostic assessments based on referral criteria and ensuring a patient-centred approach. Success requires critically evaluating the role of different types of bronchial challenge tests in diagnosing asthma.
- Discuss with your training officer to gain clarity on expectations regarding methodology selection. Discuss how to critically evaluate referral criteria to determine if a direct or indirect bronchial challenge test is most suitable for a specific patient scenario.
What is your prior experience of this activity?
- Think about what you already know about asthma referrals and the various challenge testing methodologies, including national and international guidelines.
- Consider possible challenges you might face in selecting the optimal test given diverse patient histories or ambiguous referral information, 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 complex or unusual referral cases to ensure you are working within your scope of practice.
- Acknowledge how you feel about embarking on this training activity, particularly concerning the precision required in methodology selection.
- Consider the challenge of a patient with recent respiratory infection symptoms and plan to handle this by reviewing contraindications before selecting the challenge test.
What do you anticipate you will learn from the experience?
- Consider the specific skills you want to develop in critically evaluating referral criteria and matching them with the most suitable challenge testing methodology.
- Identify specific insights you hope to gain regarding the practical application of guidelines for bronchial challenge tests and their impact on patient diagnosis.
- Focus on gaining specific insights into how national and international guidelines mandate the choice between different challenge tests (e.g., methacholine vs. mannitol) based on clinical history.
What additional considerations do you need to make?
- Review actions identified from previous experiences with patient referrals or diagnostic test selection.
- Identify important information you need to consider, such as a local protocol for challenge testing procedures or a detailed understanding of contraindications, before reviewing referrals and selecting tests.
- Review the local protocol to ensure familiarity with the preparation steps required for the selected challenge testing procedure.
In action
Is anything unexpected occurring?
- Are you noticing anything surprising or different from what you anticipate when reviewing referrals or selecting testing methods?
- Are you encountering situations such as:
- The referral history revealing a contraindication e.g., recent respiratory infection or highly sensitive airway for the challenge test methodology you initially selected?
- The clinical question from the referral being ambiguous, making it difficult to decide definitively between a direct or indirect challenge testing methodology?
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 identifying the most appropriate testing methodology?
- Consider the steps you are taking in the moment, such as:
- Rapidly consulting national and international guidelines to determine the optimal challenge test methodology based on the detailed patient history.
- Seeking immediate clarification from the referrer or senior colleague regarding the ambiguity of the clinical question.
- Reviewing the departmental protocol for challenge tests to ensure all necessary contraindications have been accounted for.
- How are you feeling in that moment? For instance, are you finding it difficult to focus on critically evaluating the referral criteria? Did it affect your confidence in selecting the appropriate test?
What is the conclusion or outcome?
- Identify how you are working within your scope of practice. For example, are you successfully identifying the most appropriate challenge testing methodology within the required guidelines? Or are you needing support because the clinical question requires specialist consensus?
- Identify what you are learning as a result of the unexpected development. For example, are you mastering a more efficient strategy for evaluating referral pathways and matching them to diagnostic criteria?
On action
What happened?
- Begin by summarising the key points of the experience of reviewing referrals for suspected asthma and identifying the appropriate challenge testing methodology.
- Consider specific events, actions, or interactions that felt important during the review or selection process, including your own feelings.
- Detail the nature of the referral, the key clinical question, and the specific decision-making process used to select the challenge test e.g., direct vs. indirect test.
- Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, rapidly consulting national and international guidelines when the patient history revealed a contraindication for the initially selected test.
- Describe adapting the testing strategy when ambiguous referral information required immediate clarification from the referring clinician.
How has this experience contributed to your developing practice?
- Identify what learning you can take from this experience regarding reviewing referrals and identifying testing methodology.
- What strengths did you demonstrate e.g., critically evaluating the referral criteria? What skills and/or knowledge gaps were evident e.g., choosing optimal challenge tests or knowledge of contraindications?
- Assess your strength in selecting the appropriate diagnostic assessment based on referral criteria, versus a gap in understanding all the nuances of different types of bronchial challenge tests.
- Compare this experience against previous engagement with similar referral review activities. Were any previously identified actions for development achieved? Has your practice in selecting appropriate testing methodology improved?
- Identify any challenges you experienced e.g., incomplete referral information, patient comorbidities impacting test choice 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 from referring clinicians or senior colleagues regarding the clinical question? Did you need to ensure you were working within your scope of practice when recommending a specific test?
- 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 with regards to reviewing referrals for patients. What feedback have you had with regards to your ability in identifying the most appropriate challenge testing methodology?
- What will you do differently next time you review a referral for suspected asthma or select a challenge test? Has anything changed in terms of what you would do if you were faced with a similar situation again?
- Plan to review the national and international guidelines for bronchial challenge tests specifically, focusing on the decision tree for selecting the appropriate methodology.
- 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 actions did you commit to for enhancing your ability to critically assess referrals or select the most suitable challenge test e.g., methacholine, exercise, mannitol? Have you completed these actions, and are you now more prepared to consistently apply an evidence-based approach to referral review and test selection?
- Engage in professional storytelling with peers, near peers, or colleagues. Did discussing specific referral scenarios or test selection dilemmas with others provide new perspectives or alternative approaches you hadn’t considered regarding the challenge testing methodology?
How have these experiences impacted upon current practice?
- How will the insights gained from this activity support you in preparing for assessments such as those involving asthma diagnosis pathways or where you might gather a history to decide on investigations?
- How has your decision-making process for selecting challenge testing methodologies evolved? Do you feel more confident in identifying cases where standard protocols may need modification or where a different approach might be more suitable, and are you aware of when to seek specialist advice? Such as identifying when standard protocols for challenge testing may need modification due to patient history or comorbidities.
- What transferable skills did you develop through this activity? Such as critically evaluating referral pathways and patient history in a range of respiratory diseases.
- Identify clear actions for continued development in the area of reviewing referrals and selecting testing methodology. For example, planning actions to review the national and international guidelines for bronchial challenge tests to ensure continuous understanding of test indications and contraindications.
Relevant learning outcomes
| # | Outcome |
|---|---|
| # 3 |
Outcome
Select the appropriate diagnostic assessment based on referral criteria. |
| # 7 |
Outcome
Demonstrate a patient centered approach to practice, considering communication with patients and relatives and the patient experience. |