Advanced Practice - Extra Cranial —
Training activity: 5

Details

Produce descriptive clinical reports of ultrasound analysis or an extracranial arterial ultrasound scan

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

• Limitations of the scan or protocol
• Local, national and international guidelines
• Appropriate documentation, including consideration of diagrammatic reports
• Communication skills
• Acting on urgent findings
• Patient pathways
• Multidisciplinary team working

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 planning and preparing to undertake upper limb nerve conduction studies, specifically producing descriptive clinical reports of ultrasound analysis.
• Consider how the learning outcomes apply, specifically in relation to planning and preparing and applying legislation, guidelines, and managing risk when planning and preparing for the studies, specifically producing an interpretive clinical report of the extracranial arterial scan findings, and analysing and interpreting the ultrasound findings for extracranial arteries with reference haemodynamics.
• Discuss with your training officer to gain clarity of what is expected of you in relation to expectations for equipment setup, patient flow logistics, and integrating necessary safety protocols, specifically report content and format.

What is your prior experience of this activity?

• Think about what you already know about planning medical procedures or preparing clinical rooms, specifically writing clinical reports for ultrasound findings.
• Consider possible challenges you might face during the activity, such as logistical issues with moving NCS equipment, ensuring necessary resources (e.g., limb temperature monitors) are available, or understanding procedural requirements, specifically ensuring clarity, precision, or incorporating all relevant findings.
• 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 if the complexity of the planned study requires specialised equipment or protocols not covered in routine procedure, or if the report conclusion requires interpretation of complex incidental findings.
• Acknowledge how you feel about producing clinical reports in the context of this training activity.

What do you anticipate you will learn from the experience?

• Consider the specific skills you want to develop, such as planning complex clinical procedures, specifically clinical report writing, drawing upon previous experiences of the activity.
• Identify the specific insights you hope to gain into the detailed requirements for upper limb NCS planning, including patient flow, equipment setup, and integrating safety protocols, specifically effective communication of findings, adherence to reporting recommendations.

What additional considerations do you need to make?

• Consult actions identified following previous experiences of similar planning or preparation activities, specifically producing clinical reports.
• Identify important information you need to consider before embarking on the activity, such as reviewing the anatomy of upper limb nerves (median, ulnar, radial) and the procedures for motor/sensory nerve conduction studies, as this knowledge is foundational for planning, specifically ultrasound reporting recommendations and guidelines.

In action

Is anything unexpected occurring?

• Are you noticing anything surprising or different from what you anticipate whilst compiling the clinical report for an extracranial arterial ultrasound scan?
• Are you encountering situations such as:
  • Difficulty in concisely describing complex findings (e.g., tandem lesions) or reconciling disparate haemodynamic and B-mode data?
  • Unexpected requirements for the report (e.g., specific prognostic language) that challenge standard descriptive terminology?

How are you reacting to the unexpected development?

• How is this impacting your actions? For example, are you responding appropriately to the situation when faced with challenges in structuring or detailing the report? Did you adapt or change your reporting approach or template to better convey the findings?
• Consider the steps you are taking in the moment, such as:
  • Immediately reviewing the departmental reporting guidelines to ensure appropriate descriptive language is used for stenosis grading.
  • Re-checking raw velocity data to ensure the reported grade aligns with the clinical conclusion before finalising the documentation.
• How are you feeling in that moment? For instance, are you finding it difficult to adapt your writing style to produce a clear and concise report? Is it affecting your confidence in producing a comprehensive and accurate clinical report?

What is the conclusion or outcome?

• Identify how you worked within your scope of practice. For example, are you successfully drafting a report that adheres to departmental reporting standards? Or are you needing support because the complexity of the incidental findings requires senior interpretive input before the report can be finalised?
• What are you learning as a result of the unexpected development? For example, are you mastering techniques for concise documentation of complex haemodynamics? Or gaining insight into the importance of adherence to specific reporting conventions?

On action

What happened?

• Begin by summarising the key points of your experience producing the clinical report.
• Consider specific events, actions, or interactions which felt important during the reporting process, such as ensuring clarity and conciseness, adhering to departmental guidelines, or your feelings.
• Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, immediately consulting the departmental reporting guidelines when faced with conflicting haemodynamic data to ensure the terminology used for stenosis severity was consistent.
• How did you feel during this experience, e.g., did you feel confident in drafting or challenged by the phrasing requirements?

How has this experience contributed to your developing practice?

• Identify what learning you can take from this experience. What strengths did you demonstrate, e.g., clarity, conciseness, or accuracy of the report?
• What skills and/or knowledge gaps were evident, e.g., including specific haemodynamic data or clinical implications?
• Compare this experience against previous engagement with similar activities – were any previously identified actions for development achieved? Has your practice improved in producing clinical reports?
• Identify any challenges you experienced, such as needing to seek advice or clarification on reporting standards or specific findings, or if escalation was required due to an urgent finding, and how you reacted to this.
• 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 learnt, including from any feedback you have received, with regards to improving the structure and terminology used in reports.
• What will you do differently next time you approach producing a descriptive clinical report, for instance, by proactively developing a standardised report structure to ensure all relevant haemodynamic and morphological data is consistently included?
• Do you need to practise any aspect of the activity further, such as concise yet comprehensive reporting of ultrasound findings?

Beyond action

Have you revisited the experiences?

• How have your subsequent experiences of producing descriptive clinical reports 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 report required precise articulation of tandem lesions and complex collateral flow forced you to re-evaluate the clarity and detail of the descriptive terminology you applied during your first attempt at reporting.
• Considering what you understand about report structure, adherence to guidelines, and effective communication of haemodynamic data 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 clinical report writing based on further learning and experiences? For example, how you proactively reviewed and integrated standardized report phrasing for summarising surgical and endovascular interventions performed for carotid disease into the conclusion section, demonstrating you have adapted improvements based on further learning.
• Has discussing reports where haemodynamic findings were ambiguously described or the impact of unclear reporting on subsequent patient intervention with colleagues, peers, or supervisors changed how you now view your initial experience in this training activity? For example, how professional storytelling with a senior colleague about a report where PSV measurements were misread refined your understanding of the critical nature of meticulous data transcription and objective report content.

How have these experiences impacted upon current practice?

• How has the learning from this initial training activity, in combination with subsequent reporting experiences, contributed to your overall confidence and competence in producing descriptive clinical reports of ultrasound analysis, particularly in preparing for assessments like Case-Based Discussions (CBDs)? For example, how your accumulated ability in structuring complex data now enables you to efficiently and clearly summarise diagnostic findings 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 producing descriptive clinical reports? 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 the report requires interpretation of highly complex prognostic data (e.g., post-stent surveillance) that falls outside factual description scope.
• Looking holistically at your training journey, how has this initial reporting experience, revisited with your current perspective, contributed to your development in meeting the objectives related to producing an interpretive clinical report and analysing and interpreting ultrasound findings? For example, how this foundational experience has supported your development in summarising surgical and endovascular interventions.

Relevant learning outcomes

#	Outcome
# 4	Outcome Analyse and interpret the ultrasound findings for extracranial arteries with reference haemodynamics.
# 5	Outcome Produce an interpretive clinical report of the extracranial arterial scan findings.
# 7	Outcome Appraise the impact of research evidence on national guidelines.
# 8	Outcome Critically evaluate the clinical significance of incidental findings.
# 9	Outcome Summarise surgical and endovascular interventions performed for carotid disease.
# 10	Outcome Describe the potential risks and benefits associated with intervention.