Major Organs and Cancer —
Training activity: 2

Details

Interpret and report on routine biochemical results in the detection of major organ disease and cancers to include:

• Renal
• Liver
• Bone
• GIT
• Cardiac
• Lipids
• Cancer

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

• Method selection, including assay advantages and limitations, quality parameters, and interference
• Equipment calibration and maintenance
• Quality control; EQA and IQC
• National and International guidelines
• Report formats

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 accurately interpreting and reporting routine biochemical results (e.g., LFTs, cardiac markers, renal panel) in the context of major organ disease and cancers.
• Consider how the learning outcomes apply, specifically in relation to demonstrating the ability to analyse and interpret biochemical data effectively.
• Discuss with your training officer to gain clarity of what is expected of you in relation to the standards for interpretation, including integrating clinical context and the appropriate use of reference ranges.

What is your prior experience of this activity?

• Think about what you already know about interpreting routine biochemical results, especially for analytes related to renal, liver, cardiac, or cancer markers.
• Consider possible challenges you might face during the activity, such as interpreting results that are significantly outside the reference range without full clinical history, or formulating a clear and concise report conclusion.
• 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 an unusual or complex result (e.g., for a Lipid profile) requires confirmation from the duty biochemist before reporting.
• Acknowledge how you feel about interpreting and reporting on the results as specified.

What do you anticipate you will learn from the experience?

• Consider the specific skills you want to develop, such as improving the ability to link biochemical results to specific conditions of major organs and cancers.
• Identify the specific insights you hope to gain into the clinical significance of biochemical markers and their connection to the pathophysiology of major organs.

What additional considerations do you need to make?

• Consult actions identified following previous experiences of interpreting routine biochemical results or drafting clinical summaries.
• Identify important information you need to consider before embarking on the activity, such as access to patient demographics, clinical history, and appropriate gender-specific reference ranges.

 

In action

Is anything unexpected occurring?

• Are you noticing anything surprising or different from what you anticipate whilst reviewing results related to renal, liver, bone, or cardiac markers?
• Are you encountering situations such as:
  • A result is significantly outside the reference range (e.g., LFTs) but lacks relevant clinical context, complicating interpretation?
  • A complex pattern emerges that might require further review, or additional testing
  • You suspect potential confounding factors (e.g., drugs or assay interference) that are not immediately obvious from the patient notes?

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 consulting guidelines or seeking clinical clarification?
• Consider the steps you are taking in the moment, such as:
  • Immediately checking previous results or consulting the patient notes for known clinical conditions or relevant medication
  • Pausing the report drafting to consult departmental guidance or seeking clarification from a senior colleague about an ambiguous result pattern
• How are you feeling in that moment? For instance, are you finding it difficult to correlate an unexpected result pattern with potential major organ disease? Is it affecting your confidence in signing off the interpretation?

What is the conclusion or outcome

• Identify how you are working within your scope of practice. For example, are you successfully applying reference ranges and clinical context to interpret a straightforward result pattern? Or are you needing support because the ambiguity of a set of results?
• What are you learning as a result of the unexpected development? For example, are you mastering a more systematic approach to evaluating complex biochemical panels (e.g., LFTs) with limited clinical history? Or gaining insight into the pitfalls of interpreting results near reference range cut-offs?

 

On action

What happened?

• Begin by summarising the key steps you took when interpreting and reporting routine biochemical results (e.g., renal, liver, cardiac, lipids).
• Consider specific events, actions, or interactions which felt important, such as how you correlated a critically abnormal LFT profile with the patient’s clinical history or the systematic process you used to check all parameters in the renal panel.
• Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, immediately consulting departmental guidelines when faced with an ambiguous or conflicting result pattern for a marker.
• How did you feel during this experience, e.g., did you feel confident in your intuitive interpretation of the renal panel or uncertain and needing support when faced with complex liver panel findings?

How has this experience contributed to your developing practice?

• Identify what learning you can take from this experience regarding the analysis and interpretation of biochemical data. What strengths did you demonstrate, e.g., systematic evaluation of results against reference ranges and clinical context?
• What skills and/or knowledge gaps were evident, e.g., unfamiliarity with all potential confounding factors (e.g., drugs) affecting liver function results?
• Compare this experience against previous engagement with similar activities – were any previously identified actions for development achieved? Has your practice improved in linking routine results to specific major organ pathophysiology?
• Identify any challenges you experienced, such as needing to seek advice or clarification on scope of practice regarding reporting a highly abnormal result without full senior review, 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 improving the clarity and clinical relevance of interpretative reports.
• What will you do differently next time you approach interpreting complex biochemical panels?
• Do you need to practise any aspect of the activity further, such as reviewing advanced interpretation strategies for lipids profiles or key learning outcomes related to analysing and interpreting biochemical data?

Beyond action

Have you revisited the experiences?

• How have your subsequent experiences of attending clinical review meetings or shadowing the duty biochemist since completing this specific training activity led you to revisit your initial approach or decisions during that activity? For example, how subsequent academic learning on the pathophysiology of renal disease forced you to re-evaluate the assumptions made during your initial interpretation of a complex renal panel (e.g., unexpected ratio of urea:creatinine).
• Considering what you understand about clinical significance, complex biochemical data correlation, and appropriate reporting terminology 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 practice for routine biochemical results based on further learning and experiences? For example, how you proactively reviewed a liver function test (LFT) interpretation when correlating results with limited clinical history.
• Has discussing specific complex cases or the principles of reporting borderline results with colleagues, peers, or supervisors changed how you now view your initial experience in this training activity? For example, how discussing with a senior colleague about a time when a poorly worded cancer marker report led to patient anxiety and unnecessary follow-up refined your understanding of the critical nature of clear, context-appropriate reporting.

How have these experiences impacted upon current practice?

• How has the learning from this initial training activity, in combination with subsequent interpretive and clinical experiences, contributed to your overall confidence and competence in critically evaluating biochemical data, particularly in preparing for assessments like Case-Based Discussions (CBDs)? For example, how your accumulated ability in systematic evaluation and interpretation of complex biochemical panels (e.g., LFTs or cardiac markers) now enables you to efficiently articulate the key findings and potential inconsistencies 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 interpreting routine biochemical panels? How does this evolved understanding help you identify when something is beyond your scope of practice or requires escalation? For example, when to seek advice from the duty biochemist immediately when interpreting complex or ambiguous results.
• Looking holistically at your training journey, how has this initial interpretation and reporting experience, revisited with your current perspective, contributed to your development in meeting the learning outcomes related to analysing and interpreting biochemical data effectively? For example, how this experience has supported your development in clinical interpretation, liaison and the reporting of urgent and critical results.

Relevant learning outcomes

#	Outcome
# 1	Outcome Perform biochemical assays involved in the assessment of major organ function and cancer diagnosis and monitoring.
# 2	Outcome Analyse and interpret biochemical data generated in the assessment of major organ function and cancer diagnosis and monitoring.