Training activity information
Details
Analyse, interpret and draft a clinical report for the detection of MRD monitoring for two of the following:
- BCR-ABL
- PML-RARA
- CBFB-MYH11
- RUNX1-RUN1T1
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 analysing, interpreting, and drafting a clinical report for Measurable Residual Disease (MRD) monitoring for two specified targets (e.g., BCR-ABL, PML-RARA).
- Consider how the learning outcomes apply, specifically in relation to reporting MRD findings and understanding the requirements for molecular monitoring.
- Discuss with your training officer to gain clarity of what is expected of you in relation to the correct interpretation and reporting of quantitative results and the significance of MRD in haematological malignancies.
What is your prior experience of this activity?
- Think about what you already know about analysing and interpreting quantitative molecular data and reporting monitoring results.
- Consider possible challenges you might face during the activity, such as interpreting quantitative data near the limit of detection, understanding specific reporting thresholds, or clearly explaining the clinical significance of MRD findings in the report.
- 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 quantitative results are ambiguous or if reporting thresholds, such as those related to BCR-ABL1 monitoring, are violated.
- Acknowledge how you feel about the responsibility of reporting quantitative monitoring data that informs therapeutic decisions.
What do you anticipate you will learn from the experience?
- Consider the specific skills you want to develop, such as accurately interpreting quantitative molecular data and assessing its clinical relevance.
- Identify the specific insights you hope to gain into the analytical and interpretative nuances of MRD monitoring assays (e.g., BCR-ABL quantification) and how to draft a clinically informative report for these findings.
What additional considerations do you need to make?
- Consult actions identified following previous experiences of reporting technical quality metrics or quantitative data.
- Identify important information you need to consider before embarking on the activity, such as reviewing specific protocols or guidelines for MRD reporting (e.g., ELN guidelines for BCR-ABL1) and understanding the analytical sensitivity and specificity of the assays used.
In action
Is anything unexpected occurring?
- Are you noticing anything surprising or different from what you anticipate whilst analysing the data for Measurable Residual Disease (MRD) monitoring?
- Are you encountering situations such as:
- Inconsistencies between time points or highly fluctuating quantitative levels for targets like BCR-ABL or PML-RARA?
- Technical issues or quality issues such as sample age and how these influence RNA quality and subsequent MRD result validity (e.g., results close to the limit of detection) making it challenging to interpret the clinical implications of subtle changes?
- Unexpected MRD persistence or sudden relapse that deviates significantly from the anticipated clinical response to therapy?
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 data review by seeking technical support for issues close to the LOD?
- Consider the steps you are taking in the moment, such as:
- Immediately reviewing the quality metrics or control values for the assay run to rule out technical errors
- Considering alternative explanations for unexpected MRD patterns (e.g., non-compliance with therapy) or the need for confirmatory testing
- How are you feeling in that moment? For instance, are you finding it difficult to understand the clinical implications of subtle quantitative changes? Is it affecting your confidence in accurately reflecting the patient’s MRD status?
What is the conclusion or outcome?
- Identify how you are working within your scope of practice. For example, are you successfully interpreting MRD levels and trends by applying established reporting standards? Or are you needing support because interpreting complex MRD trends or troubleshooting technical queries requires senior technical verification before reporting?
- What are you learning as a result of the unexpected development?
On action
What happened?
- Begin by summarising the key steps you took when analysing, interpreting, and drafting a clinical report for Measurable Residual Disease (MRD) monitoring. Which two MRD targets did you focus on (e.g., BCR-ABL, PML-RARA), and what type of data did you analyse (e.g., quantitative PCR)?
- Consider specific events, actions, or interactions which felt important, such as how you integrated the MRD results with any relevant clinical or treatment information provided, and what challenges you faced when interpreting the quantitative MRD data and drafting the report, including IQC/EQA.
- Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, immediately addressing unexpected results (e.g., fluctuating levels) or technical issues encountered.
- How did you feel during this experience, e.g., did you feel focused on integrating MRD results with treatment information or challenged by interpreting the quantitative data and drafting the report quickly?
How has this experience contributed to your developing practice?
- Identify what learning you can take from this experience regarding MRD monitoring. What strengths did you demonstrate, e.g., improved ability to analyse and interpret results for specific MRD targets?
- What skills and/or knowledge gaps were evident, e.g., unfamiliarity with the significance of different MRD levels or fold changes in relation to treatment response and international guidelines?
- Compare this experience against previous engagement with similar activities – were any previously identified actions for development achieved? Has your practice improved in interpreting the associated IQC and EQA data to impact your confidence in the accuracy of the MRD result?
- Identify any challenges you experienced, such as needing to seek advice or clarification on scope of practice regarding unexpected results (e.g., technical issues or discrepant findings), and how you reacted to this. How does accurate MRD monitoring and reporting support clinical decisions regarding patient management and therapy response?
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 MRD targets or aspects of quantitative analysis and interpretation that require further study or practice.
- What will you do differently next time you approach MRD monitoring, for instance, by proactively taking actions to deepen your knowledge of specific MRD assays and their clinical utility?
- Do you need to practise any aspect of the activity further, such as reviewing international guidelines, databases, or engaging in discussions with clinicians or senior scientists for continued development in MRD analysis and reporting?
Beyond action
Have you revisited the experiences?
- How have your subsequent experiences of analysing, interpreting, and drafting clinical reports for MRD monitoring since completing this specific training activity led you to revisit your initial approach or decisions during that activity? For example, how a subsequent case involving fluctuating quantitative levels near the limit of detection forced you to re-evaluate the diligence of your quality control checks you applied during your first attempt at this training activity?
- Considering what you understand about MRD reporting and quality control 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 MRD analysis or reporting of quantitative molecular monitoring based on further learning and experiences? For example, how you proactively reviewed and integrated European Leukaemia Net (ELN) criteria for BCR-ABL1 reporting and treatment response assessment based on further learning?
- Has discussing complex MRD monitoring results or the impact of MRD reports on patient treatment decisions with a supervisor or clinician changed how you now view your initial experience in this training activity? For example, how professional storytelling with a clinician about a false negative MRD result leading to postponed therapy refined your understanding of the critical nature of accurate quantitative interpretation and quality metric integration?
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 analysing and reporting MRD results, particularly in preparing for assessments related to interpreting RT-PCR for fusion genes?
- How has reflecting back on this specific training activity, combined with everything you’ve learned since, shaped your current approach to MRD 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 quantitative results breach defined thresholds but lack corresponding clinical signs, requiring clinical consultation?
- Looking holistically at your training journey, how has this initial MRD reporting experience, revisited with your current perspective, contributed to your development in effective reporting and practicing effectively with relevant specialities?
Relevant learning outcomes
| # | Outcome |
|---|---|
| # 4 |
Outcome
Analyse, interpret and prepare interpretive reports for common haematological malignancies, including results for somatic variants, kinase domain mutations, measurable residual disease and post-transplant monitoring. |
| # 5 |
Outcome
Interpret the associated IQC and EQA of the laboratory tests for investigation of haematological malignancies. |
| # 6 |
Outcome
Practice with the relevant specialities for the diagnosis, monitoring and management of haematological malignancies. |