Entrustable Professional Activities

EPA 11: Investigations

EPA 11

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
  • work in partnership with patients, their families or carers to facilitate choices that are right for them
  • provide aftercare for patients (if needed)
  • interpret the results and outcomes of investigations
  • communicate the outcome of investigations to 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 as an adjunct to comprehensive clinical assessments
  • assess patients’ concerns, and determine the need for particular tests that are likely to result in overall benefits
  • develop plans for investigations, identifying their roles and timings
  • assess additional needs and impacts of sedation or general anaesthesia needed for procedures or investigations for paediatric patients (e.g. in the setting of developmental delay)
  • recognise and correctly interpret abnormal findings considering patients’ specific circumstances, and act accordingly

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 patients’ factors and comorbidities
  • consider age-specific reference ranges

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 options, including the potential benefits, risks, burdens, and side effects, 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
  • confirm patients understand the information they have been given, and the need for more information before deciding
  • identify patients’ concerns and expectations, and provide adequate explanations on the rationale for individual test ordering
  • use written material, visual aids or other aids that are accurate and up to date to support discussions with patients
  • explain findings or possible outcomes of investigations to patients, families or carers
  • 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, liaising 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

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 in planning
  • seek help with interpretation of test results for less common tests or indications, or for unexpected results
  • 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:

  • use appropriate guidelines, evidence sources, and decision support tools
  • participate in clinical audits to improve test ordering strategies for diagnoses and screening

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

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

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 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 in emergencies
  • discuss with patients how decisions will be made once the 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 appropriate or evidence based
  • demonstrate awareness of escalation mechanisms in the event that decisions made by parents or carers pose the risk of harm to a minor (e.g. legal entities)
  • advise patients there may be additional costs, which patients may wish to clarify before proceeding
  • explain expected benefits as well as 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

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
  • practice within current ethical and professional frameworks
  • practice within own limits, and seek help when needed
  • involve patients in decision making regarding investigations, and obtain 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
  • adjust the investigative path depending on test results received
  • consider whether patients’ conditions may get worse or better 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 investigations 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 other members of the health care team might play, and what other sources of information and support are available
  • ensure results are checked in a timely manner, and take responsibility for following up on results and communicating them to other clinicians, patients, family members or carers

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 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, utility, safety, appropriateness, and cost • consider resource utilisation through peer review of testing behaviours