Solid Cancers 1 —
Training activity: 8

Details

Prepare a range of interpretative reports for melanoma referrals

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 preparing interpretative reports for melanoma referrals. This involves analysing, interpreting, and preparing interpretive reports of clinically relevant findings.
• Discuss with your training officer to gain clarity of what is expected of you in relation to the application of genomic results to appropriate therapeutics and disease management for melanoma.

What is your prior experience of this activity?

• Think about what you already know about preparing interpretative reports or communicating laboratory findings for oncology patients.
• Consider possible challenges you might face during the activity, such as translating specific genomic aberrations into clinically actionable therapeutic suggestions for melanoma, or ensuring accurate reporting terminology, 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 when dealing with complex or novel variants in melanoma or coordinating the report with the multidisciplinary team (MDT).
• Acknowledge how you feel about preparing the reports for the melanoma referrals

What do you anticipate you will learn from the experience?

• Consider the specific skills you want to develop, such as structuring reports to address diagnosis, prognosis, and treatment implications specifically for melanoma cases.
• Identify the specific insights you hope to gain into the standardisation and use of appropriate tools and nomenclature for reporting variants in melanoma or evaluating the appropriate therapeutics to guide patient disease management.

What additional considerations do you need to make?

• Consult actions identified following previous experiences of reporting or interpretation based on genomic findings.
• Identify important information you need to consider before embarking on the activity, such as the aetiology of melanoma, current best practice guidelines for reporting, and the application of current precision therapies based on genomic results.

In action

Is anything unexpected occurring?

• Are you noticing anything surprising or different from what you anticipate whilst compiling and writing the interpretative report for melanoma cases?
• Are you encountering situations such as:
• Challenges specific to melanoma genomic features or associated therapeutics (e.g., targeted inhibitors) complicating the phrasing of the conclusion?
• Difficulties in clearly summarising findings relevant to metastasis or prognosis?
• Questions about specific melanoma reporting standards or nomenclature (e.g., related to complex driver mutations like BRAF)?

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 revising sections, seeking feedback specific to melanoma reporting, or checking relevant guidelines immediately? Are you adapting or changing your approach to structuring or wording the report to emphasise predictive value for immunotherapy?
• Consider the steps you are taking in the moment, such as immediately checking the application of precision therapies in melanoma against current literature before finalising the report conclusion.
• How are you feeling in that moment? For instance, are you finding it difficult to correlate the genomic finding with specific treatment options? Is it affecting your confidence in reporting accurately for melanoma cases?

What is the conclusion or outcome?

• Identify how you are working within your scope of practice. For example, are you successfully ensuring the report clearly guides patient disease management based on genomic results? Or are you needing support because the specific variant requires confirmation against a clinical trial database outside routine access?
• What are you learning as a result of the unexpected development? For example, are you gaining insight into the complexities of reporting prognostic indicators relevant to the management of metastasis in melanoma?

On action

What happened?

• Begin by summarising the key steps you took when preparing the interpretative reports for melanoma referrals.
• Consider specific events, actions, or interactions which felt important, such as how you articulated the prognostic implications of the identified variants or how you ensured the report addressed specific therapeutic considerations for melanoma (e.g., targeted inhibitors).
• Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, immediately consulting melanoma-specific guidelines to verify the recommended actionability level of a BRAF variant, ensuring the report aligns with current clinical practice.
• How did you feel during this experience, e.g., did you feel aware of the importance of the report for patient treatment or challenged by incorporating specific prognostic details?

How has this experience contributed to your developing practice?

• Identify what learning you can take from this experience regarding the ability to prepare interpretive reports of clinically relevant findings for melanoma. What strengths did you demonstrate, e.g., effective synthesis of genomic findings with therapeutic agents relevant to melanoma management?
• What skills and/or knowledge gaps were evident, e.g., unfamiliarity with the specific guidelines for reporting acquired resistance mutations in metastatic melanoma?
• Compare this experience against previous engagement with similar activities – were any previously identified actions for development achieved? Has your practice improved in preparing reports that reflect the specific requirements of melanoma genomics?
• Identify any challenges you experienced, such as needing to seek advice or clarification on scope of practice regarding the appropriate sequencing of specific genomic investigations or the referral pathway for germline findings in a melanoma case, 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 preparing interpretative reports for melanoma.
• What will you do differently next time you approach drafting a melanoma report, for instance, by proactively reviewing the most recent clinical guidelines for targeted therapies and their corresponding report language?
• Do you need to practise any aspect of the activity further, such as reviewing melanoma-specific report templates or key learning outcomes related to evaluating the appropriate therapeutics?

Beyond action

Have you revisited the experiences?

• How have your subsequent experiences of preparing interpretative reports for melanoma referrals since completing this specific training activity led you to revisit your initial approach or decisions during that activity? For example, how a subsequent report requiring detailed articulation of prognostic value and current precision therapies forced you to re-evaluate the scope of contextual information included in the report summary you applied during your first attempt at this training activity?
• Considering what you understand about analysing, interpreting, and preparing reports of clinically relevant findings for melanoma 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 reporting content and terminology based on further learning and experiences? For example, how you proactively reviewed and integrated academic content on metastasis and relapse to ensure the report addresses potential progression.
• Has discussing specific melanoma reports and how findings guide patient management or the clinical application of precision therapies 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 case where genomic findings led directly to therapy selection, refined your understanding of the critical nature of linking genomic results to appropriate therapeutics?

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 preparing interpretative reports for melanoma referrals, particularly in preparing for assessments? For example, how your accumulated ability in synthesising analytical findings and clinical context now enables you to confidently prepare and defend a diagnostic report 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 melanoma report drafting? 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 drafting a report that requires interpretation of highly specific drug resistance mechanisms or complex clinical trial eligibility?
• 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 preparing interpretive reports and applying integrative knowledge of therapeutics?

Relevant learning outcomes

#	Outcome
# 3	Outcome Analyse, interpret and prepare interpretive reports of clinically relevant findings for patients with colorectal and lung cancer, and melanoma.
# 4	Outcome Evaluate the clinical significance of variants identified for colorectal and lung cancer, and melanoma using a range of bioinformatics tools following best practice guidelines.
# 5	Outcome Interpret the bioinformatic and NGS quality metrics in relation to assay performance and EQA.
# 6	Outcome Practice with relevant specialties for the diagnosis and treatment of cancer patients and contribute to multidisciplinary team meetings