Pregnancy and Screening —
Training activity: 3

Details

Perform the analyses involved in the detection of pregnancy specific complications to laboratory standard operating procedures to include three of the following:

• hCG (ectopic pregnancy)
• oGTT
• Thyroid function tests
• Uric acid
• Total bile acids
• FBC
• Liver function tests
• ACR/PCR

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, standards and pathways
• Method selection, including assay advantages and limitations, quality parameters, and interferences
• Equipment calibration and maintenance
• Quality control; EQA and IQC
• 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 and timely performance of these analyses, which are often critical for managing pregnancy complications.
• Consider how the learning outcomes apply, specifically in relation to 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 specific quality control or turnaround time considerations for these tests. What level of understanding of the clinical context is expected while performing the analysis?

What is your prior experience of this activity?

• Think about what you already know about performing these specific assays or similar complex analyses. Have you performed OGTTs, bile acid assays, or specific thyroid function tests before?
• Consider possible challenges you might face during the activity, such as managing the OGTT procedure correctly or troubleshooting assay issues.
• 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 major instrument malfunction or interpreting complex QC data.
• Acknowledge how you feel about performing assays that are specifically linked to urgent clinical conditions.

What do you anticipate you will learn from the experience?

• Consider the specific skills you want to develop, such as mastering the practical aspects of specific assays, understanding their quality control requirements, or gaining efficiency in performing tests under time pressure.
• Identify the specific insights you hope to gain into the link between the assay performance and the clinical diagnosis of complications like gestational diabetes, pre-eclampsia, or obstetric cholestasis.

What additional considerations do you need to make?

• Consult actions identified following previous experiences of performing laboratory analyses, especially those with specific protocols or urgent implications.
• Identify important information you need to consider before embarking on the activity, such as reviewing the specific SOPs for the chosen assays. This includes understanding the clinical context in which these tests are requested (e.g., criteria for an OGTT, signs of pre-eclampsia), and being aware of critical values or reporting pathways for abnormal results.

In action

Is anything unexpected occurring?

• Are you noticing anything surprising or different from what you anticipate whilst performing analyses for pregnancy-specific complications, such as oGTT, uric acid, total bile acids, or ACR/PCR?
• Are you encountering situations such as:
  • Unusual results for markers of complications like pre-eclampsia (uric acid, ACR/PCR), obstetric cholestasis (total bile acids, LFTs), or gestational diabetes (oGTT)?
  • Unexpected instrument issues or Quality Control (QC) failures specific to these assays?

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 performing the analysis?
• Consider the steps you are taking in the moment, such as:
  • Immediately troubleshooting the assay or checking sample integrity
  • Repeating the analysis or escalating a QC issue according to protocol
• How are you feeling in that moment? For instance, are you finding it difficult to adapt? Is it affecting your confidence in performing assays for specific complications? 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 repeating the analysis and validating the results for markers like total bile acids? Or are you needing support because a severe QC failure requires specialist technical intervention?
• What are you learning as a result of the unexpected development? For example, are you gaining insight into the technical aspects of assays for complications like ectopic pregnancy (hCG), gestational diabetes (oGTT), or pre-eclampsia (Uric acid, ACR/PCR)?

On action

What happened?

• Begin by summarising the key steps you took when performing the analyses for three selected pregnancy complications (e.g., oGTT, Total bile acids, uric acid) according to SOPs.
• Consider specific events, actions, or interactions which felt important, such as how you managed the strict timing and collection criteria for the oGTT procedure or how you ensured analytical accuracy for total bile acids.
• Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, immediately stopping the analysis and re-running a Quality Control (QC) check when a significant instrument flag was raised during the uric acid assay.
• How did you feel during this experience, e.g., did you feel acutely aware of the time pressure associated with urgent complication markers or challenged by dealing with a difficult sample matrix?

How has this experience contributed to your developing practice?

• Identify what learning you can take from this experience regarding technical performance for assays detecting pregnancy complications. What strengths did you demonstrate, e.g., mastery of specific analytical protocols for the oGTT?
• What skills and/or knowledge gaps were evident, e.g., unfamiliarity with the specific troubleshooting required for the total bile acid assay instrument?
• Compare this experience against previous engagement with similar activities – were any previously identified actions for development achieved? Has your practice improved in troubleshooting technical issues and managing sample integrity for time-critical assays?
• Identify any challenges you experienced, such as needing to seek advice or clarification on scope of practice regarding when to reject a sample for ACR/PCR due to poor collection or timing, 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 efficiency in performing complex, time-sensitive assays.
• What will you do differently next time you approach performing assays for pregnancy complications, for instance, by proactively reviewing the critical values and reporting pathways for pre-eclampsia markers?
• Do you need to practise any aspect of the activity further, such as troubleshooting specific QC failures related to liver function tests or key learning outcomes related to interpreting biochemical data accurately to identify the complications of pregnancy?

Beyond action

Have you revisited the experiences?

• How have your subsequent experiences of working with the analytical methods and platforms used for complication-specific assays (e.g., oGTT, Total Bile Acids) since completing this specific training activity led you to revisit your initial approach or decisions during that activity? For example, how subsequent exposure to abnormal results and final diagnoses of gestational diabetes or pre-eclampsia forced you to re-evaluate the importance of meticulous technique and strict quality control adherence during your first attempt at performing these critical analyses.
• Considering what you understand about analytical interference, pre-analytical error sources, and the clinical criteria for complications 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 precision and critical sample handling protocols based on further learning and experiences? For example, how you proactively reviewed and integrated specific checks for sample integrity when performing assays like Total Bile Acids or Uric Acid, demonstrating adapted improvements based on further learning.
• Has discussing technical difficulties with complication-critical assays or the impact of analytical error on patient diagnosis 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 positive oGTT result due to incorrect timing refined your understanding of the critical importance of procedural adherence and analytical accuracy in high-stakes tests.

How have these experiences impacted upon current practice?

• How has the learning from this initial training activity, in combination with subsequent specialised assay performance experiences, contributed to your overall confidence and ability in performing technically demanding assays that diagnose serious complications, particularly in preparing for assessments like DOPS? For example, how your accumulated meticulousness in performing critical assays (e.g., Total Bile Acids or following strict oGTT protocols) now enables you to confidently execute complication-critical analytical steps 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 critical, complication-specific assays and minimising analytical error? 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 immediately when pre-analytical or analytical sources of error (e.g., matrix interference or incorrect sample timing) compromise the reliability of a critical result, recognising the severe impact on diagnosing conditions like pre-eclampsia or gestational diabetes.
• Looking holistically at your training journey, how has this initial complication analysis experience, revisited with your current perspective, contributed to your development in meeting the learning outcomes related to interpreting biochemical data accurately to identify the complications of pregnancy? For example, how this foundational experience has supported your development in training new staff on the critical technical steps and ensuring accuracy for specialised complication-critical tests.

Relevant learning outcomes

#	Outcome
# 3	Outcome Interpret biochemical data accurately to identify the complications of pregnancy.