Solid Cancers 1 —
Training activity: 8

Details

Prepare a range of interpretative reports for colorectal 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 colorectal 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 expected format, structure, and use of appropriate standardised nomenclature for reporting variants in colorectal cancer.

What is your prior experience of this activity?

• Think about what you already know about preparing interpretative reports or communicating complex laboratory findings to clinicians.
• Consider possible challenges you might face during the activity, such as clearly communicating complex genomic information (e.g., variants of uncertain significance) in a concise manner, or ensuring the report meets the needs of the multi-disciplinary team (MDT), 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 integrating specific therapeutic recommendations based on genomic results or finalising the interpretive summary for novel findings.
• Acknowledge how you feel about preparing the reports for the colorectal referrals.

What do you anticipate you will learn from the experience?

• Consider the specific skills you want to develop, such as structuring reports to reflect the patient pathway and mastering the use of appropriate tools and nomenclature for variant reporting.
• Identify the specific insights you hope to gain into the requirements for feedback of results to clinicians or evaluating the utilisation of genomic testing in colorectal cancer with reference to diagnosis, prognosis, and treatment.

What additional considerations do you need to make?

• Consult actions identified following previous experiences of reporting or communicating technical results.
• Identify important information you need to consider before embarking on the activity, such as the clinical context of colorectal cancer (diagnosis, prognosis, treatment), current best practice guidelines for reporting, and the impact of genomics on patients and their families.

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 colorectal referrals?
• Are you encountering situations such as:
• Challenges in clearly summarising complex genomic findings in a concise and accurate manner?
• Difficulties integrating variant interpretation and relevant quality metrics into the report conclusion?
• Questions about the appropriate level of detail or specific nomenclature required for the target audience (relevant specialties/MDT)?
• Ambiguity regarding the prognostic or predictive value of a variant, complicating the final clinical statement?

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 or checking reporting standards immediately? Are you adapting or changing your approach to structuring or wording the report to better reflect the patient pathway?
• Consider the steps you are taking in the moment, such as immediately consulting departmental report templates to ensure standardised nomenclature is used for all variants.
• How are you feeling in that moment? For instance, are you finding it difficult to translate complex data into concise clinical language? Is it affecting your confidence in preparing a report that meets the needs of the MDT?

What is the conclusion or outcome?

• Identify how you are working within your scope of practice. For example, are you successfully ensuring the report template meets standard clinical governance requirements? Or are you needing support because the interpretation of a complex variant requires senior clinical correlation before final reporting?
• What are you learning as a result of the unexpected development? For example, are you mastering a more consistent approach to integrating quality metrics into the factual report summary?

On action

What happened?

• Begin by summarising the key steps you took when preparing the interpretative reports for colorectal referrals.
• Consider specific events, actions, or interactions which felt important, such as how you synthesised complex genetic information with the clinical context for the final interpretive summary, or how you ensured the report structure met the needs of the multi-disciplinary team (MDT).
• Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, immediately revising the language used in the interpretive conclusion when you realised the initial phrasing was ambiguous regarding prognostic implications, to ensure clinical utility.
• How did you feel during this experience, e.g., did you feel challenged by the requirement for concise communication or confident in applying appropriate reporting nomenclature?

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. What strengths did you demonstrate, e.g., clear and concise communication of complex variant significance?
• What skills and/or knowledge gaps were evident, e.g., uncertainty regarding the specific therapeutic agents recommended for certain low-frequency colorectal variants?
• Compare this experience against previous engagement with similar activities – were any previously identified actions for development achieved? Has your practice improved in synthesising complex information and communicating it effectively in a report format?
• Identify any challenges you experienced, such as needing to seek advice or clarification on scope of practice regarding the inclusion of specific therapeutic recommendations in the report conclusion, 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.
• What will you do differently next time you approach drafting a complex colorectal report, for instance, by using a standardised checklist to ensure all essential clinical and genomic findings are clearly integrated into the summary?
• Do you need to practise any aspect of the activity further, such as reviewing example reports for clear structure or key learning outcomes related to analysing, interpreting, and preparing interpretive reports?

Beyond action

Have you revisited the experiences?

• How have your subsequent experiences of preparing interpretative reports for colorectal 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 inclusion of prognostic and therapeutic implications forced you to re-evaluate the standard report structure and terminology you applied during your first attempt at this training activity?
• Considering what you understand about analysing, interpreting, and preparing interpretive reports of clinically relevant findings 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 methodology and use of standardised nomenclature based on further learning and experiences? For example, how you proactively implemented the use of defined summary language for linking genomic findings to specific therapeutics.
• Has discussing examples of clear and comprehensive reports or the impact of ambiguous reporting on the multi-disciplinary team (MDT) 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 report ambiguity caused clinical confusion, refined your understanding of the critical nature of clear, concise, and clinically relevant report conclusions?

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 colorectal referrals, particularly in preparing for assessments like Direct Observations of Practical Skills (DOPS)? For example, how your accumulated ability in summarising complex findings effectively now enables you to confidently produce a diagnostic clinical report for a patient 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 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 legal or ethical clarification outside the standard reporting scope?
• 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 practicing with relevant specialties?

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