Plan, prepare for, perform, and provide after care for important procedures
This activity requires the ability to:
- select procedures
- work in partnership with patients and their families or carers to make choices that are right for them, including obtaining consent
- set up the equipment, maintaining a sterile field
- perform procedures
- provide after care for patients, and communicate after-care protocols and instructions to patients and medical and nursing staff
- perform this activity in multiple settings, including inpatient and ambulatory care settings and in emergency departments.
For Adult Internal Medicine a trainee’s opportunity to perform procedures is setting dependent. In some cases, other health professionals may perform the procedure, and here Basic Trainees are expected to complete the processes before and after the procedure.
For Paediatrics & Child Health, the exemplar procedure is lumbar puncture. It is a crucial procedure for Basic Trainees in Paediatrics & Child Health, and trainees’ processes before and after completing the lumbar puncture should be applied to other procedures and those procedures observed.
This activity does not include complex procedures that require specialist training or are inappropriate for Basic Trainees.
Behaviours
Each EPA has lists of behaviours. The behaviours help trainees understand how they can improve, and help supervisors to make decisions about whether trainees can be trusted to do the task with supervision at a distance
Ready to perform with supervision at a distance
Expected behaviours of a trainee who can routinely perform this activity with supervision at a distance.
The trainee:
- identifies and correctly explains the indication for procedures
- confidently and successfully performs procedures
- mitigates the risks and complications of the procedures
- selects appropriate investigations on the samples obtained in diagnostic procedures
- may have complications relating to procedures that they recognise and manage
Not yet ready to perform with supervision at a distance
Examples of behaviours of a trainee not yet ready to perform this activity with supervision at a distance.
The trainee may:
- lack confidence in performing a procedure and may have previously only seen the procedure being performed
- be able to assist another trainee or the consultant to perform the procedure
- be unable to explain the indications for the procedure
- be unable to communicate the potential complications of procedures to patients
- approach procedures as a mechanical task without understanding of context, such as patient-specific factors, indications, contraindications, risks, benefits, and alternatives
Ready to perform with supervision at a distance
Expected behaviours of a trainee who can routinely perform this activity with supervision at a distance.
The trainee:
- explains procedures clearly to patients, including the reasons for the procedure, potential alternatives to having the procedure, possible risks of having the procedure, and expected post-procedure course, and supports them to make informed choices
- addresses all concerns of patients relating to the procedure
- attends to the procedure and the patients’ emotional response, such as pain, fear, frustration, or anger
- adequately documents procedures in clinical notes, including procedure performed, medications given, aseptic technique, and after care
- provides nursing and medical staff with clear after-care instructions and explains how to recognise possible complications
Not yet ready to perform with supervision at a distance
Examples of behaviours of a trainee not yet ready to perform this activity with supervision at a distance.
The trainee may:
- inadequately communicate with patients to help them make informed choices about procedures
Ready to perform with supervision at a distance
Expected behaviours of a trainee who can routinely perform this activity with supervision at a distance.
The trainee:
- sets up all necessary equipment and creates a sterile field
- adequately positions patients ensuring maximal comfort
- consistently uses universal precautions and aseptic technique
Not yet ready to perform with supervision at a distance
Examples of behaviours of a trainee not yet ready to perform this activity with supervision at a distance.
The trainee may:
- have a poorly managed sterile field
- inconsistently apply skills, resulting in an inability to reliably complete the procedure, such as inconsistent use of universal precautions and aseptic technique
- be unable to recognise and manage complications
Ready to perform with supervision at a distance
Expected behaviours of a trainee who can routinely perform this activity with supervision at a distance.
The trainee:
- refers to published procedural guidelines prior to undertaking the procedure
- actively seeks feedback on their technique until competent
Ready to perform with supervision at a distance
Expected behaviours of a trainee who can routinely perform this activity with supervision at a distance.
The trainee:
- refers to evidence-based clinical guidelines relating to procedures
- demonstrates understanding of the limitations of evidence and the challenges of applying research in daily practice
Ready to perform with supervision at a distance
Expected behaviours of a trainee who can routinely perform this activity with supervision at a distance.
The trainee:
- only performs procedures when suitably qualified or adequately supervised
- speaks up if asked to perform procedures when not suitably trained or adequately supervised
- ensures procedures only follow the provision of appropriate information for patient decision making, such as valid process of consent
- identifies appropriate proxy decision makers when required
- displays confidence commensurate with their knowledge and skill, thus putting patients at ease during the procedure
Ready to perform with supervision at a distance
Expected behaviours of a trainee who can routinely perform this activity with supervision at a distance.
The trainee:
- recognises their own limitations and seeks help when required in an appropriate way
Not yet ready to perform with supervision at a distance
Examples of behaviours of a trainee not yet ready to perform this activity with supervision at a distance.
The trainee may:
- recommend inappropriate procedures for patients
- attempt to perform a procedure in an unsafe environment
- overestimate their skill, which may result in potential harm to the patient, both physically and psychologically
- inadequately consult with senior colleagues
Ready to perform with supervision at a distance
Expected behaviours of a trainee who can routinely perform this activity with supervision at a distance.
The trainee:
- ensures all relevant team members are aware that procedures are occurring
Not yet ready to perform with supervision at a distance
Examples of behaviours of a trainee not yet ready to perform this activity with supervision at a distance.
The trainee may:
- perform procedures without informing relevant team members
Ready to perform with supervision at a distance
Expected behaviours of a trainee who can routinely perform this activity with supervision at a distance.
The trainee:
- performs procedures in accordance with local health guidelines and policies