Advanced Practice - Venous —
Training activity: 7

Details

Analyse and interpret the results of the lower limb venous scans, including:

• Superficial venous incompetence
• Deep venous incompetence

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.

Considerations

• Local SOPs and national guidance
• Venous pathology and ultrasound characteristics
• Effects of venous disease on venous haemodynamics
• Appearance of thrombophlebitis on ultrasound
• Clinical presentation of acute and chronic disease
• Treatment options
• Documentation
• Communication skills
• Scope of personal and professional practice
• Limitations of the scan or protocol
• Consequences of misdiagnosis
• Acting on urgent findings

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 successfully analysing and interpreting scan results for superficial and deep venous incompetence.
• Consider how the learning outcomes apply, specifically in relation to analysing and interpreting ultrasound findings with reference to haemodynamics and summarising the treatment pathways.
• Discuss with your training officer to gain clarity of what is expected of you in relation to criteria for comprehensive interpretation, including accurate assessment of reflux parameters (e.g., reflux duration, segment involvement) and linking findings to subsequent endovascular or surgical treatment pathways.

What is your prior experience of this activity?

• Think about what you already know about venous reflux mechanisms, normal vs. abnormal reflux parameters, and how scan findings influence management decisions (e.g., endovascular vs. surgical).
• Consider possible challenges you might face during the activity, such as interpreting equivocal reflux durations, synthesising multiple levels of incompetence (superficial and deep), or managing discordant findings between venous insufficiency and clinical symptoms.
• Recognise the scope of your own practice for this activity i.e. know when you will need to seek advice or help, and from whom. You will need to seek advice from your Training Officer when required, for example for complex patterns of incompetence involving perforators or when the clinical implications for treatment are unclear.
• Acknowledge how you feel about embarking on this scan interpretation activity.

What do you anticipate you will learn from the experience?

• Consider the specific skills you want to develop, such as integrating findings from different vein segments, applying haemodynamic principles to chronic disease, and forming a coherent diagnostic summary.
• Identify the specific insights you hope to gain into the diagnostic pathway for venous insufficiency and the interplay between scan findings and patient outcomes/treatment options.

What additional considerations do you need to make?

• Consult actions identified following previous experiences of scan interpretation (e.g., improving consistency in measurements or ensuring full segment assessment).
• Identify important information you need to consider before embarking on the activity, such as current treatment guidelines for venous insufficiency (e.g., medical, endovascular, surgical) and patient’s full clinical presentation.

In action

Is anything unexpected occurring?

• Are you noticing anything surprising or different from what you anticipate whilst analysing and interpreting the results of lower limb venous scans, including superficial and deep venous incompetence?
• Are you encountering situations such as:
  • Conflicting findings where severe superficial reflux is present, but unexpected deep venous incompetence is also noted, complicating the primary diagnosis?
  • Difficulty synthesising complex findings involving multiple levels of incompetence (GSV, SSV, deep system, perforators) into a single, coherent diagnostic summary?

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 systematic review or applying structured diagnostic algorithms?
• Consider the steps you are taking in the moment, such as:
  • Immediately reviewing the raw data to ensure measurement consistency across all segments (superficial and deep)
  • Pausing to apply a structured diagnostic algorithm to classify the complex pattern of superficial and deep incompetence
• How are you feeling in that moment? For instance, are you finding it difficult to adapt to synthesising multiple, complex data points? Is it affecting your confidence in forming a coherent diagnostic summary?

What is the conclusion or outcome?

• Identify how you are working within your scope of practice. For example, are you successfully integrating all superficial and deep findings to establish the overall pattern of insufficiency? Or are you needing support because complex patterns involving perforators or unclear clinical implications necessitate consultation with the Training Officer?
• What are you learning as a result of the unexpected development? For example, are you mastering data synthesis techniques for chronic venous disease? Or gaining insight into the interplay between scan findings and patient treatment options?

On action

What happened?

• Begin by summarising the key steps you took when analysing and interpreting the results of both superficial and deep venous incompetence scans, detailing how you integrated findings from different vein systems to form a comprehensive conclusion.
• Consider specific events, actions, or interactions which felt important, such as reconciling conflicting findings (e.g., severe superficial reflux with unexpected deep incompetence), identifying the primary source of reflux, or discussions with mentors.
• Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, immediately pausing the analysis to consult CEAP criteria to accurately classify the overall clinical severity based on the scan findings.
• How did you feel during this experience, e.g., did you feel confident in correlating clinical presentation with ultrasound findings or challenged by the complexity of the combined reflux pattern?

How has this experience contributed to your developing practice?

• Identify what learning you can take from analysing and interpreting these complex results. What strengths did you demonstrate, e.g., systematic review of reflux parameters or ability to correlate findings with potential treatment pathways?
• What skills and/or knowledge gaps were evident, e.g., unfamiliarity with the CEAP classification or difficulty synthesising complex multi-segment findings?
• Compare this experience against previous engagement with similar activities – were any previously identified actions for development achieved? Has your practice improved in identifying the haemodynamic significance of incompetence?
• Identify any challenges you experienced, such as needing to seek advice or clarification on scope of practice regarding a particularly challenging case involving multiple perforator incompetence or escalating to ensure the accuracy of the interpretation, and how you reacted to this.

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, with regards to improving complex venous incompetence analysis and interpretation.
• What will you do differently next time you approach interpretation of venous incompetence scans, for instance, by proactively integrating all clinical data with the scan findings to inform the CEAP classification.
• Do you need to practise any aspect of the activity further, such as reviewing various complex cases or key learning outcomes related to integrating findings from different vein segments?

Beyond action

Have you revisited the experiences?

• How have your subsequent experiences of analysing and interpreting venous incompetence scans since completing this specific training activity led you to revisit your initial approach or decisions during that activity? For example, how an instance where a subsequent case required synthesising severe deep venous reflux with complex superficial vein recurrence forced you to re-evaluate the methodology of integrating complex, multi-segment findings you applied during your first attempt at interpretation.
• Considering what you understand about haemodynamics, venous insufficiency diagnostic criteria, and treatment pathways now, were the actions or considerations you identified after your initial reflection on this training activity sufficient? How have you since implemented or adapted improvements in your interpretation methodology for venous incompetence based on further learning and experiences? For example, how you proactively reviewed and integrated the CEAP classification system to ensure consistency in correlating scan findings with clinical severity, demonstrating you have adapted improvements based on further learning.
• Has discussing complex patterns of venous incompetence or the impact of interpretation on subsequent treatment planning (endovascular vs. surgical) with colleagues changed how you now view your initial experience in this training activity? For example, how professional storytelling with a senior colleague about an under-classified case that delayed appropriate interventional treatment refined your understanding of the critical nature of coherent diagnostic summary for venous scans.

How have these experiences impacted upon current practice?

• How has the learning from this initial training activity, in combination with subsequent venous scan interpretation experiences, contributed to your overall confidence and competence in analysing and interpreting ultrasound findings for venous disease, particularly in preparing for assessments like CBDs? For example, how your accumulated ability in synthesising superficial and deep reflux data now enables you to confidently discuss the diagnostic criteria and summarise the treatment pathways for venous insufficiency during a CBD assessment.
• How has reflecting back on this specific training activity, combined with everything you’ve learned since, shaped your current approach to analysing and interpreting venous incompetence results? How does this evolved understanding help you identify when something is beyond your scope of practice or requires escalation? For example, how your evolved approach means you now routinely seek advice immediately when interpretation of severe, complex Post-Thrombotic Syndrome findings requires prognostic language that falls outside routine reporting scope.
• Looking holistically at your training journey, how has this initial venous incompetence interpretation experience, revisited with your current perspective, contributed to your development in meeting the objectives related to analysing and interpreting ultrasound findings and summarising treatment pathways? For example, how this foundational experience has supported your development in integrating haemodynamic assessment with clinical implications.

Relevant learning outcomes

#	Outcome
# 5	Outcome Analyse and interpret ultrasound findings for venous disease of the lower limbwith reference to haemodynamics.
# 8	Outcome Summarise the treatment pathways for lower limb venous disease.
# 9	Outcome Appraise the impact of research evidence on national guidelines.