Training activity information
Details
Undertake muscle function assessments with patients and report the findings
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 undertaking muscle function assessments with patients and reporting findings.
- Consider how the learning outcomes apply, including preparing equipment and patients, performing investigations safely, generating reports, using effective communication, and demonstrating a patient-centred approach. Success requires evaluating how respiratory muscle disease can impact the process of ventilation.
- Discuss with your training officer to gain clarity on expectations for performing and reporting these assessments. Clarify expectations on how to document and report the specific findings related to Vital Capacity changes (lying/sitting).
What is your prior experience of this activity?
- Think about what you already know about performing muscle function assessments such as seated and supine vital capacity measurements, MIP/MEP, and SNIP.
- Consider possible challenges you might face in preparing patients, ensuring their comfort, conducting the assessments accurately, or interpreting inconsistent results.
- Recognise the scope of your own practice; know when you will need to seek advice or help, for example, if a patient is unable to cooperate fully with the assessment or if the results are inconsistent.
- Acknowledge how you feel about embarking on this training activity, considering the patient interaction and the technical aspects of the assessments.
- If a previous reflection highlighted difficulty with patient coaching, plan to handle potential patient non-cooperation during MIP/MEP assessments.
What do you anticipate you will learn from the experience?
- Consider the specific skills you want to develop in conducting various muscle function tests and generating clear, accurate reports. This involves drawing upon theoretical knowledge of respiratory muscle physiology.
- Identify specific insights you hope to gain into how these assessments contribute to understanding respiratory muscle disease and patient management.
- Focus on improving the specific skill of performing seated and supine vital capacity measurements accurately and consistently.
What additional considerations do you need to make?
- Review actions identified from previous experiences with patient assessment, communication, or data reporting.
- Identify important information you need to consider, such as different methods and reference ranges used in muscle study investigations, and safety considerations for staff and patients, before undertaking these assessments.
- Review the safety considerations and risk management principles, especially regarding invasive tests (if applicable to the context of the assessment), before starting.
In action
Is anything unexpected occurring?
- Are you noticing anything surprising or different from what you anticipate whilst performing the assessment or reporting the findings?
- Are you encountering situations such as:
- Patient non-cooperation or inability to perform maximal effort during tests like MIP/MEP or SNIP, leading to inconsistent or suboptimal results?
- Unusual or ambiguous findings in the muscle assessment (e.g., a highly variable difference between seated and supine Vital Capacity measurements), making interpretation 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 or changing your assessment technique or patient coaching in the moment?
- Consider the steps you are taking in the moment, such as:
- Immediately changing your patient coaching approach to secure maximal effort during a challenging manoeuvre.
- Rapidly consulting protocols to ensure the use of the correct reference ranges or calculation methods for the observed results.
- Seeking immediate guidance from a senior colleague regarding the interpretation of highly variable or complex muscle function data.
- How are you feeling in that moment? For instance, are you finding it difficult to adapt your knowledge of respiratory muscle physiology to the challenges presented by patient factors? Is it affecting your confidence in performing the assessment or reporting results?
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 the abnormal findings 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 coaching patients during high-effort manoeuvres? Or gaining insight into the nuances of specific respiratory muscle disease presentation?
On action
What happened?
- Begin by summarising the key points of the experience of undertaking muscle function assessments with patients and reporting the findings.
- Consider specific events, actions, or interactions that felt important during the assessment or reporting process, including your own feelings.
- Detail the specific tests performed, such as seated and supine vital capacity measurements or MIP/MEP/SNIP, and the findings reported.
- Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, immediately changing your patient coaching approach to secure maximal effort during MIP/MEP or seeking guidance on unexpected patient discomfort.
- Describe adapting your technique when the patient was uncooperative or exhibiting ambiguous effort levels.
How has this experience contributed to your developing practice?
- Identify what learning you can take from this experience regarding performing muscle function assessments.
- What strengths did you demonstrate e.g., technical execution, patient communication? What skills and/or knowledge gaps were evident e.g., handling challenging patient presentations or interpreting complex results?
- Evaluate your strength in performing seated and supine vital capacity measurements accurately versus a knowledge gap in understanding how respiratory muscle disease can impact the process of ventilation.
- Compare this experience against previous engagement with similar assessment activities. Were any previously identified actions for development achieved? Has your practice in conducting muscle function assessments or reporting improved?
- Identify any challenges you experienced e.g., patient fatigue, difficulty positioning, ambiguous effort levels 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 on assessment techniques or reporting conventions? Did you need to ensure you were working within your scope of practice when conducting the assessment or interpreting the findings?
- 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 related to your ability to undertake such assessments. What feedback have you received about your report- writing skills?
- What will you do differently next time you undertake a muscle function assessment? Has anything changed in terms of what you would do if you were faced with a similar situation again?
- Plan to review different methods and reference ranges used in muscle study investigations to improve the accuracy of data verification.
- 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 to improve your technique, patient interaction, or the clarity/comprehensiveness of your reports? Have you taken these actions, and are you now ready to consistently demonstrate a high standard in performing these assessments and accurately reporting your findings? E.g. Confirming that techniques for accurate performance of muscle function tests, such as seated and supine vital capacity measurements, have been successfully refined.
- Did sharing these experiences alter your perspective or offer new strategies for handling challenging muscle function assessments e.g., with uncooperative patients during MIP/MEP/SNIP or dealing with unusual results?
How have these experiences impacted upon current practice?
- Consider how your enhanced skills and understanding in muscle function assessments will support your preparation for ‘in-person’ assessments, particularly those related to vital capacity measurements or other practical skills required for accurate data acquisition.
- Reflect on how your overall practice in muscle function assessment has evolved. Are you more proficient at obtaining reliable results, more insightful in interpreting findings, or more aware of when a patient’s presentation or assessment results suggest the need for further specialist input beyond your current scope?
- Reflecting on the ability to evaluate how respiratory muscle disease can impact the process of ventilation based on cumulative assessment experience.
- Identifying transferable skills like effective patient coaching which can be applied to other advanced diagnostic investigations requiring patient effort, such as bronchial challenge tests.
- Identify clear actions for continued development in the area of muscle function assessment and reporting.
- Such as reviewing different methods and reference ranges used in muscle study investigations to improve reporting accuracy and correlation with patient history.
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. |
| # 4 |
Outcome
Perform a range of advanced diagnostic investigations safely, including respiratory muscle function testing, bronchial challenge testing and polysomnographic sleep study. |
| # 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. |