Training activity information
Details
Perform and interpret the analyses to laboratory standard operating procedures on patients with:
- Thyroid diseases
- Thyroid cancers
Type
Entrustable training activity (ETA)
Evidence requirements
Evidence the activity has been undertaken by the trainee repeatedly, consistently, and effectively over time, in a range of situations. This may include occasions where the trainee has not successfully achieved the outcome of the activity themselves. For example, because it was not appropriate to undertake the task in the circumstances or the trainees recognised their own limitations and sought help or advice to ensure the activity reached an appropriate conclusion.
Reflection at multiple timepoints on the trainee learning journey for this activity.
Considerations
- Local and national training guidelines, including standards and pathways
- Method selection, including assay advantages and limitations, quality parameters, and interferences
- Equipment calibration and maintenance
- Quality control; EQA and IQC
- National and international guidelines
- Role of the duty biochemist
Reflective practice guidance
The guidance below is provided to support reflection at different time points, providing you with questions to aid you to reflect for this training activity. They are provided for guidance and should not be considered as a mandatory checklist. Trainees should not be expected to provide answers to each of the guidance questions listed.
Before action
What does success look like?
- Identify what is expected of you in relation to effectively performing and interpreting analyses related to thyroid diseases and cancers according to laboratory SOPs.
- Consider how the learning outcomes apply, specifically in relation to performing clinical and laboratory investigation, analysis and management of endocrine disorders and diabetes mellitus.
- Discuss with your training officer to gain clarity of what is expected of you in relation to interpreting complex thyroid profiles (e.g., Non-Thyroidal Illness (NTI)), managing specific assay methodologies (e.g., for autoantibodies), and ensuring accurate reporting for thyroid cancer markers.
What is your prior experience of this activity?
- Think about what you already know about performing and interpreting thyroid function tests (TFTs) and other related analyses (e.g., understanding the pituitary-thyroid axis).
- Consider possible challenges you might face during the activity, such as identifying assay interferences (e.g., heterophile antibodies), interpreting complex profiles in pregnancy, or dealing with different methodologies used for thyroid hormone measurement.
- Recognise the scope of your own practice for this activity i.e. know when you will need to seek advice or help, and from whom. You will need to seek advice from your Training Officer when required, for example if a critically ill patient presents with a TFT profile suggestive of NTI requiring complex correlation with their clinical state, or if a result suggests thyroid cancer recurrence.
- Acknowledge how you feel about embarking on performing and interpreting these specific analyses.
What do you anticipate you will learn from the experience?
- Consider the specific skills you want to develop, such as technical competence in different assay platforms for thyroid hormones and critical interpretation of TFTs in challenging clinical contexts.
- Identify the specific insights you hope to gain into the nuances of test interpretation in the context of thyroid diseases and cancers (e.g., monitoring Thyroglobulin), or how non-thyroidal factors affect TFT results.
What additional considerations do you need to make?
- Consult actions identified following previous experiences of thyroid analyses where unexpected results required re-testing or consultation due to interference.
- Identify important information you need to consider before embarking on the activity, such as specific patient information, understanding of Non-Thyroidal Illness, and current national guidelines for thyroid disease investigation and management.
In action
Is anything unexpected occurring?
- Are you noticing anything surprising or different from what you anticipate whilst performing the analysis or beginning interpretation for a thyroid condition?
- Are you encountering situations such as:
- A result that is inconsistent with the suspected clinical picture (e.g., highly elevated TSH but normal free T4)?
- Issues with understanding factors affecting thyroid function test (TFT) results, such as Non-Thyroidal Illness (NTI)?
- An assay fails quality control specifically for thyroid hormone or thyroid cancer markers?
How are you reacting to the unexpected development?
- How is this impacting your actions? For example, are you responding to the situation appropriately? Are you adapting or changing your approach to verifying the result or troubleshooting the issue?
- Consider the steps you are taking in the moment, such as:
- Immediately setting up a dilution study to confirm the linearity of a highly elevated hormone result
- Consulting academic content or departmental guidelines to understand the implications of specific cancer markers or the factors affecting TFT results
- Adjusting data review to focus on potential assay interference affecting the measurement of thyroid hormones
- How are you feeling in that moment? For instance, are you finding it difficult to verify the result against the suspected clinical picture? Is it affecting your confidence in assessing the validity of the assay run?
What is the conclusion or outcome?
- Identify how you are working within your scope of practice. For example, are you successfully verifying the result according to established SOPs? Or are you needing support because the result’s significance in the context of potential malignancy requires senior pathological interpretation?
- What are you learning as a result of the unexpected development? For example, are you mastering a systematic approach to verifying discordant thyroid results? Or gaining insight into the specific analytical challenges of thyroid cancer markers?
On action
What happened?
- Begin by summarising the key steps you took when performing and interpreting the thyroid analysis (e.g., TSH and free T4).
- Consider specific events, actions, or interactions which felt important, such as observing the analytical process of a thyroid hormone assay or correlating TFT results with the patient’s clinical status (e.g., suspected hyperthyroidism).
- Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, immediately consulting the Training Officer when faced with discordant results that might indicate non-thyroidal illness (NTI).
- How did you feel during this experience, e.g., did you feel determined to understand the analytical challenges of the hormone assay or stressed by interpreting a complex thyroid profile?
How has this experience contributed to your developing practice?
- Identify what learning you can take from this experience regarding the practical and interpretive aspects of thyroid analyses. What strengths did you demonstrate, e.g., accurate application of knowledge regarding factors affecting TFT results?
- What skills and/or knowledge gaps were evident, e.g., unfamiliarity with the nuances of Thyroglobulin monitoring in thyroid cancer follow-up?
- Compare this experience against previous engagement with similar activities – were any previously identified actions for development achieved? Has your practice improved in integrating clinical information to refine the interpretation of thyroid function?
- Identify any challenges you experienced, such as needing to seek advice or clarification on scope of practice regarding reporting a profile suggestive of NTI versus true primary disease, and how you reacted to this.
What will you take from the experience moving forward?
- Identify the actions or ‘next steps’ you will now take to support the assimilation of what you have learnt, including from any feedback you have received, with regards to applying accurate performance and context-appropriate interpretation of thyroid analyses.
- What will you do differently next time you approach interpreting complex thyroid profiles, for instance, by systematically checking for potential assay interferences before reporting unusual results?
- Do you need to practise any aspect of the activity further, such as studying complex interpretation cases involving thyroid cancer markers or key learning outcomes related to evaluating assay performance characteristics?
Beyond action
Have you revisited the experiences?
- How have your subsequent experiences of analysing thyroid function tests (TFTs) and interpreting complex profiles since completing this specific training activity led you to revisit your initial approach or decisions during that activity? For example, how an instance where a subsequent challenging case required differentiation between non-thyroidal illness (NTI) and central hypothyroidism forced you to re-evaluate the depth of clinical history review you applied during your first attempt at interpreting a discordant TFT?
- Considering what you understand about assay interferences, non-thyroidal illness (NTI), and thyroid cancer marker monitoring now, were the actions or considerations you identified after your initial reflection on this training activity sufficient? How have you since implemented or adapted improvements in your TFT result validation process based on further learning and experiences? For example, how you proactively reviewed and integrated manufacturer guidelines regarding assay interference when validating thyroid cancer marker results, demonstrating you have adapted improvements based on further learning?
- Has discussing ambiguous TFT profiles or the impact of drug interference on thyroid assay performance with colleagues, peers, or supervisors changed how you now view your initial experience in this training activity? For example, how professional storytelling with a senior colleague about a case where an unexpected TSH result was caused by heterophile antibodies refined your understanding of the critical nature of analytical troubleshooting?
How have these experiences impacted upon current practice?
- How has the learning from this initial training activity, in combination with subsequent thyroid analysis and interpretation experiences, contributed to your overall confidence and competence in effectively performing and reporting results, particularly in preparing for assessments like Case-based Discussions (CBDs) or Observed Clinical Events (OCEs)? For example, how your accumulated ability in performing accurate thyroid assays and interpreting complex profiles (e.g., non-thyroidal illness, thyroid cancer markers) now enables you to confidently discuss discordant TFT results during a CBD assessment.
- How has reflecting back on this specific training activity, combined with everything you’ve learned since, shaped your current approach to thyroid function analysis? How does this evolved understanding help you identify when something is beyond your scope of practice or requires escalation? For example, how your evolved approach means you now routinely check for pre-analytical factors (e.g., medications or suspected non-thyroidal illness) and seek advice immediately when interpreting highly discordant TFTs or complex cancer marker results, recognising this falls outside routine result validation scope.
- Looking holistically at your training journey, how has this initial thyroid analysis experience, revisited with your current perspective, contributed to your development in meeting the learning outcomes related to performing clinical and laboratory investigation, analysis and management of endocrine disorders and diabetes mellitus? For example, how this foundational experience has supported your development in confidently interpreting results in complex clinical scenarios.
Relevant learning outcomes
| # | Outcome |
|---|---|
| # 1 |
Outcome
Perform clinical and laboratory investigation, analysis and management of endocrine disorders. |
| # 2 |
Outcome
Perform clinical and laboratory investigation, analysis and management of diabetes mellitus. |