Entrustable Professional Activities

LG 12: Investigations

Learning Goal 12

Investigations

Select, organise, and interpret investigations

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 the investigation and only order investigations with appreciable benefit, e.g. to change management
  • work in partnership with patients and 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 to patients and discuss the next steps

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
  • assess patients’ concerns, and determine the need for specific investigations that are likely to result in overall benefit
  • develop plans for investigations, identifying their roles and timing
  • 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
  • liaise with colleagues and multidisciplinary teams to interpret findings in the context of specific patients when necessary

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

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

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

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 a proposed investigation, 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 that investigations are accurate and of clinical value

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 when planning them
  • seek help with interpretation of test results for less common tests or indications or unexpected results

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

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

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 with relevant information if a proposed investigation is part of a research program
  • obtain written consent from patients 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
  • explain that routine care will continue if the participant decides not to participate in research

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 investigation (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

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 and 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 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 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 own limits, and seek help when needed
  • involve patients in decision making regarding investigations, 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

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

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 members of the healthcare team, 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

direction
Requires some supervision

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

The trainee may:

  • demonstrate understanding of what parts of an investigation 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 utilisation through peer review of testing behaviours