Major Organs and Cancer —
Training activity: 5

Details

Interpret and report further actions required from the results of an EQA report

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.

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 an External Quality Assurance (EQA) report and proposing specific corrective or follow-up actions.
• Consider how the learning outcomes apply, specifically in relation to applying analytical and interpretive skills to quality assurance data.
• Discuss with your training officer to gain clarity of what is expected of you in relation to the departmental process for reviewing EQA reports and initiating necessary corrective actions.

What is your prior experience of this activity?

• Think about what you already know about quality control data, statistical measures, or previous exposure to EQA reports.
• Consider possible challenges you might face during the activity, such as understanding complex statistical measures (e.g., standard deviation index) used in EQA reports, identifying the root cause of poor performance, or proposing effective corrective actions.
• 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 the EQA results indicate persistent analytical bias requiring troubleshooting beyond your current technical skills, or if a major corrective action needs to be initiated.
• Acknowledge how you feel about engaging with quality assurance data and its implications for laboratory performance.

What do you anticipate you will learn from the experience?

• Consider the specific skills you want to develop, such as interpreting complex EQA statistical data.
• Identify the specific insights you hope to gain into the importance of quality assurance in clinical biochemistry and the process for identifying and implementing corrective actions (e.g., following poor performance in a Myocardial Infarction marker EQA).

What additional considerations do you need to make?

• Consult actions identified following previous experiences of reviewing quality control or EQA data.
• Identify important information you need to consider before embarking on the activity, such as understanding the EQA scheme’s design and performance metrics, and reviewing relevant laboratory policies related to quality assurance.

In action

Is anything unexpected occurring?

• Are you noticing anything surprising or different from what you anticipate whilst systematically reviewing the External Quality Assurance (EQA) report?
• Are you encountering situations such as:
  • A significant analytical bias or poor performance (e.g., high standard deviation index, SDI) is noted for a key marker (e.g., myocardial infarction marker) that was not anticipated?
  • Difficulty arises in understanding complex statistical measures or identifying the root cause of the reported deviation?
  • The EQA report highlights a persistent issue that previous corrective actions failed to address, requiring a major change in investigation strategy?

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 systematic root cause analysis or proposing corrective actions?
• Consider the steps you are taking in the moment, such as:
  • Immediately reviewing internal Quality Control (QC) data for the period in question to corroborate the EQA findings
  • Consulting the instrument log or departmental quality manual to identify potential equipment changes or maintenance issues
• How are you feeling in that moment? For instance, are you finding it difficult to understand the statistical implications of a low score? Is it affecting your confidence in proposing effective and necessary corrective actions?

What is the conclusion or outcome?

• Identify how you are working within your scope of practice. For example, are you successfully identifying a simple QC failure and proposing routine troubleshooting actions? Or are you needing support because the EQA results indicate persistent analytical bias requiring troubleshooting beyond your current technical skills?
• What are you learning as a result of the unexpected development? For example, are you mastering the interpretation of EQA statistical data (e.g., SDI)? Or gaining insight into the necessary steps for initiating formal root cause analysis and implementing corrective actions within a Quality Management System?

On action

What happened?

• Begin by summarising the key steps you took when systematically reviewing the External Quality Assurance (EQA) report.
• Consider specific events, actions, or interactions which felt important, such as identifying a significant analytical bias or poor performance (e.g., high SDI) for a key major organ marker or the process followed for proposing a root cause analysis.
• Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, immediately cross-referencing the EQA findings with internal Quality Control (QC) data to corroborate the deviation.
• How did you feel during this experience, e.g., did you feel confident in your understanding of the statistical data or challenged when identifying the specific corrective actions required for a persistent issue?

How has this experience contributed to your developing practice?

• Identify what learning you can take from this experience regarding quality management and continuous improvement in the laboratory. What strengths did you demonstrate, e.g., systematic review of statistical performance metrics?
• What skills and/or knowledge gaps were evident, e.g., unfamiliarity with proposing major technical troubleshooting steps for persistent analytical bias?
• Compare this experience against previous engagement with similar activities – were any previously identified actions for development achieved? Has your practice improved in proposing effective and targeted corrective actions based on statistical evidence?
• Identify any challenges you experienced, such as needing to seek advice or clarification on scope of practice regarding initiating a major change in analytical protocol based on the EQA findings, 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 interpreting EQA data and ensuring laboratory quality.
• What will you do differently next time you approach reviewing an EQA report, for instance, by proactively reviewing the statistical definitions (e.g., SDI interpretation) before commencing the report analysis?
• Do you need to practise any aspect of the activity further, such as conducting root cause analysis interviews with technical staff or key learning outcomes related to analysing and interpreting quality assurance data?

Beyond action

Have you revisited the experiences?

• How have your subsequent experiences of reviewing multiple EQA reports (e.g., for different major organ markers) or engaging in formal quality management processes since completing this specific training activity led you to revisit your initial approach or decisions during that activity? For example, how subsequently encountering a persistent analytical bias in a different assay forced you to re-evaluate the sufficiency of your initial statistical analysis (e.g., SDI interpretation) applied during your first attempt at interpreting an EQA report.
• Considering what you understand about statistical process control, root cause analysis, and the quality management system 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 methodology for investigating poor EQA performance and proposing corrective actions based on further learning and experiences? For example, how you proactively integrated a systematic process for cross-referencing EQA outliers with internal QC data and instrument logs to pinpoint the source of deviation.
• Has discussing specific EQA failures or the role of EQA in maintaining laboratory accreditation 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 major EQA failure leading to temporary suspension of service refined your understanding of the critical nature of timely and effective EQA review and corrective action.

How have these experiences impacted upon current practice?

• How has the learning from this initial training activity, in combination with subsequent quality management experiences, contributed to your overall confidence and competence in evaluating method performance and statistical data, particularly in preparing for assessments like Direct Observations of Practical Skills (DOPS)? For example, how your accumulated ability in interpreting statistical performance metrics (e.g., SDI) and cross-referencing with internal QC data now enables you to confidently propose corrective actions during a DOPS assessment focusing on EQA review.
• How has reflecting back on this specific training activity, combined with everything you’ve learned since, shaped your current approach to reviewing analytical quality and performance data? 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 EQA results indicate persistent analytical bias or poor performance that previous corrective actions failed to address, recognising this requires formal root cause analysis outside routine troubleshooting scope.
• Looking holistically at your training journey, how has this initial EQA interpretation experience, revisited with your current perspective, contributed to your development in meeting the learning outcomes related to analysing and interpreting biochemical data? For example, how this foundational experience has supported your development in contributing effectively to quality management processes and ensuring the reliability of all laboratory data reported to clinicians.

Relevant learning outcomes

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