Pregnancy and Screening —
Training activity: 1

Details

Perform the analyses involved in the detection of pregnancy to laboratory standard operating procedures

To include:

• hCG
• LH
• FSH
• Point of care devices

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.

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 performing these specific analyses, which constitutes accurately performing the assays for hCG, LH, FSH, and relevant point-of-care tests according to laboratory standard operating procedures (SOPs).
• Consider how the learning outcomes apply, specifically in relation to analysing biological samples using biochemical assays involved in the detection of pregnancy and applying scientific knowledge to evaluate assay results.
• Discuss with your training officer to gain clarity of what is expected of you in relation to the expected level of performance and any specific considerations for these pregnancy-related tests.

What is your prior experience of this activity?

• Think about what you already know about performing these specific assays or similar analytical tasks. Have you performed these analytes in other contexts (e.g., non-pregnant patients)?
• Consider possible challenges you might face during the activity, such as sample matrix, assay sensitivity for early pregnancy, QC procedures.
• 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 QC issues or unexpected results.
• Acknowledge how you feel about embarking on this training activity. Are you confident in performing these types of assays? Do you have any concerns about the specific analytes or methods?

What do you anticipate you will learn from the experience?

• Consider the specific skills you want to develop, such as focusing on the practical steps of the assay, running controls, or interpreting instrument flags.
• Identify the specific insights you hope to gain into how performing these analyses will enhance your understanding of their role in detecting pregnancy. How will it link to your knowledge of normal pregnancy physiology?

What additional considerations do you need to make?

• Consult actions identified following previous experiences of performing laboratory analyses.
• Identify important information you need to consider before embarking on the activity, such as reviewing the specific SOPs for hCG, LH, FSH, and pregnancy POCT in your laboratory, understanding the QC criteria, and being aware of critical values or urgent result reporting requirements.

In action

Is anything unexpected occurring?

• Are you noticing anything surprising or different from what you anticipate whilst performing analyses for the detection of pregnancy, such as hCG, LH, FSH, or using point-of-care devices?
• Are you encountering situations such as:
• Unexpected results, issues with the instrument, or problems with the sample?
• Unexpected differences when comparing this experience with previous experiences of similar activities, like running other assays or using point-of-care devices?

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 troubleshooting the instrument or checking reagents?
• Consider the steps you are taking in the moment, such as:
• Immediately consulting the standard operating procedure
• Deciding to re-run the sample or check reagents
• 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. For example, are you successfully troubleshooting the instrument or performing a re-run? Or are you needing support because the issue with the sample or instrument is beyond routine resolution?
• What are you learning as a result of the unexpected development? For example, are you gaining insight into the technical aspects of specific assays (hCG, LH, FSH) or point-of-care devices?

On action

What happened?

• Begin by summarising the key steps you took when performing the analyses for hCG, LH, FSH, and/or point-of-care devices according to standard operating procedures.
• Consider specific events, actions, or interactions which felt important, such as how you ensured compliance with QC procedures or how you handled the specific sample matrix requirements for these assays.
• Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, immediately troubleshooting an instrument flag or unexpected Quality Control (QC) failure encountered during the hCG assay.
• How did you feel during this experience, e.g., did you feel confident in troubleshooting the analytical instrument or stressed by the urgency of the result?

How has this experience contributed to your developing practice?

• Identify what learning you can take from this experience regarding the technical performance of pregnancy detection assays. What strengths did you demonstrate, e.g., meticulous adherence to the analytical preparation checklist?
• What skills and/or knowledge gaps were evident, e.g., unfamiliarity with the specific mechanism of interference affecting the FSH assay?
• Compare this experience against previous engagement with similar activities – were any previously identified actions for development achieved? Has your practice improved in integrating technical SOPs with the specific requirements of point-of-care device usage?
• Identify any challenges you experienced, such as needing to seek advice or clarification on scope of practice regarding whether an unexpected result required immediate senior notification (escalation), 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 efficiency and reliability of analytical performance for these assays.
• What will you do differently next time you approach performing pregnancy detection assays, for instance, by proactively checking the sample integrity checklist for potential matrix effects?
• Do you need to practise any aspect of the activity further, such as troubleshooting specific instrument alarms for LH/FSH or key learning outcomes related to applying scientific knowledge to evaluate assay results?

Beyond action

Have you revisited the experiences?

• How have your subsequent experiences of performing these pregnancy detection analyses multiple times since completing this specific training activity led you to revisit your initial approach or decisions during that activity? For example, how subsequent experience with managing unstable analytes or critical sample timing for ectopic pregnancy checks forced you to re-evaluate the meticulousness of your pre-analytical checks and adherence to SOPs during your first attempt at this training activity.
• Considering what you understand about assay performance, SOP adherence, and the physiological changes in pregnancy 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 performance and technical rigor based on further learning and experiences? For example, how you proactively reviewed and integrated specific quality control validation steps to improve method reliability based on further learning.
• Has discussing technical challenges, sample timing criticality, or the clinical utility of pregnancy detection assays 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 negative pregnancy test result due to poor sample timing refined your understanding of the critical nature of analytical performance and clinical context during detection.

How have these experiences impacted upon current practice?

• How has the learning from this initial training activity, in combination with subsequent assay performance experiences, contributed to your overall confidence and ability in performing technical procedures and adhering to Standard Operating Procedures (SOPs), particularly in preparing for assessments like Direct Observations of Practical Skills (DOPS) or Observed Communication Events (OCEs)? For example, how your accumulated meticulousness in quality control checks for hCG and vigilance in adherence to SOPs for pregnancy detection assays now enables you to confidently execute analytical steps, ensuring technical precision and quality, 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 analytical troubleshooting and ensuring pre-analytical integrity? 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 technical advice immediately when persistent interference affects the point-of-care device or quantitative hCG assay, recognising this falls outside routine troubleshooting scope.
• Looking holistically at your training journey, how has this initial pregnancy detection analyses experience, revisited with your current perspective, contributed to your development in meeting the learning outcomes related to analysing biological samples using biochemical assays involved in the detection of pregnancy and applying scientific knowledge to evaluate assay results? For example, how this foundational experience has supported your development in contributing to the validation of new analytical methods or training new staff on the critical nature of technical rigor and SOP adherence.

Relevant learning outcomes

#	Outcome
# 2	Outcome Analyse biological samples using biochemical assays involved in the detection of pregnancy and apply scientific knowledge to evaluate assay results.