Training activity information
Details
Perform the tumour markers analyses involved in the detection of major organ disease and cancers to laboratory standard operating procedures to include:
- CEA
- PSA
- Ca-125
- Ca-153
- Ca19-9
- AFP
- hCG
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 interference
- Equipment calibration and maintenance
- Quality control; EQA and IQC
- National and international guidelines
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 performing tumour marker analyses (e.g., CEA, PSA, Ca-125) according to laboratory standard operating procedures (SOPs).
- Consider how the learning outcomes apply, specifically in relation to performing the assays accurately and contributing to the interpretation of their results in line with relevant guidelines.
- Discuss with your training officer to gain clarity of what is expected of you in relation to specific sample handling requirements, instrumentation operation, and quality control interpretation for immunoassay-based tumour markers.
What is your prior experience of this activity?
- Think about what you already know about immunoassay principles or other analytical techniques relevant to measuring tumour markers (e.g., PSA, AFP).
- Consider possible challenges you might face during the activity, such as managing complex assay calibration procedures, interpreting quality control results specific to tumour marker assays, or troubleshooting instrument errors.
- 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 specific immunoassay run for a tumour marker (e.g., hCG) fails quality control and requires specialist technical troubleshooting.
- Acknowledge how you feel about performing analyses specifically related to cancer diagnosis and monitoring.
What do you anticipate you will learn from the experience?
- Consider the specific skills you want to develop, such as advanced analytical skills related to performing immunoassay-based tumour marker assays.
- Identify the specific insights you hope to gain into the quality control requirements specific to these assays and the clinical use and limitations of markers (e.g., Ca19-9 or Ca-125).
What additional considerations do you need to make?
- Consult actions identified following previous experiences of performing similar automated immunoassay analyses.
- Identify important information you need to consider before embarking on the activity, such as access to the SOPs for each tumour marker assay, understanding the operational procedures of the specific instrumentation used, and safety procedures for handling reagents.
In action
Is anything unexpected occurring?
- Are you noticing anything surprising or different from what you anticipate whilst performing tumour marker assays (e.g., CEA, PSA, Ca-125, AFP)?
- Are you encountering situations such as:
- A quality control (QC) failure specific to an immunoassay-based tumour marker that cannot be resolved with routine maintenance?
- Unexpected issues arise with low concentration analyte measurement or suspected matrix effects/assay interference (e.g., high-dose biotin interference)?
- Technical difficulty arises in calibrating the analyser or adhering to specific timing protocols for a tumour marker assay?
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 technical troubleshooting or assessing potential interference?
- Consider the steps you are taking in the moment, such as:
- Immediately re-running the affected QC material or preparing a new batch of reagent
- Consulting the immuno-analyser manual or SOP to investigate potential technical causes for the QC failure
- How are you feeling in that moment? Is it affecting your confidence in following the precise SOP for specialised assays (e.g., hCG)?
What is the conclusion or outcome?
- Identify how you are working within your scope of practice. For example, are you successfully resolving a minor technical issue related to the immunoassay platform? Or are you needing support because a severe quality control failure requires specialist technical intervention or consultation with the manufacturer?
- What are you learning as a result of the unexpected development? For example, are you mastering the advanced analytical skills required for tumour marker immunoassays? Or gaining insight into the technical challenges and interference potential specific to these assays?
On action
What happened?
- Begin by summarising the key steps you took when performing the tumour marker analyses (e.g., CEA, PSA, Ca-125, hCG).
- Consider specific events, actions, or interactions which felt important, such as managing the immunoassay analyser calibration for low concentration analytes or the specific steps followed for sample preparation for a particular tumour marker (e.g., AFP).
- Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, immediately troubleshooting a Quality Control (QC) failure specific to a single tumour marker assay (e.g., Ca-125). How did you feel during this experience, e.g., did you feel confident in following the immunoassay SOP or needing guidance when encountering a matrix effect or suspected interference?
How has this experience contributed to your developing practice?
- Identify what learning you can take from this experience regarding performing specialised immunoassay analyses. What strengths did you demonstrate, e.g., meticulous attention to detail during instrument calibration?
- What skills and/or knowledge gaps were evident, e.g., unfamiliarity with advanced troubleshooting for specific immunoassay interferences (e.g., high-dose biotin)?
- Compare this experience against previous engagement with similar activities – were any previously identified actions for development achieved? Has your practice improved in identifying and mitigating analytical challenges specific to tumour markers?
- Identify any challenges you experienced, such as needing to seek advice or clarification on scope of practice regarding resolving a persistent QC failure, 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 technical expertise in tumour marker analysis.
- What will you do differently next time you approach performing tumour marker assays, for instance, by proactively reviewing the SOP sections related to known interferences for the specific assay?
- Do you need to practise any aspect of the activity further, such as troubleshooting immunoassay QC failures or key learning outcomes related to performing assays accurately?
Beyond action
Have you revisited the experiences?
- How have your subsequent experiences of performing other specialised immunoassays or interpreting complex cancer diagnostic reports since completing this specific training activity led you to revisit your initial approach or decisions during that activity? For example, how a subsequent technical issue with assay interference in an endocrine immunoassay forced you to re-evaluate the vigilance of your QC monitoring and pre-analytical checks for the initial tumour marker runs (e.g., PSA, Ca-125).
- Considering what you understand about immunoassay performance characteristics, analytical interferences (e.g., high-dose biotin), and the clinical use and limitations of tumour markers 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 technical troubleshooting and pre-analytical verification for immunoassay-based tumour markers based on further learning and experiences? For example, how you proactively reviewed and integrated the manufacturer’s guidelines regarding sample stability and potential interference for key markers like hCG.
- Has discussing assay interferences, technical QC failures for tumour markers, or their clinical significance 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 a false negative Ca-125 result occurred due to technical error refined your understanding of the critical need for meticulous procedural performance in cancer diagnostics.
How have these experiences impacted upon current practice?
- How has the learning from this initial training activity, in combination with subsequent immunoassay performance experiences, contributed to your overall confidence and competence in performing specialised immunoassay techniques, particularly in preparing for assessments like Direct Observations of Practical Skills (DOPS)? For example, how your accumulated ability in precision in immunoassay techniques and verifying sample integrity now enables you to confidently execute the technical procedure for tumour marker analysis during a DOPS assessment.
- How has reflecting back on this specific training activity, combined with everything you’ve learned since, shaped your current approach to performing specialised immunoassay tumour marker analyses? 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 seek advice from the Technical Manager immediately when complex immunoassay QC failures persist or when suspected analytical interference (e.g., high-dose biotin) affects a critical tumour marker result, recognising this requires specialist technical investigation.
- Looking holistically at your training journey, how has this initial tumour marker analysis experience, revisited with your current perspective, contributed to your development in meeting the learning outcomes related to performing biochemical assays? For example, how this foundational experience has supported your development in understanding the technical challenges and analytical pitfalls specific to immunoassay methods, improving the reliability of all immunoassay data.
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. |
| # 3 |
Outcome
Evaluate the national guidelines for diagnosis and management of diseases associated with the major organ systems and cancer. |