Training activity information
Details
Interpret haematological assays to inform testing strategies, to include:
- CML
- AML
- MPN
- MDS
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 interpreting haematological assay results to inform appropriate molecular testing strategies for specific malignancies (CML, AML, MPN, MDS) for example, what assays from internal and external departments are to be considered?.
- Consider how the learning outcomes apply, specifically in relation to selecting relevant testing strategies and evaluating urgency based on initial haematological findings.
- Discuss with your training officer to gain clarity of what is expected of you in relation to how initial haematological findings, such as common parameters, should inform the subsequent molecular decision-making process.
What is your prior experience of this activity?
- Think about what you already know about interpreting laboratory results, especially haematological results that influence subsequent testing decisions.
- Consider possible challenges you might face during the activity, such as atypical findings in initial assay results or missing information that complicates the decision-making process.
- 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 encountering atypical haematological findings or when the result contradicts standard diagnostic protocols.
- Acknowledge how you feel about making decisions on subsequent molecular testing based on initial haematological data.
What do you anticipate you will learn from the experience?
- Consider the specific skills you want to develop, such as correlating initial haematological findings with specific molecular assay indications.
- Identify the specific insights you hope to gain into how initial haematological findings guide molecular testing strategies for CML, AML, MPN, and MDS.
What additional considerations do you need to make?
- Consult actions identified following previous experiences of interpreting results that inform subsequent testing in other specialties.
- Identify important information you need to consider before embarking on the activity, such as reviewing information on the standard diagnostic pathways and local laboratory protocols for CML, AML, MPN, and MDS.
In action
Is anything unexpected occurring?
- Are you noticing anything surprising or different from what you anticipate whilst interpreting haematological assay results and correlating them with the suspected malignancy (CML, AML, MPN, MDS)?
- Are you encountering situations such as:
- Ambiguous assay results that do not clearly align with a single malignancy (e.g., borderline findings for two potential diagnoses)?
- Haematological findings unexpectedly deviating from standard diagnostic patterns, complicating the decision on which molecular or genetic tests are indicated?
- A case that requires conscious effort due to its complexity rather than being intuitive based on routine knowledge?
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 reviewing differential diagnoses when assay results don’t fit a clear pattern?
- Consider the steps you are taking in the moment, such as:
- Immediately seeking additional clinical context or documentation to resolve ambiguity between multiple potential diagnoses
- Consulting guidelines or reference materials to verify the molecular or genetic tests indicated for an unusual haematological presentation
- How are you feeling in that moment? For instance, are you finding it difficult to resolve conflicting findings or correlation issues? Is it affecting your confidence in determining testing strategies based on these assays?
What is the conclusion or outcome?
- Identify how you are working within your scope of practice. For example, are you successfully determining the indicated molecular assays by referring to established protocols when assay results are challenging? Or are you needing support because facing a complex case or unusual assay results requires guidance to determine the correct molecular or genetic tests to select?
- What are you learning as a result of the unexpected development? For example, are you gaining insight into the nuanced link between certain haematological parameters and the need for specific molecular monitoring assays for CML ?
On action
What happened?
- Begin by summarising the key steps you took when interpreting the haematological assay results. Which haematological assays did you interpret, and for which specific malignancies (CML, AML, MPN, MDS)?
- Consider specific events, actions, or interactions which felt important, such as how you used the key findings from the assays to inform potential testing strategies and what factors you considered when evaluating the urgency of testing based on the assay results.
- Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, considering the clinical context or discussing with colleagues during interpretation to resolve ambiguous or unexpected assay results.
- How did you feel during this experience, e.g., did you feel focused on evaluating the urgency of downstream testing or challenged by ambiguous assay results that made interpretation challenging?
How has this experience contributed to your developing practice?
- Identify what learning you can take from this experience regarding interpreting haematological assay results to guide further testing. What strengths did you demonstrate, e.g., improved ability to interpret assay results to guide further testing strategies for CML, AML, MPN, or MDS?
- What skills and/or knowledge gaps were evident, e.g., unfamiliarity with the criteria or guidelines used to determine the urgency of downstream molecular testing?
- Compare this experience against previous engagement with similar activities – were any previously identified actions for development achieved? Has your practice improved in your understanding of the criteria or guidelines used to determine the urgency of downstream molecular or cytogenetic testing?
- Identify any challenges you experienced, such as needing to seek advice or clarification on scope of practice regarding resolving ambiguous or unexpected assay results, and how you reacted to this. How does interpreting these assays and informing testing strategies contribute to your role in supporting the diagnosis and management of haematological malignancies?
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 specific types of haematological assays or malignancies that require further study to improve your interpretation skills.
- What will you do differently next time you approach assay interpretation and testing strategy selection, for instance, by proactively taking actions to deepen your knowledge of the links between haematological findings and appropriate genomic testing pathways?
- Do you need to practise any aspect of the activity further, such as reviewing guidelines, case examples, or discussions with senior colleagues to consolidate your development?
Beyond action
Have you revisited the experiences?
- How have your subsequent experiences of interpreting haematological assays to inform testing strategies 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 with borderline cytopenias forced you to re-evaluate the stringency of your initial assessment of testing urgency you applied during your first attempt at this training activity?
- Considering what you understand about selecting relevant testing strategies and evaluating urgency 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 interpretation methodology or strategy selection process based on further learning and experiences? For example, how you proactively integrated specific World Health Organisation (WHO) criteria to guide molecular testing strategy for ambiguous AML cases based on further learning?
- Has discussing complex cases where initial assay results were discordant or the impact of initial interpretation on the speed of patient management with a mentor or colleague changed how you now view your initial experience in this training activity? For example, how professional storytelling with a senior colleague about a missed urgent molecular test due to misinterpretation of initial haematological findings refined your understanding of the critical nature of evaluating urgency?
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 interpreting haematological assays and selecting relevant testing strategies, particularly in preparing for assessments like Case-Based Discussions?
- How has reflecting back on this specific training activity, combined with everything you’ve learned since, shaped your current approach to interpreting initial assay results? 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 if atypical haematological findings suggest a rare or complex malignancy outside of routine protocols?
- Looking holistically at your training journey, how has this initial assay interpretation experience, revisited with your current perspective, contributed to your development in selecting relevant strategies and ensuring appropriate collaboration with relevant specialities?
Relevant learning outcomes
| # | Outcome |
|---|---|
| # 2 |
Outcome
Select the relevant testing strategy for commonly referred haematological malignancies, including CML, AML, MPN and MDS. |
| # 3 |
Outcome
Evaluate the urgency of testing for particular haematological malignancies to inform management decisions. |
| # 6 |
Outcome
Practice with the relevant specialities for the diagnosis, monitoring and management of haematological malignancies. |