Entrustable Professional Activities

EPA 8: Procedures

EPA 8

Procedures

Plan, prepare for, perform, and provide aftercare for important practical procedures

This activity requires the ability to:

  • select appropriate procedures in partnership with patients and their families or carers
  • obtain informed consent
  • set up equipment, maintaining an aseptic field
  • perform procedures
  • manage unexpected events/complications during and after procedures
  • provide aftercare for patients
  • communicate aftercare protocols and instructions to patients and medical and nursing staff
  • interpret the results and outcomes of procedures
  • communicate the outcomes of procedures and associated investigations to patients
  • perform this activity across multiple relevant settings.

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:

  • select procedures by assessing patient-specific factors, risks, benefits, and alternatives
  • confidently and consistently perform intramuscular and intra-articular injections to improve functional outcomes
  • ensure team members are aware of all allergies/adverse reactions identified, taking precautions to avoid allergies/adverse reactions during procedures
  • ensure patients have complied with pre-procedure preparation
  • confirm the correct position/site/side and level on patients for planned procedures
  • recognise and effectively manage complications arising during or after procedures
  • recognise and correctly interpret normal and abnormal findings of diagnostic procedures

direction
Requires some supervision

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

The trainee may:

  • 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 patients’ post-procedure reviews
  • perform botulinum toxin A injections

Communication

confident
Ready to perform without supervision

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

The trainee will:

  • accurately document procedures in the clinical notes, including informed consent, procedures requested and performed, reasons for procedures, medicines given, aseptic technique, and aftercare
  • explain procedures clearly to patients and family or carers, including reasons for procedures, potential alternatives, and possible risks, to facilitate informed choices
  • counsel patients sensitively and effectively, supporting them to make informed choices
  • address patients’ and family or carers’ concerns relating to procedures, providing opportunities to ask questions
  • tailor language according to patients’ age and capacity to understand
  • communicate effectively with team members, patients, and family or carers prior to, during, and after procedures
  • ensure team members are confident and competent in their assigned roles

direction
Requires some supervision

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

The trainee may:

  • explain the process of procedures to patients without providing a broader context
  • help patients and family or carers to choose the procedure
  • communicate with members of procedural teams so all team members understand who each member is
  • discuss post-procedural care with patients, family or carers
  • complete relevant patients’ documentation, and conduct an appropriate clinical handover

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:

  • obtain informed consent or other valid authority before undertaking any procedure
  • set up all necessary equipment, and consistently use universal precautions and aseptic technique
  • confirm patients’ identification, verify the procedure, and, where appropriate, the correct site/side/level for procedures
  • ensure information on patients’ consent forms match procedures to be performed
  • identify, document, and appropriately notify of any adverse event or equipment malfunction

direction
Requires some supervision

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

The trainee may:

  • provide information in a manner so that patients and families or carers are fully informed when consenting to any procedure
  • demonstrate an inconsistent application of aseptic technique
  • identify patients using approved patient identifiers before any treatment or intervention is initiated
  • attempt to perform a procedure in an unsafe 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:

  • 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 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:

  • understand individual patients’ cultural perceptions of health and illness, adapting 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

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:

  • confidently perform common procedures
  • identify appropriate proxy decision makers when required
  • show respect for knowledge and expertise of colleagues
  • maximise patients' autonomy in decision making

direction
Requires some supervision

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

The trainee may:

  • perform procedures when adequately supervised
  • follow procedures to ensure safe practice

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:

  • identify roles and optimal timings for diagnostic procedures
  • critically appraise information from assessment and evaluation of risks and benefits to prioritise patients on waiting lists
  • make clinical judgements and decisions based on the available evidence
  • select the most appropriate and cost-effective diagnostic procedures
  • adapt procedures in response to assessments of risks to individual patients
  • 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:

  • prioritise which patients receive procedures first (if there is a waiting list)
  • assess personal skill level, seeking help with procedures when appropriate
  • use tools and guidelines to support decision making
  • recommend suboptimal procedures for patients
  • refer to external service providers for procedures or assessments that could be performed safely and competently by the rehabilitation medicine trainee

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:

  • explain critical steps, anticipated events, and equipment requirements to teams on planned procedures
  • provide staff with clear aftercare instructions, and explain how to recognise possible complications
  • 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:

  • 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:

  • discuss serious incidents at appropriate clinical review meetings
  • initiate local improvement strategies in response to serious incidents
  • use resources efficiently when performing procedures

direction
Requires some supervision

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

The trainee may:

  • perform procedures in accordance with the organisational guidelines and policies