Training activity information
Details
Select the laboratory molecular assay for patients referred for solid tumour investigation for:
- Colorectal
- Melanoma
- Lung
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 selecting the appropriate molecular assay for patients referred for solid tumour investigation. This includes selecting the relevant testing strategy for patients referred for diagnostic genomic testing for colorectal and lung, cancer and melanoma.
- Discuss with your training officer to gain clarity of what is expected of you in relation to evaluating the strengths and limitations of different technologies (NGS vs non-NGS) to inform assay choice.
What is your prior experience of this activity?
- Think about what you already know about selecting laboratory assays for solid tumours or different analytical technologies applicable to colorectal and lung cancer, and melanoma.
- Consider possible challenges you might face during the activity, such as ambiguous referral information, complex case details, or distinguishing between inherited versus acquired disease considerations, and think about how you might handle them.
- 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 if the clinical context or sample limitations necessitate a deviation from standard assay selection protocols.
- Acknowledge how you feel about selecting the assay for the solid tumours under investigation.
What do you anticipate you will learn from the experience?
- Consider the specific skills you want to develop, such as applying integrative knowledge of testing technologies (NGS/non-NGS) to select the optimal strategy.
- Identify the specific insights you hope to gain into the strengths and limitations of different assays for colorectal and lung, and melanoma, or how clinical context influences assay choice.
What additional considerations do you need to make?
- Consult actions identified following previous experiences of assay selection or evaluating testing technologies.
- Identify important information you need to consider before embarking on the activity, such as the specific genomic mechanisms underpinning the development of colorectal and lung cancer and melanoma, or best practice guidelines for testing strategies.
In action
Is anything unexpected occurring?
- Are you noticing anything surprising or different from what you anticipate whilst reviewing the testing strategy or clinical context for assay selection?
- Are you encountering situations such as:
- Sample limitations (e.g., quantity or quality) unexpectedly restricting NGS options, forcing consideration of non-NGS assays?
- Conflicting clinical information or updated guidance requiring immediate consideration that challenges your initial selection strategy?
- Unexpected complexity in the case requiring evaluation of both inherited and acquired disease considerations?
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 pausing to gather more information or consult guidance to justify the chosen strategy? Are you adapting or changing your approach to decision-making based on the resource limitations or conflicting guidance?
- Consider the steps you are taking in the moment, such as immediately consulting relevant SOPs before committing to the assay choice or halting selection to verify available sample material.
- How are you feeling in that moment? For instance, are you finding it difficult to adapt your decision-making process? Is it affecting your confidence in selecting the relevant testing strategy?
What is the conclusion or outcome?
- Identify how you are working within your scope of practice. For example, are you successfully justifying the selected assay based on resource constraints? Or are you needing support because the unusual clinical presentation requires senior guidance on selecting between NGS and non-NGS methodologies?
- What are you learning as a result of the unexpected development? For example, are you mastering the evaluation of assay limitations based on available sample input requirements?
On action
What happened?
- Begin by summarising the key steps you took when selecting the laboratory molecular assay for the colorectal, lung or melanoma cases.
- Consider specific events, actions, or interactions which felt important, such as how you evaluated the strengths and limitations of NGS versus non-NGS assays for the specific clinical question, or how you justified selecting a specific assay based on sample type or anticipated variants.
- Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, changing your initial selection from a large NGS panel to a smaller, faster assay when faced with unexpected limitations on available tissue volume.
- How did you feel during this experience, e.g., did you feel focused on optimising the testing strategy despite constraints or challenged by evaluating the different technologies?
How has this experience contributed to your developing practice?
- Identify what learning you can take from this experience regarding the relevant testing strategies for diagnostic genomic testing. What strengths did you demonstrate, e.g., accurate evaluation of the clinical question to narrow assay choices?
- What skills and/or knowledge gaps were evident, e.g., unfamiliarity with the turnaround times or specific validation criteria for all non-NGS assays considered?
- Compare this experience against previous engagement with similar activities – were any previously identified actions for development achieved? Has your practice improved in linking the molecular assay choice to the clinical context?
- Identify any challenges you experienced, such as needing to seek advice or clarification on scope of practice regarding the selection of a complex, niche assay for a rare melanoma sub-type, 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 selecting the appropriate molecular assay.
- What will you do differently next time you approach selecting an assay for a complex case, for instance, by reviewing recent departmental audit data on assay performance and troubleshooting before making the final selection?
- Do you need to practise any aspect of the activity further, such as evaluating assay validation data or key learning outcomes related to selecting the relevant testing strategy?
Beyond action
Have you revisited the experiences?
- How have your subsequent experiences of selecting the laboratory molecular assay for colorectal, lung and melanoma patients since completing this specific training activity led you to revisit your initial approach or decisions during that activity? For example, how a subsequent complex case requiring differentiation between NGS and non-NGS approaches forced you to re-evaluate the thoroughness of your initial evaluation of assay limitations you applied during your first attempt at this training activity?
- Considering what you understand about the utility and limitations of different testing strategies (NGS vs non-NGS) 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 assay selection process based on clinical context based on further learning and experiences? For example, how you proactively reviewed and integrated current best practice guidelines to ensure accurate selection based on patient management goals (e.g., diagnosis vs monitoring)?
- Has discussing complex assay selection scenarios or the evaluation of different technologies 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 the constraints imposed by small tissue biopsy volumes refined your understanding of the critical nature of integrating sample quality constraints into the selection decision?
How have these experiences impacted upon current practice?
- How has the learning from this initial training activity, in combination with subsequent experiences, contributed to your overall confidence and competence in selecting the relevant testing strategy for solid tumours, particularly in preparing for assessments? For example, how your accumulated ability in evaluating the strengths and limitations of different technologies now enables you to confidently justify your assay choice during a Case-based Discussion (CBD)?
- How has reflecting back on this specific training activity, combined with everything you’ve learned since, shaped your current approach to assay selection? 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 the required assay falls outside routine departmental protocols or requires highly specialised non-NGS methods?
- Looking holistically at your training journey, how has this initial experience, revisited with your current perspective, contributed to your development in meeting the learning outcomes related to selecting the relevant testing strategy for colorectal and lung cancer and melanoma?
Relevant learning outcomes
| # | Outcome |
|---|---|
| # 2 |
Outcome
Select the relevant testing strategy for patients referred for diagnostic genomic testing for colorectal and lung cancer, and melanoma. |