Entrustable Professional Activities

EPA 10: Procedures

EPA 10

Procedures

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

This activity requires the ability to:

  • ensure appropriate procedures are selected in partnership with patients, their families or carers
  • obtain informed consent
  • set up equipment, maintaining an aseptic field (if required)
  • perform procedures (if required)
  • manage unexpected events and complications during and after procedures (if required)
  • provide aftercare for patients
  • communicate aftercare protocols and instructions to patients and medical and nursing staff
  • interpret results and outcomes of procedures, including imaging and reports
  • communicate the outcome of procedures and associated investigations to patients, their families or carers
  • perform this activity across relevant settings (if required)

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 a range of common procedures
  • ensure team members are aware of all identified allergies/adverse reactions, and take precautions to avoid allergies/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 diagnostic procedures
  • perform a range of common 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
  • perform a range of common 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:

  • accurately document procedures in clinical notes, including informed consent, procedures requested and performed, reasons for procedures, medicines given, aseptic technique, and aftercare
  • explain procedures clearly to patients, families or carers, including reasons for procedures, potential alternatives, and possible risks, to facilitate informed choices
  • counsel patients sensitively and effectively, and support 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, families 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 broader context
  • help patients, families or carers to choose procedures
  • communicate with members of procedural teams so all team members understand who each member is
  • discuss postprocedural care with patients, families 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 and verify the procedure and, where appropriate, the correct site/side/level for the procedure
  • ensure that information on patients’ consent forms match procedures to be performed
  • identify, document, and appropriately notify of any adverse event or equipment malfunction
  • demonstrate principles of physician safety, such as radiation safety in the cath lab or ergonomic position when performing echocardiograms

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, families or carers are fully informed when consenting to any procedure
  • demonstrate an inconsistent application of aseptic technique
  • identify patients using approved patients’ 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 to develop new skills
  • actively seek feedback on personal technique until competent

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:

  • 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:

  • understand institution/department protocols and ethical practices and guidelines around performing procedures
  • if required to perform procedures, do so in accordance with Ethics and professional behaviour institution/department protocols and ethical practices and guidelines
  • demonstrate knowledge of how cardiac and cardiac-related procedures are performed in their institution (e.g. heart lung bypass)
  • identify appropriate proxy decisionmakers when required
  • show respect for knowledge and expertise of colleagues
  • maximise patient 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

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:

  • identify roles and optimal timings for diagnostic procedures
  • critically appraise information from assessments and evaluations of risks and benefits to prioritise patients on a waiting list
  • make clinical judgements and decisions based on 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, and seek help with procedures when appropriate
  • use tools and guidelines to support decision making
  • recommend suboptimal procedures for patients

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 organisational guidelines and policies