Training activity information
Details
Write a plan of investigation for the diagnosis of one of the following disorders:
- Congenital hypothyroidism
- Disorders of sexual development e.g. CAH
- MEN
- Type 1 diabetes
- Autoimmune polyglandular disorders (type 1 and 2)
Type
Developmental training activity (DTA)
Evidence requirements
Evidence the activity has been undertaken by the trainee.
Reflection on the activity at one or more time points after the event including learning from the activity and/or areas of the trainees practice for development.
An action plan to implement learning and/or to address skills or knowledge gaps identified.
Considerations
- Method selection, including pre-analystical issues, assay advantages and limitations, quality parameters, and interferences
- Mechanism of disease, typical symptoms, and variant forms
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
- Which specific disorder from the list are you planning to write an investigation plan for? Why have you chosen this particular disorder?
- What are the typical clinical presentations and key biochemical features of the disorder you have chosen?
- What are the initial screening tests and subsequent confirmatory tests used in the diagnosis of this disorder? Consider both biochemical and other investigations (e.g., imaging, genetic testing).
- What are the age-specific considerations for testing and interpreting results in paediatric populations?
- Are there any relevant national or international guidelines for the diagnosis of this disorder?
- What is the role of the clinical biochemistry laboratory in the diagnostic pathway for this disorder?
- How will this activity enhance your understanding of the diagnostic process for paediatric endocrine disorders?
- What insights do you hope to gain into the selection and sequencing of appropriate laboratory investigations?
- How will this exercise improve your ability to develop a logical and systematic approach to clinical problem-solving?
- Consider different clinical scenarios or variations in presentation and how these might influence the investigation plan.
- Think about the importance of collaboration with clinical colleagues and other specialties in the diagnostic process.
In action
- How are you approaching the task of writing the plan of investigation? What logical steps are you following, and why?
- What decisions are you making as you select the appropriate biochemical tests and other investigations, considering the clinical presentation and potential differential diagnoses?
- Are you readily identifying the key investigations or are you carefully considering each possibility? Are you clear on the rationale for each test?
- How effective are your actions in developing a comprehensive and logical plan of investigation?
- What challenges are you facing during this activity? Are you unsure about the initial screening tests or the subsequent confirmatory investigations? Are you considering the cost-effectiveness and practicality of the tests?
- Are you improving your understanding of diagnostic algorithms for this endocrine disorder?
- Are there alternative investigation pathways you could be considering?
On action
- For which of the listed disorders did you write a plan of investigation? What were the initial presenting features you considered? What were the key biochemical tests and other investigations you included in your plan, and in what order? Did you consider the rationale behind each investigation in your plan? Were there any alternative diagnostic pathways you considered?
- Did you enhance your understanding of the diagnostic work-up for the chosen endocrine disorder? Did you improve your ability to select appropriate biochemical investigations based on clinical scenarios? Did you gain a better understanding of the role of different investigations in the diagnostic algorithm?
- Did you find it difficult to prioritise certain tests or differentiate between screening and confirmatory investigations? Were you able to construct a logical and efficient diagnostic plan? Did you adjust your plan as you considered different diagnostic possibilities?
- Were there any guidelines to consider or incorporate into this exercise?
- What areas for continued development have been identified as a result of this activity? Do you need to deepen your knowledge of the specific diagnostic criteria or investigation pathways for the chosen disorder? How will you approach future requests for investigation plans for endocrine disorders? Identify the actions / ‘next steps’ you will now take to support the assimilation of what you have learned. Will you review relevant clinical guidelines, discuss your plan with an endocrinologist or senior colleague, or research alternative diagnostic strategies? What support or resources might you need to further develop in the areas identified through this reflection? Would access to diagnostic algorithms or case studies be beneficial?
Beyond action
- Review your original plan of investigation. Would you approach the diagnostic pathway differently now, based on your increased knowledge and experience in paediatric endocrine disorders?
- Compare your plan with current clinical guidelines or protocols for the chosen disorder. How has your understanding of best practice evolved since writing the plan?
- Consider cases you have encountered since this training activity involving the same or similar disorders. How did the actual investigation and diagnosis compare to your proposed plan?
- Discuss your original plan with a colleague, perhaps one with more experience in paediatric endocrinology. What alternative approaches might they suggest?
- How has your understanding of the diagnostic algorithms and the role of biochemical tests in the investigation of these paediatric endocrine disorders deepened since this training activity?
- Have you applied your planning skills to other scenarios, such as formulating a strategy for investigating a complex analytical issue?
- How has this experience contributed to your ability to critically evaluate requests for endocrine investigations in your current role?
- What aspects of developing a diagnostic plan did you find challenging? What further learning or experience do you still need in this area?
- How will the skills gained in formulating this plan contribute to your ability to advise clinical colleagues on appropriate testing strategies in the future?
Relevant learning outcomes
| # | Outcome |
|---|---|
| # 1 |
Outcome
Explain the biochemical and clinical differences between adults and children. |
| # 2 |
Outcome
Employ knowledge of the technical issues associated with paediatric samples. |
| # 5 |
Outcome
Interpret results of investigations for paediatric endocrine disorders including disorders of sexual development. |