Training activity information
Details
Assess patients for safety before, during and after exercise using a range of physiological parameters ensuring test termination where appropriate
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 effectively assessing a patient’s safety at all stages of an exercise test—before, during, and after—by using a variety of physiological parameters.
- Consider how the learning outcomes apply, specifically in relation to preparing patient, selecting appropriate assessments, and critically analysing key assessment parameters.
- What does effective assessment of patient safety, including the crucial ability to appropriately terminate the test if safety concerns arise, look like for this activity?
- Discuss with your training officer to gain clarity on specific local safety protocols, precise physiological thresholds that necessitate test termination, and the required documentation of safety assessments and decisions.
What is your prior experience of this activity?
- Think about what you already know about the contraindications to exercise testing and the indications for prematurely terminating an exercise test, such as specific symptoms.
- Consider possible challenges you might face during the activity, such as real-time recognition of subtle patient distress or changes in physiological status, rapid interpretation of data during a dynamic situation, or the challenge of clearly communicating the need for test termination to a patient, and think about how you might handle them.
- Recognise the scope of your own practice for this activity i.e. know when you will need to seek immediate advice or assistance from a senior colleague, especially if a critical or unexpected event occurs, and from whom.
- Acknowledge how you feel about embarking on this training activity, reflecting on any anxiety regarding the high responsibility for patient safety, your confidence in making real-time critical decisions, or your preparedness for unexpected complications.
What do you anticipate you will learn from the experience?
- Consider the specific skills you want to develop related to enhancing your proficiency in real-time physiological monitoring and interpretation, refining your critical decision-making skills for test termination, and improving your ability to engage in effective and sensitive communication with patients.
- Identify specific insights you hope to gain regarding the variability in patient responses to exercise across different conditions and the critical importance of proactive and continuous safety assessment throughout the entire testing procedure.
What additional considerations do you need to make?
- Consult actions identified following previous experience of patient safety, interpreting physiological signs, or managing unexpected events during exercise tests.
- Identify important information you need to consider before embarking on the activity, such as confirming access to and familiarity with emergency protocols and resuscitation equipment (e.g., BLS/ALS, oxygen), and reviewing the patient’s specific medical history thoroughly.
In action
Is anything unexpected occurring?
- Are you noticing anything surprising or different from what you anticipate whilst monitoring patient physiological parameters or considering test termination?
- Are you encountering situations such as:
- A significant and rapid deterioration of a key physiological parameter e.g., profound desaturation, sudden sustained ventricular tachycardia, or severe hypotension requiring immediate test termination?
- The patient reporting symptoms like severe angina or near syncope that meet termination criteria but contradict the monitored physiological data (or vice versa), complicating the decision-making process?
- A technical issue with monitoring equipment e.g., total loss of the ECG signal or failure of the blood pressure device occurring during a critical phase of exercise, compromising real-time safety assessment?
- Consider how this specific experience compared with previous experiences of patient safety assessment during exercise.
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 monitoring or termination decision process?
- Consider the steps you are taking in the moment, such as:
- Immediately halting the test according to pre-defined protocol due to a critical physiological finding?
- Seeking immediate advice from senior staff to verify the interpretation of ambiguous termination criteria (e.g., complex or novel arrhythmias)?
- Focusing strictly on primary survey actions (if deterioration is acute) while escalating concerns to the emergency team?
- How are you feeling in that moment? For instance, are you finding it difficult to adapt to a rapidly changing patient condition? Is it affecting your confidence in making critical safety decisions?
What is the conclusion or outcome?
- Identify how you are working within your scope of practice during this activity. For example, are you successfully resolving the safety threat and ensuring patient stability? Or are you needing support because the required intervention is beyond your current clinical authority?
- Identify what you learned as a result of the unexpected development during this assessment. For example, are you learning a more efficient technique for troubleshooting monitoring or gaining insight into specific physiological thresholds for test termination?
On action
What happened?
- Begin by summarising the key points of the safety assessment and any termination decisions made.
- Consider specific events, actions, or interactions which felt important, such as how you approached interpretation, the key findings you observed while monitoring physiological parameters, or the actions taken when deciding on test termination, including your own feelings during the experience.
- Include any ‘reflect-in-action’ moments where you had to adapt to unexpected physiological changes or critical safety decisions as they unfolded during the assessment, for instance, immediately adjusting the termination decision based on a critical physiological reading.
How has this experience contributed to your developing practice?
- Identify what learning you can take from this experience regarding performing patient safety assessment and test termination. What strengths did you demonstrate e.g., technical skills in acquiring data? What skills and/or knowledge gaps were evident e.g., interpreting complex physiological responses, or knowing the precise criteria for termination?
- Compare this experience against previous engagement with similar activities – were any previously identified actions for development achieved? Has your practice improved regarding timely and appropriate termination?
- Identify any challenges you experienced, such as a rapidly deteriorating patient condition, or difficulty in communicating a termination decision to the patient/family, and how you reacted to these. How does this activity contribute to your diagnostic skills as a Cardiac Scientist?
- Identify anything significant about the activity, such as needing to seek advice or clarification e.g., from a senior colleague about an ambiguous physiological reading? Or did you need to escalate the situation to ensure that you were working within your scope of practice during a termination decision.
- Acknowledge any changes in your own feelings now 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 learnt, including from any feedback you have received related to your ability to effectively assess patient safety before, during and after exercise.
- What will you do differently next time you assess patient safety or consider test termination? Has anything changed in terms of what you would do if you were faced with a similar situation again?
- Do you need to practise any aspect of the activity further, such as quick interpretation of ECG changes or clear communication of termination reasons?
Beyond action
Have you revisited the experiences?
- Have you reviewed the actions you identified in your previous reflections for this activity, specifically related to improving your practice in real-time physiological monitoring and appropriate test termination?
- Have you completed the specific actions you previously identified? For example, if you planned to consult emergency protocols or review specific physiological thresholds for test termination, how did completing this review impact your subsequent performance in ensuring patient safety during a high-intensity test?
- Engage in professional storytelling with peers, near peers, or colleagues about challenges and successes in making critical safety decisions or managing deteriorating patients during exercise tests. How has discussing these events influenced your systematic approach to decision-making under pressure?
How have these experiences impacted upon current practice?
- Consider how the accumulated learning from performing or reflecting on patient safety assessment and termination decisions will support you in preparing for observed ‘in-person’ assessments for the module, such as a DOPS or OCE requiring demonstration of effective communication or technical support during a critical event.
- How has your practice in real-time clinical support and interpretation developed and evolved over time? For example, how does the ability to recognise deterioration developed through this activity influence your prioritisation of patient observations and communication across diagnostic tasks?
- What transferable skills e.g., situational awareness, quick decision-making, or crisis communication did you develop through this activity, and how will this understanding help you adapt to new technologies that require real-time patient assessment in the future?
Relevant learning outcomes
| # | Outcome |
|---|---|
| # 2 |
Outcome
Prepare patients to undertake field and formal clinical exercise assessments. |
| # 3 |
Outcome
Select the appropriate clinical exercise assessment based on referral criteria. |
| # 5 |
Outcome
Identify, critically analyse and report key clinical exercise assessment parameters. |