Advanced Practice - Extra Cranial —
Training activity: 8

Details

Communicate the findings of a positive extracranial artery scan to:

• The multidisciplinary team
• A patient

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

• Patient centred care and support
• Roles of the members of the wider team
• Treatment options and pathways for patients (local and national guidelines)
• Explaining results to non-scientist audience
• Adapting communication

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 communicating positive extracranial artery scan findings to both the multidisciplinary team and a patient.
• 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 identifying and communicating urgent and non-urgent results of the scan to both patients and the multidisciplinary team, and summarising surgical and endovascular interventions performed for carotid disease.
• 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 communication, including the specific audiences and types of information to convey.

What is your prior experience of this activity?

• Think about what you already know about planning medical procedures or preparing clinical rooms, specifically communicating complex medical information to healthcare professionals and patients.
• 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 explaining complex findings simply to a patient, managing patient anxiety, or effectively conveying urgency to the MDT.
• 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 finding requires urgent escalation protocols to be initiated.
• Acknowledge how you feel about communicating your findings from the scans.

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 tailoring information to different audiences, active listening, 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 best practices for conveying urgent/non-urgent results or discussing significant findings with patients.

What additional considerations do you need to make?

• Consult actions identified following previous experiences of similar planning or preparation activities, specifically communicating medical information or attending MDT meetings.
• 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 the potential risks and benefits associated with interventions related to carotid disease.

In action

Is anything unexpected occurring?

• Are you noticing anything surprising or different from what you anticipate whilst communicating complex or sensitive scan findings to either the MDT or a patient?
• Are you encountering situations such as:
  • Unexpected questions from the MDT regarding prognostic values or specific surgical/endovascular interventions performed for carotid disease?
  • Strong emotional reactions from the patient (e.g., distress over stroke risk) or difficulty in simplifying complex disease grading information?

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 an unexpected question or emotional response? Did you adapt or change your communication approach (e.g., language, detail, empathy) to address the unexpected reaction or query?
• Consider the steps you are taking in the moment, such as:
  • Immediately shifting to compassionate communication and using simplified, non-technical language to reassure the patient while conveying the risk.
  • Pausing to check departmental guidelines before answering a complex MDT question regarding the potential risks and benefits associated with intervention (e.g., Carotid Endarterectomy or stenting).
• How are you feeling in that moment? For instance, are you finding it difficult to adapt your communication style to the unexpected turn in the conversation? Is it affecting your confidence in clearly and sensitively conveying the scan findings?

What is the conclusion or outcome?

• Identify how you worked within your scope of practice. For example, are you successfully conveying the diagnosis and next steps to the patient clearly and empathetically? Or are you needing support because the patient’s emotional reaction or specific legal/ethical query requires the intervention of a senior clinician?
• What are you learning as a result of the unexpected development? For example, are you mastering techniques for tailoring complex medical information to a layperson? Or gaining insight into the critical role of communication in managing patient pathways?

On action

What happened?

• Begin by summarising the key points of your experience communicating scan findings.
• Consider specific events, actions, or interactions which felt important, such as how you explained stenosis severity to a patient or how you conveyed urgency to the MDT.
• Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, immediately simplifying the explanation of stroke risk and management options when the patient showed unexpected anxiety, adapting the style based on their reaction.
• How did you feel during this experience, e.g., did you feel empathy, confidence, or nervousness during the communication?

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., clear, concise, or empathetic communication?
• What skills and/or knowledge gaps were evident, e.g., explaining complex medical terms simply or handling difficult questions from the MDT about surgical interventions?
• Compare this experience against previous engagement with similar activities – were any previously identified actions for development achieved? Has your practice improved in communicating positive scan findings?
• Identify any challenges you experienced, such as needing to seek advice or clarification on a communication strategy, or if a communication led to an important next step in patient care, 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 tailored communication strategies for diverse audiences.
• What will you do differently next time you approach communicating positive scan findings, for instance, by proactively developing simplified analogies or visual aids to explain concepts like stenosis grading to patients?
• Do you need to practise any aspect of the activity further, such as managing patient concerns?

Beyond action

Have you revisited the experiences?

• How have your subsequent experiences of communicating positive scan findings 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 patient required detailed, compassionate counselling regarding stroke risk and intervention benefits forced you to re-evaluate the brevity and empathy of the language you applied during your first attempt at communicating sensitive results.
• Considering what you understand about effective communication, summarising surgical and endovascular interventions (e.g., CEA, stenting), and managing patient anxiety 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 communication strategies based on further learning and experiences? For example, how you proactively reviewed and integrated protocols for communicating high-risk findings to the multidisciplinary team (MDT) to ensure immediate clinical handover based on further learning.
• Has discussing challenging MDT presentations or the impact of communication failure on patient understanding/adherence 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 communication breakdown regarding intervention benefits refined your understanding of the critical nature of tailored and transparent patient communication.

How have these experiences impacted upon current practice?

• How has the learning from this initial training activity, in combination with subsequent communication experiences, contributed to your overall confidence and competence in communicating the findings of a positive extracranial artery scan, particularly in preparing for assessments like Observed Communication Events (OCEs) or CBDs? For example, how your accumulated ability in simplifying complex findings now enables you to confidently discuss significant findings with a patient or explain ultrasound findings to professional peers in an MDT meeting during an OCE assessment.
• How has reflecting back on this specific training activity, combined with everything you’ve learned since, shaped your current approach to communicating the findings of a positive extracranial artery scan? 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 a patient expresses significant legal or ethical concerns regarding intervention that requires specialist liaison outside routine communication scope.
• Looking holistically at your training journey, how has this initial communication experience, revisited with your current perspective, contributed to your development in meeting the objectives related to identifying and communicating urgent and non-urgent results and summarising surgical and endovascular interventions? For example, how this foundational experience has supported your development in demonstrating effective and compassionate communication skills.

Relevant learning outcomes

#	Outcome
# 4	Outcome Analyse and interpret the ultrasound findings for extracranial arteries with reference haemodynamics.
# 6	Outcome Identify and communicate urgent and non-urgent results of the scan to both patients and the multidisciplinary team.
# 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.