Clinical Exercise Testing —
Training activity: 9

Details

Assist in cardiopulmonary exercise testing by preparing the patient to undertake the test, ensuring effective communication and maintaining dignity at all times

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 thoroughly preparing the patient for cardiopulmonary exercise testing (CPET), and ensuring effective and compassionate communication while maintaining the patient’s dignity at all times.
• Consider how the learning outcomes apply, specifically in relation to preparing equipment and environment preparing patients, employing effective communication skills, and demonstrating a patient-centred approach.
• What does successful patient preparation, effective communication, and maintenance of dignity throughout the CPET setup look like for this activity?
• Discuss with your training officer to gain clarity on specific patient preparation steps, strategies for communicating with patients of diverse needs, and how to address sensitive topics while ensuring patient dignity is upheld.

What is your prior experience of this activity?

• Think about what you already know about detailed patient preparation steps for exercise tests, techniques for effective and empathetic communication, and the importance of adopting a patient-centred approach, including explaining complex procedures in lay terms to facilitate informed consent.
• Consider possible challenges you might face during the activity, such as managing patient anxiety, explaining technical procedures clearly and concisely, or handling unexpected patient emotional reactions while continuously ensuring their dignity is maintained, 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 emotional state, communication barriers, or specific needs require support from a senior colleague or the implementation of alternative communication strategies, and from whom.
• Acknowledge how you feel about embarking on this training activity, reflecting on your feelings about engaging in close patient interaction, the sensitivity of the situation, and your confidence in building rapport and trust with patients.

What do you anticipate you will learn from the experience?

• Consider the specific skills you want to develop related to enhancing your skills in patient engagement and rapport building, improving your empathetic communication, developing your capacity for interpreting non-verbal cues, and refining your proactive problem-solving abilities related to ensuring patient comfort and dignity.
• Identify specific insights you hope to gain regarding a deeper appreciation for the patient’s perspective and experience during a clinical assessment, and understanding the critical role that strong rapport and clear communication play in ensuring a successful and comfortable experience for the patient.

What additional considerations do you need to make?

• Consult actions identified following previous experience, observations, or feedback related to patient preparation, navigating communication challenges, or maintaining dignity in a clinical setting.
• Identify important information you need to consider before embarking on the activity, such as confirming your understanding of the specific CPET procedure, preparing any patient information leaflets or visual aids, and ensuring the testing environment is set up to maximise patient privacy and comfort before the patient arrives.

In action

Is anything unexpected occurring?

• Are you noticing anything surprising or different from what you anticipate when interacting with the patient or during the preparation?
• Are you encountering situations such as:
  • The patient exhibiting acute anxiety or panic regarding the enclosed mask or intense nature of the CPET, making relaxation and cooperation difficult?
  • A significant communication barrier e.g., profound hearing loss or language difficulties that prevents the patient from fully understanding the instructions or providing informed consent?
  • A technical setup issue e.g., inability to achieve a proper mask seal, or faulty ECG connections that compromises the patient’s feeling of dignity or comfort during the preparation process?
• Consider how this specific experience compared with previous experiences of patient preparation or communication.

How are you reacting to the unexpected development?

• How is this impacting your actions? For example, are you responding appropriately to patient anxiety or a communication barrier? Did you adapt your communication style or approach to maintaining dignity?
• Consider the steps you are taking in the moment, such as:
  • Immediately changing your explanation approach to simplify technical terms or using visual aids to address patient confusion?
  • Troubleshooting the technical setup immediately e.g., checking mask sizes to maximise patient comfort and privacy?
  • Seeking immediate clarification on the best way to address patient distress or ensure informed consent from the supervisor?
• How are you feeling in that moment? For instance, did you find it difficult to maintain clarity while managing patient anxiety? Did it affect your confidence in demonstrating effective communication?

What is the conclusion or outcome?

• Identify how you are working within your scope of practice during this activity. For example, are you successfully completing the preparation, ensuring patient comprehension, and maintaining dignity? Or are you needing support because a significant communication barrier or unresolved anxiety requires senior staff or specialist intervention?
• Identify what you learned as a result of the unexpected development during this process. For example, are you mastering a more effective communication strategy for explaining complex physiological monitoring or gaining insight into techniques for managing patient pre-test anxiety?

On action

What happened?

• Begin by summarising the key points of patient preparation, ensuring effective communication, and maintaining dignity during your assistance in cardiopulmonary exercise testing.
• Consider specific events, actions, or interactions which felt important during patient interaction or preparation steps e.g., explaining complex procedures, connecting equipment, including your own feelings during the experience.
• Include any ‘reflect-in-action’ moments where you had to adapt to patient anxiety, communication barriers, or challenges in maintaining dignity as they unfolded, for instance, immediately simplifying the explanation of the CPET procedure due to patient confusion.

How has this experience contributed to your developing practice?

• Identify what learning you can take from this experience regarding patient preparation, effective communication, or maintaining dignity during CPET assistance. What strengths did you demonstrate e.g., adherence to protocol? What skills and/or knowledge gaps were evident e.g., explaining the test in lay terms, managing patient distress, or ensuring patient privacy during equipment setup?
• Compare this experience against previous engagement with similar activities – were any previously identified actions for development achieved? Has your practice improved in engaging patients effectively or ensuring their dignity?
• Identify any challenges you experienced, such as a highly anxious patient, a language barrier, or a difficult equipment setup that compromised dignity, and how you reacted to these. How does this activity contribute to your patient education and device management skills?
• Identify anything significant about the activity, such as needing to seek advice or clarification e.g., from a senior physiologist about a specific patient concern, or communication strategy? Or did you need to escalate a concern regarding patient wellbeing or dignity 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 assist in cardiopulmonary exercise testing. What feedback have you had about your ability to communicate effectively with patients?
• What will you do differently next time you assist in CPET, particularly regarding patient preparation, communication, or dignity? 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 empathetic communication strategies, efficient patient setup, or methods for maintaining dignity in challenging situations?

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 patient communication or managing pre-test anxiety during the preparation phase?
• Have you completed the specific actions you previously identified? For example, if you planned to review patient education resources to enhance clarity regarding the CPET mask and procedure, how did completing this review impact your subsequent performance when explaining device function and remote monitoring?
• Engage in professional storytelling with peers, near peers, or colleagues about challenges and successes in patient communication regarding complex procedure preparation. How has discussing difficulties with patient comprehension changed your approach to patient education for other procedures?

How have these experiences impacted upon current practice?

• Consider how the accumulated learning from performing or reflecting on patient preparation and communication will support you in preparing for observed ‘in-person’ assessments for the module, such as the Observed Clinical Event (OCE) titled ‘Explain an exercise procedure, using lay terms’.
• How has your practice in effective communication and understanding patient experience developed and evolved over time? For example, how does your foundational knowledge from CPET preparation help you manage follow-up post-implant or troubleshoot device issues remotely?
• What transferable skills e.g., technical instruction or patient-centred communication did you develop through this activity, and how will this understanding help you evaluate and adopt new remote monitoring technologies or communication strategies in the future?

 

Relevant learning outcomes

#	Outcome
# 1	Outcome Prepare equipment and the environment in order to undertake clinical exercise assessments.
# 2	Outcome Prepare patients to undertake field and formal clinical exercise assessments.
# 7	Outcome Employ effective communication skills and compassion with a range of patients enabling patients to understand their treatment pathway.
# 8	Outcome Demonstrate a patient centered approach to practice, considering communication with patients and relatives and the patient experience.