Pregnancy and Screening —
Training activity: 2

Details

Interpret and report routine biochemical results in the pregnant population identifying cases where pregnancy specific reference ranges have been used. To include two of the following:

• LFTs
• Thyroid function tests
• Gonadotrophins
• U and E
• FBC

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 pre-analytical issues, assay advantages and limitations, quality parameters, and interferences
• Equipment calibration and maintenance
• Quality control; EQA and IQC
• Pregnancy specific reference ranges
• Communication with the multidisciplinary team and service user
• 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 accurate interpretation of routine biochemical results in a pregnant patient. How do you ensure you are using pregnancy-specific reference ranges where appropriate?
• Consider how the learning outcomes apply, specifically in relation to describing the physiological differences associated with pregnancy and interpreting biochemical data accurately to identify the complications of pregnancy.
• Discuss with your training officer to gain clarity of what is expected of you in relation to the level of detail expected in the reports. How should you comment on results that fall outside non-pregnant ranges but within pregnancy ranges?

What is your prior experience of this activity?

• Think about what you already know about interpreting routine biochemical results and using different reference ranges.
• Consider possible challenges you might face during the activity, such as interpreting borderline results or interpreting results suggestive of a complication.
• 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 complex cases or suspected complications.
• Acknowledge how you feel about interpreting results and applying physiological knowledge to a specific patient context like pregnancy.

What do you anticipate you will learn from the experience?

• Consider the specific skills you want to develop, such as identifying the need for pregnancy ranges, applying knowledge of physiological changes in pregnancy to interpretation, and drafting appropriate clinical comments.
• Identify the specific insights you hope to gain into how pregnancy affects various biochemical analytes. How will it help you appreciate the importance of using appropriate reference intervals?

What additional considerations do you need to make?

• Consult actions identified following previous experiences of interpreting and reporting results.
• Identify important information you need to consider before embarking on the activity, such as reviewing laboratory policies on pregnancy reference ranges. This includes understanding the physiological basis for changes in the chosen analytes during pregnancy and being aware of common pregnancy complications that might affect these results.

In action

Is anything unexpected occurring?

• Are you noticing anything surprising or different from what you anticipate whilst interpreting and reporting routine biochemical results (e.g., LFTs, thyroid function tests, gonadotrophins, U and E, FBC) in the pregnant population?
• Are you encountering situations such as:
  • A result that didn’t fit the clinical picture?
  • Difficulty applying pregnancy-specific reference ranges?
  • Unexpected patterns across different analytes (e.g., LFTs, thyroid function tests)?

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 interpretation?
• Consider the steps you are taking in the moment, such as:
  • Immediately double-checking the pregnancy-specific reference ranges
  • Seeking more clinical information or discussing the case with a supervisor
• How are you feeling in that moment? For instance, are you finding it difficult to adapt? Is it affecting your confidence in using pregnancy-specific ranges? 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. For example, are you successfully interpreting the results using the pregnancy-specific ranges and contextual information? Or are you needing support because the unexpected pattern requires specialist biochemical consultation?
• What are you learning as a result of the unexpected development? For example, are you gaining insight into the application of pregnancy-specific reference ranges for analytes like LFTs or thyroid function tests?

On action

What happened?

• Begin by summarising the key steps you took when interpreting and reporting routine biochemical results (e.g., LFTs, thyroid function tests, U and E) for pregnant patients and the process of applying pregnancy-specific reference ranges.
• Consider specific events, actions, or interactions which felt important, such as how you identified and applied the correct trimester-specific range or how you phrased the final report comment regarding results falling within the pregnancy range but outside the non-pregnant range.
• Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, immediately consulting a supervisor when faced with an unexpected LFT result that did not fit the expected physiological context of pregnancy.
• How did you feel during this experience, e.g., did you feel focused on applying the physiological changes or stressed by the ambiguity of a borderline result?

How has this experience contributed to your developing practice?

• Identify what learning you can take from this experience regarding the physiological differences associated with pregnancy. What strengths did you demonstrate, e.g., meticulousness in identifying the need for pregnancy-specific ranges?
• What skills and/or knowledge gaps were evident, e.g., unfamiliarity with the specific clinical significance of a borderline thyroid function test result in pregnancy?
• Compare this experience against previous engagement with similar activities – were any previously identified actions for development achieved? Has your practice improved in correlating physiological changes with appropriate report terminology?
• Identify any challenges you experienced, such as needing to seek advice or clarification on scope of practice regarding the need to confirm if a patient had complex comorbidities affecting the interpretation of U and E results, 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 systematically verifying the application of pregnancy-specific reference ranges in interpretation.
• What will you do differently next time you approach interpreting routine biochemical results in pregnancy, for instance, by proactively reviewing the physiological basis for common changes in analytes like LFTs?
• Do you need to practise any aspect of the activity further, such as interpreting borderline thyroid function tests in pregnancy or key learning outcomes related to interpreting biochemical data accurately to identify complications?

Beyond action

Have you revisited the experiences?

• How have your subsequent experiences of interpreting more routine biochemical results in pregnant patients since completing this specific training activity led you to revisit your initial approach or decisions during that activity? For example, how subsequent encounters with complex cases of obstetric cholestasis or thyroid dysfunction forced you to re-evaluate the diligence of checking pregnancy status and applying trimester-specific reference ranges during your first attempt at this training activity.
• Considering what you understand about physiological changes in pregnancy and the nuances of using pregnancy-specific reference ranges 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 interpretation methodology and vigilance regarding pregnancy status verification based on further learning and experiences? For example, how you proactively reviewed and integrated the specific interpretive criteria for Thyroid Function Tests (TFTs) across all trimesters, demonstrating adapted improvements based on further learning.
• Has discussing challenging routine biochemical results in pregnancy or the impact of inappropriate reference range use 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 delayed diagnosis due to misinterpretation of LFTs refined your understanding of the critical nature of integrating physiological knowledge during routine interpretation.

How have these experiences impacted upon current practice?

• How has the learning from this initial training activity, in combination with subsequent interpretation experiences, contributed to your overall confidence and ability in applying clinical context and physiological knowledge to biochemical interpretation, particularly in preparing for assessments like Case-Based Discussions (CBDs)? For example, how your accumulated vigilance in applying and justifying pregnancy-specific reference ranges to routine analytes (e.g., LFTs or Thyroid function tests) now enables you to confidently discuss the physiological rationale for result variations and rule out complications 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 routine biochemical reporting in complex patient groups? 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 senior advice immediately when a routine result falls within the non-pregnant range but is inconsistent with the expected physiological changes of pregnancy, recognising potential subtle pathology that requires expert review.
• Looking holistically at your training journey, how has this initial routine interpretation experience, revisited with your current perspective, contributed to your development in meeting the learning outcomes related to describing the physiological differences associated with pregnancy and interpreting biochemical data accurately? For example, how this foundational experience has supported your development in interpreting results and applying appropriate physiological context in other patient groups with altered physiology, such as paediatric or geriatric patients.

Relevant learning outcomes

#	Outcome
# 1	Outcome Describe the physiological differences associated with pregnancy.
# 3	Outcome Interpret biochemical data accurately to identify the complications of pregnancy.