Entrustable Professional Activities

LG11: Investigations and procedures

Learning Goal 11

Investigations and procedures

Select, organise, and interpret investigations, and plan, prepare for, perform, and provide aftercare for important practical procedures

This activity requires the ability to:

  • select, plan, and use evidence-based clinically appropriate investigations
  • prioritise patients receiving investigations (if there is a waiting list)
  • evaluate the anticipated value of investigations, and only order investigations with appreciable benefit (e.g., those which are likely to change management)
  • work in partnership with patients, their families or carers to facilitate choices that are right for them
  • manage patients undergoing investigations to minimise risks and maximise diagnostic yield
  • interpret the results and outcomes of investigations
  • communicate the outcome of investigations and procedures to patients and their family or carers, and discuss the next steps
  • select appropriate procedures in partnership with patients, their families or carers
  • obtain informed consent
  • perform procedures using appropriate equipment and techniques
  • manage unexpected events and complications during and after procedures
  • provide aftercare for patients

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

  • choose evidence-based investigations, and frame them in the context of comprehensive clinical assessments
  • understand the accuracy, limitations, and indications of endocrine investigations, and remain abreast of developments and local expertise in the various domains of endocrine testing, including imaging, biochemistry, dynamic testing, and invasive investigations
  • provide appropriate care for patients undergoing dynamic and invasive endocrine investigations to minimise risk and maximise diagnostic yield
  • develop plans for investigations, identifying their roles and timing
  • assess patients’ concerns, and determine the need for specific investigations that are likely to result in overall benefit
  • recognise and correctly interpret abnormal findings, considering patients’ specific circumstances, and act accordingly
  • recognise investigation results that may be erroneous or misleading, and understand the pathways for correcting these errors if required (such as discussing assay errors with the lab, or ordering further investigations)
  • liaise with colleagues and multidisciplinary teams to interpret findings in the context of specific patients when necessary
  • confidently and consistently perform a range of common procedures including, but not limited to, intravenous canulation, intramuscular injections, pump and continuous glucose monitor insertion
  • confirm the correct position / site / side / level on patients for planned procedures
  • recognise and effectively manage complications arising during or after procedures

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

  • provide rationale for investigations
  • understand the significance of abnormal test results and act on these
  • consider patient factors and comorbidities
  • consider age and gender specific reference ranges where relevant
  • identify contraindications for, and complications of, dynamic and invasive endocrine investigations
  • assess patients, and identify indications for procedures
  • check for allergies and adverse reactions
  • consider risks and complications of procedures
  • interpret results of common diagnostic procedures
  • organise and document post-procedure review of patients

Communication

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

  • explain to patients the potential benefits, risks, costs, burdens, and side effects of each option, including the option to have no investigations
  • use clear and simple language, and check that patients understand the terms used and agree to proceed with proposed investigations
  • identify patients’ concerns and expectations, providing adequate explanations on the rationale for individual test ordering
  • confirm whether patients have understood the information they have been given and the need for more information before deciding
  • use written or visual material or other aids that are accurate and up to date to support discussions with patients
  • explain findings or possible outcomes of investigations to patients
  • give information that patients may find distressing in a considerate way
  • accurately document procedures in clinical notes, including informed consent, procedures performed, reasons for procedures, medicines given, aseptic technique, and aftercare

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

  • discuss the indications, risks, benefits, and complications of investigations with patients before ordering investigations
  • explain the results of investigations to patients
  • arrange investigations, providing accurate and informative referrals, and liaise with other services where appropriate
  • explain the process of procedures to patients without providing a broader context

Quality and safety

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

  • identify adverse outcomes that may result from proposed investigations or procedures, focusing on patients’ individual situations
  • participate in clinical practice audits to ensure best available evidence-based practice is offered
  • where appropriate, collaborate with colleagues and multidisciplinary teams to ensure investigations are accurate and of clinical value
  • discuss clinical incidents at appropriate clinical review meetings
  • initiate local improvement strategies in response to clinical incidents

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

  • consider safety aspects of investigations and procedures
  • seek help with the interpretation of test results for less common tests or indications or unexpected results
  • perform investigations and procedures in accordance with the organisational guidelines and policies

Teaching and learning

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

  • use appropriate guidelines, evidence sources, and decision-support tools
  • participate in clinical audits to improve knowledge of test sensitivity / specificity and relevance for diagnoses and screening
  • teach junior staff about evidence-based use of investigations
  • organise or participate in in-service training on investigations and procedures, including the use and interpretation of new technologies
  • provide specific and constructive feedback and comments to junior colleagues
  • initiate and conduct skills training for junior staff

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

  • undertake professional development to maintain currency with investigation guidelines
  • participate in continued professional development
  • help junior colleagues develop new skills
  • actively seek feedback on personal techniques until competent

Research

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

  • provide patients or carers with relevant information if a proposed investigation is part of a research program
  • obtain written consent from patients or carers if the investigation is part of a research program
  • understand that patient participation in research is voluntary and based on an appropriate understanding about the purpose, methods, demands, risks, and potential benefits of the research, and that patients may withdraw consent at any time

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

  • refer to evidence-based clinical guidelines
  • consult current research on investigations
  • demonstrate adherence to the principles of ethical research, including consent

Cultural safety

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

  • understand patients’ views and preferences about any proposed investigations, including handling, storage, and disposal of test samples, and the adverse outcomes they are most concerned about

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

  • consider patients’ cultural and religious backgrounds, attitudes, and beliefs, and how these might influence the acceptability of proposed investigations or procedures

Ethics and professional behaviour

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

  • remain within the scope of the authority given by patients (except for emergencies)
  • when necessary, discuss with patients how decisions will be made once an investigation has started, if the patient is not able to participate in decision making
  • respect patients’ decisions to refuse investigations, even if their decisions may not be evidence-based or in their best interests medically
  • advise patients and carers of the potential costs of investigations, which patients may wish to clarify before proceeding
  • explain the expected benefits, as well as the potential burdens and risks, of any proposed investigation before obtaining informed consent or other valid authority
  • demonstrate an awareness of complex issues related to genetic information obtained from investigations, and subsequent disclosure of such information, and obtain documented informed consent from patients prior to proceeding with such investigations
  • comply with consent processes, privacy law, and professional guidelines to maintain patient confidentiality

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

  • identify appropriate proxy decision makers when required
  • choose not to investigate in situations where it is not appropriate for ethical reasons
  • practise within current ethical and professional frameworks
  • practise within one’s own limits, and seek help when needed
  • involve patients and carers in decision making regarding investigations, and obtaining the appropriate informed consent, including financial consent, if necessary

Judgement and decision making

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

  • evaluate the costs, benefits, and potential risks of each investigation in a clinical situation
  • liaise with colleagues and other members of multidisciplinary teams, providing clinical context to investigation outcomes when necessary
  • adjust the investigative path depending on test results received
  • consider the clinical impact if no tests are selected
  • adapt procedures in response to assessments of risks to individual patients

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

  • choose the most appropriate investigation for the clinical scenario, in discussion with patients
  • recognise personal limitations, and seek help in an appropriate way when required
  • assess personal skill levels, and seek help with procedures when appropriate
  • use tools and guidelines to support decision making

Leadership, management, and teamwork

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

  • consider the role of other health professionals, and what other sources of information and support are available
  • ensure results are checked in a timely manner, taking responsibility for following up results and progressing management as appropriate based on these results
  • identify relevant management options with colleagues, according to their level of training and experience, to reduce error, prevent complications, and support efficient teamwork
  • coordinate efforts, encourage others, and accept responsibility for work done

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

  • demonstrate an understanding of what parts of an investigation or procedure are provided by different doctors or health professionals

Health policy, systems, and advocacy

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

  • select and justify investigations regarding the pathological basis of disease, appropriateness, utility, safety, and cost effectiveness
  • consider resource use through peer review of testing behaviours
  • use resources efficiently when ordering investigations or performing procedures