Training activity information
Details
Perform analysis of:
- Glucose
- Ammonia
- Bilirubin (conjugated/unconjugated)
- Creatinine
- Lactate
- Bicarb/blood gases
- Uric acid (plasma/urine)
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 pre-analystical issues, assay advantages and limitations, quality parameters, and interferences
- Equipment calibration and maintenance
- Quality control; EQA and IQC
- Clinical utility
- 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 accurately performing the analysis of the listed core analytes in a paediatric context according to SOPs.
- Consider how the learning outcomes apply, specifically in relation to employing knowledge of the technical issues associated with paediatric samples, identifying appropriate specialist testing for inborn errors and applying the appropriate testing strategy.
- Discuss with your training officer to gain clarity of what is expected of you in relation to achieving analytical quality specific to paediatric ranges and understanding how these analytes are used in common paediatric scenarios (e.g., metabolic acidosis).
What is your prior experience of this activity?
- Think about what you already know about SOPs for performing core clinical biochemistry analysis, QC procedures, and the function of the laboratory equipment.
- Consider possible challenges you might face during the activity, such as managing the technical challenges of performing assays on small paediatric sample volumes or ensuring accuracy due to matrix effects, or applying quality control procedures specific for paediatric ranges.
- 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 you encounter difficulties pipetting small volumes accurately or if an unusual result requires correlation with expected reference ranges that change with age.
- Acknowledge how you feel about analysing key paediatric biochemistry analytes that are often critical in acute presentations.
What do you anticipate you will learn from the experience?
- Consider the specific skills you want to develop, such as gaining practical experience in performing assays for analytes like lactate, ammonia, and blood gases.
- Identify the specific insights you hope to gain into the importance of using appropriate paediatric reference ranges for interpretation and the clinical significance of abnormal results for analytes used in the investigation of common paediatric conditions (e.g., hyperammonaemia).
What additional considerations do you need to make?
- Consult actions identified following previous experiences of performing automated or manual assays and dealing with quality control failures.
- Identify important information you need to consider before embarking on the activity, such as reviewing the relevant SOPs and analytical methods for each analyte, studying the paediatric reference ranges and their age-dependent changes, and reading about the clinical relevance of these analytes in paediatric disorders.
In action
Is anything unexpected occurring?
- Are you noticing anything surprising or different from what you anticipate whilst performing analyses on paediatric samples for specific analytes?
- Are you encountering situations such as:
- Sample matrix effects on methods?
- Unexpected results given available clinical information?
- Instrument issues?
- Unexpected differences when comparing this experience with previous experiences of similar activities, noting differences in sample size, reference ranges, and the physiological context of paediatric biochemistry
How are you reacting to the unexpected development?
- How is this impacting your actions? For example, are you responding to the situation appropriately? Did you adapt or change your analytical approach?
- Consider the steps you are taking in the moment, such as:
- Troubleshooting the instrument
- Re-running the sample according to protocol
- Seeking supervisor advice
- How are you feeling in that moment? For instance, are you finding it difficult to adapt? Is it affecting your confidence? Did you feel positive you could reach a successful conclusion?
What is the conclusion or outcome?
- Identify how you are working within your scope of practice while performing the analysis and addressing the unexpected issue. For example, are you performing the analysis according to SOP despite sample size constraints? Or are you needing support because the unexpected result given the physiological context requires specialist interpretation?
- What are you learning as a result of the unexpected development? For example, are you gaining insight into technical issues and implications of paediatric patients on testing, such as sample size and matrix effects?
On action
What happened?
- Begin by summarising the key steps you took when performing the analysis for one or more of the listed analytes.
- Consider specific events, actions, or interactions which felt important, such as describing the analytical method(s) used for the samples or how you managed quality control checks for an analyte like ammonia.
- Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, immediately troubleshooting an instrument error or unexpected result encountered during the analysis of lactate.
- How did you feel during this experience, e.g., did you feel confident in troubleshooting the analytical instrument or stressed by the need to adapt your technique for a very small paediatric sample volume?
How has this experience contributed to your developing practice?
- Identify what learning you can take from this experience regarding the technical challenges or specific considerations when analysing these analytes in paediatric samples. What strengths did you demonstrate, e.g., accurate management of analytical methods and quality control procedures?
- What skills and/or knowledge gaps were evident, e.g., unfamiliarity with differences in sample types, reference ranges, or physiology compared to adults?
- Compare this experience against previous engagement with similar activities – were any previously identified actions for development achieved? Has your practice improved in understanding the biochemical differences between adults and children?
- Identify any challenges you experienced, such as needing to seek advice or clarification on scope of practice regarding interpreting an unexpected creatinine result in a neonate, 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 your technique or understanding for future analyses of these analytes.
- What will you do differently next time you approach analysing critical paediatric analytes like blood gases or ammonia, for instance, by proactively reviewing age-dependent reference ranges prior to analysis?
- Do you need to practise any aspect of the activity further, such as troubleshooting specific analytical methods or key learning outcomes related to employing knowledge of the technical issues associated with paediatric samples.
Beyond action
Have you revisited the experiences?
- How have your subsequent experiences of analysing the same analytes (e.g., lactate, ammonia) in acute adult samples or interpreting complex metabolic profiles since completing this specific training activity led you to revisit your initial approach or decisions during that activity? For example, how subsequent learning on paediatric physiology and metabolic acidosis forced you to re-evaluate the accuracy of blood gas analysis and the use of age-dependent reference ranges during your first attempt at this training activity.
- Considering what you understand about age-dependent reference intervals, analytical matrix effects, and the clinical context of acute paediatric disorders (e.g., hyperammonaemia) 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 QC validation and interpretation relative to age-specific norms based on further learning and experiences? For example, how you proactively reviewed and integrated guidelines for handling and interpreting conjugated/unconjugated bilirubin in neonatal jaundice.
- Has discussing patient cases involving hypoglycaemia or metabolic acidosis or the analytical challenges of small volume testing 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 false lactate elevation due to technical error refined your understanding of the critical nature of technical rigor in paediatric biochemistry.
How have these experiences impacted upon current practice?
- How has the learning from this initial training activity, in combination with subsequent analytical and troubleshooting experiences, contributed to your overall confidence and ability in performing analyses efficiently and troubleshooting analytical challenges, particularly in preparing for assessments like DOPS? For example, how your accumulated skill in troubleshooting analytical challenges related to small sample volumes and matrix effects now enables you to confidently perform a blood gas analysis and deal with minor instrument flags during a technical DOPS assessment.
- How has reflecting back on this specific training activity, combined with everything you’ve learned since, shaped your current approach to analysing core paediatric analytes? 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 matrix effects and age-dependent reference intervals immediately when interpreting results like creatinine or bilirubin, seeking advice if there is discordance suggesting analytical bias.
- Looking holistically at your training journey, how has this initial core analysis experience, revisited with your current perspective, contributed to your development in meeting the learning outcomes related to employing knowledge of the technical issues associated with paediatric samples and applying appropriate testing strategies? For example, how this foundational experience has supported your development in evaluating new analytical methods or technologies for paediatric samples.
Relevant learning outcomes
| # | Outcome |
|---|---|
| # 2 |
Outcome
Employ knowledge of the technical issues associated with paediatric samples. |
| # 3 |
Outcome
Identify the appropriate specialist testing for the major categories of inborn errors of metabolism. |
| # 4 |
Outcome
Apply the appropriate testing strategy for paediatric clinical scenarios. |