Pregnancy and Screening —
Training activity: 4

Details

Identify cases that require urgent intervention and offer clinical advice on the follow-up and further management for three of the following situations:

• HELLP
• Obstetric cholestasis
• Ectopic pregnancy
• Thyroid dysfunction
• Gestational diabetes
• Pre-eclampsia

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

• Appropriate action for escalation
• Further tests
• Patient centred care and support
• Communication with the multidisciplinary team and service user

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 identifying cases requiring urgent intervention based on biochemical results. What does appropriate clinical advice or recommended follow-up look like for these specific 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 the level of clinical knowledge expected. What are the established pathways for escalating results and communicating with clinical teams for these urgent situations?

What is your prior experience of this activity?

• Think about what you already know about interpreting results in a clinical context and communicating with clinical staff.
• Consider possible challenges you might face during the activity, such as integrating multiple biochemical results with limited clinical information or communicating effectively under pressure.
• 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 when identifying urgent cases and offering advice.
• Acknowledge how you feel about identifying urgent cases and providing advice in a specialist area like pregnancy complications.

What do you anticipate you will learn from the experience?

• Consider the specific skills you want to develop, such as integrating biochemical data with clinical scenarios, applying knowledge of specific pregnancy complications to interpretation, and developing effective communication strategies for urgent results and advice.
• Identify the specific insights you hope to gain into the clinical pathways for these urgent pregnancy complications. How will it highlight the critical role of the laboratory in timely diagnosis and management?

What additional considerations do you need to make?

• Consult actions identified following previous experiences of interpreting complex cases or communicating critical results.
• Identify important information you need to consider before embarking on the activity, such as reviewing the clinical presentations and diagnostic criteria for HELLP, obstetric cholestasis, ectopic pregnancy, thyroid dysfunction in pregnancy, gestational diabetes, and pre-eclampsia. You should also understand the biochemical markers associated with each and the typical thresholds for urgent action and familiarise yourself with communication protocols for critical results.

In action

Is anything unexpected occurring?

• Are you noticing anything surprising or different from what you anticipate whilst reviewing cases and offering clinical advice for urgent pregnancy situations (e.g., HELLP, Ectopic pregnancy, Pre-eclampsia)?
• Are you encountering situations such as:
  • A case presenting differently than expected based on the biochemical results?
  • Difficulty applying guidelines for urgent intervention?
  • An unexpected piece of clinical information impacting the recommended follow-up?

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 case identification or advice?
• Consider the steps you are taking in the moment, such as:
  • Immediately pausing to re-evaluate the case against clinical guidelines for HELLP or Pre-eclampsia
  • Seeking input from a senior colleague or Duty Biochemist
  • Modifying the clinical advice based on the new information
• How are you feeling in that moment? For instance, are you finding it difficult to adapt? Is it affecting your confidence in identifying urgent cases or providing advice? 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 formulating initial advice based on confirmed Pre-eclampsia markers and guidelines? Or are you needing support because you need to escalate to ensure you were working within your scope of practice?
• What are you learning as a result of the unexpected development? For example, are you gaining insight into the identification of urgent cases, the clinical context of conditions like ectopic pregnancy or gestational diabetes, or the process of formulating clinical advice?

On action

What happened?

• Begin by summarising the key steps you took when reviewing cases for urgent intervention and offering clinical advice for three complications (e.g., pre-eclampsia, ectopic pregnancy, obstetric cholestasis).
• Consider specific events, actions, or interactions which felt important, such as how you assessed the biochemical severity of a case (e.g., HELLP syndrome) or the precise wording used when communicating advice to a clinical team.
• Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, immediately seeking clarification from the duty biochemist when faced with ambiguous results that made formulating definitive advice difficult.
• How did you feel during this experience, e.g., did you feel focused on applying diagnostic guidelines for urgent complications or challenged by the lack of sufficient clinical history?

How has this experience contributed to your developing practice?

• Identify what learning you can take from this experience regarding recognising urgency and formulating clinical advice. What strengths did you demonstrate, e.g., rapid identification of critical result patterns?
• What skills and/or knowledge gaps were evident, e.g., unfamiliarity with the national management guidelines for specific complications like ectopic pregnancy?
• Compare this experience against previous engagement with similar activities – were any previously identified actions for development achieved? Has your ability to identify urgent cases and offer appropriate advice improved, particularly under pressure?
• Identify any challenges you experienced, such as needing to seek advice or clarification on scope of practice regarding the level of detail or action required when advising on borderline gestational diabetes 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 improving the speed and clarity of your urgent case assessment and communication.
• What will you do differently next time you approach reviewing cases for urgent intervention, for instance, by proactively reviewing the latest clinical guidelines for complications like HELLP or pre-eclampsia?
• Do you need to practise any aspect of the activity further, such as reviewing guidelines for urgent conditions or role-playing formulating clinical advice with a supervisor 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 interpreting complex biochemical results and identifying urgent patient cases in pregnancy or other contexts since completing this specific training activity led you to revisit your initial approach or decisions during that activity? For example, how an instance where a subsequent urgent case required immediate intervention for HELLP syndrome forced you to re-evaluate the speed and rigor of your critical result assessment and communication during your first attempt at identifying urgent pregnancy cases.
• Considering what you understand about disease pathways, clinical criticality, and the importance of clear communication 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 urgent case identification protocols and clinical advice formulation based on further learning and experiences? For example, how you proactively reviewed and integrated national guidelines for escalating Pre-eclampsia markers into your daily review process, demonstrating adapted improvements based on further learning.
• Has discussing management protocols for urgent pregnancy complications (e.g., ectopic pregnancy, gestational diabetes) or the impact of clinical advice accuracy 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 communication failure regarding a critical pre-eclampsia marker refined your understanding of the critical nature of clear and timely advisory skills.

How have these experiences impacted upon current practice?

• How has the learning from this initial training activity, in combination with subsequent critical result interpretation and communication experiences, contributed to your overall confidence and ability in synthesising complex biochemical data to assess clinical urgency, particularly in preparing for assessments like Observed Communication Events (OCEs) or CBDs? For example, how your accumulated skill in rapidly identifying the critical markers for HELLP or severe Pre-eclampsia now enables you to confidently articulate urgent management advice and clinical priority during an OCE assessment.
• How has reflecting back on this specific training activity, combined with everything you’ve learned since, shaped your current approach to critical result review and advisory communication? 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 clinical consultation immediately when required to offer prognostic advice beyond immediate diagnosis and follow-up, recognising this requires expert medical authority outside routine clinical advice scope.
• Looking holistically at your training journey, how has this initial urgent case identification 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 performing future on-call duties requiring critical result interpretation and timely, clear communication of clinical advice.

Relevant learning outcomes

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