Clinical Exercise Testing —
Training activity: 7

Details

Undertake field exercise tests and provide a report of 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 in relation to competently undertaking field exercise tests and subsequently producing a clear, accurate, and comprehensive report of the findings.
• Consider how the learning outcomes apply, specifically in relation to selecting the appropriate assessment, undertaking clinical assessments, and identifying, analysing, and reporting key parameters.
• What does accurately undertaking a field exercise test, including the interpretation of results, and producing a comprehensive report that effectively answers the clinical questions posed by the referral, look like for this activity?
• Discuss with your training officer to gain clarity on the specific expectations for test execution, methods for accurate data collection, the required structure and content of the report, and the level of interpretation expected within the report.

What is your prior experience of this activity?

• Think about what you already know about various field exercise protocols e.g., six-minute walk, incremental shuttle walk, endurance shuttle walk, sit to stand, the necessary equipment, the specific measurements to be taken e.g., heart rate, oxygen saturation, Borg scale, and the principles of interpretation and reporting of results, including common patterns seen in various diseases and differentiating normal from abnormal findings.
• Consider possible challenges you might face during the activity, such as maintaining consistent patient effort throughout the test, accurately recording measurements in a dynamic environment, or structuring the report effectively to convey findings and answer clinical questions, and think about how you might handle them.
• Recognise the scope of your own practice for this activity i.e. know when a patient’s medical condition or an unexpected event during the test requires immediate senior input or a deviation from standard protocol, and from whom.
• Acknowledge how you feel about embarking on this training activity, reflecting on your feelings about conducting the test independently, your confidence in interpreting the collected data, and your ability to write a clear and concise clinical report.

What do you anticipate you will learn from the experience?

• Consider the specific skills you want to develop related to enhancing your proficiency in efficiently and accurately conducting field tests, improving your skills in real-time data acquisition, and developing your capability in comprehensive clinical report writing specifically tailored for field exercise test findings.
• Identify specific insights you hope to gain regarding the practical application and inherent limitations of various field exercise tests and learning how to effectively translate raw physiological and symptomatic data into meaningful clinical insights for the patient’s care.

What additional considerations do you need to make?

• Consult actions identified following previous experience related to test execution, precise data recording, or the clarity and completeness of your report writing.
• Identify important information you need to consider before embarking on the activity, such as ensuring that all required equipment is calibrated and fully functional, reviewing the patient’s specific referral to fully understand the clinical question, and re-familiarising yourself with all safety considerations and protocols pertinent to field exercise tests.

In action

Is anything unexpected occurring?

• Are you noticing anything surprising or different from what you anticipate during the test execution or report generation?
• Are you encountering situations such as:
  • The patient displaying unexpectedly poor performance (e.g., stopping the walk test much earlier than anticipated) due to previously undocumented symptoms or poor effort?
  • Technical difficulties in the field setting, such as intermittent failure of the pulse oximeter or blood pressure monitor, compromising required data acquisition?
  • Difficulty in correlating the test results (e.g., distance walked) with the patient’s reported symptoms or baseline functional capacity, which complicates the report’s conclusion?
• Consider how this specific experience compared with previous experiences of performing field exercise tests or reporting findings.

How are you reacting to the unexpected development?

• How is this impacting your actions? For example, are you responding appropriately to patient fatigue or an unexpected test outcome? Did you adapt your testing procedure (within safety limits) or your approach to interpreting and reporting findings?
• Consider the steps you are taking in the moment, such as:
  • Troubleshooting monitoring connections immediately to secure necessary data?
  • Adapting the test procedure subtly to maximise patient effort if safe and appropriate?
  • Seeking immediate advice on how to phrase the report when results are ambiguous or unexpected given the referral history?
• How are you feeling in that moment? For instance, did you find it difficult to adapt to an unexpected patient response? Did it affect your confidence in generating an accurate report?

What is the conclusion or outcome?

• Identify how you are working within your scope of practice during this activity. For example, are you successfully adapting the procedure and producing a report that clearly communicates the clinical findings and limitations? Or are you needing support because the unexpected test outcome requires senior clinical interpretation?
• Identify what you learned as a result of the unexpected development during this activity. For example, are you mastering a more effective technique for monitoring effort or gaining insight into translating field test data into meaningful clinical insights?

On action

What happened?

• Begin by summarising the key points of undertaking the field exercise test and generating the report.
• Consider specific events, actions, or interactions which felt important during the test execution (e.g., equipment settings used, measurements taken) or report generation, including your own feelings during the experience.
• Include any ‘reflect-in-action’ moments where you had to adapt to unexpected patient responses during the test e.g., sudden fatigue, environmental challenges or challenges in interpreting data for the report as they unfolded, for instance, immediately re-measuring a parameter due to data inconsistency.

How has this experience contributed to your developing practice?

• Identify what learning you can take from this experience regarding conducting the field exercise test or preparing the report. What strengths did you demonstrate e.g., technical skills in acquiring data? What skills and/or knowledge gaps were evident e.g., managing test procedures in a less controlled field setting, or accurately interpreting and reporting nuanced findings from a field test?
• Compare this experience against previous engagement with similar activities – were any previously identified actions for development achieved? Has your practice improved in test execution or report accuracy/clarity?
• Identify any challenges you experienced, such as an uncooperative patient, unexpected weather changes, or difficulties with data consistency, and how you reacted to these. How does this activity contribute to your practical echocardiography skills?
• Identify anything significant about the activity, such as needing to seek advice or clarification e.g., from a supervisor about a particular test anomaly, or reporting format? Or did you need to escalate a safety concern encountered during the field test to ensure you were working within your scope of practice?
• 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 about your ability to undertake field exercise tests. What feedback have you received with regards to your reporting capabilities?
• What will you do differently next time you undertake a field exercise test or prepare a report? 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 managing field conditions, specific reporting techniques, or interpreting common patterns of results in disease for field tests?

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 test execution or report accuracy and clarity?
• Have you completed the specific actions you previously identified? For example, if you planned to review techniques for dealing with poor patient effort or challenges with data consistency during a shuttle walk test, how did completing this action influence your ability to execute subsequent field tests effectively?
• Engage in professional storytelling with peers, near peers, or colleagues about challenging image acquisition scenarios or troubleshooting technical issues in the field setting. How has observing different functional testing modalities influenced your perspective on accurate data acquisition?

How have these experiences impacted upon current practice?

• Consider how the accumulated learning from performing or reflecting on field exercise testing will support you in preparing for observed ‘in-person’ assessments for the module, such as the Direct Observation of Practical Skills (DOPS) titled ‘Perform a field exercise test’.
• How has your practice in applying technical skills and observation knowledge to functional assessment developed and evolved over time? For example, how do your skills in monitoring effort and recognising unexpected responses developed here apply when performing measurements or interpreting abnormal studies using other modalities?
• What transferable skills e.g., technical dexterity or systematic functional assessment did you develop through this activity, and how has this foundational knowledge (e.g., in functional capacity) informed problem-solving in other areas of cardiac or respiratory diagnostics?

Relevant learning outcomes

#	Outcome
# 3	Outcome Select the appropriate clinical exercise assessment based on referral criteria.
# 4	Outcome Undertake clinical exercise assessments.
# 5	Outcome Identify, critically analyse and report key clinical exercise assessment parameters.