Entrustable Professional Activities

LG10: Investigations and procedures

Learning Goal 10

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 and procedures
  • prioritise patients receiving investigations and procedures
  • evaluate the anticipated value of investigations and procedures
  • gain informed consent
  • collaborate with patients to facilitate choices that are right for them
  • organise set up of equipment, maintaining an aseptic field
  • communicate aftercare protocols and instructions to patients and medical and nursing staff
  • perform investigations and procedures under appropriate sedation or anaesthetic
  • resolve unexpected events and complications during and after procedures
  • arrange procedural aftercare for patients
  • interpret results and outcomes of investigations and procedures, including imaging and reports
  • communicate the outcome of procedures and investigations to patients
  • perform this activity across relevant settings, including outpatients, theatre, and day clinics

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 procedures, and frame them as an adjunct to comprehensive clinical assessments
  • know local and international guidelines for investigations and procedures
  • assess patients’ concerns, and determine the need for specific tests that are likely to result in overall benefits
  • recognise and correctly interpret abnormal findings, considering patients’ specific circumstances, and act accordingly
  • develop plans for investigations and procedures, identifying their roles and timing
  • recognise and correctly interpret abnormal findings, considering patients’ specific circumstances, and act accordingly
  • select procedures by assessing patient-specific factors, risks, benefits, and alternatives
  • confidently and consistently perform a range of common procedures
  • ensure team members are aware of all identified allergies and adverse reactions, and take precautions to avoid allergies and adverse reactions during procedures
  • ensure patients have complied with pre-procedure preparations
  • recognise and effectively manage complications arising during or after procedures
  • recognise and correctly interpret normal and abnormal findings of investigations and procedures 
  • demonstrate knowledge of how stem cell collection and stem cell transplants are performed

direction
Requires some supervision

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

The trainee may:

  • provide rationale for investigations and procedures
  • understand the significance of abnormal test results, and act on these
  • consider patients’ factors and comorbidities
  • consider age-specific reference ranges
  • assess patients, and identify indications for investigations and procedures
  • perform a range of common procedures
  • check for allergies and adverse reactions
  • consider risks and complications of procedures
  • interpret results of common diagnostic investigations and 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 procedures to patients clearly and sensitively, including reasons for investigations and procedures, potential alternatives, and possible risks, to facilitate informed choices and obtain consent
  • use clear and simple language, and check that patients understand the terms used and agree to proceed with proposed investigations and procedures
  • 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
  • address patients’ concerns relating to procedures, providing opportunities to ask questions
  • tailor language according to patients’ age and capacity to understand
  • use written or visual material or other aids that are accurate and up to date to support discussions with patients
  • explain findings or outcomes of investigations and procedures to patients in a considerate way
  • document procedures accurately and in detail in clinical notes, including:
    • aftercare
    • aseptic technique
    • informed consent
    • medicines given
    • procedures requested and performed
    • reasons for procedures
  • communicate effectively with all persons involved prior to, during, and after procedures, including team members and patients
  • identify appropriate proxy decision makers when required

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
  • arrange investigations, providing accurate and informative referrals, and liaise with other services where appropriate
  • explain the process of procedures to patients without providing broader context
  • help patients to choose aspects of the procedures that can be modified, such as timing
  • communicate with members of procedural teams so all team members understand who each member is
  • discuss post-procedural care with patients
  • complete relevant patients’ documentation, and conduct appropriate clinical handovers
  • explain the results of investigations to patients

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 and procedures, focusing on patients’ individual situations
  • obtain informed consent or other valid authority before undertaking any investigation or procedure
  • set up all necessary equipment, and consistently use universal precautions and aseptic technique
  • confirm patients’ identification and verify the investigation or procedure, and, where appropriate, the correct site / side / level for the procedure
  • ensure that information on patients’ consent forms match investigations and procedures to be performed
  • identify, document, and appropriately notify of any adverse event or equipment malfunction
  • demonstrate principles of physician safety:
    • chemotherapy
    • radiation safety
  • discuss serious incidents at appropriate clinical review meetings

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 when planning them
  • seek help with interpretation of test results for less common tests or indications or unexpected results
  • provide information in a manner so patients are fully informed when consenting to any procedure
  • demonstrate a consistent application of aseptic technique
  • identify patients using approved patients’ identifiers before any treatment or intervention is initiated
  • perform investigations and procedures in a safe environment

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 test ordering strategies for diagnoses and screening
  • refer to and/or be familiar with relevant published procedural guidelines prior to undertaking procedures
  • organise or participate in in-service training on new technology
  • 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:

  • participate in continued professional development
  • help junior colleagues develop new skills
  • actively seek feedback on personal technique 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 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
  • be aware of relevant open clinical trials, and offer them to the patient
  • obtain consent for biobank samples and other biological samples as required for patient care or by clinical trials

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
  • consider samples required for biobanking or clinical trials

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 and procedures, and the adverse outcomes they are most concerned about
  • consider individual patients’ cultural perceptions of health and illness, and adapt practice accordingly

direction
Requires some supervision

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

The trainee may:

  • respect religious, cultural, linguistic, and family values and differences

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, with the exception of emergencies
  • discuss with patients how decisions will be made once the investigation or procedure has started and the patient is not able to participate in decision making
  • understand and perform procedures in accordance with institution or department protocols, ethical practices, and guidelines around performing procedures
  • demonstrate awareness of complex issues related to genetic information obtained from investigations, and subsequent disclosure of such information
  • show respect for knowledge and expertise of colleagues
  • maximise patient autonomy in decision making
  • advise patients there may be additional costs, which patients may wish to clarify

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
  • 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
  • explain the expected benefits, burdens and risks of any proposed investigation or procedure before obtaining informed consent or other valid authority
  • perform procedures when adequately supervised
  • follow procedures to ensure safe practice

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 and procedure in a clinical situation
  • adjust the investigative path depending on test results received and in response to risks to individual patients
  • consider whether patients’ conditions may get worse or better if no tests are selected
  • identify roles and optimal timings for diagnostic procedures
  • critically appraise information from assessments and evaluations of risks and benefits to prioritise patients on waiting lists
  • make clinical judgements and decisions based on available evidence
  • select the most appropriate and cost-effective diagnostic procedures
  • select appropriate investigations on the samples obtained in diagnostic procedures

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
  • prioritise which patients receive procedures first, if there is a waiting list
  • use tools and guidelines to support decision making
  • recognise optimal procedures for patients
  • consider whether a paediatric, adolescent and young adult (AYA), or adult setting may be more appropriate to conduct investigations or procedures

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 other members of the health care team might play, and what other sources of information and support are available
  • ensure team members are confident and competent in their assigned roles
  • coordinate efforts, encourage others, and accept responsibility for work done
  • ensure results are checked in a timely manner, taking responsibility for following up results
  • provide staff with clear aftercare instructions, and explain how to recognise possible complications

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
  • ensure all relevant team members are aware that a procedure is occurring
  • discuss patients’ management plans for recovery with colleagues

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
  • initiate local improvement strategies in response to serious incidents
  • use resources efficiently when performing procedures and ordering investigations
  • know relevant local and international guidelines for investigations and procedures

direction
Requires some supervision

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

The trainee may:

  • perform investigations and procedures in accordance with organisational guidelines and policies